Outcomes After Mini-Laparotomy for Tissue Extraction Following Laparoscopic Hysterectomy [19D

Abstract

INTRODUCTION: Recognizing the importance of specimen integrity for patient care and pathologic evaluation, we aimed to determine if mini-laparotomy for tissue extraction of large specimens following laparoscopic hysterectomy would yield compromised outcomes when compared with vaginal extraction. METHODS: A retrospective analysis including all benign laparoscopic hysterectomies over a two year period was performed. Patients were separated into two groups depending on whether specimen was extracted vaginally or via mini-laparotomy. T-student and chi-square tests where used to assure both groups were homogenous to age, BMI, history of cesarean delivery and presence of diabetes or hypertension. Differences in complications, operating time, EBL and length of hospital stay between groups were determined. This was done via chi-square analysis. In the case of EBL and operating time, MANCOVA was employed to adjust for differences in specimen weight. RESULTS: A total of 225 patients were selected for analysis. There were no significant differences between vaginal extraction (n=157) and mini-laparotomy (n=68) groups in terms of age, BMI, previous cesarean deliveries, presence of diabetes or hypertension. No significant differences regarding presence of intraoperative (0.6% vs 1.5% p= 0.43) or postoperative complications (15.3% vs 7.4% p=0.10) were found. After controlling for specimen weight, there was no significant difference between groups with regard to operating time (143.66min vs 180.16min p=0.12), EBL (73.07ml vs 107.32ml p=0.80), or length of hospital stay (1248.71min vs 1512.21min p=0.98). CONCLUSION: Mini-laparotomy for tissue extraction is a safe approach and does not appear to add morbidity to minimally invasive hysterectomies, while conserving an intact specimen.