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1093 Optimising outcomes for laparoscopic hysterectomy in patients with morbid obesity
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1093 Optimising outcomes for laparoscopic hysterectomy in patients with morbid obesity
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1093 Optimising outcomes for laparoscopic hysterectomy in patients with morbid obesity
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Journal Article
1093 Optimising outcomes for laparoscopic hysterectomy in patients with morbid obesity
2021
Overview
Introduction/Background*Operating on patients with a significantly raised body mass index (BMI) represents a significant challenge to the surgical and the anaesthetic team. Hysterectomy for early-stage uterine cancer is usually performed via laparoscopy.We aimed to evaluate whether a two consultant ‘buddy operating’ approach improves on intra-operative and post-operative outcomes in patients undergoing total laparoscopic hysterectomy (TLH) for endometrial cancer who are morbidly obese.MethodologyA prospectively selected cohort of 25 patients with a BMI 47-70 undergoing TLH was divided into two groups according to whether the first assistant to the Gynae-Oncology consultant was a registrar (ST3-7), or a consultant (‘buddy operating’). Anaesthetic time, operating time, intraoperative estimated blood loss (EBL), requirement for high dependency unit (HDU) bed and length of stay (LOS) were compared in the two groups.Result(s)*Average ‘buddy’ operating time was significantly shorter compared to the registrar-assistant group (01:31h vs 01:59h respectively; p<0.001); a similar trend was seen with the average total anaesthetic time (02:48h vs 03:23h respectively; p<0.001). EBL was less in the ‘buddy operating’ group (39 mls) vs registrar-assistant group (169 mls; p<0.001). Post-operatively, LOS was shorter in the ‘buddy operating’ group as compared to the registrar-assistant, though not significantly so (1.13 vs 1.59 days; p=0.109). 2 of the total patients (8%) required a one-night stay in HDU for observation due to their co-morbidities, both in the registrar-assistant group. Mean BMI, age, ASA and comorbidities were similar in the two groups.Conclusion*In patients with a significantly raised BMI, TLHs by two consultants vs consultant and registrar are associated with better intra and post-operative outcomes, including reduced overall anaesthetic time, operating time, and EBL. There is an association with a reduced length of overall hospital stay, though this was not significant.
Publisher
BMJ Publishing Group Ltd,Elsevier Inc,Elsevier Limited
Subject
