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Indications and surgical route for hysterectomy for benign disorders: a retrospective analysis in a large Australian tertiary hospital network. Arch Gynecol Obstet 2022; 306:2027-2033. [PMID: 35996033 DOI: 10.1007/s00404-022-06736-5] [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: 05/19/2022] [Accepted: 08/02/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Hysterectomy is a common but expensive and morbid procedure. Alternative treatments for heavy menstrual bleeding (HMB) are effective in up to 80% of cases, but there is substantial variation in surgical approach and pre-operative management of HMB. This study aims to assess the approach to hysterectomies for benign indications including alternative treatments and route of operation. METHODS We retrospectively collected patient and surgical data on all hysterectomies for benign indications from 1/4/2018 to 31/6/2020 at our tertiary-led hospital network. RESULTS Hysterectomies were performed in 582 women at a median age of 49(44-56) with a median BMI of 27.9(24.5-33.3)kg/m2 and 251(43%) were referred from private rooms. Hysterectomies for HMB were performed laparoscopically (TLH)(156, 51.7%) more often than abdominally (TAH)(133, 44%) or vaginally (4.3, 13%), with wide variation between sites. Approach was predicted by a history of previous abdomino-pelvic surgery and uterine size but not by other patient factors (BMI, parity or comorbidities). Referral source, on the other hand, was a significant predictor of route of hysterectomy. In women with HMB without uterine abnormalities, 45% tried a levonorgestrel intrauterine device and 25% tried endometrial ablation before proceeding to surgery. The use of alternative therapies pre-operatively did not vary between sites or referral sources. CONCLUSIONS The variations in route of hysterectomy that are unexplained by patient factors suggest room for improvement and raises the question whether some of the patients undergoing a TAH may have been candidates for less invasive surgery. Uptake of alternative management strategies for HMB could also be improved.
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Chrysostomou A, Djokovic D, Edridge W, van Herendael BJ. Evidence-based practical guidelines of the International Society for Gynecologic Endoscopy (ISGE) for vaginal hysterectomy. Eur J Obstet Gynecol Reprod Biol 2020; 252:118-126. [PMID: 32599477 DOI: 10.1016/j.ejogrb.2020.06.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/10/2020] [Accepted: 06/15/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The study was established by the International Society for Gynecologic Endoscopy (ISGE) to provide evidence-based recommendations in the steps that should be undertaken in successfully performing a vaginal hysterectomy for a non-prolapsed uterus. MATERIAL AND METHODS The ISGE Task Force for vaginal hysterectomy for the non-prolapsed uterus defined key clinical questions regarding the surgical technique, which led the Medline/PubMed and the Cochrane Database literature search. Identified pertinent articles, published in English from 1997 to 2019, were analysed. The available information was graded by the level of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Working Group approach. The recommendations were developed through multiple cycles of literature analysis and expert discussion. RESULTS Six recommendations were established: 1. A circular incision at the level of cervico-vaginal junction is recommended (grade IC). 2. The posterior peritoneum should be opened first (grade IC). 3. Clamping and cutting the uterosacral and cardinal ligaments before or after getting access into anterior peritoneum is recommended (grade IC). 4. Routine closure of the peritoneum during vaginal hysterectomy is not recommended (grade IB). 5. Vertical or horizontal closure of the vaginal vault following vaginal hysterectomy is recommended (grade IC). 6. To insert a vaginal plug following vaginal hysterectomy is not recommended (grade IB). CONCLUSION Vaginal hysterectomy for a non-prolapsed uterus should be the preferential route for removing the uterus when hysterectomy is indicated. The ISGE provides evidence-based practical guidelines on how vaginal hysterectomy for non-prolapsed uterus should be undertaken. All efforts should be directed in teaching the surgical technique of vaginal hysterectomy during residency.
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Affiliation(s)
- Andreas Chrysostomou
- Department of Obstetrics and Gynaecology, University of the Witwatersrand, Johannesburg, South Africa
| | - Dusan Djokovic
- Department of Obstetrics and Gynecology, Nova Medical School - Faculdade de Ciências Médicas, Nova University of Lisbon, Lisbon, Portugal; Department of Obstetrics and Gynecology, Hospital S. Francisco Xavier - CHLO, Lisbon, Portugal.
| | - William Edridge
- Chris Hani Baragwanath Hospital, Soweto, University of Witwatersrand, Johannesburg, South Africa
| | - Bruno J van Herendael
- Stuivenberg General Hospital, Ziekenhuis Netwerk Antwerpen (ZNA), Antwerp, Belgium; Università degli Studi dell'Insubria, Varese, Italy
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A Comparative Study of Non-descent Vaginal Hysterectomy and Laparoscopic Hysterectomy. J Obstet Gynaecol India 2019; 69:369-373. [PMID: 31391746 DOI: 10.1007/s13224-019-01227-1] [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: 06/01/2018] [Accepted: 03/21/2019] [Indexed: 10/26/2022] Open
Abstract
Objective To compare intra- and post-op complications between non-descent vaginal hysterectomy and laparoscopic hysterectomy and establish the better method for hysterectomy in non-descent uterus. Methods A prospective comparative study of 80 hysterectomies was done over a period of January 2017-Dec 2017, with 40 cases each in one group of non-descent vaginal hysterectomy (NDVH) and other group of total laparoscopic hysterectomy (TLH). Demographic characteristics, co-morbid conditions, indications for surgery, operative time, intra-operative blood loss, post-operative analgesia requirements, post-operative hospital stay and post-operative complications were compared between both groups. Results The most common age in both groups was 41-50 years. Fibroid uterus was the most common indication for surgery in both groups. The mean operative time in NDVH group was 40 min while it was 120 min in TLH group, and the mean blood loss in NDVH group was 50 ml, while it was 120 ml in TLH group. P < 0.001 when intraoperative blood loss and operative time were compared between both groups. There were no conversions to laparotomy in NDVH group, while there were three conversions to laparotomy in TLH group. Both groups were similar in post-operative analgesia requirement and post-operative hospital stay. Post-operative complications were similar in both groups. Conclusions Non-descent vaginal hysterectomy has advantage over laparoscopic hysterectomy as scarless surgery with fewer complications.
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Teaching Vaginal Hysterectomy via Simulation: Creation and Validation of the Objective Skills Assessment Tool for Simulated Vaginal Hysterectomy on a Task Trainer and Performance Among Different Levels of Trainees. Female Pelvic Med Reconstr Surg 2018; 25:298-304. [DOI: 10.1097/spv.0000000000000558] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sewell T, Courtney H, Tawfeek S, Afifi R. The feasibility and safety of transvaginal bilateral salpingo-oophorectomy. Int J Gynaecol Obstet 2018; 141:344-348. [PMID: 29388683 DOI: 10.1002/ijgo.12458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/01/2017] [Accepted: 01/29/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the feasibility and safety of transvaginal bilateral salpingo-oophorectomy (BSO). METHODS The present retrospective case series included consecutive women who underwent transvaginal BSO at a single general gynecology unit at Weston General Hospital, Weston-super-Mare, UK, between February 1, 2011, and July 31, 2014. Transvaginal BSO procedures were performed by an experienced surgeon. Feasibility and safety outcomes were reviewed from patient case notes. RESULTS There were 127 patients included in the analysis. In all, 109 patients underwent transvaginal BSO at the time of vaginal hysterectomy, whereas 18 women underwent this procedure following a previous vaginal hysterectomy. Transvaginal BSO was successful in 126 (99.2%) patients; adverse events occurred among nine (7.1%) patients, including a single occurrence of ureteric injury that was detected and repaired intraoperatively. CONCLUSION The present study demonstrated that transvaginal BSO was a feasible and safe procedure when conducted by an experienced surgeon.
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Affiliation(s)
- Thomas Sewell
- Department of Obstetrics and Gynaecology, Weston General Hospital, Weston-super-Mare, UK
| | - Hannah Courtney
- Department of Obstetrics and Gynaecology, Weston General Hospital, Weston-super-Mare, UK
| | - Sherif Tawfeek
- Department of Obstetrics and Gynaecology, Christchurch Women's Hospital, Christchurch, New Zealand
| | - Reda Afifi
- Department of Obstetrics and Gynaecology, Weston General Hospital, Weston-super-Mare, UK
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Schmitt JJ, Occhino JA, Weaver AL, McGree ME, Gebhart JB. Vaginal versus Robotic Hysterectomy for Commonly Cited Relative Contraindications to Vaginal Hysterectomy. J Minim Invasive Gynecol 2017; 24:1158-1169. [DOI: 10.1016/j.jmig.2017.06.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 06/28/2017] [Accepted: 06/30/2017] [Indexed: 11/27/2022]
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Dikici S, Aldemir Dikici B, Eser H, Gezgin E, Başer Ö, Şahin S, Yılmaz B, Oflaz H. Development of a 2-dof uterine manipulator with LED illumination system as a new transvaginal uterus amputation device for gynecological surgeries. MINIM INVASIV THER 2017. [DOI: 10.1080/13645706.2017.1341927] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Serkan Dikici
- Department of Biomedical Engineering, Izmir Katip Celebi University, Izmir, Turkey
- Department of Biomedical Technologies, Izmir Katip Celebi University, Izmir, Turkey
| | - Betül Aldemir Dikici
- Department of Biomedical Engineering, Izmir Katip Celebi University, Izmir, Turkey
- Department of Biomedical Technologies, Izmir Katip Celebi University, Izmir, Turkey
| | - Hakan Eser
- Department of Biomedical Technologies, Izmir Katip Celebi University, Izmir, Turkey
| | - Erkin Gezgin
- Department of Mechatronics Engineering, Izmir Katip Celebi University, Izmir, Turkey
| | - Özgün Başer
- Department of Mechatronics Engineering, Izmir Katip Celebi University, Izmir, Turkey
| | - Savaş Şahin
- Department of Electrical and Electronic Engineering, Izmir Katip Celebi University, Izmir, Turkey
| | - Bülent Yılmaz
- Department of Obstetrics and Gynecology, Izmir Katip Celebi University, Izmir, Turkey
- In vitro Fertilization Unit, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Hakan Oflaz
- Department of Biomedical Engineering, Izmir Katip Celebi University, Izmir, Turkey
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9
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Muffly TM, Kow NS. Effect of Obesity on Patients Undergoing Vaginal Hysterectomy. J Minim Invasive Gynecol 2014; 21:168-75. [DOI: 10.1016/j.jmig.2013.07.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 07/25/2013] [Accepted: 07/27/2013] [Indexed: 11/27/2022]
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Wright KN, Jonsdottir GM, Jorgensen S, Shah N, Einarsson JI. Costs and outcomes of abdominal, vaginal, laparoscopic and robotic hysterectomies. JSLS 2013; 16:519-24. [PMID: 23484557 PMCID: PMC3558885 DOI: 10.4293/108680812x13462882736736] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Complication rates did not vary significantly among minimally invasive methods of hysterectomy; however, patient costs were significantly influenced by the technique used for hysterectomy. Background and Objectives: To estimate the incidence of operative complications and compare operative cost and overall cost of different methods of benign hysterectomy including abdominal, vaginal, laparoscopic, and robotic techniques. Methods: We performed a retrospective cohort analysis (Canadian Task Force classification II-2) of all patients who underwent a hysterectomy for benign reasons in 2009 at a single urban academic tertiary care center using the χ2 test and Student t test. A multivariate regression analysis was also performed for predictors of costs. Cost data were gathered from the hospital's billing system; the remainder of data was extracted from patient's medical records. Results: In 2009, 688 patients underwent a benign hysterectomy; 185 (26.9%) hysterectomies were abdominal, 135 (19.6%) vaginal, 352 (51.5%) laparoscopic, and 14 (2.0%) robotic. The rate of intraoperative complication was 1.7% for abdominal, 0.8% for vaginal, 0.3% for laparoscopic, and 0 for robotic. Mean total patient costs were $43,622 for abdominal, $31,934 for vaginal, $38,312 for laparoscopic, and $49,526 for robotic hysterectomies. Costs were significantly influenced by method of hysterectomy, operative time, and length of stay. Conclusion: Though complication rates did not vary significantly among minimally invasive methods of hysterectomy, patient costs were significantly influenced by the method of hysterectomy.
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Affiliation(s)
- Kelly N Wright
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA.
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11
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Abstract
Vaginal hysterectomy has been demonstrated to be the cheapest route to perform a hysterectomy but no detailed costing has been performed in the United Kingdom. In this study the costs incurred by a UK teaching hospital for 30 women aged between 40 and 50 years of age undergoing either abdominal (AH), laparoscopically assisted vaginal hysterectomy (LH) were compared with vaginal hysterectomy (VH). VH was significantly the cheapest procedure (993.00 Pounds, 95th Cl 883.20 Pounds to 1124.80 Pounds) and there was a tendency for LH (1148.00 Pounds, 95th Cl 1006.80 Pounds to 1289.20 Pounds) to be less expensive than AH (1340.00 Pounds, 95th CI 1080.80 Pounds to 1595.20 Pounds); this difference may be reversed if disposable laparoscopic instruments were to be used for LH. Our study agrees with data from other countries showing that VH is the cheapest type of hysterectomy. With the added benefits of shorter hospital stay, convalescence and return to work, effort should be directed towards increasing the proportion of hysterectomies performed vaginally in the UK.
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Affiliation(s)
- R J Hart
- University Department of Obstetrics and Gynaecology, Royal Free Hospital, London, UK
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12
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McCracken G, Lefebvre GG. Vaginal hysterectomy: dispelling the myths. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2007; 29:424-428. [PMID: 17493374 DOI: 10.1016/s1701-2163(16)35494-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Despite advances in minimally invasive surgery, most hysterectomies are still performed by laparotomy. The ratio of abdominal to vaginal hysterectomies ranges from 1:1 to 6:1 across North America, and in Canada is approximately 3:1. The SOGC clinical practice guideline on hysterectomy states that the vaginal route should be considered for every hysterectomy; if it is assumed that most surgeons would try to follow accepted guidelines, vaginal hysterectomy is presumably being considered and excluded. The evidence is compelling that vaginal hysterectomy is the approach of choice for benign pathology. The cited contraindications to vaginal hysterectomy are often unsubstantiated. In this commentary we examine the four reasons most often cited for avoiding a vaginal hysterectomy: (1) uterine size, (2) nulliparity and uterine descent, (3) need for oophorectomy, and (4) previous abdominopelvic surgery and extrauterine disease. More research is necessary to evaluate and demystify the barriers to performing minimally invasive hysterectomy. We recommend that preceptorship programs be developed for gynaecologic surgeons in an attempt to decrease the ratio of abdominal to vaginal hysterectomies.
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Affiliation(s)
- Geoff McCracken
- Department of Obstetrics and Gynecology, St. Michael's Hospital, Toronto ON
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Akyol D, Esinler I, Guven S, Salman MC, Ayhan A. Vaginal hysterectomy: results and complications of 886 patients. J OBSTET GYNAECOL 2007; 26:777-81. [PMID: 17130029 DOI: 10.1080/01443610600984529] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this study was to determine the feasibility, results and complications of vaginal hysterectomy. A total of 886 consecutive patients who had undergone vaginal hysterectomy for benign gynecological diseases were retrospectively analysed. Vaginal hysterectomy was successfully performed in 96.1% of the nulliparous and 99.9% of the parous patients. The mean duration (min) of the operation was 89.1+/-29.1. The operation time (min) of the nulliparous women was significantly higher than that of the primiparous and multiparous women (109.3+/-40.2 vs 81.1+/-33.2 and 85.1+/-28.3, respectively). The overall complication rate was 14.6%. The intraoperative and postoperative complication rates were 4.1% and 10.5%, respectively. The most common intraoperative complication was bladder injury (2.5%). Vaginal hysterectomy for benign gynaecological diseases has high feasibility with acceptable complication rates.
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Affiliation(s)
- D Akyol
- Department of Obstetrics and Gynaecology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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14
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David-Montefiore E, Rouzier R, Chapron C, Daraï E. Surgical routes and complications of hysterectomy for benign disorders: a prospective observational study in French university hospitals. Hum Reprod 2007; 22:260-5. [PMID: 16950826 DOI: 10.1093/humrep/del336] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Despite the advantages of the vaginal and laparoscopic approaches, most hysterectomies carried out involve laparotomy. The objective of this prospective observational multicentre study was to examine the routes and complications of hysterectomy for benign disorders. METHODS Of the 15 university hospitals belonging to Collégiale de Gynécologie-Obstétrique de Paris-Ile de France, 12 participated in this study that took place between June and December 2004. We analysed the characteristics of the patients, the indications for hysterectomy and intra- and post-operative complications (and their determinants) according to the surgical approach. RESULTS In total, 634 women underwent hysterectomy for benign disorders during the study period. The patients' mean age (+/-SD), BMI, parity and previous Caesarean sections were 51.4 +/- 10.3 years, 25 +/- 5.7 kg/m(2), 2 +/- 1.6 children and 0.2 +/- 0.6, respectively. Hysterectomy was performed by the laparoscopic, laparoscopically assisted vaginal hysterectomy (LAVH), laparotomic and vaginal routes in 19.1, 8.2, 24.4 and 48.3% of cases, respectively. The operating time was shorter with the vaginal route than with laparoscopy, laparotomy and LAVH (P < 0.0001). Intra- and post-operative complications were significantly more frequent in the laparotomic group (18%) compared with the vaginal group (8.2%), the laparoscopic group (5.8%) and the LAVH group (8.2%) (P < 0.0001). In a multivariate logistic regression model, obesity [odds ratio (OR): 2.84, 95% confidence interval (CI): 1.53-5.27, P = 0.001], history of pelvic surgery (OR: 2.47, 95% CI: 1.39-4.39, P = 0.002) and history of Caesarean section (OR: 2.04, 95% CI: 1.01-4.1, P = 0.046) were significantly associated with intra- and post-operative complications. Laparoconversion was necessary in 36 cases (7.5%) overall and was more frequent with laparoscopy and LAVH than with the vaginal route (P < 0.0001). CONCLUSIONS This study confirms that the vaginal route is increasingly used for hysterectomy in France and that it is the route of choice for benign disorders.
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Affiliation(s)
- E David-Montefiore
- Service de Gynécologie-Obstétrique, Hôpital Tenon, Université Pierre et Marie Curie-Paris VI, France
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Abstract
PURPOSE OF REVIEW Uterine fibroids remain the most common benign gynaecological pathology and a frequent reason for gynaecological referral and treatment. The range of available treatments is currently undergoing a minor revolution with the introduction of nonsurgical therapies, but their role remains to be established. RECENT FINDINGS Arguably the most significant change in recent years has been the availability of uterine artery embolization as a form of nonsurgical management. A survey of UK gynaecologists, however, has shown that the option of embolization is only utilized by just over half the respondents. Instead, conventional surgery such as hysterectomy and myomectomy remain the mainstay of nonsymptomatic treatment. In the absence of gross uterine enlargement, vaginal hysterectomy is feasible and safe. Fewer hysterectomies, however, are being done and more women are undergoing myomectomy, with almost 50% of UK consultant gynaecologists carrying out hysteroscopic myomectomy and just over 10% laparoscopic myomectomy. SUMMARY Greater utilization of less invasive endoscopic or vaginal procedures for the management of uterine fibroids seems a reasonable target. In the longer term, it is likely that the various nonsurgical techniques which shrink fibroids and thereby reduce symptoms will have an increasingly important role in the treatment of this common condition.
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Affiliation(s)
- Lynne Chapman
- Minimally Invasive Therapy Unit & Endoscopic Training Centre, University Department of Obstetrics and Gynaecology, Royal Free Hospital, London, UK
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Abstract
The vaginal route is a safe, feasible, and patient-friendly method of performing a hysterectomy. Proponents and practitioners of vaginal hysterectomy have widened their indications and decreased the contraindications through liberal usage of debulking, performing oophorectomy, laparoscopic evaluation and trial vaginal hysterectomy. This traditional approach with surgical advances can be used more frequently.
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Affiliation(s)
- Shirish S Sheth
- Breach Candy Hospital and Sir Hurkisondas Nurrotamdas Hospital, International Federation of Gynecology and Obstetrics, 2/2 Navjivan Society, Lamington Road, Mumbai 400 008, India.
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Hefni MA, Bhaumik J, El-Toukhy T, Kho P, Wong I, Abdel-Razik T, Davies AE. Safety and efficacy of using the LigaSure vessel sealing system for securing the pedicles in vaginal hysterectomy: randomised controlled trial. BJOG 2005; 112:329-33. [PMID: 15713149 DOI: 10.1111/j.1471-0528.2004.00325.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the safety and efficacy of using the LigaSure vessel sealing system for securing the pedicles during vaginal hysterectomy in comparison with the conventional method of securing the pedicles by suture ligation. DESIGN Randomised controlled trial. SETTING Gynaecology Department, Benenden Hospital, Kent. POPULATION One hundred and sixteen women undergoing vaginal hysterectomy were prospectively randomised to either LigaSure (Group I) or suture ligation (Group II) for securing the pedicles. METHODS Data of patients were collected prospectively. Statistical analysis was performed using the Mann-Whitney U test, chi(2) and Fisher's exact test as appropriate. MAIN OUTCOME MEASURES Operating time, operative blood loss and peri-operative complications. RESULTS The operating time was significantly shorter in the LigaSure group compared with the control group (P < 0.04). There was no statistical significant difference between the two groups in operative blood loss (P= 0.433), but peri-operative haemorrhagic complications were less frequent in the LigaSure group (0%vs 6.8%, P= 0.057). Four patients in the control group required either conversion to laparotomy because of bleeding, return to theatre for immediate post-operative haemorrhage or readmission for vault haematoma, whereas none in the LigaSure group had bleeding from unsecured pedicles. CONCLUSION The LigaSure vessel sealing system is a safe alternative for securing pedicles in vaginal hysterectomy when compared with conventional suture ligation. Larger studies are required to determine its place in gynaecological surgery.
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Affiliation(s)
- M A Hefni
- Department of Gynaecology, Benenden Hospital, Kent TN17 7AX, UK
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Cooper BC, Riddick DH. Alternative Technique for Bilateral Salpingo-Oophorectomy During Vaginal Hysterectomy. J Gynecol Surg 2005. [DOI: 10.1089/gyn.2005.21.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Brian C. Cooper
- Department of Obstetrics and Gynecology, University of Vermont College of Medicine, Burlington, VT
| | - Daniel H. Riddick
- Department of Obstetrics and Gynecology, University of Vermont College of Medicine, Burlington, VT
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Harmanli OH, Khilnani R, Dandolu V, Chatwani AJ. Narrow Pubic Arch and Increased Risk of Failure for Vaginal Hysterectomy. Obstet Gynecol 2004; 104:697-700. [PMID: 15458888 DOI: 10.1097/01.aog.0000139945.14591.70] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the risk factors involved in failed vaginal hysterectomies. METHODS Data on all vaginal hysterectomies performed by a single gynecologic surgeon were collected prospectively. Patients requiring pelvic floor repair were excluded. Any procedure converted to the abdominal approach was classified as a failed vaginal hysterectomy and comprised the study group. For every woman who had a failed vaginal hysterectomy, the next 2 women who had successful vaginal hysterectomies immediately after the failed vaginal hysterectomy were taken as controls. Risk factors such as age, parity, body weight, surgical indication, uterine size, presence of leiomyomata in the anterior lower uterine segment, previous pelvic surgeries, abdominopelvic adhesions, location and length of cervix, narrow pubic arch, intraoperative complications such as bleeding requiring transfusion, visceral injury, nulliparity, and adnexal removal were compared between groups. RESULTS We compared 25 failed vaginal hysterectomies with 50 controls whose procedures were completed successfully through the vagina. Among all the factors gynecologists can assess preoperatively, only the presence of a narrow pubic arch increased the risk of failure for vaginal hysterectomy (odds ratio [OR] 4.1; 95% confidence interval 1.32-12.69). Intraoperative bleeding with transfusion was also found as an independent cause for conversion to laparotomy (OR 7.37; 95% confidence interval 1.75-31.06). CONCLUSION Women with a narrow pubic arch are not good candidates for vaginal hysterectomy. The most common unpredictable cause for conversion to laparotomy from the vaginal approach is intraoperative bleeding requiring transfusion. LEVEL OF EVIDENCE II-2
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Affiliation(s)
- Ozgur H Harmanli
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, Temple University, 3401 North Broad Street, Philadelphia, PA 19140, USA.
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Miskry T, Magos A. A national survey of senior trainees surgical experience in hysterectomy and attitudes to the place of vaginal hysterectomy. BJOG 2004; 111:877-9. [PMID: 15270942 DOI: 10.1111/j.1471-0528.2004.00204.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We set out to determine the current status of training in vaginal hysterectomy in the UK. In total, 255 year 4 or 5 'Calman' trainees were identified and sent an anonymous questionnaire assessing surgical experience, quality of training and attitudes towards vaginal hysterectomy. Our results demonstrate that senior trainees' experience in vaginal as opposed to abdominal hysterectomy is relatively poor. Despite this, trainees believed that the majority of hysterectomies should be done vaginally, and only a minority, laparoscopically.
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Affiliation(s)
- Tariq Miskry
- Minimally Invasive Therapy Unit and Endoscopy Training Centre, University Department of Obstetrics and Gynaecology, Royal Free Hospital, London, UK
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Abstract
Abdominal hysterectomy is performed in the United States at a 3:1 ratio over vaginal hysterectomy, despite evidence that vaginal hysterectomy offers advantages over abdominal hysterectomy with regard to operative time, complication rates, recovery, return to daily activities, and overall costs of treatment. In fact, the predominance of the abdominal approach may be based on factors other than clinical considerations, including resident training, use of limited or obsolete guidelines, greater third-party compensation for abdominal procedures, a presumption rather than a confirmation that pathology exists that contraindicates a vaginal approach, and misconceptions about the safety and cost of vaginal hysterectomy. A number of studies spanning several years demonstrate that the use of more systematic guidelines for selecting the route of hysterectomy results in a major shift toward the vaginal approach. Evidence also shows that transvaginal hysterectomy is both feasible and optimum for types of patients who have long been considered inappropriate candidates for the vaginal route. New instrumentation facilitates the vaginal approach and contributes to improved hemostasis and decreased operative time. Included here is a step-by-step approach to determining appropriate candidates for the vaginal approach via assessment of access, uterus size, and extent of pathology.
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Affiliation(s)
- S Robert Kovac
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 69 Jesse Hill Jr. Drive SE, Atlanta, GA 30303, USA.
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Ayoubi JM, Fanchin R, Monrozies X, Imbert P, Reme JM, Pons JC. Respective consequences of abdominal, vaginal, and laparoscopic hysterectomies on women's sexuality. Eur J Obstet Gynecol Reprod Biol 2004; 111:179-82. [PMID: 14597248 DOI: 10.1016/s0301-2115(03)00213-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the relative effects of abdominal, vaginal or laparoscopic approaches for hysterectomy on female sexuality. STUDY DESIGN One hundred and seventy women who underwent abdominal (n=68), vaginal (n=67), and laparoscopic (n=35) hysterectomy for benign disease were studied. Pre- and postoperative sexuality was assessed by questionnaire. RESULTS Overall, sexuality after hysterectomy remained unchanged in 60.4% of cases, and improved or deteriorated in 21.3 and 18.3%, respectively. Postoperative delay in resuming sexual activity was shorter after vaginal (45.2+/-6.7 days) hysterectomy than after abdominal hysterectomy (62.4+/-9.3 days). Deterioration of sexual function occurred more frequently after abdominal hysterectomy (24%) than after vaginal (13.5%) or laparoscopic (8.5%) hysterectomy. CONCLUSION These results indicate that the impact of vaginal and laparoscopic hysterectomy on women's sexuality may be milder than that of abdominal hysterectomy.
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Affiliation(s)
- J M Ayoubi
- Department of Gynecology and Obstetrics, University Hospital, Toulouse, France.
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Roovers JPWR, van der Bom JG, van der Vaart CH, Heintz APM. Hysterectomy and sexual wellbeing: prospective observational study of vaginal hysterectomy, subtotal abdominal hysterectomy, and total abdominal hysterectomy. BMJ 2003; 327:774-8. [PMID: 14525872 PMCID: PMC214074 DOI: 10.1136/bmj.327.7418.774] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To compare the effects of vaginal hysterectomy, subtotal abdominal hysterectomy, and total abdominal hysterectomy on sexual wellbeing. DESIGN Prospective observational study over six months. SETTING 13 teaching and non-teaching hospitals in the Netherlands. PARTICIPANTS 413 women who underwent hysterectomy for benign disease other than symptomatic prolapse of the uterus and endometriosis. MAIN OUTCOME MEASURES Reported sexual pleasure, sexual activity, and bothersome sexual problems. RESULTS Sexual pleasure significantly improved in all patients, independent of the type of hysterectomy. The prevalence of one or more bothersome sexual problems six months after vaginal hysterectomy, subtotal abdominal hysterectomy, and total abdominal hysterectomy was 43% (38/89), 41% (31/76), and 39% (57/145), respectively (chi2 test, P = 0.88). CONCLUSION Sexual pleasure improves after vaginal hysterectomy, subtotal abdominal hysterectomy, and total abdominal hysterectomy. The persistence and development of bothersome problems during sexual activity were similar for all three techniques.
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Affiliation(s)
- Jan-Paul W R Roovers
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, 3584 CX Utrecht, Netherlands.
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Randomized Trial of Suture Versus Electrosurgical Bipolar Vessel Sealing in Vaginal Hysterectomy. Obstet Gynecol 2003. [DOI: 10.1097/00006250-200307000-00027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sharma M, Buck L, Mastrogamvrakis G, Kontos K, Magos A, Taylor A. Cost effectiveness of pre-operative gonadotrophin releasing analogues for women with uterine fibroids undergoing hysterectomy or myomectomy. BJOG 2003; 110:712; author reply 712-3. [PMID: 12842071 DOI: 10.1046/j.1471-0528.2003.30021.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Miskry T, Magos A. Randomized, prospective, double-blind comparison of abdominal and vaginal hysterectomy in women without uterovaginal prolapse. Acta Obstet Gynecol Scand 2003; 82:351-8. [PMID: 12716320 DOI: 10.1034/j.1600-0412.2003.00115.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND To determine under controlled conditions whether there are significant differences in the duration of hospitalization and recovery between abdominal and vaginal hysterectomy for indications other than uterovaginal prolapse. METHOD In a two-center prospective, double-blind randomized trial, 36 women with dysfunctional uterine bleeding, uterine fibroids or pelvic pain scheduled for hysterectomy were randomized to abdominal or vaginal hysterectomy. The primary outcome measure was the duration of hospital stay. Secondary outcome measures included analgesic requirements and return to normal health and function. RESULTS There were no significant differences in peri-operative patient or surgical characteristics. Vaginal hysterectomy was associated with a reduction in hospital stay compared to abdominal hysterectomy (median stay 3 days vs. 5 days, p = 0.01). In addition, patients undergoing vaginal hysterectomy had reduced analgesic requirements (mean 75.4 mg vs. 131.4 mg morphine equivalent, p = 0.002), shorter need for intravenous hydration (mean 25.3 h vs. 32.7 h, p = 0.05), and faster return of bowel action (median 3 days vs. 4 days, p = 0.002). They also returned to normal domestic activities (mean 4.6 weeks vs. 8.5 weeks, p = 0.01) and work (mean 7.0 weeks vs. 13.9 weeks, p = 0.005), and completed their recovery (mean 7.9 weeks vs. 16.9 weeks, p = 0.008) more quickly. CONCLUSIONS Vaginal hysterectomy was associated with significant benefits in terms of reduced hospital stay and improved patient recovery. Vaginal hysterectomy should be the route of choice not only for women with genital tract prolapse but also those without.
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Affiliation(s)
- Tariq Miskry
- Minimally Invasive Therapy Unit and Endoscopy Training Center, University Department of Obstetrics and Gynaecology, Royal Free Hospital, London, UK
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Hwang JL, Seow KM, Tsai YL, Huang LW, Hsieh BC, Lee C. Comparative study of vaginal, laparoscopically assisted vaginal and abdominal hysterectomies for uterine myoma larger than 6 cm in diameter or uterus weighing at least 450 g: a prospective randomized study. Acta Obstet Gynecol Scand 2002; 81:1132-8. [PMID: 12519109 DOI: 10.1034/j.1600-0412.2002.811206.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The purpose of this study was to compare peri-operative morbidity, preoperative sonographic estimation of uterine weight and postoperative outcomes of women with uterine fibroids larger than 6 cm in diameter or uteri estimated to weigh at least 450 g, undergoing either vaginal, laparoscopically assisted vaginal or abdominal hysterectomies. METHOD Ninety patients who met the criteria of uterine fibroids larger than 6 cm by ultrasonographic examination were included in our prospective study. Patients were randomized into laparoscopic-assisted vaginal hysterectomy (30 patients), vaginal hysterectomy (30 patients) and abdominal hysterectomy (30 patients) groups. RESULTS The laparoscopically assisted vaginal hysterectomy group had significantly longer operative times than the abdominal and vaginal hysterectomy groups (109 +/- 22 min, 98 +/- 16 min, and 74 +/- 22 min, respectively, p < 0.001). Blood loss for vaginal hysterectomy was significantly lower than for either abdominal or laparoscopically assisted vaginal hysterectomies (215 +/- 134 ml, 293 +/- 182 ml, and 343 +/- 218 ml, respectively, p = 0.04). Vaginal hysterectomy and laparoscopically assisted vaginal hysterectomy groups had shorter hospital stays, lower postoperative pain scores, more rapid bowel recovery and lower postoperative antibiotic use than the abdominal hysterectomy group. Uterine weight in the abdominal hysterectomy group was significantly heavier than in the vaginal and laparoscopically assisted vaginal hysterectomy groups (1020 +/- 383 g, 835 +/- 330 g, and 748 +/- 255 g, respectively, p = 0.02). We estimated that when a myoma measured between 8 and 10 cm, the uterus weighed approximately 450 g, and the sensitivity of this prediction was 57.5%. For a myoma larger than 13 cm, the estimated uterine weight was more than 900 g and the sensitivity of this prediction was 71%. CONCLUSION The study shows vaginal hysterectomy and laparoscopically assisted vaginal hysterectomy can be performed in women with uterine weight of at least 450 g. Preoperative ultrasonographic examination can provide the surgeon with valuable information on the size of the fibroid and the estimated weight of the enlarged uterus before implementing a suitable surgical method.
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Affiliation(s)
- Jiann-Loung Hwang
- Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Medical Center, National Yang-Ming University, Taipei, Taiwan
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Kay VJ, Das N, Mahmood TA, Smith A. Current practice of hysterectomy and oophorectomy in the United Kingdom and Republic of Ireland. J OBSTET GYNAECOL 2002; 22:672-80. [PMID: 12554262 DOI: 10.1080/0144361021000020529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The purpose of this study was to estimate current surgical practice of hysterectomy and prophylactic oophorectomy of UK and Irish consultant gynaecologists. Individual and regional variation in surgical practice and factors influencing surgical practice were assessed. A postal questionnaire was sent to all 1536 consultants in obstetrics and gynaecology currently practising in the United Kingdom and Ireland, with a 52.7% response rate. Approximately 60% of hysterectomies were abdominal, 37% vaginal and 4% laparoscopic-assisted, with junior consultants performing a greater proportion of hysterectomies vaginally. There was a wide variation in method of hysterectomy, both individually and regionally. Only 21% of consultants would routinely consider performing prophylactic oophorectomy and of these the majority would perform this procedure in women aged between 46 and 50 years old. This large variation in surgical practice indicates a need to form a consensus on optimal surgical techniques and to ensure adequate surgical training for all gynaecologists.
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Affiliation(s)
- Vanessa J Kay
- Department of Obstetrics and Gynaecology, Forth Park Hospital, Kirkcaldy, Fife, UK
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Cengiz B, Demirel LC, Dokmeci F, Güngör M, Canga A, Cengiz SD. Bilateral Salpingo-Oophorectomy During Vaginal Hysterectomy in Cases with Nonprolapsed Uterus: Role of Laparoscopy in a Residency Training Program Without Much Vaginal Salpingo-Oophorectomy Experience. J Gynecol Surg 2002. [DOI: 10.1089/104240602760363600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Nazha I, Camatte S, Robin F, Rizk E, Tamborini A, Taurelle R, Lecuru F. Evolution in the Route of Hysterectomy: Vaginal Hysterectomy Takes the Place of Abdominal Hysterectomy. J Gynecol Surg 2002. [DOI: 10.1089/104240602753595430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Intissar Nazha
- Service de Chirurgie Gynécologique et Cancérologique, Hôpital Européen Georges Pompidou, Paris, France
| | - Sophie Camatte
- Service de Chirurgie Gynécologique et Cancérologique, Hôpital Européen Georges Pompidou, Paris, France
| | - François Robin
- Service de Chirurgie Gynécologique et Cancérologique, Hôpital Européen Georges Pompidou, Paris, France
| | - Elie Rizk
- Service de Chirurgie Gynécologique et Cancérologique, Hôpital Européen Georges Pompidou, Paris, France
| | - Alain Tamborini
- Service de Chirurgie Gynécologique et Cancérologique, Hôpital Européen Georges Pompidou, Paris, France
| | - Roland Taurelle
- Service de Chirurgie Gynécologique et Cancérologique, Hôpital Européen Georges Pompidou, Paris, France
| | - Fabrice Lecuru
- Service de Chirurgie Gynécologique et Cancérologique, Hôpital Européen Georges Pompidou, Paris, France
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Abstract
OBJECTIVES To determine the feasibility and acceptability of minilaparotomy-assisted vaginal hysterectomy. METHODS A prospective pilot study in a general hospital was conducted. Twenty patients who were on the waiting list for abdominal hysterectomy were included in the study. All these patients had one or more relative contraindications to vaginal hysterectomy. The hysterectomy procedure was started vaginally in all cases. A minilaparotomy incision was performed to complete the procedure if vaginal hysterectomy was not feasible. Results were analyzed on the intention to treat basis. RESULTS The procedure was successfully completed as intended in 19/20 patients (95%). Six patients had the procedure completed vaginally (30%). Thirteen patients had the procedure completed with minilaparotomy assistance (65%). The mean operative time was 63+/-24.8 min (+/-S.D.). The median estimated blood loss was 155 ml (range: 20-800). One bladder injury occurred. The overall post-operative complication rate was 35% (7/20). This included urinary retention necessitating catheterization for 24 h (n=3), urinary infection (n=2), vaginal infection (n=1) and wound hematoma (n=1). The mean post-operative pain score on a scale from 1 to 10 was 3.1. The overall patient satisfaction based on a scale from 1 to 10 was 9.23 (range: 8-10). CONCLUSIONS Minilaparotomy-assisted vaginal hysterectomy is a feasible and safe procedure. Our results suggest that this approach is potentially useful in increasing the proportion of hysterectomies performed vaginally.
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Affiliation(s)
- A A Ahmed
- Obstetrics and Gynecology Department, Queen Elizabeth Hospital, King's Lynn, UK.
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Cosson M, Boukerrou M, Lambaudie E, Narducci F, Crépin G. Hysterectomy for Benign Lesions: What Is Left for the Abdominal Route? J Gynecol Surg 2001. [DOI: 10.1089/104240601317207075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Varol N, Healey M, Tang P, Sheehan P, Maher P, Hill D. Ten-year review of hysterectomy morbidity and mortality: can we change direction? Aust N Z J Obstet Gynaecol 2001; 41:295-302. [PMID: 11592544 DOI: 10.1111/j.1479-828x.2001.tb01231.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The medical records of all women who underwent hysterectomy for benign disease performed between 1986 and 1995 were reviewed to ascertain the incidence of morbidity and mortality of abdominal, vaginal, and laparoscopically assisted vaginal hysterectomy at a university teaching hospital. A total of 1940 hysterectomies were performed during this period; 74% of hysterectomies were performed abdominally, 24% vaginally and 2% were laparoscopically assisted. In 80% of the patients uterine leiomyomas, adenomyosis, dysfunctional uterine bleeding or uterine prolapse were the indications for hysterectomy The overall complication rate was 44% for abdominal hysterectomy (AH) and 27.3% for vaginal hysterectomy (VH). An unintended major surgical procedure was required in 3% and 1% of women undergoing AH and VH respectively The rate of return to the operating room for haemostasis was 0.6% for AH and 0.2% for VH. The AH group was four times more likely than the VH group to require surgical intervention (36% versus 9%) at readmission. Vaginal hysterectomy was associated with a lower febrile morbidity and minor complication rate. Prophylactic antibiotics reduced the febrile morbidity for VH and AH by 50% (Student's t-test, p = 0.02) and 40% (Student's t-test, p < 0.001) respectively The overall mortality rate was 1.5 per 1000.
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Affiliation(s)
- N Varol
- Endosurgery Unit, Mercy Hospital for Women, East Melbourne, Victoria, Australia
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Abstract
A retrospective review of women undergoing hysterectomy between May 1998 and April 2000 was performed. Multiple logistic regression analysis was used to identify factors influencing the choice of hysterectomy performed. Two independent factors, the surgeons' expertise and the concomitant adnexal surgery, had a strong influence on the decision-making process regarding type of hysterectomy Generalist gynaecologists tended to perform either an abdominal hysterectomy (AH) or a vaginal hysterectomy (VH) while non-generalist gynaecologists were more likely to perform laparoscopic hysterectomy (LH). Patients undergoing a hysterectomy along with adnexal surgery had a far greater chance of undergoing either an AH or a LH as opposed to a VH. In addition, patients who had bigger uterus were more likely to undergo an AH versus a VH as compared to those with a small uterus. Patients aged 50 or older had more chance of undergoing a VH than a LH.
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Affiliation(s)
- J B Shao
- Liverpool Health Service, New South Wales, Australia
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Abstract
Vaginal hysterectomy represents the ultimate minimal access hysterectomy. The indications for the procedure extend well beyond those of prolapse. Good training and advances in surgical technique allow the removal of enlarged fibroid uteri as well as vaginal oophorectomy. This article also considers the complications which may follow.
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Affiliation(s)
- A Farkas
- Jessop Hospital for Women, Sheffield S3 7RE
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40
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WITTICH ARTHURC. Uterine Morcellation During Vaginal Hysterectomy for Leiomyomata. J Gynecol Surg 2000. [DOI: 10.1089/gyn.2000.16.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Miskry T, Davies A, Magos AL. Laparoscopically assisted vaginal hysterectomy compared with total abdominal hysterectomy. Am J Obstet Gynecol 1999; 181:1580-1. [PMID: 10601951 DOI: 10.1016/s0002-9378(99)70416-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Marana R, Zupi E. Reply. Am J Obstet Gynecol 1999. [DOI: 10.1016/s0002-9378(99)70417-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Chapron C, Laforest L, Ansquer Y, Fauconnier A, Fernandez B, Bréart G, Dubuisson JB. Hysterectomy techniques used for benign pathologies: results of a French multicentre study. Hum Reprod 1999; 14:2464-70. [PMID: 10527970 DOI: 10.1093/humrep/14.10.2464] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The objective of this study was to assess the techniques by which hysterectomies are carried out and to determine the rate of total laparoscopic hysterectomy (TLH). A transversal multicentre study was conducted in 23 gynaecology and obstetrics departments of French University Hospital Centres. The study population comprised only those patients for whom hysterectomy was indicated for benign disease without genital prolapse or urinary stress incontinence. Whereas the rates of performance of hysterectomy by laparotomy and by the vaginal route are comparable [respectively 40.0% (94 patients) and 46.8% (110 patients)], the rate of performance of TLH is only 13.2% (31 patients). All 23 centres (100%) carried out hysterectomy by laparotomy and 21 centres (91.3%) carried out vaginal hysterectomy; however, only nine centres (39.1%) carried out TLH. Only seven centres (30.4%) performed all three types of operation. Of the eight centres whose rate of vaginal hysterectomy was >60%, six (75%) did not carry out TLH. The study suggests that the usage of the TLH technique appears to be limited. The extent of surgical training is a major factor in the choice of technique for hysterectomy.
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Affiliation(s)
- C Chapron
- Service de Chirurgie Gynécologique (Pr Dubuisson), Clinique Universitaire Baudelocque, CHU Cochin Port-Royal, 123, Boulevard Port-Royal, 75014 Paris
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Davies A. Treatment with a gonadotrophin releasing hormone agonist before hysterectomy for leiomyomas: results of a multicentre, randomised controlled trial. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1999; 106:751-2. [PMID: 10428541 DOI: 10.1111/j.1471-0528.1999.tb08388.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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