Total laparoscopic hysterectomy in the management of endometrial carcinoma

Study Objective. To compare total laparoscopic hysterectomy (TLH) with open hysterectomy in the management of endometrial carcinoma. Design. Retrospective chart review (Canadian Task Force classification 11-3). Setting. Gynecologic cancer center. Patients. All women with endometrial carcinoma managed between January 1, 1993, and June 30, 1999. Interventions. Of 403 patients reviewed, in 167 (40%) the surgical intention was laparoscopic management, in 230 (57%) the intention was open management, and in 12 (3%) it was vaginal hysterectomy Total laparoscopic hysterectomy was successfully completed in 153 (95%) of the laparoscopic group. Measurements and Main Results. Mean weight of women in the laparoscopic group (80.7 kg) was greater than that in the open group (73.3 kg, p = 0.002), and included 27 patients weighing over 100 kg (maximum individual weight 170 kg), Mean operating times were 138 minutes for laparoscopy and 12 7 minutes for the open procedure (p = 0.002). Complications differed, with significantly more occurring in the open group (43%, 100) than in the laparoscopic group (17%, 27, p <0.00001). Mean postoperative hospital stay was significantly shorter for the laparoscopic group (4.3 days) than for the open group (8.5 days, p = 0.0001). Conclusion. TLH combined with laparoscopic surgical stiging has many advantages over the open approach, especially in obese women.