1
|
He Z, He Y, Xie C. Surgical techniques and experience-sharing of transumbilical single-port laparoscopic hysterectomy in difficult conditions. Asian J Surg 2024; 47:2820-2821. [PMID: 38378409 DOI: 10.1016/j.asjsur.2024.02.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 02/02/2024] [Indexed: 02/22/2024] Open
Affiliation(s)
- Zuoxi He
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province, PR China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, Sichuan Province, PR China
| | - Yuedong He
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province, PR China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, Sichuan Province, PR China
| | - Chuan Xie
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province, PR China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, Sichuan Province, PR China.
| |
Collapse
|
2
|
Polyakov A, Mirmilstein V, Rozen G. The numbers just do not add up. Fertil Steril 2024; 121:133. [PMID: 37839722 DOI: 10.1016/j.fertnstert.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 10/17/2023]
Affiliation(s)
- Alex Polyakov
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia; Reproductive Biology Unit, The Royal Women's Hospital, Parkville, Victoria, Australia; Melbourne IVF, East Melbourne, Victoria, Australia; Laparoscopic Unit, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Vadim Mirmilstein
- Laparoscopic Unit, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Genia Rozen
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia; Reproductive Biology Unit, The Royal Women's Hospital, Parkville, Victoria, Australia; Melbourne IVF, East Melbourne, Victoria, Australia
| |
Collapse
|
3
|
Coyne K, Purdy MP, Bews KA, Habermann EB, Khan Z. Reply of the authors: comment on "Risk of hysterectomy at the time of myomectomy - An underestimated surgical risk". Fertil Steril 2024; 121:134. [PMID: 37951492 DOI: 10.1016/j.fertnstert.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Kathryn Coyne
- Division of Reproductive Endocrinology and Infertility, University Hospitals, Cleveland, Ohio
| | | | - Katherine A Bews
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Surgical Outcomes 8 Program, Mayo Clinic, Rochester, Minnesota
| | - Elizabeth B Habermann
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Surgical Outcomes 8 Program, Mayo Clinic, Rochester, Minnesota
| | - Zaraq Khan
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, Minnesota; Division of Minimally Invasive Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
4
|
Mouro S, Hamed JLC, Whiteside JL, Tumin D. Relevance of Uterine Weight for Predicting Surgical Complications in Minimally Invasive Benign Hysterectomy. J Minim Invasive Gynecol 2023; 30:976-982. [PMID: 37611741 DOI: 10.1016/j.jmig.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/25/2023]
Abstract
STUDY OBJECTIVES To describe the uterine weight threshold for increasing risk of complications after a laparoscopic hysterectomy using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. DESIGN Cross-sectional analysis using the American College of Surgeons NSQIP database from 2016 to 2021. SETTING American College of Surgeons NSQIP database. PATIENTS Patients undergoing minimally invasive hysterectomy for benign indications (N = 64 289). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Uterine weight was entered in grams and 30-day complications were abstracted from patient charts. In the analytic sample, median uterine weight was 135 grams (interquartile range, 90-215) and 6% of patients (n = 4085) experienced complications. Uterine weight performed very poorly in predicting complications on bivariate analysis (area under the receiver operating characteristics curve, 0.53; 95% confidence interval, 0.53-0.54). On multivariable analysis, a uterine weight cutoff of 163 grams was associated with higher odds of complications (odds ratio, 1.11; 95% confidence interval, 1.03-1.19; p = .003), but this threshold achieved only a 43% sensitivity and 62% specificity for predicting complications. CONCLUSIONS Uterine weight alone possessed negligible utility for predicting the risk of perioperative complications in minimally invasive hysterectomy.
Collapse
Affiliation(s)
- Steven Mouro
- Department of Obstetrics and Gynecology (Drs. Mouro and Whiteside), East Carolina University, Greenville, North Carolina.
| | - Jenna L Carter Hamed
- Brody School of Medicine (Ms. Carter Hamed), East Carolina University, Greenville, North Carolina
| | - James L Whiteside
- Department of Obstetrics and Gynecology (Drs. Mouro and Whiteside), East Carolina University, Greenville, North Carolina
| | - Dmitry Tumin
- Department of Pediatrics and Department of Academic Affairs (Dr. Tumin), East Carolina University, Greenville, North Carolina
| |
Collapse
|
5
|
Dion L, Sousa C, Legendre G, Nyangoh-Timoh K, Le Lous M, Morel O, Lavoue V, Descamps P. Assessment of the self-confidence of obstetrics & gynecology fellows to perform a postpartum hemostasis hysterectomy. J Gynecol Obstet Hum Reprod 2023; 52:102548. [PMID: 36781074 DOI: 10.1016/j.jogoh.2023.102548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 02/13/2023]
Abstract
INTRODUCTION Hemostasis Hysterectomy (HH) is a last resort surgical procedure performed in situations of uncontrolled post-partum hemorrhage in maternity wards. The chances of being confronted with this situation are scarce during residency, and the situation is not well suited for teaching. Nevertheless, every obstetrician-gynecologist can be confronted with this stressful situation, and should therefore possess the surgical competence required, regardless of his routine practice. The aim of the present study is to evaluate clinical exposure and self-awareness concerning HH amongst obstetrics and gynecology residents and fellows. MATERIEL AND METHODS We performed a survey amongst French obstetrics and gynecology fellows. An anonymous survey was sent by email between December 1, 2020 to July 1, 2021. RESULTS Half of the interrogated fellows had practiced (as operator) an HH during residency with a senior and only 22,6% in post-residency. During the last year of residency 70% of them had performed less than 10 scheduled hysterectomies as primary operator. The laparoscopic approach was the most frequently practiced. Very few hysterectomies were performed as primary operator. Fellows with a surgical or mixed activity (both gynecological surgery and obstetrical activity in current practice) felt significantly more capable of performing HH compared to those with exclusive obstetrical or reproductive medicine activity; respectively 60% vs 36%, p = 0.008; Odds Ratio: 2.629 (95% CI 1.2214; 5.8094). CONCLUSION The number of scheduled hysterectomies or HH performed as primary operator is very low during residency or fellowship. It remains largely inferior to the number deemed necessary in previous publications about the learning curve for scheduled hysterectomy, which varies from 18 to 80 interventions. Nowadays, the increasing number of residents, added to the decrease of hemostasis hysterectomies through better management of post-partum hemorrhage, pushes towards the development of specific training, such as "damage control simulation".
Collapse
Affiliation(s)
- Ludivine Dion
- Rennes University Hospital, Department of Gynecology, Hôpital Sud, France; Irset - Inserm UMR_S 1085, Rennes, France.
| | - Carla Sousa
- Rennes University Hospital, Department of Gynecology, Hôpital Sud, France; Irset - Inserm UMR_S 1085, Rennes, France
| | | | | | - Maëla Le Lous
- Rennes University Hospital, Department of Gynecology, Hôpital Sud, France
| | - Olivier Morel
- Nancy University Hospital, Department of Obstetrics, France
| | - Vincent Lavoue
- Rennes University Hospital, Department of Gynecology, Hôpital Sud, France; Irset - Inserm UMR_S 1085, Rennes, France
| | | |
Collapse
|
6
|
Tchartchian G, Bojahr B, Krentel H, De Wilde RL. Evaluation of complications, conversion rate, malignancy rate, and, surgeon's experience in laparoscopic assisted supracervical hysterectomy (LASH) of 1274 large uteri: A retrospective study. Acta Obstet Gynecol Scand 2022; 101:1450-1457. [PMID: 36203317 PMCID: PMC9812207 DOI: 10.1111/aogs.14468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Hysterectomy now belongs to standard gynecological procedures. Moreover, a shift towards laparoscopic techniques is ever more apparent as they provide many advantages such as less traumatization and shorter convalescence. Large uteri are still mentioned as contraindications for laparoscopic hysterectomy even though those patients might benefit from the lower morbidity associated with minimal invasive techniques. In this study, the largest reported so far, we analyzed intraoperative and postoperative complications as well as the surgeon's experience of laparoscopic assisted supracervical hysterectomy (LASH) in patients with a uterus weight over 500 g. MATERIAL AND METHODS The present retrospective study, between June 27, 1998 and August 31, 2019, evaluates 1274 patients with a uterus weight over 500 g who were treated with LASH for benign uterine diseases at the Clinic for Minimal Invasive Surgery (Berlin, Germany). All surgeries were performed by one of four in-house surgeons with experience in LASH: they had performed at least 500 LASH procedures before the study. Patients receiving surgical treatment for malignant tumors were not included in the study. Major and minor intraoperative and postoperative complications were recorded and evaluated. Additionally, medical files were evaluated for demographic data, American Society of Anesthesiologists score (I-IV), name of the surgeon, duration and indication for surgery, history of previous gynecological procedures and concomitant surgical interventions, weight of removed uterine tissue, duration of postoperative hospitalization in patients with complications, intraoperative conversion from laparoscopy to laparotomy, and malignancy rate. RESULTS The mean age was 47.0 ± 7.3 years and mean body mass index was 25.6 ± 7.1 kg/m2 . Average parity was 1.04 ± 1.57. Average uterus weight was 761.8 ± 317.9 g (500-4065 g). The mean duration of surgery was 96.9 ± 49.5 min; 54% of all patients were treated without concomitant intervention, conversion rate was 2.12%. The malignancy rate was 0.4% and the complication rate was 6.81% with 1.36% intraoperative complications and 5.45% postoperative complications. CONCLUSIONS The overall low complication and malignancy rates observed in this study allow us to present LASH as a safe and efficient alternative laparoscopic approach to remove uteri of any size in the hands of experienced surgeons.
Collapse
Affiliation(s)
| | - Bernd Bojahr
- Clinic for Gynecology and Breast CenterUniversitätsklinikum GreifswaldGreifswaldGermany
| | - Harald Krentel
- Clinic of Gynecology, Obstetrics, Gynecological Oncology and Senology, Academic Teaching HospitalBethesda HospitalDuisburgGermany
| | | |
Collapse
|
7
|
Lu Y, Yang F, Tong L, Zheng Y. Comparison of learning curves for laparoendoscopic single-site myomectomy performed by 2 surgeons. Medicine (Baltimore) 2022; 101:e29830. [PMID: 35777038 PMCID: PMC9239588 DOI: 10.1097/md.0000000000029830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
We aimed to compare the learning curves of 2 surgeons with different endoscopic bases when performing laparoendoscopic single-site myomectomy (LESS-M). We retrospectively analyzed and compared 2 groups of patients who underwent LESS-M performed by 2 surgeons with different bases in multi-port laparoscopic surgery (MLS) from October 2019 to December 2020 at West China Second Hospital of Sichuan University. Patients' characteristics and related surgical indicators were compared, and surgeons' learning curves were analyzed using a cumulative sum analysis. All of the patients completed LESS-M without converting to MLS or laparotomy, despite Surgeon A being MLS-unqualified and Surgeon B being MLS-qualified. There were no significant differences in patients' characteristics or surgical indicators between the 2 groups (P > 0.05 for all). Surgeons A and B crossed the learning curve after 21 and 18 cases, respectively. LESS-M is safe and feasible. Approximately 20 cases are required for surgeons to achieve LESS-M proficiency, and surgeons without MLS experience can still master LESS-M.
Collapse
Affiliation(s)
- Yuanyuan Lu
- Department of Gynecologic Oncology, West China Second Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Fan Yang
- Department of Gynecologic Oncology, West China Second Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Longxia Tong
- Department of Gynecologic Oncology, West China Second Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Ying Zheng
- Department of Gynecologic Oncology, West China Second Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- *Correspondence: Ying Zheng, Department of Gynecologic Oncology, West China Second Hospital, Sichuan University, and Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No. 17, Renmin South Road, Chengdu 610041, Sichuan, China (e-mail: )
| |
Collapse
|
8
|
Uccella S, Kho RM, Garzon S, Casarin J, Zorzato PC, Ghezzi F. The Large Uterus Classification System: a prospective observational study. BJOG 2021; 128:1526-1533. [PMID: 33988895 PMCID: PMC8362220 DOI: 10.1111/1471-0528.16753] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 12/22/2022]
Abstract
Objective To investigate the Large Uterus Classification System (LUCS) ability to predict surgical outcomes and complications in total laparoscopic hysterectomies (TLHs) for large uteri. Design Prospective observational study. Setting Two referral centres. Population or sample Three hundred and ninety‐two women who underwent TLH for a large uterus (uterine fundus at or over the transverse umbilical line). Methods Between 2004 and 2019, the intraoperative LUCS was estimated in all patients. The LUCS considers the uterine and adnexal vascular pedicles displacement. Type 1 is without vascular pedicles displacement. Type 2 has the cephalad displacement of adnexal vascular pedicles. The uterine vessels displacement regardless of adnexal pedicles defines Type 3. Main outcome measures Patients’ characteristics with perioperative outcomes were prospectively collected and compared between the three types of large uteri. Results Two hundred and fifty‐one (64%), 82 (20.9%) and 59 (15.1%) women had Type 1, Type 2 and Type 3 uteri, respectively. Women with Type 1 uteri had a lower uterine weight, shorter operative time, less blood loss and lower complication rates than women with Types 2 and 3. The conversion rate to laparotomy in Type 1 was similar to that in Type 2 (odds ratio [OR] 0.98; 95% CI 0.32–3.56) but lower than Type 3 (OR 0.35; 95% CI 0.14–0.97); in Type 2 it was lower than Type 3, although without the conventional statistical significance (OR 0.36; 95% CI 0.13–1.13; P = 0.07). Multivariable analysis showed that the uterine Type (1 versus 2–3) was independently associated with the total complications rate (OR 2.00; 95% CI 1.09–3.68; P = 0.02). Conclusions The LUCS appears associated with surgical outcomes and complications, potentially stratifying the surgical risk and guiding the surgical technique in TLHs for large uteri. Tweetable abstract The Large Uterus Classification System may predict outcomes in total laparoscopic hysterectomy of large uteri. The Large Uterus Classification System may predict outcomes in total laparoscopic hysterectomy of large uteri.
Collapse
Affiliation(s)
- S Uccella
- Division of Obstetrics and Gynaecology, Department of Maternal, Neonatal and Infant Health, ASL Biella, Biella, Italy.,Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
| | - R M Kho
- Department Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - S Garzon
- Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
| | - J Casarin
- Department of Obstetrics and Gynaecology, F. Del Ponte Hospital, University of Insubria, Varese, Italy
| | - P C Zorzato
- Division of Obstetrics and Gynaecology, Department of Maternal, Neonatal and Infant Health, ASL Biella, Biella, Italy.,Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
| | - F Ghezzi
- Department of Obstetrics and Gynaecology, F. Del Ponte Hospital, University of Insubria, Varese, Italy
| |
Collapse
|
9
|
Pepin K, Cope A, Einarsson JI, Cellini J, Cohen SL. Safety of Minimally Invasive Tissue Extraction in Myoma Management: A Systematic Review. J Minim Invasive Gynecol 2020; 28:619-643. [PMID: 32977002 DOI: 10.1016/j.jmig.2020.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/28/2020] [Accepted: 09/08/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This review seeks to establish the incidence of adverse outcomes associated with minimally invasive tissue extraction at the time of surgical procedures for myomas. DATA SOURCES Articles published in the following databases without date restrictions: PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews and Trials. Search was conducted on March 25, 2020. METHODS OF STUDY SELECTION Included studies evaluated minimally invasive surgical procedures for uterine myomas involving morcellation. This review did not consider studies of nonuterine tissue morcellation, studies involving uterine procedures other than hysterectomy or myomectomy, studies involving morcellation of known malignancies, nor studies concerning hysteroscopic myomectomy. A total of 695 studies were reviewed, with 185 studies included for analysis. TABULATION, INTEGRATION, AND RESULTS The following variables were extracted: patient demographics, study type, morcellation technique, and adverse outcome category. Adverse outcomes included prolonged operative time, morcellation time, blood loss, direct injury from a morcellator, dissemination of tissue (benign or malignant), and disruption of the pathologic specimen. CONCLUSION Complications related to morcellation are rare; however, there is a great need for higher quality studies to evaluate associated adverse outcomes.
Collapse
Affiliation(s)
- Kristen Pepin
- Department of Obstetrics & Gynecology, Weill Cornell Medical Center, New York, New York (Dr. Pepin).
| | - Adela Cope
- Department of Obstetrics & Gynecology, The Mayo Clinic, Rochester, Minnesota (Drs. Cope and Cohen)
| | - Jon I Einarsson
- Department of Obstetrics & Gynecology, Brigham and Women's Hospital (Dr. Einarsson)
| | - Jacqueline Cellini
- Department of Research & Instruction, Harvard TH Chan School of Public Health (Ms. Cellini), Boston, Massachusetts
| | - Sarah L Cohen
- Department of Obstetrics & Gynecology, The Mayo Clinic, Rochester, Minnesota (Drs. Cope and Cohen)
| |
Collapse
|
10
|
Sezgin B, Camuzcuoğlu A, Küçük M, Camuzcuoğlu H. Bilateral uterine artery coagulation in laparoscopic hysterectomy for benign disease in uteri more than 1000 g. J Obstet Gynaecol Res 2019; 46:133-139. [PMID: 31646706 DOI: 10.1111/jog.14148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/07/2019] [Indexed: 12/17/2022]
Abstract
AIM We aimed to evaluate the efficacy of bipolar uterine artery coagulation in laparoscopic hysterectomy for uteri larger than 1000 g. METHODS Data from 674 patients who underwent laparoscopic hysterectomy were retrospectively analyzed. Among those, 75 patients with uteri weighing more than 1000 g were included. The clinical and surgical outcomes of patients with large uteri were compared according to bipolar uterine artery coagulation performance status. RESULTS The mean difference in intraoperative blood loss between the groups of patients with uterine artery occlusion and without uterine artery occlusion was statistically significant (89.26 ± 65.52 vs 227.94 ± 124.65 mL; P < 0.001). The hemoglobin decrease was also significantly lower in the patients with uterine artery occlusion (0.46 ± 0.23 vs 1.21 ± 0.79 g/dL; P < 0.001). CONCLUSION When performing laparoscopic hysterectomy of uteri weighing over 1000 g, the occlusion of the bilateral uterine arteries at the point of exit from the internal iliac arteries using bipolar coagulation at the beginning of the operation reduces intraoperative hemorrhage and hemoglobin decrease.
Collapse
Affiliation(s)
- Burak Sezgin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Muğla Sıtkı Koçman University, Mugla, Turkey
| | - Aysun Camuzcuoğlu
- Department of Obstetrics and Gynecology, Private Adatıp Sakarya Hospital, Sakarya, Turkey
| | - Mert Küçük
- Department of Medical Education and Bioinformatics, Muğla Sıtkı Koçman University, Mugla, Turkey.,Department of Obstetrics and Gynecology, Mugla Sitki Kocman University, Mugla, Turkey
| | | |
Collapse
|
11
|
Sinha R, Bana R, Sanjay M. Comparison of Robotic and Laparoscopic Hysterectomy for the Large Uterus. JSLS 2019; 23:JSLS.2018.00068. [PMID: 30675091 PMCID: PMC6328360 DOI: 10.4293/jsls.2018.00068] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background and Objectives: We compared the outcome of robotic hysterectomy (RH) with laparoscopic hysterectomy (LH) for large uteri (≥16 weeks). Methods: This was a retrospective review over 5 years of 165 women (RH, 46; LH, 119). Demographic data, conversion, hemoglobin drop, indication, operating time, postoperative stay, and intra-operative strategies (adhesiolysis, myomectomy) were recorded. Results: Mean age was 45.7 ± 6.4 years and 44.5 ± 5.4 years (no diff) and body mass index was 30.2 ± 6.3 kg/m2 and 27.8 ± 4.8 kg/m2 (P = .009) in the RH and LH groups. There was no difference in percentage of women with previous laparotomy (RH, 15.2% vs LH, 13.4%) and mean number of lower-segment caesarean section (RH, 1.0 vs LH, 0.8). Mean size of uterus was similar (RH, 20.0 weeks vs LH, 17.4 weeks). The mean number of ports was higher in the RH group (RH, 4.2 vs LH, 3.4; P < .001) as was needed for adhesiolysis (RH, 71.7% vs LH, 35.3%; P < .001). Difficult bladder dissection was more in the RH group (56.5% vs 26.1%; P < .001). Vaginal morcellation was similar in both groups (RH, 89.1%; LH, 83.2%). RH took longer operating time (131.0 vs 110.6 minutes; P = .006). RH had less drop in Hb (1.0 vs 1.8 g/dL; P < .001) and remained the same after multiple regression analysis. Postoperative stay was similar in both groups (1.4 days). Requirement of intravenous analgesia was significantly lower in the RH group (12.5 vs 30.9 hours; P < .001). Open conversion rate was 4.3% (RH) and 10.9% (LH) but not significant. Conclusion: A higher body mass index, more adhesiolysis, and difficult bladder dissection imply a more challenging nature of women who underwent RH. Despite this, RH was shown to be feasible and safe with a lower blood loss.
Collapse
Affiliation(s)
- Rooma Sinha
- Department of Gynecology, Apollo Hospitals, Jubilee Hills, Hyderabad, India
| | - Rupa Bana
- Department of Gynecology, Apollo Hospitals, Jubilee Hills, Hyderabad, India
| | - Madhumathi Sanjay
- Department of Gynecology, Apollo Hospitals, Jubilee Hills, Hyderabad, India
| |
Collapse
|