title: Does laparoscopy safely improve technicity for complex hysterectomy cases?
abstract: OBJECTIVE
  The minimally invasive surgical (MIS) approach to hysterectomy (vaginal or laparoscopic), when compared with laparotomy, results in shorter length of stay, fewer minor and major complications, and quicker return to normal activity. The complexity of the hysterectomy procedure or pathology may affect the success of an MIS approach. This study examined the indications, complications, and outcomes of all hysterectomies performed, irrespective of the severity of pathology or patient habitus, in a Canadian tertiary level gynaecologic surgical referral service.
  
  
  METHODS
  We performed a retrospective chart review of all hysterectomies performed by a single surgeon between September 2007 and June 2011, noting indications, complications, and outcomes. One-way analysis of variance was used to calculate the influence of various factors across surgery types. Significance was set at P < 0.05 for all tests.
  
  
  RESULTS
  A total of 305 cases were included; 291 of these (95.4%) were managed through an MIS approach, providing a technicity rate of 95.4%. Mean patient age was 45.5 years, and mean BMI was 28.9. The main indicators for surgery were fibroids (42.0%), pain (38.4%), and heavy menstrual bleeding (37.4%). Eighty-one percent of cases were tertiary referrals. Of the laparoscopic cohort, endometriosis was moderate-severe in 61.2% of patients. Mean length of stay was 1.14 days, mean uterine weight was 277.6 g, and mean estimated blood loss was 179 mL.
  
  
  CONCLUSIONS
  This retrospective study of a tertiary level referral gynaecologic service suggests that complex hysterectomy may be effectively and efficiently managed through an MIS approach.
authors.affiliation: Department of Obstetrics and Gynaecology, The Ottawa Hospital, Ottawa ON.
authors.forename: Amanda
authors.initials: A
authors.lastname: Grant-Orser
authors.affiliation: Department of Obstetrics and Gynaecology, The Ottawa Hospital, Ottawa ON; Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, ON.
authors.forename: Ramadan
authors.initials: R
authors.lastname: El Sugy
authors.affiliation: Department of Obstetrics and Gynaecology, The Ottawa Hospital, Ottawa ON; Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, ON; Ottawa Hospital Research Institute, Ottawa ON.
authors.forename: Sukhbir S
authors.initials: SS
authors.lastname: Singh
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods* / Q000706:statistics & numerical data; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000706:statistics & numerical data; D007889:Leiomyoma / Q000601:surgery; D008595:Menorrhagia / Q000601:surgery; D008875:Middle Aged; D010146:Pain / Q000601:surgery; D011183:Postoperative Complications; D012189:Retrospective Studies
keywords: complications; hysterectomy; laparoscopy; technicity