Borahay Mostafa A, Tapısız Ömer Lütfi, Alanbay İbrahim, Kılıç Gökhan Sami
Department of Obstetrics and Gynecology, Johns Hopkins University, Maryland, USA
Department of Obstetrics and Gynecology, University of Texas Medical Branch, Texas, USA
J Turk Ger Gynecol Assoc. 2018 Jun 4;19(2):72-77. doi: 10.4274/jtgga.2018.0018. Epub 2018 Apr 27.
To compare outcomes of robotic-assisted (RAH), total laparoscopic hysterectomy (LH), and total abdominal hysterectomy (TAH) for benign conditions in obese patients.
Retrospective cohort (Class II-2) analysis. All obese patients who underwent RAH, LH or TAH for benign conditions by a single surgeon at the University of Texas Medical Branch between January 2009 and December 2011 were identified and their charts reviewed. The patients’ characteristics, operative data, and post-operative outcomes were collected and statistically analyzed.
A total of 208 patients who underwent RAH (n=51), LH (n=24) or TAH (n=133) were analyzed. There were no significant differences among the groups in demographic characteristics, indications for surgery or pathologic findings. RAH and LH were associated with lower estimated blood loss (EBL) (p<0.001) and shorter length of hospital stay (LOS) (p<0.001) compared with TAH. In addition, RAH and LH had lower intraoperative and early postoperative (≤6 weeks) complications compared with TAH (p=0.002). However, the procedure time was longer in RAH and LH (p<0.001). No significant differences were noted among the groups for late post-operative complications (after 6 weeks) or unscheduled post-operative visits.
Minimally invasive hysterectomy appears to be safe in obese patients with the advantages of less EBL, fewer intraoperative complications, and shorter LOS.
比较机器人辅助全子宫切除术（RAH）、全腹腔镜子宫切除术（LH）和经腹全子宫切除术（TAH）治疗肥胖患者良性疾病的疗效。
回顾性队列（II-2类）分析。确定2009年1月至2011年12月期间在德克萨斯大学医学分校由同一外科医生为良性疾病行RAH、LH或TAH的所有肥胖患者，并查阅其病历。收集患者的特征、手术数据和术后结果并进行统计学分析。
共分析了208例行RAH（n = 51）、LH（n = 24）或TAH（n = 133）的患者。各组在人口统计学特征、手术指征或病理结果方面无显著差异。与TAH相比，RAH和LH的估计失血量（EBL）较低（p < 0.001），住院时间（LOS）较短（p < 0.001）。此外，与TAH相比，RAH和LH的术中及术后早期（≤6周）并发症较低（p = 0.002）。然而，RAH和LH的手术时间较长（p < 0.001）。各组术后晚期并发症（6周后）或非计划术后就诊情况无显著差异。
微创子宫切除术在肥胖患者中似乎是安全的，具有EBL较少、术中并发症较少和LOS较短的优点。
