İkinci Basamak Hastanede Beş Yıllık Total Laparoskopik Histerektomi Deneyimiz
GİRİŞ ve AMAÇ: İkinci basamak hastanede yapılan total laparoskopik histerektomi operasyonları ile ilgili deneyimlerimizi sunmayı amaçladık YÖNTEM ve GEREÇLER: Ocak 2012- Kasım 2017 tarihleri arasında hastanemizde yapılmış olan 250 total laparoskopik histerektomi vakasının tıbbi kayıtlarını retrospektif olarak incelendi. Hastaların yaşı, paritesi, vücut kitle endeksi (BMI), histerektomi nedenleri, geçirilmiş abdominal cerrahi öyküsü, ameliyat öncesi ve sonrası ortalama hemoglobin (Hb) ve hemotokrit (Htc) değerleri arasındaki fark, operasyon sırasında ve sonrasında kan transfüzyonu ihtiyacı, operasyon süresi, hastanede yatış süresi, komplikasyonlar, laparatomiye geçiş sıklığı ve uterus ağırlığı değerlendirildi. BULGULAR: Hastaların ortalama yaşı 48.01±5,7 yıl olarak saptandı. Ortalama operasyon süresi ve ortalama hastanede yatış süresi sırasıyla 156.5±49,4 dakika ve 3.75±1,04 gün olarak hesaplandı. Laparaskopiden laparatomiye geçiş sadece bir hastada (%0.4) meydana geldi. Ortalama uterus ağırlığı 201.03±107.2 gr olarak saptandı. Üç hastaya (%1.2) intraoperatif kanama nedeniyle eritrosit süspansiyonu verildi. Cerrahi sırasında 1 (%0.4) hastada rektum seroza hasarı, 3 (%1,2) hastada mesane perforasyonu, 1 (%0.4) hastada rektum tam kat hasar meydana geldi. Postoperatif dönemde vajen kaf hematomu ve vezikovajinal fistül sırasıyla 1 (%0.4), 1 (%0.4) hastada gelişmiştir. Dört hastada (%1.6) postoperative ateş ve C-Reaktif Protein (CRP) yüksekliği tespit edildi. Toplam komplikasyon oranı %5.6 olarak saptandı TARTIŞMA ve SONUÇ: Total laparoskopik histerektomi deneyimli ellerde başarılı bir şekilde uygulanabilen morbidite ve mortalitesi laparotomiye kıyasla daha az olan, postoperatif daha kısa derlenme süresine ve daha iyi kozmetik sonuçlara sahip minimal invaziv bir işlemdir.
Five-year Total Laparoscopic Hysterectomy Experience in Second-Line Hospital
INTRODUCTION: We aimed to present our experience withtotal laparoscopic hysterectomy operations in second-linehospitalMETHODS: 250 cases who underwent total laparoscopichysterectomy in the obstetrics and gynecology clinic betweenJanuary 2012 and November 2017 were retrospectivelyevaluated in terms of age, parity, body mass index (BMI),preoperative and postoperative hemoglobin (Hb) andhematocrit (Htc) values, hysterectomy indications, the rate ofswitching from laparoscopy to laparotomy, blood transfusionrequirement, operation time, complications, the length ofhospital stay and uterine weight. In the morning of operation,venous blood was taken for measuring preoperative Hb andHtc values.RESULTS: The mean age of the patients was 48.01 ± 5.7. Themean operation time and the mean duration of hospitalizationwere 156.5 ± 49.4 minutes and 3.75 ± 1.04 days respectively.Mean uterine weight was 201.03 ± 107.2 grams. In one patient(0.4%), there was a transition from laparoscopy to laparotomy.Perioperative-postoperative blood transfusion was needed atthree patients (%1.2). Intraoperative complications weresigmoid colon serosa injury in 1 patient (%0.4) and bladderperforation in 3 patients (%1.2) and a. full-thickness rectuminjury in one patient (%0.4) has occurred. In postoperativeperiod, vaginal cuff hematoma was and the vesicovaginalfistula was developed in 1 (%0.4) and 1 (%0.4) patientrespectively. The postoperative fever and C-Reactive Protein(CRP) elevation were detected in four patients (1.6%). Theoverall complication rate was %5.6.DISCUSSION and CONCLUSION: Total laparoscopichysterectomy is a minimally invasive procedure with lessmorbidity and mortality than experienced laparotomy, shorterpostoperative follow-up, and better cosmetic results.
___
- 1. Wright JD, Herzog TJ, Tsui J, Ananth CV,
Lewin SN, Lu YS, et al. Nationwide trends in the
performance of inpatient hysterectomy in the
United States. Obstet Gynecol 2013; 122: 233-41.
- 2. Nieboer TE, Johnson N, Lethaby A,
Tavender E, Curr E, Garry R, et al. Surgical
approach to hysterectomy for benign
gynaecological disease. Cochrane Database Syst
Rev 2009; 8: CD003677.
- 3. Fatih Şendağ, Nuri Peker. Robotik
Histerektomi. Turkiye Klinikleri J Gynecol Obst-
Special Topics 2017;10(4):353-8
- 4. Terzi H, Biler A, Demirtas O, Guler OT,
Peker N, Kale A. Total laparoscopic hysterectomy:
Analysis of the surgical learning curve in benign
conditions. Int J Surg. 2016; 35: 51-7.
- 5. Aarts JW, Nieboer TE, Johnson N, Tavender
E, Garry R, Mol BW, et al. Surgical approach to
hysterectomy for benign gynaecological disease.
Cochrane Database Syst Rev. 2015; 12; (8).
- 6. Johnson N(1), Barlow D, Lethaby A,
Tavender E, Curr E, Garry R. Surgical approach to
hysterectomy for benigngynaecological disease.
Cochrane Database Syst Rev 2006; 19: CD003677.
- 7. Garry R Fountain J, Mason S, Hawe J, Napp
V, Abbott J, et al. The evaluate study: two parallel
randomised trials, one comparing laparoscopic with
abdominal hysterectomy, the other comparing
laparoscopic with vaginal hysterectomy. BMJ 2004;
328: 129.
- 8. Cohen SL, Vitonis AF, Einarsson JI. Updated
hysterectomy surveillance: Factors associated with
minimally invasive hysterectomy, a cross-sectional
analysis. JSLS 2014;18 pii: e2014.00096
- 9. ACOG Committee Opinion No. 444.
Choosing the route of hysterectomy for benign
disease. Obstet Gynecol 2009; 114: 1156-8.
- 10. Lee YH, Chong GO, Kim MJ, Gy Hong D,
Lee YS, Overcoming the learning curve of singleport
total laparoscopic hysterectomy with barbed
suture: a single surgeon's initial experience.
Wideochir Inne Tech Maloinwazyjne. 2017; 12(3):
264-70.
- 11. Rossitto C, Cianci S, Gueli Alletti S,
Perrone E, Pizzacalla S, Scambia G, Laparoscopic,
minilaparoscopic, single-port and percutaneous
hysterectomy: Comparison of perioperative
outcomes of minimally invasive approaches in
gynecologic surgery. Eur J Obstet Gynecol Reprod
Biol. 2017; 216: 125-9.
- 12. Roh HF, Nam SH, Kim JM. Robot-assisted
laparoscopic surgery versus conventional
laparoscopic surgery in randomized controlled
trials: A systematic review and meta-analysis. PLoS
One. 2018; 23; 13(1).
- 13. Madueke-Laveaux OS, Advincula AP.
Robot-assisted laparoscopy in benign gynecology:
Advantageous device or controversial gimmick.
Best Pract Res Clin Obstet Gynaecol. 2017; 45: 2-6.
- 14. Mäkinen J, Johansson J, Tomás C, Tomás
E, Heinonen PK, Laatikainen T, et al. Morbidity of
10 110 hysterectomies by type of approach. Hum
Reprod 2001; 16: 1473-8.
- 15. Canis M, Botchorishvili R, Ang C,
Rabischong B, Jardon K, Wattiez A, et al. When is
laparotomy needed in hysterectomy for benign
uterine disease? J Minim Invasive Gynecol 2008;
15: 38-43.
- 16. Morelli M, Caruso M, Noia R, Chiodo D,
Cosco C, Lucia E, et al. Total laparoscopic
hysterectomy versus vaginal hysterectomy: a
prospective randomized trial. Minerva Ginecol
2007; 59: 99-105.
- 17. Levy BS, Soderstrom RM, Dail DH. Bowel
injuries during laparoscopy. Gross anatomy and
histology. Reprod Med 1985; 30: 168-172.
- 18. Phillips JM, Hulka JF, Peterson HB.
American Association of Gynecologic
Laparoscopists’ 1982 membership survey. J Reprod
Med 1984; 29: 592-4.
- 19. Chapron C, Querleu D, Bruhat MA,
Madelenat P, Fernandez H, Pierre F, et al. Surgical
complications of diagnostic and operative
gynaecological laparoscopy: a series of 29,966
cases. Hum Reprod. 1998; 13(4): 867-72.
- 20. Jung YW, Lee M, Yim GW, Lee SH, Paek
JH, Kwon HY, et al. A randomized prospective study of single-port and four-port approaches for
hysterectomy in terms of postoperative pain. Surg
Endosc 2011; 25: 2462-9.