Although more than 500,000 hysterectomies are performed annually in the U.S. to treat benign pelvic diseases, most outcome studies of the procedure look at clinical factors such as operation time, surgical complications, and hospital stays while ignoring patient satisfaction and quality of life issues. Now, a new study published in Obstetrics & Gynecology has found that patients who receive laparoscopic hysterectomy may fare better than those who receive abdominal hysterectomy.
To better understand the impact of laparoscopic versus abdominal hysterectomies on long-term quality of life, Dr. Theodoor E. Nieboer, from the department of obstetrics and gynecology at Radboud University Nijmegen Medical Centre in Nijmegen, the Netherlands, and colleagues conducted a prospective, randomized controlled trial of women with benign gynecologic disease. All abdominal hysterectomies (N=32) were performed via standard extrafascial technique while laparoscopic hysterectomies (N=27) were all intentionally total laparoscopic hysterectomies. Participants were followed for a median of 4 years; at which point they were sent a general health-based survey to ascertain quality of life.
Overall, Nieboer and colleagues found that patients in the laparoscopic treatment group scored statistically higher on the self-assessment than their counterparts in the abdominal treatment group, which indicates the laparoscopic group fared better and reported higher quality of life. Nieboer et al. also noted that women who received laparoscopic surgery generally had better scores in domains such as vitality, physical functioning, and social functioning. However, the researchers failed to find significant differences for such items as general health, physical role functioning, emotional role functioning, social functioning, and mental health. Interestingly, in the early weeks after the surgery, the laparoscopic group scored higher in the bodily pain domain, but the difference was not statistically significant at 12 weeks and 4 years after surgery.
“The finding that quality of life is still better 4 years after laparoscopic hysterectomy is striking,” the authors wrote. “The benefits of avoiding laparotomy seem to work through after several years. Until now, laparoscopic hysterectomy has only proven to result in better quality of life until 6 and 12 weeks after surgery.”
Based on these results, Nieboer and colleagues concluded, “All patients listed for hysterectomy in whom vaginal hysterectomy is not possible and with a moderately enlarged uterus should be able to opt for laparoscopic hysterectomy.”