Implication of Umbilical Port and Endoscope Size on Total Laparoscopic Hysterectomy

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Laparoscopy is increasingly replacing open surgery as the preferred treatment option in most patients across disciplines. Additionally as technological improvements have occurred, mini-laparoscopic instruments have been designed to further reduce surgical trauma and minimize invasiveness. There are several studies in the literature, which show that using mini-laparoscopic instruments does not increase complication rates and may reduce patient recovery. Typically a 10mm umbilical incision and endoscope is routine for a total laparoscopic hysterectomy. In 2011, St John of God Hospital began to use high definition 5mm endoscopes. At this stage Dr Salfinger began to complete his total laparoscopic hysterectomy with a 5mm umbilical incision and endoscope and anecdotally noted that patients were requesting discharge earlier. In 2012 Dr Salfinger and Acton audited 328 consecutive cases in a single-surgeon series of total laparoscopic hysterectomy, comparing use of 5mm and 10mm rigid laparoscopes examining for length of hospital stay (LOS), return to normal daily routine, complication rates and conversion to laparotomy in women aged between 29-92 years. Findings were a significant increase in the number of women being discharged from hospital on day 1 in the 5mm-scope group compared to the 10mm scope group. Both groups had similar blood loss and complication rates. Notably the 5mm-scope group also had a significantly shorter time to return to normal function (subjective, patient assessed outcome) with 8 days in comparison to 17 days for the 10mm scope group. Because of these findings we are encouraged to perform a randomized controlled trial examining the impact of umbilical incision, port size and endoscope size on total laparoscopic hysterectomy. This will be a randomized controlled trial with participants randomized to either the 10mm or 5mm incision and endoscope. Participants will be recruited from Dr Salfinger and Dr Tan’s patients. Data collected will include basic patient demographics, type of umbilical incision and endoscope used, operating time, complication rates, discharge time and post operative pain scores on day 1 and day 7. It is hoped that this data will be used by other surgeons and encourage them to trial 5mm umbilical incision and endoscope as well as other health centers, encouraging them to provide new technology for their surgeons and patients, aiming for shorter length of stay.

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