Total Laparoscopic Hysterectomy Patients Research Articles

Risk factors for perioperative blood transfusion in patients undergoing total laparoscopic hysterectomy

PurposeThe goal is to identify risk factors associated with receiving a blood transfusion during the perioperative period in patients who undergo total laparoscopic hysterectomy (TLH) using a large-scale national database.MethodsIn this retrospective analysis, data from the Nationwide Inpatient Sample (NIS) was utilized to review the medical records of all patients who underwent TLH from 2010 to 2019. The researchers identified patients who had received a blood transfusion during the perioperative period and compared with those who had not. The subsequent factors associated with blood transfusion were examined: hospital characteristics (type of admission and payer, patient demographics (age and race), bed size, teaching status, location, and region of hospital), length of stay (LOS), total charges during hospitalization, in-hospital mortality, comorbidities, and perioperative complications. The data was analyzed using descriptive statistics. The independent risk factors of perioperative blood transfusion after TLH was identified by performing multivariate logistic regression.ResultsA total of 79,933 TLH were captured from the NIS database, among which 3433 (4.40%) patients received a perioperative blood transfusion. TLH patients affected by blood transfusion were 2 days longer hospital stays (P < 0.001), higher overall costs (P < 0.001), the patients who received a transfusion after a long-term hospitalization had a significantly higher rate of mortality (0.5% vs. 0.1%; P < 0.001). Perioperative blood transfusion after TLH was associated with chronic blood loss anemia, deficiency anemia, coagulopathy, congestive heart failure, fluid and electrolyte disorders, renal failure, metastatic cancer, sepsis, weight loss, deep vein thrombosis, gastrointestinal hemorrhage, shock, acute myocardial infarction, and pneumonia, stroke, hemorrhage, pulmonary embolism, and disease of the genitourinary system.ConclusionStudying the risk factors of perioperative blood transfusion after TLH is advantageous in order to ensure proper management and optimize outcomes.

Comparison perioperative outcomes for endometrial cancer staging via traditional laparotomy, laparoscopy and robotic-assisted surgery: short term initial experience

Abstract: &#x0D; Aim: To compare the perioperative outcomes of traditional abdominal hysterectomy (TAH), total laparoscopic hysterectomy (TLH), and robotic-assisted hysterectomy (TRH) for endometrial cancer staging, which is the most common gynecological cancer type in Turkey Materials and Methods: Fifty eight women who underwent endometrial cancer staging surgery were performed by a same gynecologic oncologist (E.B.) from February 2015 to May 2016 in Sağlık Bilimleri University Adana Numune Hospital. The primary outcome measure was perioperative complications. The secondary outcome were operative time, postoperative hemoglobin drop, blood transfusion rates and length of the hospital stay. Results: Three groups were identified.(TAH, n=23; TLH, n=10; TRH, n=25) There were no statistically significant differences between the groups in terms of age, parity, grade and depth of myometrial invasion. Overall complication rate was higher in TAH group. TRH and TLH patients were less likely to have renal failure, urinary tract infection and postoperative fever compared to TAH patients. A significantly lower drop in hemoglobin was detected in the TRH group compared with the other groups. (p= 0,797) Mean operative time was longer in TRH cases than TLH and TAH cases (300, 230, 165 minutes, respectively). The median lengths of hospitalization for TAH, TLH, and TRH patients were 5, 3, and 2 days, respectively (p &lt; 0.0001). There were significantly fewer blood transfusion requirements in minimal invasive surgery groups (0/10 case in TLH and 3/25 cases in TRH) than traditional approaches (5/23 cases in TAH ). Conclusions:With our short term initial experience, minimally invasive surgical approach resulted in superior perioperative outcomes. Despite longer operative times, the results from this study suggest that robotic-assisted surgical staging in the management of endometrial cancer is both feasible and associated with a shorter length of hospitalization.

Comparison of intraoperative and postoperative outcomes of nondescent vaginal hysterectomy and total laparoscopic hysterectomy

Introduction: Nondescent vaginal hysterectomy (NDVH) and total laparoscopic hysterectomy (TLH) are the two approaches used to perform a hysterectomy in a nonprolapsed uterus based on indication for surgery, size of the uterus, availability of types of equipment, skills of the surgeon, and patient’s preference. Each surgical approach has its own merits and demerits. Materials and Methods: A prospective and comparative study was conducted in the Department of Obstetrics and Gynaecology at a tertiary care center from December 2018 to November 2020 to compare the intraoperative and postoperative outcomes of NDVH and TLH. A total of 80 patients (40 in NDVH and 40 in TLH group) were calculated based on the average number of hysterectomies (mainly TLH). All patients admitted to the hospital for NDVH and TLH were selected based on the selection criteria. Results: The mean age group irrespective of the route of surgery is found to be within the age group of 41–45 years. The majority of the patients who were operated on were diagnosed to have fibroids as the main cause for their complaints followed by adenomyotic changes and hyperplasia. The mean blood loss of NDVH was found less as compared to TLH but not significant as P value &gt;0.05. The mean number of days for a hospital stay for NDVH is 4.26, whereas the hospital stay for TLH patients was found to be 4.7 days that is greater as compared with NDVH. The most common complication irrespective of the type of surgery is urinary tract infection followed by pyrexia. Conclusion: Considering the outcomes and cost-effectiveness of both routes of surgery, it is found that nondescending vaginal hysterectomy is more advantageous over total laparoscopic hysterectomy.

Robotic-assisted versus conventional laparoscopic hysterectomy for endometrial cancer.

ObjectiveThe safety and efficacy of robotic-assisted laparoscopic hysterectomy (RALH) compared with conventional total laparoscopic hysterectomy (TLH) for surgical staging of endometrial cancer has not been clearly established. With the commencement of a robotic program at our institution, our objective was to evaluate and compare the surgical outcomes of RALH with TLH for endometrial cancer.MethodsA retrospective cohort study was performed on 39 patients who underwent RALH and 41 patients who underwent TLH for endometrial cancer at a tertiary care academic institution.ResultsIn the setting of endometrial cancer RALH is significantly longer to perform than TLH (mean operating time 133 min vs 107 min, p = 0.0001). There is higher estimated blood loss in TLH cases than RALH cases (78 mL vs 22 mL, p = 0.015). Women who underwent RALH had a shorter length of stay (1.3 days vs 1.8 days, p = 0.006) than TLH patients, and six cases (15 %) of the RALH group were discharged on the same day of surgery. There were no differences between the RALH and TLH groups in intraoperative or postoperative complications and there were no conversions to laparotomy.ConclusionRALH is safe and feasible for the treatment of endometrial cancer, with low morbidity, less blood loss and shorter length of stay than TLH. RALH is associated with longer mean operating times than TLH and this may improve with enlisting a consistent experienced team. Prospective randomised studies which include analysis of quality of life measures and long-term outcomes are required to further establish the role of RALH in the surgical staging of endometrial cancer.

The Impact of Systematic Laparoscopic Skills and Suture Training on Laparoscopic Hysterectomy Outcomes in a Brazilian Teaching Hospital.

To evaluate the impact of systematic laparoscopic skills and suture training (SLSST) on the total laparoscopic hysterectomy intra- and postoperative outcomes in a Brazilian teaching hospital. A cross-sectional observational study in which 244 charts of total laparoscopic hysterectomy (TLH) patients operated from 2008 to 2014 were reviewed. Patient-specific (age, parity, previous cesarean sections, abdominal surgeries and endometriosis) and surgery-related variables (hospital stay, operative time, uterine volume and operative complications) were analyzed in three different time-frame groups: 2008-09 (I-1) - TLHs performed by senior attending physicians; 2010-11 (I-2) - TLHs performed by residents before the implementation of the SLSST program; and 2012-14 (I-3) - TLHs performed by residents after the implementation of the SLSST program. A total of 244 TLH patients (mean age: 45.93 years) were included: 24 (I-1), 55 (I-2), and 165 (I-3). The main indication for TLH was uterine myoma (66.4%). Group I-3 presented a decrease in surgical time compared to group I-2 (p = 0.010). Hospital stay longer than 2 days decreased in group I-3 compared to group I-2 (p = 0.010). Although we observed decreased uterine volume (154.2 cm3) in group I-2 compared to group I-1 (217.8 cm3) (p = 0.030), logistic regression did not find any association between uterine volume and surgical time (p = 0.103). The total operative time for laparoscopic hysterectomy was significantly shorter in the group of patients (I-3) operated after the systematic laparoscopic skills and suture training was introduced in our hospital.

Preoperative assessment of factors associated with difficulty in performing total laparoscopic hysterectomy.

Our objective was to determine the preoperative factors associated with difficulty in total laparoscopic hysterectomy (TLH). This retrospective clinical study included 157 patients who underwent TLH for leiomyoma or adenomyosis between 2009 and 2013. All patients underwent magnetic resonance imaging (MRI) before surgery. We categorized patients as 'difficult' if the operation time was>243 min, if total blood loss was>500 mL, or if conversion to laparotomy was necessary. Preoperative information, including MRI findings, was compared between the difficult and 'other' patients. Stepwise logistic regression analysis was used to control for covariates that were significant on univariate analysis (P<0.05). The presence of an endometrioma, a previous cesarean section (CS), a wide uterus, and a high body mass index were independent risk factors for being a difficult patient. For adenomyosis patients, the presence of an endometrioma, a prior CS, subtype II adenomyosis, and high body mass index were independent risk factors for being a difficult patient. For leiomyoma patients, the presence of an endometrioma, a prior CS, and having at least seven leiomyomas were independent risk factors for being a difficult patient. All laparotomy conversion patients had multiple risk factors. We have elucidated the factors associated with difficult TLH patients using patients' background and preoperative MRI findings. Awareness of these predictive factors may enable surgeons to prepare for the operation, minimize complications, or choose another more appropriate route of hysterectomy than TLH.

Perioperative outcomes in laparoscopic hysterectomy: identifying surgical risk factors

This study aimed to evaluate the effect of surgical risk factors, including type of surgery, body mass index, uterine size and presence of adhesions, on perioperative outcomes and complication rates in laparoscopic hysterectomy (LH). This was a retrospective cohort study of 264 LH cases performed between 2005 and 2013 at a London University Hospital. One hundred sixty six (62.9 %) underwent laparoscopic subtotal hysterectomy (LASH) and 98 (37.1 %) total laparoscopic hysterectomy (TLH). Mean operation duration was 77 (±35) min and mean estimated blood loss (EBL) was 196 (±128) ml. Mean specimen weight was 323 g (range 46–1765 g). There were no conversions to laparotomy. Patients undergoing LASH were older than TLH patients (46.7 vs 42.8 years, p < 0.0001) and with larger uterine size (16.9 vs 11.0 weeks, p < 0.0001). There were no differences in operation duration, EBL or hospital stay. Bladder injury occurred in 3 LASH cases (1.8 %) and no TLH cases. Presence of adhesions increased operative duration (95.2 vs 71.5 min, p < 0.0001). Preoperative uterine size correlated positively with specimen weight (p < 0.001), operation duration (p < 0.001) and EBL (p < 0.001). There was a linear relationship between BMI and EBL and operation duration (EBL r2 0.028, p = 0.006; operative duration r2 0.017, p = 0.038). This study shows that overall, LH is a safe procedure with low risk of major complications, even in patients with significant surgical risk factors. This study has highlighted particular groups which might be at increased surgical risk, particularly those with a combination of elevated BMI and large uterus, which can aid preoperative counselling.

Differences in Epidural and Analgesic Use in Patients with Apparent Stage I Endometrial Cancer Treated by Open versus Laparoscopic Surgery: Results from the Randomised LACE Trial

Objectives. We compared postoperative analgesic requirements between women with early stage endometrial cancer treated by total abdominal hysterectomy (TAH) or total laparoscopic hysterectomy (TLH). Methods. 760 patients with apparent stage I endometrial cancer were treated in the international, multicentre, prospective randomised trial (LACE) by TAH (n = 353) or TLH (n = 407) (2005–2010). Epidural, opioid, and nonopioid analgesic requirements were collected until ten months after surgery. Results. Baseline demographics and analgesic use were comparable between treatment arms. TAH patients were more likely to receive epidural analgesia than TLH patients (33% versus 0.5%, P < 0.001) during the early postoperative phase. Although opioid use was comparable in the TAH versus TLH groups during postoperative 0–2 days (99.7% versus 98.5%, P = 0.09), a significantly higher proportion of TAH patients required opioids 3–5 days (70% versus 22%, P < 0.0001), 6–14 days (35% versus 15%, P < 0.0001), and 15–60 days (15% versus 9%, P = 0.02) after surgery. Mean pain scores were significantly higher in the TAH versus TLH group one (2.48 versus 1.62, P < 0.0001) and four weeks (0.89 versus 0.63, P = 0.01) following surgery. Conclusion. Treatment of early stage endometrial cancer with TLH is associated with less frequent use of epidural, lower post-operative opioid requirements, and better pain scores than TAH.

Total Laparoscopic Hysterectomy versus Laparoscopic-Assisted Vaginal Hysterectomy in Endometrial Cancer: Surgical and Survival Outcomes

Study Objective To compare surgical and survival outcomes of patients with early-stage endometrial cancer (EC) who underwent total laparoscopic hysterectomy (TLH) or laparoscopic-assisted vaginal hysterectomy (LAVH) ± lymphadenectomy. Design Retrospective, nonrandomized clinical study (Canadian Task Force classification II-2). Setting Two tertiary care academic medical centers. Patients Patients with EC treated by TLH or LAVH from 1998 through 2006. Interventions TLH and LAVH were performed in 80 and 24 patients, respectively. Patient demographics and clinical variables were collected, and surgical and survival outcomes were determined. Measurements and Main Results Median operating time was significantly higher for patients undergoing LAVH than for those undergoing TLH (212.5 and 183.5 minutes, respectively; p = .039). EBL was also greater in patients undergoing LAVH (median 220 mL) compared with those undergoing TLH (median100 mL; p = .001). After a median follow-up time of 51.5 months, there was no difference in recurrence or survival rates between the groups. Conclusion Early-stage EC can be treated effectively with either TLH or LAVH. TLH patients may experience shorter operating times and less blood loss. When performed by experienced laparoscopists, TLH may be more feasible than LAVH in this cohort of patients.

Comparison of Three Hysterectomy Methods in a Set of Female to Male Transsexuals

Purpose: The aim of our study was to compare three widely used surgical techniques of hysterectomy in the well defined sub-population of patients undergoing hysterectomy - FtM transsexuals. Material and methods of investigation: Hysterectomy with bilateral adnexectomy was performed in 61 FtM transsexuals; patients were randomized into three categories: abdominal hysterectomy through a lower midline laparotomy (AHL), abdominal hysterectomy through a low transverse incision (AH), and total laparoscopic hysterectomy (TLH). Methods of assessing the results: The criteria studied were duration of surgery, blood loss and the length of post-operative hospitalization. The incidence of complications was also recorded. Results: Mean blood loss (136 ml) in the TLH patients was significantly lower than in either the AH (217 ml) or the AHL (226 ml) patients. Similarly, the length of post-operative hospitalization was significantly shorter for TLH (4.7 days) than for AH (6.4 days) and AHL (6.7 days). However, the duration of the surgery was significantly longer in TLH group (110 minutes) than with either the AH (55 minutes) or AHL (54 minutes). Differences between the AH and AHL procedures were not significant in any of the three studied criteria. Discussion, conclusions: In our set of patients TLH was associated with lower blood loss and shorter hospital stay compared to the laparotomic procedures and we found no post-operative complications in TLH patients. The only significant disadvantage was longer duration of TLH procedure compared to the open procedures. Based on our experience, we regard TLH as the method of choice in the surgical management of the FtM transsexuals.

Total laparoscopic intrafascial hysterectomy

ObjectivesTo evaluate the efficacy of a new technique, total laparoscopic intrafascial hysterectomy (TLIH) and investigate whether there are any advantages of TLIH over total laparoscopic hysterectomy (TLH) which included laparoscopically assisted vaginal hysterectomy (LAVH) and laparoscopic hysterectomy (LH).DesignA retrospective chart review was conducted on all cases of TLIH (n = 112) and TLH (n = 72) performed between January 1 1995 and September 30 1995, and 86 cases of TLIH performed during the following 6 months from October 1 1995 to March 31 1996, at the Jeil Womens' Hospital, Seoul, Korea. All the procedures were performed utilizing electrocautery and/or suture ligature. The upper pedicles (round and infundibulo pelvic or utero‐ovarian ligaments) were treated in the usual manner, and the uterine artery was cut either at the level of the internal os of the cervix or immediately after its bifurcation from the hypogastric artery, depending upon the size of the uterus or pelvic side‐wall pathology such as severe endometriosis and chronic pelvic inflammatory disease. The cervix was circumcized intrafascially at the level of the internal os of the cervix, preserving the entire uterosacral and cardinal ligament complex and full length of the vagina. The vagina was closed either vertically or transversally and a modified McCall culdoplasty was also performed if necessary.ResultsThere were no differences concerning patient characteristics and indications for surgery. Average uterine weight was slightly lower for the TLIH than the TLH patients (193.1 ± 96.2 vs. 237.4 ± 84.5 g). Among the TLIH patients there were 33 cases (29.46%) who had undergone previous surgery and 35 cases (31.25%) in whom moderate to severe concurrent pelvic endometriosis, was found during surgery besides the primary diagnosis, compared with 12 cases each (16.67%) in the TLH cases. Operation time was shorter with TLIH (117.6 ± 38.2 min) compared with TLH (134.9 ± 37.4 min). Less bleeding, less damage to the genitourinary tract and less granulation tissue formation occurred with TLIH compared with TLH. With respect to the TLIH cases, during the second review period there were more cases with previous surgery (39.53%) and with concurrent pelvic endometriosis (37.21%), the average uterine weight was greater (254.1 ± 82.5 g). However, the operation time was shorter in the second review period group compared with the first (109.2 ± 35.3 vs. 117.6 ± 38.2 min).ConclusionTLIH can be performed faster and more safely than TLH by an experienced surgeon. Fewer complications occurred with TLIH compared with TLH because surgery can be done more precisely under direct vision. TLIH has all the benefits of both laparoscopic total and subtotal hysterectomy with the advantage of lengthening of the vagina, fewer pelvic floor defects and fewer complications, such as damage to the urinary tract and granulation tissue formation on the vaginal cuff, and there is definitely no fear of cancer development on the cervical stump postoperatively. However, these issues warrant further long‐term follow‐up evaluation, with a randomized prospective study on a large scale.