Gynecologic laparoscopy in patients aged 65 or more: feasibility and safety in the presence of increased comorbidity.

Objectives: To evaluate the feasibility, operative outcome and postoperative complications of laparoscopic gynaecologic surgery in patients aged 65 or more, with increased comorbidity and obesity.

Study Design: The medical records of patients aged 65 or more with uterine or ovarian disease admitted to minimally invasive gynecologic surgery units from January 2009 to December 2011 were retrospectively analyzed in an observational cohort study. Surgical outcomes of the laparoscopic cohort (n=65) were compared with the outcomes of those who had laparotomy (n=67) at general gynecologic surgery units, and evaluated with respect to indication for surgery, medical comorbidity and obesity. Laparoscopic surgery was attempted in women who accepted minimally invasive management and who had no absolute contraindications to laparoscopy. Surgical inclusion criteria were benign and malignant uterine and adnexal pathologies; benign uterine pathologies when uterine size was less than 18 weeks' gestation or myoma smaller than 10cm; malignancies in apparent early-stage disease. There was no attempt to use laparoscopy for tumor debulking and cytoreductive surgery. Exclusion criteria were patients with emergency operations or a concomitant urogynecologic procedure. Data were analyzed using Student's t-test, the Mann-Whitney U test, χ(2) testing and the Fisher exact test.

Results: Patients undergoing laparoscopy had a significantly shorter hospital stay (p<0.001), less intraoperative bleeding (p<0.001), less postoperative hemoglobin decline (p<0.001), less need for blood transfusions (p=0.007) and a generally lower incidence of complications compared to women who had laparotomy, regardless of medical comorbidity. Obese patients who had laparoscopy had significantly less intraoperative bleeding and a smaller postoperative hemoglobin drop; no adjunctive complication was observed. In patients over 70 (80 cases) the laparoscopic group (39 cases) maintained significantly less intraoperative bleeding (p<0.001) and a smaller hemoglobin drop (p<0.001) with respect to laparotomy, with few postoperative complications.

Conclusions: According to the results of the study, laparoscopic surgery appears feasible and safe in elderly patients, regardless of medical comorbidity and obesity.