Clinic for Minimal Invasive Surgery, Berlin-Zehlendorf, Germany.
Clinic for Gynecology and Breast Center, Universitätsklinikum Greifswald, Greifswald, Germany.
Acta Obstet Gynecol Scand. 2022 Dec;101(12):1450-1457. doi: 10.1111/aogs.14468. Epub 2022 Oct 6.
Hysterectomy now belongs to standard gynecological procedures. Moreover, a shift towards laparoscopic techniques is ever more apparent as they provide many advantages such as less traumatization and shorter convalescence. Large uteri are still mentioned as contraindications for laparoscopic hysterectomy even though those patients might benefit from the lower morbidity associated with minimal invasive techniques. In this study, the largest reported so far, we analyzed intraoperative and postoperative complications as well as the surgeon's experience of laparoscopic assisted supracervical hysterectomy (LASH) in patients with a uterus weight over 500 g.
The present retrospective study, between June 27, 1998 and August 31, 2019, evaluates 1274 patients with a uterus weight over 500 g who were treated with LASH for benign uterine diseases at the Clinic for Minimal Invasive Surgery (Berlin, Germany). All surgeries were performed by one of four in-house surgeons with experience in LASH: they had performed at least 500 LASH procedures before the study. Patients receiving surgical treatment for malignant tumors were not included in the study. Major and minor intraoperative and postoperative complications were recorded and evaluated. Additionally, medical files were evaluated for demographic data, American Society of Anesthesiologists score (I-IV), name of the surgeon, duration and indication for surgery, history of previous gynecological procedures and concomitant surgical interventions, weight of removed uterine tissue, duration of postoperative hospitalization in patients with complications, intraoperative conversion from laparoscopy to laparotomy, and malignancy rate.
The mean age was 47.0 ± 7.3 years and mean body mass index was 25.6 ± 7.1 kg/m . Average parity was 1.04 ± 1.57. Average uterus weight was 761.8 ± 317.9 g (500-4065 g). The mean duration of surgery was 96.9 ± 49.5 min; 54% of all patients were treated without concomitant intervention, conversion rate was 2.12%. The malignancy rate was 0.4% and the complication rate was 6.81% with 1.36% intraoperative complications and 5.45% postoperative complications.
The overall low complication and malignancy rates observed in this study allow us to present LASH as a safe and efficient alternative laparoscopic approach to remove uteri of any size in the hands of experienced surgeons.
子宫切除术现在属于标准的妇科手术。此外，腹腔镜技术的应用越来越广泛，因为它们具有创伤小、恢复时间短等优点。尽管这些患者可能受益于微创技术相关的较低发病率，但大型子宫仍被认为是腹腔镜子宫切除术的禁忌症。在这项迄今为止规模最大的研究中，我们分析了体重超过 500 克的患者行腹腔镜辅助经宫颈子宫切除术（LASH）的术中及术后并发症以及外科医生的经验。
本回顾性研究于 1998 年 6 月 27 日至 2019 年 8 月 31 日进行，评估了 1274 名体重超过 500 克的良性子宫疾病患者，他们接受了 LASH 治疗。所有手术均由 4 名具有 LASH 经验的内部外科医生之一进行：他们在研究前至少完成了 500 例 LASH 手术。未纳入接受恶性肿瘤手术治疗的患者。记录和评估了主要和次要的术中及术后并发症。此外，还评估了病历中的人口统计学数据、美国麻醉医师协会评分（I-IV）、外科医生姓名、手术持续时间和适应证、既往妇科手术史和同时进行的手术干预、切除子宫组织的重量、有并发症患者的术后住院时间、术中从腹腔镜转为剖腹手术以及恶性肿瘤发生率。
平均年龄为 47.0±7.3 岁，平均体重指数为 25.6±7.1 kg/m²。平均孕次为 1.04±1.57 次。平均子宫重量为 761.8±317.9 克（500-4065 克）。手术平均持续时间为 96.9±49.5 分钟；54%的患者未行同时干预，转化率为 2.12%。恶性肿瘤发生率为 0.4%，并发症发生率为 6.81%，其中术中并发症发生率为 1.36%，术后并发症发生率为 5.45%。
本研究观察到的总体低并发症和恶性肿瘤发生率使我们能够提出，在经验丰富的外科医生手中，LASH 是一种安全有效的替代腹腔镜方法，可用于切除任何大小的子宫。
