Safety of Three-Dimensional versus Two-Dimensional Laparoscopic Hysterectomy during the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic has resulted in a significant decrease in the number of surgical procedures performed. Therefore, it is important to use surgical methods that carry the lowest possible risk of virus transmission between the patient and the operating theater staff.

AIM

Safety evaluation of three-dimensional (3D) versus two-dimensional (2D) laparoscopic hysterectomy during the COVID-19 pandemic.

METHODS

44 patients were assigned to a prospective case-control study. They were divided either to 3D (n = 22) or 2D laparoscopic hysterectomy (n = 22). Fourteen laparoscopic supracervical hysterectomies (LASH) and eight total laparoscopic hysterectomies (TLH) were performed in every group. The demographic data, operating time, change in patients' hemoglobin level and other surgical outcomes were evaluated.

RESULTS

3D laparoscopy was associated with a significantly shorter operating time than 2D. (3D vs. 2D LASH 70 ± 23 min vs. 90 ± 20 min, p = 0.0086; 3D vs. 2D TLH 72 ± 9 min vs. 85 ± 9 min, p = 0.0089). The 3D and 2D groups were not significantly different in terms of change in serum hemoglobin level and other surgical outcomes.

CONCLUSIONS

Due to a shorter operating time, 3D laparoscopic hysterectomy seems to be a safer method both for both the surgeon and the patient. Regarding terms of possible virus transmission, it may be particularly considered the first-choice method during the COVID-19 pandemic.

Cervical stump necrosis after laparoscopic supracervical hysterectomy: successful management by laparoscopic approach

Persistent bleeding from the remaining cervix after laparoscopic supracervical hysterectomy (LSH) is normally related to the presence of residual functioning endometrial tissue. However, postoperative significant vaginal hemorrhage caused by cervical necrosis following LSH is relatively rare. A 39-year-old nulligravida was admitted to the emergency department with hypovolemic shock after LSH performed in another hospital for treatment of uterine fibroids 18 days previously. Following hemodynamic stabilization and mechanical tamponade of the bleeding uterine cervix, laparoscopic simple trachelectomy was carried out and antibiotics were administered. The patient developed no surgical or clinical complications and was discharged 4 days after surgery. Histologic examination revealed extensive areas of tissue necrosis and no signs of malignancy. Stump necrosis and accompanying bleeding are rare but serious complications of LSH. Infection is an important component of this entity and should be treated. Endoscopic management of this condition appears to be feasible and safe.

Occult uterine malignancy during laparoscopic supracervical hysterectomy

OBJECTIVES

To estimate the incidence of occult uterine malignancies during laparoscopic supracervical hysterectomy (LSH).

MATERIAL AND METHODS

Retrospective cohort study based on archival data (2010-2016) of the Department of Gynecology and Oncology, Jagiellonian University.

RESULTS

Medical records of 696 women, who underwent LSH were analyzed. Two occult sarcomas (2/696; 0.29%, 0.003, 95% CI: 0.001 to 0.01), including one case of low-grade endometrial stromal sarcoma (ESS) with co-occurring atypical endometrial hyperplasia (AH) and one case of high-grade ESS were found postoperatively. One case of invasive primary fallopian tube cancer (1/696; 0.14%, 0.001, 95% CI: 0.00 to 0.008) and additional three cases of AH (3/696; 0.57%, 0.004, 95% CI: 0.001 to 0.013) were also identified. No case of EC was documented. One hundred sixty nine (24.3%) women of 696 had an endometrial sampling prior LSH including these with ESS. We did not observe worsening of the prognosis and all patients with confirmed malignancy are still alive and free from recurrence in 2-5 years of observations.

CONCLUSIONS

Most commonly the occult malignancy would have not been recognized if the surgery had not been conducted. When appropriate diagnostics is conducted, rare incidents of malignant tissue morcellation should not be considered as a professional misconduct but as a possible adverse event. Patients should be informed about the risk of malignancy according to available estimations and that endometrial sampling cannot eliminate such a risk. A consensus regarding safe indications, required diagnostics, and justifiability of mandatory use of contained morcellation for LSH should be developed.

Persistent bleeding after laparoscopic supracervical hysterectomy

Background and Objectives:

In our clinical experience, there seemed to be a correlation between cervical stump bleeding and adenomyosis. Therefore, we wanted to conduct a study to determine whether there was an actual correlation and to identify other risk factors for persistent bleeding after a laparoscopic supracervical hysterectomy.

Methods:

The study included women who underwent laparoscopic supracervical hysterectomy from January 1, 2003, through December 31, 2012. Data were collected on age, postmenopausal status, body mass index (BMI), uterine weight, indication for hysterectomy, concomitant bilateral salpingo-oophorectomy (BSO), presence of endometriosis, surgical ablation of the endocervix, adenomyosis, presence of endocervix in the specimen, and postoperative bleeding.

Results:

The study included 256 patients, of whom 187 had no postoperative bleeding after the operation, 40 had bleeding within 12 weeks, and 29 had bleeding after 12 weeks. The 3 groups were comparable in BMI, postmenopausal status, uterine weight, indication for hysterectomy, BSO, surgical ablation of the endocervix, adenomyosis, and the presence of endocervix. However, patients who had postoperative bleeding at more than 12 weeks were significantly younger (P = .002) and had a higher rate of endometriosis (P < .001).

Conclusions:

Risks factors for postoperative bleeding from the cervical stump include a younger age at the time of hysterectomy and the presence of endometriosis. Therefore, younger patients and those with endometriosis who desire to have no further vaginal bleeding may benefit from total hysterectomy over supracervical hysterectomy. All patients who are undergoing supracervical hysterectomy should be counseled about the possible alternatives, benefits, and risks, including continued vaginal bleeding from the cervical stump and the possibility of requiring future treatment and procedures.

Laparoscopic supracervical hysterectomy compared to total hysterectomy

BACKGROUND

The aim of this study was to compare perioperative results of laparoscopic supracervical hysterectomy (LSH) with those of laparoscopic total hysterectomy (TLH).

METHODS

A retrospective cohort study was conducted at the Department of Gynecology at a teaching hospital. A group of 157 patients who underwent TLH was compared with a group of 157 patients who underwent LSH with or without bilateral salpingo-oophorectomy (BSO). Both groups had similar baseline characteristics and comparable surgical indications.

RESULTS

We reviewed our 7-year experience with laparoscopic hysterectomies performed at our department between October 2000 and November 2007. The similarities between patient characteristics were tested by using Wilcoxon Rank Sum Statistics. Patient and surgery characteristics as well as surgery outcomes were analyzed with descriptive statistics showing medians and 95% CIs. Women who underwent LSH had a shorter operation time compared with women in the TLH group (100 min vs. 110 min). Major complication rates were higher in the TLH group than in the LSH group (4.5% vs. 1.3%). Minor complication rates were 13.3% in the TLH group compared with 13.4% in the LSH group.

CONCLUSIONS

Our data and experience provide specific information about the perioperative performance of LSH compared with TLH. In our experience, LSH proved to be a valid alternative to TLH in the absence of specific indications for TLH. Adequate counseling concerning the risk of cyclical bleeding and reoperation is mandatory.

Laparoscopic supracervical hysterectomy: a retrospective analysis of 1000 cases

OBJECTIVE

Laparoscopic supracervical hysterectomy (LASH) was analyzed with regard to surgical indications and outcomes.

METHODS

This is a retrospective analysis of the first 1,000 consecutive laparoscopic supracervical hysterectomies performed by one gynecologist from September 1, 2002 to April 30, 2006. The objective of the study was to find out to what extent the indication and the outcome of surgery changed with the increase in experience of the surgeon and whether a learning curve could be established based on the results. The demographic patient data, indication for surgery, patient history with regard to previous surgery, duration of surgery, intraoperative complications, uterus weight, and length of in-patient stay were collected from the medical records.

RESULTS

The main indication in 80.4% of cases was uterus myomatosis. The median duration of surgery was 70.9+/-26.3 minutes (95% CI, 69.2 to 72.5) with an average uterus weight of 212.5+/-177.0g (95% CI, 201 to 223.6). This was reduced from 85.4+/-25.9 minutes (95% CI, 78.5 to 92.3) in 2002 to 72.4+/-30.1 minutes (95% CI, 66.7 to 78.2) in 2006, in conjunction with an increase in average uterus weight from 192.3+/-145.4g (95% CI, 153.8 to 230.9) to 228.7+/-160.3g (95% CI, 198.1 to 259.3). Overall, one intraoperative lesion of the bladder (0.1%) occurred, and in 4 cases the surgeon had to convert to laparotomy instead, due to the size and immobility of the uterus. Sixty-eight patients had a uterus weight of more than 500 g. In 67% of the cases, surgery was performed on patients with at least one previous laparotomy, and 51.4% of the patients required further interventions.

CONCLUSION

An experienced surgeon can rapidly learn the technique of laparoscopic supracervical hysterectomy and can safely perform it. In patients with symptomatic uterine myomatosis, previous laparotomy and/or with a uterine weight of more than 500g, laparoscopic supracervical hysterectomy is a useful alternative to total hysterectomy. There are few complications if preservation of the cervix is not contraindicated.

Laparoscopic supracervical hysterectomy for benign gynecologic conditions

Recent results from metaanalyses and observational studies have suggested that total abdominal hysterectomy (TAH) is superior to laparoscopic supracervical hysterectomy (LSH) for the treatment of benign gynecologic conditions. However, because LSH is associated with fewer intraoperative complications, shorter operative time, and preserves patient anatomy and sexual function in comparison with TAH, clinicians should reconsider the benefits of LSH.

Comparison of cervical detachment using monopolar lap loop ligature and conventional methods in laparoscopic supracervical hysterectomy

OBJECTIVES

Our aim was to evaluate a new electrosurgical instrument (Lap Loop device) that amputates the uterine corpus from the cervix during a laparoscopic supracervical hysterectomy (LSH) and to compare the time required for cervical amputation with traditional methods.

METHODS

This comparative trial was conducted at the University of Louisville and Norton Healthcare Hospitals, Louisville, KY. The patients comprised 29 women scheduled for hysterectomy for benign conditions. All patients underwent laparoscopic supracervical hysterectomy. The Lap Loop device was used in 17 patients to section the cervix. Conventional methods with either laparoscopic monopolar scissors or Harmonic scalpel were used in 12 patients.

RESULTS

In the control group, the mean cervical cutting time with laparoscopic scissors or Harmonic scalpel was 14.4 minutes. The mean time for the application of the loop electrode and cutting time was 6.6 minutes and was significantly shorter than the cutting time of conventional methods. Two minor complications (7.4% of cases) and one relatively major complication (3.7%), an incisional hernia, occurred in the study patients. None of the complications were related to the new device.

CONCLUSION

An electrosurgical loop decreased the time required for resection of the uterine cervix during LSH for benign uterine conditions. This device facilitates and increases the safety of this procedure.

Laparoscopic supracervical hysterectomy compared with abdominal, vaginal, and laparoscopic vaginal hysterectomy in a primary care hospital setting

OBJECTIVE

This study compares the operative parameters of laparoscopic supracervical hysterectomy, laparoscopically assisted vaginal hysterectomy, total vaginal hysterectomy, and total abdominal hysterectomy in patients in a small suburban medical center.

METHODS

This investigation is a Canadian Classification II-2. It was performed in a 238 bed not-for-profit community general hospital. Charts of 117 patients were reviewed. These patients had undergone the following procedures: laparoscopic supracervical hysterectomy, laparoscopically assisted vaginal hysterectomy, total vaginal hysterectomy, total abdominal hysterectomy; questionnaires completed by the patients were reviewed. All patients had hysterectomies performed by members of the Ob/Gyn department of Alamance Regional Medical Center. Comparisons of intraoperative and postoperative events were made in those patients who consented to the study and who returned their questionnaires. Parameters compared were patient age, weight, preoperative diagnosis, operative time, operative complications, blood loss, uterine weight, length of stay, postoperative complications, return to hospital, return to work, resumption of intercourse, dyspareunia, and bowel or bladder problems.

RESULTS

Patient demographics and outcomes are similar. Laparoscopic supracervical hysterectomy showed lower morbidity and quicker return to normal function, but most findings did not reach statistical significance.

CONCLUSION

The results support the conclusion that the patients in each arm of the study are similar. The operative parameters show a longer operating time for the laparoscopic procedures than for total abdominal hysterectomy and total vaginal hysterectomy, respectively. The other indicators of morbidity show slight advantages of laparoscopic supracervical hysterectomy in blood loss, length of stay, and resumption of normal activities.