title: Perioperative outcomes of total laparoscopic hysterectomy at a regional hospital in New Zealand.
abstract: BACKGROUND
  Total laparoscopic hysterectomy (TLH) is established as a safe method of hysterectomy, with a satisfactory patient experience. However, most published data derive from high-volume centres with experienced teams. It is not clear whether these data translate to smaller centres?
  
  
  OBJECTIVE
  To evaluate the implementation of a minimally invasive option for hysterectomy at a regional public hospital in New Zealand.
  
  
  METHODS
  Prospective audit of 120 cases of TLH over three years. We retrospectively compared outcomes to the same number of abdominal (AH) and vaginal hysterectomy (VH).
  
  
  RESULTS
  TLH and AH were predominantly performed for heavy menstrual bleeding (65 and 64%) and VH for prolapse (54%). The largest uteri were AH (range 30-3400 g), TLH (35-550) then VH (21-256). Compared to TLH, both AH and VH had shorter mean operating theatre times (TLH 126.8 ± 44.8 min, AH 103.2 ± 32.8 and VH 93 ± 26.9), longer mean hospital stay (TLH 51.3 ± 21.3 h, AH 101.9 ± 36.6 and VH 75.1 ± 31.3) and increased mean blood loss (TLH 153 ± 116.1 mL, AH 517 ± 672.3 and VH 244 ± 206.8). One TLH was converted to laparotomy and one required interval laparoscopy. Major complications (2.5%) were lowest in the TLH group and were consistent with large international series.
  
  
  CONCLUSIONS
  TLH would appear to be a safe and effective local option. The outcomes for patients at a regional general hospital can replicate the results of larger centres.
authors.affiliation: Department of Women's and Children's Health, Tauranga Hospital, Bay of Plenty District Health Board, Tauranga, New Zealand.|Women's Health Unit, Palmerston North Hospital, Palmerston North, New Zealand.
authors.forename: Philip
authors.initials: P
authors.lastname: Suisted
authors.affiliation: Department of Women's and Children's Health, Tauranga Hospital, Bay of Plenty District Health Board, Tauranga, New Zealand.
authors.forename: Brad
authors.initials: B
authors.lastname: Chittenden
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D061887:Conversion to Open Surgery; D005260:Female; D006767:Hospitals, District; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods*; D007045:Hysterectomy, Vaginal / Q000009:adverse effects; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008485:Medical Audit; D008875:Middle Aged; D009520:New Zealand; D061646:Operative Time; D009929:Organ Size; D059035:Perioperative Period; D011446:Prospective Studies; D012189:Retrospective Studies; D014599:Uterus / Q000473:pathology*; D055815:Young Adult
keywords: New Zealand; complications; hysterectomy; laparoscopy