■非宫腔镜子宫肌瘤切除术很少在独立的非卧床环境中进行,部分是由于术中出血的风险。在这种情况下,病态肥胖患者的手术风险也会增加。本研究的目的是报告在独立门诊手术中心(ASC)进行的一系列腹腔镜辅助子宫肌瘤切除术(LAM)的手术结果,包括对病态肥胖患者(BMI>40kg/m2)结局的比较分析。
■对969名女性进行了回顾性比较分析,18岁或以上,没有怀孕,他以两个高音量之一接受了LAM,为华盛顿提供服务的独立门诊手术中心的腹腔镜妇科手术专家,DC面积,2013年10月至2019年2月。通过在子宫峡部周围放置基于乳胶的橡胶导管作为止血带,在腹腔镜下进行可逆闭塞,导致双侧子宫动脉暂时闭塞。通过腹膜后解剖和子宫动脉结扎在the内动脉前支的起点在腹腔镜下进行永久性闭塞。在所有情况下都进行了剖腹手术切除标本。没有使用功率分折。使用Clavien-Dindo分类系统对术后并发症进行分级。使用Pearson卡方比较了不同BMI类别的结果。
■平均肌瘤重量和大小分别为422.7g和8.3cm,分别。平均估计失血量(EBL)为192.1mL;术中和术后3级并发症发生率分别为1.4%和1.6%,分别。虽然肥胖和病态肥胖患者的EBL明显更高,这种差异没有临床意义,输血率无显著差异。不同BMI类别的术中或术后并发症发生率无统计学意义。所有患者的医院转院率都很低(0.7%)。
■腹腔镜辅助子宫肌瘤切除术可以在独立的非卧床手术环境中安全地进行,包括病态肥胖的病人.这在COVID-19年龄尤其重要,因为由于2020年大流行,选择性手术被推迟,这可能导致门诊手术从医院到ASC的戏剧性和永久性转移。
UNASSIGNED: Non-hysteroscopic myomectomy is infrequently performed in a freestanding ambulatory setting, in part due to risks of intraoperative hemorrhage. There are also concerns about increased surgical risks for morbidly obese patients in this setting. The purpose of this study is to report the surgical outcomes of a series of laparoscopic-assisted myomectomy (LAM) cases at a freestanding ambulatory surgery center (
ASC), including a comparative analysis of outcomes in morbidly obese patients (BMI > 40 kg/m2).
UNASSIGNED: A retrospective comparative analysis was performed of 969 women, age 18 years or older, non-pregnant, who underwent LAM by one of two high volume, laparoscopic gynecologic surgical specialists at a freestanding ambulatory surgery center serving the Washington, DC area, between October 2013 and February 2019. Reversible occlusion was performed laparoscopically by placing a latex-based rubber catheter as a tourniquet around the isthmus of the uterus, causing a temporary occlusion of the bilateral uterine arteries. Permanent occlusion was performed laparoscopically via retroperitoneal dissection and uterine artery ligation at the origin of the anterior branch of the internal iliac artery. Minilaparotomy was performed for specimen removal in all cases. No power morcellation was used. Postoperative complications were graded using the Clavien-Dindo Classification system. Outcomes were compared across BMI categories using Pearson Chi-Square.
UNASSIGNED: Average myoma weight and size were 422.7 g and 8.3 cm, respectively. Average estimated blood loss (EBL) was 192.1 mL; intraoperative and grade 3 postoperative complication rates were 1.4% and 1.6%, respectively. While EBL was significantly higher in obese and morbidly obese patients, this difference was not clinically meaningful, with no significant difference in blood transfusion rates. There were no statistically significant intraoperative or postoperative complication rates across BMI categories. There was a low rate of hospital transfers (0.7%) for all patients.
UNASSIGNED: Laparoscopic-assisted myomectomy can be performed safely in a freestanding ambulatory surgery setting, including morbidly obese patients. This is especially important in the age of COVID-19, as elective surgeries have been postponed due to the 2020 pandemic, which may lead to a dramatic and permanent shift of outpatient surgery from the hospital to the
ASC setting.