ABSTRACT
It is suggested that laparoscopic surgery reduces postoperative pain and shortens hospital stay and convalescence because of the small amount of tissue trauma. We evaluated the inflammatory response during abdominal hysterectomy (AH, 12 women) and laparoscopic hysterectomy (LH, 12 women) by measuring interleukin (IL)-6, neopterin and terminal C5b9 complement complex (TCC). Blood samples were drawn preoperatively, perioperatively, 1 minute, 24 hours, and 7 days postoperatively. Levels of IL-6 were determined to evaluate cytokine release, neopterin was determined as a marker for macrophage-monocyte activation, and TCC was determined to assess complement activation. The IL-6 concentrations, as a percentage of preoperative level, were significantly elevated postoperatively in both groups, and also perioperatively in the LH group. Neopterin concentrations, as a percentage of perioperative level, were significantly increased in the LH group preoperatively and postoperatively. No elevation was seen in the AH group. There was no sign of complement activation in either group. Our results indicate significant tissue trauma during both LH and AH. The extent of trauma might be greater in laparoscopic surgery. Despite this, the LH group had a shorter hospital stay and convalescence than the AH group. The proposed advantages to the patient of laparsocopic surgery thus seem to be attributable to other factors than the amount of tissue trauma.
ABSTRACT
Laparoscopic hysterectomy has rapidly become a routine procedure without a preceding evaluation of its cost effectiveness in comparison with abdominal hysterectomy. Economic analysis must include an assessment of patients' health status. Direct costs (hospital costs) and indirect costs (value of production loss) were calculated for 20 women randomized to total laparoscopic hysterectomy (TLH) and 20 to total abdominal hysterectomy (TAH). Health status was evaluated by scoring responses to standardized questions 1, 3, and 12 weeks after the operation. Direct costs were 7% lower for TLH than for TAH. The shorter hospital stay after TLH more than compensated for the increased costs due to longer operating time. Indirect costs were 52% lower for TLH than for TAH. One and 3 weeks after the operation, limitations in physical and social activity were less pronounced, general mental health was better, and pain less pronounced after TLH compared with TAH. Fewer women considered their hospital stay and sick leave as too short after TLH compared with TAH. We conclude that, compared with TAH, TLH offers economic advantages to the patient, hospital, and society.
