Objective: To asses and compare tissue damage during alternative hysterectomies. Design: Prospective clinical study. Setting: Department of Gynaecology, Endoscopic Training Centre, Kladno Hospital. Methods: Tissue damage and perioperative parameters were assessed using the enzymatic activity of creatine kinase (CK) and C-reactive protein (CRP). Serum levels of these markers were measu- red in 127 women who underwent laparoscopic, abdominal and vaginal hysterectomy. Results: The rare of CK activity and CRP were significantly greater in 45 patients who underwent abdominal hysterectomy compared with that in the patients who underwent laparoscopic and vaginal hysterectomies (57 and 25 patients, respectively) Conclusion: Clinical experience and metabolic changes indicate that the tissue damage and perio- perative stress in patients undergoing laparoscopic hysterectomy is lower than in patients where an abdominal approach is used. Large prospective studies are needed to evaluate the surgical trauma and metabolic changes induced by laparoscopic hysterectomy.

        Key words: tissue damage, hysterectomy