title: Laparoscopic supracervical hysterectomy (LSH) versus total laparoscopic hysterectomy (TLH): an implementation study in 1,952 patients with an analysis of risk factors for conversion to laparotomy and complications, and of procedure-specific re-operations.
abstract: OBJECTIVE
  To compare laparoscopic supracervical hysterectomy (LSH) with total laparoscopic hysterectomy (TLH) with regard to relevant surgical parameters and risk factors of conversion to laparotomy and complications.
  
  
  METHODS
  This prospective, open, single-center, interventional study included women with benign gynecologic disease who underwent standardized LSH or TLH. The techniques were compared for conversion rate and mean operating time, hemoglobin drop, hospital stay, and complication rates using descriptive statistics and standard non-parametric statistical tests. Risk factors of conversion and complications were identified by logistic regression analysis.
  
  
  RESULTS
  During January 2003 to December 2010, 1,952 women [mean age (SD): 47.5 (7.2) years] underwent LSH [1,658 (84.9%)] or TLH [294 (15.1%)], mostly (>70%) for uterine fibroids. Significant differences in surgical parameters were observed for conversion rate (LSH/TLH: 2.6/6.5%), mean operating time [87 (34)/103 (36) min], hemoglobin drop [1.3 (0.8)/1.6 (1.0) g/dL], and hospital stay [4.3 (1.5)/4.9 (2.8) days]. Overall intraoperative (0.2/0.7%) and long-term (>6 weeks) post-operative (0.8/1.7%) complication rates did not differ significantly, but the short-term LSH complication rate was significantly lower (0.6 vs. 4.8%). Spotting (LSH, 0.2%) and vaginal cuff dehiscence (TLH, 0.7%) were long-term method-specific complications. Logistic regression showed that uterine weight and extensive adhesiolysis were significant factors for conversion while previous surgery, age, and BMI were not. Major risk factors of short-term complications were age, procedure (LSH/TLH), and extensive adhesions.
  
  
  CONCLUSIONS
  Both procedures proved effective and were well tolerated. LSH performed better than TLH regarding most outcome measures. LSH is associated with very low rates of re-operation and spotting.
authors.affiliation: Department of Obstetrics and Gynecology, University of Heidelberg, Voßstraße 9, 69115, Heidelberg, Germany, markus.wallwiener@med.uni-heidelberg.de.
authors.forename: Markus
authors.initials: M
authors.lastname: Wallwiener
authors.forename: Florin-Andrei
authors.initials: FA
authors.lastname: Taran
authors.forename: Ralf
authors.initials: R
authors.lastname: Rothmund
authors.forename: Adam
authors.initials: A
authors.lastname: Kasperkowiak
authors.forename: Gabriel
authors.initials: G
authors.lastname: Auwärter
authors.forename: Antje
authors.initials: A
authors.lastname: Ganz
authors.forename: Bernhard
authors.initials: B
authors.lastname: Kraemer
authors.forename: Harald
authors.initials: H
authors.lastname: Abele
authors.forename: Birgitt
authors.initials: B
authors.lastname: Schönfisch
authors.forename: Keith B
authors.initials: KB
authors.lastname: Isaacson
authors.forename: Sara Yvonne
authors.initials: SY
authors.lastname: Brucker
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005831:Genital Diseases, Female / Q000601:surgery*; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D016015:Logistic Models; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome