title: Feasibility and surgical outcome in obese versus nonobese patients undergoing laparoendoscopic single-site hysterectomy: a multicenter case-control study.
abstract: OBJECTIVE
  To assess the feasibility and perioperative outcomes of laparoendoscopic single-site (LESS) hysterectomy in obese and nonobese women.
  
  
  METHODS
  A multicentric retrospective case-control study (Canadian Task Force II-2).
  
  
  METHODS
  Catholic University of the Sacred Heart and National Cancer Institute "Regina Elena" (Rome, Italy), Massachusetts General Hospital (Boston, MD), and Johns Hopkins Hospital (Baltimore, MD).
  
  
  METHODS
  From July 2009 to April 2013, 120 women underwent LESS hysterectomy. Five women (8%) were excluded from the analysis. The remaining 115 women were divided into 2 groups: obese (n = 43, body mass index [BMI] ≥30 kg/m(2)) and nonobese (n = 72, BMI <30 kg/m(2)).
  
  
  METHODS
  Total LESS hysterectomies for malignant and premalignant uterine disease or at least for prophylactic intent were performed.
  
  
  RESULTS
  No statistical differences regarding perioperative outcomes were observed between the 2 groups. Conversion to standard laparoscopy occurred in 2 obese (5%) and 2 (5%) nonobese women (p = .62). Conversion to laparotomy occurred in 1 obese (2.3%) and 3 (4.2%) nonobese women (p = .212). The median operative time was 115 minutes (range, 48-300 minutes) in obese and 114 minutes (range, 55-342 minutes) in nonobese women (p = .787). The intraoperative complication rate was 11.6% and 9.6% in obese and nonobese women, respectively (p = .712). The early postoperative complication rate was 6.9% in obese and 4.1% in nonobese women (p = .516).
  
  
  CONCLUSIONS
  Despite the fact that the present analysis was performed in a relatively small group of patients, this study suggests that obesity (BMI ≥30) does not preclude successful completion of total LESS hysterectomy. Further prospective studies are required to confirm these preliminary data and to clarify potential advantages and disadvantages of LESS in obese women.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Hearth, Rome, Italy. Electronic address: francesco.fanfani@rm.unicatt.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Fanfani
authors.affiliation: Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: David M
authors.initials: DM
authors.lastname: Boruta
authors.affiliation: Division of Gynecologic Oncology, John Hopkins Medical Institute, Baltimore, Maryland.
authors.forename: Amanda N
authors.initials: AN
authors.lastname: Fader
authors.affiliation: Gynecology Oncology Unit, Department of Oncological Surgery, "Regina Elena" National Cancer Institute, Rome, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Vizza
authors.affiliation: Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Withfiel B
authors.initials: WB
authors.lastname: Growdon
authors.affiliation: Division of Gynecologic Oncology, John Hopkins Medical Institute, Baltimore, Maryland.
authors.forename: Cristina L
authors.initials: CL
authors.lastname: Kushnir
authors.affiliation: Gynecology Oncology Unit, Department of Oncological Surgery, "Regina Elena" National Cancer Institute, Rome, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Corrado
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Hearth, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Scambia
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Hearth, Rome, Italy.
authors.forename: Luigi C
authors.initials: LC
authors.lastname: Turco
authors.affiliation: Minimally Invasive Gynecology, St Maria Hospital, University of Perugia, Terni, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Fagotti
mesh_terms: D015992:Body Mass Index; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D014481:United States; D014591:Uterine Diseases / Q000150:complications / Q000601:surgery
keywords: Hysterectomy; Laparoendoscopic single-site surgery; Laparoscopy; Obesity; Single site