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Comparison of Laparoscopic Hysterectomy in Patients with Endometriosis with and without an Obliterated Cul-de-sac.

Abstract

STUDY OBJECTIVE

To determine if intraoperative outcomes for patients undergoing laparoscopic hysterectomy with endometriosis and an obliterated cul-de-sac are different than patients with endometriosis and no obliteration of the cul-de-sac.

DESIGN

A retrospective cohort study.

SETTING

An academic tertiary care hospital.

PATIENTS

Patients undergoing total laparoscopic hysterectomy with endometriosis between 2012 and 2016.

INTERVENTIONS

Total laparoscopic hysterectomy, laparoscopic modified radical hysterectomy, and other procedures as indicated.

MEASUREMENTS AND MAIN RESULTS

A total of 333 patients undergoing hysterectomy were found to have endometriosis at the time of surgery. Ninety-six (29%) patients were found to have stage IV endometriosis as defined by the American Society for Reproductive Medicine staging criteria. Of those, 55 (57%) had an obliterated cul-de-sac, and 41 (43%) did not. The remaining 237 (71%) patients had stage I, II, or III endometriosis. Fifty-one (93%) patients with an obliterated cul-de-sac required laparoscopic modified radical hysterectomy compared with 12 (29%) patients with stage IV endometriosis without obliteration and 60 (25%) patients with stages I through III endometriosis (p < .0001). The median total surgical time in minutes differed among the 3 groups as follows: obliterated cul-de-sac = 159 minutes, stage IV endometriosis without obliteration = 108 minutes, and stages I through III endometriosis = 116 minutes (p <.0001). Additional procedures at the time of hysterectomy were more frequently performed for patients with an obliterated cul-de-sac and included salpingectomy (p = .02), ureterolysis (p <.0001), enterolysis (p <.0001), cystoscopy (p = .0006), ureteral stenting (p <.0001), proctoscopy (p <.0001), oversewing of the bowel (p <.0001), and anterior resection and anastomosis (p = .006).

CONCLUSION

Patients with stage IV endometriosis and an obliterated cul-de-sac required laparoscopic modified radical hysterectomy and various other intraoperative procedures more than patients with stage IV endometriosis without obliteration and stages I through III. Patients with obliterated cul-de-sacs who are identified intraoperatively should be referred to minimally invasive gynecologic specialists because of the difficult nature of these procedures and extra training required to perform them safely with limited morbidity.

Authors+Show Affiliations

Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, Pennsylvania (Drs. Melnyk, Rindos, and Lee).Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, Pennsylvania (Drs. Melnyk, Rindos, and Lee).Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania (Dr. Khoudary).Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, Pennsylvania (Drs. Melnyk, Rindos, and Lee). Electronic address: leextt@mail.magee.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31279776

Citation

Melnyk, Alexandra, et al. "Comparison of Laparoscopic Hysterectomy in Patients With Endometriosis With and Without an Obliterated Cul-de-sac." Journal of Minimally Invasive Gynecology, 2019.
Melnyk A, Rindos NB, El Khoudary SR, et al. Comparison of Laparoscopic Hysterectomy in Patients with Endometriosis with and without an Obliterated Cul-de-sac. J Minim Invasive Gynecol. 2019.
Melnyk, A., Rindos, N. B., El Khoudary, S. R., & Lee, T. T. M. (2019). Comparison of Laparoscopic Hysterectomy in Patients with Endometriosis with and without an Obliterated Cul-de-sac. Journal of Minimally Invasive Gynecology, doi:10.1016/j.jmig.2019.07.001.
Melnyk A, et al. Comparison of Laparoscopic Hysterectomy in Patients With Endometriosis With and Without an Obliterated Cul-de-sac. J Minim Invasive Gynecol. 2019 Jul 4; PubMed PMID: 31279776.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of Laparoscopic Hysterectomy in Patients with Endometriosis with and without an Obliterated Cul-de-sac. AU - Melnyk,Alexandra, AU - Rindos,Noah B, AU - El Khoudary,Samar R, AU - Lee,Ted Teh Min, Y1 - 2019/07/04/ PY - 2019/02/25/received PY - 2019/06/10/revised PY - 2019/07/01/accepted PY - 2019/7/8/pubmed PY - 2019/7/8/medline PY - 2019/7/8/entrez KW - Endometriosis KW - Frozen pelvis KW - Hysterectomy KW - Obliterated cul-de-sac KW - Severe endometriosis KW - Stage IV endometriosis JF - Journal of minimally invasive gynecology JO - J Minim Invasive Gynecol N2 - STUDY OBJECTIVE: To determine if intraoperative outcomes for patients undergoing laparoscopic hysterectomy with endometriosis and an obliterated cul-de-sac are different than patients with endometriosis and no obliteration of the cul-de-sac. DESIGN: A retrospective cohort study. SETTING: An academic tertiary care hospital. PATIENTS: Patients undergoing total laparoscopic hysterectomy with endometriosis between 2012 and 2016. INTERVENTIONS: Total laparoscopic hysterectomy, laparoscopic modified radical hysterectomy, and other procedures as indicated. MEASUREMENTS AND MAIN RESULTS: A total of 333 patients undergoing hysterectomy were found to have endometriosis at the time of surgery. Ninety-six (29%) patients were found to have stage IV endometriosis as defined by the American Society for Reproductive Medicine staging criteria. Of those, 55 (57%) had an obliterated cul-de-sac, and 41 (43%) did not. The remaining 237 (71%) patients had stage I, II, or III endometriosis. Fifty-one (93%) patients with an obliterated cul-de-sac required laparoscopic modified radical hysterectomy compared with 12 (29%) patients with stage IV endometriosis without obliteration and 60 (25%) patients with stages I through III endometriosis (p < .0001). The median total surgical time in minutes differed among the 3 groups as follows: obliterated cul-de-sac = 159 minutes, stage IV endometriosis without obliteration = 108 minutes, and stages I through III endometriosis = 116 minutes (p <.0001). Additional procedures at the time of hysterectomy were more frequently performed for patients with an obliterated cul-de-sac and included salpingectomy (p = .02), ureterolysis (p <.0001), enterolysis (p <.0001), cystoscopy (p = .0006), ureteral stenting (p <.0001), proctoscopy (p <.0001), oversewing of the bowel (p <.0001), and anterior resection and anastomosis (p = .006). CONCLUSION: Patients with stage IV endometriosis and an obliterated cul-de-sac required laparoscopic modified radical hysterectomy and various other intraoperative procedures more than patients with stage IV endometriosis without obliteration and stages I through III. Patients with obliterated cul-de-sacs who are identified intraoperatively should be referred to minimally invasive gynecologic specialists because of the difficult nature of these procedures and extra training required to perform them safely with limited morbidity. SN - 1553-4669 UR - https://www.unboundmedicine.com/medline/citation/31279776/Comparison_of_Laparoscopic_Hysterectomy_in_Patients_with_Endometriosis_with_and_without_an_Obliterated_Cul-de-sac L2 - https://linkinghub.elsevier.com/retrieve/pii/S1553-4650(19)30300-0 DB - PRIME DP - Unbound Medicine ER -