WASHINGTON — Retroperitoneal dissection and uterine artery occlusion offer a successful approach to laparoscopic hysterectomy in morbidly obese patients, Dr. Jessica M. Vaught and her associates reported in a poster presented at the annual meeting of the American College of Obstetricians and Gynecologists.
The option to perform a laparoscopic hysterectomy can spare morbidly obese women the potential morbidity associated with an abdominal procedure, the investigators wrote.
Dr. Vaught and her colleagues at George Washington University Medical Center in Annapolis, Md., reviewed 186 laparoscopic hysterectomies performed by the same surgeon at a teaching hospital. Of these, 84 patients qualified as morbidly obese, with a body mass index ranging from 35 to 58 kg/m
Overall, the average operating time was 98 minutes, with an average estimated blood loss of 230 mL. Uterine weight ranged from 41 to 2,032 g, with an average of 426 g.
Complications included blood transfusions required by two patients, readmission for a pelvic hematoma in one patient, and an intestinal obstruction in one patient that required a 3-day hospital stay. The average hospital stay was 1.2 days.
None of the patients experienced vascular, bowel, or lower urinary tract injuries. More than half (55%) of the patients had undergone prior abdominal surgery, and nine had a laparoscopic pelvic node dissection concurrently with the hysterectomy.