Body Mass Index and Its Role in Total Laparoscopic Hysterectomy

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.

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Outcome of total laparoscopic hysterectomy in relation to the size of the uterus

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20185290 ◽

2018 ◽

Vol 8 (1) ◽

pp. 74 ◽

Cited By ~ 1

Author(s):

Virupakshi Ajjammanavar ◽

Vinodini P. ◽

Jayashree S.

Keyword(s):

Blood Loss ◽

Operative Time ◽

Laparoscopic Hysterectomy ◽

Total Laparoscopic Hysterectomy ◽

P Value ◽

Early Return ◽

Duration Of Surgery ◽

The Mean ◽

Group 2 ◽

Group 1

Background: Laparoscopic hysterectomy is a safe and feasible technique to manage benign uterine pathology as it offers minimal postoperative discomfort; with shorter hospital stay, rapid convalescence and early return to the activities of daily living. However, to date very few studies have been reported on safety and feasibility of total laparoscopic hysterectomy (TLH) in large sized uteri. The present study was planned to evaluate the intra-operative and post-operative parameters in relation to size of the uterus during TLH.Methods: This study was a comparative study. Fifty women with uterine size less than 12 weeks (Group 1) and fifty women with uterine size more than or equal to 12 weeks (Group 2) for whom TLH was planned for benign indications were included in the study. Intra-operative and post-operative parameters like blood loss, duration of surgery, post-operative pain and complications were compared between the two groups. Comparison was done using independent sample t test. A probability (‘p’ value) of less than or equal to 0.05 at 95% confidence interval was considered as statistically significant.Results: The mean age of the patients in both the groups was matched (44.82 years vs. 43.96 years). The mean operative time (48.80±14.12 minutes vs. 77.3±35.11 minutes; p <0.001) and blood loss (40.10±18.25ml vs. 70.6±65.46 ml; p=0.002) were significantly high in Group 2 compared to Group 1. The mean pain scores were similar in both the groups at 6 hours, 24 hours and at the time of discharge. No significant complications were noted in both the groups.Conclusions: TLH is safe, feasible and acceptable for large size uterus (>12 weeks). However, it is associated with longer operative time, and greater amount of blood loss.

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Total Laparoscopic Hysterectomy with Prior Uterine Artery Ligation at Its Origin

International Journal of Reproductive Medicine ◽

10.1155/2014/420926 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 6

Author(s):

Vidyashree Ganesh Poojari ◽

Vidya Vishwanath Bhat ◽

Ravishankar Bhat

Keyword(s):

Blood Loss ◽

Uterine Artery ◽

Laparoscopic Hysterectomy ◽

Total Laparoscopic Hysterectomy ◽

Artery Ligation ◽

Uterine Arteries ◽

Uterine Artery Ligation ◽

Duration Of Surgery ◽

Group A ◽

Group B

We compared the duration of surgery, blood loss, and complications between patients in whom both uterine arteries were ligated at the beginning of total laparoscopic hysterectomy (TLH) and patients in whom ligation was done after cornual pedicle. Using a prospective study in a gynecologic laparoscopic center, a total of 52 women who underwent TLH from June 2013 to January 2014 were assigned into two groups. In group A, uterine arteries were ligated after the cornual pedicles as done conventionally. In group B, TLH was done by ligating both uterine arteries at the beginning of the procedure. All the other pedicles were desiccated using harmonic scalpel or bipolar diathermy. Uterus with cervix was removed vaginally or by morcellation. The indication for TLH was predominantly dysfunctional uterine bleeding and myomas in both groups. In group A, the average duration of surgery was 71 minutes, when compared to 60 minutes in group B(P<0.001). In group A, the total blood loss was 70 mL, when compared to 43#x2009;mL in group B (Pvalue < 0.001). There were no major complications in both groups. To conclude, prior uterine artery ligation at its origin during TLH reduces the blood loss and surgical duration as well as the complications during surgery.

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Robotic partial nephrectomy for renal tumours in obese patients: Perioperative outcomes in a multi-institutional analysis

Canadian Urological Association Journal ◽

10.5489/cuaj.3197 ◽

2015 ◽

Vol 9 (11-12) ◽

pp. 859 ◽

Cited By ~ 12

Author(s):

Newaj Abdullah ◽

Deepansh Dalela ◽

Ravi Barod ◽

Jeff Larson ◽

Michael Johnson ◽

...

Keyword(s):

Regression Analysis ◽

Blood Loss ◽

Partial Nephrectomy ◽

Operative Time ◽

Independent Predictor ◽

Operating Time ◽

Perioperative Outcomes ◽

Robotic Partial Nephrectomy ◽

Obese Patients ◽

Estimated Blood Loss

Introduction: We sought to evaluate the association of obesity with surgical outcomes of robotic partial nephrectomy (RPN) using a large, multicentre database. Methods: We identified 1836 patients who underwent RPN from five academic centres from 2006-2014. A total of 806 patients were obese (body mass index [BMI] ≥30 kg/m2). Patient characteristics and outcomes were compared between obese and non-obese patients. Multivariable analysis was used to assess the association of obesity on RPN outcomes.Results: A total of 806 (44%) patients were obese with median BMI of 33.8kg/m2. Compared to non-obese patients, obese patients had greater median tumour size (2.9 vs. 2.5 cm, p<0.001), mean RENAL nephrometry score (7.3 vs. 7.1, p = 0.04), median operating time (176 vs. 165 min, p=0.002), and median estimated blood loss (EBL, 150 vs. 100 ml, p=0.002), but no difference in complications. Obesity was not an independent predictor of operative time or EBL on regression analysis. Among obese patients, males had a greater EBL (150 vs. 100 ml, p<0.001), operative time (180 vs. 166 min, p<0.001) and warm ischemia time (WIT, 20 vs. 18, p=0.001) and male sex was an independent predictor of these outcomes on regression analysis.Conclusion: In this large, multicentre study on RPN, obesity was not associated with increased complications and was not an independent predictor of operating time or blood loss. However, in obese patients, male gender was an independent predictor of greater EBL, operative time, and WIT. Our results indicate that obesity alone should not preclude consideration for RPN.

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Total laparoscopic hysterectomy for benign, malignant and pre-malignant gynaecological pathology: relation between surgical outcome and body mass index

Gynecological Surgery ◽

10.1007/s10397-016-0968-y ◽

2016 ◽

Vol 13 (4) ◽

pp. 493-497

Author(s):

Vasileios Minas ◽

Claudia Ventii ◽

Nicola Murray ◽

Thomas Aust ◽

David Rowlands ◽

...

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Surgical Outcome ◽

Laparoscopic Hysterectomy ◽

Total Laparoscopic Hysterectomy

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Effect of Body Mass Index on Robotic-Assisted Total Laparoscopic Hysterectomy

Journal of Minimally Invasive Gynecology ◽

10.1016/j.jmig.2011.01.009 ◽

2011 ◽

Vol 18 (3) ◽

pp. 328-332 ◽

Cited By ~ 29

Author(s):

A. Karim Nawfal ◽

Mona Orady ◽

David Eisenstein ◽

Ganesa Wegienka

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Laparoscopic Hysterectomy ◽

Total Laparoscopic Hysterectomy ◽

Robotic Assisted

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Laparoscopic Sleeve Gastrectomy for Mildly Obese Patients (Body Mass Index of 30 <35 kg/m2): Operative Outcome and Short-Term Results

Journal of Obesity ◽

10.1155/2012/813650 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 10

Author(s):

Roger Noun ◽

Ghassan Chakhtoura ◽

Marwan Nasr ◽

Judith Skaff ◽

Naîm Choucair ◽

...

Keyword(s):

Body Mass Index ◽

Sleeve Gastrectomy ◽

Laparoscopic Sleeve Gastrectomy ◽

Body Mass ◽

Operative Time ◽

Excess Weight ◽

Obese Patients ◽

Short Term ◽

Preoperative Body Mass Index ◽

Mild Obesity

Background. Data concerning laparoscopic sleeve gastrectomy (LSG) in mild obesity are under investigation.Aim/Objective. May 2010 to May 2012, 122 consecutive patients with preoperative body mass index (BMI) of33±2.5 kg/m2(range 30–34.9) undergoing LSG were studied. Mean age was33±10years (range 15–60), and 105 (86%) were women. Mean preoperative weight was91±9.7 kg (range 66–121), and preoperative excess weight was30±6.7 kg (range 19–43). Comorbidities were detected in 44 (36%) patients.Results. Mean operative time was58±15 min (range 40–95), and postoperative stay was1.8±0.19days (range 1.5–3). There were no admissions to intensive care unit and no deaths within 30 days of surgery. The rates of leaks and strictures were 0%, and of hemorrhage 1.6%. At 12 months, BMI decreased to24.7±2, and the percentage of excess weight loss (% EWL) reached 76.5%. None of the patients had a BMI below 20 kg/m2. Comorbidities resolved in 70.5% or improved in 29.5%. Patient satisfaction scoring (1–5) at least 1 year after was4.6±0.8for body image and4.4±0.6for food tolerance.Conclusion. LSG for mildly obese patients has proved to be technically relatively easy, safe, and benefic in the short term.

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Polymeric clips are a quicker and cheaper alternative to endoscopic ligatures for securing the appendiceal stump during laparoscopic appendicectomy

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2018.0036 ◽

2018 ◽

Vol 100 (6) ◽

pp. 454-458 ◽

Cited By ~ 3

Author(s):

MSJ Wilson ◽

P Maniam ◽

A Ibrahim ◽

N Makaram ◽

SR Knight ◽

...

Keyword(s):

Body Mass Index ◽

Hospital Stay ◽

Body Mass ◽

Operative Time ◽

Controlled Trial ◽

Operating Time ◽

Antibiotic Use ◽

Laparoscopic Appendicectomy ◽

Duration Of Surgery ◽

Appendiceal Stump

Introduction The use of polymeric clips in securing the appendiceal stump has been increasingly reported as a viable alternative to current methods in emergency laparoscopic appendicectomy. We evaluated the operative outcomes following the use of polymeric clips versus endoscopic ligatures. The primary endpoint was operative time, with secondary outcomes including complications, inpatient stay, and cost analysis. Materials and methods Operative records were retrospectively analysed to identify patients undergoing laparoscopic appendicectomy between January 2014 and June 2015. Data collected included age, gender, body mass index, duration of surgery, length of hospital stay, antibiotic use, preoperative haematological and biochemical parameters, 30-day readmission rate and complications. Results A total of 125 patients were included within the study, with 78 within the endoloop group and 47 in the polymeric clip group. There were no differences in age, gender, body mass index, hospital stay, antibiotic use, 30-day readmission rates or postoperative complications. Operative time was significantly reduced in the polymeric clip group (59 vs. 68 minutes, P = 0.00751). The use of polymeric clips cost £21 compared with £49 for endoloops per operation, which rose to £70 if both clips and endoloops were used during the procedure. Discussion Polymeric clips are a safe, viable and economical method for securing the appendiceal stump during laparoscopic appendicectomy. The clinical significance of nine minutes of reduced operating time in the polymeric clip cohort warrants further study with an adequately powered randomised controlled trial.

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Effect of Body Mass Index on Robotic-Assisted Total Laparoscopic Hysterectomy

Journal of Minimally Invasive Gynecology ◽

10.1016/j.jmig.2010.08.682 ◽

2010 ◽

Vol 17 (6) ◽

pp. S106

Author(s):

A.K. Nawfal ◽

M. Orady ◽

D. Eisenstein ◽

G. Wegienka

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Laparoscopic Hysterectomy ◽

Total Laparoscopic Hysterectomy ◽

Robotic Assisted

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A Comparative Study of the Influence of Body Mass Index on Clinical Outcomes of Total Laparoscopic Hysterectomy in Birat Medical College Teaching Hospital, Morang, Nepal

Birat Journal of Health Sciences ◽

10.3126/bjhs.v6i1.37642 ◽

2021 ◽

Vol 6 (1) ◽

pp. 1383-1387

Author(s):

Bhanubhakta Neupane ◽

Gyanendra Man Singh Karki ◽

Hanoon P Pokharel ◽

Prerana Dahal ◽

Garima Bhandari

Keyword(s):

Body Mass Index ◽

Postoperative Complications ◽

Body Mass ◽

Teaching Hospital ◽

College Teaching ◽

Laparoscopic Hysterectomy ◽

Total Laparoscopic Hysterectomy ◽

Medical College ◽

Increased Risk ◽

High Bmi

Introduction: Although laparoscopy is a safe route of hysterectomy as it provides battier view of abdominal anatomy, facilitates meticulous hemostasis and reduces surgical morbidity, laparoscopic hysterectomy in overweight and obese women may pose an increased risk of intraoperative and postoperative complications as omental fat and limited manipulation of instruments may render operation difficult. Objectives: The aim of the study is to evaluate the impact of Body Mass Index (BMI) on the clinical outcome of total laparoscopichysterectomy. Methodology: This is a comparative cross-sectional study conducted in 190 patients who underwent total laparoscopic hysterectomy (TLH) in Department of Obstetrics and Gynecology of Birat Medical College, Teaching Hospital from July, 2019 to November 2020.Ninety five patients were enrolled in high BMI group and normal BMI group each Result: Mean BMI was 28.90±2.27 ( Kg/M2)in high BMI group and 23.54 ± 1.14 (Kg/M2)in normal BMI group. Urinary tract injury occurred in 4 (4.21%) cases in high BMI group and 2 (2.1%) cases in normal BMI group. Intraoperative and immediate postoperative complication were similar in both groups. Conclusion: Intraoperative and postoperative complications were similar in both the groups. Patients with high BMI have no increased risk of complications during total laparoscopic hysterectomy.

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Laparoscopic versus open hysterectomies in obese patients

International Surgery Journal ◽

10.18203/2349-2902.isj20185014 ◽

2018 ◽

Vol 5 (12) ◽

pp. 3893

Author(s):

Soliman A. El Shakhs ◽

Moharam A. Mohamed ◽

Mahmoud A. Shahin ◽

Ahmed M. Eid

Keyword(s):

Blood Loss ◽

Surgical Procedure ◽

Operative Time ◽

Laparoscopic Hysterectomy ◽

Obese Patients ◽

Optimal Route ◽

Significant Difference ◽

Group A ◽

Prospective Comparative Study ◽

Group B

Background: Hysterectomy is one of the most frequently performed surgical procedure. Though there are three approaches in hysterectomy (open, vaginal and laparoscopic), still there are controversies regarding the optimal route for performing it.Methods: This prospective comparative study included 42 obese patients subjected for pan-hysterectomy as a treatment. The forty-two patients were allocated into two groups: group (A) subjected to laparoscopic pan-hysterectomy, group (B) subjected to open pan-hysterectomy.Results: There was significant difference between the two groups regarding mean operative time, blood loss, analgesic requirements and hospital stay, while no significant difference regarding intra-operative complications.Conclusions: Laparoscopic hysterectomy in obese patients has emerged as a viable, safe and better alternative to open hysterectomy amongst appropriately trained surgeons.

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