Francesco Fanfani1, David M Boruta2, Amanda N Fader3, Enrico Vizza4, Withfiel B Growdon2, Cristina L Kushnir3, Giacomo Corrado4, Giovanni Scambia5, Luigi C Turco5, Anna Fagotti6. 1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Hearth, Rome, Italy. Electronic address: francesco.fanfani@rm.unicatt.it. 2. Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. 3. Division of Gynecologic Oncology, John Hopkins Medical Institute, Baltimore, Maryland. 4. Gynecology Oncology Unit, Department of Oncological Surgery, "Regina Elena" National Cancer Institute, Rome, Italy. 5. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Hearth, Rome, Italy. 6. Minimally Invasive Gynecology, St Maria Hospital, University of Perugia, Terni, Italy.
Abstract
OBJECTIVE: To assess the feasibility and perioperative outcomes of laparoendoscopic single-site (LESS) hysterectomy in obese and nonobese women. DESIGN: A multicentric retrospective case-control study (Canadian Task Force II-2). SETTING: Catholic University of the Sacred Heart and National Cancer Institute "Regina Elena" (Rome, Italy), Massachusetts General Hospital (Boston, MD), and Johns Hopkins Hospital (Baltimore, MD). PATIENTS: From July 2009 to April 2013, 120 women underwent LESS hysterectomy. Five women (8%) were excluded from the analysis. The remaining 115 women were divided into 2 groups: obese (n = 43, body mass index [BMI] ≥30 kg/m(2)) and nonobese (n = 72, BMI <30 kg/m(2)). INTERVENTIONS: Total LESS hysterectomies for malignant and premalignant uterine disease or at least for prophylactic intent were performed. MEASUREMENTS AND MAIN RESULTS: No statistical differences regarding perioperative outcomes were observed between the 2 groups. Conversion to standard laparoscopy occurred in 2 obese (5%) and 2 (5%) nonobese women (p = .62). Conversion to laparotomy occurred in 1 obese (2.3%) and 3 (4.2%) nonobese women (p = .212). The median operative time was 115 minutes (range, 48-300 minutes) in obese and 114 minutes (range, 55-342 minutes) in nonobese women (p = .787). The intraoperative complication rate was 11.6% and 9.6% in obese and nonobese women, respectively (p = .712). The early postoperative complication rate was 6.9% in obese and 4.1% in nonobese women (p = .516). CONCLUSION: Despite the fact that the present analysis was performed in a relatively small group of patients, this study suggests that obesity (BMI ≥30) does not preclude successful completion of total LESS hysterectomy. Further prospective studies are required to confirm these preliminary data and to clarify potential advantages and disadvantages of LESS in obese women.
OBJECTIVE: To assess the feasibility and perioperative outcomes of laparoendoscopic single-site (LESS) hysterectomy in obese and nonobese women. DESIGN: A multicentric retrospective case-control study (Canadian Task Force II-2). SETTING: Catholic University of the Sacred Heart and National Cancer Institute "Regina Elena" (Rome, Italy), Massachusetts General Hospital (Boston, MD), and Johns Hopkins Hospital (Baltimore, MD). PATIENTS: From July 2009 to April 2013, 120 women underwent LESS hysterectomy. Five women (8%) were excluded from the analysis. The remaining 115 women were divided into 2 groups: obese (n = 43, body mass index [BMI] ≥30 kg/m(2)) and nonobese (n = 72, BMI <30 kg/m(2)). INTERVENTIONS: Total LESS hysterectomies for malignant and premalignant uterine disease or at least for prophylactic intent were performed. MEASUREMENTS AND MAIN RESULTS: No statistical differences regarding perioperative outcomes were observed between the 2 groups. Conversion to standard laparoscopy occurred in 2 obese (5%) and 2 (5%) nonobese women (p = .62). Conversion to laparotomy occurred in 1 obese (2.3%) and 3 (4.2%) nonobese women (p = .212). The median operative time was 115 minutes (range, 48-300 minutes) in obese and 114 minutes (range, 55-342 minutes) in nonobese women (p = .787). The intraoperative complication rate was 11.6% and 9.6% in obese and nonobese women, respectively (p = .712). The early postoperative complication rate was 6.9% in obese and 4.1% in nonobese women (p = .516). CONCLUSION: Despite the fact that the present analysis was performed in a relatively small group of patients, this study suggests that obesity (BMI ≥30) does not preclude successful completion of total LESS hysterectomy. Further prospective studies are required to confirm these preliminary data and to clarify potential advantages and disadvantages of LESS in obesewomen.
Authors: E Perrone; F Fanfani; C Rossitto; S Cianci; A Fagotti; S Restaino; C Fedele; G Scambia; S Gueli Alletti Journal: Facts Views Vis Obgyn Date: 2020-03-27