Nomogram for predicting difficult total laparoscopic hysterectomy: a multi-institutional, retrospective model development and validation study.

BACKGROUND: Total laparoscopic hysterectomy (TLH) is the most commonly performed gynaecological surgery. However, the difficulty of the operation varies depending on the patient and surgeon. Subsequently, patient's outcomes and surgical efficiency are affected. The authors aimed to develop and validate a preoperative nomogram to predict the operative difficulty in patients undergoing TLH. METHODS: This retrospective study included 663 patients with TLH from Southwest Hospital and 102 patients from 958th Hospital in Chongqing, China. A multivariate logistic regression analysis was used to identify the independent predictors of operative difficulty, and a nomogram was constructed. The performance of the nomogram was validated internally and externally. RESULTS: The uterine weight, history of pelvic surgery, presence of adenomyosis, surgeon's years of practice, and annual hysterectomy volume were identified as significant independent predictors of operative difficulty. The nomogram demonstrated good discrimination in the training dataset [area under the receiver operating characteristic curve (AUC), 0.827 (95% CI, 0.783-0.872], internal validation dataset [AUC, 0.793 (95% CI, 0.714-0.872)], and external validation dataset [AUC, 0.756 [95% CI, 0.658-0.854)]. The calibration curves showed good agreement between the predictions and observations for both internal and external validations. CONCLUSION: The developed nomogram accurately predicted the operative difficulty of TLH, facilitated preoperative planning and patient counselling, and optimized surgical training. Further prospective multicenter clinical studies are required to optimize and validate this model.

A preoperative scoring system to predict the probability of laparoendoscopic single-site extracorporeal cystectomy in patients with benign ovarian cysts.

Objective: To develop a preoperative scoring system (PSS) to predict whether laparoendoscopic single-site extracorporeal (LESS-E) cystectomy can be performed in patients with benign ovarian cysts. Method: We reviewed data on patients who underwent LESS cystectomy between August 2016 and October 2019 at the first Affiliated Hospital, Army Medical University. The independent predictors of LESS-E cystectomy in patients with benign ovarian cysts were identified using multivariate logistic regression analyses. A nomogram for predicting LESS-E cystectomy in patients with benign ovarian cysts was developed, and to simplify the score, we establish a preoperative scoring system to guide the choice of surgical approach in patients with highly probable benign ovarian cysts. Results: Our analysis showed that age, BMI, height and the diameter of ovarian cysts were independent predictors of LESS-E cystectomy. A nomogram was developed based on these four factors, which had a concordance index of 0.838 and R 2 = 0.415. To simplify the score, the predicted indicators in the regression model were scored by dividing the beta coefficient by the absolute value of the minimum beta coefficient, and the sum of each predictor score established a PSS. In the total set, the selected cutoff value according to the maximum point of the Youden index was 8, and a preoperative score ≥ 8 identified patients undergoing LESS-E cystectomy with a positive predictive value of 67.4% and a negative predictive value of 88.6%. Conclusion: A PSS to predict the chances of LESS-E cystectomy was established. This system could be helpful for selecting the appropriate surgical strategy for patients with benign ovarian cysts.

Perioperative outcomes of laparoendoscopic single-site extracorporeal versus intracorporeal cystectomy for benign ovarian cysts: a retrospective cohort study based on propensity score matching.

BACKGROUND: Ovarian cysts are the most common gynecological disease, and laparo-endoscopic single-site (LESS) cystectomy is a popular surgical procedure. A new laparoscopic technique combining the advantages of LESS surgery and open surgery has been introduced to treat large ovarian cysts. To our knowledge, no previous research has compared LESS-extracorporeal (LESS-E) cystectomy to LESS-intracorporeal (LESS-I) cystectomy. This study compared the perioperative results of LESS-E cystectomy and LESS-I cystectomy in the treatment of benign ovarian cysts. METHODS: Two hundred eighty-eight cases of cystectomy from our institutional database were retrospectively reviewed. 1:1 propensity score matching (PSM) was performed to minimize bias due to any imbalanced baseline features between the 2 groups, which were matched in terms of age, body mass index, and the largest diameter of ovarian cysts. Seventy-nine cases were then selected from each group, and the perioperative outcomes of the 2 cohorts were analyzed. RESULTS: The mean (standard deviation) largest diameter of ovarian cysts was 8.30 (3.56) cm in the LESS-I group and 9.14 (3.15) cm in the LESS-E group (P=0.118). No statistically significant difference was found between the 2 groups in terms of estimated blood loss, postoperative hemoglobin decline, postoperative pain in 24 hours, postoperative hospital stay, and total hospital costs (P>0.05). However, the mean operation time of the LESS-E group was shorter than that of the LESS-I group (85.01 vs. 104.25 minutes; P=0.001). Additionally, the spillage rate of the LESS-I group was significantly greater than that of the LESS-E group (46.8% vs. 17.7%; P<0.001). The mean pain scores at 6 postoperative hours as measured by a visual analogue scale were significantly greater in the LESS-I group than the LESS-E group (3.85 vs. 3.37; P=0.016). CONCLUSIONS: LESS-E cystectomy is a safe and feasible approach with a shorter operation time and lower spillage rate than LESS-I cystectomy.