No abstract

Objective: To investigate outcomes and ascertain the safety and efficacy on patients having total laparoscopic hysterectomy (TLH), stratified by body mass index (BMI), focusing on high-BMI patients.Methods: This was a retrospective cohort study that reviewed 2,266 patients with benign gynecologic diagnoses, early cervical, endometrial, and ovarian carcinoma from September 1996 to October 2017. BMI was from 14.5 to 74.2 and were classified as normal or underweight (<24.9); overweight (25.0-29.9); class I obese (>30.0-34.9); class II obese (35-39.9); or class III obese (>40.0). All patients underwent TLH.Results: Patients' characteristics were similar across all BMI classes except for age, postoperative pathological diagnoses, and whether a cystoscopy was performed. Surgical duration, and estimated blood loss were similar across BMI classes. Overweight and obese class III patients had lower odds of staying >1 day compared to patients of normal BMI (OR = 0.65, P = .015). Obese class II patients had fewer complications compared to normal BMI patients (OR = 0.27, P = .013), but patients from other high BMI categories did not show any difference compared to patients with normal BMI. The rate of unplanned laparotomy was statistically, but not clinically, higher in obese class III patients (1.8% versus .7%, P = 0.011), most often due to large fibroids. The mean reoperation rate was 2.7%, with the lowest rate (.5%) among obese class II patients, and the highest rate (3.9%) among the normal BMI patients. Conclusion:TLH is feasible and safe for obese women, regardless of BMI. Obesity is not a contraindication to good outcomes from laparoscopic surgery.

Ultrasound scan (USS) is an important tool for assessing and diagnosing early pregnancy and gynaecological emergencies. Providing an ultrasound scanning service at all hours would enable and ease prompt diagnosis and appropriate management. It would also help hospitals in reducing costs secondary to unnecessary admissions due to lack of ultrasound out of hours. We have conducted a retrospective observational study that looked into the out of hours admissions to a busy early pregnancy unit in a general district hospital, over a 3-month period. Our results highlight the important role and possible benefits of using ultrasound out of hours and prove it is a cost-effective approach. However, providing ultrasound scanning out of hours is affected by limitations of staff and resources at each unit. This could be avoided by following a multidisciplinary approach in acute services and providing more training for medical staff in ultrasound scanning.