Journal of minimally invasive gynecology 2017 07 12() pii S1553-4650(17)30391-6
To present a large single-center series of hysterectomies for uteri≥ 1 kilogram and to compare laparoscopic and open abdominal approach in terms of peri-operative outcomes and complications.
Retrospective analysis of prospectively-collected data (Canadian Task Force II-2).
Academic research center.
Consecutive women who underwent hysterectomy for uteri ≥ 1 kilogram in the period between January 2000 and December 2016. Patients with a pre-operative diagnosis or suspect of uterine malignancy were excluded. The subjects were divided according to the intended initial surgical approach (whether open or laparoscopic). The two groups were compared in terms of intra-operative data and post-operative outcomes. Multivariable analysis was performed to identify possible independent predictors of overall complications. A subanalysis including only obese women was accomplished.
Total laparoscopic vs. abdominal hysterectomy (± bilateral adnexectomy).
MAIN OUTCOME MEASURES
Intra- and post-operative surgical outcomes.
A total of 258 patients was included: 55 (21.3%) women were initially approached by open surgery and 203 (78.7%) by laparoscopy. Nine (4.4%) conversions from laparoscopic to open surgery were registered. Median operative time was longer in the laparoscopic group (120[range:50-360] vs. 85[35-240] minutes;p=0.014). Estimated blood loss (150[0-1700] vs. 200[50-3000];p=0.04), postoperative haemoglobin drop and hospital stay (1[1-8] vs. 3[1-8] days;p<0.001) were lower among patients operated by laparoscopy. No difference was found between groups in terms of intra- and post-operative complications. However, the overall rate of complications (10.8% vs. 27.2%; p=0.015) and the incidence of significant complications (defined as intra-operative adverse events or post-operative Clavien-Dindo ≥ 2 events; 4.4% vs. 10.9%; p=0.04) were significantly higher among patients who initially received open surgery. Laparoscopic approach was found to be the only independent predictor of a lower incidence of overall complications (OR 0.42; 95% CI:019-0.9). The overall morbidity of minimally-invasive hysterectomy was lower also in the subanalysis concerning only obese patients. CONCLUSIONS
In experienced hands and in dedicated centers, laparoscopic hysterectomy for uteri weighing≥ 1 kilogram is feasible and safe. Minimally-invasive surgery retains its well-known advantages over open surgery even in patients with extremely enlarged uteri.