English 简体中文

510K Clear

K162387/K162648

​​Top Premium Quality

   -- by LEAN

          -- by Zero Defect                    

                -- by UWELL

Laparoscopic Surgery in Elderly Patients Aged 65 Years and Older with Gynecologic Disease
Source:https://www.hindawi.com/journals/isrn/2012/678201/ | Author:youwai | Published time: 2020-04-15 | 1298 Views | Share:
Objectives. The study was conducted to characterize the use of the laparoscopic surgery in elderly patients. Methods. The medical records of elderly patients aged ≥65 years who underwent laparoscopic surgery were retrospectively reviewed for diseases, surgical procedures, histological diagnosis, intraoperative and postoperative complications, and reasons for presentation. Results. Of the 405 patients who underwent laparoscopic surgery between January 2005 and March 2012, 41 (10.1%) were aged ≥65 years. The most common disease treated by surgery was ovarian tumor, followed by uterine prolapse. Histological diagnosis of ovarian tumor specimens obtained from 23 patients included serous cystadenoma (44.0%), mature cystic teratoma (20.0%), mucinous cystadenoma (20.0%), and endometrioma (4%). In contrast, in the non-elderly group, the most common histological diagnosis was endometrioma (42.9%), followed in order by mature cystic teratoma (28.3%), serous cystadenoma (18.0%), and mucinous cystadenoma (4.7%). While 23.7% of the non-elderly patients required emergency laparoscopic surgery, none of the elderly patients required emergency surgery. Only 1 of 27 patients who underwent surgery for an ovarian or adnexal mass presented with abdominal pain. No one developed serious intraoperative or postoperative complications. Conclusion. Laparoscopic surgery can be safely performed in elderly patients. It should be noted, however, that few elderly patients with benign pelvic mass manifest symptoms before undergoing surgery.

1. Introduction

Laparoscopic surgery is widely performed for the treatment of benign gynecologic diseases as it is associated with lower invasiveness, less pain, and shorter postoperative hospital stay than open surgery [1, 2]. In Japan, where the population is rapidly aging and life expectancy is increasing, laparoscopic surgery is expected to be performed more frequently in elderly women with gynecologic disease.

In the field of gastrointestinal surgery, where many patients are elderly, laparoscopic surgery has been extensively used for elderly patients undergoing surgeries such as cholecystectomy and resection of digestive tumors since the 1990s, with fewer complications reported compared with open surgery [3, 4]. In the field of gynecology, the use of laparoscopy was initially intended for intraperitoneal examination of infertile women and was later extended to surgical treatment of conditions commonly affecting younger women, such as benign ovarian cyst and ectopic pregnancy. The selection of laparoscopic versus open surgery therefore takes into account esthetic considerations, and there have been a limited number of studies on the use of laparoscopic surgery in elderly patients with gynecologic disease.

This study aimed to characterize and evaluate the safety of laparoscopic surgery in elderly patients with gynecologic disease by retrospectively analyzing the medical records of elderly female patients aged ≥65 years who underwent laparoscopic surgery during a 7-year period between January 2005 and March 2012.

2. Methods

A retrospective medical record review was conducted at Shimane University Hospital in Shimane prefecture, Japan. The medical records of all women who underwent laparoscopy for gynecologic disorders at some time between January 1, 2005 and March 31, 2012 () were reviewed. Medical history was taken by a physician, and all patients gave informed consent for the surgery. A single investigator reviewed each record and abstracted the data.

While no upper age limit was defined for selecting candidates for laparoscopic surgery, elderly patients with impaired function of major organs, were bedridden, or had advanced dementia were excluded. The age of ≥65 years is generally considered as the stage of old age and therefore, for the purpose of the present study, we identified elderly patients aged ≥65 years who underwent laparoscopic surgery in the past 7 years. Their medical records were analyzed for diseases treated by surgery, surgical procedures, histological diagnosis of resected specimens, events that led to surgery, and intraoperative and postoperative complications.

In laparoscopy surgery, after general anesthesia, a 10 mm trocar was inserted just below the umbilicus and insufflated with carbon dioxide at a pressure of 8–10 mm Hg. On direct view, two trocars (12 or 5 mm) were placed through lower abdominal incisions. In some cases, single-port surgery was applied.

3. Results

Of the 405 patients who underwent laparoscopic surgery between January 2005 and March 2012, 41 (10.1%) were aged ≥65 years. One patient, a 66-year-old woman with benign ovarian cyst in whom laparoscopic procedure was converted to open surgery after severe intraperitoneal adhesion was identified during the procedure, was excluded from the analysis.