title: Risk of thromboembolic disease in patients undergoing laparoscopic gynecologic surgery.
abstract: OBJECTIVE
  To estimate the incidence of venous thromboembolism among patients undergoing gynecologic laparoscopy and characterize the risk of venous thromboembolism among patients with gynecologic malignancy.
  
  
  METHODS
  Data were collected for patients who underwent laparoscopic gynecologic surgery from January 2000 to January 2009. Incidence of deep vein thrombosis (DVT) or pulmonary embolism diagnosed within 6 weeks of surgery was estimated. Fisher's exact test was used to estimate the association between the presence of perioperative venous thromboembolism and categorical variables.
  
  
  RESULTS
  Six (of 849) patients developed symptomatic venous thromboembolism (0.7%, 95% confidence interval: 0.024-1.44%). The median time to diagnosis of venous thromboembolism was postoperative day 15.5 (range, 1-41 days), median body mass index was 25.4 kg/m (range, 18.4-50 kg/m), median operative time was 176 minutes (range, 53-358 minutes), and median estimated blood loss was 125 mL (range, 10-250 mL). Five of 430 (1.2%) patients with a history of gynecologic malignancy developed postoperative thromboembolic events. Venous thromboembolism was diagnosed in three of 662 (0.5%) patients undergoing intermediate complexity procedures and three of 106 (2.8%) patients undergoing high-complexity procedures. Three patients with venous thromboembolism (50%) had a history of at least one previous modality of cancer treatment before laparoscopy. One patient (17%) had DVT only, four (67%) had pulmonary emboli without an identified DVT, and one (17%) had both. There were no associated mortalities.
  
  
  CONCLUSIONS
  The incidence of thromboembolism in patients undergoing low- and intermediate-complexity, minimally invasive surgery was low, even among patients with a gynecologic malignancy. Patients undergoing high-complexity, minimally invasive procedures may benefit from postoperative anticoagulation.
  
  
  METHODS
  II.
authors.affiliation: From the Departments of Gynecologic Oncology and Biostatistics, The University of Texas MD Anderson Medical Cancer Center, Houston, Texas; and Hospital de Clinicas de Porto Alegre, Gynecologic Oncology Service, Universidade Federal Do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Alpa M
authors.initials: AM
authors.lastname: Nick
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Schmeler
authors.forename: Michael M
authors.initials: MM
authors.lastname: Frumovitz
authors.forename: Pamela T
authors.initials: PT
authors.lastname: Soliman
authors.forename: Whitney A
authors.initials: WA
authors.lastname: Spannuth
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Burzawa
authors.forename: Robert L
authors.initials: RL
authors.lastname: Coleman
authors.forename: Caimiao
authors.initials: C
authors.lastname: Wei
authors.forename: Ricardo
authors.initials: R
authors.lastname: Dos Reis
authors.forename: Pedro T
authors.initials: PT
authors.lastname: Ramirez
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D015992:Body Mass Index; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D054556:Venous Thromboembolism / Q000453:epidemiology*; D020246:Venous Thrombosis / Q000453:epidemiology