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GnRHa Before Single-Port Laparoscopic Hysterectomy in a Large Barrel-Shaped Uterus.
JSLS 2019 Jul-Sep; 23(3)JSLS

Abstract

Background and Objectives

Laparoscopic hysterectomy for a large barrel-shaped uterus is difficult. We assessed the feasibility of single-port laparoscopic hysterectomy in a large barrel-shaped uterus after gonadotropin-releasing hormone agonist (GnRHa).

Methods

We retrospectively reviewed 39 patients with a large barrel-shaped uterus who were treated with GnRHa (leuprolide acetate) before single-port laparoscopic hysterectomy. During the same period, 134 patients without GnRHa pretreatment were included as control subjects.

Results

Patients with GnRHa treatment had an average increase in hemoglobin of 3.0 mg/dL and a decrease in uterine weight of 330.9 g (40.1%). Ancillary ports were required in 2 patients in the treatment group and none in the control group. There were no differences in uterine weights, operative time, and estimated blood loss in the 2 groups of patients. The estimated average operative time was shortened by 34 min after GnRHa treatment. However, bladder and ureter injuries were marginally higher (10.3% versus 2.2%) and days of hospital stay (3.7 versus 3.1) were significantly longer in the treatment group compared with controls. Complication rates were correlated with previous operative history, pelvic adhesion, and larger uterine weight but not with GnRHa treatment and operative sequence.

Conclusions

GnRHa pretreatment in patients with a large barrel-shaped uterus during SPH is feasible with shortened operative time. However, the higher complication rates in these patients suggest that a weight-reduced barrel-shaped uterus that is achieved with GnRHa treatment could still be difficult and should be handled in cautious.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan.Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan.Department of Obstetrics and Gynecology, Hsin-Chu Branch, National Taiwan University Hospital, Hsin-Chu, Taiwan.Department of Obstetrics and Gynecology, Hsin-Chu Branch, National Taiwan University Hospital, Hsin-Chu, Taiwan.Institute of Statistical Science, Academia Sinica, Taipei, Taiwan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31341378

Citation

Torng, Pao-Ling, et al. "GnRHa Before Single-Port Laparoscopic Hysterectomy in a Large Barrel-Shaped Uterus." JSLS : Journal of the Society of Laparoendoscopic Surgeons, vol. 23, no. 3, 2019.
Torng PL, Pan SP, Hsu HC, et al. GnRHa Before Single-Port Laparoscopic Hysterectomy in a Large Barrel-Shaped Uterus. JSLS. 2019;23(3).
Torng, P. L., Pan, S. P., Hsu, H. C., Chen, I. H., & Hwang, J. S. (2019). GnRHa Before Single-Port Laparoscopic Hysterectomy in a Large Barrel-Shaped Uterus. JSLS : Journal of the Society of Laparoendoscopic Surgeons, 23(3), doi:10.4293/JSLS.2019.00019.
Torng PL, et al. GnRHa Before Single-Port Laparoscopic Hysterectomy in a Large Barrel-Shaped Uterus. JSLS. 2019;23(3) PubMed PMID: 31341378.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - GnRHa Before Single-Port Laparoscopic Hysterectomy in a Large Barrel-Shaped Uterus. AU - Torng,Pao-Ling, AU - Pan,Song-Po, AU - Hsu,Heng-Cheng, AU - Chen,I-Hui, AU - Hwang,Jing-Shiang, PY - 2019/7/26/entrez PY - 2019/7/26/pubmed PY - 2019/7/26/medline KW - Gonadotropin-releasing hormone agonist KW - Single-port KW - laparoscopic hysterectomy JF - JSLS : Journal of the Society of Laparoendoscopic Surgeons JO - JSLS VL - 23 IS - 3 N2 - Background and Objectives: Laparoscopic hysterectomy for a large barrel-shaped uterus is difficult. We assessed the feasibility of single-port laparoscopic hysterectomy in a large barrel-shaped uterus after gonadotropin-releasing hormone agonist (GnRHa). Methods: We retrospectively reviewed 39 patients with a large barrel-shaped uterus who were treated with GnRHa (leuprolide acetate) before single-port laparoscopic hysterectomy. During the same period, 134 patients without GnRHa pretreatment were included as control subjects. Results: Patients with GnRHa treatment had an average increase in hemoglobin of 3.0 mg/dL and a decrease in uterine weight of 330.9 g (40.1%). Ancillary ports were required in 2 patients in the treatment group and none in the control group. There were no differences in uterine weights, operative time, and estimated blood loss in the 2 groups of patients. The estimated average operative time was shortened by 34 min after GnRHa treatment. However, bladder and ureter injuries were marginally higher (10.3% versus 2.2%) and days of hospital stay (3.7 versus 3.1) were significantly longer in the treatment group compared with controls. Complication rates were correlated with previous operative history, pelvic adhesion, and larger uterine weight but not with GnRHa treatment and operative sequence. Conclusions: GnRHa pretreatment in patients with a large barrel-shaped uterus during SPH is feasible with shortened operative time. However, the higher complication rates in these patients suggest that a weight-reduced barrel-shaped uterus that is achieved with GnRHa treatment could still be difficult and should be handled in cautious. SN - 1938-3797 UR - https://www.unboundmedicine.com/medline/citation/31341378/GnRHa_Before_Single-Port_Laparoscopic_Hysterectomy_in_a_Large_Barrel-Shaped_Uterus L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/31341378/ DB - PRIME DP - Unbound Medicine ER -