The Effect of Operative Time on Perioperative Morbidity After Laparoscopic Hysterectomy

2014 ◽  
Vol 123 ◽  
pp. 123S ◽  
Author(s):  
Tatiana Catanzarite ◽  
Sujata Saha ◽  
Matthew A. Pilecki ◽  
John Y. S. Kim ◽  
Magdy Milad
Keyword(s):  
Operative Time ◽  
Laparoscopic Hysterectomy ◽  
Perioperative Morbidity

scholarly journals Operative Time, Age, and Serum Albumin Predict Surgical Morbidity After Laparoscopic Liver Surgery

2021 ◽  
pp. 155335062199122
Author(s):  
Daniel Heise ◽  
Jan Bednarsch ◽  
Andreas Kroh ◽  
Sandra Schipper ◽  
Roman Eickhoff ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Surgery ◽  
Postoperative Morbidity ◽  
Operative Time ◽  
Multivariable Analysis ◽  
Operation Time ◽  
Laparoscopic Liver Surgery ◽  
Surgical Morbidity ◽  
Perioperative Morbidity ◽  
Preoperative Albumin

Background. Laparoscopic liver resection (LLR) has emerged as a considerable alternative to conventional liver surgery. However, the increasing complexity of liver resection raises the incidence of postoperative complications. The aim of this study was to identify risk factors for postoperative morbidity in a monocentric cohort of patients undergoing LLR. Methods. All consecutive patients who underwent LLR between 2015 and 2019 at our institution were analyzed for associations between complications with demographics and clinical and operative characteristics by multivariable logistic regression analyses. Results. Our cohort comprised 156 patients who underwent LLR with a mean age of 60.0 ± 14.4 years. General complications and major perioperative morbidity were observed in 19.9% and 9.6% of the patients, respectively. Multivariable analysis identified age>65 years (HR = 2.56; P = .028) and operation time>180 minutes (HR = 4.44; P = .001) as significant predictors of general complications (Clavien ≥1), while albumin<4.3 g/dl (HR = 3.66; P = .033) and also operative time (HR = 23.72; P = .003) were identified as predictors of major postoperative morbidity (Clavien ≥3). Conclusion. Surgical morbidity is based on patient- (age and preoperative albumin) and procedure-related (operative time) characteristics. Careful patient selection is key to improve postoperative outcomes after LLR.

scholarly journals Complications of Extended Endoscopic Endonasal Surgery in Elderly Patients

2018 ◽  
Vol 79 (S 03) ◽  
pp. S287-S288 ◽  
Author(s):  
Tyler Kenning ◽  
Carlos Pinheiro-Neto
Keyword(s):  
Cerebrospinal Fluid ◽  
Elderly Population ◽  
Operative Time ◽  
The Elderly ◽  
High Flow ◽  
Endoscopic Endonasal ◽  
Surgical Interventions ◽  
Perioperative Morbidity ◽  
Increased Risk ◽  
Cerebrospinal Fluid Leaks

AbstractExtended endoscopic endonasal procedures are not unique among surgical interventions in carrying increased risk in the elderly population. There are, however, components of the procedure, namely high-flow cerebrospinal fluid leaks, that do result in the potential for increased perioperative morbidity for these patients. We present the case of a 77-year-old male with a large invasive pituitary macroadenoma resected through a transplanum-transtuberculum-transsellar endonasal approach. A gross total resection was obtained with resolution of the patient's preoperative ophthalmologic deficits. One month postoperatively, the patient developed progressive lethargy and cranial imaging demonstrated a left convexity subacute subdural hematoma. This was evacuated through a twist drill craniostomy. Despite measures to limit the operative time of the initial endonasal procedure as well as the absence of a postoperative cerebrospinal fluid fistula, the patient still developed this complication. Along with more typical potential causes of postoperative decline following extended endonasal procedures, problems from high-flow intraoperative cerebrospinal fluid leaks alone can result in morbidity in the elderly population. This should be acknowledged preoperatively and a high suspicion should exist for the presence of intracranial hemorrhage in these patients with any postoperative deficits. Additional intraoperative measures can be utilized to minimize such risks.The link to the video can be found at: https://youtu.be/EkLmt2T8_UE.

scholarly journals Association between Obesity, Surgical Route, and Perioperative Outcomes in Patients with Uterine Cancer

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Entidhar Al Sawah ◽  
Jason L. Salemi ◽  
Mitchel Hoffman ◽  
Anthony N. Imudia ◽  
Emad Mikhail
Keyword(s):  
Vaginal Hysterectomy ◽  
Uterine Cancer ◽  
Temporal Trends ◽  
Laparoscopic Hysterectomy ◽  
Total Abdominal Hysterectomy ◽  
Perioperative Outcomes ◽  
Morbidly Obese ◽  
Improvement Program ◽  
Perioperative Morbidity ◽  
Laparoscopic Assisted Vaginal Hysterectomy

Objective. To study temporal trends of hysterectomy routes performed for uterine cancer and their associations with body mass index (BMI) and perioperative morbidity. Methods. A retrospective review of the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) 2005-2013 databases was conducted. All patients who were 18 years old and older with a diagnosis of uterine cancer and underwent hysterectomy were identified using ICD-9-CM and CPT codes. Surgical route was classified into four groups: total abdominal hysterectomy (TAH), total vaginal hysterectomy (TVH), laparoscopic assisted vaginal hysterectomy (LAVH), and total laparoscopic hysterectomy (TLH) including both conventional and robotically assisted. Patients were then stratified according to BMI. Results. 7199 records were included in the study. TLH was the most commonly performed route of hysterectomy regardless of BMI, with proportions of 50.9%, 48.9%, 50.4%, and 51.2% in ideal, overweight, obese, and morbidly obese patients, respectively. The median operative time for TAH was 2.2 hours compared to 2.7 hours for TLH (p < 0.01). The median length of stay for TAH was 3 days compared to 1 day for TLH (p < 0.01). The percentage of patients with an adverse outcome (composite indicator including transfusion, deep venous thrombosis, and infection) was 17.1 versus 3.7 for TAH and TLH, respectively (p < 0.01). Conclusion. During the last decade, TLH has been increasingly performed in women with uterine cancer. The increased adoption of TLH was seen in all BMI subgroups.

After Posterior Fusions for Adult Spinal Deformity, Operative Time is More Predictive of Perioperative Morbidity, Rather Than Surgical Invasiveness

Spine ◽  
2017 ◽  
Vol 42 (24) ◽  
pp. 1880-1887 ◽  
Author(s):  
Andre M. Samuel ◽  
Michael C. Fu ◽  
Nidharshan S. Anandasivam ◽  
Matthew L. Webb ◽  
Adam M. Lukasiewicz ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Operative Time ◽  
Adult Spinal Deformity ◽  
Perioperative Morbidity

scholarly journals A multimodal concept for vaginal cuff closure by modification of the Bakay technique in total laparoscopic hysterectomy: a randomized clinical study

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Üzeyir Kalkan ◽  
Kadir Bakay
Keyword(s):  
Hospital Stay ◽  
Operative Time ◽  
Laparoscopic Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Controlled Study ◽  
Complication Rates ◽  
Vaginal Cuff ◽  
Total Operative Time ◽  
Vaginal Length ◽  
Vaginal Cuff Closure

Abstract Background The aim of this study was to compare the outcomes of modified Bakay technique (MT) to standard colpotomy (ST) and cuff closure in total laparoscopic hysterectomy (TLH). Methods This two-centre, randomized-controlled study included a total of 160 patients who were scheduled for TLH for benign diseases (ClinicalTrials.gov Identifier is NCT05080114 and the first posted date was 15/10/2021). The patients were allocated into two groups by a computer-based randomization programme as ST group and MT group. Total operative time, cuff closure time, length of hospital stay, intra- and postoperative complications according to the Clavien-Dindo classification, pre- and postoperative vaginal length, and patient satisfaction according to the Patient Global Impression of Improvement (PGI-I) questionnaire were assessed. Results Seventy-seven patients in the ST group and 80 patients in the MT group underwent TLH. The total operative time was significantly shorter in the MT compared to the ST (55.5 vs. 59 min, respectively; p = 0.001). The median total operative time for colpotomy, extraction of uterus, and vaginal cuff closure steps was 9 (range 6–12 in MT vs. 6 to 11 in ST) min in both groups. The median hospital stay was 2 (range 1–4) days in both groups. Intraoperative blood loss was not significantly different between the groups (90 mL in ST vs. 80 mL in MT; p = 0.456). The mean uterine weight for the ST group and MT group was comparable (258.6 ± 88.6 g vs. 232.9 ± 102.5 g, respectively; p = 0.107). The preoperative vaginal length was not significantly different between the groups (p = 0.502). The median postoperative vaginal length was significantly higher in the MT group compared to the ST group on Day 90 (8 cm vs. 7,5 cm, respectively; p = 0.001). The PGI-I questionnaire score on Day 90 postoperatively was 2 (range 1–5) in both groups (p = 0.636). The complication rates were similar between the groups (p = 0.230). Conclusion The MT can be safely performed in most of the cases requiring TLH with the advantages of vaginal cuff closure before the alteration of pelvic anatomy, support to primary healing of the vaginal cuff, and routine concomitant apical support.

Operative Outcomes of Single-Incision Laparoscopic Hysterectomy vs Conventional Laparoscopic Total Hysterectomy: A Prospective Randomized Controlled Study

2021 ◽  
pp. 155335062110418
Author(s):  
Adel Fathi ◽  
Mahmoud M. Saleh ◽  
Mosab Shetiwy ◽  
Islam A. Elzahaby ◽  
Omar Farouk ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Postoperative Pain ◽  
Hospital Stay ◽  
Operative Time ◽  
Single Incision ◽  
Laparoscopic Hysterectomy ◽  
Controlled Study ◽  
Total Hysterectomy ◽  
Conventional Laparoscopic ◽  
Randomized Controlled

Background. Over time, there was an emerging need to shift from laparotomy to minimally invasive laparoscopic surgery, with the success of laparoscopic surgery in the last decade in gyne-oncology. Patients and Methods. This is a prospective randomized controlled trial conducted in Surgical Oncology Unit, Oncology Centre, Mansoura University, in the period between February 2016 and October 2019. Fifty female patients planned for total hysterectomy were randomized into two equal groups; the first underwent conventional laparoscopic hysterectomy (CLH), while the second underwent single-incision laparoscopic hysterectomy (SILH). Results. The mean operative time in the SILH group was 120.00 ± 28.72 minutes vs 103.20 ± 23.04 minutes in the CLH group ( P= .027). Median hospital stay in the SILH group was 1 day (range: 1–3 days), the same as that in the CLH group, with no statistical significance ( P= .384). Postoperative pain assessment using the Visual Analogue Scale (VAS) after 6 hours had a median score of 6 (2–8) in the SILH group and 6 (4–7) in the CLH group with significant increase in experienced pain in the SILH group ( P= .004), while no significant difference was noted after 12 hours and 24 hours in both SILH and CLH groups. Conclusion. Single-incision laparoscopic hysterectomy (SILH) has similar outcomes when compared to conventional laparoscopic hysterectomy as regard blood loss, hospital stay, conversion to laparotomy, intraoperative and postoperative complications with the disadvantages of longer operative time, increased surgeon’s workload, and relatively more postoperative pain.

scholarly journals A comparative study of non-descent vaginal hysterectomy and total laparoscopic hysterectomy

2020 ◽  
Vol 9 (2) ◽  
pp. 777
Author(s):  
Vijay Kansara ◽  
Jaydeep Chaudhari ◽  
Ajesh Desai
Keyword(s):  
Comparative Study ◽  
Hospital Stay ◽  
Vaginal Hysterectomy ◽  
Pap Smear ◽  
Operative Time ◽  
Laparoscopic Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Significant Difference ◽  
Operative Complications ◽  
Post Operative Complications

Background: Hysterectomy is the second most common operation performed by the gynecologists, next only to caesarean section. Objective of the study was to compare fall in blood haemoglobin level, duration of operation, intra- and post-op complications between non-descent vaginal hysterectomy and total laparoscopic hysterectomy and establish the better method for hysterectomy in non-descent uterus.Methods: A retrospective comparative study of 90 hysterectomies was done from a period of May 2018 - April 2019 at GMERS Medical College and Hospital Sola, with 45 cases in group of non-descent vaginal hysterectomy (NDVH) and 45 in group of total laparoscopic hysterectomy (TLH). Demographic characteristics, co-morbid conditions, indications for surgery, operative time, intra- operative blood loss, post-operative analgesia requirements, post-operative hospital stay and post-operative complications were compared between both groups. Those patients having malignancy as diagnosed by Pap smear or by D and C were excluded from the studyResults: The most common age in both groups was 41-50 years. Adenomyotic uterus was the most common indication for surgery in both groups. The mean operative time in NDVH group was 45 min while it was 80 min in TLH group. p<0.001 suggested significant difference when operative time were compared between both groups. Both groups were similar in post-operative analgesia requirement and post-operative hospital stay. Post-operative complications were similar in both groups.Conclusions: In which way to approach the uterus shall depend upon skill of the surgeon, size and pathological nature of uterus, technology available in the hospital and preference of patient as well as surgeon.

scholarly journals Body Mass Index and Its Role in Total Laparoscopic Hysterectomy

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Shilpa Bhandari ◽  
Pallavi Agrawal ◽  
Aparna Singh
Keyword(s):  
Body Mass Index ◽  
Blood Loss ◽  
Body Mass ◽  
Operative Time ◽  
Intraoperative Complications ◽  
Laparoscopic Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Perioperative Outcomes ◽  
Obese Patients ◽  
Duration Of Surgery

Objective. To evaluate operative and perioperative outcomes in patients undergoing total laparoscopic hysterectomy according to their body mass index. Method. A retrospective study was performed for patients undergoing total laparoscopic hysterectomy at a tertiary care center for a period of 4 years. Patients were divided into two groups: obese (BMI > 30 Kg/m2) and nonobese (BMI < 30 Kg/m2). Duration of surgery, intraoperative blood loss, successful laparoscopic completion, and intraoperative complications were compared in two groups. Result. A total of 253 patients underwent total laparoscopic hysterectomy from January 2010 to December 2013. Out of them, 105 women (41.5%) had a BMI of more than 30 kg/m2. Overall, the mean blood loss was 85.79 ± 54.17 mL; the operative time was 54.17 ± 19.83 min. The surgery was completed laparoscopically in 244 (96.4%) women while laparotomy was done in 4 cases and vaginal suturing and closure of vault were done in 5 cases. Risk of vaginal assistance was higher in obese patients whereas out of the 4 conversions to laparotomy 3 had BMI < 30 kg/m2. The operative time was increased as the BMI of patient increased. Conclusions. Total laparoscopic hysterectomy is a safe and effective procedure for obese patients and can be performed with an efficacy similar to that in nonobese patients.

scholarly journals Perioperative Outcomes Of Laparoscopic Hysterectomy: Comparison With Abdominal, Vaginal, And Robot-Assisted Surgical Approaches

2015 ◽  
Vol 8 (1) ◽  
pp. 52-60
Author(s):  
Slavcho T. Tomov ◽  
Grigor A. Gortchev ◽  
Latchesar S. Tantchev ◽  
Todor I. Dimitrov ◽  
Chavdar A. Tzvetkov ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Vaginal Hysterectomy ◽  
Operative Time ◽  
Laparoscopic Hysterectomy ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Perioperative Outcomes ◽  
Surgical Approaches ◽  
Significant Linear Correlation ◽  
The Mean

SummarySelection of an appropriate surgical method for hysterectomy in an individual patient is currently an issue that remains open and debatable. This study aimed to analyze perioperative outcomes in gynecologic patients who underwent laparoscopic hysterectomy at a single institution during a 6-year period and to compare the data for simple hysterectomy patients treated with different surgical approaches. The study included a retrospective analysis of demographics, pre- and post-operative characteristics of 1,023 patients, operated on using four types of simple hysterectomy approaches: 635 laparoscopic hysterectomies (62.1%), 289 total abdominal hysterectomies (28.3%), 45 total vaginal hysterectomies (4.4%) and 54 robotic-assisted hysterectomies (5.3%). For the laparoscopic hysterectomy group, the mean operative time was shorter as compared to the abdominal and vaginal hysterectomy groups (p<0.05), as well as a significantly shorter hospital length-of-stay when compared to the abdominal, robotic or vaginal hysterectomy groups (p<0.05). Regression analysis revealed significant linear correlation between operative time and body-mass index of laparoscopic hysterectomy patients (R2 =0.008; p=0.026). Complications emergence and hemotransfusion often prolonged the mean operative time significantly by 17.8 min (p=0.002) and 15.5 min, respectively (p<0.001). The rate of major complications was significantly higher in the laparoscopic vs. abdominal groups (p<0.05). Clinical outcomes in patients operated on with laparoscopic hysterectomy were better than in those operated with total abdominal and vaginal hysterectomy in terms of operative time and hospital length-of-stay. Prospective randomized multi-center studies would be desirable to further define the place of the modern minimally invasive hysterectomy approaches.

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