Perioperative outcomes of total laparoscopic hysterectomy at a regional hospital in New Zealand.

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?

AIMS: To evaluate the implementation of a minimally invasive option for hysterectomy at a regional public hospital in New Zealand.

MATERIALS AND 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.