Date of Award

January 2018

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Masoud Azodi

Abstract

Study Objective: To study the safety, feasibility and patient satisfaction of posterior colpotomy technique as a port site and to retrieve specimen in benign gynecology.

Design: Retrospective chart review (Canadian Task Force Classification II-2) and retrospective survey administration and validation.

Settings: Two tertiary care hospitals, one academic and one community setting.

Patients: Fifty-four (54) women who underwent adnexal surgery with/without hysterectomy for benign indications from February 2013 till August 2017.

Interventions: The procedures were performed via conventional laparoscopy. Posterior colpotomy was the intervention of interest and was utilized to minimize abdominal incision sites/numbers for better cosmesis.

Main Results: Average patient age was 53.6 ± 10.0 years and BMI was 27.8 ± 6.2 kg/m2. Parity ranged from 0 to 7. Forty-six percent (46%) of the patients had prior abdominal or pelvic surgery (25/54). Procedures included unilateral/ bilateral salpingectomy and oophorectomy (63%); unilateral/ bilateral salpingectomy only (4%), or laparoscopic-assisted vaginal hysterectomy (LAVH) (33%). Four percent (4%) of women had a colpotomy incision only (2/54), and a vast majority (83%) of women had two abdominal incisions and a colpotomy incision (45/54). The abdominal incision size was 5 mm in 98% of the patients. Operative time was 78 ± 32 minutes and estimated blood loss (EBL) was 53 ± 120 mL. Length of hospital stay (LOS) was 0.7 ± 0.7 days. Total specimen weight was 80 ± 77 g. There were no major intra-operative or post-operative complications. In addition, no patients had postoperative vaginal infections or pelvic abscesses. There were no readmissions in 30 days. Thirty-two patients (59%) filled out the satisfaction survey at 4-week postoperative visit. They were either very satisfied (84%) or satisfied (16%) with surgical results.

Conclusion: Minimally invasive gynecologic surgeons should consider using posterior colpotomy in order to minimize the number and size of abdominal incisions when performing benign gynecologic surgery.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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