Total laparoscopic hysterectomy, vaginal hysterectomy and total abdominal hysterectomy using electrosurgical bipolar vessel sealing technique: a randomized controlled trial.

Purpose: To compare total laparoscopic hysterectomy (TLH), total abdominal hysterectomy (TAH) and vaginal hysterectomy (VH) using electrosurgical bipolar vessel sealing (EBVS) technique regarding operative time, intra and postoperative complications.

Methods: The current prospective randomized controlled clinical trial was conducted at Ain-shams University maternity Hospital, Cairo, Egypt. Ninety patients who were admitted from gynecologic outpatient clinic to undergo hysterectomy were enrolled. The study population was randomized according to type of hysterectomy done into 3 groups: group 1: VH; group 2: AH and group 3: TLH. EBVS was used in all groups. Three staff members' surgeons were also randomized to operate on the patients and they were all equally competent in all the procedures. Main outcome measures were operative time, operative blood loss, operative complications, postoperative pain assessment using the visual analogue scale (0-10), and the need for analgesics as well as the postoperative hospital stay.

Results: Ninety patients were randomized to undergo VH, TAH or TLH for benign pathology using EBVS. Postoperative pain score and the need for analgesia were least in TLH compared to the other two groups, (p < 0.001). The hospital stay in TLH group was shorter than the other two groups, but there was no significant difference between VH group and TAH group with regard to hospital stay, (p < 0.001). The total operative time was shortest in the VH group (100.4 ± 35.8 min) compared to TLH (126 ± 42.7 min) and TAH (123.6 ± 44.5 min) (p = 0.033). The operative complications were more with VH and TAH groups. The blood loss was more with VH (p = 0.039).

Conclusion: TLH had a longer operation time, yet, less blood loss, shorter hospital stay, less postoperative pain and fewer complications, compared to TAH and VH using EBVS.