A review of mortality rates in minimally invasive surgery adds insight, importance to perioperative counseling

Dec. 21, 2019

Despite its learning curves, the use of minimally invasive technology is becoming the preferred surgical technique, according to specialists at Mayo Clinic. It's associated with shorter hospital stays, decreased intraoperative blood loss, and reduced postoperative pain. Gynecology is following that trend and adopting laparoscopic and robotic surgery approaches.

Even though recent studies have emphasized that robotic surgery is improving perioperative outcomes, evidence is lacking regarding postoperative mortality rates. For that reason, Paul M. Magtibay, M.D., with Medical and Surgical Gynecology at Mayo Clinic in Phoenix/Scottsdale, Arizona, and a team of researchers conducted a systemic review of mortality in minimally invasive gynecological surgery. Their findings were published in the Journal of Minimally Invasive Gynecology in 2019.

The research team reviewed data associated with minimally invasive gynecological procedures from sources including Pubmed, Embase, Scopus and Cochrane Database of Systematic Reviews. "We believe that reporting mortality rates specific to certain gynecological procedures may help with appropriate preoperative patient counseling," says Dr. Magtibay.

"In our search, we incorporated articles that included benign laparoscopic or robotic gynecological surgery and perioperative mortality rates for minimally invasive gynecological procedures ― and were published as original, peer-reviewed articles. Furthermore, articles had to report mortality in the 30-day postoperative period."

From a total of 498 identified articles, the team found 21 (124,216 patients pooled) that reported mortality for benign gynecological minimally invasive surgery and fit the research team's inclusion criteria.

The research team found that the odds of death for minimally invasive surgery for benign gynecological procedures are 1 in 6,456 procedures. "While data is scarce, mortality rates reported after minimally invasive surgery in other surgical specialties are actually higher than those reported here for gynecological surgery," explains Dr. Magtibay.

The researchers believe that these numbers support existing evidence that shows there is no difference in complication rates between the two minimally invasive surgical approaches. "Results from this study show that the odds of death for laparoscopic and robotic gynecological surgery appear to be similar," says Dr. Magtibay. "However, there was insufficient data available to statistically compare the two approaches."

The researchers note that all minimally invasive procedures, regardless of complexity, pose a risk of mortality. In a study published in The Australian & New Zealand Journal of Obstetrics & Gynaecology in 2015 that reviewed deaths after gynecological laparoscopic surgery in Australia, mortality was reported to occur in 1 in 70,000 procedures. Deaths were related to entry, bowel perforation and hemorrhage.

"Mortality after minimally invasive surgery bowel injury is reported to be as high as 1 in 125 procedures," says Dr. Magtibay. "Given the associated consequences, gynecologists need to be trained to inspect for unrecognized injuries and for an early postoperative diagnosis of these rare, life-threatening events."

The researchers found that most preoperative counseling is focused on common intraoperative complications. However, the research team notes that patients must be given accurate information before undergoing surgery. "Given the significance of such an outcome, the risk of perioperative mortality needs to be incorporated into the informed consent," says Dr. Magtibay. "Results from this study may improve patient counseling in relation to the risk of death associated with specific gynecological procedures."

For more information

Behbehani S, et al. Mortality rates in benign laparoscopic and robotic gynecological surgery: A systematic review and meta-analysis. Journal of Minimally Invasive Gynecology. In press.

Lawson G. Gynaecological laparoscopy deaths in Australia. The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2015;55:477.