The effect of obesity on cost of total laparoscopic hysterectomy.

STUDY OBJECTIVE: To test for the association between increasing patient body mass index (BMI) and the cost of total laparoscopic hysterectomy (TLH). Secondary outcomes include the relationship between increasing BMI and both peri- and post-operative morbidity. MATERIALS AND METHODS: Retrospective cohort study of patients (N = 510) who underwent TLH between January 2017 and December 2018 at a single public tertiary teaching hospital. RESULTS: Morbid obesity (n = 63) was associated with significantly higher total admission costs ($19 654 vs $17 475 Australian dollars, P = 0.002), operative costs ($9447 vs $8630, P = 0.017) and total costs including readmissions ($20 476 vs $18 399, P = 0.016) when compared to patients with normal BMI (n = 103) and adjusting for age, indication for surgery, additional procedures and conversion to total abdominal hysterectomy. Costs for overweight (n = 134) and obese (n = 210) BMI groups did not differ from costs for the normal BMI group. Increased operative costs observed in the morbidly obese group, were largely driven by the time associated with set-up, transfer and anaesthetic time while surgical and recovery times were not statistically significant. CONCLUSION: The total cost of TLH is increased in the morbidly obese category of patients. The operative costs appear to be related to pre-operative measures such as theatre set-up and anaesthetic requirements. TLH in the obese and morbidly obese category group is not associated with increased intra-operative or post-operative complications. There may be a role for exploring improvements in managing morbidly obese patients in the pre-operative setting.

A prospective study of the use of the Myosure resectoscope to manage endometrial polyps in an outpatient setting.

BACKGROUND: The Myosure resectoscope has been in use since 2009. Our unit is the first in Australia to describe the use of the Myosure device in the outpatient setting to resect endometrial polyps. AIM: To compare patient satisfaction and pain scores of pre- and postmenopausal women undergoing outpatient removal of endometrial polyps using the Myosure device. MATERIAL AND METHODS: Public hospital based prospective study. Patients (n=42) who opted to have resection of endometrial polyps under local anaethesia were recruited. Procedures were performed using a 6.25-mm hysteroscope with a MyoSure Lite device. Patient experiences were collected using a questionnaire immediately postprocedure. Pain level was assessed using 100-mm visual analogue score (VAS). Resection times and untoward events were recorded. RESULTS: Mean endometrial polyp size was 13 mm and the mean resection time was 39.4s. Complete resection was achieved in 95.2% of cases. The median VAS was 2.7 (range 0.7-7.5). The pain scores did not differ significantly between nulliparous or parous women who only had a caesarean section delivery and those who have delivered vaginally. However, VAS was statistically less in postmenopausal women in comparison with premenopausal women (2.5 vs 3.2, respectively; (P = 0.047)). Overall, women were very satisfied; 97.6% would recommend the procedure to a friend and 95.2% happy to consider a repeat procedure in the future if required. The complication rate was 4.8%, and all were minor in nature. CONCLUSION: Operative hysteroscopic procedures can be performed successfully in the outpatient setting using the Myosure Lite device with a high level of patient satisfaction.