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Balgobin S, Balk EM, Porter AE, Misal M, Grisales T, Meriwether KV, Jeppson PC, Doyle PJ, Aschkenazi SO, Miranne JM, Hobson DT, Howard DL, Mama S, Gupta A, Antosh DD. Enabling Technologies for Gynecologic Vaginal Surgery: A Systematic Review. Obstet Gynecol 2024; 143:524-537. [PMID: 38301255 DOI: 10.1097/aog.0000000000005522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/07/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVE To systematically review the literature to evaluate clinical and surgical outcomes for technologies that facilitate vaginal surgical procedures. DATA SOURCES We systematically searched MEDLINE, EMBASE, and ClinicalTrials.gov from January 1990 to May 2022. METHODS OF STUDY SELECTION Comparative and single-arm studies with data on contemporary tools or technologies facilitating intraoperative performance of vaginal gynecologic surgical procedures for benign indications were included. Citations were independently double screened, and eligible full-text articles were extracted by two reviewers. Data collected included study characteristics, technology, patient demographics, and intraoperative and postoperative outcomes. Risk of bias for comparative studies was assessed using established methods, and restricted maximum likelihood model meta-analyses were conducted as indicated. TABULATION, INTEGRATION, AND RESULTS The search yielded 8,658 abstracts, with 116 eligible studies that evaluated pedicle sealing devices (n=32), nonrobotic and robotic vaginal natural orifice transluminal endoscopic surgery (n=64), suture capture devices (n=17), loop ligatures (n=2), and table-mounted telescopic cameras (n=1). Based on 19 comparative studies, pedicle sealing devices lowered vaginal hysterectomy operative time by 15.9 minutes (95% CI, -23.3 to -85), blood loss by 36.9 mL (95% CI, -56.9 to -17.0), hospital stay by 0.2 days (95% CI, -0.4 to -0.1), and visual analog scale pain scores by 1.4 points on a subjective 10-point scale (95% CI, -1.7 to -1.1). Three nonrandomized comparative studies and 53 single-arm studies supported the feasibility of nonrobotic vaginal natural orifice transluminal endoscopic surgery for hysterectomy, adnexal surgery, pelvic reconstruction, and myomectomy. Data were limited for robotic vaginal natural orifice transluminal endoscopic surgery, suture capture devices, loop ligatures, and table-mounted cameras due to few studies or study heterogeneity. CONCLUSION Pedicle sealing devices lower operative time and blood loss for vaginal hysterectomy, with modest reductions in hospital stay and pain scores. Although other technologies identified in the literature may have potential to facilitate vaginal surgical procedures and improve outcomes, additional comparative effectiveness research is needed. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42022327490.
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Affiliation(s)
- Sunil Balgobin
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, the Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, and the Division of Urogynecology, Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas; the Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island; the Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, Ohio; the Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, California; the Division of Urogynecology, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico; the Woman's Center for Advanced Pelvic Surgery, Phoenix, Arizona; the Departments of Obstetrics and Gynecology and Urology, School of Medicine & Dentistry, University of Rochester, Rochester, New York; the Department of Obstetrics and Gynecology, Medical College of Wisconsin, Waukesha, Wisconsin; the Division of Urogynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; the Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan; the Department of Obstetrics, Gynecology, and Reproductive Health, Rutgers New Jersey Medical School, Newark, and the Department of Obstetrics and Gynecology, Cooper Medical School of Rowan University, Camden, New Jersey; and the Division of Female Pelvic Medicine & Reconstructive Surgery, University of Louisville Health, Louisville, Kentucky
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Muacevic A, Adler JR, Kanhere A, Biswas N, De R, Koley A, Banerjee PK. Electrothermal Vessel Sealing Versus Conventional Suturing in Abdominal Hysterectomy: A Randomised Trial. Cureus 2023; 15:e34123. [PMID: 36843794 PMCID: PMC9947513 DOI: 10.7759/cureus.34123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION The present randomised controlled trial was conducted to compare haemostatic efficiency, operative time, and overall performance of the electrothermal bipolar vessel sealing (EBVS) system with conventional suturing in abdominal hysterectomy. MATERIALS AND METHODS The trial was designed with standard parallel arms, i.e., vessel sealing and suture ligature arms. Sixty patients were block randomised into either arms with 30 patients in each. A hand-held vessel sealing instrument was used to perform a hysterectomy in the vessel sealing arm and the quality of the uterine artery seal achieved at the first attempt was graded on an ordinal scale of 1-3 to quantify haemostatic efficiency. Operative time, intra-operative blood loss, and peri-operative complications were compared between the two arms. RESULTS Significantly reduced mean operative time (26.97±8.92 vs 33.67±8.62 minutes; p=0.005) and intra-operative blood loss (111±53.31 mL vs 320±193.90 mL; p=0.001) was observed in the Vessel Sealing Arm compared to Suture Ligature Arm. Of total 60 uterine seals (from bilateral uterine artery transaction in 30 hysterectomies in the Vessel Sealing Arm), 83.34% were Level 1 with Complete Seal and no residual bleeding, 8.33% were Level 2 or Partial Seals with minimal bleeding, requiring the use of vessel sealers for a second time, while 8.33% had Seal Failure (Level 3) with significant bleeding requiring additional re-security of stumps with sutures. Modal pain scores on the first three postoperative days and duration of hospital stay were significantly less in the Vessel Sealer Arm, reflecting reduced postoperative morbidity. Outcomes were comparable across operators. CONCLUSION Vessel Sealing System gives superior surgical results with lesser operative time, minimal blood loss, and reduced morbidity.
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Nager CW. "You Need More Than a Hammer". UROGYNECOLOGY (PHILADELPHIA, PA.) 2022; 28:627-632. [PMID: 36256958 DOI: 10.1097/spv.0000000000001239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Charles W Nager
- From the Department of Obstetrics, Gynecology, and Reproductive Sciences, UC San Diego Health, San Diego, CA
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[Outpatient hysterectomy: criteria for acceptability and feasibility, survey among 152 surgeons]. ACTA ACUST UNITED AC 2020; 48:153-161. [PMID: 31953208 DOI: 10.1016/j.gofs.2020.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this study is to determine one-day hysterectomy's criteria of acceptability and feasibility. MATERIALS AND METHODS We realized an observational descriptive survey based on questionnaires which were sent to gynecologic surgeons. Criteria were defined as major when rate of favorable responses was superior to 70%. RESULTS Main major criteria were: definition of an age limit (80.3% of respondents), of a Body Mass Index limit (70%), no history of coronary artery disease (77.6%), no anticoagulant therapy with curative intent (95.4%) or antiplatelet (71.1%), no history of sleep apnea (77.4%), surgery within two hours (85.1%), definition of intraoperative bleeding limit (87.5%), no laparotomy (97.4%), no intra abdominal drainage (77.6%), presence of an accompanying at home (99.3%), pain evaluation (97.4%), absence of nausea before leaving (75.5%) and spontaneous urination (96.7%). CONCLUSION Our study determined major criteria to practice one-day hysterectomy. Decision should be based on a personalized benefice-risk balance analysis. Final decision belongs to patient, as her complete engagement is fundamental.
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Gingold JA, Chichura A, Harnegie MP, Kho RM. Perioperative Interventions to Minimize Blood Loss at the Time of Hysterectomy for Uterine Leiomyomas: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2019; 26:1234-1252.e1. [PMID: 31039407 DOI: 10.1016/j.jmig.2019.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 04/12/2019] [Accepted: 04/22/2019] [Indexed: 10/26/2022]
Abstract
STUDY OBJECTIVE Hysterectomy for uterine leiomyoma(s) is associated with significant morbidity including blood loss. A systematic review and meta-analysis was conducted to identify nonhormonal interventions, perioperative surgical interventions, and devices to minimize blood loss at the time of hysterectomy for leiomyoma. DATA SOURCES Librarian-led search of Embase, MEDLINE, Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature, and Cochrane databases from 1946 to 2018 with hand-guided updates. METHODS OF STUDY SELECTION Included studies reported on keywords of hysterectomy, leiomyoma, and operative blood loss/postoperative hemorrhage/uterine bleeding/metrorrhagia/hematoma. The review excluded a comparison of route of hysterectomy, morcellation, vaginal cuff closure, hormonal medications, vessel sealing devices for vaginal hysterectomy, and case series with <10 patients. TABULATION, INTEGRATION, AND RESULTS Surgical blood loss, postoperative hemoglobin (Hb) drop, hemorrhage, transfusion, and major and minor complications were analyzed and aggregated in meta-analyses for comparable studies in each category. A total of 2016 unique studies were identified, 33 of which met the inclusion criteria, and 22 were used for quantitative synthesis. The perioperative use of misoprostol in abdominal hysterectomy (AH) was associated with a lower postoperative Hb drop (0.59 g/dL; 95% confidence interval [CI], 0.39-0.79; p < .01) and blood loss (-96.43 mL; 95% CI, -153.52 to -39.34; p < .01) compared with placebo. Securing the uterine vessels at their origin in laparoscopic hysterectomy (LH) was associated with decreased intraoperative blood loss (-69.07 mL; 95% CI, -135.20 to -2.95; p = .04) but no significant change in postoperative Hb (0.24 g/dL; 95% CI, -0.31 to 0.78; p = .39) compared with securing them by the uterine isthmus. Uterine artery ligation in LH before dissecting the ovarian/utero-ovarian vessels was associated with lower surgical blood loss compared with standard ligation (-27.72 mL; 95% CI, -35.07 to -20.38; p < .01). The postoperative Hb drop was not significantly different with a bipolar electrosurgical device versus suturing in AH (0.26 g/dL; 95% CI, -0.19 to 0.71; p = .26). There was no significant difference between an electrosurgical bipolar vessel sealer (EBVS) and conventional bipolar electrosurgical devices in the Hb drop (0.02 g/dL; 95% CI, -0.15 to 0.20; p = .79) or blood loss (-50.88 mL; 95% CI, -106.44 to 4.68; p = .07) in LH. Blood loss in LH was not decreased with the LigaSure (Medtronic, Minneapolis, MN) impedance monitoring EBVS compared with competing EBVS systems monitoring impedance or temperature (2.00 mL; 95% CI, -8.09 to 12.09; p = .70). No significant differences in hemorrhage, transfusion, or major complications were noted for all interventions. CONCLUSION Perioperative misoprostol in AH led to a reduction in surgical blood loss and postoperative Hb drop (moderate level of evidence by Grading of Recommendations, Assessment, Development and Evaluation guidelines) although the clinical benefit is likely limited. Remaining interventions, although promising, had at best low-quality evidence to support their use at this time. Larger and rigorously designed randomized trials are needed to establish the optimal set of perioperative interventions for use in hysterectomy for leiomyomas.
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Affiliation(s)
| | - Anna Chichura
- Women's Health Institute (Drs. Gingold, Chichura, and Kho)
| | - Mary Pat Harnegie
- Library Services (Ms. Harnegie), Cleveland Clinic Foundation, Cleveland, Ohio
| | - Rosanne M Kho
- Women's Health Institute (Drs. Gingold, Chichura, and Kho).
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Improved hemostasis with plasma kinetic bipolar sealing device in the vaginal steps of laparoscopic-assisted vaginal hysterectomy. Taiwan J Obstet Gynecol 2019; 58:64-67. [DOI: 10.1016/j.tjog.2018.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2018] [Indexed: 11/17/2022] Open
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Interventions to reduce morbidity from vault hematoma following vaginal hysterectomy: a systematic review and meta-analysis. Int Urogynecol J 2018; 30:1061-1070. [PMID: 30498932 DOI: 10.1007/s00192-018-3829-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 11/14/2018] [Indexed: 01/11/2023]
Abstract
INTRODUCTION AND HYPOTHESIS A frequent complication following vaginal hysterectomy is the formation of vaginal vault hematoma. The objective of our systematic review was to assess the impact of various interventions in reducing the incidence of vault hematoma or postoperative febrile morbidity following vaginal hysterectomy. METHODS We carried out a systematic search of Cochrane, MEDLINE, Embase, CINAHL, HTA database, PROSPERO, meta-Register of Controlled Trials (mRCT), PubMed, CENTRAL, Google Scholar, conference abstracts, and a hand search of journals from inception until September 2018. Our search strategy included interventions in women undergoing vaginal hysterectomy with modified vault closure with inclusion of peritoneal edges, vaginal vault drainage, or vaginal packing to reduce the incidence of clinically significant vault hematomas. Two independent reviewers (SR and AD) extracted data using a structured proforma. Meta-analysis was carried out using RevMan 5.3 software. RESULTS We identified two studies on modified vaginal vault closure incorporating peritoneal edges that reported a significant reduction in vault hematoma incidence. Meta-analysis of two randomized trials on vaginal drains showed no difference in postoperative febrile morbidity secondary to vault hematoma [risk ratio (RR) 0.8, 95% confidence intervals (CI) 0.43-1.50]. Similar results were seen on meta-analysis of four randomized trials on the use of vaginal packing (RR 0.8, 95% CI 0.43-1.50). CONCLUSIONS Inclusion of peritoneal edges in vaginal vault closure may reduce the incidence of vault hematoma. The routine use of vaginal vault drainage and/or packing has not shown to reduce vault hematoma incidence or postoperative febrile morbidity. We recommend a change of practice to include peritoneal edges in vault closure based on the evidence available in our systematic review.
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Letter to the Editor on the Article "A network meta-analysis of updated haemostatic strategies for hysterectomy". Int J Surg 2017; 47:39-41. [PMID: 28951286 DOI: 10.1016/j.ijsu.2017.09.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 09/16/2017] [Indexed: 11/24/2022]
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Giraudet G, Lucot JP, Sanz F, Rubod C, Collinet P, Cosson M. Outpatient vaginal hysterectomy: Comparison of conventional suture ligature versus electrosurgical bipolar vessel sealing. J Gynecol Obstet Hum Reprod 2017; 46:399-404. [PMID: 28934083 DOI: 10.1016/j.jogoh.2017.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/17/2017] [Accepted: 03/23/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of our study was to evaluate the feasibility of vaginal hysterectomy in an ambulatory care system and the best way to perform it between conventional and bipolar vessel sealing system ligatures. PATIENTS AND METHODS This was a prospective study of 32 patients with vaginal hysterectomy at Lille University Hospital between December 2013 and May 2015. Two surgical techniques were compared: conventional suture ligature (CSL) and electrosurgical bipolar vessel sealing (BVS). Patients stayed in classical hospitalization but were managed how if they were in an ambulatory unit to evaluate their capacity to come back home the same evening of the surgery. The evaluation of same-day discharge was based on Post Anesthetic Discharge Scoring System (PADSS) score?9/10 and Visual Analogic Scale (VAS) score?4/10. Other data collected were: operative time, uterus weight, peroperative bleeding, PADSS score at the 8th postoperative hour, VAS score at the 4th, 6th, 8th, 12th and 24th postoperative hours, the presence of postoperative nausea/vomiting and rehospitalization. RESULTS In the BVS group, 93.8% of patients validated the combined score (PADSS+VAS) on the evening of the intervention against 50% of patients in the CSL group (P<0.05). Hundred percent of BVS group patients were discharged on the day after surgery against 87.5% in the CSL group. The VAS was significantly lower in the BVS group at the 8th (1.4), 12th (1.2) and 24th (1.3) postoperative hours. Operative time was significantly shorter in the BVS group. We found more events such as nausea/vomiting in the CSL group. CONCLUSION Vaginal hysterectomy is feasible in an ambulatory care system most of times. By reducing postoperative pain, electrosurgical bipolar vessel sealing would promote outpatient hospitalization.
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Affiliation(s)
- G Giraudet
- Department of Gynecological Surgery, Jeanne-de-Flandre Hospital, Regional University Hospital of Lille, avenue Eugène-Avinée, 59000 Lille, France.
| | - J P Lucot
- Department of Gynecological Surgery, Jeanne-de-Flandre Hospital, Regional University Hospital of Lille, avenue Eugène-Avinée, 59000 Lille, France; Department of Gynecology and Obstetrics, Hospital of Bethune, 27, rue Delbecque, 62131 Verquigneul, France
| | - F Sanz
- Department of Anesthesiology in Obstetrics, Gynecology and Reproductive Medicine, Jeanne-de-Flandre Hospital, avenue Eugène-Avinée, 59000 Lille, France; Department of anesthesia, groupement des hôpitaux de l'institut catholique de Lille, hôpital Saint-Philibert, rue du Grand-But, 59160 Lomme, France
| | - C Rubod
- Department of Gynecological Surgery, Jeanne-de-Flandre Hospital, Regional University Hospital of Lille, avenue Eugène-Avinée, 59000 Lille, France
| | - P Collinet
- Department of Gynecological Surgery, Jeanne-de-Flandre Hospital, Regional University Hospital of Lille, avenue Eugène-Avinée, 59000 Lille, France
| | - M Cosson
- Department of Gynecological Surgery, Jeanne-de-Flandre Hospital, Regional University Hospital of Lille, avenue Eugène-Avinée, 59000 Lille, France
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Comparison of Vaginal Hysterectomy Techniques and Interventions for Benign Indications. Obstet Gynecol 2017; 129:877-886. [DOI: 10.1097/aog.0000000000001995] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Clavé H, Clavé A. Safety and Efficacy of Advanced Bipolar Vessel Sealing in Vaginal Hysterectomy: 1000 Cases. J Minim Invasive Gynecol 2016; 24:272-279. [PMID: 27826116 DOI: 10.1016/j.jmig.2016.10.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 10/05/2016] [Accepted: 10/13/2016] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE To determine the safety and efficacy of advanced electrothermal bipolar vessel sealing (EBVS) during vaginal hysterectomy by evaluating urinary complications, overall complications, and reoperation rate. DESIGN A retrospective cohort (Canadian Task Force classification III). SETTING High-volume gynecologic surgeon practice, private hospital. PATIENTS One thousand consecutive patients who have undergone vaginal hysterectomy for benign conditions carried out with EBVS between January 2002 and December 2012. INTERVENTIONS Vaginal hysterectomy performed using an EBVS device. MEASUREMENTS AND MAIN RESULTS One thousand consecutive patients underwent vaginal hysterectomy with advanced EBVS between January 2002 and December 2012 with an average age of 51.4 ± 8.9 years (range, 31-88) and mean weight and body mass index of 57.4 ± 7.2 kg (range, 42-105) and 25.8 ± 4.2 kg/m2 (range, 19.1-38.9), respectively. Eighty-five percent of patients (852/1000) were healthy without any severe systemic disease. A single experienced surgeon performed all vaginal hysterectomies with EBVS, specifically by not applying traction during thermofusion to avoid hemorrhage, amputating the cervix to transform the uterus to an apple shape to facilitate a vaginal approach and rotation of the uterus, and placing bi-clamp forceps on the edge of the uterus and not at a 45- or 90-degree angle. Wound closure was completed with a continuous suture. Eleven urinary complications (1.1%) were recorded (10 bladder mechanical injuries and 1 vesicovaginal fistula). This was not statistically different from the rate of .64% previously reported in the FINHYST study (p = .15). The overall rate of complications was 5.3%, and 20 patients (2.0%) required reoperation. The presence of uterine scar tissue (odds ratio, 5.5; 95% confidence interval, 1.6-19.2) and larger uterus size (odds ratio, 2.5; 95% confidence interval, 1.01-19.2) were associated with a higher risk of urinary complications. CONCLUSION The use of EBVS during vaginal hysterectomy results in urinary and overall complication rates of 1.1% and 5.3%, respectively, statistically similar to previously reported series that did not use EBVS. The use of advanced EBVS is a safe and effective method of achieving hemostasis during vaginal hysterectomy.
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Affiliation(s)
- Henri Clavé
- Service de Chirurgie Gynécologique, Clinique Saint-George, Nice, France
| | - Arnaud Clavé
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; Service de Chirurgie Orthopédique, Hôpital de la Cavale Blanche, CHRU de Brest, Brest, France.
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Hysterectomy for benign disease: clinical practice guidelines from the French College of Obstetrics and Gynecology. Eur J Obstet Gynecol Reprod Biol 2016; 202:83-91. [PMID: 27196085 DOI: 10.1016/j.ejogrb.2016.04.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 03/30/2016] [Accepted: 04/02/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The objective of the study was to draw up French College of Obstetrics and Gynecology (CNGOF) clinical practice guidelines based on the best available evidence concerning hysterectomy for benign disease. METHODS Each recommendation for practice was allocated a grade, which depends on the level of evidence (clinical practice guidelines). RESULTS Hysterectomy should be performed by a high-volume surgeon (>10 hysterectomy procedures per year) (gradeC). Stimulant laxatives taken as a rectal enema are not recommended prior to hysterectomy (gradeC). It is recommended to carry out vaginal disinfection using povidone-iodine solution prior to hysterectomy (grade B). Antibiotic prophylaxis is recommended during hysterectomy, regardless of the surgical approach (grade B). The vaginal or laparoscopic approach is recommended for hysterectomy for benign disease (grade B), even if the uterus is large and/or the patient is obese (gradeC). The choice between these two surgical approaches depends on other parameters, such as the surgeon's experience, the mode of anesthesia, and organizational constraints (duration of surgery and medical economic factors). Vaginal hysterectomy is not contraindicated in nulliparous women (gradeC) or in women with previous cesarean section (gradeC). No specific hemostatic technique is recommended with a view to avoiding urinary tract injury (gradeC). In the absence of ovarian disease and a personal or family history of breast/ovarian carcinoma, the ovaries should be preserved in pre-menopausal women (grade B). Subtotal hysterectomy is not recommended with a view to reducing the risk of peri- or postoperative complications (grade B). CONCLUSION The application of these recommendations should minimize risks associated with hysterectomy.
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Chêne G, Lamblin G, Marcelli M, Huet S, Gauthier T. [Urinary, infectious and digestive adverse events related to benign hysterectomy and the associated surgery on the Fallopian tube: Guidelines]. ACTA ACUST UNITED AC 2015; 44:1183-205. [PMID: 26527024 DOI: 10.1016/j.jgyn.2015.09.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 09/18/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To provide clinical practice guidelines from the French College of Obstetrics and Gynecology (CNGOF) based on the best evidence available, concerning the urinary, infectious and digestive adverse events related to benign hysterectomy and the associated surgery including opportunistic salpingectomy and adnexectomy. MATERIAL AND METHOD Review of literature using following keywords: benign hysterectomy; urinary injury; bladder injury; ureteral injury; vesicovaginal fistula; infection; bowel injury; salpingectomy. RESULTS Urinary catheter should be removed before 24h following uncomplicated hysterectomy (grade B). In case of urinary catheter during hysterectomy, immediate postoperative removal is possible (grade C). No hemostasis technics can be recommended to avoid urinary injury (grade C). There is not any evidence to recommend to perform a window in the broad ligament or an ureterolysis, to put ureteral stent or a uterine manipulator in order to avoid ureteral injury. An antibiotic prophylaxis by a cephalosporin is always recommended (grade B). Mechanical bowel preparation before hysterectomy is not recommended (grade B). If there is no ovarian cyst/disease and no familial or personal history of ovarian/breast cancer, ovarian conservation is recommended in premenopausal women (grade B). In postmenopausal women, informed consent and surgical approach should be taken in account to perform a salpingo-oophorectomy. Since the association salpingectomy and hysterectomy is not assessed in the prevention of ovarian cancer, systematic bilateral salpingectomy is not recommended (expert consensus). CONCLUSIONS Practical application of these guidelines should decrease the prevalence of visceral complications associated with benign hysterectomy.
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Affiliation(s)
- G Chêne
- Département de gynécologie-obstétrique, hôpital Femme-Mère-Enfant, HFME, hospices civils de Lyon, 69002 Lyon, France; Université Claude-Bernard Lyon 1, EMR 3738, 69100 Villeurbanne, France.
| | - G Lamblin
- Département de gynécologie-obstétrique, hôpital Femme-Mère-Enfant, HFME, hospices civils de Lyon, 69002 Lyon, France
| | - M Marcelli
- Département de gynécologie-obstétrique, hôpital La Conception, Aix-Marseille université, 13005 Marseille, France
| | - S Huet
- Département de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, avenue Larrey, 87000 Limoges, France
| | - T Gauthier
- Département de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, avenue Larrey, 87000 Limoges, France
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Response to Gizzo et al.: electrosurgical bipolar vessel sealing for vaginal hysterectomies. Arch Gynecol Obstet 2014; 290:1047. [PMID: 25248632 DOI: 10.1007/s00404-014-3459-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Gizzo S, Noventa M. Electrosurgical bipolar vessel sealing for vaginal hysterectomies: criticism of evidences from a meta-analysis. Arch Gynecol Obstet 2014; 290:1045-6. [DOI: 10.1007/s00404-014-3454-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 08/28/2014] [Indexed: 11/30/2022]
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