Inflammatory response and tissue trauma in laparoscopic hysterectomy: comparison of electrosurgery and harmonic scalpel.

OBJECTIVE: Our aim was to quantify and compare clinical outcome and surgical inflammatory response and tissue trauma after laparoscopic hysterectomy for a benign disorder which was performed by electrosurgery or harmonic scalpel. METHODS: Sixty patients scheduled for laparoscopic hysterectomy were selected according to patient preference to undergo either electrosurgery or an ultrasonic operative technique. Blood samples for assay of markers of tissue trauma (C-reactive protein, interleukin-6, creatine kinase, white blood cell count) were taken preoperatively, on the first and third postoperative day. Three patients with intraoperative complications or incomplete records were excluded from tissue analysis. RESULTS: No differences were present in the demographic characteristics and clinical outcomes (blood loss, uterine weight, operating time and hospital stay) in 57 uncomplicated laparoscopic hysterectomies. Both electrosurgery (n = 36) and use of the harmonic scalpel (n = 21) resulted in statistically significant changes in the inflammatory and systemic immune response in comparison with preoperative values. No significant differences were observed in the studied inflammatory and tissue markers (C-reactive protein, interleukin-6, creatine kinase and white blood cells) between the compared groups. CONCLUSION: The harmonic scalpel and electrosurgery in laparoscopic hystsrectomy were equally traumatic in terms of surgical inflammatory response and tissue trauma.

Clinical outcome, inflammatory response and tissue trauma in total laparoscopic hysterectomy: comparison to laparoscopically-assisted vaginal hysterectomy.

OBJECTIVE: Our aim was quantify and compare the clinical outcome and surgical inflammatory response and tissue trauma between the total laparoscopic hysterectomy (TLH) and laparoscopically-assisted vaginal hysterectomy (LAVH). DESIGN: Clinical study. SETTING: Departments of Gynaecology, Obstetrics and Biochemistry, Hospital Kladno, Department of Biochemistry, Faculty Hospital Motol-Prague. METHODS: Fifty-eight patients scheduled for laparoscopic hysterectomy were selected according patients or doctor preference to undergo either TLH or LAVH operative technique. Blood samples for assay of markers of tissue trauma (C-reactive protein, interleukin-6, creatine kinase, cortisol, cystatin C, serotonin and white blood cells count) were taken preoperatively, on the first and third postoperative day. One patient with intraoperative complication (ureteral injury) was excluded from tissue analysis. RESULTS: No differences were present in the demographic characteristics and clinical outcomes (blood loss, complications and hospital stay) in fifty seven laparoscopic hysterectomies. The statistically significant difference was found only in duration of surgery (70 min in TLH group vs. 90 min in LAVH group, P < 0.05). This difference can be related to difference in uterine specimen weight (185 g in TLH group vs. 289 g in LAVH group, P < 0.02). Both the LAVH (n = 37) and TLH (n = 20) resulted in statistically significant changes in the inflammatory and systemic immune response in comparison with preoperative value. No significant differences were observed in the studied inflammatory and tissue markers between the studied operative techniques of laparoscopic hysterectomy. CONCLUSION: The total laparoscopic hysterectomy and laparoscopically-assisted vaginal hysterectomy were equally traumatic in terms of surgical inflammatory response and tissue trauma.

Laparoscopic hysterectomy in obese women: a clinical prospective study.

OBJECTIVE: To compare perioperative and postoperative outcomes of laparoscopic hysterectomy (LH) in surgical management of gynecological conditions in two groups of different weight. METHODS: A prospective comparative clinical study of 271 LH performed for disease of female pelvic organs in a group of 54 obese patients (over 30 body mass index (BMI)) and in a group of 217 non-obese patients (less than 30 BMI). The following criteria were assessed: patient characteristics, indications for surgery, previous surgery, presence of adhesions, duration of procedure, blood loss, weight of specimen, hospital stay and complications. Statistical analysis was performed using the unpaired t-test and non-parametric Chi-square test when appropriate, with a significance level of P=0.05. RESULTS: Three non-obese patients were converted to laparotomy due to operative complications. Laparoscopy in the remaining 268 patients (98.89%) was completed successfully. There was no significant difference in estimated blood loss, presence and degree of adhesions, weight of specimen, length of hospital stay and postoperative complications between women with high BMI and those with low BMI. The rate of major operative complications (5.55% versus 3.22%) was higher in the obese group. The duration of the operation was longer in obese women. However, the significance of the difference was borderline (P=0.06).

Laparoscopic surgery in obese women with endometrial cancer.

STUDY OBJECTIVE: To analyze perioperative and postoperative outcomes of laparoscopic treatment of endometrial cancer in two groups of women of different weight. DESIGN: Prospective, multicenter clinical study (Canadian Task Force classification II-1). SETTING: Three laparoscopic oncology centers. PATIENTS: Sixty-five consecutive women with endometrial cancer, of whom 32 were not obese (weight <81. 7 kg) and 33 were obese (weight (3)81.7 kg, body mass index 30-40). INTERVENTION: Laparoscopic surgery. MEASUREMENTS AND MAIN RESULTS: Three patients (1 nonobese, 2 obese) in whom laparoscopy was converted to laparotomy were removed from data analysis. Laparoscopy in the remaining 62 (94.38%) was completed successfully. Hysterectomy and pelvic and paraaortic lymphadenectomies were performed based on tumor grade and depth of myometrial invasion. In both groups, 28 women underwent pelvic lymphadenectomy and 21 paraaortic lymph node dissection or sampling. Eight patients had metastases in pelvic or paraaortic nodes. Deep myometrial invasion over 50% was present in five obese and two nonobese women. Mean operating time was 166 and 172 minutes, respectively. The rate of major complications and conversions was higher in the obese group (8 vs 5). CONCLUSION: Laparoscopic surgery is feasible in obese women and may also be considered for endometrial cancer, which typically occurs in obese women.

[Tissue damage in alternative types of hysterectomy: prospective study]. / Tkánové poskození u alternativních typu hysterektomií: prospektivní studie.

OBJECTIVE: To assess and compare tissue damage during alternative hysterectomies. DESIGN: Prospective clinical study. SETTING: Department of Gynaecology, Endoscopic Training Centre, Kladno Hospital. METHODS: Tissue damage and perioperative parameters were assessed using the enzymatic activity of creatine kinase (CK) and C-reactive protein (CRP). Serum levels of these markers were measured in 127 women who underwent laparoscopic, abdominal and vaginal hysterectomy. RESULTS: The rare of CK activity and CRP were significantly greater in 45 patients who underwent abdominal hysterectomy compared with that in the patients who underwent laparoscopic and vaginal hysterectomies (57 and 25 patients, respectively). CONCLUSION: Clinical experience and metabolic changes indicate that the tissue damage and perioperative stress in patients undergoing laparoscopic hysterectomy is lower than in patients where an abdominal approach is used. Large prospective studies are needed to evaluate the surgical trauma and metabolic changes induced by laparoscopic hysterectomy.

Evaluation of perioperative stress after laparoscopic and abdominal hysterectomy in premalignant and malignant disease of the uterine cervix and corpus.

OBJECTIVE: To compare the differences in laparoscopic and abdominal hysterectomy in surgery of premalignant and malignant uterine disease. DESIGN: Prospective study. SETTING: Baby Friendly Hospital, Kladno, Czech Republic. SUBJECT: A total 32 patients underwent hysterectomies for premalignant and malignant uterine conditions. INTERVENTIONS: Patients were assigned to either laparoscopic-assisted vaginal hysterectomy or total abdominal hysterectomy (LAVH), with bilateral salpingo-oophorectomy and lymph node dissection. MEASURES: Clinical data and value of total creatine kinase and C-reactive protein were measured. RESULTS: All 32 procedures were successfully completed. There were no major complications. Mean order of CRP concentrations was significantly lower (p = 0.001) in patients with LAHV. Mean order of total CK activities was also significantly lower in these patients (p = 0.003) and the median hospital stay was 4.1 days (p = 0.05). CONCLUSIONS: Laparoscopic procedures were followed by shorter hospital stays and the proposed evaluation of tissue damage using serum enzymes and proteins demonstrates that the laparoscopic approach to hysterectomy and accessory procedures has considerable importance in decreasing perioperative patient stress. The presented results are supported by clinical experience and should have a decisive impact on the chosen approach to the course and duration of convalescence in patients undergoing a hysterectomy in premalignant and malignant disease of the uterine cervix and corpus.