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Gollop TR, Santos AGD, Rossi AGZ, Bianchi RF. Vaginal hysterectomy in non-prolapsed uteri: a 6-year experience. EINSTEIN-SAO PAULO 2013; 10:462-5. [PMID: 23386087 DOI: 10.1590/s1679-45082012000400012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 11/22/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the applicability of the technique of vaginal hysterectomy in non-prolapsed uterus. METHODS A retrospective cohort study with 220 patients submitted to vaginal hysterectomy from January 2004 to July 2010 by the Vaginal Surgery and Pelvic Floor Team. Patients mean age was 44.4 years and they had on average three births (0-10 deliveries). The surgery was performed even in cases of previous abdominal surgery, and cesarean section was prevalent in 54.6% of patients. RESULTS The mean uterus weight was 278.9 g. The mean operative time was 93 minutes, and length of hospital stay was 24 hours after surgery in 65% of cases. There were no cases of visceral injury. The mean postoperative complication was cellulitis of the vaginal vault that occurred in 11 cases (5%) that received antibiotics. Mean blood loss corresponded to 1.4 g/dL hemoglobin. From the analyzed sample, vaginal hysterectomy by vaginal route was feasible in 96.8% of patients, and abdominal conversion was necessary in 3.2%. CONCLUSION Vaginal hysterectomy is a minimally invasive surgery, with fewer complications, and low morbidity. We believe that this procedure should be indicated to treat gynecological benign diseases.
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252
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Ates S, Tulandi T. Malpractice claims and avoidance of complications in endoscopic surgery. Best Pract Res Clin Obstet Gynaecol 2013; 27:349-61. [PMID: 23375232 DOI: 10.1016/j.bpobgyn.2012.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 12/17/2012] [Indexed: 10/27/2022]
Abstract
Laparoscopy has become a valuable tool for the gynaecologist in the diagnosis and treatment of a variety of gynecological disorders. Its quicker recovery time and other advantages has benefitted countless women. Laparoscopic procedures, however, have their own associated risks and complications, and the surgeon must become thoroughly familiar with these. This awareness will help reduce patient morbidity and mortality, and potentially avoid the stress and burden of litigation, which has been increasing in recent years. Complications of gynaecologic laparoscopy include entry-related problems, and injuries to bowel, urinary tract, blood vessels, and nerves. Although some of these complications have been well described, some have emerged recently in relation to new technology and techniques. In this chapter, we discuss some of the complications of endoscopic surgery, including their incidence, prevention, and medico-legal implications, and provide a brief overview of their management.
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Affiliation(s)
- Senem Ates
- Department of Obstetrics and Gynecology, McGill University, Montreal, Canada
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Tuschy B, Berlit S, Sütterlin M, Hornemann A. Duration of hospital stay after gynaecologic laparoscopic surgery: preferences of patients. Arch Gynecol Obstet 2013; 288:335-9. [DOI: 10.1007/s00404-013-2733-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 01/17/2013] [Indexed: 11/28/2022]
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De Wilde RL, Herrmann A. Robotic surgery - advance or gimmick? Best Pract Res Clin Obstet Gynaecol 2013; 27:457-69. [PMID: 23357200 DOI: 10.1016/j.bpobgyn.2012.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 12/14/2012] [Indexed: 12/15/2022]
Abstract
Robotic surgery is increasingly implemented as a minimally invasive approach to a variety of gynaecological procedures. The use of conventional laparoscopy by a broad range of surgeons, especially in complex procedures, is hampered by several drawbacks. Robotic surgery was created with the aim of overcoming some of the limitations. Although robotic surgery has many advantages, it is also associated with clear disadvantages. At present, the proof of superiority over access by laparotomy or laparoscopy through large randomised- controlled trials is still lacking. Until results of such trials are present, a firm conclusion about the usefulness of robotic surgery cannot be drawn. Robotic surgery is promising, making the advantages of minimally invasive surgery potentially available to a large number of surgeons and patients in the future.
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Affiliation(s)
- Rudy L De Wilde
- Pius-Hospital, Department of Obstetrics, Gynecology and Gynecological Oncology, Carl-von-Ossietzky-University, Georgstraβe 12, 26121 Oldenburg, Germany.
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Patzkowsky KE, As-Sanie S, Smorgick N, Song AH, Advincula AP. Perioperative outcomes of robotic versus laparoscopic hysterectomy for benign disease. JSLS 2013; 17:100-6. [PMID: 23743379 PMCID: PMC3662725 DOI: 10.4293/108680812x13517013317914] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We compared the perioperative outcomes of hysterectomy performed by robotic (RH) versus laparoscopic (LH) routes for benign indications using the Dindo-Clavien scale for classification of the surgical complications. METHODS Retrospective chart review of all patients who underwent robotic (n=288) and laparoscopic (n=257) hysterectomies by minimally invasive surgeons at the University of Michigan from March 2001 until June 2010. RESULTS Age, body mass index, operative time, and estimated blood loss were not statistically different between groups. The RH subgroup had a larger uterine weight (LH 186.4±130.6 g vs RH 234.9±193.9 g, P=.001), higher prevalence of severe adhesions (13.2% vs 23.3%, respectively, P=.003), and stage III-IV endometriosis (4.7% vs 15.3%, respectively, P<.05). There were no differences in the rates of Dindo-Clavien grade I, grade II, and grade III surgical complications between the RH and LH groups (9.7%, 13.2%, and 3.1%, respectively, in the RH group vs 6.2%, 9.3%, and 5.8%, respectively, in the LH group, P>.05). However, the rates of urinary tract infection were higher in the RH group (LH 2.7% vs RH 6.9%, P=.02), whereas the conversion to laparotomy rate was higher in the LH group (LH 6.2% vs RH 1.7%, P=.007). CONCLUSIONS Perioperative outcomes for laparoscopic and robotic hysterectomy for benign indications appear to be equivalent.
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Chittawar PB, Magon N, Bhandari S. Laparoendoscopic single-site surgery in gynecology: LESS is actually how much less? J Midlife Health 2013; 4:46-51. [PMID: 23833535 PMCID: PMC3702066 DOI: 10.4103/0976-7800.109638] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Gynecological surgery is evolving continuously. Laparoendoscopic single-site surgery (LESS) is the recent addition in this field that stands to benefit almost 40% of women in midlife who will eventually undergo adnexal surgery or hysterectomy. Carried out through a single umbilical incision, the potential benefit of single site surgery is improvement in operative morbidity and cosmesis. The safety, feasibility and efficacy of laparoendoscopic single site procedures have been established in studies over the last few years. In this article, we will review the nomenclature, instruments, and the evidence around the commonly performed gynecologic surgeries using the LESS procedure.
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Affiliation(s)
- Priya Bhave Chittawar
- Department of Reproductive Medicine, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
| | - Navneet Magon
- Department of Obstetrics and Gynaecology, Air Force Hospital, Kanpur, Uttar Pradesh, India
| | - Shilpa Bhandari
- Department of Reproductive Medicine, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
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Feasibility and economic impact of same-day discharge for women who undergo laparoscopic hysterectomy. Am J Obstet Gynecol 2012; 207:382.e1-9. [PMID: 23107080 DOI: 10.1016/j.ajog.2012.09.014] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Revised: 08/30/2012] [Accepted: 09/13/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We examined the use, safety, and economic impact of same-day discharge for women undergoing laparoscopic hysterectomy. STUDY DESIGN We identified women in the Perspective database who underwent laparoscopic hysterectomy from 2000 through 2010. Discharge was classified as same-day, 1 day, and ≥2 days. Multivariable models were used to examine predictors of same-day discharge, reevaluation, and cost. RESULTS Among 128,634 women, 34,070 (26.5%) were discharged on the day of surgery. Same-day discharge increased from 11.3% in 2000 to 46.0% by 2010 (P < .0001). The rate of reevaluation within 60 days was 4.0% for those discharged same day, 3.6% after a 1-day stay, and 5.1% for patients whose stay was ≥2 days (P < .0001). In a multivariable model, patients discharged on postoperative day 1 were less likely to require reevaluation (risk ratio, 0.89; 95% confidence interval, 0.82-0.96), but costs were $207 (95% confidence interval, $179-234) greater. CONCLUSION Same-day discharge after laparoscopic hysterectomy is safe and associated with decreased cost.
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Batista CS, Osako T, Clemente EM, Batista FCA, Osako MTJ. Observational evaluation of preoperative, intraoperative, and postoperative characteristics in 117 Brazilian women without uterine prolapse undergoing vaginal hysterectomy. Int J Womens Health 2012; 4:505-10. [PMID: 23071420 PMCID: PMC3469231 DOI: 10.2147/ijwh.s35927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Despite the introduction of minimally invasive approaches for various benign uterine problems, hysterectomy is often still performed abdominally, but the vaginal route should be used whenever possible. The aim of this study was to identify the preoperative, intraoperative, and postoperative characteristics of women undergoing vaginal hysterectomy in the absence of uterine prolapse. METHODS A prospective, descriptive, quantitative, noncomparative study was conducted in 117 women between August 2009 and February 2011 in Petropolis, Rio de Janeiro, Brazil. The women included had a uterine indication for hysterectomy, their surgeries were performed by the same team, and they were followed up for 12 months. An adapted Pelvic Organ Prolapse Quantification system was used to check for uterine prolapse. RESULTS The age range of the women was 33-59 years, uterine volume was 300-900 mL, and 73.50% has undergone prior cesarean section. The main indication for hysterectomy was uterine myoma (64.95%), with a surgery time of 30-60 minutes in 55 (59.82%) and 19 (15.98%) cases, respectively. Uterine volume reduction was performed in 41 (35.05%) cases, salpingectomy was the most common associated surgery (81.19%), and anesthesia was subdural (68.37%). Common intraoperative complications included bladder lesions (8.54%), with conversion to the abdominal route being necessary in one case (1.28%), and the most common postoperative complication being vaginal cupola granuloma (32.47%). There was a statistically significant relationship between surgery time and uterine volume (χ(2) = 17.367; P = 0.002). CONCLUSION This study suggests that vaginal hysterectomy is a safe surgical procedure in view of its good performance and low complication rate.
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Affiliation(s)
- Claudio Sergio Batista
- Department of Gynecology and Obstetrics of Faculty of Medicine of Petropolis, Petropolis, Rio de Janeiro, Brazil
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259
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Krissi H, Eitan R, Ram E, Peled Y. How accurate is preoperative evaluation of pelvic organ prolapse in women undergoing vaginal reconstruction surgery? PLoS One 2012; 7:e47027. [PMID: 23056566 PMCID: PMC3467242 DOI: 10.1371/journal.pone.0047027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Accepted: 09/07/2012] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate the differences between the in-office and intraoperative techniques used to evaluate pelvic organ prolapse. MATERIALS AND METHODS A prospective study included 25 women undergoing vaginal reconstruction surgery including vaginal hysterectomy for pelvic organ prolapse. The outpatient pelvic and site-specific vaginal examination was performed in the lithotomy position with the Valsalva maneuver. Repeated intraoperative examination was performed under general anesthesia with standard mild cervical traction. The Pelvic Organ Prolapse Quantification system (POPQ) was used for both measurements and staging. The values found under the two conditions were compared. RESULTS The intraoperative POPQ-measurements values were significantly higher than the outpatient values for apical wall prolapse in 17/25 (68%) women and for anterior wall prolapse in 8/25 (32%) women. There was not a significant difference in the posterior wall where increase in staging was shown in 3/25 (12%) patients. CONCLUSIONS Clinicians and patients should be alert to the possibility that pelvic organ measurements performed under general anesthesia with mild traction may be different from preoperative evaluation.
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Affiliation(s)
- Haim Krissi
- Urogynecology Unit, Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel.
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Causes and prevention of laparoscopic ureter injuries: an analysis of 31 cases during laparoscopic hysterectomy in the Netherlands. Surg Endosc 2012; 27:946-56. [PMID: 23052517 DOI: 10.1007/s00464-012-2539-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 08/09/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Ureter injuries are the most dreaded complication in gynecological surgery. Some risk factors for the occurrence of urinary tract injuries are known, but clear guidelines to prevent ureter injuries during laparoscopic hysterectomy (LH) are lacking. The aim of this study was to analyze all known ureter injuries that occurred during LH for a benign indication in the Netherlands, in order to identify patient- and surgeon-related risk factors. METHODS Ninety-five LH-performing gynecologists were asked to recall all cases of known ureter injuries during LH in their hospital. After identification of ureter injuries, a structured interview was performed with a questionnaire that focused on the identification of predisposing factors which could account for the cause of the injury. RESULTS Forty-one injuries were detected in 37 patients (4 bilateral ureter injuries) in a 20-year period. The questionnaire could be completed for 31 cases. Predisposing factors were retrospectively assessed and classified into categories: patient-related (i.e., deep infiltrating endometriosis, intraligamentary fibroids) (n = 18), surgeon-related (insufficient experience and/or technique) (n = 16), or both (insufficient experience and difficult case) (n = 8). According to earlier-mentioned recommendations in a Delphi study among experts, in 48.4 % of these ureter injury cases, more than one of the recommended techniques or predisposing conditions were not applied or available. Only one ureter injury was diagnosed during the LH; the mean time to diagnose the injury was 29 days. CONCLUSIONS Incomplete learning curve, insufficient applied technique such as coagulation of the uterine artery without the use of a uterine manipulator, and/or from the contralateral side and/or without previously performed ureterolysis in case of distorted anatomy may be considered as the main predisposing factors.
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261
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Twijnstra ARH, Dahan A, ter Kuile MM, Jansen FW. Nociceptive and stress hormonal state during abdominal, laparoscopic, and vaginal hysterectomy as predictors of postoperative pain perception. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s10397-012-0769-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Evaluation of sexual function in sexually active women 1 year after transvaginal NOTES: a prospective cohort study of 106 patients. Langenbecks Arch Surg 2012; 398:139-45. [PMID: 22922839 DOI: 10.1007/s00423-012-0993-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 08/13/2012] [Indexed: 01/05/2023]
Abstract
PURPOSE The primary objective of this prospective cohort study was to investigate sexual function, quality of life and patient satisfaction in sexually active women 1 year after transvaginal hybrid natural orifice transluminal endoscopic surgery (NOTES). PATIENTS AND METHODS This prospective single-centre cohort study included sexually active female patients after transvaginal hybrid NOTES cholecystectomy or anterior resection. Sexual life impairment and quality of life were assessed by the Gastrointestinal Quality of Life Index (GIQLI) prior and 1 year after surgery. Patient satisfaction was assessed as well as the sexual function 1 year postoperatively using the validated German version of the Female Sexual Function Index (FSFI-D). RESULTS Between September 2008 and December 2009, 106 sexually active women after transvaginal hybrid NOTES cholecystectomy or anterior resection were identified. Sexual life significantly improved (GIQLI scores 3.2 ± 1.0 preoperatively vs. 3.7 ± 0.7 1 year postoperatively, P < 0.001), and painful sexual intercourse (3.3 ± 1.0 vs. 3.6 ± 0.7, P = 0.008) decreased post-surgery. The mean FSFI-D total score after transvaginal NOTES was 28.1 ± 4.6, exceeding the cutoff for sexual dysfunction defined as 26. Four (4.5 %) out of 88 patients who answered this question were not satisfied with the transvaginal hybrid NOTES procedure. CONCLUSIONS This prospective cohort study of female sexual function after transvaginal NOTES provides compelling evidence that the transvaginal access is safe and associated with high satisfaction rate.
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264
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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.
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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
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Dobrotwir A, Pun E. Clinical 24 month experience of the first MRgFUS unit for treatment of uterine fibroids in Australia. J Med Imaging Radiat Oncol 2012; 56:409-16. [PMID: 22883648 DOI: 10.1111/j.1754-9485.2012.02376.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To describe and evaluate treatment of uterine fibroids using Magnetic Resonance Guided Focused Ultrasound (MRgFUS) during its first 24 months of use at The Royal Women's Hospital Melbourne. METHODS One hundred Victorian women were treated with MRgFUS using the ExAblate 2000 system. Treatment outcomes based on fibroid volume shrinkage measured at 4 and 12 months post-treatment and symptom severity score assessment (Symptom Severity Score Quality of Life - SSS-QOL) pre- and post- (4-6 weeks, 4, 6 and 12 months) treatment. RESULTS Mean non-perfused volume of the treated fibroids were 67% ± 25% (n = 100) immediately post-treatment. At 4 months post-treatment, the treated fibroids demonstrated an average volume reduction of 29% ± 32% (n = 74) and at 12 months 38% ± 45% (n = 32). Mean symptom severity scores (SSS-QOL) improved by 51% from 59 ± 21 (n = 97) at baseline to 29 ± 17 (n = 36) by 12 months. CONCLUSION From our experience, we believe there is a role for MRgFUS in the treatment of uterine fibroids in selected women.
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Affiliation(s)
- Andrew Dobrotwir
- Department of Radiology, The Royal Women's Hospital, Melbourne, Victoria, Australia
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SONG TAEJONG, KIM TAEJOONG, KANG HEESEOK, LEE YOOYOUNG, CHOI CHELHUN, LEE JEONGWON, KIM BYOUNGGIE, BAE DUKSOO. Factors associated with complications and conversion to laparotomy in women undergoing laparoscopically assisted vaginal hysterectomy. Acta Obstet Gynecol Scand 2012; 91:620-4. [DOI: 10.1111/j.1600-0412.2012.01376.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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267
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When Will Laparoscopy Totally Replace Laparotomy? J Minim Invasive Gynecol 2012; 19:236-7. [DOI: 10.1016/j.jmig.2011.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 12/09/2011] [Indexed: 11/21/2022]
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Benhidjeb T, Gericke C, Spies C, Miller K, Schneider A, Müller F. [Perception of natural orifice surgery. Results of a survey of female physicians and nursing staff]. Chirurg 2012; 82:707-13. [PMID: 21431963 DOI: 10.1007/s00104-011-2079-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Natural orifice surgery (NOS) is now being elaborated with the aim to make abdominal surgery simpler and safer. In order to obtain women's perception of NOS and their willingness to consent to this type of approach a survey was conducted among female employees from surgical disciplines at the University Hospital Charité Berlin. MATERIAL AND METHODS A written description and information on minimally invasive surgery and the NOS concept were distributed among 500 female physicians and nursing staff along with a 14-item questionnaire. Of the staff members 118 participants completed the questionnaire anonymously. Data analysis was carried out using SPSS 16.0. RESULTS With regard to ovarectomy 55% of women surveyed indicated that they would prefer a transvaginal approach to standard laparoscopy (44%) or a transgastric approach (1%). When asked about preferred access for cholecystectomy only 31% would prefer the transvaginal method compared to 61% for the laparoscopic technique. Objections against the transvaginal access concerned the impact on a healthy sexual life and effects on fertility. Reasons for choosing NOS were no wound pain and no scar. CONCLUSION This survey shows that among the surveyed female medical employees the transvaginal approach is associated with concerns and fears but these are not justifiable, as the transvaginal access has been used for more than 100 years for gynecological purposes. There is a strong need for outcome data to enlighten female patients and to help guide physicians when talking to patients regarding NOS and the transvaginal approach.
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Affiliation(s)
- T Benhidjeb
- Klinik und Poliklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, Hamburg, Germany.
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Soto E, Lo Y, Friedman K, Soto C, Nezhat F, Chuang L, Gretz H. Total laparoscopic hysterectomy versus da Vinci robotic hysterectomy: is using the robot beneficial? J Gynecol Oncol 2011; 22:253-9. [PMID: 22247802 PMCID: PMC3254844 DOI: 10.3802/jgo.2011.22.4.253] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 07/25/2011] [Accepted: 08/09/2011] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To compare the outcomes of total laparoscopic to robotic approach for hysterectomy and all indicated procedures after controlling for surgeon and other confounding factors. METHODS Retrospective chart review of all consecutive cases of total laparoscopic and da Vinci robotic hysterectomies between August 2007 and July 2009 by two gynecologic oncology surgeons. Our primary outcome measure was operative procedure time. Secondary measures included complications, conversion to laparotomy, estimated blood loss and length of hospital stay. A mixed model with a random intercept was applied to control for surgeon and other confounders. Wilcoxon rank-sum, chi-square and Fisher's exact tests were used for the statistical analysis. RESULTS The 124 patients included in the study consisted of 77 total laparoscopic hysterectomies and 47 robotic hysterectomies. Both groups had similar baseline characteristics, indications for surgery and additional procedures performed. The difference between the mean operative procedure time for the total laparoscopic hysterectomy group (111.4 minutes) and the robotic hysterectomy group (150.8 minutes) was statistically significant (p=0.0001) despite the fact that the specimens obtained in the total laparoscopic hysterectomy group were significantly larger (125 g vs. 94 g, p=0.002). The robotic hysterectomy group had statistically less estimated blood loss than the total laparoscopic hysterectomy group (131.5 mL vs. 207.7 mL, p=0.0105) however no patients required a blood transfusion in either group. Both groups had a comparable rate of conversion to laparotomy, intraoperative complications, and length of hospital stay. CONCLUSION Total laparoscopic hysterectomy can be performed safely and in less operative time compared to robotic hysterectomy when performed by trained surgeons.
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Affiliation(s)
- Enrique Soto
- Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai School of Medicine, New York, USA
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Histopathology diagnosis in women who underwent a hysterectomy for a benign condition. Arch Gynecol Obstet 2011; 285:1339-43. [DOI: 10.1007/s00404-011-2152-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 11/15/2011] [Indexed: 11/27/2022]
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272
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Comparative analysis of different laparoscopic hysterectomy procedures. Arch Gynecol Obstet 2011; 285:1353-61. [PMID: 22124531 DOI: 10.1007/s00404-011-2140-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Accepted: 11/04/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE To compare the antecedent gynecological characteristics, indications for, and complications associated with, the different laparoscopic approaches to hysterectomy, in women with benign gynecological conditions. METHODS A retrospective cohort study of 957 patients who underwent laparoscopic supracervical (LSH), total (TLH), and assisted vaginal (LAVH) hysterectomies between January 2003 and December 2009. RESULTS Among 957 LH, 799 (83.5%) were LSH, 62 (6.4%) TLH, and 96 (10.1%) LAVH. Demographic characteristics were not different among the groups. Antecedent gynecologic conditions that were associated with the type of laparoscopic hysterectomy (LH) performed were: postmenopausal bleeding [LAVH vs. LSH, odds ratio (OR) 2.20; 95% confidence interval (CI) 1.04-4.65], previous pelvic surgery (TLH vs. LSH, OR 1.92; CI 1.05-3.52), previous cesarean delivery (LAVH vs. LSH, OR 0.39; CI 0.21-0.76), and prior hysteroscopy (LAVH vs. LSH, OR 0.29; CI 0.16-0.50). Preoperative diagnoses that were associated with the choice of LH were: menometrorrhagia (LAVH vs. LSH, OR 0.23; CI 0.14-0.38; TLH vs. LSH, OR 0.50; CI 0.26-0.98), uterine fibroids (LAVH vs. LSH, OR 0.25; CI 0.15-0.41), endometrial hyperplasia (TLH vs. LSH, OR 5.5; CI 2.04-14.84), and cervical dysplasia (TLH vs. LSH, OR 17.1; CI 6.83-42.79; LAVH vs. LSH, OR 8.05; CI 3.05-22.06). Estimated blood loss, operating time, and length of hospital stay were significantly reduced with LSH. CONCLUSION Antecedent gynecological history and the indications for surgery were associated with the type of LH performed in our institution. LSH was the most common approach and was associated with significantly less morbidity.
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273
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Lee M, Kim SW, Nam EJ, Yim GW, Kim S, Kim YT. Single-port laparoscopic surgery is applicable to most gynecologic surgery: a single surgeon’s experience. Surg Endosc 2011; 26:1318-24. [DOI: 10.1007/s00464-011-2030-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 08/31/2011] [Indexed: 01/24/2023]
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274
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Dua A, Galimberti A, Subramaniam M, Popli G, Radley S. The effects of vault drainage on postoperative morbidity after vaginal hysterectomy for benign gynaecological disease: a randomised controlled trial. BJOG 2011; 119:348-53. [DOI: 10.1111/j.1471-0528.2011.03170.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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275
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Leone Roberti Maggiore U, Ferrero S, Mancuso S, Costantini S. Feasibility and outcome of vaginal paravaginal repair using the Capio suture-capturing device. Int Urogynecol J 2011; 23:341-7. [PMID: 21932135 DOI: 10.1007/s00192-011-1566-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Accepted: 08/30/2011] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This investigation describes the feasibility and outcome of vaginal paravaginal repair (VPVR) performed using the Capio suture-capturing device. METHODS This prospective study included 36 women with paravaginal fascial defects, symptomatic stage II to IV anterior vaginal wall prolapse, and uterine prolapse equal or more than stage 2. VPVR was performed using the Capio device. In addition, anterior colporrhaphy, posterior colporrhaphy, and vaginal hysterectomy were performed. RESULTS The mean time required to perform the VPVR was 12.9 min (range, 11-18 min). The median blood loss during the VPVR was 35 ml (range, 20-65 ml). There were no major intraoperative complications. At 2-year follow-up, the rate of recurrent anterior vaginal wall prolapse (stage ≥ 2) was 8.6%. CONCLUSIONS VPVR performed using the Capio device is associated with minimal dissection of the tissues, blood loss, and operating time and has low recurrence rate at 2-year follow-up.
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Affiliation(s)
- Umberto Leone Roberti Maggiore
- Department of Obstetrics and Gynecology, San Martino Hospital and University of Genoa, Largo Rosanna Benzi 1, Genoa 16132, Italy
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276
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Forsgren C, Lundholm C, Johansson ALV, Cnattingius S, Zetterström J, Altman D. Vaginal hysterectomy and risk of pelvic organ prolapse and stress urinary incontinence surgery. Int Urogynecol J 2011; 23:43-8. [DOI: 10.1007/s00192-011-1523-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 07/21/2011] [Indexed: 12/01/2022]
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277
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Stang A, Merrill RM, Kuss O. Hysterectomy in Germany: a DRG-based nationwide analysis, 2005-2006. DEUTSCHES ARZTEBLATT INTERNATIONAL 2011; 108:508-14. [PMID: 21904583 DOI: 10.3238/arztebl.2011.0508] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 05/05/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hysterectomy is among the more common surgical procedures in gynecology. The aim of this study was to calculate population-wide rates of hysterectomy across Germany and to obtain information on the different modalities of hysterectomy currently performed in German hospitals. This was done on the basis of nationwide DRG statistics (DRG = diagnosis-related groups) covering the years 2005-2006. METHODS We analyzed the nationwide DRG statistics for 2005 and 2006, in which we found 305 015 hysterectomies. Based on these data we calculated hysterectomy rates for the female population. We determined the indications for each hysterectomy with an algorithm based on the ICD-10 codes, and we categorized the operations on the basis of their OPS codes (OPS = Operationen- und Prozedurenschlüssel [Classification of Operations and Procedures]). RESULTS The overall rate of hysterectomy in Germany was 362 per 100 000 person-years. 55% of hysterectomies for benign diseases of the female genital tract were performed transvaginally. Bilateral ovariectomy was performed concomitantly in 23% of all hysterectomies, while 4% of all hysterectomies were subtotal. Hysterectomy rates varied considerably across federal states: the rate for benign disease was lowest in Hamburg (213.8 per 100 000 women per year) and highest in Mecklenburg-West Pomerania (361.9 per 100 000 women per year). CONCLUSION Hysterectomy rates vary markedly from one region to another. Moreover, even though recent studies have shown that bilateral ovariectomy is harmful to women under 50 who undergo hysterectomy for benign disease, it is still performed in 4% of all hysterectomies for benign indications in Germany.
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Affiliation(s)
- Andreas Stang
- Institut für Klinische Epidemiologie, Medizinische Fakultät, Martin-Luther-Universität, Halle-Wittenberg, Deutschland.
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278
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NIELSEN SIDSELLYKKE, DAUGBJERG SIGNEB, GIMBEL HELGA, SETTNES ANNETTE. Use of vaginal hysterectomy in Denmark: rates, indications and patient characteristics. Acta Obstet Gynecol Scand 2011; 90:978-84. [DOI: 10.1111/j.1600-0412.2011.01199.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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279
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The Hohl instrument for optimizing total laparoscopic hysterectomy: results of more than 500 procedures in a university training center. Arch Gynecol Obstet 2011; 285:123-7. [DOI: 10.1007/s00404-011-1905-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 03/28/2011] [Indexed: 10/18/2022]
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280
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Ottosen C. Trachelectomy for cancer of the cervix: Dargent’s operation. Vaginal hysterectomy for early cancer of the cervix stage IA1 and CIN III. Best Pract Res Clin Obstet Gynaecol 2011; 25:217-25. [DOI: 10.1016/j.bpobgyn.2010.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 08/31/2010] [Accepted: 10/07/2010] [Indexed: 10/18/2022]
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281
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Sheth SS, Paghdiwalla KP, Hajari AR. Vaginal route: A gynaecological route for much more than hysterectomy. Best Pract Res Clin Obstet Gynaecol 2011; 25:115-32. [DOI: 10.1016/j.bpobgyn.2010.12.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 09/24/2010] [Accepted: 12/28/2010] [Indexed: 11/29/2022]
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282
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Carcinoma of the endometrium treated only by vaginal route. Best Pract Res Clin Obstet Gynaecol 2011; 25:239-45. [DOI: 10.1016/j.bpobgyn.2010.10.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 10/20/2010] [Accepted: 10/27/2010] [Indexed: 11/23/2022]
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283
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Kluivers KB, Ten Cate FA, Bongers MY, Brölmann HAM, Hendriks JCM. Total laparoscopic hysterectomy versus total abdominal hysterectomy with bilateral salpingo-oophorectomy for endometrial carcinoma: a randomised controlled trial with 5-year follow-up. ACTA ACUST UNITED AC 2011; 8:427-434. [PMID: 22081769 PMCID: PMC3205270 DOI: 10.1007/s10397-011-0668-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 02/13/2011] [Indexed: 11/24/2022]
Abstract
This report is on recovery and long-term outcomes in a small-scale randomised controlled trial (RCT) after total laparoscopic hysterectomy versus total abdominal hysterectomy in (potential) endometrial carcinoma patients. An RCT was performed among women with atypical endometrial hyperplasia and endometrial carcinoma scheduled for hysterectomy in a teaching hospital in The Netherlands. Women were randomised to total laparoscopic hysterectomy versus total abdominal hysterectomy both with bilateral salpingo-oophorectomy and were followed until 5 years after the intervention. Patients completed the RAND 36-Item Short Form Health Survey (RAND-36), Quality of Recovery-40 (QoR-40) and Recovery Index-10 (RI-10) until 12 weeks after surgery. Main outcome measure was quality of life and recovery in the first 12 weeks after surgery. A linear mixed model was used for statistical analysis while accounting for baseline values where applicable. Seventeen women were included, of whom 11 allocated to the laparoscopic arm and 6 to the abdominal arm. Laparoscopic hysterectomy performed better on all scales and subscales used in the study. A statistically significant treatment effect, favouring laparoscopic hysterectomy, was found in the total RAND-36 (difference between groups 142 units, 95% confidence interval 46; 236). Clinical follow-up was completed after median 60 months, but this study was too small for conclusions regarding the safety and survival. Laparoscopic hysterectomy results in better postoperative quality of life in the first 12 weeks after surgery when compared with abdominal hysterectomy.
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Affiliation(s)
- Kirsten B. Kluivers
- Department of Obstetrics & Gynaecology, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Florien A. Ten Cate
- Department of Obstetrics & Gynaecology, Máxima Medical Centre, De Run 4600, 5504 DB Veldhoven, The Netherlands
| | - Marlies Y. Bongers
- Department of Obstetrics & Gynaecology, Máxima Medical Centre, De Run 4600, 5504 DB Veldhoven, The Netherlands
| | - Hans A. M. Brölmann
- Department of Obstetrics & Gynaecology, VU University Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Jan C. M. Hendriks
- Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands
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284
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O’Hanlan KA, McCutcheon SP, McCutcheon JG. Laparoscopic Hysterectomy: Impact of Uterine Size. J Minim Invasive Gynecol 2011; 18:85-91. [DOI: 10.1016/j.jmig.2010.09.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 09/25/2010] [Accepted: 09/30/2010] [Indexed: 10/18/2022]
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285
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Uppal S, Frumovitz M, Escobar P, Ramirez PT. Laparoendoscopic single-site surgery in gynecology: review of literature and available technology. J Minim Invasive Gynecol 2011; 18:12-23. [PMID: 20965792 PMCID: PMC4361065 DOI: 10.1016/j.jmig.2010.07.013] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 07/20/2010] [Accepted: 07/22/2010] [Indexed: 01/22/2023]
Abstract
The objective of this article was to review the published literature on laparoendoscopic single-site surgery (LESS) in gynecology and to present current advances in instruments used in LESS surgery. Inasmuch as LESS surgery is relatively new, the current literature on use of this technique in gynecology is somewhat limited. Sixteen articles were available for the literature review: 10 case series, 2 comparative studies, 3 case reports, and 1 surgical technique demonstration. In recent years, however, improvements in traditional laparoscopic techniques and availability of more advanced instruments has made single-incision laparoscopy more feasible and safer for the patient. There is increasing interest in LESS surgery both as an alternative to traditional laparoscopy and as an adjunct to robotic surgery when performing complicated procedures through a single incision. Although LESS surgery provides another option in the arena of minimally invasive gynecologic surgery, the ultimate role of this approach remains to be determined.
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Affiliation(s)
- Shitanshu Uppal
- Department of Obstetrics and Gynecology, Temple University Hospital, Philadelphia, Pennsylvania
| | - Michael Frumovitz
- Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Pedro Escobar
- Department of Gynecologic Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Pedro T. Ramirez
- Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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286
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Thomas B, Magos A. Subtotal hysterectomy and myomectomy - vaginally. Best Pract Res Clin Obstet Gynaecol 2010; 25:133-52. [PMID: 21185235 DOI: 10.1016/j.bpobgyn.2010.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 10/22/2010] [Accepted: 11/02/2010] [Indexed: 11/28/2022]
Abstract
Vaginal subtotal (or supracervical) hysterectomy and vaginal myomectomy are elegant procedures rarely carried out by the average gynaecologist. Both techniques, however, are easily learned, and in view of the proven advantages of vaginal surgery over abdominal or laparoscopic approaches, they are worthy of a wider application. Subtotal hysterectomy may be preferred to excision of the entire uterus in certain circumstances, and may be carried out vaginally. Vaginal myomectomy allows for a more thorough myomectomy and stronger uterine repair than a laparoscopic procedure, as well as avoiding abdominal wounds. It may represent the optimal approach where fibroids are favourably sited. We first set out the case for subtotal hysterectomy and then describe the development of vaginal subtotal hysterectomy and vaginal myomectomy. We discuss the evidence supporting their use and indications, and then describe techniques for both vaginal procedures.
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Affiliation(s)
- Benjamin Thomas
- Minimally Invasive Therapy Unit and Endoscopy Training Centre, University Department of Obstetrics and Gynaecology, The Royal Free Hospital, Pond Street, Hampstead, London NW3 2QG, UK
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287
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Quinlan D, Quinlan DK. Vaginal hysterectomy for the enlarged fibroid uterus: a report of 85 cases. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2010; 32:980-3. [PMID: 21176308 DOI: 10.1016/s1701-2163(16)34687-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To demonstrate that increased uterine size should not be a deterrent to the vaginal approach for performing hysterectomy. METHOD We performed a retrospective study of the medical records pertaining to 2769 hysterectomies performed by a single surgeon. For this study, we reviewed the surgical details and outcome of 85 women who had a vaginal hysterectomy for a symptomatic fibroid uterus that was estimated to be equivalent in size to a uterus of between 10 and 20 weeks' gestation. RESULTS The vaginal approach for hysterectomy was successful in all 85 cases and complication rates were low. Sixteen women had additional adnexal surgery besides hysterectomy. In 52 cases, morcellation of the uterus was required. Average operating time was 60 minutes. CONCLUSION Increased uterine size should not be an automatic deterrent to the vaginal approach for hysterectomy. Nevertheless, individual surgeons should perform such challenging procedures only if they are properly trained and are comfortable doing so. Some surgeons may choose not to perform hysterectomies using the vaginal approach.
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Affiliation(s)
- David Quinlan
- Victoria Gynecology and Continence Clinic, Victoria BC
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288
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Carter J. Laparoscopy or laparotomy for early endometrial cancer? Lancet Oncol 2010; 11:1021-2; author reply 1022-3. [PMID: 21051018 DOI: 10.1016/s1470-2045(10)70195-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
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289
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AAGL position statement: route of hysterectomy to treat benign uterine disease. J Minim Invasive Gynecol 2010; 18:1-3. [PMID: 21059487 DOI: 10.1016/j.jmig.2010.10.001] [Citation(s) in RCA: 184] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Accepted: 10/07/2010] [Indexed: 10/18/2022]
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290
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Matthews CA, Reid N, Ramakrishnan V, Hull K, Cohen S. Evaluation of the introduction of robotic technology on route of hysterectomy and complications in the first year of use. Am J Obstet Gynecol 2010; 203:499.e1-5. [PMID: 21055514 DOI: 10.1016/j.ajog.2010.07.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Revised: 05/27/2010] [Accepted: 07/20/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We sought to determine the differential rates and complications of hysterectomy type in the year prior to and following the introduction of robotic technology. STUDY DESIGN This was a retrospective chart review of 461 hysterectomies performed from July 2007 through June 2008 (period 1) and July 2008 through June 2009 (period 2) at Virginia Commonwealth University Medical Center. RESULTS In all, 199 vs 262 hysterectomies were performed in periods 1 and 2: open, 52.3% vs 43.1%; laparoscopic, 18.1% vs 8.0%; robotic, 2.5% vs 24.8%; and vaginal, 27.4% vs 24.1%, respectively. The increase in robotic hysterectomies in period 2 was associated only with a decline in laparoscopic hysterectomy (P < .0001). Major morbidity by route was 23.04% open, 11/1% vaginal, 7.02% laparoscopic, and 4.29% robotic (P < .0001). CONCLUSION Route of hysterectomy changed significantly after the introduction of robotic technology primarily due to a change in management of pelvic organ prolapse. Open hysterectomy was associated with significantly higher complication rates.
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291
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Tchartchian G, Dietzel J, Bojahr B, Hackethal A, De Wilde R. No more abdominal hysterectomy for myomata using a new minimally-invasive technique. Int J Surg Case Rep 2010; 1:7-8. [PMID: 22096663 PMCID: PMC3199612 DOI: 10.1016/j.ijscr.2010.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 06/14/2010] [Indexed: 11/22/2022] Open
Abstract
To perform hysterectomy in uterus myomatosus, there are several surgical techniques. For a uterine weight of >1000 g, after a caesarean section and in nullipara per vaginam, the most common surgical technique for hysterectomy in patients is hysterectomy per laparotomiam. A new endoscopical technique developed to treat such patients and to avoid laparotomy is described in this case report: the laparoscopic combined hysterectomy (LACH) using the change-over technique. Adhesiolysis, preparation of the ureters and the bladder and morcellation of the uterus of 2480 g were performed minimally-invasive in two steps, from one side of the patient with a change-over of the OP-team to the other side of the patient. The cervix was removed per vaginam.
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Affiliation(s)
- G. Tchartchian
- Department of Obstetrics and Gynecology, Pius-Clinic, Oldenburg, Germany
| | - J. Dietzel
- Department of Obstetrics and Gynecology, Pius-Clinic, Oldenburg, Germany
| | - B. Bojahr
- Clinic of Minimally Invasive Surgery, Evangelic Hospital Hubertus, Berlin, Germany
| | - A. Hackethal
- Department of Obstetrics and Gynecology, University of Gießen, Germany
| | - R.L. De Wilde
- Department of Obstetrics and Gynecology, Pius-Clinic, Oldenburg, Germany
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292
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Ghezzi F, Uccella S, Cromi A, Siesto G, Serati M, Bogani G, Bolis P. Postoperative pain after laparoscopic and vaginal hysterectomy for benign gynecologic disease: a randomized trial. Am J Obstet Gynecol 2010; 203:118.e1-8. [PMID: 20522410 DOI: 10.1016/j.ajog.2010.04.026] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2010] [Revised: 03/09/2010] [Accepted: 04/14/2010] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To compare postoperative pain after laparoscopic and vaginal hysterectomy for benign disease. STUDY DESIGN A prospective randomized trial was designed to compare laparoscopic hysterectomy and vaginal hysterectomy in patients with uterine volume <or=14 weeks of gestation. Postoperative pain was measured using the visual analog scale (VAS) at 1, 3, 8, and 24 hours postoperatively. Intra- and postoperative outcomes were carefully recorded, including the need for postoperative rescue doses of analgesia. RESULTS A total of 82 patients were enrolled. Patients who underwent vaginal hysterectomy complained of higher postoperative pain at each VAS evaluation (VAS-1 hour, P < .0001; VAS-3 hour, P < .0001; VAS-8 hour, P < .0001; VAS-24 hour, P = .0003) with a higher need for rescue analgesia (P < .0001) and a longer hospitalization (P = .001). The other perioperative characteristics were comparable between the 2 groups. CONCLUSION Laparoscopic hysterectomy provides an advantage over vaginal hysterectomy in terms of postoperative pain, need for rescue analgesia and hospital stay, with similar perioperative outcomes.
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Affiliation(s)
- Fabio Ghezzi
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy.
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293
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Perrone AM, Scifo MC, Martelli V, Casadio P, Morselli PG, Pelusi G, Meriggiola MC. Hysterectomy and Bilateral Salpingoovariectomy in a Transsexual Subject without Visible Scaring. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2010; 2010:845029. [PMID: 20811647 PMCID: PMC2929487 DOI: 10.1155/2010/845029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 05/04/2010] [Accepted: 05/29/2010] [Indexed: 12/02/2022]
Abstract
Objective. To report on the use of laparoendoscopic single-site surgery (LESS) for the management of total hysterectomy (TH) with bilateral salpingoovariectomy (BSO) in a subject affected by gender identity disorder. Design. Case report. Setting. University Hospital. Patient(s). A 27-year-old affected by Gender Identity Disorder underwent a hysterectomy and BSO as part of surgical sex reassignment. Intervention(s). Laparoendoscopic single-site surgery access for TH and BSO. Main Outcome Measure(s). The procedure was performed without incident. The trocar placement was easy and safe, without inadvertent port removal. No vascular or visceral injuries, loss of pneumoperitoneum, or intraoperative port site bleeding occurred. Result(s). A detailed description of the technique of a single-site surgery for management of hysterectomy and BSO. Conclusion. Our case presents the first report of single-site surgery for surgical treatment of subjects affected by GID.
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Affiliation(s)
- Anna Myriam Perrone
- Centre for Sexual Health, Gynecology and Obstretrics Unit, S. Orsola Hospital, University of Bologna, Via Massarenti 190, 40138 Bologna, Italy
| | - Maria Cristina Scifo
- Centre for Sexual Health, Gynecology and Obstretrics Unit, S. Orsola Hospital, University of Bologna, Via Massarenti 190, 40138 Bologna, Italy
| | - Valentina Martelli
- Centre for Sexual Health, Gynecology and Obstretrics Unit, S. Orsola Hospital, University of Bologna, Via Massarenti 190, 40138 Bologna, Italy
| | - Paolo Casadio
- Centre for Sexual Health, Gynecology and Obstretrics Unit, S. Orsola Hospital, University of Bologna, Via Massarenti 190, 40138 Bologna, Italy
| | - Paolo Giovanni Morselli
- Centre for Sexual Health, Plastic Surgical Unit, S. Orsola Hospital, University of Bologna, Via Massarenti 190, 40138 Bologna, Italy
| | - Giuseppe Pelusi
- Centre for Sexual Health, Gynecology and Obstretrics Unit, S. Orsola Hospital, University of Bologna, Via Massarenti 190, 40138 Bologna, Italy
| | - Maria Cristina Meriggiola
- Centre for Sexual Health, Gynecology and Obstretrics Unit, S. Orsola Hospital, University of Bologna, Via Massarenti 190, 40138 Bologna, Italy
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294
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Past, Present, and Future of Hysterectomy. J Minim Invasive Gynecol 2010; 17:421-35. [DOI: 10.1016/j.jmig.2010.03.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Revised: 03/03/2010] [Accepted: 03/07/2010] [Indexed: 11/18/2022]
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295
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Implementation of Advanced Laparoscopic Surgery in Gynecology: National Overview of Trends. J Minim Invasive Gynecol 2010; 17:487-92. [DOI: 10.1016/j.jmig.2010.03.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2009] [Revised: 03/03/2010] [Accepted: 03/07/2010] [Indexed: 01/06/2023]
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Gynaecologists estimate and experience laparoscopic hysterectomy as more difficult compared with abdominal hysterectomy. ACTA ACUST UNITED AC 2010; 7:359-363. [PMID: 21124999 PMCID: PMC2974921 DOI: 10.1007/s10397-010-0592-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Accepted: 05/12/2010] [Indexed: 11/24/2022]
Abstract
The level of difficulty of various types of hysterectomy differs and may influence the choice of either approach. When surgeons consider one specific approach to hysterectomy as more difficult, they may be reluctant to perform this type of hysterectomy. The main objective of this study was to investigate the potential different levels of difficulty for laparoscopic and abdominal hysterectomy. Furthermore, the accuracy of estimating the level of difficulty was examined. In a randomized controlled trial between laparoscopic hysterectomy (LH) and abdominal hysterectomy (AH), gynaecologists were asked to record the preoperatively estimated and postoperatively experienced level of difficulty on a Visual Analogue Scale (VAS). Differences between LH and AH were examined and the correlation between the estimated uterine weight on bimanual palpation and the actual uterine weight was calculated. A difference on the VAS of three points or more (ΔVAS ≥ 3) was considered clinically relevant. In 72 out of 76 cases, both VAS scores were recorded. LH was estimated and experienced as significantly more difficult as compared with AH. In 13 (18%) cases, ΔVAS was ≥3, equally distributed between LH (n = 6) and AH (n = 7). Eleven of these 13 cases had a positive ΔVAS ≥3, meaning that surgery was experienced as more difficult than it was estimated. Surgeon’s estimation of uterine size correlated well with the actual uterine weight. LH is considered as more difficult than AH, which might be a reason for its slow implementation. In a large proportion of cases, gynaecologists seem to be able to estimate the level of difficulty of hysterectomy accurately.
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van Evert JS, Smeenk JMJ, Dijkhuizen FPHLJ, de Kruif JH, Kluivers KB. Laparoscopic subtotal hysterectomy versus laparoscopic total hysterectomy: a decade of experience. ACTA ACUST UNITED AC 2009; 7:9-12. [PMID: 20234836 PMCID: PMC2837242 DOI: 10.1007/s10397-009-0529-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Accepted: 09/21/2009] [Indexed: 10/26/2022]
Abstract
At present, there are only few data on the surgical outcomes of laparoscopic hysterectomy (LH). Up till now, it has been unclear whether there is a difference in number of complications among the subcategories of laparoscopic total hysterectomy and laparoscopic subtotal hysterectomy (LSH). Therefore, we have performed a retrospective analysis to evaluate the peri- and postoperative outcomes in women undergoing LSH versus LH. This multi-centre retrospective cohort study (Canadian Task Force classification II-2) was conducted in multi-centres (two teaching hospitals and one university medical centre) in the Netherlands, all experienced in minimally invasive gynaecology. In a multi-centre retrospective cohort study we compared the long-term outcomes of laparoscopic subtotal hysterectomy and laparoscopic total hysterectomy (including laparoscopic assisted vaginal hysterectomy, laparoscopic hysterectomy and total laparoscopic hysterectomy). All laparoscopic hysterectomies from the last 10 years (January 1998 till December 2007) were included. Patient characteristics, intra- and postoperative complications, operating time and duration of hospital stay were recorded. The minimum follow-up was 6 months. A total of 390 cases of laparoscopic hysterectomies were included in the analysis: 192 laparoscopic subtotal hysterectomies and 198 laparoscopic total hysterectomies. Patient characteristics such as age and parity were equal in the groups. The overall number of short-term and long-term complications was comparable in both groups: 17% and 15%. Short-term complications (bleeding, fever) were 3% in the LSH group and 12% in the LH group. Long-term complications were (tubal prolapse and cervical stump reoperations) 15% in the LSH group and 3% in the LH group. Laparoscopic subtotal hysterectomy as compared with the different types of laparoscopic total hysterectomy is associated with more long-term postoperative complications, whereas laparoscopic total hysterectomy is associated with more short-term complications.
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Abstract
BACKGROUND Heavy menstrual bleeding (HMB) significantly impairs the quality of life of many otherwise healthy women. Perception of HMB is subjective and management usually depends upon what symptoms are acceptable to the individual. Medical treatment options include oral medication and a hormone-releasing intrauterine system (LNG-IUS). Surgical options include conservative surgery (uterine resection or ablation) and hysterectomy. OBJECTIVES To compare the effectiveness, safety and acceptability of surgery versus medical therapy for HMB. SEARCH STRATEGY In September 2005 we searched the Cochrane Menstrual Disorders and Subfertility Group trials register Cochrane Controlled Trials Register (The Cochrane Library Issue 3, 2005), MEDLINE EMBASE, Current Contents, Biological Abstracts, PsycINFO, and CINAHL. We also searched reference lists of articles retrieved and contacted pharmaceutical companies and experts in the field. SELECTION CRITERIA Controlled randomised trials comparing conservative surgery or hysterectomy versus medical therapy (oral or intrauterine) for HMB DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trials for quality and extracted data . MAIN RESULTS The eight included trials randomised 821 women. In comparisons of oral medication versus surgery, 58% of women randomised to medical treatment had received surgery by two years. Compared to oral medication, endometrial resection was significantly more effective in controlling bleeding (at four months: OR 10.62, 95% CI 5.30 to 21.27) and significantly less likely to cause side effects (at four months: OR 0.15, 95% CI 0.07 to 0.31) and hysterectomy resulted in significantly greater improvements in mental health (at six months p = 0.04). In comparisons of LNG-IUS versus conservative surgery or hysterectomy, at one year there was no statistically significant difference in satisfaction rates or quality of life, though adverse effects were significantly less likely with conservative surgery (OR 0.24, 95% CI 0.11 to 0.49). Two trials found conservative surgery significantly more effective than LNG-IUS in controlling bleeding at one year (OR 3.99, 95% CI 1.53 to 10.38). Two other small trials with longer follow-up found no difference or favoured LNG-IUS - however in both these studies the data were skewed and fewer than two thirds of participants were analysed. Hysterectomy stopped all bleeding but caused serious complications for some women. AUTHORS' CONCLUSIONS Surgery, especially hysterectomy, reduces menstrual bleeding at one year more than medical treatments but LNG-IUS appears equally effective in improving quality of life. The evidence for longer term comparisons is weak and inconsistent. Oral medication suits a minority of women long term.
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Affiliation(s)
- J Marjoribanks
- Cochrane Menstrual Disorders and Subfertility Group, Obstetrics and Gynaecology, University of Auckland, PO Box 92019, Auckland, New Zealand, 1003.
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