Outcomes of robotic, laparoscopic, and open hysterectomy for benign conditions in obese patients

Borahay, Mostafa A.; Tapisiz, Omer Lutfi; Alanbay, İbrahim; Kılıç, Gökhan

doi:10.4274/jtgga.2018.0018

Cited by 18 publications

(12 citation statements)

References 38 publications

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“…Similarly, average days of postopera ve hospital stay in obese pa ents a er 15 TLH was one day , ranging from 1-5 days. In another study by Otake A et al (2019), mean postopera ve hospital stay was 5 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13) days in normal BMI group, 5 (4-10) days in 3 overweight group and 5 (4-37 ) days in obese group. In our study, mean postopera ve hospital stay was 3.46±0.68 days (range: 3-6 days) in high BMI group and 3.05±0.47 days (range:3-4days), the difference was sta s cally not significant (p=0-74 Chopin N et al (2009) analyzed 1460 women who underwent TLH among which 1021(69.9%) had normal BMI, 338 (23.2%) were overweight pa ents and 101 (6.9%) were obese (BMI >30).…”

Section: Discussionmentioning

confidence: 91%

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A Comparative Study of the Influence of Body Mass Index on Clinical Outcomes of Total Laparoscopic Hysterectomy in Birat Medical College Teaching Hospital, Morang, Nepal

Neupane¹,

Karki²,

Pokharel³

et al. 2021

Birat J. Health Sci.

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Introduction: Although laparoscopy is a safe route of hysterectomy as it provides battier view of abdominal anatomy, facilitates meticulous hemostasis and reduces surgical morbidity, laparoscopic hysterectomy in overweight and obese women may pose an increased risk of intraoperative and postoperative complications as omental fat and limited manipulation of instruments may render operation difficult. Objectives: The aim of the study is to evaluate the impact of Body Mass Index (BMI) on the clinical outcome of total laparoscopichysterectomy. Methodology: This is a comparative cross-sectional study conducted in 190 patients who underwent total laparoscopic hysterectomy (TLH) in Department of Obstetrics and Gynecology of Birat Medical College, Teaching Hospital from July, 2019 to November 2020.Ninety five patients were enrolled in high BMI group and normal BMI group each Result: Mean BMI was 28.90±2.27 ( Kg/M2)in high BMI group and 23.54 ± 1.14 (Kg/M2)in normal BMI group. Urinary tract injury occurred in 4 (4.21%) cases in high BMI group and 2 (2.1%) cases in normal BMI group. Intraoperative and immediate postoperative complication were similar in both groups. Conclusion: Intraoperative and postoperative complications were similar in both the groups. Patients with high BMI have no increased risk of complications during total laparoscopic hysterectomy.

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Section: Discussionmentioning

confidence: 91%

“…These problems may be overcome by skilled surgeons, anesthe sts, and medical staff in the 3 opera ng room. Laparoscopic hysterectomies are feasible, safe, and provide shorter hospital stays and less blood loss in 5,13,14 the obese pa ent popula on.…”

Section: Discussionmentioning

confidence: 99%

A Comparative Study of the Influence of Body Mass Index on Clinical Outcomes of Total Laparoscopic Hysterectomy in Birat Medical College Teaching Hospital, Morang, Nepal

Neupane¹,

Karki²,

Pokharel³

et al. 2021

Birat J. Health Sci.

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“…In a different study, when a subgroup analysis of obese patients was done, procedure time was longer in RALH and LH ( P < .001). 22…”

Section: Discussionmentioning

confidence: 99%

Comparison of Robotic and Laparoscopic Hysterectomy for the Large Uterus

Sinha

Rupa

Sanjay

2019

JSLS

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Background and Objectives:We compared the outcome of robotic hysterectomy (RH) with laparoscopic hysterectomy (LH) for large uteri (≥16 weeks).Methods:This was a retrospective review over 5 years of 165 women (RH, 46; LH, 119). Demographic data, conversion, hemoglobin drop, indication, operating time, postoperative stay, and intra-operative strategies (adhesiolysis, myomectomy) were recorded.Results:Mean age was 45.7 ± 6.4 years and 44.5 ± 5.4 years (no diff) and body mass index was 30.2 ± 6.3 kg/m2 and 27.8 ± 4.8 kg/m2 (P = .009) in the RH and LH groups. There was no difference in percentage of women with previous laparotomy (RH, 15.2% vs LH, 13.4%) and mean number of lower-segment caesarean section (RH, 1.0 vs LH, 0.8). Mean size of uterus was similar (RH, 20.0 weeks vs LH, 17.4 weeks). The mean number of ports was higher in the RH group (RH, 4.2 vs LH, 3.4; P < .001) as was needed for adhesiolysis (RH, 71.7% vs LH, 35.3%; P < .001). Difficult bladder dissection was more in the RH group (56.5% vs 26.1%; P < .001). Vaginal morcellation was similar in both groups (RH, 89.1%; LH, 83.2%). RH took longer operating time (131.0 vs 110.6 minutes; P = .006). RH had less drop in Hb (1.0 vs 1.8 g/dL; P < .001) and remained the same after multiple regression analysis. Postoperative stay was similar in both groups (1.4 days). Requirement of intravenous analgesia was significantly lower in the RH group (12.5 vs 30.9 hours; P < .001). Open conversion rate was 4.3% (RH) and 10.9% (LH) but not significant.Conclusion:A higher body mass index, more adhesiolysis, and difficult bladder dissection imply a more challenging nature of women who underwent RH. Despite this, RH was shown to be feasible and safe with a lower blood loss.

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“…RH provides a 3D view, greater range of movement with wristed instruments, improved dexterity, higher stability, and fatigue-resistant properties allowing for better visualization and a more precise surgical technique [17,26,29]. Whereas, CLH uses the abdominal wall as leverage for movement, limiting mobility and causing more tissue damage at the abdominal wall [37].…”

Section: Advantages Of Rh Compared To Clhmentioning

confidence: 99%

Surgical and Patient Outcomes of Robotic Versus Conventional Laparoscopic Hysterectomy: A Systematic Review

Alshowaikh¹,

Karpinska-Leydier²,

Amirthalingam³

et al. 2021

Cureus

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Hysterectomy is a commonly performed gynecologic surgery that can be associated with significant morbidity and mortality. However, the evolution of the surgical approach, from open to minimally invasive gynecologic surgery (MIGS), has substantially improved patient outcomes by reducing perioperative complications, pain, and length of hospitalization. The evident advantages and the approval of the da Vinci Surgical System by the Food and Drug Administration led to the exponential rise in the use of MIGS. In particular, robotic hysterectomy (RH) witnessed unparalleled popularity compared to other MIGS despite the lack of strong evidence demonstrating its superiority. Therefore, we conducted a systematic review of the literature to evaluate and compare various patient and surgical outcomes of RH with conventional laparoscopic hysterectomy (CLH), including operating time, estimated blood loss, length of hospitalization, overall complications, survival, and cost. Overall, the outcomes were comparable between RH and CLH except concerning cost. RH is significantly more expensive than CLH due to the higher costs of robotic equipment, including disposable instruments, equipment maintenance, and sterilization. Although RH demonstrated comparable outcomes and higher costs, its technical advantages such as improved ergonomics, three-dimensional view, a wider range of wristed mobility, mechanical lifting of robot's hand, and greater stability might benefit patient subsets (e.g., obesity, large uterine weights >750 g). Therefore, large and multicentered randomized control trials are imperative to determine the most effective surgical approach between RH and other MIGS for different patient subsets.

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Outcomes of robotic, laparoscopic, and open hysterectomy for benign conditions in obese patients

Cited by 18 publications

References 38 publications

A Comparative Study of the Influence of Body Mass Index on Clinical Outcomes of Total Laparoscopic Hysterectomy in Birat Medical College Teaching Hospital, Morang, Nepal

A Comparative Study of the Influence of Body Mass Index on Clinical Outcomes of Total Laparoscopic Hysterectomy in Birat Medical College Teaching Hospital, Morang, Nepal

Comparison of Robotic and Laparoscopic Hysterectomy for the Large Uterus

Surgical and Patient Outcomes of Robotic Versus Conventional Laparoscopic Hysterectomy: A Systematic Review

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