Berlit Sebastian, Hornemann Amadeus, Sütterlin Marc, Weiss Christel, Tuschy Benjamin
Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Arch Gynecol Obstet. 2017 Jan;295(1):125-131. doi: 10.1007/s00404-016-4215-6. Epub 2016 Oct 13.
To evaluate the influence of three-dimensional (3D) high-definition (HD) visualisation in laparoscopic hysterectomy in normal weight, overweight and obese women.
A retrospective analysis of 180 patients undergoing total laparoscopic hysterectomy (TLH: n = 90) or laparoscopic supracervical hysterectomy (LASH: n = 90) was performed. The study collective consisted of 90 women (TLH: n = 45, LASH: n = 45), who underwent laparoscopic hysterectomy with a 3D HD laparoscopic system. Ninety matched (uterine weight, previous surgeries) women with hysterectomy (TLH: n = 45, LASH: n = 45) performed by the same surgeon with conventional two-dimensional laparoscopy formed the control group. Statistical analysis was accomplished stratifying patients according to body mass index (BMI) (≤24.9, 25-29.9, ≥30.0 kg/m). In each BMI, collective subtypes of surgery (TLH, LASH) as well as hysterectomies as a whole were analysed. Demographic data and surgical parameters were evaluated.
In all BMI subgroups, there were no significant differences concerning demographic parameters. Number of trocar site incisions needed was significantly less in women undergoing 3D compared to 2D laparoscopy independent of BMI. Furthermore, a significantly lower blood loss was revealed using 3D visualisation in LASH subgroups of the normal and overweight collectives. Three-dimensional laparoscopy was additionally associated with a significantly shorter duration of surgery in the TLH subgroup in overweight patients and a lower haemoglobin drop in the LASH subgroup of the obese.
The need of less trocar site incisions concerning all weight groups as well.
评估三维（3D）高清（HD）可视化技术在正常体重、超重及肥胖女性腹腔镜子宫切除术中的影响。
对180例行全腹腔镜子宫切除术（TLH：n = 90）或腹腔镜次全子宫切除术（LASH：n = 90）的患者进行回顾性分析。研究对象包括90名女性（TLH：n = 45，LASH：n = 45），她们接受了3D HD腹腔镜系统下的腹腔镜子宫切除术。另外90名匹配（子宫重量、既往手术史）的接受同一外科医生传统二维腹腔镜手术的子宫切除术女性（TLH：n = 45，LASH：n = 45）组成对照组。根据体重指数（BMI）（≤24.9、25 - 29.9、≥30.0 kg/m²）对患者进行分层统计分析。在每个BMI组中，分析手术的集体亚型（TLH、LASH）以及整个子宫切除术情况。评估人口统计学数据和手术参数。
在所有BMI亚组中，人口统计学参数无显著差异。与二维腹腔镜手术相比，接受3D腹腔镜手术的女性所需的套管针穿刺切口数量显著减少，且与BMI无关。此外，在正常体重和超重人群的LASH亚组中，使用3D可视化技术显示出血量显著更低。在超重患者的TLH亚组中，三维腹腔镜手术还与显著缩短的手术时间相关，在肥胖患者的LASH亚组中与更低的血红蛋白下降相关。
所有体重组所需的套管针穿刺切口数量也更少。
