Fatores associados à taxa de conversão para laparotomia em pacientes submetidas à laparoscopia por portal único para abordagem de massas anexiais

Abstract

Introduction: Laparoendoscopic single-site surgery (LESS) emerged in the field of minimally invasive surgery to improve cosmetic satisfaction with the surgical scar and to reduce the morbidity associated with multiple incisions. For adnexal mass approach, possible advantages include less postoperative pain and better cosmetic satisfaction. The knowledge of factors that can be associated with adverse outcomes is essential for correct indication and follow-up of patients. Objectives: to assess possible factors associated with the occurrence of conversion to laparotomy in patients undergoing laparoscopy for the approach of adnexal masses with LESS. Methods: In a retrospective study, a total of 117 women that underwent LESS for adnexal mass approach, from June of 2012 to December of 2015, were included in a data bank. We performed a 2.5 cm incision in the umbilicus, to insert the single access platform. We performed a multivariate logistic regression, considering a significance level of 0.05. Results: The average age of the patients was 43 ± 13.5 years (ranging from 18 to 77 years) and the median of body mass index was 25 Kg/m2 (17-37 Kg/m2); 53 women (45.3%) had previous abdominal surgeries and 18 patients (16,4%) were obese. The median time of the surgical procedures completed by single portal was 65 minutes (20-197 minutes) and the length of hospital stay was 22 hours (14-78 hours). Sixteen patients (13.7%) required a conversion to laparotomy due to technical difficulties. The occurrence of conversion to laparotomy was associated with history of prior abdominal surgeries (OR 4.12; 95% CI 1.32-14.07; p 0.027) and obesity (OR 2,75; IC 95% 1,46-19,21; p 0,044). Conclusion: The previous history of abdominal surgery and obesity are factors that are associated with the occurrence of conversion to laparotomy in women undergoing LESS for adnexal mass approach.