Laparoscopic versus open hysterectomies in obese patients

Soliman A. El Shakhs, Moharam A. Mohamed, Mahmoud A. Shahin, Ahmed M. Eid


Background: Hysterectomy is one of the most frequently performed surgical procedure. Though there are three approaches in hysterectomy (open, vaginal and laparoscopic), still there are controversies regarding the optimal route for performing it.

Methods: This prospective comparative study included 42 obese patients subjected for pan-hysterectomy as a treatment. The forty-two patients were allocated into two groups: group (A) subjected to laparoscopic pan-hysterectomy, group (B) subjected to open pan-hysterectomy.

Results: There was significant difference between the two groups regarding mean operative time, blood loss, analgesic requirements and hospital stay, while no significant difference regarding intra-operative complications.

Conclusions: Laparoscopic hysterectomy in obese patients has emerged as a viable, safe and better alternative to open hysterectomy amongst appropriately trained surgeons.


Hysterectomy, Laparoscopy, Laparotomy, Minimally-invasive, Obese

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Litta P, Fabris AM, Breda E, Bartolucci C, Conte L, Saccardi C, et al. Laparoscopic surgical staging of endometrial cancer: does obesity influence feasibility and perioperative outcome? Eur J Gynaecol Oncol. 2013;34:231-3.

Baskett TF.: Hysterectomy: evolution and trends. Best Practice Res Clin Obstetrics Gynaecol. 2005;19(3):295-305.

Thiel J, Gamelin A. Outpatient total laparoscopic hysterectomy. J Am Assoc Gynecol. Laparosc. 2003;10:481-3.

Matthews KJ, Brock E, Cohen SA, Chelmow D. Hysterectomy in obese patients: special considerations. Clin Obstet Gynecol. 2014;57:106-14.

Joshi GP. Complications of laparoscopy. Anesthesiol Clin North Am. 2001;19(1):89-105.

Geppert B, Lonnerfors C, Persson J. Robot-assisted laparoscopic hysterectomy in obese and morbidly obese women: surgical technique and comparison with open surgery. Acta Obstet Gynecol Scand. 2011;90:1210-7.

Tinelli R, Litta P, Meir Y, Surico D, Leo L, Fusco A, et al. Advantages of laparoscopy versus laparotomy in extremely obese women (BMI>35) with early-stage endometrial cancer: a multicenter study. Anticancer Res. 2014;34:2497-502.

Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB, Mannel RS, et al. Recurrence and Survival After Random Assignment to Laparoscopy Versus Laparotomy for Comprehensive Surgical Staging of Uterine Cancer: Gynecologic Oncology Group LAP2 Study. J Clin Oncol. 2012;30(7):695-700.

Sokol AI, Chuang K, Milad MP. Risk factors for conversion to laparotomy during gynecologic laparoscopy. J Am Assoc Gynecol Laparosc 2003;10:469-73.

Walsh CA, Walsh SR, Tang TY, Slack M. European J Obst Gynecol Reproductive Biol. 2009;144:3-7.

Malzoni M, Tinelli R, Cosentino F, Fusco A, Malzoni C. Total laparoscopic radical hysterectomy versus abdominal radical hysterectomy with lymphadenectomy in patients with early cervical cancer: our experience. Ann Surg Oncol. 2009;16:1316-23.

Lu Q, Liu H, Liu C, Wang S, Li S, Guo S, et al. Comparison of laparoscopy and laparotomy for management of endometrial carcinoma: a prospective randomized study with 11-year experience. J Cancer Res Clin Oncol. 2013;139:1853-9.

Eltabbakh GH, Shamonki MI, Moody JM, Garafano LL. Hysterectomy for Obese Women with Endometrial Cancer: Laparoscopy or Laparotomy? Gynecologic Oncology. 2000;78(3):329-35.

Makinen J, Johansson J, Tomás C, Tomás E, Heinonen PK, Laatikainen T, et al. Morbidity of 10 110 hysterectomies by type of approach Hum Reprod. 2001;16(7):1473-8.