Comparative Study of Total Laparoscopic Hysterectomy versus Non-Descent Vaginal Hysterectomy Conducted in a Tertiary Care Centre

Background: Hysterectomy refers to removal of uterus; there are different routes of hysterectomy-abdominal, vaginal, laparoscopic and robotic assisted laparoscopy. Any two routes can be combined. Choice of route of surgery is based on uterine size, mobility, accessibility, and whether pathology confined to uterus alone, surgeon?s decision and expertise and patient?s choice. Decision is made based on up-to-date evidences. Ideal route of hysterectomy is one with low morbidity, cost effectiveness, less operating time, minimal blood loss, less duration of hospital stays, it should be minimally invasive and better patient satisfaction. This study aims to match intra and post operative outcomes of NDVH and TLH, and to assess most feasible and to assess effective route of hysterectomy. Aim and Objective: To compare laparoscopic and vaginal hysterectomy for a non-descent uterus with respect-blood loss by drop of hemoglobin, operative time, intra operative and postoperative complications, rate of conversion to open abdominal procedures, Length of stay in hospital, post-operative pain, and ambulation time. Methods: Patients are selected on the basis of inclusion and exclusion criteria, and randomizing them into 2 groups with 53 patients in each group. Intra-operative & post-operative parameters will be recorded, and for each parameter a P value will be calculated and a value of less than0.05 will be statistically significant. Results: It was also noted in our study additional surgical procedures for extrauterine pathologies were done significantly more in TLH compared with NDVH. 83.9% cases of TLH had underwent additional procedures along with TLH could be attributed to better visualization with TLH. Our study found mean ambulation time in TLH group as 15 hrs and NDVH as 17 hrs. We found ambulation time of TLH was significantly less compared with NDVH and this can be attributed to the lesser postoperative pain in TLH group. The mean pain score, sum of 4 th post operative hour, 24 th postoperative hour and 3rd post operative day pain scores using visual analogue scale was observed to be 12.2 in TLH and 14.5 in NDVH. We found that patients who underwent TLH had significantly lower post operative pain compared to patients undergoing NDVH. The mean drop in haemoglobin in NDVH group was 0.7 g/dl and TLH group was 0.6g/dl. Our study found less blood loss with TLH compared with NDVH, this could be attributed to the experience of the surgeon as the TLH at the centre studied is performed by surgeons with minimum of 10 years? experience. Operative time. NDVH was found less compared with TLH and this was found statistically significant in our study. In our study, the intraoperative complications are significantly more with TLH compared with NDVH. Out of 56 cases studied, 1 bowel and 1 ureteric injury was reported and in NDVH cases 1 bladder injury was reported.16.1% cases of TLH and 3.6% cases of NDVH reported intraoperative complications. Conclusions: TLH is associated with less post operative pain, earlier ambulation, better management of extrauterine pathologies. NDVH associated lesser intraoperative complications and lesser operative time. Decision on approach depends on the pathology involved, the size of the uterus, prior surgical history, availability of equipment and surgeons experience and skill. We found similar outcome for NDVH and TLH provided the centre we conduct the surgeries should be provided with experienced surgeons and modernised equipments.