Total Laparoscopic Hysterectomy: Making It Safe and Successful for Obese Patients

O’Hanlan, Katherine A.; Emeney, Pamela L.; Frank, M.; Milanfar, Leila C; Sten, M.S.; Uthman, Kathryn F.

doi:10.4293/jsls.2020.00087

Cited by 7 publications

(8 citation statements)

References 23 publications

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“…It goes without saying that surgery, especially laparoscopic procedures, requires a trained team of professionals and appropriate equipment. Our operation time and blood loss were comparable with literature data for obese as well as for normal weight patients [10]. The patient was discharged on the third postoperative day, which is a day or two longer than the standard protocol for normal weight patients undergoing total laparoscopic hysterectomy.…”

Section: Discussionsupporting

confidence: 77%

“…At present, surgeons are still unfamiliar with laparoscopic operations on patients with a BMI > 40, possibly due to initial trocar entry, port placement, management of hypercarbia or a higher rate of laparotomy conversions. Nevertheless, laparoscopic surgery is more and more present even in the most severe cases [10]. It goes without saying that surgery, especially laparoscopic procedures, requires a trained team of professionals and appropriate equipment.…”

Section: Discussionmentioning

confidence: 99%

“…U ovom trenutku, hirurzi su još uvek nedovoljno upoznati sa laparoskopskim operacijama na pacijentima čiji je BMI > 40, možda zbog inicijalnog ulaza trokara, plasmana porta, kontrole hiperkapnije ili zbog više stope konverzije u otvorenu operaciju. Ipak, laparoskopske operacije su sve prisutnije čak i u najtežim slučajevima [10]. Podrazumeva se da je za izvođenje hirurških operacija, posebno laparoskopskih, potrebno imati stručno obučen tim i odgovarajuću tehničku opremu.…”

Section: Diskusijaunclassified

“…Podrazumeva se da je za izvođenje hirurških operacija, posebno laparoskopskih, potrebno imati stručno obučen tim i odgovarajuću tehničku opremu. Vreme trajanja naše operacije, kao i gubitak krvi kod pacijentkinje, komparabilni su sa podacima iz literature koji se odnose na gojazne ali i na pacijente normalne telesne mase [10]. Pacijentkinja je otpuštena iz bolnice trećeg postoperativnog dana, što je za jedan do dva dana duža hospitalizacija od standardnog protokola za pacijentkinje sa normalnom telesnom masom koje se podvrgavaju totalnoj laparoskopskoj histerektomiji.…”

Section: Diskusijaunclassified

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Extreme obesity and total laparoscopic hysterectomy: Case report

Dokić,

Šljivančanin,

Babić

et al. 2022

Srpski medicinski časopis Lekarske komore

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Introduction: Previously, the laparoscopic approach was not considered for obese people, because of the increased risk of operative and postoperative complications. In recent years, however, the approach has changed in favor of minimally invasive procedures that avoid laparotomy, which, in obese people, is the most common cause of complications, in the form of slower and aggravated wound healing, bleeding, and infections at the laparotomy site. In emergency situations, extreme obesity accompanied by multiple comorbidities still remains a real challenge for endoscopic surgery, the surgeon and the entire surgical and anesthesiology team. Case report: We present a case of a 61-year-old, extremely obese patient, who was admitted to hospital as an emergency case, due to prolonged vaginal bleeding and anemia. After preoperative preparation, the patient underwent surgery - laparoscopic total hysterectomy with bilateral salpingo-oophorectomy. Conclusion: Obesity is a major problem in modern society. In addition to directly affecting health, excessive body weight in a patient makes it very difficult to perform surgical procedures. The thickness of the abdominal wall and accompanying health problems are a contraindication for laparoscopic operations. In such cases, performing surgery, especially laparoscopic procedures, requires a trained team of professionals and appropriate equipment. Laparoscopic surgery is more and more present, even in the most difficult cases. In presenting this case, we aimed to demonstrate that it is possible to successfully perform total laparoscopic hysterectomy in extremely obese patients with associated health problems, even in emergency situations.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Section: Diskusijaunclassified

See 2 more Smart Citations

Extreme obesity and total laparoscopic hysterectomy: Case report

Dokić,

Šljivančanin,

Babić

et al. 2022

Srpski medicinski časopis Lekarske komore

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“…The median BMI of the operated women was approximately 22. Compared to patients with normal BMI, the high BMI patients who underwent TLH reported no particular increase in complications [ 28 ], which would be unlikely to account for the relatively low rate of organ damage in this study.…”

Section: Discussionmentioning

confidence: 79%

Does the experience of the first assistant affect organ injuries in laparoscopic hysterectomy for benign diseases?

Tsuzuki

Hirata

Tsuzuki

et al. 2022

Arch Gynecol Obstet

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Purpose This study sought to explore whether the experience level of the first assistant surgeon influences perioperative organ injuries (ureteral, bladder, and intestinal injuries) in patients undergoing total laparoscopic hysterectomy (TLH) for benign diseases. We defined an experienced surgeon as a surgeon certified by the Skill Qualification Committee of the Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy or a surgeon with equivalent surgical skills. Methods We reviewed our surgical registry database of TLH for benign indications between 2014 and 2020 and only selected cases performed by an experienced primary surgeon. Patients were divided into two groups based on the experience level of the first assistant. Inverse probability of treatment weighting by propensity score, which was adjusted for patient and procedure characteristics, was used to examine differences in perioperative organ injuries according to the experience level of the first assistant. Results Among 1682 patients who underwent TLH, 18 organ injuries were found (0.83%). In the propensity score inverse probability of treatment weighting models, less experience of the first assistant had no significant impact on the occurrence of perioperative organ injuries (p = 0.348). Conclusion In TLH for benign indications at our hospital, given an experienced primary surgeon, the inclusion of a less experienced first assistant does not negatively affect the occurrence of perioperative organ injuries.

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