Outpatient laparoscopic subtotal hysterectomies considered safe.(Gynecology)

SAN DIEGO -- Laparoscopic supracervical hysterectomies can be done safely on an outpatient basis, a review of 190 cases suggests, Stefanos Chandakas, M.D., reported.

The surgeries were performed over a 14-month period by a two-surgeon team at Princess Royal University Hospital, London, where subtotal hysterectomies have been the norm since 2001. Patients underwent the hysterectomies to treat endometriosis (22%), menorrhagia (66%), and endometrial pathology (12%). All had failed medical therapy.

Patients lost an estimated 200 mL of blood on average, ranging from 50 to 2,000 mL. Less than 100 mL of blood was lost in 74% of cases, estimated Dr. Chandakas of the hospital, and his associates.

There were no significant intraoperative complications, vascular injuries, or nerve or ureter injuries. The average length of stay was 8 hours, and 94% of patients were discharged in less than 24 hours.

Postoperative complications included bladder infection or dysfunction in 2%, deep vein thrombosis in less than 1%, and paralytic ileus in one patient. Minimal cyclic bleeding occurred in 1% of patients. That's better than complication rates of 1%-10% reported in the literature, perhaps "because we spend 3-5 minutes coagulating the cervical canal" during the surgery, he said. One patient required reoperation for an intraabdominal abscess.

Compared with total abdominal hysterectomy or total vaginal hysterectomy, laparoscopic supracervical hysterectomy is "a much safer ...