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Abstract
OBJECTIVE In a 3-year period, the main mode of access for hysterectomy at Brigham and Women's Hospital changed from abdominal to laparoscopic. We estimated potential effects of this shift on perioperative outcomes and costs. METHODS We compared the perioperative outcomes and the cost of care for all hysterectomies performed in 2006 and 2009 at an urban academic tertiary care center using the χ² test or Fisher's exact test for categorical variables and two-sided Student's t test for continuous variables. A multivariate regression analysis was also performed for the major perioperative outcomes across the study groups. Cost data were gathered from the hospital's billing system; the remainder of data was extracted from patients' medical records. RESULTS This retrospective study included 2,133 patients. The total number of hysterectomies performed remained stable (1,054 procedures in 2006 compared with 1,079 in 2009) but the relative proportions of abdominal and laparoscopic cases changed markedly during the 3-year period (64.7% to 35.8% for abdominal, P<.001; and 17.7% to 46% for laparoscopic cases, P<.001). The overall rate of intraoperative complications and minor postoperative complications decreased significantly (7.2% to 4%, P<.002; and 18% to 5.7%, P<.001, respectively). Operative costs increased significantly for all procedures aside from robotic hysterectomy, although no significant change was noted in total mean costs. CONCLUSION A change from majority abdominal hysterectomy to minimally invasive hysterectomy was accompanied by a significant decrease in procedure-related complications without an increase in total mean costs.
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The Feasibility of Societal Cost Equivalence between Robotic Hysterectomy and Alternate Hysterectomy Methods for Endometrial Cancer. Obstet Gynecol Int 2011; 2011:570464. [PMID: 22190947 PMCID: PMC3236413 DOI: 10.1155/2011/570464] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 09/20/2011] [Accepted: 09/25/2011] [Indexed: 11/18/2022] Open
Abstract
Objectives. We assess whether it is feasible for robotic hysterectomy for endometrial cancer to be less expensive to society than traditional laparoscopic hysterectomy or abdominal hysterectomy. Methods. We performed a retrospective cohort analysis of patient characteristics, operative times, complications, and hospital charges from all (n = 234) endometrial cancer patients who underwent hysterectomy in 2009 at our hospital. Per patient costs of each hysterectomy method were examined from the societal perspective. Sensitivity analysis and Monte Carlo simulation were performed using a cost-minimization model. Results. 40 (17.1%) of hysterectomies for endometrial cancer were robotic, 91 (38.9%), were abdominal, and 103 (44.0%) were laparoscopic. 96.3% of the variation in operative cost between patients was predicted by operative time (R = 0.963, P < 0.01). Mean operative time for robotic hysterectomy was significantly longer than other methods (P < 0.01). Abdominal hysterectomy was consistently the most expensive while the traditional laparoscopic approach was consistently least expensive. The threshold in operative time that makes robotic hysterectomy cost equivalent to the abdominal approach is within the range of our experience. Conclusion. It is feasible for robotic hysterectomy to be less expensive than abdominal hysterectomy, but unlikely for robotic hysterectomy to be less expensive than traditional laparoscopy.
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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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Vaginal hysterectomy in non-prolapsed uteruses: "no scar hysterectomy". Int Urogynecol J 2009; 20:1009-12. [PMID: 19495535 DOI: 10.1007/s00192-009-0911-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2009] [Accepted: 05/02/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Traditionally, vaginal hysterectomy (VH) has been limited to cases of uterine prolapse, despite the fact that vast worldwide literature has demonstrated its applicability in other common benign diseases, such as uterine fibromatosis and abnormal uterine bleeding, with excellent outcomes. METHODS Such outstanding results have made this procedure one of the most useful and advantageous alternatives when compared to the abdominal and laparoscopic routes. RESULTS Currently, VH (an ancient procedure) does not represent a first-line alternative. CONCLUSION Therefore, the main goal of this paper is to describe some of the advantages of the vaginal route in order to help vaginal surgery schools to re-establish the leading role of this approach as a part of the minimally invasive gynecological surgery trend.
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Review of the confusion in current and historical terminology and definitions for disturbances of menstrual bleeding. Fertil Steril 2008; 90:2269-80. [DOI: 10.1016/j.fertnstert.2007.10.060] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2007] [Revised: 10/08/2007] [Accepted: 10/08/2007] [Indexed: 10/22/2022]
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Liu Z, Doan QV, Blumenthal P, Dubois RW. A systematic review evaluating health-related quality of life, work impairment, and health-care costs and utilization in abnormal uterine bleeding. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2007; 10:183-94. [PMID: 17532811 DOI: 10.1111/j.1524-4733.2007.00168.x] [Citation(s) in RCA: 209] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVES Abnormal uterine bleeding (AUB) impacts women's health-related quality of life (HRQoL) and puts a heavy economic burden on society. To date, this burden has not been systematically studied. We conducted a systematic review of the medical literature to evaluate the impact of AUB on HRQoL and to quantify the economic burden of AUB from a societal perspective. METHODS We searched the PubMed and Cochrane databases, and article bibliographies for the period up to July 2005. Teams of two reviewers independently abstracted data from studies that reported outcomes of interest: prevalence, HRQoL, work impairment, and health-care utilization and costs associated with AUB. RESULTS The search yielded 1009 English-language articles. Ninety-eight studies (including randomized controlled trials, observational studies, and reviews) that met the inclusion and exclusion criteria underwent a full-text review. The prevalence of AUB among women of reproductive age ranged from 10% to 30%. The HRQoL scores from the 36-item Short-Form Health Survey Questionnaire (SF-36) suggested that women with AUB have HRQoL below the 25th percentile of that for the general female population within a similar age range. The conservatively estimated annual direct and indirect economic costs of AUB were approximately $1 billion and $12 billion, respectively. These figures do not account for intangible costs and productivity loss due to presenteeism. CONCLUSIONS The burden of AUB needs further and more thorough investigation. Additional research should prospectively evaluate the impact of AUB and the value of treatment provided to help guide future health resource allocation and clinical decision-making.
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Affiliation(s)
- Zhimei Liu
- Cerner LifeSciences, 9100 Wilshire Boulevard, Beverly Hills, CA 90212, USA.
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You JHS, Sahota DS, MoYuen P. A cost-utility analysis of hysterectomy, endometrial resection and ablation and medical therapy for menorrhagia. Hum Reprod 2006; 21:1878-83. [PMID: 16585125 DOI: 10.1093/humrep/del088] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Four types of treatment [hysterectomy, endometrial resection/ablation, levonorgestrel-releasing intrauterine system (LNG-IUS) and oral medical therapy] are available for management of menorrhagia. The objective of this study was to compare the cost and quality-adjusted life-years (QALYs) gained by these four treatment alternatives. METHODS A Markov model was designed to simulate the healthcare resource utilization and QALYs of the four treatment alternatives for patients presenting with menorrhagia over 5 years. Clinical inputs were estimated from literature, and the cost analysis was conducted from the perspective of healthcare provider in Hong Kong. RESULTS The base-case analysis showed that the hysterectomy group was the most effective (4.725 QALYs) alternative with the highest cost (USD6878, 1USD=7.8HKD). The incremental cost per additional QALY (ICER) gained by hysterectomy was USD23 500. The probability of extra surgery in the endometrial resection/ablation was an influential factor. Probabalistic sensitivity analysis of 10,000 simulations of the Monte Carlo model showed that the hysterectomy group gained higher number of QALYs than the LNG-IUS, oral medical treatment and endometrial resection/ablation groups, 99, 99 and 98% of the time, and it was more costly than the other three groups over 85% of the time. CONCLUSIONS Hysterectomy appears to be cost effective, with ICER less than USD50,000, for management of menorrhagia.
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Affiliation(s)
- Joyce H S You
- Centre for Pharmacoeconomics Research, School of Pharmacy, The Chinese University of Hong Kong, China.
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O'Hanlan KA, Huang GS, Lopez L, Garnier AC. Total laparoscopic hysterectomy for oncological indications with outcomes stratified by age. Gynecol Oncol 2004; 95:196-203. [PMID: 15385132 DOI: 10.1016/j.ygyno.2004.07.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE We hypothesize that there is no difference in surgical outcomes of patients undergoing total laparoscopic hysterectomy (TLH) for various oncological indications when stratified by age categories. METHODS Data were analyzed by ANOVA and chi-square test with significance of P < 0.05, stratified by age (young: <50 years, middle: 50-64, senior age 65+). RESULTS There were 208 patients, age 26-86 years: 85 young, 82 middle, and 41 senior women. Preoperative diagnoses included 13 cases of cervical dysplasia, 10 cervical or upper vaginal carcinoma, 60 endometrial neoplasias, 22 prophylaxes of familial ovarian carcinoma, 95 with complex pelvic mass, and 8 with early ovarian carcinoma. Mean body mass index (BMI) was 27.2 kg/m(2) for all groups. Parity increased with age (1.0, 1.3, and 2.0; P = 0.001). Surgical duration was longer for young than middle or senior (168, 147, and 140 min, P = 0.0095). All groups had a similar mean blood loss (133 cc, ns) and similar mean length of hospital stay (1.8 days, ns). Overall complication rate was 7.7% with no variance by age: one seroma, one hematoma, one diverticulitis, one incisional hernia, one vaginal nonhealing, one adhesive bowel obstruction, and five urologic complications (two bladder, three ureteral; four treated with catheter or stent, one reimplant. Reoperation was required in 2.8%. CONCLUSIONS Null hypothesis accepted: TLH appears feasible and safe for oncological practice indications throughout the life span. This pilot data can facilitate guidelines for a randomized controlled trial of TLH with TAH and laparoscopic assisted vaginal hysterectomy (LAVH).
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O'Hanlan KA, Huang GS, Lopez L, Garnier AC. Selective incorporation of total laparoscopic hysterectomy for adnexal pathology and body mass index. Gynecol Oncol 2004; 93:137-43. [PMID: 15047227 DOI: 10.1016/j.ygyno.2003.12.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2003] [Indexed: 11/23/2022]
Abstract
OBJECTIVES We studied patients undergoing adnexectomy with total laparoscopic hysterectomy (TLH) for ovarian pathology, over a 6-year period. METHODS Chart abstraction, analyzed by ANOVA, Fisher's Exact Test with significance at P < 0.05, stratifying by body mass index (BMI, kg/m(2): ideal < 25; overweight 25-29.9; obese 30+). RESULTS Of 354 patients undergoing TLH, 90 cases had adnexal pathology: 69 complex masses, 16 BRCA1/2 mutations, 5 unstaged ovarian carcinomas; 48 having ideal BMI, 26 overweight, and 16 obese. Mean age (51 years) and parity (1.2 children) were similar between BMI groups. Thirty-four percent were nulliparous. All 90 underwent TLH, adnexectomy, washings; with 14 appendectomies, 5 lymphadenectomies, 3 node samplings, 6 omentectomies, 8 ureterolyses, and 1 Burch. Mean surgery duration (156 min), blood loss (152cc), and hospital stay (1.9 days) were similar across BMI groups. Mean nodal yield from each lymphadenectomy was 14, and 2.6 from sampling. Mean size of pelvic masses was 8 cm (range 3-19 cm). There were seven cases of ovarian carcinoma: 2 Stage IA, 1 IB, 2 IC, 1 IIC, 1 IIIB; 1 recurrent breast cancer, 16 adenofibromas, 15 endometriomas, 10 dermoids, and 41 serous/mucinous cystadenomas. Mean complication rate was 6.6% (ns): 1 seroma, 1 hematoma, 1 obstructive adhesions, and 3 urological injuries. All urological injuries were within the first third of patients. CONCLUSIONS TLH appears feasible for women with adnexal pathology regardless of BMI, in an oncological practice. This pilot data can facilitate guidelines for a randomized controlled trial of TLH with TAH and LAVH, and help surgeons avoid our early complications.
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OʼHanlan KA, Lopez L, Dibble SL, Garnier AC, Huang GS, Leuchtenberger M. Total Laparoscopic Hysterectomy. Obstet Gynecol 2003. [DOI: 10.1097/00006250-200312000-00028] [Citation(s) in RCA: 5] [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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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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Daniell JF, Channell C, Lindsay J, Staggs S, Henry T. Early evaluation of an electromechanical morcellator for laparoscopic supracervical hysterectomy. ACTA ACUST UNITED AC 2002. [DOI: 10.1046/j.1365-2508.1998.00209.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Møller C, Kehlet H, Friland SG, Schouenborg LO, Lund C, Ottesen B. Fast track hysterectomy. Eur J Obstet Gynecol Reprod Biol 2001; 98:18-22. [PMID: 11516794 DOI: 10.1016/s0301-2115(01)00342-6] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To identify factors limiting early discharge after laparoscopically assisted vaginal hysterectomy (LAVH) and abdominal hysterectomy, in a fast track setting with emphasis on information, treatment of pain, early mobilization, and early food intake. STUDY DESIGN A prospective, descriptive study of 32 unselected women allocated to either abdominal hysterectomy (n=16) or LAVH (n=16). The patients received the same information, care, and advice for the perioperative period except for an assumed 1-day hospital stay in the LAVH-group and 2 days in the abdominal group. RESULTS Patients were discharged median 1 day (1-3) after LAVH and 2 days (2-4) after abdominal hysterectomy. Work was resumed median 23 days after abdominal hysterectomy and 28 days after LAVH (P > 0.05). CONCLUSIONS The study questions the previously proposed advantages of shortened hospitalization and convalescence after LAVH compared with abdominal hysterectomy. Further studies with active rehabilitation are needed to demonstrate real differences between laparoscopic and open hysterectomy.
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Affiliation(s)
- C Møller
- Department of Obstetrics and Gynecology, HS-Hvidovre University Hospital, Kettegaard Alle 30, DK-2650, Hvidovre, Denmark.
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Love BR, McCorvey R, Chaddha JS. Video Office Rollerbar Endometrial Ablation Under Local Anesthesia Using 24 French Wolf Resectoscope and Aquasens™ Fluid Monitoring System. J Gynecol Surg 2001. [DOI: 10.1089/104240601750200341] [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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Hidlebaugh DA. Cost and quality-of-life issues associated with different surgical therapies for the treatment of abnormal uterine bleeding. Obstet Gynecol Clin North Am 2000; 27:451-65. [PMID: 10991717 DOI: 10.1016/s0889-8545(00)80035-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abnormal uterine bleeding is a common problem among women of reproductive age and can be treated medically or surgically. When medical therapy fails to cure menorrhagia, many women undergo hysterectomy. Over the past 15 years, operative laparoscopy and hysteroscopy increasingly have replaced traditional surgery (i.e., abdominal and vaginal hysterectomy). An endoscopic approach such as LAVH has been added to the therapeutic choices of patient and physician. Additionally, hysterectomy alternatives such as endometrial resection and ablation and myomectomy have been offered to women with significant menorrhagia. This article reviewed the cost and quality-of-life issues of endoscopic treatment versus traditional surgical methods. Vaginal hysterectomy is the least costly of all hysterectomy techniques. Studies have shown that for LAVH, direct costs are higher that abdominal hysterectomy. However, this difference decreases with additional operator experience and with the use of nondisposable instrumentation. The indirect cost of LAVH is significantly less than abdominal hysterectomy because of the more rapid convalescence. With endometrial resection and ablation, direct and indirect costs are significantly less than those of hysterectomy even when high failure rates are factored. Women choose this procedure over hysterectomy because it avoids major surgery, allows for a fast return to normal functioning, and entails short hospitalization. Hysterectomy can lead to many psychologic and physical changes for a woman. It continues to provide a high satisfaction rate because it is a guaranteed cure for abnormal bleeding.
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Affiliation(s)
- D A Hidlebaugh
- Department of Gynecology, Cleveland Clinic Florida, Naples, USA
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Erian M, McLaren GR, Buck RJ, Wright G. Reducing costs of laparoscopic hysterectomy. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 1999; 6:471-5. [PMID: 10548707 DOI: 10.1016/s1074-3804(99)80013-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE To establish the role of laparoscopic hysterectomy using reuseable surgical equipment. DESIGN Prospective, observational study (Canadian Task Force classification II-2). SETTING Tertiary major teaching hospital. PATIENTS Fifty consecutive women carefully selected for laparoscopic hysterectomy. INTERVENTIONS The ultrasonically activated (harmonic) scalpel was used for coagulative cutting of pedicles and ligaments attached to the uterus and adnexa, backed by bipolar diathermy. No nonabsorbable material was left in the pelvis at the conclusion of the procedures. MEASUREMENTS AND MAIN RESULTS Patient characteristics, uterine weight, histology, operating time, recovery, analgesic requirements, and hospital stay were recorded. Complications were noted and critically assessed for constructive quality assurance appraisal. Outcomes were satisfactory according to both patients and gynecologists. CONCLUSION This pilot study suggests that the method is an efficacious, cost-effective, and well-controlled technique of laparoscopic hysterectomy.
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Affiliation(s)
- M Erian
- Department of Obstetrics and Gynecology, Queensland University, Brisbane, Australia
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Abstract
The LAVH revolution beginning in the late 1980s is far from over. The overwhelming growth and, at times, overuse of the laparoscopic approach have waned somewhat as physicians reevaluate LAVH, adopt new techniques such as arterial embolization and myolysis, and rediscover old techniques such as uterine morcellation at vaginal hysterectomy. In addition, the cost of new procedures and instrumentation has come under intense scrutiny. As analysis of patient care moves from cost containment to improved outcomes, there will be renewed interest in minimally invasive approaches. The challenge to accumulate data, critically analyze each approach, and select the most appropriate procedure for each patient holds the greatest promise for improved patient satisfaction and outcomes.
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Affiliation(s)
- J M Shwayder
- Department of Obstetrics and Gynecology, Denver Health and Hospital Authority, Colorado, USA
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Kresch AJ, Lyons TL, Westland AB, Winer WK, Savage GM. Laparoscopic supracervical hysterectomy with a new disposable morcellator. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 1998; 5:203-6. [PMID: 9564073 DOI: 10.1016/s1074-3804(98)80092-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Laparoscopic supracervical hysterectomy (LSH) can be performed more easily with a powered morcellator for removal of the uterus. Available laparoscopic morcellators are expensive and may be difficult to use, but a new, powered, disposable instrument was developed (Diva; FemRx, Sunnyvale, CA) to morcellate the entire uterus for easy removal through a 15-mm cannula. Twelve consecutive women for whom subtotal hysterectomy was indicated underwent LSH by standard laparoscopic protocol and were monitored postoperatively for a minimum of 1 month. In the current trend of "less is more," LSH is an emerging option for less extensive hysterectomies and can be made more cost and time effective with a single-use powered morcellator.
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Affiliation(s)
- A J Kresch
- California Center for Pelvic Pain, Palo Alto, CA 94304, USA
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