Laparoscopic Versus Open Hysterectomy for Benign Disease in Women with Giant Uteri (≥1500 g): Feasibility and Outcomes

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• 作者：Stefano Uccella ; MD ; PhD ; ^{stefucc@libero.it" class="auth_mail" title="E-mail the corresponding author} ; Jvan Casarin ; MD ; Nicola Marconi ; MD ; Antonella Cromi ; MD ; Chiara Morosi ; MD ; Baldo Gisone ; MD ; Ciro Pinelli ; MD ; Fabio Ghezzi ; MD
• 关键词：Complications ; Giant uterus ; Laparoscopy ; Large uterus ; Total laparoscopic hysterectomy
• 刊名：Journal of Minimally Invasive Gynecology
• 出版年：2016
• 出版时间：September-October 2016
• 年：2016
• 卷：23
• 期：6
• 页码：922-927
• 全文大小：340 K

文摘

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-oophorectomy.

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 reduction 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.