Hysterectomy In Obese Patients Research Articles

Retrospective analysis between total laparoscopic and vNOTES hysterectomy in obese patients: single-center study.

Hysterectomy is one of the most common major gynecological surgeries, and it is performed for benign and malignant reasons. Currently, five types of hysterectomies are described: vaginal (VH), abdominal (AH), laparoscopic (LH), robotic, and vNOTES (vaginal natural orifice transluminal endoscopic surgery). This paper compares these two types of surgery in obese patients by analyzing the surgeries performed by our team. The research was conducted from January 2022 to December 2023 at the Department of Gynecology and Obstetrics of the General Hospital in Zadar. The study included female patients aged 18-75years with a BMI > 30kg/m2, regardless of parity, who were operated on for benign pathology. There were 24 patients included in total. One conversion was observed in the TLH group because of excessive bleeding. Median operative time (IQR) was significantly lower in the vNOTES group (p < 0.05) than in the TLH group 35 (10.9) vs 125 (74.0) min. The results concerning the duration of surgery, conversion rate, and postoperative bleeding and complications show that vNOTES hysterectomies seem to be feasible for obese patients. Further studies are needed to confirm these observations.

Effect of two different modalities of hysterectomy on wound infection and wound dehiscence in obese patients.

This research intended to investigate the influence of the operation of both kinds of hysterectomies in the risk of wound infection and the degree of wound dehiscence. Both of them were open field and laparoscope. In this research, we looked into four databases: PubMed, Web of Science, Embase and Cochrane Library. Research was conducted on various operative methods for hysterectomy in obese patients between 2000 and October 2023. Two independent investigators performed an independent review of the data, established the inclusion and exclusion criteria, and managed the results with Endnote software. It also evaluated the quality of the included literature. Finally, the data were analysed with RevMan 5.3. This study involved 874 cases, 387 cases received laparoscopy and 487 cases received open access operation. Our findings indicate that there is a significant reduction in the rate of post-operative wound infection among those who have received laparoscopy compared with who have received open surgical procedures (odds ratio [OR], 0.04; 95% confidence interval [CI], 0.01-0.15; p < 0.001); There was no statistical difference between the rate of post-operative wound dehiscence and those who received laparotomy compared with those who received open surgical procedures (OR, 0.33; 95% CI, 0.10-1.11; p = 0.07); The estimated amount of blood lost during the operation was less in the laparoscopy group compared with the open procedure (mean difference, -123.72; 95% CI, -215.16 to -32.28; p = 0.008). Generally speaking, the application of laparoscopy to overweight women who have had a hysterectomy results in a reduction in the expected amount of bleeding during surgery and a reduction in the risk of post-operative wound infections.

The Comparison of Surgical Outcomes following Laparoscopic Hysterectomy and vNOTES Hysterectomy in Obese Patients

Aim This study aimed to compare the surgical outcomes of total laparoscopic hysterectomy (TLH) and vaginally assisted natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy procedures in obese patients. Materials and methods This cross-sectional study was conducted with 83 obese women (BMI > 30 kg/m2) who underwent TLH (35 patients) or vNOTES hysterectomy (48 patients) for benign gynecological indications. The duration of surgery, intra/postoperative complications, intra- and postoperative hemoglobin (Hb) and hematocrit (Hct) levels, hospital stay, Visual analogue scale (VAS) scores at the postoperative 6th and 24th hours of the patients were compared. Results There was no significant difference between TLH and vNOTES groups regarding age (49 vs. 52 years, p = 0.35), parity (2 vs. 3, p = 0.17), and uterine weight (290 vs. 230 g., p = 0.13) The median BMI was 31.6 kg/m2 (30–42.2 kg/m2) in the TLH group and 31.9 kg/m2 (30–54.6 kg/m2) in the vNOTES group (p = 0.31). The vNOTES hysterectomy group had significantly shorter durations of surgery (67.5 vs. 136 min) and postoperative hospitalization than the TLH group (p < 0.05 for all comparisons). Besides, the 6th-hour (6 vs. 7, p = 0.02) and 24th-hour (4 vs. 3, p < 0.001) VAS scores were significantly lower in the vNOTES hysterectomy group. The propensity-matched group analysis showed significantly lower 6th-hour and 24th-hour VAS scores and shorter duration of surgery (80 vs. 135 min, p < 0.001) in the vNOTES hysterectomy group than the TLH group. Conclusion vNOTES is a feasible technique in obese women who require a hysterectomy and provides favorable outcomes considering the shorter duration of surgery and postoperative hospitalization and lower pain scores.

Anesthetic management for robotic hysterectomy in obese women.

Obesity is a major health epidemic, with the prevalence reaching ∼40% in the United States in recent years. It is associated with increased risk of hypertension, diabetes, heart disease, stroke, obstructive sleep apnea (OSA), and gynecologic conditions requiring surgery. Those comorbidities, in addition to the physiologic changes associated with obesity, lead to increased risk of perioperative complications. The purpose of this review is to highlight the anesthetic considerations for robotic assisted hysterectomy in obese patients. In the general gynecologic population, minimally invasive surgery is associated with less postoperative fever, pain, hospital length of stay, total cost of care and an earlier return to normal function. This also applies to robotic surgery in obese patients, which is on the rise. The physiologic changes of obesity bring different anesthetic challenges, including airway management and intraoperative ventilation. Vascular access and intraoperative blood pressure monitoring can also be challenging and require modifications. Optimizing analgesia with a focus on opioid-sparing strategies is crucial due to the increased prevalence of OSA in this patient population. Anesthesia for obese patients undergoing robotic hysterectomy is challenging and must take into consideration the anatomic and physiologic changes associated with obesity.

Incidence of venous thromboembolism after robotic-assisted hysterectomy in obese patients with endometrial cancer: do we need extended prophylaxis?

Robotic surgery for gynecologic malignancy is associated with a lower rate of venous thromboembolism (VTE) than laparotomy. Obese patients represent a particularly high-risk group for VTE, but prior studies tend to focus on patients with a much lower BMI and without extended VTE prophylaxis. Our objective was to examine the role of extended thromboprophylaxis in obese patients who underwent robotic-assisted surgery for endometrial cancer. We conducted a retrospective cohort study of obese patients (BMI ≥ 35kg/m2) who underwent robotic surgery for newly diagnosed endometrial cancer. The primary outcome measured was the occurrence of a VTE event within the 30-day postoperative period. The Farrington-Manning score test was used for equivalence analysis with a 5% margin. Secondary outcomes were perioperative complications. One hundred thirty-two robotic cases for endometrial cancer met our criteria. One hundred twenty-one (92%) received preoperative pharmacologic thromboprophylaxis, and 100% used pneumatic compression devices. Ninety-three percent and 90% received preoperative pharmacologic prophylaxis in the extended and no extended group, respectively (p-value = 0.7). Seventy patients (54%) received 4-week extended prophylaxis. Estimated blood loss was similar in both groups (75mL vs 60mL, p-value = 0.6). Perioperative complications and readmissions were similar between the two groups. There were no VTE events during hospital stay. One patient in the group that did not receive extended prophylaxis developed a VTE in the 30-day postoperative period (1.6%), versus 0% in the group that did receive extended prophylaxis (p-value = 0.1). The risk of VTE was low. The absence of extended VTE prophylaxis did not significantly increase the risk for VTE in obese patients with newly diagnosed endometrial cancer who underwent robotic-assisted surgery.

Laparoscopic versus open hysterectomies in obese patients

Background: Hysterectomy is one of the most frequently performed surgical procedure. Though there are three approaches in hysterectomy (open, vaginal and laparoscopic), still there are controversies regarding the optimal route for performing it.Methods: This prospective comparative study included 42 obese patients subjected for pan-hysterectomy as a treatment. The forty-two patients were allocated into two groups: group (A) subjected to laparoscopic pan-hysterectomy, group (B) subjected to open pan-hysterectomy.Results: There was significant difference between the two groups regarding mean operative time, blood loss, analgesic requirements and hospital stay, while no significant difference regarding intra-operative complications.Conclusions: Laparoscopic hysterectomy in obese patients has emerged as a viable, safe and better alternative to open hysterectomy amongst appropriately trained surgeons.

68 - A Comparison between Laparoscopic and Robotic Hysterectomy in Obese Patients: Effect on Cost, Operating Time and Estimated Blood Loss

68 - A Comparison between Laparoscopic and Robotic Hysterectomy in Obese Patients: Effect on Cost, Operating Time and Estimated Blood Loss

The Senhance™ surgical robotic system ("Senhance") for total hysterectomy in obese patients: a pilot study.

This pilot study was aimed to value the feasibility and safety of Senhance Robotic Platform for hysterectomy in obese patients. Ten obese patients (30<BMI<40) underwent elective Senhance total extrafascial hysterectomy with bilateral salpingo-oophorectomy at the Division of Gynecologic Oncology of "Policlinico A. Gemelli" Foundation, Rome, Italy. Perioperative and postoperative outcomes data were recorded. The median age was 60years (range 51-75) and the median BMI was 33.3kg/m2 (range 30.4-38.3). The median uterine weight was 112.5g (range 77-225). Indication to total hysterectomy was early-stage (FIGO Stage IA) endometrial cancer in 100% of patients. The median operative time (OT) was 110min (70-200). The median docking time was 10.5min (5-25). The median estimated blood loss was 100mL (50-200). No conversions to laparotomy were recorded. No intra- and 30-day postoperative complications were registered. The median ileus was 17h (12-36) and the median time to discharge was 2days (1-4). The median VAS scores registered at 2, 4, 12, and 24h were, respectively, 2 (1-3), 2 (1-3), 4 (1-8), and 3 (1-5). Our study results suggest that Senhance platform could be safe for hysterectomy even in obese patients. More clinical data are needed to determine whether this approach would offer any additional benefits in a new middle line between standard laparoscopy and robotics.

Robotic assisted hysterectomy in obese patients: a systematic review.

Robotic hysterectomy is an alternative approach to the management of female genital tract pathology. A systematic literature review was performed to evaluate the till now available literature evidence on robotic assisted hysterectomy in obese and morbidly obese patients. In total, robotic assisted hysterectomy was performed on 2769 patients. The most frequent indication for robotic hysterectomy was endometrial carcinoma (1832 out of 2769 patients, 66.2%). Hypertension, diabetes mellitus, obstructive sleep apnea, chronic obstructive pulmonary disease and venous thromboembolism were the most common comorbidities reported. The conversion rate to laparotomy was 92 out of 2226 patients (4.1%). The most frequent intraoperative complications for robotic hysterectomy were gastrointestinal injury (17 out of 2769 patients, 0.6%), haemorrhage (five out of 2769 patients, 0.2%) and bladder injury (five out of 2769 patients, 0.2%). Wound infections/dehiscence (66 out of 2769 patients, 2.4%), fever (56 out of 2769 patients, 2%), pulmonary complications (55 out of 2769 patients, 1.9%), urogenital complications (36 out of 2769 patients, 1.3%) and postoperative ileus (28 out of 2769 patients, 1%) were the most common postoperative complications. Death was reported in three out of 2769 patients (0.1%). The ICU admitted patients were eight of 2226 patients (0.4%). The robotic technique, especially in obese, can optimize the surgical approach and recovery of such patients with equally if not better outcomes compared to open and/or laparoscopic techniques.

Observations on the application of LMA in the airway management in total laparoscopic hysterectomy in obese patients

Objective To observe the curative effects of applying laryngeal masks in the airway management in total laparoscopic hysterectomy in obese patients. Methods 60 cases of obese patients who underwent total laparoscopic hysterectomy were collected and were randomly divided into, the Endotracheal intubation(ET)group(n=30) and the laryngeal mask(LMA)group(n=30). The pre-operative co-existent diseases, applications of analgesia and intra-operative vital signs, the peak airway waves(Paw)60min after pneumoperitoneum,blood gas;revival time; the incidences of complications were observed. Results 60min after pneumoperitoneum,MAP,HR, Paw and Sp O 2 values were:ET group:[(114.6±22.4)mm Hg,(108.2±19.6)times/min,(25.4±3.1)mm Hg, (96.1±1.2%)]LMA group:[(97.5±20.8)mm Hg,(86.5±20.7)times/min,(22.6±3.7)mm Hg,(98.9±0.8%)].The difference was statistically significant(P<0.05);The blood gas analysis,PH,PaO2,PaCO2 and BE values are:ET group:[(7.34±0.05),(177.5±44.5)mm Hg,(42.6±6.1)mm Hg,(-4.9±0.8)mmol/L],LMA group:[(7.38±0.05),(216.7±46.6)mm Hg,(38.4±5.5)mm Hg,(-3.1±0.6)mmol/L].The difference was statistically significant(P<0.05);the status of complications:23 cases in ET group,accounting for 77%,10 cases in LMA group,accounting 30%,presenting significant differences(P<0.05). Conclusion The application of laryngeal masks in the airway management in total laparoscopic hysterectomy in obese patients facilitated the maintaining the stability of hemodynamics and blood gas, resulted in smooth post-anesthesia recovery and fewer complications. Key words: Hysterectomy; Laparoscopy; Obesity; Laryngeal mask anesthesia, surface

Hysterectomy in Obese Patients

A literature search was performed to find evidence-based practices that aid in the preoperative evaluation, intraoperative techniques, and postoperative management of the obese patient requiring hysterectomy. Complications are more frequent than in normal weight patients and are more difficult to manage. Few studies provide direct evidence with which to help guide surgical decision-making and postoperative management. However, there is sufficient evidence to support that when feasible, the vaginal route is preferable in obese patients. Techniques validated for normal weight patients like antibiotic and thromboembolism prophylaxis seem effective in obese patients, and are likely even more important.

A Comparison of Robotic vs. Conventional Laparoscopic Hysterectomy in Obese Patients

A Comparison of Robotic vs. Conventional Laparoscopic Hysterectomy in Obese Patients

Laparoscopic hysterectomy in patients weighing 100 kg or more: a 7-year experience

Obesity is an increasingly prevalent condition in our society. The majority of hysterectomies are still being undertaken abdominally. Obese patients have a high rate of complications from abdominal surgery. Laparo-vaginal hysterectomy has a faster recovery than abdominal hysterectomy. If the uterine vessels are ligated laparoscopically at laparo-vaginal hysterectomy, there is a low conversion rate to abdominal hysterectomy. The aim of this study was to establish whether laparoscopic hysterectomy is a feasible alternative in obese patients. A 7-year audit of patients requiring a hysterectomy identified 27 women weighing 100 kg or more. All patients gave informed consent to an initial laparoscopic procedure, having been assessed as suitable for such, and then had a laparoscopic hysterectomy performed. Data regarding their operation was prospectively collected and retrospectively reviewed. All patients had successful laparoscopic hysterectomies with none requiring conversion to open operation, reoperation or readmission. There were no major complications. The postoperative stay was short (mean 2.4 days), but operation times were long (mean 175 min). Laparoscopic hysterectomy is a feasible alternative to abdominal hysterectomy in obese patients weighing 100 kg or more with low morbidity and fast recovery with short hospital stay.

Laparoscopy as the preferred route for hysterectomy in obese patients

Laparoscopy as the preferred route for hysterectomy in obese patients

Evaluating the route of hysterectomy in obese patients

Evaluating the route of hysterectomy in obese patients