全腹腔鏡下子宮全摘術の手術困難度術前評価モデル

抄録

Objective: To evaluate the preoperative factors associated with difficulty in performing total laparoscopic hysterectomy (TLH) and to develop a statistical model predicting surgical outcomes of TLH.

Methods: We retrospectively reviewed 240 patients who underwent TLH between January 2014 and March 2018. Preoperative magnetic resonance imaging (MRI) findings were evaluated in the analysis. Patient characteristics (age, body mass index [BMI], parity, and surgical history), preoperative MRI findings (uterine size and presence of an endometrioma), surgical outcomes (operative time, blood loss, pathologic uterine weight, transfusion, and conversion to laparotomy) were extracted from the medical records.

  Multiple regression analysis was performed to identify independent predictors of surgical outcomes.

Results: We examined 81 patients. The estimated uterine volume (length × width × depth × 0.52) and the presence of an endometrioma were independent risk factors for longer operative time and more blood loss. In this study, surgical history and increase in BMI were not associated with these outcomes.

Conclusion: Using preoperative MRI, the model developed in this study can predict the length of operative time and amount of blood loss associated with TLH.