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Research paper
Published online: 2021-05-21
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Impact of clinicopathological variables on laparoscopic hysterectomy complications, a tertiary center experience

Utku Akgör1, Oğuzhan Kuru2, Ali Can Güneş1, Esra Karataş1, B. Esat Temiz1, B. Emre Erzeneoğlu1, Murat Gültekin1, M. Coşkun Salman1, Z. Selçuk Tuncer1, Nejat Özgül1
DOI: 10.5603/GP.a2021.0097
·
Pubmed: 34105742
Affiliations
  1. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
  2. Tepecik Training And Research Hospital, Division of Gynecologic Oncology, Izmir, Turkey

open access

Ahead of Print
ORIGINAL PAPERS Gynecology
Published online: 2021-05-21

Abstract

Objectives: To analyze intraoperative and postoperative complications according to Clavian-Dindo Classification (CDC) and evaluate the influence of clinicopathological features on the feasibility and safety of total laparoscopic hysterectomy (TLH) in patients that underwent surgery in a tertiary center.

Material and methods: We retrospectively reviewed the database of 469 patients that underwent surgery for patients who underwent extra facial TLH from 2013 to 2020.

Results: A total of 86 (18.3%) peri-postoperative complications were observed. The incidence of intraoperative complications was 2% (n = 10). The overall conversion rate to open surgery was 1.9% (n = 9). A total of 76 postoperative complications were observed in 61 patients (14.3%). The incidence of minor (Grade I [n = 16, 3.4%] and II [n = 42, 8.9%]) and major complications (Grade III [n = 15, 3.2%], IV [n = 2, 0.4%] and V [n = 1, 0.2 %]) were 12.3% and 3.8%, respectively.

A higher BMI and performing surgery at the first step of learning are found to be associated with intraoperative and postoperative complications (p < 0.05). Postoperative complications related to having a history of the cesarean section, additional comorbidities, and uterine weight ≥ 300 g (p < 0.05).

Conclusions: The implementation of TLH by experienced surgeons appears to have remarkable advantages over open surgery. However, the risk factor for complications should be taken into account by surgeons in the learning curve in selecting the appropriate patient for surgery.

Abstract

Objectives: To analyze intraoperative and postoperative complications according to Clavian-Dindo Classification (CDC) and evaluate the influence of clinicopathological features on the feasibility and safety of total laparoscopic hysterectomy (TLH) in patients that underwent surgery in a tertiary center.

Material and methods: We retrospectively reviewed the database of 469 patients that underwent surgery for patients who underwent extra facial TLH from 2013 to 2020.

Results: A total of 86 (18.3%) peri-postoperative complications were observed. The incidence of intraoperative complications was 2% (n = 10). The overall conversion rate to open surgery was 1.9% (n = 9). A total of 76 postoperative complications were observed in 61 patients (14.3%). The incidence of minor (Grade I [n = 16, 3.4%] and II [n = 42, 8.9%]) and major complications (Grade III [n = 15, 3.2%], IV [n = 2, 0.4%] and V [n = 1, 0.2 %]) were 12.3% and 3.8%, respectively.

A higher BMI and performing surgery at the first step of learning are found to be associated with intraoperative and postoperative complications (p < 0.05). Postoperative complications related to having a history of the cesarean section, additional comorbidities, and uterine weight ≥ 300 g (p < 0.05).

Conclusions: The implementation of TLH by experienced surgeons appears to have remarkable advantages over open surgery. However, the risk factor for complications should be taken into account by surgeons in the learning curve in selecting the appropriate patient for surgery.

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Keywords

otal laparoscopic hysterectomy; complication; learning curve; Clavian-Dindo classification

About this article
Title

Impact of clinicopathological variables on laparoscopic hysterectomy complications, a tertiary center experience

Journal

Ginekologia Polska

Issue

Ahead of Print

Article type

Research paper

Published online

2021-05-21

DOI

10.5603/GP.a2021.0097

Pubmed

34105742

Keywords

otal laparoscopic hysterectomy
complication
learning curve
Clavian-Dindo classification

Authors

Utku Akgör
Oğuzhan Kuru
Ali Can Güneş
Esra Karataş
B. Esat Temiz
B. Emre Erzeneoğlu
Murat Gültekin
M. Coşkun Salman
Z. Selçuk Tuncer
Nejat Özgül

References (28)
  1. Hammer A, Rositch AF, Kahlert J, et al. Global epidemiology of hysterectomy: possible impact on gynecological cancer rates. Am J Obstet Gynecol. 2015; 213(1): 23–29.
  2. Kluivers KB. Women's preference for laparoscopic or abdominal hysterectomy. Gynecol Surg. 2009; 6(3): 223–228.
  3. He H, Yang Z, Zeng D, et al. Comparison of the short-term and long-term outcomes of laparoscopic hysterectomies and of abdominal hysterectomies: a case study of 4,895 patients in the Guangxi Zhuang Autonomous Region, China. Chinese Journal of Cancer Research. 2016; 28(2): 187–196.
  4. Ray M, Kumar N, Kuppusamy R. The red alert zone in pelvis for radical hysterectomy: the precise anatomy and safe surgical technique. Journal of Gynecologic Surgery. 2020; 36(4): 194–197.
  5. Garry R, Fountain J, Mason Su, et al. The eVALuate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy. BMJ. 2004; 328(7432): 129.
  6. Liang C, Liu P, Cui Z, et al. Effect of laparoscopic versus abdominal radical hysterectomy on major surgical complications in women with stage IA-IIB cervical cancer in China, 2004–2015. Gynecol Oncol. 2020; 156(1): 115–123.
  7. Aarts JWM, Nieboer TE, Johnson N. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database of Systematic Reviews. 2015; 8: CD003677.
  8. Benson CR, Thompson S, Li G, et al. Bladder and ureteral injuries during benign hysterectomy: an observational cohort analysis in New York State. World J Urol. 2020; 38(8): 2049–2054.
  9. Terzi H, Biler A, Demirtas O, et al. Total laparoscopic hysterectomy: Analysis of the surgical learning curve in benign conditions. Int J Surg. 2016; 35: 51–57.
  10. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240(2): 205–213.
  11. Ghomi A, Littman P, Prasad A, et al. Assessing the learning curve for laparoscopic supracervical hysterectomy. JSLS. 2007; 11(2): 190–194.
  12. Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992; 111(5): 518–526.
  13. Hwang JH. Urologic complication in laparoscopic radical hysterectomy: meta-analysis of 20 studies. Eur J Cancer. 2012; 48(17): 3177–3185.
  14. Wong JMK, Bortoletto P, Tolentino J, et al. Urinary tract injury in gynecologic laparoscopy for benign indication: a systematic review. Obstet Gynecol. 2018; 131(1): 100–108.
  15. Uppal S, Liu JR, Kevin Reynolds R, et al. Trends and comparative effectiveness of inpatient radical hysterectomy for cervical cancer in the United States (2012–2015). Gynecol Oncol. 2019; 152(1): 133–138.
  16. Siedhoff MT, Carey ET, Findley AD, et al. Effect of extreme obesity on outcomes in laparoscopic hysterectomy. J Minim Invasive Gynecol. 2012; 19(6): 701–707.
  17. Mamik MM, Antosh D, White DE, et al. Risk factors for lower urinary tract injury at the time of hysterectomy for benign reasons. Int Urogynecol J. 2014; 25(8): 1031–1036.
  18. Brummer THI, Jalkanen J, Fraser J, et al. FINHYST, a prospective study of 5279 hysterectomies: complications and their risk factors. Human Reproduction. 2011; 26(7): 1741–1751.
  19. Uccella S, Cromi A, Serati M, et al. Laparoscopic hysterectomy in case of uteri weighing ≥1 kilogram: a series of 71 cases and review of the literature. J Minim Invasive Gynecol. 2014; 21(3): 460–465.
  20. Morgan-Ortiz F, Soto-Pineda JM, López-Zepeda MA, et al. Effect of body mass index on clinical outcomes of patients undergoing total laparoscopic hysterectomy. Int J Gynaecol Obstet. 2013; 120(1): 61–64.
  21. Chopin N, Malaret JM, Lafay-Pillet MC, et al. Total laparoscopic hysterectomy for benign uterine pathologies: obesity does not increase the risk of complications. Hum Reprod. 2009; 24(12): 3057–3062.
  22. Twijnstra ARH, Blikkendaal MD, van Zwet EW, et al. Clinical relevance of conversion rate and its evaluation in laparoscopic hysterectomy. J Minim Invasive Gynecol. 2013; 20(1): 64–72.
  23. Galvis JN, Vargas MV, Robinson HN, et al. Impact of chronic obstructive pulmonary disease on laparoscopic hysterectomy outcome. JSLS. 2019; 23(1): e2018.00089.
  24. Chiu LH, Chen CH, Tu PC, et al. Comparison of robotic surgery and laparoscopy to perform total hysterectomy with pelvic adhesions or large uterus. J Minim Access Surg. 2015; 11(1): 87–93.
  25. Bonilla DJ, Mains L, Whitaker R, et al. Uterine weight as a predictor of morbidity after a benign abdominal and total laparoscopic hysterectomy. J Reprod Med. 2007; 52(6): 490–498.
  26. Terzi H, Hasdemir PS, Biler A, et al. Evaluation of the surgical outcome and complications of total laparoscopic hysterectomy in patients with enlarged uteruses. Int J Surg. 2016; 36(Pt A): 90–95.
  27. Macciò A, Chiappe G, Kotsonis P, et al. Surgical outcome and complications of total laparoscopic hysterectomy for very large myomatous uteri in relation to uterine weight: a prospective study in a continuous series of 461 procedures. Arch Gynecol Obstet. 2016; 294(3): 525–531.
  28. Naveiro-Fuentes M, Rodríguez-Oliver A, Fernández-Parra J, et al. Effect of surgeon's experience on complications from laparoscopic hysterectomy. J Gynecol Obstet Hum Reprod. 2018; 47(2): 63–67.

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