OBJECTIVE: The purpose of this study was to analyze our initial 10-year experience with laparoscopy and to determine risk factors for complications and conversions to laparotomy for technical difficulty. STUDY DESIGN: We reviewed the charts of all laparoscopic procedures from January 1991 through December 2000 and divided the procedures into 4 levels on the basis of the degree of difficulty: level I, diagnostic; level II, procedures on the uterus and/or adnexa; level III, second look operations for malignancy; and level IV, lymphadenectomies/other complex procedures. Complications were graded from 1 (mild) to 5 (death). Standard univariate and multivariate analyses were performed. RESULTS: We identified 1451 evaluable procedures. The number of complications was as follows: grades 1 to 5, 129 complications (9%); grades 3 to 5, 36 complications (2.5%). On multivariate analysis, older age ( P = .03), previous radiation ( P = .03), and malignancy ( P = .006) were associated with an increased risk of complications grades 3 to 5. Complication rates for grades 3 to 5 for patients with malignancy versus benign disease was 4% versus 1%, respectively. Technical difficulty led to conversion to laparotomy in 105 cases (7%). Previous abdominal surgery ( P < .001) significantly increased the rate of conversion to laparotomy; more complex, higher procedure levels were associated with a significant decrease in conversions ( P = .005). CONCLUSION: Both simple and complex laparoscopic procedures can be performed by a gynecologic oncology service with a low rate of complications and conversions to laparotomy. Older age, malignancy, previous radiation therapy, and previous abdominal surgery were identified as significant risk factors for complications and/or conversion and should be taken into account in patient selection, preoperative counseling, and surgical planning.
OBJECTIVE: The purpose of this study was to analyze our initial 10-year experience with laparoscopy and to determine risk factors for complications and conversions to laparotomy for technical difficulty. STUDY DESIGN: We reviewed the charts of all laparoscopic procedures from January 1991 through December 2000 and divided the procedures into 4 levels on the basis of the degree of difficulty: level I, diagnostic; level II, procedures on the uterus and/or adnexa; level III, second look operations for malignancy; and level IV, lymphadenectomies/other complex procedures. Complications were graded from 1 (mild) to 5 (death). Standard univariate and multivariate analyses were performed. RESULTS: We identified 1451 evaluable procedures. The number of complications was as follows: grades 1 to 5, 129 complications (9%); grades 3 to 5, 36 complications (2.5%). On multivariate analysis, older age ( P = .03), previous radiation ( P = .03), and malignancy ( P = .006) were associated with an increased risk of complications grades 3 to 5. Complication rates for grades 3 to 5 for patients with malignancy versus benign disease was 4% versus 1%, respectively. Technical difficulty led to conversion to laparotomy in 105 cases (7%). Previous abdominal surgery ( P < .001) significantly increased the rate of conversion to laparotomy; more complex, higher procedure levels were associated with a significant decrease in conversions ( P = .005). CONCLUSION: Both simple and complex laparoscopic procedures can be performed by a gynecologic oncology service with a low rate of complications and conversions to laparotomy. Older age, malignancy, previous radiation therapy, and previous abdominal surgery were identified as significant risk factors for complications and/or conversion and should be taken into account in patient selection, preoperative counseling, and surgical planning.
Authors: Behrouz Zand; Michael Frumovitz; Matias F Jofre; Alpa M Nick; Ricardo Dos Reis; Mark F Munsell; Haleh Sangi-Haghpeykar; Charles Levenback; Pamela T Soliman; Kathleen M Schmeler; Pedro T Ramirez Journal: Gynecol Oncol Date: 2012-06-02 Impact factor: 5.482
Authors: M P Radosa; G Meyberg-Solomayer; J Radosa; J Vorwergk; K Oettler; A Mothes; S Baum; I Juhasz-Boess; E Petri; E F Solomayer; I B Runnebaum Journal: Geburtshilfe Frauenheilkd Date: 2014-08 Impact factor: 2.915
Authors: Katrijn L M Michielsen; Ignace Vergote; Raphaëla Dresen; Katya Op de Beeck; Ragna Vanslembrouck; Frédéric Amant; Karin Leunen; Philippe Moerman; Steffen Fieuws; Frederik De Keyzer; Vincent Vandecaveye Journal: Br J Radiol Date: 2016-09-21 Impact factor: 3.039
Authors: Jason D Wright; Alfred I Neugut; Elizabeth T Wilde; Donna L Buono; Wei-Yann Tsai; Dawn L Hershman Journal: J Oncol Pract Date: 2012-06-19 Impact factor: 3.840