Outcomes Of Laparoscopic Hysterectomy Research Articles

Effect of Surgical Volume on Outcomes for Laparoscopic Hysterectomy for Benign Indications

To estimate the influence of surgical volume on outcome and resource utilization for laparoscopic hysterectomy for benign indications. Patients who underwent laparoscopic hysterectomy from 2000 to 2010 and recorded in a commercial database were analyzed. Patients were stratified into tertiles according to the number of procedures performed by their surgeons and at their hospital. The influence of surgeon and hospital volume on perioperative morbidity and resource utilization was examined using multivariable regression models. A total of 124,615 patients were identified. The overall complication rate decreased from 6.2% for low-volume surgeons to 4.2% for high-volume surgeons (P<.001). Patients operated on by high-volume surgeons were 25% (risk ratios [RRs] 0.75, 95% confidence interval [CI] 0.68-0.82) less likely to experience a complication. In multivariable models intraoperative complications, surgical-site complications, medical complications, prolonged hospitalization, and transfusion rates were lower for high-volume surgeons. Overall morbidity was 5.8% for women treated at low-volume hospitals compared with 4.7% at high-volume centers (P<.001). Women treated at high-volume centers were 18% (RR 0.82, 95% CI 0.75-0.90) less likely to experience a complication. Procedure costs for high-volume surgeons were $867 lower than for low-volume surgeons, and treatment at a high-volume center reduced costs by $966 per procedure. Performance of laparoscopic hysterectomy by high-volume surgeons and at high-volume hospitals is associated with modest reductions in morbidity and lower costs. II.

Predictors of Successful Surgical Outcome in Laparoscopic Hysterectomy

To estimate, after correction for patient factors, to what extent blood loss, operative time, and adverse events are decisive factors for the successful outcome of laparoscopic hysterectomy. A secondary objective was to estimate to what extent a successful outcome can be predicted from surgical experience or other measures of surgical skill. A nationwide multivariate 1-year cohort analysis was conducted with gynecologists who perform laparoscopic hysterectomy. The primary outcomes were blood loss, operative time, and adverse events. The procedures were corrected for multiple covariates in a mixed-effects logistic regression model. Furthermore, all primary outcomes were related to experience and the influence of individual surgical skills factors. One thousand five hundred thirty-four laparoscopic hysterectomies were analyzed for 79 surgeons. The success of the surgical outcome was significantly influenced by uterus weight, body mass index, American Society of Anesthesiologists Physical Status Classification, previous abdominal surgeries, and the type of laparoscopic hysterectomy. Surgical experience also predicted the successful outcome of laparoscopic hysterectomy with respect to blood loss and adverse events (P=.048 and .036, respectively). A significant improvement in surgical outcomes tends to continue up to approximately 125 procedures. Independently from surgical experience, an individual surgical skills factor was identified as odds ratio 1.67 and 3.60 for blood loss and operative time, respectively. After adjusting for risk factors, it was shown that an increase in experience positively predicted a successful outcome in laparoscopic hysterectomy with respect to blood loss and adverse events. However, the independent surgical skills factor shows a large variation in proficiency between individuals. The fact that a surgeon has performed many laparoscopic hysterectomies does not necessarily guarantee good surgical outcome. II.

Outcomes of obese versus non-obese subjects undergoing robotic-assisted hysterectomy: a multi-institutional study.

The goal of our study was to determine whether there was a difference in operative outcomes in obese versus non-obese subjects undergoing robotic-assisted hysterectomies of varying levels of difficulty. Secondarily, we sought to analyze the published outcomes between robotic-assisted hysterectomy and total laparoscopic hysterectomy in obese women at each of these levels of difficulty. This was a multi-institutional retrospective cohort study of all patients undergoing robotic-assisted hysterectomy by five gynecologic oncologists at four geographically separate locations from April 2003 to March 2008. The cohort was stratified into obese vs. non-obese groups, and defined surgical outcomes compared between groups, then further divided into three subgroups based on case difficulty level. Univariate analysis and regression analysis using SAS 9.1 was performed. We then conducted a literature search of total laparoscopic hysterectomy outcomes in obese women, dividing the resulting studies into three comparative subgroups based on surgical difficulty levels for comparison with our robotic-assisted hysterectomy results. Our cohort had 228 obese and 323 non-obese subjects. Overall, the obese group had higher blood loss and longer operative time. When further stratified by level of difficulty, obese subjects also had a higher average blood loss and longer operative time in the hysterectomy-alone subgroup. No clinically significant differences in operative outcomes exist between obese and non-obese women when utilizing the da Vinci robotic system to perform a hysterectomy, independent of case difficulty level. More prospective, controlled studies which compare the two surgical approaches of robotic-assisted and laparoscopic hysterectomy approaches are needed.

Effect of concomitant oophorectomy on the perioperative outcomes of laparoscopic hysterectomy

Effect of concomitant oophorectomy on the perioperative outcomes of laparoscopic hysterectomy

Laparoscopic hysterectomy versus abdominal hysterectomy for severe pelvic endometriosis

Objective To compare the surgical outcomes of laparoscopic hysterectomy (LH) versus abdominal hysterectomy (AH) in patients with severe pelvic endometriosis. Methods A retrospective review of patients undergoing hysterectomy for endometriosis was conducted between January 2002 and December 2007. A total of 503 patients had severe pelvic endometriosis; of these, 115 patients underwent LH and 388 patients underwent AH. Surgical outcomes—including operative time, blood loss, length of hospital stay, and need for blood transfusion—were analyzed and compared between the 2 treatment groups. Results Operative time was significantly longer for LH than for AH (185.1 ± 48.7 minutes and 139.9 ± 52.4 minutes, respectively; P < 0.001). However, estimated volume of blood loss, length of hospital stay, and complication rates were significantly less for patients in the LH group than for those in the AH group (302.6 ± 255.1 mL versus 760.9 ± 633.2 mL [ P < 0.001]; 3.5 ± 1.1 days versus 6.4 ± 3.0 days [ P < 0.001]; and 18.3% versus 49.0% [ P < 0.001], respectively). Conclusion Compared with AH, LH was associated with fewer complications. LH should, therefore, be the preferred surgical option for women with severe pelvic endometriosis who require a hysterectomy.

Influence of Surgical Volume on Outcome for Laparoscopic Hysterectomy for Endometrial Cancer

The volume of surgical procedures performed by hospitals and surgeons has a strong influence on outcomes for a number of surgeries. We examined the influence of surgeon and hospital case volume on morbidity, mortality, and resource utilization for women with endometrial cancer undergoing laparoscopic hysterectomy. Perspective, a nationwide inpatient database developed to measure utilization and quality, was used to examine women with endometrial cancer who underwent laparoscopic hysterectomy with or without lymphadenectomy from 2000 to 2010. Perioperative morbidity, mortality, and cost were compared using Chi-square tests and multivariable generalized estimating equations. A total of 4,137 patients were identified. The overall complication rate was 9.8% for low-volume vs. 10.4% for high-volume surgeons [multivariable odds ratio (OR) = 0.71; 95% confidence interval (CI), 0.41-1.22]. The rates of intraoperative complications, surgical-site complications, medical complications, transfusion, and reoperation were similar for patients treated by low- and high-volume surgeons (p > 0.05 for all). The adjusted estimate for hospital cost for patients treated by high- compared with low-volume surgeons was 219 USD (95% CI, -790 to 1,228 USD). The odds ratio for any complication in high- compared with low-volume hospitals was 1.24 (95% CI, 0.78-1.96). The average cost for patients treated in high- compared with low-volume facilities was -815 USD (95% CI, -1,641 to 11 USD). Neither physician nor hospital volume had a statistically significant effect on perioperative mortality. Laparoscopic hysterectomy for endometrial cancer is well tolerated and associated with an acceptable morbidity profile. Surgeon and hospital volume appear to have little effect on perioperative morbidity, mortality, and resource utilization.

Impact of Extreme Obesity on Outcomes in Laparoscopic Hysterectomy

Impact of Extreme Obesity on Outcomes in Laparoscopic Hysterectomy

Impact of Uterine Weight on Outcomes in Laparoscopic Hysterectomy

Impact of Uterine Weight on Outcomes in Laparoscopic Hysterectomy

Does size matter? The effect of uterine weight on robot-assisted total laparoscopic hysterectomy outcomes.

The objective of this study was to determine whether uterine weight affects the surgical outcomes of robot-assisted total laparoscopic hysterectomy (RH) procedures. The design of this study is retrospective cohort study. The classification of the study design is level II-2 evidence. The study setting is the Henry Ford Health System's Community Teaching Hospitals. One-hundred and thirty-five patients underwent RH for benign indications at one of two hospitals between January1, 2008, and June 1, 2010. Interventions were scheduled RH without concomitant uro-gynecologic procedures as the intention to treat. Patient demographics, age, height, weight, estimated blood loss (EBL), procedure duration, uterine weight, pathology, length of hospital stay (LOS), and any complications were obtained from a detailed review of electronic medical records. Uterine weight ranged from 47 to 1,290g (<250g, n=87; 250-500g, n=28; >500g, n=18). Overall, uterine weight was highly correlated with procedure duration (r=.53, P<.001.). Median procedure duration increased from 150min for the <250g group, to 205min for the 250-500g group, and to 295min for the >500g group. Uterine weight was also moderately correlated with EBL (r=.30, P=.0005). Median EBL increased from 50ml for uteri <250g to 87.5ml for the 250-500g group, and 100ml for the >500g group. This correlation did not persist in the assessment of decrease in peri-operative hemoglobin (r=.09, P=.30). Ninety-one women had a LOS of 1day (67.4%), 31 women had a LOS of 2days (23%), and 13 women had a LOS of greater than 2days (9.6%). Uterine weight was not correlated with LOS (r=.14, P=.10) and was not associated with increased major or minor complications (WRS P=.79) re-admission (WRS P=.35), or blood transfusion (n=3). RH can be performed on patients with large uteri exceeding 500g without associated adverse outcomes. Although procedure duration is increased, there is no significant effect on EBL and no increase in the occurrence of complications or length of stay.

Surgical Outcomes of Laparoscopic Hysterectomy for Enlarged Uteri

Study Objective To compare surgical outcomes of laparoscopic hysterectomy for benign diseases according to the uterine weight. Design Retrospective study (Canadian Task Force classification II-3). Setting Teaching and research hospital, a tertiary center. Patients Women undergoing laparoscopic hysterectomy for benign diseases. Interventions Patients were divided into three groups according to the uterine weight: <250 g (n = 1300), 250 to 500 g (n = 614), and >500 g (n = 178). Measurements and Main Results Primary outcomes were differences in conversion rates, operating time, and blood loss. Secondary outcomes were differences in length of hospital stay, time to first bowel movement, time of bladder catheterization, and complications. Operating time increased according to the uterine weight (116.5 vs 124.1 vs 133 minutes; p <.001). The rate of conversion was statistically higher only for patients with uteri >500 g (3.3% vs 5% vs 13.5%; p <.001). However, the difference between preoperative and postoperative hemoglobin levels was equivalent for the three groups, as well as the overall rates of minor and major intraoperative complications. There was no difference in the time of bladder catheterization, time to first bowel movement, length of hospital stay, and incidence of minor and major postoperative complications among the three groups. Conclusion Despite longer operating time, there is no increase in the intraoperative or postoperative complication rates in those patients with enlarged uteri undergoing laparoscopic hysterectomy. Only conversion is higher in patients with uteri >500 g.

The Effect of Obesity on Perioperative Outcomes of Laparoscopic Hysterectomy

The Effect of Obesity on Perioperative Outcomes of Laparoscopic Hysterectomy

Does Size Matter? The Effect of Uterine Weight on Robotic Assisted Total Laparoscopic Hysterectomy Outcomes

Study Objective: To determine whether benefits of robotic assisted total laparoscopic hysterectomy (RH) extend across the spectrum of uterine sizes. Design: Retrospective Cohort Study. Setting: Henry Ford Health System's Community Teaching Hospitals. Patients: 110 patients who underwent RH for benign indications, at one of two hospitals, between January 2008 and February 2010. Intervention: Scheduled RH without concomitant urogynecologic procedures as the intention to treat. Measurements and Main Results: Patient demographics, height, weight, age, estimated blood loss (EBL), procedure duration, uterine weight, pathology, length of hospital stay (LOS) and Immediate and delayed complications were obtained from a detailed review of the Electronic Medical Record. Uterine weight ranged from 47-1020 grams (<250 grams, n=71; 250-500 grams, n=24; >500 grams, n=13). Most women had a LOS of 1 day (n=73, 66.4%), 25 women had a LOS of 2 days (22.7%), and 12 women had a LOS of greater than 2 days (10.9%). Overall, the uterine weight was highly correlated with procedure duration (Spearman correlation, r=0.51, p<0.001.). Median procedure duration increased from 154 minutes in the < 250 gram group, to 201 minutes in the 250-500 gram group, to 294 minutes in the >500 gram group. Uterine weight was also moderately correlated with EBL (Spearman correlation r=0.29, p=0.003). Median EBL increased from 50 ml (<250 g group) to 100 ml in both the 250-500 gram and >500 gram groups. This was also reflected in the assessment of decrease in peri-operative hemoglobin. Uterine weight was not correlated with LOS (r=0.17, p=0.08) and had no impact on the risk of major or minor complications or blood transfusion. Conclusion: Results indicate that RH can be performed routinely and safely on patients of various uterine weights, including uteri > 500 grams, and even uteri >1000 grams without affecting outcomes. Although procedure duration is increased, complication rates and LOS are not increased, and there is no significant impact on EBL.

Laparoscopic Subtotal Hysterectomy Versus Laparoscopic Total Hysterectomy: A Decade of Experience

There are limited data on the surgical outcomes of laparoscopic hysterectomy (LH). It is unclear whether more or less complications occur among the LH subcategories and laparoscopic subtotal hysterectomy (LSH). This multicenter retrospective cohort study compared peri- and postoperative outcomes in women undergoing LSH and LH (including laparoscopic-assisted vaginal hysterectomy, laparoscopic hysterectomy, and total laparoscopic hysterectomy) over a 10-year period. All laparoscopic hysterectomies were performed between 1998 and 2007 at 3 hospitals in the Netherlands with experience in minimally invasive gynecology. Both short-term and long-term postoperative outcomes were studied. Outcome data was obtained from medical records on patient characteristics including (indication, age, and parity), intra- and postoperative complications and operating time. Patients were followed for at least 6 months. All subcategories of LH procedures were combined into one group. No statistically significant differences between the groups were found for parity and indication for surgery. The women in the LH group were older than the LSH group women: 49 years, range: 30-81 years versus 44 years, range: 28-60 years. The total number of complications (short-term and long-term) was comparable in both groups (LSH:18% and LH: 15%). More short-term complications (blood loss, fever) were observed in the LH group compared with the LSH group (12% vs. 3%), whereas more long-term complications (dyspareunia and cervical stump problems) were found in the LSH group than in the LH group (15 versus 3%). None of the above differences were statistically significant. The investigators conclude from these findings that the different types of LSH are associated with more long-term postoperative complications, whereas LH is associated with more short-term complications. However, the lack of statistically significant differences limits interpretation of the data in this small study.

Does surgical volume influence short-term outcomes of laparoscopic hysterectomy?

To evaluate whether surgical volume has an impact on short-term outcomes of laparoscopic hysterectomy. This is a retrospective analysis of 1016 laparoscopic hysterectomies. The surgeons were divided into 2 groups based on a cutoff of 30 cases. Patient characteristics, the rates of laparotomy (4.5% vs 6.7%), and serious complications (3.6% vs 5.5%) were similar between 9 "high" and the remaining 39 "low volume" gynecologists, respectively (P < .05). Mean operating time was longer in the "low volume" group. Compared with their first 29 hysterectomies, the "high volume" surgeons decreased their operating time significantly in their subsequent cases. The "high volume" surgeons improved their conversion rate (9.2% vs 2.4%; P < .0001) over time but not their serious complications. In laparoscopic hysterectomy, increasing the surgical volume can reduce the operating time and the risk for conversion to laparotomy but not the rate of serious complications.

Laparoscopic subtotal hysterectomy versus laparoscopic total hysterectomy: a decade of experience

At present, there are only few data on the surgical outcomes of laparoscopic hysterectomy (LH). Up till now, it has been unclear whether there is a difference in number of complications among the subcategories of laparoscopic total hysterectomy and laparoscopic subtotal hysterectomy (LSH). Therefore, we have performed a retrospective analysis to evaluate the peri- and postoperative outcomes in women undergoing LSH versus LH. This multi-centre retrospective cohort study (Canadian Task Force classification II-2) was conducted in multi-centres (two teaching hospitals and one university medical centre) in the Netherlands, all experienced in minimally invasive gynaecology. In a multi-centre retrospective cohort study we compared the long-term outcomes of laparoscopic subtotal hysterectomy and laparoscopic total hysterectomy (including laparoscopic assisted vaginal hysterectomy, laparoscopic hysterectomy and total laparoscopic hysterectomy). All laparoscopic hysterectomies from the last 10 years (January 1998 till December 2007) were included. Patient characteristics, intra- and postoperative complications, operating time and duration of hospital stay were recorded. The minimum follow-up was 6 months. A total of 390 cases of laparoscopic hysterectomies were included in the analysis: 192 laparoscopic subtotal hysterectomies and 198 laparoscopic total hysterectomies. Patient characteristics such as age and parity were equal in the groups. The overall number of short-term and long-term complications was comparable in both groups: 17% and 15%. Short-term complications (bleeding, fever) were 3% in the LSH group and 12% in the LH group. Long-term complications were (tubal prolapse and cervical stump reoperations) 15% in the LSH group and 3% in the LH group. Laparoscopic subtotal hysterectomy as compared with the different types of laparoscopic total hysterectomy is associated with more long-term postoperative complications, whereas laparoscopic total hysterectomy is associated with more short-term complications.

La histerectomía laparoscópica: un abordaje posible. Estudio retrospectivo de las histerectomías laparoscópicas realizadas en un hospital público

ObjectiveTo assess the outcomes of laparoscopic hysterectomy in a public hospital. Material and methodsWe performed a retrospective study of laparoscopic hysterectomies carried out between January 2005 and December 2007. The parameters evaluated were indication, type of hysterectomy, uterine weight, length of hospital stay, and complications. ResultsIn the period analyzed, we performed 284 hysterectomies, of which 103 (36.36%) were laparoscopic. The morbidity rate was 9.7% and complications were related to the learning curve. The mean length of hospital stay was 2.56 days. ConclusionsLaparoscopic hysterectomy is a safe procedure that requires a learning curve of 30-40 procedures. Due to its advantages, this option should be offered in all gynecology services.

Laparoscopic hysterectomy in obese women: a clinical prospective study

Objective: To compare perioperative and postoperative outcomes of laparoscopic hysterectomy (LH) in surgical management of gynecological conditions in two groups of different weight. Methods: A prospective comparative clinical study of 271 LH performed for disease of female pelvic organs in a group of 54 obese patients (over 30 body mass index (BMI)) and in a group of 217 non-obese patients (less than 30 BMI). The following criteria were assessed: patient characteristics, indications for surgery, previous surgery, presence of adhesions, duration of procedure, blood loss, weight of specimen, hospital stay and complications. Statistical analysis was performed using the unpaired t-test and non-parametric Chi-square test when appropriate, with a significance level of P=0.05. Results: Three non-obese patients were converted to laparotomy due to operative complications. Laparoscopy in the remaining 268 patients (98.89%) was completed successfully. There was no significant difference in estimated blood loss, presence and degree of adhesions, weight of specimen, length of hospital stay and postoperative complications between women with high BMI and those with low BMI. The rate of major operative complications (5.55% versus 3.22%) was higher in the obese group. The duration of the operation was longer in obese women. However, the significance of the difference was borderline ( P=0.06).