Outcomes of robotic, laparoscopic, and open hysterectomy for benign conditions in obese patients

Mostafa A Borahay,İbrahim Alanbay,Gökhan Sami Kılıç,Ömer Lütfi Tapısız

doi:10.4274/jtgga.2018.0018

Mostafa A Borahay, İbrahim Alanbay + Show 2 more

Open Access

https://doi.org/10.4274/jtgga.2018.0018

Copy DOI

Abstract

Objective:To compare outcomes of robotic-assisted (RAH), total laparoscopic hysterectomy (LH), and total abdominal hysterectomy (TAH) for benign conditions in obese patients.Material and Methods:Retrospective cohort (Class II-2) analysis. All obese patients who underwent RAH, LH or TAH for benign conditions by a single surgeon at the University of Texas Medical Branch between January 2009 and December 2011 were identified and their charts reviewed. The patients’ characteristics, operative data, and post-operative outcomes were collected and statistically analyzed.Results:A total of 208 patients who underwent RAH (n=51), LH (n=24) or TAH (n=133) were analyzed. There were no significant differences among the groups in demographic characteristics, indications for surgery or pathologic findings. RAH and LH were associated with lower estimated blood loss (EBL) (p<0.001) and shorter length of hospital stay (LOS) (p<0.001) compared with TAH. In addition, RAH and LH had lower intraoperative and early postoperative (≤6 weeks) complications compared with TAH (p=0.002). However, the procedure time was longer in RAH and LH (p<0.001). No significant differences were noted among the groups for late post-operative complications (after 6 weeks) or unscheduled post-operative visits.Conclusion:Minimally invasive hysterectomy appears to be safe in obese patients with the advantages of less EBL, fewer intraoperative complications, and shorter LOS.

Highlights

Obesity is defined by the World Health Organization as having a body mass index (BMI) ≥ 30 kg/m2(1)
While current evidence suggests that laparoscopic hysterectomy is associated with fewer complications than abdominal hysterectomy in obese patients[5], most of these studies include cancer patients[19,20,21,22]
RAH and LH performed in this study were American Association of Gynecologic Laparoscopists (AAGL) type IVE, defined as total laparoscopic removal of the uterus and cervix including vaginal cuff closure[25]

Summary

Introduction

Obesity is defined by the World Health Organization as having a body mass index (BMI) ≥ 30 kg/m2(1). It has been reported that obesity is associated with increased intra- and post-operative complications including bleeding and infections in patients undergoing hysterectomy[18]. While current evidence suggests that laparoscopic hysterectomy is associated with fewer complications than abdominal hysterectomy in obese patients[5], most of these studies include cancer patients[19,20,21,22].

Results

Conclusion