41: Laparoscopic retroperitoneal hysterectomy with uterine artery ligation in morbidly obese patients at a freestanding ambulatory surgery center

Abstract

To compare the outcomes of laparoscopic retroperitoneal hysterectomy (LRH) in morbidly obese patients (BMI ≥ 40 k/m2) versus non-obese patients (BMI < 30 k/m2) and obese patients (BMI ≥ 30 and < 40 k/m2) at a freestanding ambulatory surgery center. A retrospective comparative analysis was performed of 1,679 women, age 18 years or older, non-pregnant, who underwent LRH by one of two laparoscopic gynecologic surgical specialists at a freestanding ambulatory surgery center serving the Washington, DC area, between October 2013 and January 2019. The study was deemed exempt from informed consent according to 45 CFR 46.101(b) by IntegReview IRB, an independent institutional review board. LRH performed via retroperitoneal dissection, uterine artery ligation at the origin at the anterior branch of the internal iliac artery, vaginal uterine extraction, and transvaginal cuff closure. No power morcellation used. Postoperative complications graded using the Clavien-Dindo Classification system. The only statistically significant differences in surgical outcomes were higher mean operative time and estimated blood loss (EBL) in the obese groups, however these differences were not clinically meaningful (3-4 minutes and 25-31 mL, respectively). There was no difference in intraoperative complication rates across BMI categories. The postoperative complication rates were lower in the in the morbidly obese group compared to the non-obese group. There were a total of 2 postoperative hospital transfers out of the 1,679 patients (Table 1, Figure 1). Laparoscopic retroperitoneal hysterectomy can be performed safely in a freestanding ambulatory surgery setting, with low rate of complications and hospital transfers, and no significant difference in surgical outcomes in morbidly obese patients.View Large Image Figure ViewerDownload Hi-res image Download (PPT)