Study Objective: To evaluate perioperative outcomes and complications of laparoscopic hysterectomy (LH) in women with giant uteri (>= 1.5 kg) compared with open abdominal hysterectomy (AH), which is considered the reference.Design: A retrospective analysis of prospectively collected data (Canadian Task Force Classification II-2).Setting: An academic research center.Patients: All consecutive women who underwent hysterectomy for uteri weighing >= 1500 g (total = 51) between 2000 and 2015 were analyzed. Twenty-seven (53%) patients had been scheduled for the laparoscopic approach (LH), whereas 24 (48%) had been scheduled for AH.Interventions: Hysterectomy +/- mono/bilateral salpingo-oophorectoiny.Main Outcome Measures: Perioperative details, incidence, severity, and type of complications were analyzed according to surgical approach (AH vs LH). We also evaluated the trends over time in terms of perioperative outcomes.Results: AH was associated with a shorter operative time (97.5 vs 160 minutes, p = .004) compared with LH. Blood loss (200 vs 225 mL, p = .21) and the decrease in postoperative hemoglobin (-1.2 vs 1.1, p = .89) were similar between AH and LH. Intra- and postoperative complications were similar between the 2 groups; however, hospital stay was significantly shorter in the LH group (median = 3 days vs 1 day, p < .001). A significant trend toward a progressive increase in the use of the minimally invasive approach was registered through the years (p = .001). Parallel to this increase, we observed a significant reducdon in terms of length of stay. Moreover, a decrease in the total number of complications, mainly because of a decrease in the rate of early minor events, was observed through the years.Conclusions: Our experience shows that LH can be considered a feasible procedure, even in cases of uteri >= 1.5 kg, with significant advantages over open surgery in terms of postoperative hospital stay. (C) 2016 AAGL. All rights reserved.
Laparoscopic Versus Open Hysterectomy for Benign Disease in~Women with Giant Uteri ($\geq$1500~g): Feasibility and Outcomes
Stefano Uccella;
2016-01-01
Abstract
Study Objective: To evaluate perioperative outcomes and complications of laparoscopic hysterectomy (LH) in women with giant uteri (>= 1.5 kg) compared with open abdominal hysterectomy (AH), which is considered the reference.Design: A retrospective analysis of prospectively collected data (Canadian Task Force Classification II-2).Setting: An academic research center.Patients: All consecutive women who underwent hysterectomy for uteri weighing >= 1500 g (total = 51) between 2000 and 2015 were analyzed. Twenty-seven (53%) patients had been scheduled for the laparoscopic approach (LH), whereas 24 (48%) had been scheduled for AH.Interventions: Hysterectomy +/- mono/bilateral salpingo-oophorectoiny.Main Outcome Measures: Perioperative details, incidence, severity, and type of complications were analyzed according to surgical approach (AH vs LH). We also evaluated the trends over time in terms of perioperative outcomes.Results: AH was associated with a shorter operative time (97.5 vs 160 minutes, p = .004) compared with LH. Blood loss (200 vs 225 mL, p = .21) and the decrease in postoperative hemoglobin (-1.2 vs 1.1, p = .89) were similar between AH and LH. Intra- and postoperative complications were similar between the 2 groups; however, hospital stay was significantly shorter in the LH group (median = 3 days vs 1 day, p < .001). A significant trend toward a progressive increase in the use of the minimally invasive approach was registered through the years (p = .001). Parallel to this increase, we observed a significant reducdon in terms of length of stay. Moreover, a decrease in the total number of complications, mainly because of a decrease in the rate of early minor events, was observed through the years.Conclusions: Our experience shows that LH can be considered a feasible procedure, even in cases of uteri >= 1.5 kg, with significant advantages over open surgery in terms of postoperative hospital stay. (C) 2016 AAGL. All rights reserved.
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