LAUSR

Study Objective To compare long-term quality of life outcomes of patients undergoing laparoscopic vs. abdominal hysterectomy for non-cancerous gynecologic conditions. Design Randomized controlled trial. Setting Academic teaching hospital. Patients or Participants All patients undergoing hysterectomy from the benign gynecology service with clinical uterine size Interventions Women were randomized to laparoscopic (TLH or LAVH) or abdominal (TAH) hysterectomy with evaluation of clinical and patient reported outcomes (PROs) using validated questionnaires including quality of life (SF12), body image (BIS), sexual functioning (SAQ), and physical activity (AAS) measured at baseline, hospital discharge, 2 weeks, 6 weeks, 6 months and 12 months postoperatively. Measurements and Main Results 94 patients underwent abdominal (48) or laparoscopic (46) hysterectomy. There were no differences in demographics including median age, BMI, race, comorbidities or surgical indication. There were no significant differences in operative time, estimated blood loss, uterine weight, surgical complications, nor Clavien-Dindo grade. PROs were systematically collected with 95% completing follow up to 12 months. Conclusion Comparisons of clinical outcomes after laparoscopic vs. abdominal hysterectomy are well-documented and our study affirms these findings of diminished pain, shorter hospital stay and earlier return to activities after laparoscopic hysterectomy. This study demonstrates overall quality of life improves up to 1 year after hysterectomy, regardless of route, but is significantly better in patients undergoing laparoscopic hysterectomy as early as 2 weeks postoperatively. Body image improves after either type of hysterectomy and is more dramatically improved after laparoscopic hysterectomy as early as 6 weeks postoperatively. Compared to abdominal hysterectomy, sexual functioning is significantly better after laparoscopic hysterectomy and continues to be better up to 12 months postoperatively. PROs of quality of life, pain, body image, physical activity, and sexual functioning improve after hysterectomy regardless of route of surgery; for several outcomes, laparoscopic hysterectomy confers earlier, and more substantial, improvements over abdominal hysterectomy.