摘要：Background: Treatment of obese female patients represents a real challenge. Indeed, obesity among women hasreached epidemic levels not only elevating the cardiovascular and endocrinological risks, but also increasingthe incidence of various gynecological pathologies (e.g. endometrial cancer and hyperplasia, uterine fibroids,genital prolapse) which commonly require hysterectomy as a surgical solution. In the last decade, minimallyinvasive surgery has emerged as an approach reducing the invasiveness of the standard laparoscopic surgicalprocedures while maintaining efficacy and feasibility. As such, in this study we aimed to evaluate the feasibilityof percutaneous hysterectomy (PSS-H) approach in obese patients by reporting the first prospective comparisonbetween the PSS-H to laparoscopic hysterectomy (LPS-H).Methods: In this multicentric comparative prospective study, 45 patients affected by benign and malignantgynecological conditions were considered eligible for minimally invasive surgery (MIS). Fifteen patients receivedPSS-H and 30 LPS-H. All patients enrolled received a total hysterectomy ± bilateral salpingo-oophorectomy, withor without lymph nodal staging.Results: No statistically significant differences were noted in operative time and estimated blood loss between thetwo groups. Four patients in PSS-H group and 3 in LPS-H group received lymph node staging. A multifunctionalenergy device was used in all PSS-H and 73.3% of LPS-H procedures (p=0.038). There were no conversions tolaparotomy in either group and similarly there were no conversions to conventional laparoscopy in the PSS-Hgroup. In the LPS-H group, there was one (3.3%) case of major bleeding( ≥ 500 mls). We recorded one vaginalcuff bleeding in PSS-H, whereas for LPS-H we reported 4 (13.3%) 30-days complications (p=0.651). No differencesin visual analogue scale (VAS) score were recorded. A significant disparity was noted in cosmetic outcome atdischarge (p=0.001), but not after 30 days.Conclusion: We demonstrated for the first time, in a prospective comparison between PSS and LPS approaches,that PSS-H may represent a valid alternative to performing total hysterectomy in obese patients..
