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LAVH versus TAH in a high risk obese indigent population
Oral Presentations
wound infections, post operative hemorrhages, significant post-operative febrile morbidity, or rehospitalizations were encountered. Corzclusiorz. Given the absence of complications, particularly wound infection, laparoscopic hysterectomy should be considered the preferred approach in an obese woman requiring a hysterectomy.
137. LAVH versus TAH in a High Risk Obese Indigent Population RS Gist. LSUHSC School of Medicine, Baton Rouge, Louisiana.
Objective. To retrospectively review outcomes of LAVH matched with TAH in obese indigent high risk patients. Desigrz. Retrospective cohort study. Settirzg. University public (charity) hospital. Patierzts. Indigent obese patients with multiple medical problems. Irzterverztiorzs. LAVH (study) patient outcomes were retrospectively compared with TAH (control) patients whose surgery was performed the same day or within the same week as the control TAH patients. Measuremerzts arzd Mairz Results. Each group fell into the obese category (BMI >30). Preoperative uterine size by exam was larger in the TAH group (p=.0001). Operative time was slightly longer in the LAVH group (p=.0001). Blood loss was less in the LAVH group as compared to the TAH group (p=.0001) Pain scores at 12 and 24 hours were significantly less in the LAVH group as well as decreased need for parenteral and oral narcotics. Rates of transfusion, wound complications, febrile morbidity, readmission, and ED visits related to surgery were higher in the TAH group. Post-operative hospital stays were shorter in the LAVH group. Corzclusiorz. LAVH is preferred in obese, high risk patients over TAH when technically possible.
138. The Ligasure "Atlas" for LAVH, BSO in a Community Setting 1JF Dulemba, 1C Medler, 2AG Vilos, 3G Pron, 2j Bennett, 2R Kozak, 2G Garvin. 1The Women's Centre, Denton, Texas; 2The University of Western Ontario, St. Joseph's Health Centre, London, Canada; 3The University of Toronto, Toronto, Canada.
Objective. To evaluate the operative time and safety of the Ligasure "Arias" for LAVH, BSO. Desigrz. Analysis of over 200 consecutive cases undergoing LAVH, BSO. Sett#zg. A 200 bed Community Hospital in Denton, Texas. A single surgeon, in a group private practice, performed the analysis. Patierzts. Over 200 consecutive patients (ages 25-74) undergoing LAVH, BSO. The average age and weight of the patients was 44 years and 169 lbs, respectively. Irzterverztiorzs. The analysis included total time of the procedure, blood loss, pre and post-op hemoglobin, and uter-
ine weight. The procedure time included: Insuffiation, trocar insertions, evaluation of the pelvis, adhesiolysis, excision of endometriosis, skeletonizing the infundibulopelvic and uterine vessels, making a bladder flap, transitioning and completing the vaginal portion, transitioning back to laparoscopy, ensuring hemostasis, repair of any complications, injecting marcaine into the trocar sites, and suturing the umbilicus. Measummerzts arzd Ma#z Results. The average operative time for the LAVH,BSO was 57 minutes. Total blood loss was 156cc's. The pre-op and post-op hemoglobin was 13.6/11.3. The average uterine weight was 138 granls. There were 3 complications: 2 bladder infections and 1 bladder cystotomy. Conclusion. The Ligasure "Arias" is a safe instrument that helps minimize surgical time and blood loss.
139. Vaginal Cervical Amputation for Laparoscopic-Assisted Vaginal Hysterectomy of Large Myomatous Uteri YY Kuei, Jr. Taipei Medical University Hospital, Taipei, Taiwan.
Objective. To evaluate whether transvaginal cervical amputation improves laparoscopic-assisted vaginal hysterectomy (LAVH). Desigrz. Prospective randomized, longitudinal study. Sett#zg. Private practice and university-affiliated hospital. Patierzts. Sixty-four women (age 34-52 years) with symptomatic myomatous uteri larger than 12 weeks on bimanual examination. lnterverztiorzs. Laparoscopic-assisted vaginal hysterectomy (LAVH) with or without transvaginal cervical amputation. Measuremerzt arzd Ma#z Results. Hysterectomy was performed successfully in 39 women (Group A) with ligation of the round ligament, ovarian ligament, or infundibulopelvic ligament, and preparation of the bladder flap in the laparoscopic phase, and ligation of the uterosacral ligament, cardinal ligament containing descending uterine vessels followed by cervical amputation and severing the unilateral broad ligament. Then the morcellation was done and uterus was retracted outward with fundal delivery. The remaining tissue connection of opposite broad ligament was served with ease. Hysterectomy was performed successfully in 32 comparable patients (Group B) with same laparoscopic procedure. In vaginal phase, the vaginal was opened and the uterosacral ligaments, cardinal ligaments, uterine vessels and broad ligaments were desiccated, cut and ligated. Then the uterus was removed by vaginal morcellation, bivalving and intranlyometrial coring when necessary. The average operating time was 119.8 and 148.5 minutes in groups A and B, respectively (P<0.05); Average blood loss was 181.4 and 305.8 ml, respectively (p<0.05); and hemoglobin decreased on average 0.8 and 1.6g/ml, respectively (p<0.05). Conclusion. Serving the uterosacral ligament and the uterine vessels followed by cervical amputation reduces operating
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wound infections, post operative hemorrhages, significant post-operative febrile morbidity, or rehospitalizations were encountered. Corzclusiorz. Given the absence of complications, particularly wound infection, laparoscopic hysterectomy should be considered the preferred approach in an obese woman requiring a hysterectomy.
137. LAVH versus TAH in a High Risk Obese Indigent Population RS Gist. LSUHSC School of Medicine, Baton Rouge, Louisiana.
Objective. To retrospectively review outcomes of LAVH matched with TAH in obese indigent high risk patients. Desigrz. Retrospective cohort study. Settirzg. University public (charity) hospital. Patierzts. Indigent obese patients with multiple medical problems. Irzterverztiorzs. LAVH (study) patient outcomes were retrospectively compared with TAH (control) patients whose surgery was performed the same day or within the same week as the control TAH patients. Measuremerzts arzd Mairz Results. Each group fell into the obese category (BMI >30). Preoperative uterine size by exam was larger in the TAH group (p=.0001). Operative time was slightly longer in the LAVH group (p=.0001). Blood loss was less in the LAVH group as compared to the TAH group (p=.0001) Pain scores at 12 and 24 hours were significantly less in the LAVH group as well as decreased need for parenteral and oral narcotics. Rates of transfusion, wound complications, febrile morbidity, readmission, and ED visits related to surgery were higher in the TAH group. Post-operative hospital stays were shorter in the LAVH group. Corzclusiorz. LAVH is preferred in obese, high risk patients over TAH when technically possible.
138. The Ligasure "Atlas" for LAVH, BSO in a Community Setting 1JF Dulemba, 1C Medler, 2AG Vilos, 3G Pron, 2j Bennett, 2R Kozak, 2G Garvin. 1The Women's Centre, Denton, Texas; 2The University of Western Ontario, St. Joseph's Health Centre, London, Canada; 3The University of Toronto, Toronto, Canada.
Objective. To evaluate the operative time and safety of the Ligasure "Arias" for LAVH, BSO. Desigrz. Analysis of over 200 consecutive cases undergoing LAVH, BSO. Sett#zg. A 200 bed Community Hospital in Denton, Texas. A single surgeon, in a group private practice, performed the analysis. Patierzts. Over 200 consecutive patients (ages 25-74) undergoing LAVH, BSO. The average age and weight of the patients was 44 years and 169 lbs, respectively. Irzterverztiorzs. The analysis included total time of the procedure, blood loss, pre and post-op hemoglobin, and uter-
ine weight. The procedure time included: Insuffiation, trocar insertions, evaluation of the pelvis, adhesiolysis, excision of endometriosis, skeletonizing the infundibulopelvic and uterine vessels, making a bladder flap, transitioning and completing the vaginal portion, transitioning back to laparoscopy, ensuring hemostasis, repair of any complications, injecting marcaine into the trocar sites, and suturing the umbilicus. Measummerzts arzd Ma#z Results. The average operative time for the LAVH,BSO was 57 minutes. Total blood loss was 156cc's. The pre-op and post-op hemoglobin was 13.6/11.3. The average uterine weight was 138 granls. There were 3 complications: 2 bladder infections and 1 bladder cystotomy. Conclusion. The Ligasure "Arias" is a safe instrument that helps minimize surgical time and blood loss.
139. Vaginal Cervical Amputation for Laparoscopic-Assisted Vaginal Hysterectomy of Large Myomatous Uteri YY Kuei, Jr. Taipei Medical University Hospital, Taipei, Taiwan.
Objective. To evaluate whether transvaginal cervical amputation improves laparoscopic-assisted vaginal hysterectomy (LAVH). Desigrz. Prospective randomized, longitudinal study. Sett#zg. Private practice and university-affiliated hospital. Patierzts. Sixty-four women (age 34-52 years) with symptomatic myomatous uteri larger than 12 weeks on bimanual examination. lnterverztiorzs. Laparoscopic-assisted vaginal hysterectomy (LAVH) with or without transvaginal cervical amputation. Measuremerzt arzd Ma#z Results. Hysterectomy was performed successfully in 39 women (Group A) with ligation of the round ligament, ovarian ligament, or infundibulopelvic ligament, and preparation of the bladder flap in the laparoscopic phase, and ligation of the uterosacral ligament, cardinal ligament containing descending uterine vessels followed by cervical amputation and severing the unilateral broad ligament. Then the morcellation was done and uterus was retracted outward with fundal delivery. The remaining tissue connection of opposite broad ligament was served with ease. Hysterectomy was performed successfully in 32 comparable patients (Group B) with same laparoscopic procedure. In vaginal phase, the vaginal was opened and the uterosacral ligaments, cardinal ligaments, uterine vessels and broad ligaments were desiccated, cut and ligated. Then the uterus was removed by vaginal morcellation, bivalving and intranlyometrial coring when necessary. The average operating time was 119.8 and 148.5 minutes in groups A and B, respectively (P<0.05); Average blood loss was 181.4 and 305.8 ml, respectively (p<0.05); and hemoglobin decreased on average 0.8 and 1.6g/ml, respectively (p<0.05). Conclusion. Serving the uterosacral ligament and the uterine vessels followed by cervical amputation reduces operating
$44