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Compares Four Hysterectomy Techniques

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  • tarnishedsilverheart
    Compares Four Hysterectomy Techniques MIRIAM E. TUCKER (Senior Writer) Article Outline • Copyright WASHINGTON — Laparoscopic supracervical hysterectomy was
    Message 1 of 1 , Feb 19, 2008
      Compares Four Hysterectomy Techniques
      MIRIAM E. TUCKER (Senior Writer)
      Article Outline
      • Copyright
      WASHINGTON — Laparoscopic supracervical hysterectomy was less
      expensive to perform than total vaginal hysterectomy in an analysis
      of 200 patients randomly assigned to one of four different
      hysterectomy techniques in an outpatient setting.
      Although the study was randomized, patients with current cervical
      dysplasia or endometrial hyperplasia were not offered laparoscopic
      supracervical hysterectomy (LSH), while those with extra large uteri
      were not offered total vaginal hysterectomy (TVH), Dr. O. Robert
      Sarmini said at the annual meeting of the AAGL.
      There were no exclusions for the other two procedures, laparoscopic-
      assisted vaginal hysterectomy (LAVH) and total laparoscopic
      hysterectomy (TLH). Baseline age (range, 40.2-40.4 years) and
      previous abdominal surgeries (range, 0.9-1.0) did not differ among
      the four surgical groups. However, mean weight was significantly
      lower among those who underwent TVH (66.5 kg) compared with the
      other three groups (range, 83.5-86.8kg).
      Operating room times were the shortest for the LSH patients, at just
      54 minutes, followed by the TVH group at 57 minutes. The other two
      procedures took significantly longer: 77 minutes for TLH and 79
      minutes for LAVH. Recovery room times didn't differ significantly,
      ranging from 81 minutes for LSH to 96 minutes for LAVH, said Dr.
      Sarmini, who practices gynecology in Dallas-Fort Worth.
      However, post-recovery room hospital stays were significantly lower
      for LSH, just 4 hours, while the TVH group had much longer stays,
      averaging 26 hours. The TLH group had a mean stay of 8 hours, and
      the LAVH group, 19 hours. All of the LSH patients were able to be
      discharged directly from the outpatient surgical suite, compared
      with 84% of the TLH group, 48% who underwent LAVH, and just 24% of
      the TVH patients. The rest were admitted for observation, with mean
      hospitalization times ranging from 23 to 32 hours, Dr. Sarmini
      reported.
      Overall complication rates were lowest for LSH (2%) and highest for
      TVH (10%). There were only two intraoperative complications in the
      entire study cohort, neither in an LSH patient: One was a bladder
      perforation in a TVH patient with previous cesarean sections, the
      other was an estimated blood loss of more than 500 cc in an LAVH
      patient that did not require transfusion. Two other TVH patients
      were converted to laparoscopy (which was not considered a
      complication).
      Because of the exclusion criteria, uterine weights were lowest in
      the TVH group (104 g), but did not differ significantly among the
      three laparoscopic groups. The mean uterine weight was 179 g.
      Pathologic diagnoses were just about evenly split among the four
      groups. Uterine fibroids were the most common, followed by
      adenomyosis, endometriosis, and pelvic inflammatory disease, he said.
      Postoperative complications included fevers of more than 38° C in a
      total of five patients, one ileus (in a TVH patient), and
      readmission for pelvic infections (one each in the TVH and TLH
      group). Only one postoperative complication, an incisional hernia,
      occurred in an LSH patient.
      Total costs didn't differ significantly among the four procedures,
      but LSH was the least expensive overall, with a mean of $2,267,
      while LAVH was the costliest, at $3,038.
      However, there were significant differences when costs were broken
      down into fixed charges (referring to the facility's overhead for a
      level III procedure, including rent, salaries, insurance, etc.) and
      variable charges (cost of disposable items, medications, surgical
      devices, etc.): LSH was the least expensive of the four procedures
      for fixed charges ($580, compared with $619 for TVH, $801 for TLH,
      and $816 for LAVH), but the most expensive for variable charges
      ($1,200, versus $760 for LAVH, $687 for TLH, and just $100 for TVH).
      This differential is not surprising, since LSH incurs the shortest
      hospital stays but requires more disposable items during the
      procedure, Dr. Sarmini explained.
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