Objectives To evaluate whether a consultant ‘buddy’ operating approach improves on intra-operative and post-operative outcomes in patients undergoing total laparoscopic hysterectomy (TLH) for endometrial cancer who are extremely and morbidly obese.
Methods A prospectively selected cohort of 25 patients with a BMI 47–70 undergoing TLH was divided into two groups according to whether the first assistant to the Gynae-Oncology consultant was a registrar, or a consultant (‘buddy operating’). Anaesthetic time, operating time, intraoperative estimated blood loss (EBL), requirement for high dependency unit (HDU) bed and length of stay (LOS) were compared.
Results Average ‘buddy’ operating time was significantly shorter compared to the registrar-assistant group (01:31h vs 01:59h respectively; p<0.001); a similar trend was seen with the average total anaesthetic time (02:48h vs 03:23h respectively; p<0.001). EBL was less in the ‘buddy operating’ group (39 mls) vs registrar-assistant group (169 mls; p<0.001). Post-operatively, LOS was shorter in the ‘buddy operating’ group as compared to the registrar-assistant, though not significantly so (1.13 vs 1.59 days; p=0.109). 2 of the total patients (8%) required a one-night stay in HDU for observation due to their co-morbidities, both in the registrar-assistant group. Mean BMI, age, ASA and comorbidities were similar in the two groups.
Conclusions In patients with a significantly raised BMI, TLHs by two consultants vs consultant and registrar are associated with better intra and post-operative outcomes, including reduced overall anaesthetic time, operating time, and EBL. There is an association with a reduced length of overall hospital stay, though this was not significant.
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