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Laparoscopic Approach to Hysterectomy for Benign Disease: Our Experience
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Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S152–S177
556 Laparoscopic Approach to Hysterectomy for Benign Disease: Our Experience Guerra T, Asturgo´ A, Man˜alich L, Sua´rez E, Bradbury M, Xercavins J. Endoscopy Gynecological, Hospital Universitari de la Vall d’Hebron, Barcelona, Spain Study Objective: To evaluate clinical and surgical results of laparoscopic hysterectomies for benign gynaecological disease, and to compare the results in time. Design: A retrospective descriptive study was performed reviewing 225 cases of laparoscopic hysterectomies with non-oncologic indication. We collected clinical, surgical and hystopathological data from the medical history. We evaluated all the information doing a descriptive analysis with SPSS 17.0. We compared the median postoperative hospital stay, the rate of operative complications and the rate of conversion to laparotomy in every year of the study. Setting: The study was carried out in our University Hospital Vall d’Hebron (Barcelone - Spain). Patients: We selected all women who were operated of laparoscopic hysterectomy for benign disease in our centre from January 2005 to December 2009. Intervention: No interventions. Measurements and Main Results: - The mean age was 46,3. The most common indication for hysterectomy was uterine leyomiomas associated to abnormal bleeding (46,9%). Of the 225 hysterectomies, 94,7% were performed by laparoscopic approach (78,4% supracervical hysterectomies and 21,6% total hysterectomies) with a rate of conversion to laparotomy of 10,3%; and 5,3% by laparoscopical assisted vaginal approach. Surgical complications were registered in 34 patients. The median postoperative hospital stay was 2,9 days. Comparing year by year, there were not statistically significant differences in the rate of operative complications and in the rate of conversion to laparotomy. However, significant differences were found in the median postoperative hospital stay, a higher number of patients with a median postoperative hospital stay %2 days was observed in time (2005-25% versus 2009-73,9%, p=0,0001). Conclusion: The experience in our centre shows that the laparoscopic approach to hysterectomy for benign disease is feasible; and it offers advantages, regarding low surgical complications and lower median postoperative hospital stay. Comparing the results in time, a decrease in the median postoperative hospital stay was noted. 557 A Prospective Comparison of Vaginal Stump Suturing Techniques during Total Laparoscopic Hysterectomy Im HS, Jeung IC, Park EK, Kim CJ, Lee YS. Gynecology, The Catholic University of Korea, Seoul, Korea Study Objective: We compared the incidence of vaginal cuff dehiscence and other surgical complications after different modes of suturing during total laparoscopic hysterectomy (TLH), and reviewed the characteristics of patients with complications. Design: Randomized, controlled trial (Canadian Task Force classification I). Setting: Single-center university teaching hospital in Korea. Patients: We enrolled 248 patients undergoing TLH for benign diseases at Daejeon St Mary’s Hospital of Korea from March 2007 through February 2009. Intervention: We evaluated the clinical outcomes of different vaginal cuff suture techniques during TLH: the widely used interrupted figure-of-eight suture and a two-layer running suture. Measurements and Main Results: All operations were completed successfully by laparoscope. Three of 248 hysterectomies (1.2%) were complicated by vaginal cuff dehiscence. One of them belonged to the two-layer running suture group, and the others belonged to the interrupted figure-of-eight suture group. However, there was no statistically significant difference in outcomes between the two suture methods. One case of trocar site incisional herniation occurred. No ureteral, bladder, or major vascular injury occurred. The overall major complication rate including vaginal bleeding was 2.0% (5/248).
Conclusion: The two-layer running suture technique was safe and effective for vaginal cuff suture during TLH, but there was no statistically significant advantage over the widely used figure-of-eight suture method. Diabetes, cigarette smoking and pelvic adhesions produced statistically significant increased risks of complication.
558 Urologic Complications after Total Laparoscopic Radical Hysterectomy in the Treatment of Cervical Cancer Kang WD, Kim SM. Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Republic of Korea Study Objective: To compare the urologic complication in patients undergoing total laparoscopic radical hysterectomy and abdominal radical hysterectomy for cervical cancer. Design: Retrospective analysis of 138 consecutive patients who underwent total laparoscopic radical hysrerectomy or abdominal radical hysrerectomy in the treatment of cervical cancer. Setting: University department of obstetrics and gynecology. Patients: Seventy-two patients underwent abdominal radical hysterectomy, and 56 underwent total laparoscopic radical hysrerectomy. We excluded patients receiving postoperative chemoradiation to reduce the impact of radiotherapy complication on the outcome of the surgery. Intervention: Total laparoscopic radical hysterectomy and abdominal radical hysterectomy. Measurements and Main Results: Of the 138 patients who completed surgery without receiving postoperative chemoradiation. Mean age was 48.4 years, and mean body mass index 23.1. On pathologic examination, there was no significant difference in the amount of parametrial tissue, vaginal cuff, or negative margins obtained. For abdominal radical hysterectomy, 15.2% of patients experienced postoperative urinary tract infection compared with 3.6% for total laparoscopic radical hysterectomy (P=0.038). The overall noninfectious urologic complication in the total laparoscopic radical hysterectomy and abdominal radical hysterectomy, respectively, were as follows: long-term voiding difficult (2/56 and 4/72), ureteral stricture (1/56 and 1/72), ureterovaginal fistula (2/56 and 1/ 72), and vesicovaginal fistula (0/56 and 2/72). There was no difference in overall noninfectious postoperative urinary tract complication between the two groups (P=0.91). None of the 138 patients had any long-term sequelae. Conclusion: Despite the inherent limitations of total laparoscopic radical hysterectomy associated learning curve, the procedure reduces urinary tract infection.
559 Laparoscopic Hysterectomy Rate in Korea Kim D-H,1 Lee E-J,1 Kim T,2 Park HM.1 1Obstetrics and Gynecology, Chung-Ang University, Seoul, Korea; 2Obstetrics and Gynecology, Korea University, Seoul, Korea Study Objective: To assess the proportion of hysterectomies performed laparoscopically in 2007 and 2008 in Korea. Design: Retrospective study. Setting: Department of obstetrics and gynecology in Korea. Patients: Women underwent simple or radical hysterectomy in Korea. Intervention: Simple or Radical hysterectomy. Measurements and Main Results: A descriptive statistical analysis of national discharge data was undertaken. Data was provided by Health Insurance Review & Assessment Service according to our request through public opening route of administration information. Hysterectomy was defined as the presence of hysterectomy codes for benign disease (R4130, R4143, R4144, R4145, R4146, and R4202) and radical hysterectomy codes (R4154 and R4155). The code for laparoscopic hysterectomy was not introduced so far and thus, laparoscopic surgery was identified when the code of material for laparoscopy (N0031001) was used. A total of 29,762 and 30,395 simple hysterectomies were performed for benign disease in 2007 and 2008 on women in Korea. Of them, laparoscopic hysterectomy accounted for 12,818 (43.1%) in 2007 and 14,484 (47.7%)
Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S152–S177
556 Laparoscopic Approach to Hysterectomy for Benign Disease: Our Experience Guerra T, Asturgo´ A, Man˜alich L, Sua´rez E, Bradbury M, Xercavins J. Endoscopy Gynecological, Hospital Universitari de la Vall d’Hebron, Barcelona, Spain Study Objective: To evaluate clinical and surgical results of laparoscopic hysterectomies for benign gynaecological disease, and to compare the results in time. Design: A retrospective descriptive study was performed reviewing 225 cases of laparoscopic hysterectomies with non-oncologic indication. We collected clinical, surgical and hystopathological data from the medical history. We evaluated all the information doing a descriptive analysis with SPSS 17.0. We compared the median postoperative hospital stay, the rate of operative complications and the rate of conversion to laparotomy in every year of the study. Setting: The study was carried out in our University Hospital Vall d’Hebron (Barcelone - Spain). Patients: We selected all women who were operated of laparoscopic hysterectomy for benign disease in our centre from January 2005 to December 2009. Intervention: No interventions. Measurements and Main Results: - The mean age was 46,3. The most common indication for hysterectomy was uterine leyomiomas associated to abnormal bleeding (46,9%). Of the 225 hysterectomies, 94,7% were performed by laparoscopic approach (78,4% supracervical hysterectomies and 21,6% total hysterectomies) with a rate of conversion to laparotomy of 10,3%; and 5,3% by laparoscopical assisted vaginal approach. Surgical complications were registered in 34 patients. The median postoperative hospital stay was 2,9 days. Comparing year by year, there were not statistically significant differences in the rate of operative complications and in the rate of conversion to laparotomy. However, significant differences were found in the median postoperative hospital stay, a higher number of patients with a median postoperative hospital stay %2 days was observed in time (2005-25% versus 2009-73,9%, p=0,0001). Conclusion: The experience in our centre shows that the laparoscopic approach to hysterectomy for benign disease is feasible; and it offers advantages, regarding low surgical complications and lower median postoperative hospital stay. Comparing the results in time, a decrease in the median postoperative hospital stay was noted. 557 A Prospective Comparison of Vaginal Stump Suturing Techniques during Total Laparoscopic Hysterectomy Im HS, Jeung IC, Park EK, Kim CJ, Lee YS. Gynecology, The Catholic University of Korea, Seoul, Korea Study Objective: We compared the incidence of vaginal cuff dehiscence and other surgical complications after different modes of suturing during total laparoscopic hysterectomy (TLH), and reviewed the characteristics of patients with complications. Design: Randomized, controlled trial (Canadian Task Force classification I). Setting: Single-center university teaching hospital in Korea. Patients: We enrolled 248 patients undergoing TLH for benign diseases at Daejeon St Mary’s Hospital of Korea from March 2007 through February 2009. Intervention: We evaluated the clinical outcomes of different vaginal cuff suture techniques during TLH: the widely used interrupted figure-of-eight suture and a two-layer running suture. Measurements and Main Results: All operations were completed successfully by laparoscope. Three of 248 hysterectomies (1.2%) were complicated by vaginal cuff dehiscence. One of them belonged to the two-layer running suture group, and the others belonged to the interrupted figure-of-eight suture group. However, there was no statistically significant difference in outcomes between the two suture methods. One case of trocar site incisional herniation occurred. No ureteral, bladder, or major vascular injury occurred. The overall major complication rate including vaginal bleeding was 2.0% (5/248).
Conclusion: The two-layer running suture technique was safe and effective for vaginal cuff suture during TLH, but there was no statistically significant advantage over the widely used figure-of-eight suture method. Diabetes, cigarette smoking and pelvic adhesions produced statistically significant increased risks of complication.
558 Urologic Complications after Total Laparoscopic Radical Hysterectomy in the Treatment of Cervical Cancer Kang WD, Kim SM. Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Republic of Korea Study Objective: To compare the urologic complication in patients undergoing total laparoscopic radical hysterectomy and abdominal radical hysterectomy for cervical cancer. Design: Retrospective analysis of 138 consecutive patients who underwent total laparoscopic radical hysrerectomy or abdominal radical hysrerectomy in the treatment of cervical cancer. Setting: University department of obstetrics and gynecology. Patients: Seventy-two patients underwent abdominal radical hysterectomy, and 56 underwent total laparoscopic radical hysrerectomy. We excluded patients receiving postoperative chemoradiation to reduce the impact of radiotherapy complication on the outcome of the surgery. Intervention: Total laparoscopic radical hysterectomy and abdominal radical hysterectomy. Measurements and Main Results: Of the 138 patients who completed surgery without receiving postoperative chemoradiation. Mean age was 48.4 years, and mean body mass index 23.1. On pathologic examination, there was no significant difference in the amount of parametrial tissue, vaginal cuff, or negative margins obtained. For abdominal radical hysterectomy, 15.2% of patients experienced postoperative urinary tract infection compared with 3.6% for total laparoscopic radical hysterectomy (P=0.038). The overall noninfectious urologic complication in the total laparoscopic radical hysterectomy and abdominal radical hysterectomy, respectively, were as follows: long-term voiding difficult (2/56 and 4/72), ureteral stricture (1/56 and 1/72), ureterovaginal fistula (2/56 and 1/ 72), and vesicovaginal fistula (0/56 and 2/72). There was no difference in overall noninfectious postoperative urinary tract complication between the two groups (P=0.91). None of the 138 patients had any long-term sequelae. Conclusion: Despite the inherent limitations of total laparoscopic radical hysterectomy associated learning curve, the procedure reduces urinary tract infection.
559 Laparoscopic Hysterectomy Rate in Korea Kim D-H,1 Lee E-J,1 Kim T,2 Park HM.1 1Obstetrics and Gynecology, Chung-Ang University, Seoul, Korea; 2Obstetrics and Gynecology, Korea University, Seoul, Korea Study Objective: To assess the proportion of hysterectomies performed laparoscopically in 2007 and 2008 in Korea. Design: Retrospective study. Setting: Department of obstetrics and gynecology in Korea. Patients: Women underwent simple or radical hysterectomy in Korea. Intervention: Simple or Radical hysterectomy. Measurements and Main Results: A descriptive statistical analysis of national discharge data was undertaken. Data was provided by Health Insurance Review & Assessment Service according to our request through public opening route of administration information. Hysterectomy was defined as the presence of hysterectomy codes for benign disease (R4130, R4143, R4144, R4145, R4146, and R4202) and radical hysterectomy codes (R4154 and R4155). The code for laparoscopic hysterectomy was not introduced so far and thus, laparoscopic surgery was identified when the code of material for laparoscopy (N0031001) was used. A total of 29,762 and 30,395 simple hysterectomies were performed for benign disease in 2007 and 2008 on women in Korea. Of them, laparoscopic hysterectomy accounted for 12,818 (43.1%) in 2007 and 14,484 (47.7%)