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Baekelandt JF, Stuart A, Wagenius J, Laenen A, Mol BW, Deprest J, Bosteels JJA. VaNoLaH trial: a study protocol-a multinational randomised controlled trial including two identical substudies comparing vaginal versus vNOTES (vaginal natural orifice transluminal surgery) hysterectomy or laparoscopic versus vNOTES hysterectomy. BMJ Open 2024; 14:e081979. [PMID: 38658010 PMCID: PMC11043683 DOI: 10.1136/bmjopen-2023-081979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 04/08/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION Hysterectomy is one of the most common surgeries performed in women. Minimally invasive methods are on the rise globally as they have been shown to decrease surgical morbidity compared with abdominal hysterectomy. Hysterectomy by vaginal natural orifice transluminal endoscopic surgery (vNOTES) is the latest innovation. It combines the vaginal approach and endoscopy via the vagina. Large pragmatic randomised controlled trials (RCTs) are lacking comparing outcomes after vNOTES, vaginal hysterectomy (VH) and laparoscopic hysterectomy (LH). METHODS Multicentre pragmatic RCT aiming to recruit 1000 women aged 18-75 years undergoing hysterectomy for benign disease. The RCT includes two identical substudies (groups A and B). If VH is considered safe and feasible, the patient will be randomised within group A (VH vs vNOTES). If VH is not considered safe or feasible, patients will be randomised within group B (LH vs vNOTES). ANALYSIS Primary outcome is the proportion of women leaving the hospital within 12 hours after surgery. Secondary outcomes are hospitalisation time, conversion rates, duration of the surgical procedure, intraoperative complications, postoperative complications and readmission. ETHICS AND DISSEMINATION The Ethical Board Committee at Imelda Hospital, Bonheiden, Belgium, has approved the research protocol 230704 (principal investigator). Before including patients, all centres will require local or national ethical approval. The results of the study will be published in international peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05971875.
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Affiliation(s)
| | - Andrea Stuart
- Obstetrics and Gynecology, Lund University Department of Clinical Sciences Lund, Lund, Sweden
- Department of Obstetrics and Gynecology, Helsingborg, Sweden
| | - Johanna Wagenius
- Obstetrics and Gynecology, Lund University Department of Clinical Sciences Lund, Lund, Sweden
- Department of Obstetrics and Gynecology, Helsingborg, Sweden
| | - Annouschka Laenen
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Leuven, Belgium
| | - Ben W Mol
- OB/GYN, School of Medicine, Monash University, Melbourne, Clayton, Victoria, Australia
| | - Jan Deprest
- Gynaecology, University Hospital Leuven, Leuven, Belgium
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Zhang W, Deng L, Yang F, Liu J, Chen S, You X, Gou J, Zi D, Li Y, Qi X, Wang Y, Zheng Y. Comparing the efficacy and safety of three surgical approaches for total hysterectomy (TSATH): protocol for a multicentre, single-blind, parallel-group, randomised controlled trial. BMJ Open 2024; 14:e074478. [PMID: 38199630 PMCID: PMC10807007 DOI: 10.1136/bmjopen-2023-074478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 11/16/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Hysterectomy is the most common surgical procedure in the field of gynaecology. The traditional multiport laparoscopy, transumbilical laparoendoscopic single-site surgery (TU-LESS) and transvaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy approaches have been implemented to varying degrees in clinical practice. At present, although their feasibility has been proven, there are no large randomised controlled studies on postoperative rehabilitation. This study aims to evaluate postoperative recovery and assess the safety and effectiveness of these three surgical approaches for total laparoscopic hysterectomy. METHOD AND ANALYSIS This is a multicentre, randomised, single-blind, three-arm, parallel-group, interventional clinical trial. Recruitment will be carried out in five tertiary hospitals in China. Patients diagnosed with benign uterine disease or precancerous lesions will be assigned to the vNOTES group, TU-LESS group and conventional laparoscopy group at a 1:1:1 ratio. The achievement rate of comprehensive indices of enhanced recovery after surgery (ERAS) within 24 hours postoperatively will be considered the primary outcome (the comprehensive indicators of ERAS include fluid intake, passing flatus, urination after catheter removal, ambulation and a Visual Analogue Scale score ≤3.) This study will use a non-inferiority test, with a power (1-ß) of 80% and a margin of -0.15, at a one-sided α of 0.0125. The sample size will be 480 patients (including an assumed 15% dropout rate), calculated according to the primary outcome. ETHICS AND DISSEMINATION This study was approved on 25 April 2022 by the Medical Ethics Committee of West China Second University Hospital (2022(057)), Sichuan University, Chengdu, China. All participants will be required to provide informed consent before their participation in the study. The results of the trial will be submitted for publication in a peer-reviewed journal and presented at international conferences. PROTOCOL VERSION V.3.0, 31 August 2023. TRIAL REGISTRATION NUMBER ChiCTR2200057405.
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Affiliation(s)
- Wenxi Zhang
- Department of Gynecologic Oncology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Li Deng
- Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Fan Yang
- Department of Gynecologic Oncology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Jianhong Liu
- Department of Gynecologic Oncology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Sijing Chen
- Department of Gynecologic Oncology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Xiaolin You
- Department of Gynecologic Oncology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Jiani Gou
- Department of Gynecologic Oncology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Dan Zi
- Department of Gynecology and Obstetrics, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Yonghong Li
- Department of Gynaecology and Obstetrics, The People's Hospital of Wenjiang Chengdu, Chengdu, Sichuan, China
| | - Xiaoxue Qi
- Department of Gynecology and Obstetrics, Chengdu First People's Hospital (Chengdu Integrated TCM&Western Medicine), Chengdu, Sichuan, China
| | - Yanzhou Wang
- Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Ying Zheng
- Department of Gynecologic Oncology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
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Lee YL, Chiang KJ, Lin CK, Chao TK, Yu MH, Liu YL, Wang YC. Robotic Hysterectomy with Ureter Identification and Uterine Artery Ligation for Benign Gynecological Conditions: An Early-Year Single-Center Experience. Diagnostics (Basel) 2023; 13:diagnostics13101809. [PMID: 37238293 DOI: 10.3390/diagnostics13101809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/18/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023] Open
Abstract
The use and application of robotic systems with a high-definition, three-dimensional vision system and advanced EndoWrist technology have become widespread. We sought to share our clinical experience with ureter identification and preventive uterine artery ligation in robotic hysterectomy. The records of patients undergoing robotic hysterectomy between May 2014 and December 2015, including patient preoperative characteristics, operative time, and postoperative outcomes, were analyzed. We evaluated the feasibility and safety of using early ureteral identification and preventive uterine artery ligation in robotic hysterectomy in patients with benign gynecological conditions. Overall, 49 patients diagnosed with benign gynecological conditions were evaluated. The mean age of the patients and mean uterine weight were 46.2 ± 5.3 years and 348.7 ± 311.8 g, respectively. Robotic hysterectomy achieved satisfactory results, including a short postoperative hospital stay (2.7 ± 0.8 days), low conversion rate (n = 0), and low complication rate (n = 1; 2%). The average estimated blood loss was 109 ± 107.2 mL. Our results suggest that robotic hysterectomy using early ureteral identification and preventive uterine artery ligation is feasible and safe in patients with benign gynecological conditions.
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Affiliation(s)
- Yi-Liang Lee
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
- Department of Obstetrics and Gynecology, Kang-Ning General Hospital, Kang Ning University, Taipei 114, Taiwan
| | - Kai-Jo Chiang
- Department of Nursing, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
- School of Nursing, National Defense Medical Center, Taipei 114, Taiwan
| | - Chi-Kung Lin
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Tai-Kuang Chao
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Mu-Hsien Yu
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Yung-Liang Liu
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Yu-Chi Wang
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
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Neis F, Reisenauer C, Kraemer B, Wagner P, Brucker S. Retrospective analysis of secondary resection of the cervical stump after subtotal hysterectomy: why and when? Arch Gynecol Obstet 2021; 304:1519-1526. [PMID: 34453213 PMCID: PMC8553675 DOI: 10.1007/s00404-021-06193-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/14/2021] [Indexed: 12/26/2022]
Abstract
Purpose The rates of hysterectomy are falling worldwide, and the surgical approach is undergoing a major change. To avoid abdominal hysterectomy, a minimally invasive approach has been implemented. Due to the increasing rates of subtotal hysterectomy, we are faced with the following questions: how often does the cervical stump have to be removed secondarily, and what are the indications? Methods This was a retrospective, single-centre analysis of secondary resection of the cervical stump conducted from 2004 to 2018. Results Secondary resection of the cervical stump was performed in 137 women. Seventy-four percent of the previous subtotal hysterectomy procedures were performed in our hospital, and 26% were performed in an external hospital. During the study period, 5209 subtotal hysterectomy procedures were performed at our hospital. The three main indications for secondary resection of the cervical stump were prolapse (31.4%), spotting (19.0%) and cervical dysplasia (18.2%). Unexpected histological findings (premalignant and malignant) after subtotal hysterectomy resulted in immediate (median time, 1 month) secondary resection of the cervical stump in 11 cases. In four patients, the indication was a secondary malignant gynaecological disease that occurred more than 5 years after subtotal hysterectomy. The median time between subtotal hysterectomy and secondary resection of the cervical stump was 40 months. Secondary resection of the cervical stump was performed vaginally in 75.2% of cases, laparoscopically in 20.4% of cases and abdominally in 4.4% of cases. The overall complication rate was 5%. Conclusion Secondary resection of the cervical stump is a rare surgery with a low complication rate and can be performed via the vaginal or laparoscopic approach in most cases. The most common indications are prolapse, spotting and cervical dysplasia. If a secondary resection of the cervical stump is necessary due to symptoms, 66.6% will be performed within the first 6 years after subtotal hysterectomy.
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Affiliation(s)
- Felix Neis
- Department of Obstetrics and Gynecology, University Hospital Tübingen, Calwerstrasse 7, 72076, Tübingen, Germany.
| | - Christl Reisenauer
- Department of Obstetrics and Gynecology, University Hospital Tübingen, Calwerstrasse 7, 72076, Tübingen, Germany
| | - Bernhard Kraemer
- Department of Obstetrics and Gynecology, University Hospital Tübingen, Calwerstrasse 7, 72076, Tübingen, Germany
| | - Philipp Wagner
- Department of Obstetrics and Gynecology, University Hospital Tübingen, Calwerstrasse 7, 72076, Tübingen, Germany
| | - Sara Brucker
- Department of Obstetrics and Gynecology, University Hospital Tübingen, Calwerstrasse 7, 72076, Tübingen, Germany
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Manandhar T, Sitaula S, Thapa BD, Agrawal A, Thakur A. Prevalence of Hysterectomy among Gynecological Surgeries in a Tertiary Care Hospital. JNMA J Nepal Med Assoc 2020; 58:965-970. [PMID: 34506386 PMCID: PMC8028525 DOI: 10.31729/jnma.5315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Hysterectomy is the most common gynecological procedure. Over the last decade, the minimally invasive approach has been practiced more frequently. Fibroid uterus being the most common indication for hysterectomy justifies this minimal approach, however, whenever feasible, vaginal hysterectomy can be the preferred route. The objective of this study was to find out the prevalence and indication of hysterectomy among major gynecological surgeries in a tertiary care hospital. METHODS A descriptive cross-sectional study was done at a tertiary care hospital among 1912 patients who had major gynecological surgeries from January 2017 to December 2019. Ethical clearance was obtained from the institutional review committee (ref. no. ACD 935/076/077). Convenient sampling was used. Statistical analysis was done using Statistical Package for Social Sciences version 21.0. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS During the study period, there were 1,912 major gynecological surgeries and the prevalence of hysterectomy was 1,131 (59.15%) (56.94-61.35 at 95% Confidence Interval). Fibroid uterus was the most common clinical indication for hysterectomy which was done in 397 (35.10%) patients, followed by uterovaginal prolapse in 254 (22.46) patients, adnexal mass in 210 (18.56%), and abnormal uterine bleeding in 117 (10.34%) patients. CONCLUSIONS Hysterectomy, being the most common gynecological surgery, selection of the most appropriate route is of paramount importance. As for any other surgery, it is not without complication and hysterectomy should always be justified. With the advancement in the conservative approaches, these organ-preserving options should be explored rigorously before opting for hysterectomy.
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Affiliation(s)
- Tara Manandhar
- Department of Obstetrics and Gynecology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Sarita Sitaula
- Department of Obstetrics and Gynecology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Baburam Dixit Thapa
- Department of Obstetrics and Gynecology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Ajay Agrawal
- Department of Obstetrics and Gynecology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Achala Thakur
- Department of Obstetrics and Gynecology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
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Elfering L, van de Grift TC, Bouman MB, van Mello NM, Groenman FA, Huirne JA, Budiman IYW, Goijen LDJ, van Loenen DKG, Mullender MG. Combining total laparoscopic hysterectomy and bilateral salpingo-oophorectomy with subcutaneous mastectomy in trans men: The effect on safety outcomes. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2020; 21:138-146. [PMID: 33015665 PMCID: PMC7430461 DOI: 10.1080/26895269.2020.1751014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Background: Masculinizing mastectomy is the most requested gender affirming surgery (GAS) in trans men, followed by genital GAS. Mastectomy and total laparoscopic hysterectomy, with or without bilateral salpingo-oophorectomy (TLH ± BSO), can both be performed in one single operation session. However, data on complication rates of the combined procedure is scarce and no consensus exists on the preferred order of procedures. Aims: To compare safety outcomes between mastectomy performed in a single procedure with those when performed in a combined procedure and assess whether the order of procedures matters when they are combined. Methods: A retrospective chart review was performed of trans men who underwent masculinizing mastectomy with or without TLH ± BSO in a combined session. The effects of the surgical procedure on complication and reoperation rate of the chest were assessed using logistic regression. Results: In total, 480 trans men were included in the study. Of these, 212 patients underwent the combined procedure. The gynecological procedure was performed first in 152 (71.7%) patients. In the total sample, postoperative hematoma of the chest occurred in 11.3%; 16% in the combined versus 7.5% in the single mastectomy group (p = 0.001). Reoperations due to hematoma of the chest were performed in 7.5% of all patients; 10.8% in the combined versus 4.9% in the single mastectomy group (p = 0.017). The order of procedures in the combined group had no significant effect on postoperative hematoma of the chest (p = 0.856), and reoperations (p = 0.689). Conclusion: Combining masculinizing mastectomy with TLH ± BSO in one session was associated with significantly more hematoma and reoperations compared with separately performing mastectomy. This increased risk of complications after a combined procedure should be considered when deciding on surgical options. The order of procedures in a combined procedure did not have an effect on safety outcomes.
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Affiliation(s)
- Lian Elfering
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Tim C. van de Grift
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, Amsterdam UMC, Amsterdam, The Netherlands
| | - Mark-Bram Bouman
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Norah M. van Mello
- Department of Obstetrics and Gynecology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Freek A. Groenman
- Department of Obstetrics and Gynecology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Judith A. Huirne
- Department of Obstetrics and Gynecology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ivo Y. W. Budiman
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Linde D. J. Goijen
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Margriet G. Mullender
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
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Differences in the recommendation of laparoscopic clinical practice guidelines according to the recommendation system—Re-evaluation using GRADE. Eur Surg 2020. [DOI: 10.1007/s10353-019-00622-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Summary
Background
Guidelines are essential for safe and effective treatment. They usually have multiple statements. Since the supporting information for the guidelines varies widely, the degree to which these statements are recommended also differ. We rely on recommendation systems for grading the recommendations for different statements. All recommendation systems have different grading criteria and they could potentially cause confusion and affect the quality of recommendations. Therefore, there is a need to determine the extent of variation and explore the potential reasons behind it.
Methods
A purposive sampling on PubMed was conducted to find four different laparoscopic guidelines using different methods to grade the recommendations. Each statement was then re-evaluated using the GRADE recommendation system.
Results
The guidelines used GRADE, Oxford Methodology, SIGN, and ‘bespoke’ systems. The number of statements with similar strength for the different statements as the re-evaluated strengths in the four guidelines were 24.1, 62.2, 35.8 and 50.0% respectively.
Conclusion
There were a wide variety of recommendation systems for laparoscopic guidelines and there were differences between the recommendations from the guidelines using GRADE, Oxford Methodology, SIGN and the ‘Bespoke’ system when re-evaluated by GRADE. A systematic review of recent laparoscopic guidelines might provide the extent and the main reasons of the problem.
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Surgical steps of total laparoscopic hysterectomy: Part 1: Benign disease by the European Society for Gynaecological Endoscopy (ESGE) 1. Facts Views Vis Obgyn 2019; 11:103-110. [PMID: 31824631 PMCID: PMC6897515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Laparoscopic hysterectomy, which is associated with well-documented benefits compared to an abdominal approach, should be the surgical treatment choice for certain gynaecological conditions. The aim of this document is to provide recommendations on the technical aspects of this procedure. MATERIALS AND METHODS The European Society for Gynaecological Endoscopy (ESGE) has established a working group with the goal of standardizing the surgical steps of total laparoscopic hysterectomy for benign disease, which is one of the most commonly performed major surgical procedures in Gynaecology. RESULTS A properly equipped surgical theatre and the correct positioning of both the laparoscopic tower and the surgeons are of utmost importance and insure that the surgical procedure can be performed uneventfully.The incorporation of standardized surgical steps in routine practice should help to ensure an optimal surgical outcome based on the available scientific evidence as reviewed by expert surgeons. CONCLUSIONS The description of the surgical steps of total laparoscopic hysterectomy and its adoption by minimally invasive gynaecologists will make this approach safer.
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Wagner P, Kommoss F, Kommoss S, Hartkopf A, Pasternak I, Oberlechner E, Greif K, Wallwiener M, Neis F, Abele H, Krämer B, Reisenauer C, Staebler A, Wallwiener D, Brucker S, Taran F. Unexpected malignant uterine pathology: Incidence, characteristics and outcome in a large single-center series of hysterectomies for presumed benign uterine disease. Gynecol Oncol 2019; 153:49-54. [DOI: 10.1016/j.ygyno.2018.12.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/23/2018] [Accepted: 12/28/2018] [Indexed: 02/06/2023]
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