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Le AL, Xie R, Liao Y, Chen I. Outcomes of Concurrent Prophylactic Mastectomy and Oophorectomy, Compared to Mastectomy and Hysterectomy, in Hereditary Breast and Gynecologic Cancer: A National Surgical Quality Improvement Program Database Analysis. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2021.0088] [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)
- Ai-Lien Le
- University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Rihua Xie
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Nanhai Hospital, Foshan, Guangdong Province, China
| | - Yan Liao
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Innie Chen
- University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
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Vermeulen CKM, Veen J, Adang C, van Leijsen SAL, Coolen ALWM, Bongers MY. Pelvic organ prolapse after laparoscopic hysterectomy compared with vaginal hysterectomy: the POP-UP study. Int Urogynecol J 2020; 32:841-850. [PMID: 33170314 PMCID: PMC8009772 DOI: 10.1007/s00192-020-04591-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/26/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to review the long-term prevalence of pelvic organ prolapse (POP) after laparoscopic hysterectomy (LH) compared with vaginal hysterectomy (VH). METHODS An observational cohort study was conducted amongst women who underwent an LH or a VH for benign indications during the period 1996-2004: the POP-UP study. The prevalence of POP was inventoried by a questionnaire involving the Pelvic Floor Distress Inventory (PFDI-20) and a pelvic floor examination (POP-Q). Women were divided into groups based on route and indication of hysterectomy: LH, VH-1 (for nonprolapse), and VH-2 (prolapse). RESULTS Four hundred and six of the 706 eligible patients (58%) returned the questionnaire and 247 underwent POP-Q examination. Sixty-eight patients (17%) received treatment for prolapse; 8% LH, 10% VH-1, and 29% VH-2 (Chi-squared test, p < 0.001). The prevalence of vaginal vault prolapse (apical surgery or ≥ stage 2 at POP-Q) was 4.4% for LH and 5.8% for VH-1 (p = 0.707); and 23% for VH-2 (VH-2 versus others, p < 0.0001). The prevalence of prolapse ≥ stage 2 in any compartment was 62% (n = 153) in total and in 42% of the LH group, 51% of the VH-1 group, and 84% of the VH-2 group (Chi-squared test, p < 0.001). A symptomatic POP (anatomical POP ≥ stage 2 with bulging) was present in 11% of the population. CONCLUSIONS No difference was found in the prevalence of POP between LH and VH for nonprolapse indications. However, POP after VH for prolapse occurs more frequently than after hysterectomy for other indications.
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Affiliation(s)
- Carolien K M Vermeulen
- Department of Gynecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5500, MB, Veldhoven, The Netherlands.
- Department of Gynecology and Obstetrics, Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, The Netherlands.
| | - Joggem Veen
- Department of Gynecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5500, MB, Veldhoven, The Netherlands
| | - Caroline Adang
- Department of Gynecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5500, MB, Veldhoven, The Netherlands
| | - Sanne A L van Leijsen
- Department of Gynecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5500, MB, Veldhoven, The Netherlands
| | - Anne-Lotte W M Coolen
- Department of Gynecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5500, MB, Veldhoven, The Netherlands
- GROW, Research School of Oncology and Developmental Biology, University of Maastricht, Universiteitssingel 40, 6229, ER, Maastricht, The Netherlands
| | - Marlies Y Bongers
- Department of Gynecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5500, MB, Veldhoven, The Netherlands
- GROW, Research School of Oncology and Developmental Biology, University of Maastricht, Universiteitssingel 40, 6229, ER, Maastricht, The Netherlands
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Yalcin Bahat P, Gülova S, Yuksel Ozgor B, Cakmak K. Is Vaginal Hysterectomy Safe for an Enlarged Uterus? Cureus 2020; 12:e6816. [PMID: 32133272 PMCID: PMC7049894 DOI: 10.7759/cureus.6816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective The purpose of this study was to compare the surgical outcomes between two sets of women undergoing vaginal hysterectomy (VH) for benign gynecological conditions: those with moderately enlarged ( ≥12 weeks') uteruses and those with normal-sized uteruses. Materials and Methods The medical records of 84 women who underwent vaginal hysterectomies for benign gynecological conditions at Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey between 2013 and 2015 were reviewed. Age, uterine sizes, indications, duration of hospitalization, operation time, hematocrit (HCT) levels, and complications were analyzed. Results The most common indications for VH were uterine descensus. However, most women had presented with more than one indication. The mean age of the patients who underwent VH was 56.12. The maximum volume of the uterus was found to be 1244.74 ml, and the smallest volume was found to be 18.83 ml. The mean volume of the uterus was found as 122.6629 ml. The mean duration of operation was 159.70 minutes, whereas the mean duration of hospital stay was 3.79 days. The mean preoperative HCT and hemoglobin (Hgb) values were 37.098 (±3.64) gr/dl and 12.365 (±1.35) gr/dl respectively. Postoperative HCT and Hgb values were 31.363 (±3.94) gr/dl and 10.52 (±1.38) respectively. Conclusion VH is usually a simple procedure with low morbidity. It is important to choose the appropriate patient when deciding on the operation. In addition, having experienced surgeons in the field of VH increases the success of surgery.
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Affiliation(s)
- Pinar Yalcin Bahat
- Obstetrics and Gynecology, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, TUR
| | - Sibel Gülova
- Obstetrics and Gynecology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, TUR
| | - Bahar Yuksel Ozgor
- Obstetrics and Gynecology, Esenler Maternity and Children's Hospital, Istanbul, TUR
| | - Kubra Cakmak
- Obstetrics and Gynecology, Esenler Maternity and Children's Hospital, Istanbul, TUR
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Factors for a Successful Laparoscopic Hysterectomy in Very Large Uteri. Case Rep Med 2017; 2017:1637472. [PMID: 29056970 PMCID: PMC5606097 DOI: 10.1155/2017/1637472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/09/2017] [Accepted: 08/02/2017] [Indexed: 11/17/2022] Open
Abstract
Minimally invasive hysterectomy is a standard procedure. Different approaches, as laparoscopically assisted vaginal hysterectomy, vaginal hysterectomy, and subtotal and total laparoscopic hysterectomy, have been described and evaluated by various investigations as safe and cost-effective methods. In particular, in comparison to abdominal hysterectomy, the minimally invasive methods have undoubted advantages for the patients. The main reason for a primary abdominal hysterectomy or conversion to abdominal hysterectomy during a minimal invasive approach is the uterine size. We describe our course of action in the retrospective analysis of five cases of total minimal-access hysterectomy, combining the laparoscopic subtotal hysterectomy and the vaginal extirpation of the cervix in uterine myomatosis with a uterine weight of more than 1000 grams, and discuss the factors that limit the use of laparoscopy in the treatment of big uteri. Trail Registration. The case report is registered in Research Registry under the UIN researchregistry743.
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Stancu B, Grad NO, Mihaileanu VF, Chiorescu S, Pintea SD, Constantinescu MI. Surgical technique of concomitant laparoscopically assisted vaginal hysterectomy and laparoscopic cholecystectomy. Med Pharm Rep 2017; 90:348-352. [PMID: 28781532 PMCID: PMC5536215 DOI: 10.15386/cjmed-747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 03/23/2017] [Accepted: 05/22/2017] [Indexed: 12/22/2022] Open
Abstract
Background Laparoscopically assisted vaginal hysterectomy is one of the most frequently performed gynecologic operations, and numerous authors have demonstrated its safety and feasibility. Case presentation We practiced in some selected cases simultaneous laparoscopically assisted vaginal total hysterectomy with bilateral adnexectomy and laparoscopic cholecystectomy using 5 trocars without uterine manipulator. Previous examinations included abdominal ultrasound, cervix biopsy and CT of abdomen and pelvis. Our aim was to evaluate the surgical technique of our initial experiences for combined laparoscopically assisted vaginal hysterectomy and laparoscopic colecystectomy. Conclusions Laparoscopic hysterectomy had a number of advantages over the conventional technique given the underlying associated diseases, postoperative pain, rapid recovery and aesthetic benefits.
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Affiliation(s)
- Bogdan Stancu
- 2 Surgery Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Nicolae Ovidiu Grad
- 2 Surgery Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Stefan Chiorescu
- 2 Surgery Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Simona Daniela Pintea
- 2 Surgery Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Yi YX, Zhang W, Zhou Q, Guo WR, Su Y. Laparoscopic-assisted vaginal hysterectomy vs abdominal hysterectomy for benign disease: a meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol 2011; 159:1-18. [PMID: 21664034 DOI: 10.1016/j.ejogrb.2011.03.033] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 02/12/2011] [Accepted: 03/28/2011] [Indexed: 01/03/2023]
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Choi JS, Kyung YS, Kim KH, Lee KW, Han JS. The four-trocar method for performing laparoscopically-assisted vaginal hysterectomy on large uteri. J Minim Invasive Gynecol 2006; 13:276-80. [PMID: 16825066 DOI: 10.1016/j.jmig.2006.04.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2005] [Revised: 03/22/2006] [Accepted: 04/13/2006] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE To assess the feasibility and efficacy of laparoscopically-assisted-vaginal hysterectomy (LAVH) for a large uterus with the new trocar technique. DESIGN Retrospective clinical study (Canadian Task Force classification III). SETTING University teaching hospital. PATIENTS Thirty-four women with a large uterus (>500 g). INTERVENTION LAVH with Choi's 4-trocar method. MEASUREMENTS AND MAIN RESULTS We reviewed the medical records of 34 patients for age, parity, history of previous abdominal surgery, operative indications, histopathologic diagnosis, mean operative time, weight of the removed uterus, change in the hemoglobin level, hospital stay, and occurrence of any complications. The patient's median age was 45 years (range 36-51 years), median parity was 2 (range 0-3), and 18 patients (52.9%) had a previous operative history. The most common operative indication was a palpable abdominal mass, and the most common histopathologic diagnosis was leiomyoma. The median operative time was 62.5 minutes (range 35-245 minutes), and the median weight of the removed uterus was 615.0 g (range 500-1200 g). The median change in hemoglobin level was 1.4 g/dL (range 0-5 g/dL). The median hospital stay was 4.0 days (range 2-6 days). The only complication was superficial port site bleeding (1 patient). None of the operations were switched to total abdominal hysterectomy. CONCLUSION Choi's 4-trocar method provided an excellent operative field during LAVH for a large uterus.
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Affiliation(s)
- Joong Sub Choi
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Vaisbuch E, Goldchmit C, Ofer D, Agmon A, Hagay Z. Laparoscopic hysterectomy versus total abdominal hysterectomy: A comparative study. Eur J Obstet Gynecol Reprod Biol 2006; 126:234-8. [PMID: 16616408 DOI: 10.1016/j.ejogrb.2005.10.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2004] [Revised: 05/21/2005] [Accepted: 10/12/2005] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to compare the intraoperative and short-term postoperative complications of laparoscopic hysterectomy and total abdominal hysterectomy. STUDY DESIGN Retrospective study of 167 women who had laparoscopic hysterectomy and 119 women who had total abdominal hysterectomy. For assessing the learning curve, the laparoscopic hysterectomies were further subdivided to the first 30 hysterectomies and the later hysterectomies. For data analysis Student's t-test, chi2-test and Fisher's exact test were used. RESULTS There were no statistically significant differences between the two groups for age, body mass index, previous abdominal surgery, uterine weight, first postoperative day hemoglobin drop, blood transfusion and major or minor complications rate. Operation time was significantly longer for laparoscopic than abdominal hysterectomy (156+/-40 and 91.2+/-33 min, respectively; P<0.001) but the length of hospital stay was significantly shorter (3.9 and 6.55 days, respectively; P<0.001). The conversion rate of laparoscopic hysterectomy was 1.8% (three cases). CONCLUSIONS Laparoscopic hysterectomy can be safely done even during the learning curve with a low and reasonable complication rate, and a shorter hospital stay but with longer operation time. As experience is gained the operation time, complication rate and hospital stay are decreased.
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Affiliation(s)
- Edi Vaisbuch
- Department of Obstetrics and Gynecology, Kaplan Medical Center (Affiliated to the School of Medicine, Hebrew University and Hadassah), Rehovot 76100, Israel.
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Roumm AR, Pizzi L, Goldfarb NI, Cohn H. Minimally invasive: minimally reimbursed? An examination of six laparoscopic surgical procedures. Surg Innov 2006; 12:261-87. [PMID: 16224649 DOI: 10.1177/155335060501200313] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
It is generally believed that minimally invasive surgery (MIS) results in less postoperative pain, fewer complications, and shorter recovery periods compared with open procedures. Yet despite these benefits, the level of reimbursement assigned to the surgeon by United States health-care payers is often lower than that for open procedures. Furthermore, the cost of performing a MIS may be higher vs an open procedure because specialized equipment, increased surgical time, or both may be required. In this report, we examine the issue by comparing reimbursements for MIS with open procedures, summarizing the medical literature on MIS vs open surgical procedures, and offering recommendations for payers who establish reimbursement policies. The review is focused on six MIS procedures where outcomes data exist: laparoscopic cholecystectomy (lap chole), laparoscopic colectomy (LC), laparoscopic fundoplication (LF), laparoscopic hysterectomy (LH), laparoscopic ventral hernia repair (LVHR), and laparoscopic appendectomy (LA). Outcomes summarized were length of hospital stay (LOS), operating room time, operating room costs, complications, and return to work or normal activities. The level of scientific evidence was assigned to each study using predetermined criteria. A total of 112 articles were reviewed: 14 for lap chole, 26 for LC, 7 for LF, 19 for LH, 9 for LVHR, and 37 for LA. The data demonstrate that these procedures result in reduced hospital stay, reduced hospital costs, and faster return to work or normal activities. Yet, the operating room time and costs are frequently higher for MIS. These findings suggest that as both the outcomes value and level of operating room resources are greater, MIS warrants reimbursement that meets or exceeds that of open procedures.
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Affiliation(s)
- Adam R Roumm
- Department of Health Policy, Jefferson Medical College, Philadelphia, PA 19107, USA
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McMaster-Fay R. Why are we still doing radical hysterectomies for cervical cancer? Aust N Z J Obstet Gynaecol 2005; 45:260-1. [PMID: 15904462 DOI: 10.1111/j.1479-828x.2005.00405.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: 12/01/2022]
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Atabekoglu C, Sönmezer M, Güngör M, Aytaç R, Ortaç F, Unlü C. Tissue Trauma in Abdominal and Laparoscopic-Assisted Vaginal Hysterectomy. ACTA ACUST UNITED AC 2004; 11:467-72. [PMID: 15701187 DOI: 10.1016/s1074-3804(05)60077-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVE To compare the degree of tissue damage between abdominal and laparoscopic-assisted hysterectomy. DESIGN Prospective, randomized, controlled study (Canadian Task Force classification I). SETTING University hospital. PATIENTS Forty-six women. INTERVENTION Laparoscopic-assisted and abdominal hysterectomy. MEASUREMENTS AND MAIN RESULTS The degree of tissue injury caused by surgical trauma was assessed by measuring plasma levels of creatine phosphokinase (CPK), C-reactive protein (CRP), lactic dehydrogenase (LDH), and CA 125 in patients undergoing laparoscopic-assisted (n = 23) and abdominal hysterectomy (n = 23). Plasma levels of CPK-MB isoenzyme were measured in order to exclude the possibility of myocardial injury. Blood samples were taken preoperatively, and on the first and second postoperative days. There was no difference in demographic characteristics between the groups. One patient in the laparotomy group and two patients in the laparoscopy group were excluded from analysis due to bladder injury, postoperative thrombophlebitis, and conversion to laparotomy because of severe adhesions. The mean operation time was longer (105.5 +/- 23.1 minutes vs 77.3 +/- 18.7 minutes, p < .001), but the duration of hospital stay was shorter (2.7 +/- 0.8 days vs 4.3 +/- 1.4 days, p < .001) and analgesic requirement was lower in the laparoscopy group compared with the abdominal group. We observed significant postoperative increases in CRP and CPK in both groups on postoperative days 1 and 2, whereas the increase in LDH was significant only in the laparotomy group on postoperative day 2. There were no significant changes in CPK-MB and CA 125. Moreover, mean plasma levels of CRP and CPK were significantly higher in the laparotomy group on postoperative days 1 and 2 than in the laparoscopy group (p < .05). CONCLUSION Surgery is a significant cause of tissue injury that can be assessed by specific enzymes and proteins. We suggest that laparoscopic surgery causes less tissue damage as assessed by lower postoperative CRP and CPK values, and that less tissue trauma related with laparoscopic surgery may account for early mobilization and reduced analgesic requirement in these patients.
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Affiliation(s)
- Cem Atabekoglu
- Ankara University School of Medicine, Department of Obstetrics and Gynecology, 06100 Cebeci Ankara, Turkey
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Parker WH. Total laparoscopic hysterectomy and laparoscopic supracervical hysterectomy. Obstet Gynecol Clin North Am 2004; 31:523-37, viii. [PMID: 15450315 DOI: 10.1016/j.ogc.2004.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Laparoscopic hysterectomy was first performed in 1989 and has become one of the procedures that may be offered to women with significant gynecologic symptoms. This article describes alternatives to hysterectomy, indications for laparoscopic hysterectomy, and outcomes and complications of laparoscopic hysterectomy as compared with vaginal and abdominal hysterectomy. Surgical technique for both total and supracervical hysterectomy are described as well as the learning curve, training, and credentialing for these procedures.
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Affiliation(s)
- William H Parker
- Department of Obstetrics and Gynecology, Saint John's Hospital and Medical Center, 1450 Tenth Street, Santa Monica, CA 90401, USA.
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Lenihan JP, Kovanda C, Cammarano C. Comparison of laparoscopic-assisted vaginal hysterectomy with traditional hysterectomy for cost-effectiveness to employers. Am J Obstet Gynecol 2004; 190:1714-20; discussion 1720-2. [PMID: 15284779 DOI: 10.1016/j.ajog.2004.02.059] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the cost-effectiveness of laparoscopic-assisted vaginal hysterectomy to traditional total abdominal hysterectomy and total vaginal hysterectomy with regard not only to direct hospital costs but also to indirect costs. STUDY DESIGN This was a combined retrospective cohort study (Canadian Task Force classification II-2) that was conducted in a suburban private practice. The cases of 268 patients who underwent hysterectomies over a 27-month period were analyzed to include clinical outcomes, direct hospital costs, and indirect costs (time to return to normal function, time to return to work, and time away from work required by other family members). RESULTS For all patients, length of hospital stay and time of return to normal function were shorter for laparoscopic-assisted vaginal hysterectomy than for total abdominal hysterectomy and total vaginal hysterectomy. For working patients, time to return to work and time off for working family members were all significantly shorter after laparoscopic-assisted vaginal hysterectomy when compared with both total abdominal hysterectomy and total vaginal hysterectomy. Operating times were similar for total abdominal hysterectomy and laparoscopic-assisted vaginal hysterectomy, and complications were greater for total abdominal hysterectomy. In a comparison of all procedures, direct hospital costs were greatest for laparoscopic-assisted vaginal hysterectomy and least for total vaginal hysterectomy. CONCLUSION For most patients, laparoscopic-assisted vaginal hysterectomy provides a minimally invasive way to accomplish a hysterectomy with a lower cost to employers (payers) on the basis of lost work hours.
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Shen CC, Wu MP, Lu CH, Hung YC, Lin H, Huang EY, Huang FJ, Hsu TY, Chang SY. Small Intestine Injury in Laparoscopic-Assisted Vaginal Hysterectomy. ACTA ACUST UNITED AC 2003; 10:350-5. [PMID: 14567810 DOI: 10.1016/s1074-3804(05)60260-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE To review laparoscopic-assisted vaginal hysterectomy (LAVH) cases for instances of small intestine injury. DESIGN Retrospective review (Canadian Task Force Classification II-2). SETTING Tertiary care university hospital. PATIENTS Two thousand six hundred eighty-two women. INTERVENTION LAVH. MEASUREMENTS AND MAIN RESULTS Indications for hysterectomy were myomata uteri, adenomyosis, intractable menorrhagia, endometriosis, severe pelvic adhesions, cervical intraepithelial neoplasia, endometrial polyps, and hyperplasia. Small bowel injuries occurred in five women (1.9/1000), one (20%) of which was recognized postoperatively. Thermal injuries occurred in two patients, trocar injuries in two, and a dissection wound in one. Two-layer closure was performed for three patients, and partial resection with reanastomosis for two. All patients were discharged without sequelae. CONCLUSION Small bowel injury during LAVH is not common. It may have unusual characteristics and devastating consequences if not recognized and treated promptly.
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Affiliation(s)
- Chung-Chang Shen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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