Total laparoskopik histerektominin laparotomiye dönüşümünün risk faktörleri ve sonuçları: Tek merkezli bir deneyim
Abstract
Amaç: Bu çalışmanın amacı, iyi huylu jinekolojik hastalıklar nedeniyle total laparoskopik histerektomi (TLH) uygulanan hastalarda laparotomiye dönüşüm ile ilişkili risk faktörlerini ve sonuçları analiz etmektir.
Gereç ve Yöntem: Mayıs 2016 ile Ağustos 2021 tarihleri arasında TLH veya laparoskopik olarak başlatılıp laparotomiye dönüştürülen ameliyat geçiren, yaşları 35 ile 70 arasında değişen 160 kadının retrospektif analizi yapıldı. Şüpheli malignitesi olanlar, önceki onkolojik operasyon geçirenler ve eksik verisi olan hastalar çalışma dışı bırakıldı. Toplanan veriler arasında demografik bilgiler, cerrahi endikasyonlar, cerrah deneyimi, intraoperatif komplikasyonlar ve hastanede yatış süresi, kan transfüzyonu gereksinimi, yoğun bakım ünitesine (YBÜ) kabul gibi sonuçlar yer aldı. Dönüşüm için anlamlı risk faktörlerini belirlemek amacıyla istatistiksel analizler yapıldı.
Bulgular: 160 hastanın 81’i (%50,6) ameliyatı laparoskopik olarak tamamladı, 79’u (%49,4) ise laparotomiye dönüştürüldü. Dönüşümün başlıca nedenleri adezyonlar (%41,8) ve büyük uterus varlığı (%27,8) idi. Dönüşüm yapılan olgularda hastanede kalış süresi anlamlı derecede daha uzun (p = 0,012), kan transfüzyon oranı (p = 0,006) ve YBÜ’ye kabul oranı (p = 0,011) daha yüksekti. Cerrah deneyimi dönüşüm oranları üzerinde istatistiksel olarak anlamlı bir etki göstermedi (p = 0,198); ancak deneyimli cerrahlar daha çok büyük uteruslu olgularla karşılaştı.
Sonuç: TLH’den laparotomiye dönüşüm, daha uzun hastanede yatış süresi ve daha yüksek transfüzyon ihtiyacı gibi artmış morbidite ile ilişkilidir. Adezyonlar ve büyük uterus boyutu, başlıca risk faktörleri olarak saptanmıştır. Preoperatif değerlendirme ve dikkatli planlama, dönüşüm ihtiyacını azaltarak hasta sonuçlarını iyileştirebilir.
References
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- Perino A, Cucinella G, Venezia R, et al. Total laparoscopic hysterectomy versus total abdominal hysterectomy: an assessment of the learning curve in a prospective randomized study. Hum Reprod, 1999. 14(12): p. 2996-9. https://doi: 10.1093/humrep/14.12.2996.
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Risk factors and outcomes of conversion to laparotomy of total laparoscopic hysterectomy: A single center experience
Abstract
Aim: This study aimed to analyze the risk factors and outcomes associated with conversion of total laparoscopic hysterectomy (TLH) to laparotomy in patients undergoing surgery for benign gynecologic conditions.
Materials and Methods: A retrospective analysis was conducted of 160 women aged 35 to 70 years who underwent TLH or a procedure that started laparoscopically but required conversion to laparotomy between May 2016 and August 2021. Patients with suspected malignancy, previous oncologic procedures or incomplete data were excluded. Data collected included demographics, surgical indications, surgeon experience, intraoperative complications, and outcomes such as hospitalization, blood transfusion requirements, and intensive care unit (ICU) admission. Statistical analyses were performed to identify significant risk factors for conversion.
Results: Of the 160 patients, 81 (50.6%) completed surgery laparoscopically, while 79 (49.4%) required conversion to laparotomy. The main reasons for conversion were adhesions (41.8%) and a large uterus (27.8%). Conversion cases had significantly longer hospital stays (p = 0.012), a higher rate of blood transfusion (p = 0.006) and a higher need for ICU admission (p = 0.011). Surgeon experience was not a statistically significant factor for conversion rates (p = 0.198), although experienced surgeons encountered more cases with the large uterus.
Conclusion: Conversion from TLH to laparotomy is associated with increased morbidity, including longer hospital stays and higher transfusion rates. Adhesions and large uterine size were identified as major risk factors. Preoperative assessment and careful planning may reduce the need for conversion and improve patient outcomes.
References
- Wu JM, Wechter ME, Geller EJ, et al. Hysterectomy rates in the United States, 2003. Obstet Gynecol, 2007.110(5): p. 1091-5. https://doi: 10.1097/01.AOG.0000285997.38553.4b
- Koroglu N, Cetin BA, Turan G, et al. Characteristics of total laparoscopic hysterectomy among women with or without previous cesarean section: retrospective analysis. Sao Paulo Med J, 2018. 136(5): p. 385-9. https://doi: 10.1590/1516-3180.2018.0197030718.
- Lim CS, Mowers EL, Mahnert N, et al. Risk Factors and Outcomes for Conversion to Laparotomy of Laparoscopic Hysterectomy in Benign Gynecology. Obstet Gynecol, 2016. 128(6): p.1295-305. https://doi: 10.1097/AOG.0000000000001743
- Richards L, Healey M, Cheng C, et al. Risk Factors and Outcomes of Conversion to Open Surgery in Benign Gynecologic Laparoscopies: A Case-Control Study. J Minim Invasive Gynecol, 2021. 28(10): p. 1786-94. https://doi.org/10.1016/j.jmig.2021.03.013
- Perino A, Cucinella G, Venezia R, et al. Total laparoscopic hysterectomy versus total abdominal hysterectomy: an assessment of the learning curve in a prospective randomized study. Hum Reprod, 1999. 14(12): p. 2996-9. https://doi: 10.1093/humrep/14.12.2996.
- Mattingly, R.F., R.W. Te Linde, and J.D. Thompson, Te Linde’s operative gynecology. 1985: Lippincott.
- Twijnstra AR, Blikkendaal MD, van Zwet EW, et al. Clinical relevance of conversion rate and its evaluation in laparoscopic hysterectomy. J Minim Invasive Gynecol, 2013. 20(1): p. 64-72. https://doi: 10.1016/j.jmig.2012.09.006.
- Uccella S, Morosi C, Marconi N, et al. Laparoscopic Versus Open Hysterectomy for Benign Disease in Uteri Weighing >1 kg: A Retrospective Analysis on 258 Patients. J Minim Invasive Gynecol, 2018. 25(1): p. 62-9. https://doi: 10.1016/j.jmig.2017.07.005.
- Doll, K.M., M.P. Milad, D.R. Gossett. Surgeon volume and outcomes in benign hysterectomy. J Minim Invasive Gynecol, 2013. 20(5): p. 554-61. https://doi: 10.1016/j.jmig.2013.03.005.
- Twijnstra AR, Blikkendaal MD, van Zwet EW, et al. Predictors of successful surgical outcome in laparoscopic hysterectomy. Obstet Gynecol, 2012. 119(4): p. 700-8. https://doi: 10.1097/AOG.0b013e31824b1966.
- Mäkinen J, Johansson J, Tomás C, et al. Morbidity of 10 110 hysterectomies by type of approach. Hum Reprod, 2001. 16(7): p. 1473-8. https://doi: 10.1093/humrep/16.7.1473.
- Yada-Hashimoto N, Onoue M, Yoshimi K, et al. Total laparoscopic hysterectomy in patients with previous abdominal surgery. Arch Gynecol Obstet, 2011. 284(6): p. 1467-71. https://doi: 10.1007/s00404-011-1882-1. Epub 2011 Mar 24.
- Leonard F, Chopin N, Borghese B, et al. Total laparoscopic hysterectomy: preoperative risk factors for conversion to laparotomy. J Minim Invasive Gynecol, 2005. 12(4): p. 312-7. https://doi: 10.1016/j.jmig.2005.05.015.
- Park, S.H., H.Y. Cho, H.B. Kim, Factors determining conversion to laparotomy in patients undergoing total laparoscopic hysterectomy. Gynecol Obstet Invest, 2011. 71(3): p. 193-7. https://doi: 10.1159/000317520.
- Brill AI, Nezhat F, Nezhat CH, et al. The incidence of adhesions after prior laparotomy: a laparoscopic appraisal. Obstet Gynecol, 1995. 85(2): p. 269-72. https://doi: 10.1016/0029-7844(94)00352-E.
- Szomstein S, Lo Menzo E, Simpfendorfer C, et al. Laparoscopic lysis of adhesions. World J Surg, 2006. 30(4): p. 535-40. https://doi: 10.1007/s00268-005-7778-0.
- Sokol, A.I., K. Chuang, M.P. Milad, Risk factors for conversion to laparotomy during gynecologic laparoscopy. J Am Assoc Gynecol Laparosc, 2003. 10(4): p. 469- 73. https://doi: 10.1016/s1074-3804(05)60146-6.
- Wang L, Merkur H, Hardas G, et al. Laparoscopic hysterectomy in the presence of previous caesarean section: a review of one hundred forty-one cases in the Sydney West Advanced Pelvic Surgery Unit. J Minim Invasive Gynecol, 2010. 17(2): p. 186-91. https://doi: 10.1016/j.jmig.2009.11.007.
Details
| Primary Language | English |
|---|---|
| Subjects | Obstetrics and Gynaecology |
| Journal Section | Research Article |
| Authors | |
| Publication Date | December 8, 2025 |
| Submission Date | May 22, 2025 |
| Acceptance Date | August 13, 2025 |
| Published in Issue | Year 2025 Volume: 64 Issue: 4 |
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