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Feasibility of LAVH for the large uterus as a short stay procedure

Feasibility of LAVH for the large uterus as a short stay procedure. C Legit, H Hamoda, K Kunde Guy’s and St Thomas’ Hospital NHS Foundation Trust London. Introduction. Laparoscopic Hysterectomy (LH) first performed in 1988 in Pennsylvania by Harry Reich

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Feasibility of LAVH for the large uterus as a short stay procedure

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  1. Feasibility of LAVH for the large uterus as a short stay procedure C Legit, H Hamoda, K Kunde Guy’s and St Thomas’ Hospital NHS Foundation Trust London

  2. Introduction • Laparoscopic Hysterectomy (LH) first performed in 1988 in Pennsylvania by Harry Reich • Worldwide more than 70% of hysterectomies done via the abdominal route • This trend has not changed significantly since the introduction of LH in 1988

  3. Laparoscopic hysterectomy Advantages • Safe procedure • Reduced hospital stay • Less postoperative pain • Less intra- and postoperative complications • Quicker return to work and normal life activities • Overall reduced hospital stay with LAVH /LH compared to TAH Disadvantages • Longer operating times • More expensive instruments • Expertise American Journal of Obstetrics and Gynecology, Volume 190, Issue 6, Pages 1714-1720J.Lenihan, C.Kovanda, C.Cammarano American Journal of Obstetrics and Gynecology, Volume 196, Issue 5, Pages e19-e21R. Mittapalli, J. Fanning, R. Flora, B. Fenton American Journal of Obstetrics and Gynecology, 1995, ISSN: 0002-9378

  4. Methods • 31 cases of women undergoing laparoscopic procedures between 2008 and 2009 • Gynaecology Department, Guy’s & St Thomas’ Hospital NHS Foundation Trust, London • Sisa statistical package for analysis • Procedures conducted: • Laparoscopic assisted vaginal hysterectomy (LAVH) • Laparoscopic subtotal hysterectomy (STLH) • Total laparoscopic hysterectomy (TLH)

  5. Methods • Inclusion criteria and indications: Uterus equal or less than 18/40 size Fibroids +/- pressure symptoms Adenomyosis Chronic pelvic pain Menorrhagia Dysmenorrhea Intermenstrual bleeding Post menopausal bleeding CIN III Severe PMS

  6. Procedures

  7. Instruments

  8. Patient’s postoperative stay • Bed costs/ 24 hours in St Thomas’ Hospital = £600 • Routine stay post laparoscopic procedures is 24 to 48 hours (mean 41 hours in this analysis) • Routine stay post open procedure is 72 to 96 hours • £ 1744 laparoscopy 41 hours stay • £ 1860 TAH 3 days stay • £ 2460 TAH 4 days

  9. Results for laparoscopic procedures • Mean operating time 93 min • Complications in 4 cases • Difficult haemostasis x 4 • 1 conversion to laparotomy • Mean hospital stay 41 hours with LAVH • Mean hospital stay 85 hours with TAH

  10. Results

  11. Discussion • Better quality of life and postoperative health in first few weeks post laparoscopic procedures. European Journal of Obstetrics &Gynaecology and Reproductive Biology 136 (2008) 3-8. • A shorter hospital stay in the laparoscopic group compensates for higher procedure costs. Reported indirect costs in the LH group were half of those reported in the TAH group even without taking into account earlier return to work. Bijen CBM et al. (2009) Costs and Effects of Abdominal versus Laparoscopic Hysterectomy: Systematic Review of Controlled trials. PloS ONE 4(10): e7340.

  12. Discussion • In the expert hand laparoscopic hysterectomy reduces hospital stay and complication rate and results therefore in an overall reduction of costs. • If we took into account further cost reduction due to reduced complication rate with laparoscopic procedures, reduced need for pain relief and indirect savings due to earlier return to work , the impact of costs savings might be be even greater.

  13. Thank you

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