Laparoscopic hysterectomy

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Abstract
In this review we intend to describe the recent developments and experience gained in recent years with the different types of laparoscopic hysterectomies, and to compare results with those of abdominal hysterectomy. In the United States, in the last decade, there has been clear trend towards laparoscopic hysterectomy. An increase from 0.3% to 9.9% was observed within a 7-year period from 1990 to 1997. High costs and lack of appropriate educational systems for residents and fellows slows the anticipated spread of this relatively new modality. From some retrospective publications it seems that complication rates have increased in laparoscopic hysterectomies, especially those involving the urinary system. However, a recent analysis revealed a reasonable complication rate for the procedure, compared with abdominal hysterectomy, if the surgeon passes a learning curve of the first 30 procedures. A conflict arises in regard to preservation of the uterine cervix during laparoscopic hysterectomy. Alternative procedures, such as supracervical laparoscopic hysterectomy or classic intrafascial supra-cervical hysterectomy, have been proposed. However, careful long-term analysis of results demonstrates a high complication rate requiring further operations in 24% of patients. Less intraoperative bleeding, shorter hospital stay with less morbidity and shorter convalescence period remains the obvious advantages of laparoscopic in comparison with abdominal hysterectomy.

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