Total laparoscopic hysterectomy – clinical comparison of the method using two types of uterine manipulators

Czech version

Authors: M. Szypulová; Michal Felsinger; Vít Weinberger; R. Hudeček; Luboš Minář
Authors‘ workplace: Gynekologicko‑porodnická klinika LF MU a FN, Brno, přednosta doc. MUDr. V. Weinberger, Ph. D.
Published in: Ceska Gynekol 2020; 85(6): 385-395
Category:

Overview

Aim of the study: Comparison of two types of uterine manipulators used in total laparoscopic hysterectomy (TLH) and clinical evaluation of the method in patients in a two-year group supplemented by subjective evaluation.

Design: Prospective observational study.

Setting: Department of Gynecology and Obstetrics, Masaryk University, Faculty of Medicine and University Hospital Brno.

Material and methods: A group of patients operated in the years 2018–2019 by the TLH method using one of two types of uterine manipulators – Karl Storz HOHL (group No. 1) vs. plastic ring of Koh's manipulator (group No. 2). We compared surgical time (min), blood loss (ml), perioperative complications, length of hospital stay (days), early and late complications. We were interested in the possible influence of BMI, uterine on these parameters. Subjective evaluation of the method by patients took place before the procedure and 12 weeks after the operation with a standardized questionnaire.

Results: A total of 134 patients were enrolled in the study (75 in group 1 vs. 59 in group 2). The monitored parameters: age, BMI, operative time, blood loss and length of hospitalization did not differ statistically significantly. When comparing the individual groups with different manipulators, the total number of complications (mild difficulties, serious complications) was without statistical significance (p = 0.58), but the spectrum of symptoms was different in both groups. More than a third of the patients in the group were obese. There were more serious complications than non-obese ones, the performance was longer, however, for a small number it was statistically insignificant (p = 0.11). In patients with uterine surgery, we recorded more adhesiolysis. We did not show that previous surgery on the uterus was associated with a higher incidence of complications (p = 0.6). We did not notice any statistically significant difference in the subjective evaluation (p = 0.3).

Conclusion: TLH is the dominant method of uterine removal in our workplace. In a group of 134 women, we did not show a statistically significant difference in the monitored parameters. The HOHL manipulator has proved to be more user-friendly due to its technical parameters and better clarity of the operating field. Subjective evaluation of the method was positive in patients.

Keywords:

total laparoscopic hysterectomy – uterine manipulator – complications

Sources

1. Abdel Khalek, Y., Bitar, R., Christoforou, C., et al. Uterine manipulator in total laparoscopic hysterectomy, safety and usefulness. Updates Surg, 2019, [online]. Dostupné z https://doi.org/10.1007/s13304-019-00681-w.

2. Brummer, THI., Seppälä T., Härkki, PSM. National learning curve for laparoscopic hysterectomy and trends in hysterectomy in Finland 2000–2005, Hum Reprod, 2008, 23(4), p. 840–845.

3 Deffieux, X., De Rochambeau, B., Chêne, G., et al. Hystérectomie pour pathologie bénigne : Recommandations pour la pratique clinique. J Gynecol Obstet Biol Reprod, 2015, 44(10), p. 1219–1227.

4. Dietl, A,, Klar, M., Aumann, K., et al. Minimally invasive surgery for early-stage cervical cancer: Is the uterine manipulator a risk factor? Am J Obstet Gynecol, 2019, 221(5), p. 537–538. Dostupné z https://doi:10.1016/j.ajog.2019.07.042.

5. Gil-Gimeno, A., Laberge, PY., Lemyre M., et al. Morcellation during total laparoscopic hysterectomies, implications of the use of a contained bag system. J Obstet Gynaecol Can, 2020, [online]. Dostupné z https://doi:10.1016/j.jogc.2019.11.004.

6. Hohl, MK., Hauser, N. Safe total intrafascial laparoscopic (TAIL) hysterectomy. Gynecol Surg. 2010, 7(3), p. 231–239.

7. Husslein, H., Frecker, H., Shore, EM., et al. Comparing two uterine manipulators during total laparoscopic hysterectomy. J Minim Invasive Gynecol, 2017, 24(5), p. 764–771.

8. Karacan, T., Ozyurek, E., Usta, T., et al. Comparison of barbed unidirectional suture with figure of eight standard sutures in vaginal cuff closure in total laparoscopic hysterectomy. J Obstet Gynaecol, 2018, 38(6), p. 842–847.

9. Machida, H., Hom, MS., Adams, CL., et al. Intrauterine manipulator use during minimally invasive hysterectomy and risk of lymphovascular space invasion in endometrial cancer. Int J Gynecol Cancer, 2018, 28(2), p. 208–219.

10. Meng, Y., Liu. Y., Lin, S., et al. The effects of uterine manipulators in minimally invasive hysterectomy for endometrial cancer: A systematic review and meta-analysis. Eur J Surg Oncol, 2020, 46(7), p. 1225–1232.

11. Misirlioglu, S., Boza, A., Urman, B., et al. Clermont-Ferrand versus Vectec uterine manipulator for total laparoscopic hysterectomy. Minim Invasive Ther Allied Technol, 28(1), p. 51–56.

12. https://www.richard-wolf.com/en/disciplines/gynecology/secufix-uterus-manipulator/.

13. Reich, H. Laparoscopic oophorectomy and salpingo-oophorectomy in the treatment of benign tubo-ovarian disease. Int J Fertil, 1987, 32(3), p. 233–236.

14. Reich, H. Total laparoscopic hysterectomy: indications, techniques and outcomes. Curr Opin Obstet Gynecol, 2007, 19(4), p. 337–344.

15. Semm, K. Hysterectomy via laparotomy or pelviscopy. A new cash method without colpotomy. Geburtshilfe Frauenheilkd, 1991, 51(12), S. 996–1003.

16. Taşkın, S., Şükür, YE., Turgay, B., et al. Vaginal cuff dehiscence following total laparoscopic hysterectomy by monopolar cut vs coagulation mode during colpotomy. Eur J Obstet Gynecol Reprod Biol, 2019, 234 (1), p. 38–42.

17. Uccella, S., Bonzini, M., Malzoni, M., et al. The effect of a uterine manipulator on the recurrence and mortality of endometrial cancer: a multi-centric study by the Italian Society of Gynecological Endoscopy. Am J Obstet Gynecol, 2017, 216(6), p. 592.e1–592. e11.

18. Van den Haak, L., Alleblas, C., Nieboer, TE., et al. Efficacy and safety of uterine manipulators in laparoscopic surgery. Arch Gynecol Obstet, 2015, 292(5), p. 1003–1011. Dostupné z http://dx.doi.org.ezproxy.muni.cz/10.1007/s00404-015-3727-9.

19. Yanazume, S., Togami, S., Fukuda, M., et al. New continuous barbed suture device with Stratafix for the vaginal stump in laparoscopic hysterectomy. Gynecol Minim Invasive Ther, 2018, 7(4), p. 167–171.