title: Outcomes of Total Laparoscopic Hysterectomy Using a 5-mm Versus 10-mm Laparoscope: A Randomized Control Trial.
abstract: OBJECTIVE
  To determine if the use of a 5-mm umbilical incision and laparoscope would result in a higher likelihood of earlier discharge from hospital after total laparoscopic hysterectomy (TLH) compared with a 10-mm umbilical incision and laparoscope. Secondary objectives of the study were to determine if the use of a 5-mm laparoscope would lead to a reduction in postoperative pain scores and a shorter operating time without an increase in complication rates.
  
  
  METHODS
  Prospective, randomized, double-blinded, clinical trial (Canadian Task Force classification I).
  
  
  METHODS
  A tertiary care setting.
  
  
  METHODS
  Seventy-eight patients scheduled for TLH were prospectively recruited.
  
  
  METHODS
  Women undergoing TLH were assigned to either a 5-mm umbilical port and laparoscope (5LH) or a 10-mm umbilical port and laparoscope (10LH). All patients underwent a standardized operative technique and anesthetic protocol. Patients and research assistants responsible for postoperative pain assessment were blinded to group. Analysis was by intention-to-treat.
  
  
  RESULTS
  The primary outcome measure was length of hospital stay. Secondary outcome measures were operating time, pain scores on postoperative days 1 and 7, and complication rates. There was no difference in length of hospital stay between the 2 arms. Compared with the 10LH group, the 5LH group had shorter operative times (32.6 vs 40 minutes; p = .01) and less postoperative pain on day 1 (2.5 vs 3.3; p = .03 for "pain with movement") and on day 7 (.92 vs 1.8; p = .002). Complication rates were similar between the 2 groups.
  
  
  CONCLUSIONS
  TLH with a 5-mm laparoscope resulted in shorter operative times and less pain on postoperative days 1 and 7, compared with a 10-mm laparoscope, with similar length of stay and complications.
authors.affiliation: Department of Endoscopy, King Edward Memorial Hospital, Perth, Western Australia, Australia. Electronic address: jadeacton@gmail.com.
authors.forename: Jade N
authors.initials: JN
authors.lastname: Acton
authors.affiliation: Department of Gynaecologic Oncology, St. John of God Hospital Subiaco, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Stuart G
authors.initials: SG
authors.lastname: Salfinger
authors.affiliation: Department of Gynaecologic Oncology, St. John of God Hospital Subiaco, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Jason
authors.initials: J
authors.lastname: Tan
authors.affiliation: Department of Gynaecologic Oncology, St. John of God Hospital Subiaco, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Cohen
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods; D007902:Length of Stay / Q000706:statistics & numerical data*; D008875:Middle Aged; D061646:Operative Time; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011446:Prospective Studies
keywords: Laparoscopic hysterectomy; Laparoscopy/methods; Mini-laparoscopy; Pain; Port size