Risk Factors and Outcomes for Conversion to Laparotomy of Laparoscopic Hysterectomy in Benign Gynecology

Lim, Courtney S.; Mowers, Erika L.; Mahnert, Nichole; Skinner, Bethany; Kamdar, Neil; Morgan, Daniel M.; As‐Sanie, Sawsan

doi:10.1097/aog.0000000000001743

Cited by 45 publications

(41 citation statements)

References 19 publications

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“…Overall, almost 7,000 women underwent an attempted LH with 3.93% (n=275) converted to laparotomy. After adjusting for intra-operative associated-factors, hysterectomy indication, and socioeconomic differences, the authors observed a decreased odds of conversion to laparotomy with the use of robotic-assisted laparoscopy compared with conventional laparoscopy (adjusted odds ratio 0.14, 95% confidence interval 0.07–0.25) with a predicted risk of conversion of 0.8% compared with 5.4% ( P <0.001) 14 .…”

Section: Discussionmentioning

confidence: 95%

“…These results are in agreement with previous studies, which showed lack of evidence of RH benefits over other conventional techniques for benign uterine conditions but did show greater costs 1 , 12 , 13 . However, there was one study, by Lim et al 14 , that estimated the incidence and reasons for conversion to laparotomy in women submitted to LH for benign gynecologic indications. Overall, almost 7,000 women underwent an attempted LH with 3.93% (n=275) converted to laparotomy.…”

Section: Discussionmentioning

confidence: 99%

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Advances on minimally invasive approach for benign total hysterectomy: a systematic review

2017

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Hysterectomy is one of the most commonly performed gynecologic surgeries, mainly for uterine myomas, abnormal uterine bleeding, and prolapses. It can be performed through several routes, each of which has its advantages and disadvantages. We conducted this systematic review to evaluate recent advances in surgical outcomes of benign total hysterectomies by any route: vaginal (VH), laparoscopic (LH), laparoscopically assisted vaginal (LAVH), single-port (SP), and robotic-assisted laparoscopy (RH). The search was applied to the PubMed electronic database by using keywords “hysterectomy” and “uterine benign disease”, “adenomyosis”, and “myoma”. Prospective and randomized trials of the last 3 years were included. Nine studies were selected and showed that VH was superior to LH, LAVH, and RH in terms of hospital stay and operation time and had the same complication rate and lower costs. SP hysterectomy had no clear advantages over VH or conventional LH.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Advances on minimally invasive approach for benign total hysterectomy: a systematic review

2017

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“…In particular, this may become valid in some particular settings such as those with less laparoscopic expertise. To note, Lim et al . (2016) recently reported the rate of conversion was lower with robotic surgery when referring to a general community-based sample of gynecologic surgeons.…”

Section: The 10 ‘Don’ts’ In Endometriosis Managementmentioning

confidence: 99%

When more is not better: 10 ‘don’ts’ in endometriosis management. An ETIC* position statement

Alio¹,

Angioni²,

Arena³

et al. 2019

Human Reproduction Open

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A network of endometriosis experts from 16 Italian academic departments and teaching hospitals distributed all over the country made a critical appraisal of the available evidence and definition of 10 suggestions regarding measures to be de-implemented. Strong suggestions were made only when high-quality evidence was available. The aim was to select 10 low-value medical interventions, characterized by an unfavorable balance between potential benefits, potential harms, and costs, which should be discouraged in women with endometriosis. The following suggestions were agreed by all experts: do not suggest laparoscopy to detect and treat superficial peritoneal endometriosis in infertile women without pelvic pain symptoms; do not recommend controlled ovarian stimulation and IUI in infertile women with endometriosis at any stage; do not remove small ovarian endometriomas (diameter <4 cm) with the sole objective of improving the likelihood of conception in infertile patients scheduled for IVF; do not remove uncomplicated deep endometriotic lesions in asymptomatic women, and also in symptomatic women not seeking conception when medical treatment is effective and well tolerated; do not systematically request second-level diagnostic investigations in women with known or suspected non-subocclusive colorectal endometriosis or with symptoms responding to medical treatment; do not recommend repeated follow-up serum CA-125 (or other currently available biomarkers) measurements in women successfully using medical treatments for uncomplicated endometriosis in the absence of suspicious ovarian cysts; do not leave women undergoing surgery for ovarian endometriomas and not seeking immediate conception without post-operative long-term treatment with estrogen–progestins or progestins; do not perform laparoscopy in adolescent women (<20 years) with moderate–severe dysmenorrhea and clinically suspected early endometriosis without prior attempting to relieve symptoms with estrogen–progestins or progestins; do not prescribe drugs that cannot be used for prolonged periods of time because of safety or cost issues as first-line medical treatment, unless estrogen–progestins or progestins have been proven ineffective, not tolerated, or contraindicated; do not use robotic-assisted laparoscopic surgery for endometriosis outside research settings. Our proposal is to better address medical and surgical approaches to endometriosis de-implementing low-value interventions, with the aim to prevent unnecessary morbidity, limit psychological distress, and reduce the burden of treatment avoiding medical overuse and allowing a more equitable distribution of healthcare resources.

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“…19 The conversion rate from laparoscopic to open hysterectomy for benign cases might be as high as 19%. 20 Reported risk factors for conversion include increasing age, BMI, history of previous abdominopelvic surgery, adhesive disease, endometriosis, leiomyomata, uterine weight, and low-volume surgeons. 20 A retrospective cohort analysis of a multicenter Michigan database of almost 7000 women undergoing benign hysterectomy found a sevenfold reduction in the odds of conversion to laparotomy with use of the robotic platform compared to conventional laparoscopy.…”

Section: Robotic Surgery Outcomesmentioning

confidence: 99%

Route of Hysterectomy: Robotic

Chen

Robertson

2021

Journal of Gynecologic Surgery

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The annual percentage of hysterectomies performed with robotic-assisted laparoscopy has steadily increased since the U.S. Food and Drug Administration (FDA) approved the platform for gynecologic surgery in 2005. The rapid adoption and continued expansion of this technique are due to many factors, including 3-dimensional cameras with better visualization, instrumentation enabling precise movements with tremor control, and better ergonomics for surgeons.Residency training, with decreased numbers of minimally invasive techniques using vaginal and laparoscopic approaches, likely contributes to this trend as well. Despite these ever-increasing numbers, gynecologic societies have yet to determine and outline a standardized credentialing process. The robotic-assisted laparoscopic platform enables challenging cases, which previously would have been relegated to laparotomy, to be addressed in a minimally invasive platform. Obese patients and those with enlarged uteri or with significant adhesive disease have benefited from this unique technology. Hysterectomies performed with the robotic platform have consistently had lower surgical blood loss and shorter lengths of hospital stays. Complication rates between robotic-assisted laparoscopy and standard laparoscopy for hysterectomies appear to be similar; however, the robotic platform has longer operative times. This could be balanced by the demonstrated overall shorter hospital stay, compared to standard laparoscopic hysterectomy, and by a lower conversion rate to laparotomy. Advantages of the robotic platform appear to be magnified when surgeons have greater experience. Costs associated with purchase and use of robotic platforms continue to cause concern. It is hoped that competition with alternative robotic systems will decrease these costs. However, they must be viewed within the context of improved surgical and perioperative outcomes. ( J GYNECOL SURG 37:112

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Risk Factors and Outcomes for Conversion to Laparotomy of Laparoscopic Hysterectomy in Benign Gynecology

Abstract: This analysis demonstrates that conversion to laparotomy is associated with increased odds of postoperative morbidity, and robotic assistance and surgeon volume are strongly associated with decreased odds of conversion.

Cited by 45 publications

References 19 publications

Advances on minimally invasive approach for benign total hysterectomy: a systematic review

Advances on minimally invasive approach for benign total hysterectomy: a systematic review

When more is not better: 10 ‘don’ts’ in endometriosis management. An ETIC* position statement

Route of Hysterectomy: Robotic

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