Ito Traci E, Vargas Maria V, Moawad Gaby N, Opoku-Anane Jessica, Shu Michael K M, Marfori Cherie Q, Robinson James K
Department of Obstetrics and Gynecology, The George Washington University Hospital.
The George Washington University Hospital, and the George Washington University Medical School, Washington, DC, USA.
JSLS. 2017 Jan-Mar;21(1). doi: 10.4293/JSLS.2016.00098.
To assess the feasibility and safety of minimally invasive hysterectomy for uteri >1 kg.
Clinical and surgical characteristics were collected for patients in an academic tertiary care hospital. Included were patients who underwent minimally invasive hysterectomy by 1 of 3 fellowship-trained gynecologists from January 1, 2009, to July 1, 2015 and subsequently had confirmed uterine weights of 1 kg or greater on pathology report. Both robotic and conventional laparoscopic procedures were included.
During the study period, 95 patients underwent minimally invasive hysterectomy with confirmed uterine weight over 1 kg. Eighty-eight percent were performed with conventional laparoscopy and 12.6% with robot-assisted laparoscopy. The median weight (range) was 1326 g (range, 1000-4800). The median estimated blood loss was 200 mL (range, 50-2000), and median operating time was 191 minutes (range, 75-478). Five cases were converted to laparotomy (5.2%). Four cases were converted secondary to hemorrhage and one secondary to extensive adhesions. There were no conversions after 2011. Intraoperative transfusion was given in 6.3% of cases and postoperative transfusion in 6.3% of cases. However, after 2013, the rate of intraoperative transfusion decreased to 1.0% and postoperative transfusion to 2.1%. Of the 95 cases, there were no cases with malignancy.
This provides the largest case series of hysterectomy over 1 kg completed by a minimally invasive approach. Our complication rate improved with experience and was comparable to other studies of minimally invasive hysterectomy for large uteri. When performed by experienced surgeons, minimally invasive hysterectomy for uteri >1 kg can be considered feasible and safe.
评估对子宫重量超过1千克的患者实施微创子宫切除术的可行性与安全性。
收集一家学术性三级护理医院患者的临床及手术特征。纳入2009年1月1日至2015年7月1日期间由3名经过专科培训的妇科医生之一实施微创子宫切除术且病理报告证实子宫重量为1千克或更重的患者。纳入了机器人辅助手术及传统腹腔镜手术。
在研究期间，95例患者接受了微创子宫切除术，且子宫重量经证实超过1千克。88%的手术采用传统腹腔镜手术，12.6%采用机器人辅助腹腔镜手术。中位数重量（范围）为1326克（范围为1000 - 4800克）。估计失血量中位数为200毫升（范围为50 - 2000毫升），手术时间中位数为191分钟（范围为75 - 478分钟）。5例转为开腹手术（5.2%）。4例因出血转为开腹，1例因广泛粘连转为开腹。2011年后无转为开腹的情况。6.3%的病例术中输血，6.3%的病例术后输血。然而，2013年后，术中输血率降至1.0%，术后输血率降至2.1%。95例病例中无恶性肿瘤病例。
这提供了通过微创方法完成的子宫重量超过1千克的子宫切除术的最大病例系列。随着经验积累，我们的并发症发生率有所改善，与其他关于大型子宫微创子宫切除术的研究相当。由经验丰富的外科医生实施时，对子宫重量超过1千克的患者进行微创子宫切除术可被认为是可行且安全的。
