title: Feasibility and safety of outpatient total laparoscopic hysterectomy.
abstract: OBJECTIVE
  Ambulatory total laparoscopic hysterectomy (TLH) could lead to significant cost savings, but some fear the effects of what could be premature postsurgical discharge. We sought to estimate the feasibility and safety of TLH as an outpatient procedure for benign gynecologic conditions.
  
  
  METHODS
  We report a prospective, consecutive case series of 128 outpatient TLHs performed for benign gynecologic conditions in a tertiary care center.
  
  
  RESULTS
  Of the 295 women scheduled for a TLH, 151 (51%) were attempted as an outpatient procedure. A total of 128 women (85%) were actually discharged home the day of their surgery. The most common reasons for admission the same day were urinary retention (19%) and nausea (15%). Indications for hysterectomy were mainly leiomyomas (62%), menorrhagia (24%), and pelvic pain (9%). Endometriosis and adhesions were found in 23% and 25% of the cases, respectively. Mean estimated blood loss was 56 mL and mean uterus weight was 215 g, with the heaviest uterus weighing 841 g. Unplanned consultation and readmission were infrequent, occurring in 3.1% and 0.8% of cases, respectively, in the first 72 hours. At 3 months, unplanned consultation, complication, and readmission had occurred in a similar proportion of inpatient and outpatient TLHs (17.2%, 12.5%, and 4.7% versus 18.1%, 12.7%, and 5.4%, respectively). In a logistic regression model, uterus weight, presence of adhesions or endometriosis, and duration of the operation were not associated with adverse outcomes.
  
  
  CONCLUSIONS
  Same-day discharge is a feasible and safe option for carefully selected patients who undergo an uncomplicated TLH, even in the presence of leiomyomas, severe adhesions, or endometriosis.
authors: Department of Obstetrics, Gynecology, and Reproductive Sciences, Université Laval, Québec City, Québec, Canada.
authors: Sarah
authors: S
authors: Maheux-Lacroix
authors: Department of Obstetrics, Gynecology, and Reproductive Sciences, Université Laval, Québec City, Québec, Canada.
authors: Madeleine
authors: M
authors: Lemyre
authors: Department of Obstetrics, Gynecology, and Reproductive Sciences, Université Laval, Québec City, Québec, Canada.
authors: Vanessa
authors: V
authors: Couture
authors: Department of Obstetrics, Gynecology, and Reproductive Sciences, Université Laval, Québec City, Québec, Canada.
authors: Gabrielle
authors: G
authors: Bernier
authors: Department of Obstetrics, Gynecology, and Reproductive Sciences, Université Laval, Québec City, Québec, Canada.
authors: Philippe Y
authors: PY
authors: Laberge
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014591:Uterine Diseases / Q000601:surgery*
keywords: Ambulatory surgical procedure; Feasibility study; Hysterectomy; Laparoscopy; Safety