Quantcast

Comparison of Laparoscopic Hysterectomy in Patients with Endometriosis with and without an Obliterated Cul-De-Sac.

Research paper by Alexandra A Melnyk, Noah B NB Rindos, Samar R SR El Khoudary, Ted T Lee

Indexed on: 09 Jul '19Published on: 08 Jul '19Published in: Journal of Minimally Invasive Gynecology



Abstract

To determine if intraoperative outcomes for patients undergoing a laparoscopic hysterectomy with endometriosis and an obliterated cul-de-sac are different than patients with endometriosis and no obliteration of the cul-de-sac. Retrospective cohort study. Academic tertiary-care hospital. Patients undergoing total laparoscopic hysterectomy with endometriosis between 2012 and 2016. Total laparoscopic hysterectomy, laparoscopic modified radical hysterectomy and other procedures as indicated. A total of 333 patients undergoing hysterectomy were found to have endometriosis at time of surgery. 96(29%) patients were found to have stage IV endometriosis, as defined by the American Society for Reproductive Medicine (ASRM) 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. 51(93%) patients with an obliterated cul-de-sac required a laparoscopic modified radical hysterectomy compared to 12(29%) patients with stage IV endometriosis without obliteration and 60(25%) patients with stages I-III endometriosis (p <.0001). The median of total surgical time in minutes differed among the three groups: obliterated cul-de-sac 159 minutes, stage IV endometriosis without obliteration 108 minutes, stages I-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), oversew of bowel (p <.0001), anterior resection and anastomosis (p =.006). Patients with stage IV endometriosis and an obliterated cul-de-sac required a laparoscopic modified radical hysterectomy and various other intraoperative procedures more than patients with stage IV endometriosis without obliteration and stages I-III. Patients with obliterated cul-de-sacs that 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. Copyright © 2019. Published by Elsevier Inc.