Feasibility and surgical outcome in obese versus nonobese patients undergoing laparoendoscopic single-site hysterectomy: a multicenter case-control study.

Abstract

To assess the feasibility and perioperative outcomes of laparoendoscopic single-site (LESS) hysterectomy in obese and nonobese women. A multicentric retrospective case-control study (Canadian Task Force II-2). Catholic University of the Sacred Heart and National Cancer Institute "Regina Elena" (Rome, Italy), Massachusetts General Hospital (Boston, MD), and Johns Hopkins Hospital (Baltimore, MD). From July 2009 to April 2013, 120 women underwent LESS hysterectomy. Five women (8%) were excluded from the analysis. The remaining 115 women were divided into 2 groups: obese (n=43, body mass index [BMI] ≥30kg/m(2)) and nonobese (n=72, BMI <30kg/m(2)). Total LESS hysterectomies for malignant and premalignant uterine disease or at least for prophylactic intent were performed. No statistical differences regarding perioperative outcomes were observed between the 2 groups. Conversion to standard laparoscopy occurred in 2 obese (5%) and 2 (5%) nonobese women (p=.62). Conversion to laparotomy occurred in 1 obese (2.3%) and 3 (4.2%) nonobese women (p=.212). The median operative time was 115minutes (range, 48-300minutes) in obese and 114minutes (range, 55-342minutes) in nonobese women (p=.787). The intraoperative complication rate was 11.6% and 9.6% in obese and nonobese women, respectively (p=.712). The early postoperative complication rate was 6.9% in obese and 4.1% in nonobese women (p=.516). Despite the fact that the present analysis was performed in a relatively small group of patients, this study suggests that obesity (BMI ≥30) does not preclude successful completion of total LESS hysterectomy. Further prospective studies are required to confirm these preliminary data and to clarify potential advantages and disadvantages of LESS in obese women.