Total laparoscopic hysterectomy in the management of endometrial carcinoma.

Study Objective: To compare total laparoscopic hysterectomy (TLH) with open hysterectomy in the management of endometrial carcinoma.

Design: Retrospective chart review (Canadian Task Force classification II-3).

Setting: Gynecologic cancer center.

Patients: All women with endometrial carcinoma managed between January 1, 1993, and June 30, 1999.

Interventions: Of 403 patients reviewed, in 161 (40%) the surgical intention was laparoscopic management, in 230 (57%) the intention was open management, and in 12 (3%) it was vaginal hysterectomy. Total laparoscopic hysterectomy was successfully completed in 153 (95%) of the laparoscopic group.

Measurements And Main Results: Mean weight of women in the laparoscopic group (80.1 kg) was greater than that in the open group (73.3 kg, p = 0.002), and included 27 patients weighing over 100 kg (maximum individual weight 170 kg). Mean operating times were 138 minutes for laparoscopy and 121 minutes for the open procedure (p = 0.002). Complications differed, with significantly more occurring in the open group (43%, 100) than in the laparoscopic group (17%, 27, p <0.00001). Mean postoperative hospital stay was significantly shorter for the laparoscopic group (4.3 days) than for the open group (8.5 days, p = 0.0001). Conclusion. TLH combined with laparoscopic surgical staging has many advantages over the open approach, especially in obese women.