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Open Access 01-12-2018 | Original Article

Surgical outcomes of laparoscopic hysterectomy with concomitant endometriosis without bowel or bladder dissection: a cohort analysis to define a case-mix variable

Authors: Evelien M. Sandberg, Sara R. C. Driessen, Evelien A. T. Bak, Nan van Geloven, Judith P. Berger, Mathilde J. G. H. Smeets, Johann P. T. Rhemrev, Frank Willem Jansen

Published in: Gynecological Surgery | Issue 1/2018

Abstract

Background

Pelvic endometriosis is often mentioned as one of the variables influencing surgical outcomes of laparoscopic hysterectomy (LH). However, its additional surgical risks have not been well established. The aim of this study was to analyze to what extent concomitant endometriosis influences surgical outcomes of LH and to determine if it should be considered as case-mix variable.

Results

A total of 2655 LH’s were analyzed, of which 397 (15.0%) with concomitant endometriosis. For blood loss and operative time, no measurable association was found for stages I (n = 106) and II (n = 103) endometriosis compared to LH without endometriosis. LH with stages III (n = 93) and IV (n = 95) endometriosis were associated with more intra-operative blood loss (p = < .001) and a prolonged operative time (p = < .001) compared to LH without endometriosis. No significant association was found between endometriosis (all stages) and complications (p = .62).

Conclusions

The findings of our study have provided numeric support for the influence of concomitant endometriosis on surgical outcomes of LH, without bowel or bladder dissection. Only stages III and IV were associated with a longer operative time and more blood loss and should thus be considered as case-mix variables in future quality measurement tools.

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Driessen SR, van Zwet EW, Haazebroek P et al (2016) A dynamic quality assessment tool for laparoscopic hysterectomy to measure surgical outcomes. Am J Obstet Gynecol 2016;215(6):754.e1-754.e8

Driessen SR, Sandberg EM, la Chapelle CF, Twijnstra AR, Rhemrev JP, Jansen FW (2016) Case-mix variables and predictors for outcomes of laparoscopic hysterectomy: a systematic review. J Minim Invasive Gynecol 23:317–330CrossRefPubMed

Brummer TH, Jalkanen J, Fraser J et al (2011) FINHYST, a prospective study of 5279 hysterectomies: complications and their risk factors. Hum Reprod 26:1741–1751CrossRefPubMed

Song T, Kim TJ, Kang H et al (2012) Factors associated with complications and conversion to laparotomy in women undergoing laparoscopically assisted vaginal hysterectomy. Acta Obstet Gynecol Scand 91:620–624CrossRefPubMed

Patzkowsky KE, As-Sanie S, Smorgick N, Song AH, Advincula AP (2013) Perioperative outcomes of robotic versus laparoscopic hysterectomy for benign disease. JSLS 17:100–106CrossRefPubMedPubMedCentral

Twijnstra AR, Zeeman GG, Jansen FW (2010) A novel approach to registration of adverse outcomes in obstetrics and gynaecology: a feasibility study. Qual Saf Health Care 19:132–137CrossRefPubMed

Blikkendaal MD, Twijnstra AR, Stiggelbout AM, Beerlage HP, Bemelman WA, Jansen FW (2013) Achieving consensus on the definition of conversion to laparotomy: a Delphi study among general surgeons, gynecologists, and urologists. Surg Endosc 27:4631–4639CrossRefPubMed

American Society for Reproductive Medicine (1997) Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril 67:817–821CrossRef

R Development Core Team (2008). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. http://www.R-project.org

10.

Twijnstra AR, Blikkendaal MD, van Zwet EW, van Kesteren PJ, de Kroon CD, Jansen FW (2012) Predictors of successful surgical outcome in laparoscopic hysterectomy. Obstet Gynecol 119:700–708CrossRefPubMed

11.

Van Leersum NJ, Snijders HS, Henneman D et al (2013) The Dutch surgical colorectal audit. Eur J Surg Oncol 39:1063–1070CrossRefPubMed

12.

Corson SL, Batzer FR, Gocial B, Kelly M, Gutmann JN, Maislin G (1995) Intra-observer and inter-observer variability in scoring laparoscopic diagnosis of pelvic adhesions. Hum Reprod 10:161–164CrossRefPubMed

13.

Uccella S, Marconi N, Casarin J et al (2016) Impact of endometriosis on surgical outcomes and complications of total laparoscopic hysterectomy. Arch Gynecol Obstet 294:771–778CrossRefPubMed

14.

Catanzarite T, Saha S, Pilecki MA, Kim JY, Milad MP (2015) Longer operative time during benign laparoscopic and robotic hysterectomy is associated with increased 30-day perioperative complications. J Minim Invasive Gynecol 22:1049–1058CrossRefPubMed

15.

Hanwright PJ, Mioton LM, Thomassee MS et al (2013) Risk profiles and outcomes of total laparoscopic hysterectomy compared with laparoscopically assisted vaginal hysterectomy. Obstet Gynecol 121:781–787CrossRefPubMed

16.

Maruthappu M, Gilbert BJ, El-Harasis MA et al (2015) The influence of volume and experience on individual surgical performance: a systematic review. Ann Surg 261:642–647CrossRefPubMed

Title: Surgical outcomes of laparoscopic hysterectomy with concomitant endometriosis without bowel or bladder dissection: a cohort analysis to define a case-mix variable
Authors: Evelien M. Sandberg
Sara R. C. Driessen
Evelien A. T. Bak
Nan van Geloven
Judith P. Berger
Mathilde J. G. H. Smeets
Johann P. T. Rhemrev
Frank Willem Jansen
Publication date: 01-12-2018
Publisher: Springer Berlin Heidelberg
Published in: Gynecological Surgery / Issue 1/2018
Print ISSN: 1613-2076
Electronic ISSN: 1613-2084
DOI: https://doi.org/10.1186/s10397-018-1039-3

At a glance: The STEP trials

Springer Medicine

Surgical outcomes of laparoscopic hysterectomy with concomitant endometriosis without bowel or bladder dissection: a cohort analysis to define a case-mix variable

Abstract

Background

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Results

Conclusions

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