The clinical study of 723 cases of big uterus diseases by laparoscopic hysterectomy surgery

Objective To evaluate the feasibility, safety, skill of surgery on laparoscopic hysterectomy of big uterine diseases. Methods The clinical information of laparoscopic hysterectomy of 723 cases (research group) and 125 cases (control group) of patients in total 848 cases were analyzed whose operations were carried out from Jun.2008 to Jul. 2015. Results 723 cases of laparoscopic surgery were successfully performed. The completion of 13 cases of pelvic extensive dense adhesions were completed with the help of scalpel and bipolar coagulation forceps, 9 cases (1.2%) under went conversion laparotomy for severe pelvic adhesion, and 4 cases (0.6%, 4/723) under went neoplasty with colonoscopy. Hysterectomy abnormal uterus weight 315.5- 2150.7 g (735.5 ± 303.7) g, and the operation time was 86- 138 min (94 ± 27) min and the blood loss was 70-302 ml (107 ± 52) ml. Moreover, the hospital stay was 4-10 days (5.5 ± 2.5) days. 27 cases (3.7%, 27/723) were suffered puncture hole infection, and 21 cases (2.9%, 21/723) of postoperative vaginal stump bleeding patients were recover back to normal after vaginal gauze packing and oral drug treatment to stop bleeding completely. 723 cases of postoperative were not found any obvious complications with 3, 6 and 12 months follow-up, respectively. 100% (723/723)of patients were satisfied with their abdominal wall wound. Statistical analysis was performed to compare the aforementioned indexes between 125 cases of random laparotomy in our hospital and this study, and there were no statistically significant differences (P> 0.05) between uterine quality [(675.5 ± 275.7) g ]and operation time [(76 ± 34) min] (P> 0.05). However, there were statistical difference in blood loss [(427 ± 146) ml, ] postoperative hospital stay [(9.0 ± 1.5) d], postoperative vaginal stump bleeding rate (31.2%, 39/125) and abdominal wounds satisfaction rate (57.6%, 72/125) (P< 0.05) between the two groups. Conclusions Laparoscopic hysterectomy of large uterus is safe and feasible. However, this require the surgeon′s experience and foundation on abdominal surgery, laparoscopic proficiency, mastery of surgical techniques, and even preoperative condition assessment. Furthermore, patients were have high satisfaction rate of the ministry of wound. Key words: Laparoscopic; Hysterectomy; Large uterus; Vascular closure system