Gupta Natasha, Miranda Blevins D O, Holcombe Jenny, Furr Robert Scott
Department of Minimally Invasive Gynecologic Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee, USA.
Gynecol Minim Invasive Ther. 2020 Apr 28;9(2):59-63. doi: 10.4103/GMIT.GMIT_68_19. eCollection 2020 Apr-Jun.
Minimally invasive gynecologic surgery (MIGS) is the standard of care in performing hysterectomy for benign conditions. However, the choice of laparoscopic modality is largely dependent on surgeon's discretion, experience, and equipment availability. The objective of this study is: To compare outcomes between different minimally invasive approaches available for benign hysterectomies and to evaluate patient factors that influence the use of one approach over another. With this study, we sought to provide some objective criteria while deciding the appropriate MIGS technique.
This is a retrospective study comparing perioperative outcomes between three techniques of minimally invasive hysterectomy: laparoscopy (LSC), multiport daVinci (MP-Rob) and single-site daVinci (SS-Rob). Patients undergoing benign hysterectomy (daVinci or conventional LSC) from January 2015 to July 2016 were included. 129 patients were identified and divided into: LSC ( = 44), MP-Rob ( = 36) and SS-Rob ( = 49).
There were statistically significant differences in age (MP-Rob46 ≠ LSC39), body mass index (BMI) (MP-Rob33 ≠ LSC27 or SS-Rob26.8), uterus weight (MP-Rob144 ≠ LSC102 or SS-Rob105) and operative time (LSC192 ≠ SS-Rob162.3 or MP-Rob163). Chi-square analyses revealed history of endometriosis and clinical endometriosis was statistically less common while leiomyomas were more common indications of MP-Rob. There was no statistically significant difference noted between length of stay, estimated blood loss, intraoperative, and post-operative complications between different surgical types.
Patients with higher age, BMI, uterus weight and abnormal uterine bleeding were noted to undergo MP-Rob surgery. Patients with history of endometriosis were more likely to undergo LSC or SS-Rob surgery. Operative time was significantly less for daVinci hysterectomies (SS-Rob and MP-Rob) as compared to conventional LSC.
微创妇科手术（MIGS）是良性疾病子宫切除术的标准治疗方法。然而，腹腔镜手术方式的选择很大程度上取决于外科医生的判断、经验和设备可用性。本研究的目的是：比较可用于良性子宫切除术的不同微创方法的结果，并评估影响选择一种方法而非另一种方法的患者因素。通过本研究，我们试图在决定合适的MIGS技术时提供一些客观标准。
这是一项回顾性研究，比较了三种微创子宫切除术技术的围手术期结果：腹腔镜手术（LSC）、多端口达芬奇手术（MP-Rob）和单端口达芬奇手术（SS-Rob）。纳入2015年1月至2016年7月接受良性子宫切除术（达芬奇手术或传统LSC）的患者。共识别出129例患者并分为：LSC组（n = 44）、MP-Rob组（n = 36）和SS-Rob组（n = 49）。
年龄（MP-Rob组46岁≠LSC组39岁）、体重指数（BMI）（MP-Rob组33≠LSC组27或SS-Rob组26.8）、子宫重量（MP-Rob组144≠LSC组102或SS-Rob组105）和手术时间（LSC组192分钟≠SS-Rob组162.3分钟或MP-Rob组163分钟）存在统计学显著差异。卡方分析显示，子宫内膜异位症病史和临床子宫内膜异位症在统计学上不太常见，而平滑肌瘤是MP-Rob组更常见的适应症。不同手术类型之间的住院时间、估计失血量、术中及术后并发症无统计学显著差异。
年龄较大、BMI较高、子宫重量较大且有异常子宫出血的患者接受MP-Rob手术。有子宫内膜异位症病史的患者更有可能接受LSC或SS-Rob手术。与传统LSC相比，达芬奇子宫切除术（SS-Rob和MP-Rob）的手术时间明显更短。
