1
|
Paily VP, Raj Girijadevi R, K Shefeek S. Salpingo-Oophorectomy During Non-Descent Vaginal Hysterectomy Using the Paily Vaginal Oophorectomy Clamp. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102281. [PMID: 37951573 DOI: 10.1016/j.jogc.2023.102281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/27/2023] [Accepted: 10/27/2023] [Indexed: 11/14/2023]
Abstract
We conducted a 6-year prospective surgical case series study at a tertiary care centre in South India to evaluate the safety and efficacy of the novel Paily Vaginal Oophorectomy Clamp and its unique application technique during non-descent vaginal hysterectomy requiring salpingo-oophorectomy. The Paily Vaginal Oophorectomy Clamp's reversed blade design allows direct and secure grasping of the infundibulopelvic ligament as there is no intervening tissue near the joint, reducing the risk of slippage. In contrast, while using conventional clamps such as Heaney's, infundibulopelvic slippage occurs due to the presence of tissue between blades near the joint. A demonstration video is provided (Video).
Collapse
Affiliation(s)
- Vakkanal Paily Paily
- Department of Obstetrics and Gynaecology, Rajagiri Hospital, Kochi, Kerala, India.
| | - Raji Raj Girijadevi
- Department of Obstetrics and Gynaecology, Rajagiri Hospital, Kochi, Kerala, India
| | - Suhail K Shefeek
- Department of Obstetrics and Gynaecology, Rajagiri Hospital, Kochi, Kerala, India
| |
Collapse
|
2
|
Djokovic D, Noé G, van Herendael BJ, Chrysostomou A. The routes of hysterectomy: A survey of current practices amongst members of the International Society for Gynaecologic Endoscopy (ISGE). Eur J Obstet Gynecol Reprod Biol 2023; 291:99-105. [PMID: 37857149 DOI: 10.1016/j.ejogrb.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/02/2023] [Accepted: 10/12/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE This study aimed to explore the current opinion on the routes of hysterectomy amongst the members of the International Society for Gynaecologic Endoscopy (ISGE), as well as the perceptions of potential barriers that inhibit gynaecologists from offering a minimally invasive hysterectomies (MIHs) to their patients. STUDY DESIGN An anonymous, electronic survey was designed, including the questions about the surgeon location and length of gynaecological practice, preferred approach to hysterectomy, approximate number of surgical cases performed during the year preceding the survey (2021), and potential barriers and contraindications to performing MIHs. It was validated by 12 practicing gynaecologists. Subsequently, the survey was sent to all practicing gynaecologists who are the members of the ISGE. RESULTS We received a response from 159 members of ISGE (29 % response rate), of which 92 % with ≥ 5 years in practice since the completion of their residency training in Gynaecology and Obstetrics. When asked about the preferred route of hysterectomy for themselves or their relatives, 59 % chose total laparoscopic hysterectomy (TLH), 19 % vaginal hysterectomy (VH), 8 % chose laparoscopically-assisted vaginal hysterectomy (LAVH) and 5 % chose total abdominal hysterectomy (TAH). However, TAH was the most performed hysterectomy procedure undertaken by the respondents in the year preceding the survey. When asked about the main obstacles to performing MIHs, more than half of the respondents highlighted insufficient training during residency and insufficient surgical experience. Only 25 % of the responders acknowledged reading the ISGE guidelines on performing vaginal hysterectomy. CONCLUSIONS Contrary to a full understanding of the benefits of MIHs, lack of training, as well as insufficient surgical experience and unawareness of existing evidence-based guidelines were the main reasons for the high rate of TAH among the ISGE members who participated in the study. All efforts should be directed at teaching VH and TLH techniques during residency, continuous acquisition of practical experience, and use of validated patient selection guidelines for MIH in daily clinical practice.
Collapse
Affiliation(s)
- D Djokovic
- Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisbon, Portugal; Department of Obstetrics and Gynecology, NOVA Medical School, Faculdade de Ciências Médicas, NOVA University of Lisbon, Lisbon, Portugal.
| | - G Noé
- University of Witten Herdecke, Witten, Germany; Clinic for Gynecology and Obstetrics, Rheinland Clinics, Dormagen, Germany
| | - Bruno J van Herendael
- Department of Minimally Invasive Gynecologic Surgery, Stuivenberg General Hospital, Ziekenhuis Netwerk Antwerpen (ZNA), Antwerp, Belgium; Università degli Studi dell'Insubria, Varese, Italy
| | - A Chrysostomou
- Department of Obstetrics and Gynaecology, Division of Urogynaecology, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
3
|
Al Baalharith M, AlSary S, Bamanie E, Al Mowallad S, Makki JS, Basudan SK, Alotaibi SA, Alabdulkareem ME, Abu-Zaid A. Attitudes Toward Hysterectomy in Saudi Arabian Women Undergoing Evaluation for Uterovaginal Prolapse: A Cross-Sectional Study. Cureus 2023; 15:e49967. [PMID: 38179401 PMCID: PMC10765269 DOI: 10.7759/cureus.49967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Hysterectomy is an effective management approach for uterovaginal prolapse. However, the decision to undergo hysterectomy is a complex matter, influenced not only by medical factors but also cultural beliefs, societal norms, and individual attitudes. In Saudi Arabia, a nation with its distinctive cultural and social norms, the understanding of women's attitudes toward hysterectomy is of utmost importance. Unfortunately, such related attitudes have not been explored. OBJECTIVE This first-ever study aimed to investigate the attitudes toward hysterectomy among Saudi Arabian women undergoing evaluation for uterovaginal prolapse, by exploring the factors influencing their decision-making process and treatment choices, with a particular focus on the potential impact of cultural beliefs and societal norms. METHODS A survey was conducted among 404 women referred for uterovaginal prolapse evaluation. The participants completed a self-administered questionnaire, which included demographic information, perceptions on hysterectomy's impact on well-being, and factors affecting decision-making. RESULTS The mean ± standard deviation of participants was 51.07 ± 11.1 years. Most participants were currently married (n=327, 81%), were unemployed (n=309, 76.5%), and had an "excellent" self-rated general health status (n=138, 34%). Current prolapse management methods included Kegel exercises (n=103, 25.5%), pessary use (n=32, 8%), physical therapy (n=12, 3%), planned surgery (n=75, 18.5%), and no specific treatment (n=182, 45%). Overall, the study revealed diverse findings on the potential perceived impact of hysterectomy on different aspects of well-being. Notably, for pain symptoms, 152 participants (38%) reported potential improvement, while 123 participants (30%) predicted worsening, and 129 participants (32%) anticipated no change. Moreover, the study unveiled insights into the factors influencing patients' decision-making between hysterectomy and uterine-sparing procedures. Remarkably, 97 respondents (24%) considered the doctor's opinion to be "very Important," while 91 respondents (22%) rated the impact on surgical complication risk as "very important." Furthermore, the desire to preserve all healthy organs was deemed "very important" by 106 respondents (26%). The resources of information women depended on when making a decision to undergo hysterectomy varied and included a second opinion from another physician (n=68, 17%), social media (n=81, 20%), opinion from spouse/partner (21%), second opinion from female family members (n=99, 25%), and opinion from friends (n=70, 17%). Regarding preferences for decision-making, the responses varied substantially. Overall, 65 participants (16%) indicated a preference for their doctor to make the decision entirely, 81 participants (20%) preferred shared decision-making with their doctor, 89 participants (22%) wanted their doctor to make the decision after considering their input, 77 participants (19%) wished to make the final decision after discussing it with their doctor, and 93 participants (23%) expressed a preference for independently making the final decision. Lastly, correlations between women's responses and some demographic factors were identified. CONCLUSION This pioneering study provides valuable insights into Saudi Arabian women's attitudes toward hysterectomy, emphasizing the need for patient-centered care and culturally sensitive approaches in managing uterovaginal prolapse.
Collapse
Affiliation(s)
- Maha Al Baalharith
- Department of Obstetrics and Gynecology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, SAU
| | - Saeed AlSary
- Department of Obstetrics and Gynecology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, SAU
| | - Elham Bamanie
- Department of Obstetrics and Gynecology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, SAU
| | - Sameerah Al Mowallad
- Department of Obstetrics and Gynecology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, SAU
| | - Joud S Makki
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Sarah K Basudan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Shaden A Alotaibi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Malak E Alabdulkareem
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | | |
Collapse
|
4
|
The hysterectomy: influence of the surgical method in benign disease on convalescence and quality of life. Arch Gynecol Obstet 2023; 307:797-806. [PMID: 36301347 PMCID: PMC9984345 DOI: 10.1007/s00404-022-06778-9] [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: 06/28/2022] [Accepted: 08/28/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE The aim of this study was to evaluate the postoperative course after different methods of hysterectomy for benign diseases with special emphasis on time to recovery and patient-centred aspects such as postoperative quality of life and satisfaction. METHODS A collective of 242 women who had undergone vaginal hysterectomy (VH), laparoscopic supracervical hysterectomy (LASH) or total laparoscopic hysterectomy (TLH) for various benign conditions was studied in this retrospective investigation. Patients completed a standardised questionnaire addressing quality of life, recovery and sick leave as well as general questions on their postoperative course after hysterectomy. RESULTS A total of 242 cases were analysed (82 VH, 92 LASH and 68 TLH). The data demonstrate significant differences in regard to age between groups. The present study shows shorter hospitalisation with laparoscopy, with LASH patients returning to work at least one week earlier on average. There were no relevant differences in the overall postoperative course during the index hospital stay. In the long run, laparoscopic patients were not more satisfied with their choice than VH patients. CONCLUSION No significant long-term differences could be observed in terms of quality of life and overall postoperative satisfaction between VH and LH groups. In regard to socioeconomic aspects, laparoscopic approaches were associated with shorter hospitalisation and LASH patients returning to work at least one week earlier on average. Contrary to these data on objective recovery; however, a laparoscopic approach did not lead to patient-perceived, i.e. subjective improvement of time to full recovery.
Collapse
|
5
|
Chrysostomou A, Djokovic D, Libhaber E, Edridge W, Kawonga M, van Herendael BJ. A randomized control trial comparing vaginal and laparoscopically-assisted vaginal hysterectomy in the absence of uterine prolapse in a South African tertiary institution. Eur J Obstet Gynecol Reprod Biol 2021; 267:73-78. [PMID: 34731640 DOI: 10.1016/j.ejogrb.2021.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/14/2021] [Accepted: 10/17/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The primary objectives of this study were to estimate blood loss, operation time and cost differences in patients undergoing vaginal hysterectomy (VH) versus laparoscopically-assisted vaginal hysterectomy (LAVH). The secondary objectives were to determine differences in hospital stay, need for postoperative analgesia, intra- and immediate post-operative complications, and the rate of conversion to laparotomy. VH was hypothesized to be the preferred route for hysterectomy for benign uterine conditions. STUDY DESIGN A randomized control study was undertaken at the Department of Obstetrics and Gynaecology of the Charlotte Maxeke Johannesburg Academic Hospital and included the women admitted between January 2017 and December 2019 for hysterectomy due to benign conditions, meeting the inclusion criteria (vaginally accessible uterus, estimated uterine size ≤ 12 weeks of gestation or ≤ 280 g on ultrasound examination and pathology confined to the uterus). Surgical procedures were performed by the residents in training under the supervision of specialists with large experience. The patient demographic characteristics, uterine weight, operative time, estimated blood loss(expressed as the difference between preoperative and postoperative day one serum haemoglobin),direct surgery-associated costs, intra- and immediate post-operative complications and the length of hospital stay were recorded and comparatively analysed among patients randomly placed in VH and LAVH group. RESULTS A total of 227 women were included (151 patients underwent VH and 76 LAVH, upon 2:1 randomization, performed on this way to reflect the previous pattern of operating of the unit). The patients were matched with respect to age, parity and body mass index. No significant differences between two groups were found in mean uterine weight and also in mean serum haemoglobin shift, intra- and immediate post-operative complications, and convalescence period duration. There were statistically significant differences in operating time and in cost between the two procedures. On average, LAVH took longer than VH to be performed (62.8 ± 9.3 vs 29.9 ± 6.6 min, p < 0.0001) and it was more costly, mainly due to the longer operating time and required disposables. An amount of 15698.20 South African Rand (ZAR) or 1145.85 United States Dollar (USD) more were needed to perform LAVH in comparison to VH. All VHs and LAVHs were successfully accomplished without major complications or conversation to laparotomy. CONCLUSION Our data indicate that VH is a feasible and safe alternative for a large group of women with benign pathology and non-prolapsed uteri, being a faster and less costly procedure than LAVH.
Collapse
Affiliation(s)
- Andreas Chrysostomou
- Department of Obstetrics, Gynaecology, University of the Witwatersrand, Johannesburg, South Africa
| | - Dusan Djokovic
- Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisbon, Portugal; Department of Obstetrics and Gynecology, NOVA Medical School, Faculdade de CiênciasMédicas, NOVA University of Lisbon, Lisbon, Portugal; Department of Obstetrics and Gynecology, Hospital CUF Descobertas, Lisbon, Portugal.
| | - Elena Libhaber
- School of Clinical Medicine and Health Sciences Research Office, University of the Witwatersrand, Johannesburg, South Africa
| | - William Edridge
- Department of Obstetrics and Gynaecology, CHBH, Johannesburg, South Africa
| | - Mary Kawonga
- Department of Community Health, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Bruno J van Herendael
- Stuivenberg General Hospital, ZiekenhuisNetwerkAntwerpen (ZNA), Antwerp, Belgium; UniversitàdegliStudidell'Insubria, Varese, Italy
| |
Collapse
|
6
|
Chrysostomou A, Djokovic D, Libhaber E, Edridge W, van Herendael BJ. Formal institutional guidelines promotes the vaginal approach to hysterectomy in patients with benign disease and non-prolapsed uterus. Eur J Obstet Gynecol Reprod Biol 2021; 259:133-139. [PMID: 33662755 DOI: 10.1016/j.ejogrb.2021.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/17/2021] [Accepted: 02/20/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study was undertaken at the Department of Obstetrics and Gynaecology of the Charlotte Maxeke Johannesburg Academic Hospital to determine if the use of formal guidelines and a standardised surgical technique would increase the rate of vaginal hysterectomy (VH) and result in an overall decline in open abdominal hysterectomy (AH). STUDY DESIGN All women admitted between July 2001 and December 2014 for hysterectomy due to benign conditions, meeting the guidelines criteria (vaginally accessible uterus, uterus ≤ 12 weeks size or ≤ 280 g on ultrasound examination and pathology confined to the uterus) were included. The surgical route was determined using the Unit surgical decision tree algorithm. In cases where the pathology was not confined to the uterus or success in VH was uncertain, laparoscopic assisted vaginal hysterectomy (LAVH) was performed. The VH procedures were performed by the residents in training, under the supervision of specialists with large experience in vaginal surgery. In addition to the patient characteristics and surgical approach to hysterectomy, length of hospital stay, intra-operative and immediate post-operative complications were also recorded and analysed. RESULTS A year before the initiation of the study, the percentage of all VHs undertaken in the Department was 9.8 % (mainly performed for utero-vaginal prolapse). During the study period, 1143 vaginal procedures (1017 VHs and 126 LAVHs) were performed. The most common indications were cervical dysplasia, uterine fibroids, dysmenorrhoea or abnormal uterine bleeding, adenomyosis, endometrial hyperplasia and chronic pelvic pain. Introducing a formal clinical decision tree algorithm and a standardised surgical technique resulted in an increase in the rate of VH to 48.4 % and overall decline in open AH from 91.2%-51.6%. Thus, the VH/AH ratio increased from 1/9 at the beginning of the study (July 2001) to 1/1 by its end (December 2014). In all cases, VH was performed without the need to convert the vaginal to the abdominal route. CONCLUSION The use of institutional guidelines for determining the hysterectomy route and a standardised VH technique resulted in an increased number of performed VHs. This provided an essential opportunity for residents to acquire, improve and maintain the skills required to safely perform VH.
Collapse
Affiliation(s)
- Andreas Chrysostomou
- Department of Obstetrics and Gynaecology, University of the Witwatersrand, Johannesburg, South Africa
| | - Dusan Djokovic
- Department of Obstetrics and Gynaecology, Nova Medical School - Faculdade De Ciências Médicas, Nova University of Lisbon, Lisbon, Portugal; Maternidade Dr. Alfredo Da Costa, Centro Hospitalar Universitário De Lisboa Central, Lisbon, Portugal.
| | - Elena Libhaber
- School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - William Edridge
- Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | - Bruno J van Herendael
- Stuivenberg General Hospital, Ziekenhuis Netwerk Antwerpen (ZNA), Antwerp, Belgium; Università Degli Studi Dell'Insubria, Varese, Italy
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Sirota I, Tomita SA, Dabney L, Weinberg A, Chuang L. Overcoming barriers to vaginal hysterectomy: An analysis of perioperative outcomes. J Turk Ger Gynecol Assoc 2019; 20:8-14. [PMID: 30209028 PMCID: PMC6501867 DOI: 10.4274/jtgga.galenos.2018.2018.0021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective To determine perioperative outcome differences in patients undergoing vaginal hysterectomy based on uterine weight, vaginal delivery, and menopausal state. Material and Methods Retrospective chart review of 452 patients who underwent vaginal hysterectomy performed by a single surgeon. Patients’ age, vaginal delivery, uterine weight, previous pelvic surgery, previous cesarean delivery, removal of ovaries were compared, as well as estimated blood loss (EBL), operating room time (ORT), length of stay, intraoperative complications and postoperative complications. Multivariable logistic regression was used, and all data were analyzed at the level of p<0.05 statistical significance using SAS system software (SAS Institute Inc., Cary, NC), version 9.3. Results The mean age was 57.13±11.52 years and the median vaginal delivery was 2. The uterine weight range was 16.6-1174.5 g (mean 169.79±183.94 g). The incidences of blood transfusion and bladder injury were 3.03% and 0.66%, respectively. Factors shown to be associated with longer ORT included greater uterine weight, removal of ovaries, posterior repair, tension-free vaginal tape sling, prolapse, and EBL >500 mL (p<0.001). The factors associated with EBL >500 mL were greater uterine weight (p=0.001), uterine myomas (p=0.016) and premenopausal state (p=0.014). The factors associated with conversion to laparotomy were greater uterine weight (p<0.001) and premenopausal state (p<0.001). Conclusion Vaginal hysterectomy is a safe and feasible approach for patients desiring hysterectomy regardless of uterine weight and vaginal delivery.
Collapse
Affiliation(s)
- Ido Sirota
- Department of Obstetrics and Gynecology, New York-Presbyterian Queens Weill Cornell Medicine, New York, USA
| | - Shannon A Tomita
- Department of Obstetrics, Gynecology and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, USA,Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Lisa Dabney
- Department of Obstetrics, Gynecology and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Alan Weinberg
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Linus Chuang
- Department of Obstetrics and Gynecology, Danbury Hospital – Western Connecticut Health Network, Connecticut, USA
| |
Collapse
|
9
|
Chrysostomou A, Djokovic D, Edridge W, van Herendael BJ. Evidence-based guidelines for vaginal hysterectomy of the International Society for Gynecologic Endoscopy (ISGE). Eur J Obstet Gynecol Reprod Biol 2018; 231:262-267. [DOI: 10.1016/j.ejogrb.2018.10.058] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 10/29/2018] [Accepted: 10/30/2018] [Indexed: 12/24/2022]
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
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]
|
12
|
Avoiding complications by a hands-on mentor programme. Best Pract Res Clin Obstet Gynaecol 2016; 35:3-12. [DOI: 10.1016/j.bpobgyn.2015.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/05/2015] [Indexed: 11/19/2022]
|
13
|
Andryjowicz E, Wray TB, Reinaldo Ruiz V, Rudolf J, Noroozkhani S, Crowder S, Slezak JM. Safely Increase the Minimally Invasive Hysterectomy Rate: A Novel Three-Tiered Preoperative Categorization System Can Predict the Difficulty for Benign Disease. Perm J 2015. [PMID: 26222092 DOI: 10.7812/tpp/15-023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CONTEXT A nonlaparotomic route is recommended for hysterectomy for benign indications. OBJECTIVE 1) Predict the difficulty of hysterectomy to treat benign disease as measured by operative time and risk of laparotomy, 2) confirm the safety and quality of increasing our minimally invasive hysterectomy (MIH) rate, and 3) determine whether the assistant's experience affected the likelihood of an MIH being performed in equally difficult hysterectomies. DESIGN All hysterectomies for benign disease performed at the Kaiser Permanente Fontana Medical Center in Fontana, CA, in 2012 were reviewed for length of surgery, length of stay, complications, and readmissions. A three-tiered category system was developed from four preoperative parameters (body mass index, number of vaginal deliveries, clinical uterine size, and history of major abdominal surgery) to anticipate length and difficulty of surgery. MAIN OUTCOME MEASURES Rates of MIH, complications, and readmissions as well as length of surgery and length of stay for similarly difficult hysterectomies. These outcomes were compared with surgeons' and assistants' experience. RESULTS Of 576 hysterectomies performed for benign disease, 89% were MIH with a 3% complication rate and 4% readmission rate. An increase in the hysterectomy category was statistically significantly associated with longer surgery times and a higher percentage of laparotomy. With the most experienced assistants, the MIH rate was 98%. CONCLUSIONS Using 4 preoperative parameters, the average operating time for hysterectomy for benign disease can be predicted. A higher hysterectomy category predicts a more difficult surgery. Our center has increased its MIH rate to 89% while maintaining safety.
Collapse
Affiliation(s)
| | - Teresa B Wray
- Former Regional Chief of Obstetrics and Gynecology for the Southern California Permanente Medical Group at the Fontana Medical Center in CA and the present Chief of Obstetrics and Gynecology at the Fontana Medical Center in CA.
| | - V Reinaldo Ruiz
- Obstetrician/Gynecologist at the Fontana Medical Center in CA.
| | - James Rudolf
- Obstetrician/Gynecologist at the Fontana Medical Center in CA.
| | | | - Sandra Crowder
- Obstetrician/Gynecologist at the Fontana Medical Center in CA.
| | - Jeff M Slezak
- Research Manager of Biostatistics for the Southern California Permanente Medical Group in Pasadena.
| |
Collapse
|
14
|
Ray A, Pant L, Magon N. Deciding the route for hysterectomy: Indian triage system. J Obstet Gynaecol India 2015; 65:39-44. [PMID: 25737621 DOI: 10.1007/s13224-014-0578-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 05/20/2014] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To review the limitations, major complications, and conversion rates associated with non-descent vaginal hysterectomy (NDVH); and develop a scoring system to predict the possibility of successful NDVH. METHODS The risk analysis of conversion rates from vaginal to abdominal route while attempting NDVH was applied to formulate a scoring system for the assessment of successful NDVH. Parameters were selected based on Kovacs guidelines to determine the route of hysterectomy. RESULTS From April 2005 to December 2008, NDVH was attempted in 364/1,378 women undergoing hysterectomy for benign conditions (Gp-I). Eight out of 364 cases (2.1 %) either had to be converted to the abdominal route or had major complication. Endometriosis and repeated sections had the highest risk. Scoring system was developed based on the risk analysis. Validity of this scoring system was tested in 1,177 women from January 2009 to September 2012 (Gp-II). 460 women with a score of 16 or less underwent NDVH successfully with a conversion rate of 0.2 %. CONCLUSION Careful assessment by a simple scoring system can help in deciding the feasibility of performing NDVH.
Collapse
Affiliation(s)
- Alokananda Ray
- Department of OBGYN, Tata Main Hospital, Jamshedpur, India ; 8D Road East Northern Town, Bistupur, Jamshedpur, 831001 Jharkhand India
| | - Luna Pant
- Department of OBGYN, Max Hospital, Dehradun, India
| | - Navneet Magon
- Department of OBGYN, Air Force Hospital, Jorhat, India
| |
Collapse
|
15
|
Dinesen JGR, Hessellund B, Petersen LK. Discharge less than 6 hours after robot-assisted total laparoscopic hysterectomy—is it feasible? ACTA ACUST UNITED AC 2014. [DOI: 10.1007/s10397-014-0874-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
16
|
Tian Y, Wu SD, Chen YH, Wang DB. Transvaginal laparoscopic appendectomy simultaneously with vaginal hysterectomy: initial experience of 10 cases. Med Sci Monit 2014; 20:1897-901. [PMID: 25300522 PMCID: PMC4206396 DOI: 10.12659/msm.890895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Natural orifice transluminal endoscopic surgery (NOTES) involves the introduction of instruments through a natural orifice into the peritoneal cavity to perform surgical interventions. The vagina is the most widely used approach to NOTES. We report the utilization of the vaginal opening at the time of vaginal hysterectomy as a natural orifice for laparoscopic appendectomy. Material/Methods We reviewed cases of 10 patients with chronic appendicitis who underwent transvaginal laparoscopic appendectomy simultaneously with vaginal hysterectomy. A laparoscopic approach was established after removal of the uterus, and the appendix was removed transvaginally. Among the 10 cases, 5 were conducted under gasless laparoscopy by using a simple abdominal wall-lifting instrument. Results All procedures were performed successfully without intraoperative or major postoperative complications. The appendectomy portion of the procedure took approximately 21 minutes to 34 minutes. All patients were discharged less than 4 days after surgery, without external scars. Conclusions Transvaginal appendectomy with rigid laparoscopic instruments following vaginal hysterectomy appears to be a feasible and safe modification of established techniques, with acceptable outcomes.
Collapse
Affiliation(s)
- Yu Tian
- Department of General Surgery, Shengjing Hospital, China Medical University, Shenyang, China (mainland)
| | - Shuo-Dong Wu
- Department of General Surgery, Shengjing Hospital, China Medical University, Shenyang, China (mainland)
| | - Ying-Han Chen
- Department of Gynecology, Shengjing Hospital, China Medical University, Shenyang, China (mainland)
| | - Dan-Bo Wang
- Department of Gynecology, Shengjing Hospital, China Medical University, Shenyang, China (mainland)
| |
Collapse
|
17
|
Laberge PY, Singh SS. Surgical approach to hysterectomy: introducing the concept of technicity. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 31:1050-1053. [PMID: 20175344 DOI: 10.1016/s1701-2163(16)34350-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Despite national guidelines recommending that most hysterectomies should be performed vaginally or with laparoscopic assistance, the majority are still performed by laparotomy. Advocating for minimally invasive hysterectomy requires a strategy outlining the benefits and risks of the various approaches. We propose the use of "technicity," an index that has been used in France to compare the performance of hospitals across the country. Technicity is defined by the number of hysterectomies performed vaginally and laparoscopically divided by the total number of hysterectomies performed annually in a single department. We have developed a scoring system to demonstrate the advantages of less invasive surgical approaches, thereby supporting the concept of technicity and its relevance to practice. Using technicity, gynaecologists throughout Canada can monitor their shift towards minimally invasive procedures for hysterectomy, for the benefit of patients and society.
Collapse
Affiliation(s)
- Philippe Y Laberge
- Department of Obstetrics and Gynaecology, Centre Hospitalier de l'Université Laval, Quebec City QC
| | - Sukhbir S Singh
- Society of Minimally Invasive Gynaecology, Department of Obstetrics and Gynaecology, University of Ottawa/The Ottawa Hospital, Ottawa ON
| |
Collapse
|
18
|
Chen I, Lisonkova S, Allaire C, Williams C, Yong P, Joseph K. Routes of hysterectomy in women with benign uterine disease in the Vancouver Coastal Health and Providence Health Care regions: a retrospective cohort analysis. CMAJ Open 2014; 2:E273-80. [PMID: 25485254 PMCID: PMC4251519 DOI: 10.9778/cmajo.20130080] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Minimally invasive hysterectomies performed vaginally or laparoscopically are associated with decreased perioperative morbidity. We examined temporal trends and patient and hospital factors associated with the routes of hysterectomy used in the Vancouver Coastal Health and Providence Health Care regions in British Columbia. METHODS We performed a retrospective cohort study of all women who had an elective hysterectomy for a benign indication between 2007 and 2011 in 8 hospitals in the region. Logistic regression modeling with mixed effects was used to estimate adjusted odds ratios and 95% confidence intervals for patient and hospital characteristics associated with the route of hysterectomy. RESULTS The study involved 4372 women who underwent abdominal (52.3%), vaginal (25.5%) or laparoscopic (22.3%) hysterectomy. From 2007 to 2011, the number of abdominal hysterectomies performed decreased from 58.4% to 47.7%, the number of vaginal hysterectomies performed decreased from 27.5% to 21.1% and the number of laparoscopic hysterectomies performed increased from 14.2% to 31.2% (p < 0.001 for all trends). Patient factors associated with laparoscopic versus abdominal hysterectomy included young age, pain or prolapse indication, absence of fibroid indication, absence of concurrent gynecologic procedure, rural residence and lower socioeconomic status. Patient factors associated with vaginal hysterectomy included older age, prolapse indication and concurrent procedure for prolapse. Hospital location and size were not significantly associated with vaginal hysterectomy, but urban hospital location was associated with laparoscopic hysterectomy. INTERPRETATION The proportion of minimally invasive hysterectomies is increasing and represents approximately half of all hysterectomies performed in the Vancouver Coastal Health and Providence Health Care regions. Vaginal hysterectomies are associated with patient characteristics, whereas laparoscopic hysterectomies are associated with patient and hospital characteristics.
Collapse
Affiliation(s)
- Innie Chen
- Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, Ont
- School of Population and Public Health, University of British Columbia, Vancouver, B.C
| | - Sarka Lisonkova
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, B.C
| | - Catherine Allaire
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, B.C
| | - Christina Williams
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, B.C
| | - Paul Yong
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, B.C
| | - K.S. Joseph
- School of Population and Public Health, University of British Columbia, Vancouver, B.C
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, B.C
| |
Collapse
|
19
|
[Development of technicality indices of hysterectomies in Quebec]. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 35:144-148. [PMID: 23470064 DOI: 10.1016/s1701-2163(15)31019-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Assess the evolution of the technicity index for hysterectomies in Québec. METHODS We used the ADAM ( Analyse en direct des actes médicaux) database to determine the number of hysterectomies done each year within 79 hospitals in Québec from 2002 to 2009. Excluding oncologically indicated surgeries, we calculated the number of hysteretomies and the proportion performed by the vaginal route (laparoscopically assisted or not), by laparoscopu, and by laparotomy for each study year. RESULTS We obtained complete data fo 67 (85%) of 79 hospitals, for a total of 74 210 (94%) of 79 305 hysterectomies done. We observed a decline in the total number of hysterestomies from 12 860 in 2002-2003 to 8010 in 2008-2009 (P<0.001) Furthermore, the proportion of hysterectomies done by laparoscopy increased, the proportion of vaginal hysterectomies remained stable, and the proportion of hysterectomies done by laparoscopy increased. For all of Québec, the technicity index increased from 39.9% in 2002-2003 to 44.3% in 2008-2009 (P<0.001). CONCLUSION The number of hysterectomies is declining and the technicity index is increasing in Quebec. We believe that this can be attributed to an increased use of medical alternatives and the presence of gynaecologists better trained in advanced laparoscopic surgery.
Collapse
|
20
|
Yuan L, Zhou H, Zhang H, Tang H, Chen M, Liu X, Xu C, Yao L. Constructing predictive models for vaginal surgery in patients with noninvasive gynecological conditions. Acta Obstet Gynecol Scand 2014; 93:935-40. [PMID: 24946854 DOI: 10.1111/aogs.12443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 06/08/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To develop predictive models for vaginal operative route selection based on clinical variables that can be easily assessed preoperatively in patients with noninvasive gynecological conditions. DESIGN Retrospective study. SETTING University Hospital. POPULATION Women with routine gynecological surgeries via different approaches. METHODS The medical records of 315 women without prolapse and undergoing hysterectomy, adnexal cystectomy or myomectomy were reviewed. Multiple logistic regression analysis was used to identify factors associated with the vaginal approach for each procedure. Predictive models were generated and optimal cut-off points were identified using the receiver operating characteristic curve. MAIN OUTCOME MEASURES Predictive models for different vaginal surgical procedures. RESULTS For hysterectomy, the patient's body mass index, dysmenorrheal complaints and uterine size were identified as negative predictors for vaginal hysterectomy, whereas previous vaginal delivery was positive. For adnexal cystectomy, adnexal pathology was a negative predictor, whereas previous vaginal delivery and ovarian cyst size were positive. For myomectomy, the body mass index and number of fibroids were negative predictors while previous vaginal delivery was positive. All three models were able to predict the vaginal procedures undergone by women and the areas under the curve were 0.88, 0.95 and 0.92, respectively. Each optimal model cut-off value (logit(p) = 0.53, 0.36, 0.73) resulted in good sensitivity (92.3%, 100% and 87.5%, respectively) and specificity (77.8%, 88.6% and 90.9%, respectively). CONCLUSION These predictive models, which used clinical variables that can be easily assessed preoperatively, may help surgeons to select candidates for different vaginal procedures.
Collapse
Affiliation(s)
- Lei Yuan
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Predicting the success of vaginal surgery: a quantitative risk assessment model for future investigation. Eur J Obstet Gynecol Reprod Biol 2013; 171:343-7. [PMID: 24139132 DOI: 10.1016/j.ejogrb.2013.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 08/17/2013] [Accepted: 09/17/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To introduce a model incorporating expected risks for a vaginal procedure based on objective measurements of a patient's characteristics and propose it as a potential tool to assist in the selection of candidates for vaginal surgery. STUDY DESIGN A quantitative model consisting of 13 clinical variables identified as risk factors in a prospective vaginal procedure was developed. Medical records of 315 women undergoing a set of routine gynecological surgeries via the vaginal, laparoscopic, and abdominal routes were obtained during January 2010 and November 2011. These surgeries included hysterectomy, myomectomy, bilateral or unilateral salpingo-oophorectomy and adnexal cystectomy. After that, each patient was scored according to the model. Sensitivity and specificity of the model were analyzed in one data set (cohort I) by receiver operating characteristic (ROC) curve and independently validated in a second data set (cohort II). RESULTS 175 patients were included in cohort I while the other 140 patients formed cohort II. The intra- and post-operative complication rates were 0.6% and 0%, respectively. A vaginal procedure was predicted with good accuracy (AUC=0.852). The sensitivity was 86.0% and specificity was 72.0% at an optimal cut-off point of score=3. The predication accuracy of this model was further validated in cohort II and reached as high as 85.7%. Furthermore, the score was significantly associated with the volume of estimated blood loss and the duration of operation time (P<0.05). CONCLUSION Our quantitative risk assessment model predicts safe vaginal surgery with good accuracy. Predictive tools based on such a model could help surgeons to optimize patient selection and thus contribute to reducing costs while enhancing patients' satisfaction. We invite other researchers to modify and validate the model in other populations.
Collapse
|
22
|
Smorgick N, Patzkowsky KE, Hoffman MR, Advincula AP, Song AH, As-Sanie S. The increasing use of robot-assisted approach for hysterectomy results in decreasing rates of abdominal hysterectomy and traditional laparoscopic hysterectomy. Arch Gynecol Obstet 2013; 289:101-5. [PMID: 23839534 DOI: 10.1007/s00404-013-2948-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Accepted: 07/01/2013] [Indexed: 02/06/2023]
Abstract
PURPOSE To compare the frequency of minimally invasive surgical approach to hysterectomy between two time periods, during which the use of the robotic technique has rapidly increased. METHODS This study is a retrospective review of 623 consecutive patients who underwent hysterectomy for benign indications at the Division of Minimally Invasive Gynecologic Surgery via laparoscopic, robotic, laparotomy, mini-laparotomy and vaginal approaches from July 2004 to June 2010. "Early period" refers to the first 311 patients, and "late period" refers to the remaining 312 patients. RESULTS The characteristics of patients from the early and late periods were comparable in terms of age, BMI and uterine weight. The rates of hysterectomy by laparotomy, traditional laparoscopy, robotic, vaginal, and mini-laparotomy were significantly different between the early and late periods (17.7 to 5.4%, 39.5 to 17.6%, 23.8 to 64.1%, 5.8 to 4.8% and 13.2 to 8%, respectively, P < 0.01), with the overall rates of hysterectomies completed via a minimally invasive approach increasing from 82.3 to 94.6%, respectively (P < 0.01). There were no differences in surgical complications between the two periods. CONCLUSION Increased utilization of a robotic approach to hysterectomy correlates with decreasing rates of abdominal hysterectomy concurrent with decreasing rates of traditional laparoscopic hysterectomy. This shift in surgical approach to hysterectomy, while beneficial in increasing the rates of minimally invasive approach to hysterectomy, may have significant economic implications due to the higher cost of robotic surgery.
Collapse
Affiliation(s)
- Noam Smorgick
- Department of Obstetrics and Gynecology, The University of Michigan Health System, L4100 Women's Hospital, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA,
| | | | | | | | | | | |
Collapse
|
23
|
Ekong E, Singh SS. Minimally invasive hysterectomy: ten years later, why are we still falling short? JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2013; 35:107-108. [PMID: 23470058 DOI: 10.1016/s1701-2163(15)31012-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Enobong Ekong
- Department of Obstetrics & Gynecology, Grey Bruce Health Services, Owen Sound ON
| | - Sukhbir S Singh
- Department of Obstetrics & Gynecology, The Ottawa Hospital, University of Ottawa, Ottawa ON
| |
Collapse
|
24
|
Hystérectomie à effraction minimale : Dix ans plus tard, pourquoi ne sommes-nous pas encore parvenus à notre objectif? JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2013. [DOI: 10.1016/s1701-2163(15)31013-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
25
|
Chen I, Bajzak KI, Guo Y, Singh SS. A national survey of endoscopic practice among gynaecologists in Canada. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2012; 34:257-263. [PMID: 22385669 DOI: 10.1016/s1701-2163(16)35186-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the current status of endoscopic gynaecological surgery in Canada, as well as the attitudes, perceptions, and educational preferences regarding endoscopy among Canadian obstetrician-gynaecologists. METHODS An electronic online survey was sent to 630 obstetrician-gynaecologists in Canada through the Society of Obstetricians and Gynaecologists of Canada electronic mailing list. Survey respondents were asked about demographic variables, level of training and current practice of endoscopic procedures, reasons for and barriers to performing endoscopy, and interest in continuing surgical education in laparoscopy and hysteroscopy. RESULTS A total of 178 responses (28.3%) were collected and 152 (85.4%) analyzed. The majority of respondents were general obstetrician-gynaecologists (78.0%). More gynaecologic surgeons performed abdominal (92.7%) and vaginal hysterectomies (89.7%) than laparoscopic (68.4%) and robotic hysterectomies (2.2%). Even though 93.2% of respondents selected the endoscopic approach as the preferred approach to surgery for their patients, 38.7% of respondents did not feel that they had adequate training during residency to perform endoscopy. Lack of operating room resources and lack of time and opportunity for further training were frequently selected as major barriers to performing endoscopy. Participants identified weekend continuing medical education courses and trained endoscopic surgeon outreach as preferred methods of acquiring endoscopic skills. CONCLUSION This survey provides a contemporary assessment of the current endoscopic practice patterns of Canadian obstetrician-gynaecologists, and it helps to identify some potentially modifiable factors hindering the practice of endoscopy and some possible solutions to overcoming these barriers.
Collapse
Affiliation(s)
- Innie Chen
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton AB
| | - Krisztina I Bajzak
- Discipline of Obstetrics and Gynecology, Memorial University, St John's NL
| | - Yanfang Guo
- Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa ON
| | - Sukhbir S Singh
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa ON
| |
Collapse
|
26
|
À la recherche du temps perdu. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2010. [DOI: 10.1016/s1701-2163(16)34520-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
27
|
Rowe T. Out of Time. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2010. [DOI: 10.1016/s1701-2163(16)34519-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
28
|
Abstract
Removal of the fallopian tubes and ovaries at the time of vaginal hysterectomy is a skill that must be acquired if one is to be a competent vaginal surgeon. Various techniques have been described and will be reviewed in this chapter. A single technique or series of steps often must be modified depending on the descent of the adnexa, size and shape of the pelvis, and intraperitoneal pathology. The pelvic surgeon must adhere to the basic surgical principles and understand the anatomic relationships of the adnexa to other pelvic viscera, including the lower urinary tract. Preoperative discussion with all patients regardless of age is imperative in determining their desires for oophorectomy at the time of vaginal hysterectomy.
Collapse
|
29
|
Tebeu PM, Fomulu JN, Nana Njotang P, Petignat P, Tcheliebou JM, Kouam L, Doh AS. Effectiveness of vaginal hysterectomy for benign conditions in semi-urban hospital: report from Maroua-Cameroon. Trop Doct 2009; 39:200-5. [DOI: 10.1258/td.2009.080327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We assessed the effectiveness of vaginal hysterectomy for benign uterine conditions in Northern Cameroon. This is a case series study of 29 elective vaginal hysterectomies carried out between February 2005 and June 2007 in Maroua, Cameroon. Hysterocele was found as the only or associated indication in 17 (58.6%) patients, symptomatic uterine fibroids in 4 (13.8%) and other indications in 8 (27.6%) patients. The mean duration of the operation was 132 minutes and the mean blood loss at surgery was 150 ml. Twenty-five of the 28 (89.3%) women had less than seven days of hospitalisation. There was a negative correlation (r = −0.45, P = 0.015) between duration of the surgery and the order of operation. One urinary tract and one wound infection were observed. Two patients had conversion to laparotomy. This study has shown that vaginal hysterectomy is a safe and feasible method of hysterectomy in a semi-urban hospital.
Collapse
Affiliation(s)
- P M Tebeu
- Ligue d'Initiative et de Recherche Active pour la Santé et l'Education de la Femme (LIRASEF), Yaoundé
- Department of Obstetrics and Gynecology, Provincial Hospital, Maroua
| | - J N Fomulu
- Department of Obstetrics and Gynecology, University Hospitals, Yaoundé, Cameroon
| | - P Nana Njotang
- Department of Obstetrics and Gynecology, University Hospitals, Yaoundé, Cameroon
| | - P Petignat
- Department of Obstetrics and Gynecology, University Hospitals, Geneva, Switzerland
| | - J M Tcheliebou
- Department of Radiology, Provincial Hospital, Maroua, Cameroon
| | - L Kouam
- Department of Obstetrics and Gynecology, University Hospitals, Yaoundé, Cameroon
| | - A S Doh
- Department of Obstetrics and Gynecology, University Hospitals, Yaoundé, Cameroon
| |
Collapse
|
30
|
Horgan S, Cullen JP, Talamini MA, Mintz Y, Ferreres A, Jacobsen GR, Sandler B, Bosia J, Savides T, Easter DW, Savu MK, Ramamoorthy SL, Whitcomb E, Agarwal S, Lukacz E, Dominguez G, Ferraina P. Natural orifice surgery: initial clinical experience. Surg Endosc 2009; 23:1512-8. [PMID: 19343435 PMCID: PMC2695868 DOI: 10.1007/s00464-009-0428-0] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 01/14/2009] [Accepted: 02/11/2009] [Indexed: 12/11/2022]
Abstract
BACKGROUND Natural orifice translumenal endoscopic surgery (NOTES) has moved quickly from preclinical investigation to clinical implementation. However, several major technical problems limit clinical NOTES including safe access, retraction and dissection of the gallbladder, and clipping of key structures. This study aimed to identify challenges and develop solutions for NOTES during the initial clinical experience. METHODS Under an Institutional Review Board (IRB)-approved protocol, patients consented to a natural orifice operation for removal of either the gallbladder or the appendix via either the vagina or the stomach using a single umbilical trocar for safety and assistance. RESULTS Nine transvaginal cholecystectomies, one transgastric appendectomy, and one transvaginal appendectomy have been completed to date. All but one patient were discharged on postoperative day 1 as per protocol. No complications occurred. CONCLUSION The limited initial evidence from this study demonstrates that NOTES is feasible and safe. The addition of an umbilical trocar is a bridge allowing safe performance of NOTES procedures until better instruments become available. The addition of a flexible long grasper through the vagina and a flexible operating platform through the stomach has enabled the performance of NOTES in a safe and easily reproducible manner. The use of a uterine manipulator has facilitated visualization of the cul de sac in women with a uterus to allow for safe transvaginal access.
Collapse
Affiliation(s)
- Santiago Horgan
- Department of Surgery, University of California San Diego, 200 W. Arbor Drive, 8402, San Diego, CA 92103 USA
| | - John P. Cullen
- Department of Surgery, University of California San Diego, 200 W. Arbor Drive, 8402, San Diego, CA 92103 USA
| | - Mark A. Talamini
- Department of Surgery, University of California San Diego, 200 W. Arbor Drive, 8402, San Diego, CA 92103 USA
| | - Yoav Mintz
- Department of Surgery, University of California San Diego, 200 W. Arbor Drive, 8402, San Diego, CA 92103 USA
| | - Alberto Ferreres
- Department of General Surgery, Buenos Aires Hospital de Clinicas, Buenos Aires, Argentina
| | - Garth R. Jacobsen
- Department of Surgery, University of California San Diego, 200 W. Arbor Drive, 8402, San Diego, CA 92103 USA
| | - Bryan Sandler
- Department of Surgery, University of California San Diego, 200 W. Arbor Drive, 8402, San Diego, CA 92103 USA
| | - Julie Bosia
- Department of Surgery, University of California San Diego, 200 W. Arbor Drive, 8402, San Diego, CA 92103 USA
| | - Thomas Savides
- Department of Gastroenterology, University of California San Diego, San Diego, CA USA
| | - David W. Easter
- Department of Surgery, University of California San Diego, 200 W. Arbor Drive, 8402, San Diego, CA 92103 USA
| | - Michelle K. Savu
- Department of Surgery, University of California San Diego, 200 W. Arbor Drive, 8402, San Diego, CA 92103 USA
| | - Sonia L. Ramamoorthy
- Department of Surgery, University of California San Diego, 200 W. Arbor Drive, 8402, San Diego, CA 92103 USA
| | - Emily Whitcomb
- Department of Reproductive Medicine, University of California San Diego, San Diego, CA USA
| | - Sanjay Agarwal
- Department of Reproductive Medicine, University of California San Diego, San Diego, CA USA
| | - Emily Lukacz
- Department of Reproductive Medicine, University of California San Diego, San Diego, CA USA
| | - Guillermo Dominguez
- Department of General Surgery, Buenos Aires Hospital de Clinicas, Buenos Aires, Argentina
| | - Pedro Ferraina
- Department of General Surgery, Buenos Aires Hospital de Clinicas, Buenos Aires, Argentina
| |
Collapse
|
31
|
Vaginal hysterectomy: dispelling the myths. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2007; 29:786; author reply 786. [PMID: 18050886 DOI: 10.1016/s1701-2163(16)32646-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|