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Outcome of 783 Consecutive Hysterectomies for Benign Indication-Likelihood of Completing a Minimally Invasive Hysterectomy Based On Number of Prior Cesarean Sections

Authors:
  • Marchand Institute for Minimally Invasive Surgery

Abstract

Outcome of 783 Consecutive Hysterectomies for Benign Indication— Likelihood of Completing a Minimally Invasive Hysterectomy Based On Number of Prior Cesarean Sections
Outcome of 783 Consecutive Hysterectomies for Benign Indication—
Likelihood of Completing a Minimally Invasive Hysterectomy
Based On Number of Prior Cesarean Sections
Demir RH, Marchand GJ. Section of Gynecology. Arizona Regional Medical Center, Mesa,
Arizona
Introduction: Compared with General Surgeons, Gynecological Surgeons have been slow to
adopt Minimally Invasive Surgery into their practices. Data from 2005 suggests only 33% of
hysterectomies were performed using Minimally Invasive techniques (vaginal, laparoscopic or
robotic assisted laparoscopic) compared with 90% of cholecystectomies and 82% of bariatric
procedures. Common de-selectors for Minimally Invasive Hysterectomy (MIH) include
increasing uterine size, number of prior Cesarean Sections and patient’s Body Mass Index
(BMI).
This study assessed the likelihood of completing MIH related to increasing number of prior
Cesarean Sections.
Methods: Retrospective Chart Review was used covering seven hundred eighty-three patients
having hysterectomy for benign indications. All surgeries were performed in a Community
Hospital setting and arose from a private Gynecologic Surgery practice. All patients requiring
hysterectomy for benign indications were scheduled for MIH procedures including Total
Vaginal, Laparoscopic Supracervical and Total Laparoscopic Hysterectomy and outcomes were
analyzed.
Measurements and Main Results: Of 783 consecutive hysterectomies for benign indications
scheduled for MIH, 778 (99.36%) were successfully completed. No statistical association was
found between increasing BMI and MIH failure with any listed hysterectomy type or overall.
Total Laparoscopic Total Grand
Vaginal Supracervical Laparoscopic Total
Prior C-Sections
0 0 / 102 1 / 342 1 / 145 2 / 589
1 0 / 20 0 / 90 2 / 7 2 / 117
2 0 / 4 1 / 18 0 / 15 1 / 37
3 0 / 2 0 / 9 0 / 5 0 / 16
>4 0 / 1 0 / 6 0 / 17 0 / 24
Grand Total 0 / 129 2 / 465 3 / 189 5 / 783
Conclusions: In expert hands there is a high likelihood of successfully completing Minimally
Invasive Hysterectomy and commonly held MIH de-selectors, in this case increasing number of
Prior Cesarean Sections, irregularly contribute to failure. We believe virtually all patients
requiring hysterectomy for benign indications are candidates for MIH.
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