DOI: https://doi.org/10.53350/pjmhs2023171100 ORIGINAL ARTICLE 100 P J M H S Vol. 17, No. 01, January, 2023 Outcome of total Laparoscopic Hysterectomy in adult females with Benign Uterine Pathology KASHAF NADEEM MALIK 1 , HUMA AFRIDI 2 , BEENISH RIAZ 3 , WAJIHA SHADAB 4 , ITAAT ULLAH KHAN AFRIDI 5 1 Senior Registrar Obs & Gynae 2 Associate Prof Obs & Gynae, Sialkot Medical College, Sialkot 3 Associate Prof Obs & Gynae, Islamic International Medical College, Islamabad 4 Associate Professor, Obs & Gynae, Islamic International Medical College, Islamabad 5 Professor of Pediatrics, Nawaz Sharif Medical College, Gujrat Correspondence to Dr. Huma Afridi, Email: humaafridi81@yahoo.com, Cell: 3214253315,03319324463 ABSTRACT Background: Laparoscopic hysterectomy literature showed varied results regarding outcome of laparoscopic hysterectomy. Moreover, there is no local evidence which could help us to determine the outcome of laparoscopic hysterectomy in females having uterine pathology. Methods: This descriptive case series was conducted in the Department of Obstetrics & Gynecology, Imran Idrees Teaching Hospital Sialkot for a period of 11 months from 1-1-2022 to 30-11-2022. Total 175 patients fulfilling selection criteria were enrolled in the study from emergency. Then all females underwent laparoscopic hysterectomy under general anesthesia. During surgery, operative time was noted. During surgery, bladder injury was noted if occurred (as per operational definition). Patients were shifted in post-surgical wards and were discharged from there after recovery. Results: In this study the main outcome variables were operative time, hospital stay and bladder damage. Mean operative time and hospital stay for patients who underwent laparoscopic hysterectomy was 170.93±49.18 minutes and 2.63±0.60 days. None of the patients had bladder damage. Practical implication: Laparoscopic hysterectomy is a safe, effective, and reproducible technique that can be adopted after completing a period of training required to standardize the technique. It has been associated with lesser blood loss, shorter stay in hospital, quick return to normal activity, and fewer surgical site infections when compared with abdominal hysterectomy. This approach must be established in our real, day-to-day clinical practice. Conclusion: Laparoscopic hysterectomy is an effective procedure for benign uterine pathology in terms of minimal complication rate (bladder injury), shorter hospital stay and an average mean operative time. Hence showing very promising results and a better outcome for the patients Keywords: Laparoscopic Hysterectomy, Benign Uterine Pathology, Operative time, Hospital Stay INTRODUCTION The uterus is surgically removed and procedure is known as hysterectomy. The procedure can be subtotal (removal of uterine body while leaving the cervix intact, sometimes known as "supra- cervical") or total (removal of uterine body, along with fundus and cervix; also referred to as "complete"). Removal of the fallopian tubes and bilateral ovaries is frequently related to it (Bilateral salpingo-opherectmy) 1 . The majority of benign illnesses lead to hysterectomies in >70% of cases, including menstrual irregularities, polyps, fibroids, uterineprolapse and prolonged pelvic pain 2 . Hysterectomies are performed using three different approaches including abdominal, vaginal and laparoscopic, the choice depending on the indications of surgery and preference of surgeon. Nowadays, laparoscopy is generally well-known as a vital tool in gynecological surgeries 3 . One of the more sophisticated gynaecological minimally invasive treatments was the laparoscopic hysterectomy, first performed by Harry Reich in 1988. Although it has only been available for a little over 20 years, this treatment is still not widely used 1 . Minimally invasive hysterectomies have grown in importance and popularity 4 . Less surgical stress, much less blood loss, less post-operative pain, a shorter hospital stay, early discharge, a minimum surgical scar, and a lower incidence of wound infection are benefits of laparoscopic approach than abdominal approach 1 . Mallick et al reported that total laparoscopic hysterectomy is a safe, reproducible procedure with low complication rate. From 2009-2014, rate of total laparoscopic hysterectomy increased approximately seven fold from 10% and 75% while the rate of total abdominal hysterectomy fell from 87% to 25% 5 . Laparoscopic surgery allows for lesser blood loss, shorter hospital stay, and overall decreased operation-related morbidity despite a longer operating duration 6 . ----------------------------------------------------------------------------------------- Received on 01-12-2022 Accepted on 06-01-2023 The pelvic magnification given by laparoscopy over laparotomy and the avoidance of a painful abdominal incision, which results in a quicker hospital stay and recovery time, are related to the surgical advantages of laparoscopic method over laparotomy 7 . One study found that operative time was 97.5 minutes, hospital stay was short i.e. 3 days and there were no complications 7 . Another study found that median operative time was 120 [range, 50-360] minutes while the complications occurred in 10.8% cases 6 . But another study found that the mean operative time was 227±28.8 min, mean hospital stay was 16.4±6.7days and intraoperatively bladder injury was 0% 8 . Rationale of this study is to determine the outcome of laparoscopic hysterectomy in females presenting with benign uterine pathology. Laparoscopic hysterectomy literature showed varied results regarding outcome of laparoscopic hysterectomy. Moreover, there is no local evidence which could help us to determine the outcome of laparoscopic hysterectomy in females having uterine pathology. So that in future, we can apply results of this study in local setting. This will help to improve our practice and knowledge and we will update guidelines to improve outcome of hysterectomy. The objective of the study was to determine the outcome of laparoscopic hysterectomy in adult females with uterine benign pathology MATERIALS-&-METHODS This descriptive case series was conducted in the Department of Obstetrics & Gynecology, Imran Idrees Teaching Hospital Sialkot for a period of 11 months from 01-01-2022 to 30-11-2022. Sample size of 175 cases is calculated with 95% confidence level, d=1 and taking magnitude of mean operative time was 16.4±6.7days with laparoscopic hysterectomy for females presenting with uterine tumor Sampling-technique: Non-probability, consecutive sampling