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Gioè A, Monterossi G, Gueli Alletti S, Panico G, Campagna G, Costantini B, Naldini A, Pedone Anchora L, Oliva R, Mastrovito S, Fagotti A, Fanfani F, Scambia G. The new robotic system HUGO RAS for gynecologic surgery: First European experience from Gemelli Hospital. Int J Gynaecol Obstet 2024; 166:258-265. [PMID: 38299809 DOI: 10.1002/ijgo.15396] [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: 06/06/2023] [Revised: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVE To evaluate the safety and feasibility of the new surgical robot HUGO robotic assisted surgery (RAS) in a series of gynecologic surgical procedures. METHODS Between March and October 2022, 138 patients treated at Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy were enrolled in the study. All patients suitable for a minimally-invasive approach were prospectively included and divided into two groups: Group 1 (78 patients) made up of patients operated on for uterine and/or adnexal pathologies, and Group 2 (60 patients) made up of patients treated for pelvic organ prolapse. RESULTS In Group 1, median docking time (DT) was 5 min and median console time (CT) was 90 min. In two patients (2.6%) redocking was necessary. In two patients (2.6%), the surgeon continued the surgery laparoscopically. Intraoperative complications occurred in two surgeries (2.6%). In Group 2, median DT was 4 min and median CT was 134.5 min. In three patients (5%), redocking was necessary. In all patients, the surgery was successfully completed robotically without intraoperative complications. CONCLUSIONS The present study demonstrates that the new HUGO RAS system for gynecologic surgery is safe with good results in terms of surgical efficacy and perioperative outcomes. Further studies are needed to investigate its use in other technical and surgical aspects.
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Affiliation(s)
- Alessandro Gioè
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giorgia Monterossi
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Salvatore Gueli Alletti
- UOC Ginecologica e Ostetricia, Dipartimento Materno-Infantile, Ospedale Buccheri La Ferla Fatebenefratelli, Palermo, Italy
| | - Giovanni Panico
- UOC Chirurgia Ginecologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giuseppe Campagna
- UOC Chirurgia Ginecologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Barbara Costantini
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Angelica Naldini
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luigi Pedone Anchora
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | | | - Anna Fagotti
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Fanfani
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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Long L, He X, Liu Y, Lei C. Effect of two different modalities of hysterectomy on wound infection and wound dehiscence in obese patients. Int Wound J 2024; 21:e14664. [PMID: 38439170 PMCID: PMC10912368 DOI: 10.1111/iwj.14664] [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: 12/17/2023] [Accepted: 12/29/2023] [Indexed: 03/06/2024] Open
Abstract
This research intended to investigate the influence of the operation of both kinds of hysterectomies in the risk of wound infection and the degree of wound dehiscence. Both of them were open field and laparoscope. In this research, we looked into four databases: PubMed, Web of Science, Embase and Cochrane Library. Research was conducted on various operative methods for hysterectomy in obese patients between 2000 and October 2023. Two independent investigators performed an independent review of the data, established the inclusion and exclusion criteria, and managed the results with Endnote software. It also evaluated the quality of the included literature. Finally, the data were analysed with RevMan 5.3. This study involved 874 cases, 387 cases received laparoscopy and 487 cases received open access operation. Our findings indicate that there is a significant reduction in the rate of post-operative wound infection among those who have received laparoscopy compared with who have received open surgical procedures (odds ratio [OR], 0.04; 95% confidence interval [CI], 0.01-0.15; p < 0.001); There was no statistical difference between the rate of post-operative wound dehiscence and those who received laparotomy compared with those who received open surgical procedures (OR, 0.33; 95% CI, 0.10-1.11; p = 0.07); The estimated amount of blood lost during the operation was less in the laparoscopy group compared with the open procedure (mean difference, -123.72; 95% CI, -215.16 to -32.28; p = 0.008). Generally speaking, the application of laparoscopy to overweight women who have had a hysterectomy results in a reduction in the expected amount of bleeding during surgery and a reduction in the risk of post-operative wound infections.
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Affiliation(s)
- Ling Long
- Department of Gynecological OncologyChongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer HospitalChongqingChina
| | - Xuan He
- Department of Cancer Center, Daping HospitalArmy Medical University (Third Military Medical University)ChongqingChina
| | - Yuyang Liu
- Department of Traditional Chinese Medicine, College of MedicineChangchun University of Traditional Chinese MedicineChongqingChina
| | - Cuirong Lei
- Department of Gynecological OncologyChongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer HospitalChongqingChina
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Olsen RG, Hartwell D, Dalsgaard T, Madsen ME, Bjerrum F, Konge L, Røder A. First experience with the Hugo™ robot-assisted surgery system for endometriosis: A descriptive study. Acta Obstet Gynecol Scand 2024; 103:368-377. [PMID: 38031442 PMCID: PMC10823395 DOI: 10.1111/aogs.14727] [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: 09/08/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION The Medtronic Hugo™ Robot-assisted Surgery (RAS) system was recently approved for clinical use. We explored the safety and feasibility of this system for endometriosis surgery. The primary outcome was safe case completion without major surgical complications (Clavien-Dindo grade ≤2) and no conversion to open surgery or laparoscopy. MATERIAL AND METHODS Surgeries for endometriosis performed at the Department of Gynecology, Rigshospitalet, on the Medtronic Hugo™ RAS system were included. Two experienced robotic surgeons performed all surgeries with their usual robotic team. The variables included were patient demographics, peri- and postoperative data, complications and 30-day readmission rate. We used the IDEAL framework 1/2a for surgical innovation in this descriptive study. RESULTS The first 12 patients were included. All cases were completed without intraoperative complications or conversion. Four patients experienced Clavien-Dindo grade 1 postoperative complications. No patients were re-admitted within 30 days. Median docking time (17 minutes), console time (87.5 minutes), blood loss (40 mL) and length of hospital stay (1 day) were acceptable compared with previous literature. CONCLUSIONS In this pilot study, we found the Medtronic Hugo™ RAS system safe and feasible for robot-assisted surgery for endometriosis. The advent of new robotic systems is welcomed to accelerate the development of technology that will advance surgical care for patients across the globe.
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Affiliation(s)
- Rikke Groth Olsen
- Copenhagen Academy for Medical Education and Simulation (CAMES)CopenhagenDenmark
- Copenhagen Prostate Cancer Center, Department of UrologyCopenhagen University Hospital‐RigshospitaletCopenhagenDenmark
- Department of GynecologyCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Dorthe Hartwell
- Department of GynecologyCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Torur Dalsgaard
- Department of GynecologyCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Mette Elkjær Madsen
- Department of GynecologyCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
- Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Flemming Bjerrum
- Copenhagen Academy for Medical Education and Simulation (CAMES)CopenhagenDenmark
- Department of Surgery, Herlev‐Gentofte HospitalHerlevDenmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES)CopenhagenDenmark
- Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Andreas Røder
- Copenhagen Prostate Cancer Center, Department of UrologyCopenhagen University Hospital‐RigshospitaletCopenhagenDenmark
- Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
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Pham NK, Jalloul RJ, Chen HY, Hui M, Leon MG. Venous Thromboembolism After Abdominal and Minimally Invasive Large Specimen Hysterectomy. J Minim Invasive Gynecol 2023; 30:884-889. [PMID: 37422052 DOI: 10.1016/j.jmig.2023.06.017] [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: 05/02/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/10/2023]
Abstract
STUDY OBJECTIVE To investigate the incidence of venous thromboembolism (VTE) in patients undergoing large specimen hysterectomy for benign indications. To evaluate the impact of route of surgery and operative time in the development of VTE in this population. DESIGN Retrospective cohort study (Canadian Task Force Classification II2) of targeted hysterectomy data prospectively collected from the American College of Surgeons National Surgical Quality Improvement Program involving over 500 hospitals across the United States. SETTING National Surgical Quality Improvement Program Database. PATIENTS Women aged 18 years or older undergoing hysterectomy for benign indications between 2014 and 2019. Patients were further classified into 4 groups according to uterine weight: <100 g, 100-249 g, 250 g-499 g, and specimens ≥500 g. INTERVENTIONS Current Procedural Terminology codes were used to identify cases. Variables including age, ethnicity, body mass index, smoking status, diabetes, hypertension, blood transfusion, and American Society of Anesthesiologists classification system scores were collected. Cases were stratified by route of surgery, operative time, and uterine weight. MEASUREMENTS AND MAIN RESULTS A total of 122,418 hysterectomies occurring between 2014 and 2019 were included in our study, of which 28,407 (23.2%) patients underwent abdominal, 75,490 (61.7%) laparoscopic, and 18,521 (15.1%) vaginal hysterectomy. The overall rate of VTE in patients with large specimen hysterectomies (≥500 g) was 0.64%. After multivariable adjustment, there was no significant difference in the odds of VTE between uterine weight groups. Only 30% of the surgeries with uterine weight above 500 g were performed with minimally invasive surgical routes. Patients who underwent minimally invasive hysterectomy had lower odds of VTE via laparoscopic (adjusted odds ratio [aOR] 0.62; confidence interval [CI]: 0.48-0.81) and vaginal (aOR 0.46; CI: 0.31-0.69) routes compared to laparotomy. Prolonged operative time (>120 min) was associated with increased odds of VTE (aOR 1.86; CI:1.51-2.29). CONCLUSION The occurrence of VTE after a benign large specimen hysterectomy is rare. The odds of VTE is higher with longer operative times and lower with minimally invasive approaches, even for markedly enlarged uteri.
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Affiliation(s)
- Nguyen K Pham
- Department of Obstetrics, Gynecology, and Reproductive Sciences (Drs. Pham, Jalloul, Hui, and Leon).
| | - Randa J Jalloul
- Department of Obstetrics, Gynecology, and Reproductive Sciences (Drs. Pham, Jalloul, Hui, and Leon)
| | - Han-Yang Chen
- School of Public Health (Dr. Chen), McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
| | - Mason Hui
- Department of Obstetrics, Gynecology, and Reproductive Sciences (Drs. Pham, Jalloul, Hui, and Leon)
| | - Mateo G Leon
- Department of Obstetrics, Gynecology, and Reproductive Sciences (Drs. Pham, Jalloul, Hui, and Leon)
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Forsgren C, Amato M, Johannesson U. Effects of hysterectomy on pelvic floor function and sexual function-A prospective cohort study. Acta Obstet Gynecol Scand 2022; 101:1048-1056. [PMID: 36004493 PMCID: PMC9812090 DOI: 10.1111/aogs.14437] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/12/2022] [Accepted: 07/14/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Hysterectomy is one of the most common major surgical procedures in women. The effects of hysterectomy on pelvic floor and sexual function are uncertain. Our objective was to investigate the effects of hysterectomy for benign indications on pelvic floor and sexual function and to compare different modes of surgery. MATERIAL AND METHODS We performed a prospective clinical cohort study. In all, 260 women scheduled for hysterectomy answered validated questionnaires (Pelvic Floor Impact Questionnaire, Pelvic Floor Distress Inventory and Female Sexual Function Index). Participants were followed 6 months and 1 year after surgery. Data were analyzed using nonparametric statistics and mixed effect models. RESULTS Women with subtotal hysterectomy, vaginal hysterectomy, laparoscopic assisted vaginal hysterectomy, and previous prolapse/incontinence surgery were excluded from further analysis, leaving the remaining cohort to 242 patients. The response rate at 6 months and 1 year follow-up was 180/242 (74.3%) and 169/242 (69.8%), respectively. There was an improvement of pelvic floor function at both follow-ups; mean score of Pelvic Floor Impact Questionnaire at baseline was 42.5 (51.7), at 6 months 19.9 (42.2) and at 1 year 23.7 (50.3) (p < 0.001). The mean score of Pelvic Floor Distress Inventory at baseline was 69.6 (51.1), at 6 months 49 (43.2) and at 1 year 49 (43.2) (p < 0.001). There was an improvement of sexual function after 6 months (mean score of Female Sexual Function Index at baseline 17.9 [SD 11.7] and at 6 months 21.0 [SD 11.7]) (p < 0.001). There was no difference in pelvic floor or sexual function when comparing surgical techniques. CONCLUSIONS Robotic assisted laparoscopic hysterectomy, laparoscopic hysterectomy and abdominal hysterectomy improve pelvic floor function to the same extent at 6 months and 1 year after surgery. There was an overall improvement of sexual function 6 months after hysterectomy, but this did not persist after 1 year.
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Affiliation(s)
- Catharina Forsgren
- Department of Clinical Sciences, Danderyd HospitalKarolinska InstitutetStockholmSweden,Department of Obstetrics and GynecologyDanderyd HospitalStockholmSweden
| | - Martina Amato
- Department of Clinical Sciences, Danderyd HospitalKarolinska InstitutetStockholmSweden,Department of Obstetrics and GynecologyDanderyd HospitalStockholmSweden
| | - Ulrika Johannesson
- Department of Clinical Sciences, Danderyd HospitalKarolinska InstitutetStockholmSweden,Department of Obstetrics and GynecologyDanderyd HospitalStockholmSweden
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Gueli Alletti S, Chiantera V, Arcuri G, Gioè A, Oliva R, Monterossi G, Fanfani F, Fagotti A, Scambia G. Introducing the New Surgical Robot HUGO™ RAS: System Description and Docking Settings for Gynecological Surgery. Front Oncol 2022; 12:898060. [PMID: 35756633 PMCID: PMC9218341 DOI: 10.3389/fonc.2022.898060] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
This study provides a detailed description of the new HUGO™ RAS System and suggests docking settings for gynecological surgery. The system is composed of an "open" surgical console with an HD-3D passive display, a system tower, and four arm carts. Each arm has an extremely wide range of adaptability resulting from the numerous joints. The human cadaver labs were performed at the ORSI Academy between August and December 2021. All procedures were performed by two surgical teams, each composed of a high-volume surgeon experienced in robotic surgery, gynecologic oncology, and pelvic sidewall surgery, and one bedside assistant. Three main gynecological surgical scenarios were identified: standard pelvic surgery, pelvic sidewall surgery, and para-aortic/upper abdominal surgery. Concerning the port placement, the chosen options were called "straight" and "bridge"; instead, the so-called "compact" and "butterfly" configurations were identified for the arm cart positioning. Four cadavers were used to perform total hysterectomy, radical hysterectomy, pelvic exenteration, pelvic and para-aortic lymphadenectomy, and omentectomy. We performed several tests, identifying the best system configurations to draw the proper efficiency from the flexibility of the system in all gynecological surgical scenarios. The straight port placement seems to be adequate for standard pelvic surgery. The bridge trocar position is best to reach the deeper and lateral anatomical regions of the female pelvis. The compact and butterfly arm cart allocations are adequate for both straight and bridge port placement. When deep pelvic surgery was performed, the bedside assistant became more proficient by working with a standard laparoscopic instrument from an ancillary port placed in the left iliac fossa. The arm carts needed to be moved in an open manner, like for the proposed butterfly configuration. On the contrary, the compact disposition left enough space to assist from Palmer's point port. Several basic and advanced gynecological surgical procedures were performed and completed successfully without encountering any technical or surgical issue, the results obtained were judged sufficient to proceed with the clinical experience in daily practice. The HUGO™ RAS system is flexible and highly performative in various surgical scenarios.
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Affiliation(s)
- Salvatore Gueli Alletti
- Unità Operativa Complessa (UOC) Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy.,Unità Operativa Complessa (UOC) Ginecologica e Ostetricia, Dipartimento Materno-Infantile, Ospedale Buccheri La Ferla Fatebenefratelli, Palermo, Italy
| | - Vito Chiantera
- Department of Gynecologic Oncology, Aziende di Rilievo Nazionale di Alta Specializzazione Civico Di Cristina Benfratelli, Palermo, Italy.,Department of Gynecologic Oncology, Università di Palermo, Palermo, Italy
| | - Giovanni Arcuri
- Unità Operativa Complessa Tecnologie Sanitarie, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Alessandro Gioè
- Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Riccardo Oliva
- Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giorgia Monterossi
- Unità Operativa Complessa (UOC) Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Fanfani
- Unità Operativa Complessa (UOC) Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Fagotti
- Unità Operativa Complessa (UOC) Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- Unità Operativa Complessa (UOC) Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
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The effect of hysterectomy types on vaginal length, vaginal shortening rate and FSFI scores. Taiwan J Obstet Gynecol 2022; 61:427-432. [PMID: 35595433 DOI: 10.1016/j.tjog.2022.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Vaginal length (VL), size and width may show individual differences among women. Hysterectomy causes VL shortening in patients, and this shortening varies according to the type of hysterectomy performed. Some studies in literature have shown that the shortened VL after hysterectomy may cause dyspareunia and have a negative effect on female sexuality. The aim of this study is to compare preoperative and postoperative vaginal lengths, vaginal shortening rate (VSR) not used before in the literature, and postoperative sexual functions according to hysterectomy types. MATERIALS AND METHODS In the study, which included 136 [55 Total Abdominal Hysterectomy (TAH), 33 Vaginal Hysterectomy (VH), 48 Total Laparoscopic Hysterectomy (TLH)] sexually active patients under the age of 60 who underwent hysterectomy, the patients were divided into three groups according to the type of hysterectomy performed. Groups were compared in terms of demographic variables, preoperative/postop and control VL, vaginal shortening rate and The Female Sexual Function Index (FSFI) scores. RESULTS Vaginal lengths measured after TLH was longer and vaginal lengths measured after VAH was shorter, the difference was significant (p < 0.01). VSRs were 15.9% in TAH group, 10.9% in VH group and 8.3% in TLH group (p < 0.05). Total FSFI score was higher in TLH group than TAH and VH group (p < 0.01). Group of VSR>15% had statistically significantly lower FSFI scores in lubrication, orgasm, pain and total score than both the VSR<10% group and the VSR 10-15% group (p < 0.05). CONCLUSION Calculating the VSR after hysterectomy instead of postoperative VL measurement will allow us to obtain more individual and accurate results in predicting postoperative sexual functions. We found that TLH is the best hysterectomy method in terms of preserving sexual functions due to less loss of vaginal tissue in the postoperative period from these three techniques that are frequently.
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Xie M, Huang X, Zhao S, Chen Y, Zeng X. Effect of Psychological Intervention on Pelvic Floor Function and Psychological Outcomes After Hysterectomy. Front Med (Lausanne) 2022; 9:878815. [PMID: 35547220 PMCID: PMC9081531 DOI: 10.3389/fmed.2022.878815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundHysterectomy is one of the most frequently performed operations worldwide. However, postoperative complications and body image changes may induce psychological distress after hysterectomy. The study aimed to evaluate the effect of psychological intervention on pelvic floor function and psychological outcomes following hysterectomy among patients with benign indications.MethodsNinety-nine patients underwent hysterectomy were randomly divided into intervention group (n = 50) and control group (n = 49). Patients in the control group received routine postoperative nursing care, while extra psychological intervention was provided to patients in the intervention group, including psychological support, regular lectures and family support. After 6 months, patient's psychological statuses were assessed by Generalized Anxiety Disorder scale (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). The pelvic floor function of patients was evaluated using Pelvic Floor Impact Questionnaire (PFIQ-7) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Furthermore, the incidence of postoperative complications, including uracratia, pelvic organ prolapses, sexual dysfunction and chronic pelvic pain, was evaluated.ResultsAfter 6-month intervention, the GAD-7 and PHQ-9 scores were significantly decreased in the intervention group (p < 0.001 and p = 0.018 respectively). Both scored were significantly lower than that in the control group (p < 0.001 and p < 0.001). Compared with control group, the incidence of uracratia, pelvic organ prolapse, sexual dysfunction and chronic pelvic pain for intervention group was significantly lower (p = 0.003, p = 0.027, p = 0.001, p = 0.002 respectively) and the pelvic floor muscle strength was significantly stronger (p = 0.001). Besides, the postoperative Urinary Incontinence Impact Questionnaire (UIQ-7), Pelvic Organ Prolapse Impact Questionnaire (POPIQ-7), and Colorectal-Anal Impact Questionnaire (CRAIQ-7) scores were significantly lower (p = 0.025, p = 0.04, p < 0.001) and PISQ-12 score was significantly higher in intervention group (p < 0.001).ConclusionPsychological intervention could effectively improve the psychological condition of patients with hysterectomy, which may facilitate patients' postoperative recovery in pelvic floor function. These findings emphasized the necessity of psychological intervention in routine postoperative nursing care.
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Tyan P, Hawa N, Carey E, Urbina P, Chen FR, Sparks A, Amdur R, Moawad G. Trends and Perioperative Outcomes across Elective Benign Hysterectomy Procedures from the ACS-NSQIP 2007-2017. J Minim Invasive Gynecol 2021; 29:365-374.e2. [PMID: 34610464 DOI: 10.1016/j.jmig.2021.09.714] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 09/23/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022]
Abstract
STUDY OBJECTIVE In this study, we describe trends of all 3 routes of hysterectomy, patient demographics, and perioperative morbidity among women undergoing surgery for benign indications between 2007 and 2017. We also sought to compare the rates of extended length of stay (ELOS) and readmission rates among the laparoscopic, abdominal, and transvaginal routes. STUDY DESIGN A retrospective cohort study. STUDY SETTING National database study. PATIENTS The American College of Surgeons National Surgical Quality Improvement Program database to identify patients who underwent an elective hysterectomy for benign indication between 2007 and 2017. INTERVENTIONS Patients were identified using Current Procedural Terminology codes and excluded if their indication for surgery included cancer and pelvic organ prolapse diagnoses based on International Classification of Diseases codes. The collected variables of interest included age, body mass index, American Society of Anesthesiologists classification, uterine weight of >250 grams, and operative time. Our outcomes of interest included ELOS and readmission within 30 days. ELOS was defined as a hospital admission of 2 days or more after laparoscopic and transvaginal hysterectomy and greater than 3 days for an abdominal hysterectomy. Summary statistics were used to evaluate shifts in patient characteristics and postoperative outcomes by hysterectomy route and year of surgery. Multivariable logistic regression analysis, stratified by year, comparing laparoscopic with transvaginal and abdominal hysterectomies was performed. MEASUREMENTS AND MAIN RESULTS There were 224 357 patients who met the inclusion and exclusion criteria. Of those, 132 567 (59.1%) underwent a laparoscopic hysterectomy, 30 105 (13.4%) a vaginal hysterectomy, and 61 685 (27.5%) an abdominal hysterectomy. The rate of laparoscopic hysterectomy increased by >200% between 2007 and 2017, whereas the rates of transvaginal and abdominal hysterectomies steadily decreased (-58% and -42%, respectively) The mean age, median obesity, and American Society of Anesthesiologists classification increased among women undergoing hysterectomy across all routes with the sharpest increase within the laparoscopic hysterectomy group (% increase in mean age [2.1%, 1.3%, 0.7%] and mean body mass index [9.1%, 4.3%, 3.7%] for laparoscopic, transvaginal, and abdominal routes, respectively). In 2017, the odds of ELOS were 29% lower for those who received laparoscopic than those who received abdominal hysterectomy (p <.001). Comparing the rates of readmission between the laparoscopic and abdominal hysterectomy groups shows that the odds of readmission are significantly lower for patients who receive a laparoscopic hysterectomy across all 11 years (p <.001). CONCLUSION The rates of laparoscopic hysterectomy have been steadily increasing over the past 11 years. This large retrospective study confirms the lowest rates of readmission and ELOS within the laparoscopic hysterectomy group despite the rising medical complexity of the patients.
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Affiliation(s)
- Paul Tyan
- Capital Women's Care (Drs. Tyan and Hawa), Leesburg, Virginia.
| | - Nadim Hawa
- Capital Women's Care (Drs. Tyan and Hawa), Leesburg, Virginia
| | - Erin Carey
- Division of Minimally Invasive Gynecologic Surgery, University of North Carolina Chapel Hill (Dr. Carey), Chapel Hill, North Carolina
| | | | - Frank R Chen
- Department of Anesthesiology, Hospital of the University of Pennsylvania (Dr. Chen), Philadelphia, Pennsylvania
| | | | | | - Gaby Moawad
- Division of Minimally Invasive Gynecologic Surgery (Dr. Moawad), George Washington University Health Science Center, Washington, District of Columbia
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10
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Nakayama J, Hayashi E, Shahin M, DeLozier S, El-Nashar SA. An Evaluation of Gynecologic Procedure Billing by Medicare. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- John Nakayama
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Emi Hayashi
- Department of Medicine, Mount Sinai Hospital, New York, New York, USA
| | - Mark Shahin
- Abington Jefferson Hospital, Hanjani Institute for Gynecologic Oncology, Asplundh Cancer Pavilion, Sidney Kimmel Cancer Center of Thomas Jefferson University, Willow Grove, Pennsylvania, USA
| | - Sarah DeLozier
- Clinical Research Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Sherif A. El-Nashar
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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11
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Radtke S, Umeh R, Chavez M, Curiel Z, Mendez K. Utilizing Telemedicine for Delivery of Postoperative Care Following Minimally Invasive Gynecologic Surgery: A Randomized Controlled Trial. Gynecol Minim Invasive Ther 2021; 10:148-153. [PMID: 34485058 PMCID: PMC8384027 DOI: 10.4103/gmit.gmit_66_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 10/22/2020] [Accepted: 01/21/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives: Determine if patient satisfaction is greater after delivering postoperative care via telemedicine following minimally invasive gynecologic surgery. Materials and Methods: University-based outpatient clinic; Randomized controlled trial (Canadian Task Force classification I). Females between 18 and 60 years of age scheduled to undergo laparoscopic hysterectomy or laparoscopic excision of endometriosis were invited to participate. Eligible patients were randomized to receive postoperative care either through a traditional office visit or via telemedicine. PSQ-18 satisfaction surveys were performed by phone after the visit. Results: Forty-one patients were analyzed out of which 25 were in the office group and 16 in the telemedicine group. Groups were homogenous to age (41.4 vs. 43.3 p. 48), body mass index (31.9 vs. 30.6 P = 0.52), distance in miles from home (12.7 vs. 12.4 P = 0.92), and parity (P = 0.51). PSQ-18 questionnaire was scored and each category was compared between the office and telemedicine groups. When comparing medians (interquartile range), the general satisfaction and time spent with doctor categories were significantly higher in the telemedicine group (4.0 [4.0, 4.5] vs. 4.5 [4.5, 5.0] P = 0.05), (4.0 [4.0, 4.5] vs. 4.5 [4.0, 5.0] P = 0.05). The remainder of the categories analyzed were not different between groups Technical Quality (4.0 [3.8, 4.5] vs. 4.5 [3.9, 5.0] P = 0.13), Interpersonal Manner (4.0 [4.0, 4.5] vs. 4.5 [4.0, 5.0] P = 0.34), Communication (4.5 [4.0, 4.5] vs. 4.5 [4.3, 5.0] P = 0.21), Accessibility and Convenience (4.0 [3.5, 4.5] v 4.0 [3.6, 4.5] P = 0.84). A chart review was performed, examining the first 30 days after surgery. One (4%) patient in the office group went to the ER after postoperative visit, and 0 in the telemedicine group (P = 0.42). Conclusion: Postoperative care via telemedicine after gynecologic surgery results in higher patient satisfaction.
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Affiliation(s)
- Steven Radtke
- Department of Obstetrics and Gynecology, Texas Tech University Health and Sciences Center, El Paso, Texas, USA
| | - Randle Umeh
- Department of Obstetrics and Gynecology, Texas Tech University Health and Sciences Center, El Paso, Texas, USA
| | - Martha Chavez
- Department of Obstetrics and Gynecology, Texas Tech University Health and Sciences Center, El Paso, Texas, USA
| | - Zuleika Curiel
- Department of Obstetrics and Gynecology, Texas Tech University Health and Sciences Center, El Paso, Texas, USA
| | - Karla Mendez
- Department of Obstetrics and Gynecology, Texas Tech University Health and Sciences Center, El Paso, Texas, USA
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12
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Gynecologic Surgery Proportion and Utilization Trends in the NSQIP Database from 2010 Through 2015 with Correlation to Technology and Policy. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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13
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Stewart EA, Missmer SA, Rocca WA. Moving Beyond Reflexive and Prophylactic Gynecologic Surgery. Mayo Clin Proc 2021; 96:291-294. [PMID: 33549251 PMCID: PMC8088594 DOI: 10.1016/j.mayocp.2020.05.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/14/2020] [Accepted: 05/13/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Elizabeth A Stewart
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN; Department of Surgery, Mayo Clinic, Rochester, MN; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN; Women's Health Research Center, Mayo Clinic, Rochester, MN.
| | - Stacey A Missmer
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI
| | - Walter A Rocca
- Women's Health Research Center, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic, Rochester, MN; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
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14
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Lin CH, Long CY, Huang KH, Lo TS, Wu MP. Surgical Trend and Volume Effect on the Choice of Hysterectomy Benign Gynecologic Conditions. Gynecol Minim Invasive Ther 2021; 10:1-9. [PMID: 33747766 PMCID: PMC7968603 DOI: 10.4103/gmit.gmit_68_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/11/2020] [Accepted: 09/03/2020] [Indexed: 11/04/2022] Open
Abstract
With the advance of minimally invasive surgery (MIS), the surgical trends of hysterectomy changed significantly during past 2 decades. Total number (age-standardized) of all types of hysterectomy decreased, which may be due to the availability of some other alternatives, e.g. hysteroscopy, laparoscopic myomectomy. However, laparoscopic hysterectomy (LH) still remains the mainstream of surgical treatment. LH significantly increases for benign gynecologic conditions in Taiwan and worldwide. The increase of LH was accompanied with decrease of TAH; VH kept stationary, and SAH increased slightly. The increase in popularity of LH and SAH; provides evidence of surgical trends and a paradigm shift for hysterectomy. This time-frame shift suggests LH has reached a u during the later years. Older patients tend to receive AH, while middle-aged women tend to receive LH. Oder surgeons tend to perform AH, while younger surgeons tend to perform LH. However, all type hysterectomy and LH were more commonly performed by older surgeons aged over 50 years. It means both patients and surgeons became older during the time-frames. The above phenomena may also happen due to less young surgeons entered in the gynecologic practice. Most of the LHs were performed by high-volume surgeons, however, there is a shift from high-volume, to medium- and low-volume surgeons. The above scenario may be due to the wide spread of LH techniques. Surgical volume has important impacts on both complications and costs. The high-volume surgeons have lower complications, which result in lower costs. In the future, how to increase the use of LH, to improve the training and monitoring system deserves more attentions.
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Affiliation(s)
- Chung-Hong Lin
- Department of Obstetrics and Gynecology, Chi Mei Hospital, Chiali, Taiwan.,Division of Urogynecology, Department of Obstetrics and Gynecology, Chi Mei Medical Center, Tainan, Taiwan
| | - Cheng-Yu Long
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Obstetrics and Gynecology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuan-Hui Huang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Tsia-Shu Lo
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Ping Wu
- Division of Urogynecology, Department of Obstetrics and Gynecology, Chi Mei Medical Center, Tainan, Taiwan.,Department of Obstetrics and Gynecology, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
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15
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Wang X, Wang K, Wang H, Li X, Feng J, Chen Q. 1H NMR-based dynamic metabolomics delineates the therapeutic effects of Shenfu injection on laparoscopic hysterectomy. Medicine (Baltimore) 2020; 99:e23336. [PMID: 33350724 PMCID: PMC7769324 DOI: 10.1097/md.0000000000023336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 10/19/2020] [Indexed: 11/26/2022] Open
Abstract
To explore the effect and mechanism of Shenfu Injection on serum metabolomics in laparoscopic hysterectomy.1.5 mL/kg Shenfu injection was added to inject 200 mL of normal saline after the patients who entered the standard were admitted to the operating room. NMR metabolomics were performed at each time point before anesthesia (T0), immediately after pneumoperitoneum (T1), and at the end of surgery (T2).Multivariate trajectory analysis showed that SFI treatment could make laparoscopic hysterectomy interfere with the recovery of plasma metabolites to normal metabolic state, with a time-dependent trend. In addition, the key metabolic changes of laparoscopic hysterectomy at different stages of SFI treatment involve energy metabolism, oxidative stress response, amino acid metabolism, and pyruvate metabolism. Especially, the important role of SFI in the treatment of laparoscopic hysterectomy is antioxidant capacity. The results show that SFI can be used as a potential drug for laparoscopic hysterectomy.The current findings provided, for the first time, sound evidence of the protective effects of SFI on laparoscopic hysterectomy from both biochemical and metabolomics perspectives. The mechanisms of SFI could be related to regulating amino acid metabolism, pyruvate metabolism, and energy metabolism. The present study lays an important foundation for further research and for the broad clinical application of SFI.
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Affiliation(s)
- Xue Wang
- Department of Anesthesiology, East Hospital of Sichuan Provincial People's Hospital
| | - Kai Wang
- Department of Acute Care Surgery, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences
| | - Huan Wang
- Department of Anesthesiology, East Hospital of Sichuan Provincial People's Hospital
| | - Xiangkui Li
- Department of Anesthesiology, East Hospital of Sichuan Provincial People's Hospital
| | - Jinzhou Feng
- Department of Neurosurgery, East Hospital of Sichuan Provincial People's Hospital, Chengdu, China
| | - Qian Chen
- Department of Anesthesiology, East Hospital of Sichuan Provincial People's Hospital
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16
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Ebner F, de Gregorio N, Lato C, Ohly V, Janni W, Spohrs J, Jerg-Bretzke L, Walter S. Choosing a Surgical Access Point for Hysterectomy: A Paradigm Shift Over a 10-Year Span. Front Med (Lausanne) 2020; 7:569895. [PMID: 33324658 PMCID: PMC7724105 DOI: 10.3389/fmed.2020.569895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/28/2020] [Indexed: 01/24/2023] Open
Abstract
Background: When choosing a surgical procedure for a hysterectomy, doctors and patients have various options in terms of the multiple surgical access points available. The aim of this study was to descriptively analyze developments concerning the surgical access point selected over the past 10 years at Ulm University Hospital, (south) Germany, assess the variables associated with the surgical method and explore any potential significant correlations that influence these surgical access routes. Explicitly, we wished to investigate whether the approval of ulipristal acetate and the warning issued by the Food and Drug Administration (FDA) in connection with its use changed existing trends. Material and Methods: This monocentric study retrospectively assessed data from all patients who underwent a hysterectomy due to a benign disease or endometrial cancer from January 2007 until December 2016. Results: Of the benign indications considered, myomas and descensus genitalis occurred most frequently (49.5 and 30.6%, respectively). The percentage of abdominal procedures declined from 61.4 to 13.4% between 2007 and 2016 for all hysterectomies, whilst it increased from 4.1 to 69.7% for laparoscopic hysterectomies. The rate of vaginal hysterectomies increased to 45.5% until 2013 and declined in the years afterwards. Laparoscopic assisted vaginal hysterectomies were comparatively rare. The trends in terms of surgical routes were similar for endometrial cancer. During the observation period, the share of abdominal hysterectomies fell from 100 to 11.3%, whilst the share of laparoscopic hysterectomies increased from 0 to 86.6%. The other two procedures were less frequently used. Use of the laparoscopic hysterectomy procedure also increased significantly after the FDA's 2014 warning. Ulipristal acetate may have tended to influence the process. Conclusion: Contrary to the national decrease in hysterectomy numbers, the annual number of hysterectomies at Ulm University Hospital remained stable during the observation period. Nevertheless, there was a clear shift in the preferred surgical routes for hysterectomy.
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Affiliation(s)
- Florian Ebner
- Department of Gynaecology, Helios Amper-Hospital Dachau, Dachau, Germany.,Department of Gynaecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Niko de Gregorio
- Department of Gynaecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Christiane Lato
- Department of Gynaecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Valerie Ohly
- Department of Gynaecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Wolfgang Janni
- Department of Gynaecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Jennifer Spohrs
- Medical Psychology Division, Department of Psychosomatic Medicine and Psychotherapy, Ulm University Hospital, Ulm, Germany
| | - Lucia Jerg-Bretzke
- Medical Psychology Division, Department of Psychosomatic Medicine and Psychotherapy, Ulm University Hospital, Ulm, Germany
| | - Steffen Walter
- Medical Psychology Division, Department of Psychosomatic Medicine and Psychotherapy, Ulm University Hospital, Ulm, Germany
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17
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Carlin GL, Bodner-Adler B, Husslein H, Ritter M, Umek W. The effectiveness of surgical procedures to prevent post-hysterectomy pelvic organ prolapse: a systematic review of the literature. Int Urogynecol J 2020; 32:775-783. [PMID: 33150453 PMCID: PMC8009792 DOI: 10.1007/s00192-020-04572-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 10/14/2020] [Indexed: 12/01/2022]
Abstract
Introduction and hypothesis Hysterectomy is one of the most commonly performed gynecological surgical procedures. One of the long-term risks associated with hysterectomy is the occurrence of pelvic organ prolapse (POP). To prevent post-hysterectomy POP, several suspension procedures are routinely performed at the time of hysterectomy. We performed a systematic review of published data in order to define the most effective surgical procedures for the prevention of post-hysterectomy POP. Methods We performed a systematic review of the literature by searching PubMed, the Cochrane Library, EMBASE, Ovid MEDLINE, and clinicaltrials.gov up to 24 May 2020. The search strategy included the keywords hysterectomy, post-hysterectomy, prolapse, colposuspension, culdoplasty, McCall, and combinations thereof. The inclusion criterion was a surgical procedure at the time of hysterectomy to prevent de novo POP. The outcome was incidence of post-hysterectomy POP. Results Six out of 553 retrieved studies met the methodological criteria for complete analysis. In this review, 719 women aged over 18 years were included. Only 2 studies were designed as prospective trials; however, only 1 compared women undergoing a procedure at the time of hysterectomy with controls. The prevalence of post-hysterectomy prolapse varied from 0% to 39%. Conclusion A systematic review of published literature suggests that performing variations of McCall culdoplasty at the time of hysterectomy might be the most effective prophylactic surgical procedure for preventing post-hysterectomy pelvic organ prolapse. Electronic supplementary material The online version of this article (10.1007/s00192-020-04572-2) contains supplementary material, which is available to authorized users
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Affiliation(s)
- Greta Lisa Carlin
- Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Vienna, Austria.
| | - Barbara Bodner-Adler
- Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Vienna, Austria
- Karl Landsteiner Institute of Special Gynecology and Obstetrics, Vienna, Austria
| | - Heinrich Husslein
- Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Vienna, Austria
| | - Magdalena Ritter
- Department of Gynecology and Obstetrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang Umek
- Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Vienna, Austria
- Karl Landsteiner Institute of Special Gynecology and Obstetrics, Vienna, Austria
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18
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Capozzi VA, Rosati A, Sozzi G, Armano G, Cianci S, Chiantera V, Scambia G, Berretta R, Frusca T. Italian survey on the residents' surgical level in gynecology and obstetrics. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 92:e2021011. [PMID: 33682831 PMCID: PMC7975951 DOI: 10.23750/abm.v92i1.10649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE The present study aims to investigate the number of surgical procedures performed by Italian residents and their confidence to carry out different surgeries in obstetrics and gynecology. METHODS The present study is a national survey including all Italian gynecology and obstetrics senior residents. A questionnaire including 25 questions was provided. The free Google Forms site was used to create the survey. The study was conducted from April to October 2019. The survey started from the University Hospital of Parma, a tertiary hospital, and was sent to all the Italian post-graduation medical school in gynecology and obstetrics. An e-mail was sent to all representative residents in gynecology and obstetrics in Italy, then forwarded to all the senior residents. RESULTS Of the 555 residents enrolled, 100 joined the survey (18.2%). The analysis of the different procedures performed by residents has shown that 53%, 57%, and 77% of the residents had never performed a laparotomic, laparoscopic, and vaginal hysterectomy, respectively. The analysis of cesarean section skills has shown that 1% of residents had never performed any simple cesarean section, and 6% of residents had never performed any complex cesarean section. Fifty-two doctors in training had never performed an operative vaginal delivery. Seventy-three and ninety-three residents performed more than thirty uterine curettages and sutures of 1st or 2nd degree tears, respectively. CONCLUSIONS In Italy, senior residents are generally confident with the low-complexity procedures and also with complex cesarean sections. The number of Italian residents confident to perform a hysterectomy is poor.
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Affiliation(s)
| | - Andrea Rosati
- Gynecologic Oncology, Dipartimento per le Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Department of Gynecology and Obstetrics, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy..
| | - Giulio Sozzi
- Department of Gynecologic Oncology, ARNAS Civico Di Cristina Benfratelli, Palermo, Italy.
| | - Giulia Armano
- Department of Gynecology and Obstetrics of Parma, University of Parma, Parma, Italy.
| | - Stefano Cianci
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy..
| | - Vito Chiantera
- Department of Gynecologic Oncology, ARNAS Civico Di Cristina Benfratelli, Palermo, Italy.
| | - Giovanni Scambia
- Gynecologic Oncology, Dipartimento per le Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Department of Gynecology and Obstetrics, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy..
| | - Roberto Berretta
- Department of Gynecology and Obstetrics of Parma, University of Parma, Parma, Italy.
| | - Tiziana Frusca
- Department of Gynecology and Obstetrics of Parma, University of Parma, Parma, Italy.
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19
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Perrone E, Rossitto C, Fanfani F, Cianci S, Fagotti A, Uccella S, Vizzielli G, Vascone C, Restaino S, Fedele C, Saleh FL, Scambia G, Gueli Alletti S. Percutaneous-Assisted versus Laparoscopic Hysterectomy: A Prospective Comparison. Gynecol Obstet Invest 2020; 85:318-326. [PMID: 32920558 DOI: 10.1159/000509877] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/22/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the feasibility of percutaneous approach, we prospectively compared our experience in percutaneous-assisted hysterectomy (PSS-H) with that in a series of laparoscopic hysterectomies (LPS-Hs). METHODS In this multicentric cohort study, from May 2015 to October 2017, 160 patients affected by benign and malignant gynecological conditions were considered eligible for minimally invasive surgery (MIS): 80 patients received PSS-H and 80 LPS-H. In each group, 30 cases of low-/intermediate-risk endometrial cancer were enrolled. For both groups, we documented preoperative outcomes, postoperative pain, and cosmetic outcomes. RESULTS No statistically significant differences were noted in baseline characteristics or operative time. We observed significant differences in estimated blood loss: median of 50 cc (PSS-H) and 100 cc (LPS-H) (p = 0.0001). In LPS-H, we reported 4 (5.0%) intraoperative complications and 1 (1.3%) in PSS-H. Thirty-day complications were 4 (5%) in PSS-H and 11 (13.8%) in LPS-H (p = 0.058). No significative differences were found in visual analog scale score, despite a relevant disparity in cosmetic outcome (p = 0.0001). For oncological cases, the 2 techniques had comparable intra- and postoperative outcomes and oncological accuracy. CONCLUSIONS In this study, we reported that PSS-H is comparable to LPS-H for intra- and perioperative outcomes and postoperative pain, while PSS-H seems to be superior in cosmetic outcomes and patient satisfaction. PSS-H may represent a valid alternative in ultra-MIS for benign gynecological conditions and low-/intermediate-risk endometrial cancer.
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Affiliation(s)
- Emanuele Perrone
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy,
| | - Cristiano Rossitto
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Fanfani
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Cianci
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Anna Fagotti
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Uccella
- Division of Obstetrics and Gynecology, Ospedale degli Infermi, Biella, Italy
| | - Giuseppe Vizzielli
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carmine Vascone
- Department of Obstetrics and Gynecology, Pineta Grande Hospital, Castel Volturno, Italy
| | - Stefano Restaino
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Camilla Fedele
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Farrah Layla Saleh
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Giovanni Scambia
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Salvatore Gueli Alletti
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
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20
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Das D, Sinha A, Yao M, Michener CM. Trends and Risk Factors for Vaginal Cuff Dehiscence after Laparoscopic Hysterectomy. J Minim Invasive Gynecol 2020; 28:991-999.e1. [PMID: 32920145 DOI: 10.1016/j.jmig.2020.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/15/2020] [Accepted: 09/08/2020] [Indexed: 12/16/2022]
Abstract
STUDY OBJECTIVE The primary objective was to assess the effect of the route of closure of the vaginal cuff on the incidence of vaginal cuff dehiscence (VCD) in laparoscopic hysterectomy (LH). The secondary objective was to assess patient- and surgical-risk factors associated with VCD, rate of perioperative complications by route of closure, and impact of surgeon volume on complications. DESIGN Retrospective chart review with case-control component. SETTING Tertiary care center (main hospital and regional hospitals). PATIENTS A total of 1278 women underwent LH or robot-assisted hysterectomy in 2016, and met the inclusion criteria. Independently, 26 cases of VCD were identified from 2009 through 2016. INTERVENTIONS A retrospective comparison of patients with vaginal cuff closure and laparoscopic cuff closure (LCC) undergoing LH or robot-assisted hysterectomy in 2016. Patients with VCD from 2009 through 2016 (n = 26) were matched by route of cuff closure to the next 7 patients who underwent hysterectomies (n = 182), who became controls. MEASUREMENTS AND MAIN RESULTS In 2016, there were 9 cases of VCD (0.70%). There was no significant difference in VCD between LCC (8/989; 0.81%) and vaginal cuff closure (1/289; 0.35%; p = .41). Seven VCD cases were performed by high-volume surgeons (>30 hysterectomies per year) who were more likely to perform LCC and use barbed suture. There were no significant differences in the rates of perioperative complications or surgeon volume between routes of cuff closure. The case-control patients differed in smoking status (p = .010) and history of prior laparotomy (p = .017). Logistic regression showed that increasing age (odds ratio 0.95; 95% confidence interval, 0.91-0.99) and increasing body mass index (odds ratio 0.98; 95% confidence interval, 0.83-0.97) were protective for VCD. CONCLUSION VCD is a rare but serious complication of LH. Despite previous studies, we did not find a significant difference in VCD or intra- and perioperative complications by route of cuff closure or surgeon volume. Given the lack of evidence favoring one route of cuff closure, we recommend that, to optimize patient outcomes, surgeons employ the closure technique that they are best accustomed to.
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Affiliation(s)
- Deepanjana Das
- Department of Obstetrics and Gynecology, Women's Health Institute (Drs. Das, Sinha, and Michener).
| | - Annika Sinha
- Department of Obstetrics and Gynecology, Women's Health Institute (Drs. Das, Sinha, and Michener)
| | - Meng Yao
- Department of Quantitative Health Sciences (Mr. Yao), Cleveland Clinic, Cleveland, Ohio
| | - Chad M Michener
- Department of Obstetrics and Gynecology, Women's Health Institute (Drs. Das, Sinha, and Michener)
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21
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Bastidas-Guarín C, Zambrano-Moncayo CP, López-Isanoa JD, López-Jaramillo JD, Herrera-Betancourt AL, Cuello-Salcedo A, Gutiérrez-Calderón E, Piedrahíta-Gutiérrez DL, Villegas-Echeverri JD. [Safety of total laparoscopic hysterectomy in a high complexity Hospital in Pereira, Colombia, between 2007 and 2017. Cohort study]. ACTA ACUST UNITED AC 2020; 71:257-264. [PMID: 33247889 DOI: 10.18597/rcog.3530] [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: 04/14/2020] [Accepted: 08/25/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To describe intra and postoperative complications of total laparoscopic hysterectomy (TLH) for benign uterine pathology and to compare with other hospitals with large volumes of laparoscopic hysterectomies. METHODS Retrospective cohort study of women who underwent TLH for benign gynecological pathology between 2007 and 2017 in a private high complexity institution that serves populations covered by contributive and state-subsidized insurance in Pereira, Colombia. The procedures were performed by the group of surgeons of the ALGIA training center. Consecutive sampling was used. Sociodemographic and baseline clinical characteristics, intra-operative findings and intra- and post-operative complications are described. Descriptive statistics were used. RESULTS A total of 1.350 patients were included during the study period. Surgical time was 95 minutes (SD ± 31), blood loss 88 cc (SD ± 66), and average uterine weight was 236 g (SD ± 133); 96.5% of the patients were assessed within the next 30 to 45 days; 3.48% had minor complications and 2.5% had major complications; 3 patients were converted to laparotomy. There were no deaths in the study sample. CONCLUSIONS TLH is a safe procedure and the rate of complications is similar to the best international standards. Further prospective studies using objective criteria are important in order to compare the performance of different groups and institutions offering surgical procedures and training.
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Affiliation(s)
- Claudia Bastidas-Guarín
- Unidad de laparoscopia ginecológica avanzada y dolor pélvico - ALGIA, Pereira, Colombia. Clínica Comfamiliar, Pereira, Colombia
| | | | - Jorge Darío López-Isanoa
- Unidad de laparoscopia ginecológica avanzada y dolor pélvico - ALGIA, Pereira, Colombia. Clínica Comfamiliar, Pereira, Colombia
| | - José Duván López-Jaramillo
- Unidad de laparoscopia ginecológica avanzada y dolor pélvico - ALGIA, Pereira, Colombia. Clínica Comfamiliar, Pereira, Colombia
| | - Ana Lucía Herrera-Betancourt
- Unidad de laparoscopia ginecológica avanzada y dolor pélvico - ALGIA, Pereira, Colombia. Clínica Comfamiliar, Pereira, Colombia
| | - Angélica Cuello-Salcedo
- Unidad de laparoscopia ginecológica avanzada y dolor pélvico - ALGIA, Pereira, Colombia. Clínica Comfamiliar, Pereira, Colombia
| | - Eliana Gutiérrez-Calderón
- Unidad de laparoscopia ginecológica avanzada y dolor pélvico - ALGIA, Pereira, Colombia. Clínica Comfamiliar, Pereira, Colombia
| | | | - Juan Diego Villegas-Echeverri
- Unidad de laparoscopia ginecológica avanzada y dolor pélvico - ALGIA, Pereira, Colombia. Clínica Comfamiliar, Pereira, Colombia
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22
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Guo XM, Runge M, Miller D, Aaby D, Milad M. A bundled intervention lowers surgical site infection in hysterectomy for benign and malignant indications. Int J Gynaecol Obstet 2020; 150:392-397. [DOI: 10.1002/ijgo.13257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 01/22/2020] [Accepted: 06/01/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Xiaoyue Mona Guo
- Department of Obstetrics and Gynecology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Megan Runge
- Department of Obstetrics and Gynecology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Deborah Miller
- Department of Obstetrics and Gynecology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - David Aaby
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Magdy Milad
- Department of Obstetrics and Gynecology Northwestern University Feinberg School of Medicine Chicago IL USA
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23
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Abstract
Objective To compare early surgical outcomes of robotic assisted laparoscopic hysterectomy with laparoscopic hysterectomy for benign diseases, in terms of operation time, estimated blood loss (EBL), perioperative complications, hospital stay and first gas discharge. Material and Methods Medical records of 146 patients who either underwent laparoscopic (n=84) or robotic assisted laparoscopic hysterectomy (n=62) for benign diseases were extracted from records. Demographic characteristics and operation time, EBL, length of hospital stay and first gas discharge were compared between the groups. Results Mean age and mean body mass index of both groups were comparable. The difference in the mean EBL was not statistically significant between laparoscopic (91±65 mL) and robotic group (80±37 mL, p=0.43). The difference in the mean first gas discharge time was not statistically different between laparoscopic (15±5 hours) and robotic group (17±6 hours, p=0.33). The length of hospital stay was comparable between groups (1.4±0.5 vs 1.5±0.7 days, p=0.64). The mean operation time was longer for the robotic group (150±180 minimum) when compared with laparoscopic group (105±18 minimum, p<0.01). The mean uterine weight of the robotic group was significantly heavier compared with laparoscopic group (234±157 grams vs 153±119 grams, respectıvely, p<0.01). Conclusion Early surgical outcomes of robotic assisted laparoscopic and laparoscopic hysterectomy were comparable in terms of EBL, first gas discharge and hospital stay. Operation time was longer for robotic hysterectomy.
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Affiliation(s)
- Özgüç Takmaz
- Department of Obstetrics and Gynecology, Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | - Mete Güngör
- Department of Obstetrics and Gynecology, Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
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24
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Li ZJ, Jia ZX, Zheng YQ. A new technique for supracervical hysterectomy: Anterograde vaginal subtotal hysterectomy. Medicine (Baltimore) 2020; 99:e20006. [PMID: 32481265 PMCID: PMC7249868 DOI: 10.1097/md.0000000000020006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To review the results of a novel method of subtotal hysterectomy, called anterograde vaginal subtotal hysterectomy (AVSH), and to compare them with those of laparoscopic subtotal hysterectomy (LSH).We recruited 100 women with non-prolapsed uteruses and benign lesions of the uterus who required surgery. Of these, 60 underwent AVSH and 40 underwent LSH. Clinical data included average operation time, average volume of bleeding, postoperative anal exsufflation time, operative complications, average length of hospital stay and average hospital maintenance fee.There were no significant differences in terms of average operation time, average length of hospital stay, or operative complications between the AVSH and LSH groups. The AVSH group showed early postoperative anal exsufflation (P = .000), and had a low average hospital maintenance fee (P = .000). The AVSH group showed a higher perioperative bleeding volume than the LSH group (P = .001), which may be a result of the relatively amateur AVSH technique.AVSH is a minimally invasive, safe and feasible surgical procedure, with favorable early postoperative anal exsufflation and a low average hospital maintenance fee.
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Affiliation(s)
- Zi-Jun Li
- Department of Gynecology, ZheJiang QuHua Hospital, QuZhou, ZheJiang
| | - Zhen-Xiang Jia
- Department of Gynecology, Women and Children Hospital of TaiAn, TaiAn, ShanDong, China
| | - Ya-Qin Zheng
- Department of Gynecology, ZheJiang QuHua Hospital, QuZhou, ZheJiang
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25
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Seckin KD, Kadirogullari P, Kiyak H. Which Anti-Incontinence Surgery Option is Better in Patients Undergoing Total Laparoscopic Hysterectomy? Burch Colposuspension or Transobturator Tape Procedure. Eur J Obstet Gynecol Reprod Biol 2020; 249:59-63. [PMID: 32361330 DOI: 10.1016/j.ejogrb.2020.04.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Stress urinary incontinence (SUI) surgery and hysterectomy are often performed in the same session. The aim of this study was to determine which urinary incontinence surgery would be a better option for patients who would undergo a hysterectomy for various indications. STUDY DESIGN This retrospective study included 65 patients who had undergone total laparoscopic hysterectomy and anti-incontinence surgery (TOT or Burch).A retrospective chart review was performed to record the patient data including demographic features, duration of operations, postoperative complete blood count values and post-void residual urine volumes. ICIQ-UI and UDI-6 interrogations related to urinary incontinence were compared pre- and postoperatively between two groups. RESULTS There was no difference in demographic characteristics and menopausal status between groups. No significant difference was found between two groups in postoperative period for urinary incontinence scores (p>0,05). When the duration of operation was compared, the duration was significantly higher in the TOT group. And the hematocrit drop in the group with TOT was significantly higher (p<0.05). CONCLUSIONS Because the success rates of Burch colposuspension and transobturator procedures are similar, either of these two methods can be selected according to patient characteristics and surgeon experience. But Burch colposuspension seems to be more preferable in terms of blood loss and operation time than TOT.
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Affiliation(s)
- Kerem Doga Seckin
- Istanbul Health Sciences University, Kanuni Sultan Suleyman Research and Training Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.
| | - Pinar Kadirogullari
- Istanbul Health Sciences University, Kanuni Sultan Suleyman Research and Training Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.
| | - Huseyin Kiyak
- Istanbul Health Sciences University, Kanuni Sultan Suleyman Research and Training Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.
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26
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Perrone E, Fanfani F, Rossitto C, Cianci S, Fagotti A, Restaino S, Fedele C, Scambia G, Gueli Alletti S. Laparoscopic vs percutaneous hysterectomy in obese patients: a prospective evaluation. Facts Views Vis Obgyn 2019; 11:307-313. [PMID: 32322826 PMCID: PMC7162661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Treatment of obese female patients represents a real challenge. Indeed, obesity among women has reached epidemic levels not only elevating the cardiovascular and endocrinological risks, but also increasing the incidence of various gynecological pathologies (e.g. endometrial cancer and hyperplasia, uterine fibroids, genital prolapse) which commonly require hysterectomy as a surgical solution. In the last decade, minimally invasive surgery has emerged as an approach reducing the invasiveness of the standard laparoscopic surgical procedures while maintaining efficacy and feasibility. As such, in this study we aimed to evaluate the feasibility of percutaneous hysterectomy (PSS-H) approach in obese patients by reporting the first prospective comparison between the PSS-H to laparoscopic hysterectomy (LPS-H). METHODS In this multicentric comparative prospective study, 45 patients affected by benign and malignant gynecological conditions were considered eligible for minimally invasive surgery (MIS). Fifteen patients received PSS-H and 30 LPS-H. All patients enrolled received a total hysterectomy ± bilateral salpingo-oophorectomy, with or without lymph nodal staging. RESULTS No statistically significant differences were noted in operative time and estimated blood loss between the two groups. Four patients in PSS-H group and 3 in LPS-H group received lymph node staging. A multifunctional energy device was used in all PSS-H and 73.3% of LPS-H procedures (p=0.038). There were no conversions to laparotomy in either group and similarly there were no conversions to conventional laparoscopy in the PSS-H group. In the LPS-H group, there was one (3.3%) case of major bleeding( ≥ 500 mls). We recorded one vaginal cuff bleeding in PSS-H, whereas for LPS-H we reported 4 (13.3%) 30-days complications (p=0.651). No differences in visual analogue scale (VAS) score were recorded. A significant disparity was noted in cosmetic outcome at discharge (p=0.001), but not after 30 days. CONCLUSION We demonstrated for the first time, in a prospective comparison between PSS and LPS approaches, that PSS-H may represent a valid alternative to performing total hysterectomy in obese patients.
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Affiliation(s)
- E Perrone
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - F Fanfani
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy;,Università Cattolica del Sacro Cuore, Istituto di Clinica Ostetrica e Ginecologia, Rome, Italy
| | - C Rossitto
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - S Cianci
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A Fagotti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy;,Università Cattolica del Sacro Cuore, Istituto di Clinica Ostetrica e Ginecologia, Rome, Italy
| | - S Restaino
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - C Fedele
- Università Cattolica del Sacro Cuore, Istituto di Clinica Ostetrica e Ginecologia, Rome, Italy
| | - G Scambia
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy;,Università Cattolica del Sacro Cuore, Istituto di Clinica Ostetrica e Ginecologia, Rome, Italy
| | - S Gueli Alletti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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27
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Katon JG, Bossick AS, Doll KM, Fortney J, Gray KE, Hebert P, Lynch KE, Ma EW, Washington DL, Zephyrin L, Callegari LS. Contributors to Racial Disparities in Minimally Invasive Hysterectomy in the US Department of Veterans Affairs. Med Care 2019; 57:930-936. [PMID: 31730567 DOI: 10.1097/mlr.0000000000001200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Minimally invasive hysterectomy for fibroids decreases recovery time and risk of postoperative complications compared with abdominal hysterectomy. Within Veterans Affair (VA), black women with uterine fibroids are less likely to receive a minimally invasive hysterectomy than white women. OBJECTIVE To quantify the contributions of patient, facility, temporal and geographic factors to VA black-white disparity in minimally invasive hysterectomy. RESEARCH DESIGN A cross-sectional study. SUBJECTS Veterans with fibroids and hysterectomy performed in VA between October 1, 2012 and September 30, 2015. MEASURES Hysterectomy mode was defined using ICD-9 codes as minimally invasive (laparoscopic, vaginal, or robotic-assisted) versus abdominal. The authors estimated a logistic regression model with minimally invasive hysterectomy modeled as a function of 4 sets of factors: sociodemographic characteristics other than race, health risk factors, facility, and temporal and geographic factors. Using decomposition techniques, systematically substituting each white woman's characteristics for each black woman's characteristics, then recalculating the predicted probability of minimally invasive hysterectomy for black women for each possible combination of factors, we quantified the contribution of each set of factors to observed disparities in minimally invasive hysterectomy. RESULTS Among 1255 veterans with fibroids who had a hysterectomy at a VA, 61% of black women and 39% of white women had an abdominal hysterectomy. Our models indicated there were 99 excess abdominal hysterectomies among black women. The majority (n=77) of excess abdominal hysterectomies were unexplained by measured sociodemographic factors beyond race, health risk factors, facility, and temporal or geographic trends. CONCLUSION Closer examination of the equity of VA gynecology care and ways in which the VA can work to ensure equitable care for all women veterans is necessary.
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Affiliation(s)
- Jodie G Katon
- Health Services Research and Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, US Department of Veterans Affairs (VA) Puget Sound Health Care System
- Department of Health Services, University of Washington
| | | | - Kemi M Doll
- Department of Health Services, University of Washington
- Departments of Obstetrics and Gynecology
| | - John Fortney
- Health Services Research and Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, US Department of Veterans Affairs (VA) Puget Sound Health Care System
- Psychiatry and Behavioral Science, University of Washington School of Medicine, Seattle, WA
| | - Kristen E Gray
- Health Services Research and Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, US Department of Veterans Affairs (VA) Puget Sound Health Care System
- Department of Health Services, University of Washington
| | - Paul Hebert
- Health Services Research and Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, US Department of Veterans Affairs (VA) Puget Sound Health Care System
- Department of Health Services, University of Washington
| | - Kristine E Lynch
- Department of Veterans Affairs Salt Lake City Health Care System
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Erica W Ma
- Health Services Research and Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, US Department of Veterans Affairs (VA) Puget Sound Health Care System
| | - Donna L Washington
- HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System
- Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA
| | - Laurie Zephyrin
- Women's Health Services, Office of Patient Services, VA Central Office, Washington, DC
- Department of Obstetrics and Gynecology, New York University Langone School of Medicine, New York, NY
| | - Lisa S Callegari
- Health Services Research and Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, US Department of Veterans Affairs (VA) Puget Sound Health Care System
- Department of Health Services, University of Washington
- Departments of Obstetrics and Gynecology
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28
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Xiong Z, Rindos NB, Lee T. Increasing the Rate of Laparoscopic Hysterectomy Safely for Benign Gynecologic Disease. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2019.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Zhoufang Xiong
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Noah B. Rindos
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee–Women's Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Ted Lee
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee–Women's Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA
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29
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Xu X, Lin H, Wright JD, Gross CP, Boscoe FP, Hutchison LM, Schwartz PE, Desai VB. Association Between Power Morcellation and Mortality in Women With Unexpected Uterine Cancer Undergoing Hysterectomy or Myomectomy. J Clin Oncol 2019; 37:3412-3424. [PMID: 31518176 DOI: 10.1200/jco.19.00562] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Despite concerns that power morcellation may adversely affect prognosis of patients with occult uterine cancer, empirical evidence has been limited and inconclusive. In this study, we aimed to determine whether uncontained power morcellation at the time of hysterectomy or myomectomy is associated with increased mortality risk in women with occult uterine cancer. METHODS By linking statewide hospital discharge records with cancer registry data in New York, we identified 843 women with occult endometrial carcinoma and 334 women with occult uterine sarcoma who underwent a hysterectomy or myomectomy for presumed benign indications during the period October 1, 2003, through December 31, 2013. Within this cohort, we compared disease-specific and all-cause mortality of women who underwent laparoscopic supracervical hysterectomy/laparoscopic myomectomy (LSH/LM), a surrogate indicator for uncontained power morcellation, with women who underwent supracervical abdominal hysterectomy and total abdominal hysterectomy (TAH), which did not involve power morcellation. Multivariable Cox regressions and propensity score method were used to adjust for patient characteristics. RESULTS Among women with occult uterine sarcoma, LSH/LM was associated with a higher risk for disease-specific mortality than TAH (adjusted hazard ratio [aHR], 2.66, 95% CI, 1.11 to 6.37; adjusted difference in 5-year disease-specific survival, -19.4%, 95% CI, -35.8% to -3.1%). In the subset of women with leiomyosarcoma, LSH/LM was associated with an increased risk for disease-specific mortality compared with supracervical abdominal hysterectomy (aHR, 3.64, 95% CI, 1.50 to 8.86; adjusted difference in 5-year disease-specific survival, -31.2%, 95% CI, -50.0% to -12.3%) and TAH (aHR, 4.66, 95% CI, 1.97 to 11.00; adjusted difference in 5-year disease-specific survival, -37.3%, 95% CI, -54.2% to -20.3%). Among women with occult endometrial carcinoma, there was no significant association between surgical approach and disease-specific mortality. CONCLUSION Uncontained power morcellation was associated with higher mortality risk in women with occult uterine sarcoma, especially in those with occult leiomyosarcoma.
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Affiliation(s)
- Xiao Xu
- Yale University, New Haven, CT
| | | | | | | | - Francis P Boscoe
- New York State Department of Health, Albany, NY.,University at Albany, State University of New York, Albany, NY
| | | | | | - Vrunda B Desai
- Yale University, New Haven, CT.,CooperSurgical, Trumbull, CT
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30
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Pai AH, KN S. Profile of Hysterectomy at a Teaching Hospital in India Over 5 Years. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2018.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ashwini Harish Pai
- Department of Obstetrics and Gynecology, Subbaiah Institute of Medical Sciences, Shimoga, Karnataka, India
| | - Sreelakshmi KN
- Department of Obstetrics and Gynecology, Subbaiah Institute of Medical Sciences, Shimoga, Karnataka, India
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31
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Huang CC, Lo TS, Huang YT, Long CY, Law KS, Wu MP. Surgical Trends and Time Frame Comparison of Surgical Types of Hysterectomy: A Nationwide, Population-based 15-year Study. J Minim Invasive Gynecol 2019; 27:65-73.e1. [PMID: 30928611 DOI: 10.1016/j.jmig.2019.02.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/25/2019] [Accepted: 02/04/2019] [Indexed: 12/16/2022]
Abstract
STUDY OBJECTIVE To investigate the surgical trends among different types of hysterectomy (abdominal, vaginal, laparoscopic, and subtotal) over a 15-year period in Taiwan. DESIGN A retrospective cohort study. SETTING A population-based National Health Insurance Research Database. PATIENTS Women undergoing various types of hysterectomy for noncancerous lesions. INTERVENTIONS Data for this study were extracted from the inpatient expenditures by admissions files of Taiwan's National Health Insurance Research Database from 1998 through 2012 and divided into three 5-year time frames: first (1998-2002), second (2003-2007), and third (2008-2012). The variables included types of hysterectomy, patient age, gynecologist age and sex, hospital accreditation level, and surgical volume. Chi-square and trend tests were used to examine the association between the variables. MEASUREMENTS AND MAIN RESULTS A total of 329 438 patients who underwent various types of hysterectomy were identified; 306 257 were included in the study. During the 15-year period, 45% underwent total abdominal hysterectomy, 41% underwent laparoscopic hysterectomy (LH), 9.8% underwent vaginal hysterectomy, and 4.2% underwent subtotal abdominal hysterectomy. The frequency of LHs increased from 35.9% in the first period to 43.9% in the second period and remained at 44.2% in the third period. During the same time period, there was a decrease in the frequency of total abdominal hysterectomies. Typically, younger patients underwent LHs by gynecologists with large volume surgical practices and medical centers. CONCLUSION This 15-year study describes an increase of LHs and subtotal abdominal hysterectomies over time and provides evidence of surgical trends and a paradigm shift of hysterectomies. Surgical skills and performance extended from high- to low-surgical volume gynecologists and from medical centers to regional and local hospitals. This shift may have a great influence on patient and health care provider choice of treatment.
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Affiliation(s)
- Chun-Che Huang
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan (Dr C.-C. Huang)
| | - Tsia-Shu Lo
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung General Hospital, Keelung, Taiwan (Dr. Lo); School of Medicine, Chang Gung University, Taoyuan, Taiwan (Dr. Lo)
| | - Yu-Tung Huang
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan (Dr. Y.-T. Huang)
| | - Cheng-Yu Long
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (Dr. Long); Department of Obstetrics and Gynecology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (Dr. Long)
| | - Kim-Seng Law
- Department of Obstetrics and Gynecology, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan (Dr. Law)
| | - Ming-Ping Wu
- Division of Urogynecology, Department of Obstetrics and Gynecology, Chi Mei Foundation Hospital, Tainan, Taiwan (Dr. Wu); Department of Obstetrics and Gynecology, College of Medicine, Fu-Jen Catholic University, Taipei, Taiwan (Dr. Wu).
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32
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Tyan P, Robinson J, Dandapani M, Li J, Gu A, Moawad GN. Novel Approach for 2-Port Laparoscopic Hysterectomy. Surg Innov 2019; 26:442-448. [PMID: 30907239 DOI: 10.1177/1553350619827693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Objectives. To describe a novel technique for a port-reducing laparoscopic hysterectomy. The 2-port laparoscopic hysterectomy (TPH) is performed through two 5-mm ports without the use of any multiport channels. We demonstrate outcomes via a large case series. We also describe and provide a video showing the TPH technique. Methods. Retrospective comparative study between the newly developed TPH and the conventional 4-port hysterectomy techniques. Variables of patients who underwent a TPH with fellowship-trained gynecologic surgeons at a single academic university hospital were collected through electronic medical records chart review. Results. Forty-five patients underwent a TPH. Mean age was 39.4, body mass index was 28.5 kg/m2, and uterine weight was 170.0 g. Our outcomes of interest were operative time (98.4 minutes, mean), estimated blood loss (65.6 mL, mean), conversion to 3-port (1/45), and intraoperative (0/45) and postoperative (5/45) complications. By comparing the TPH to the conventional 4-port laparoscopic hysterectomy within a similar setting, we provide insight into variables that prompt the minimally invasive gynecologic surgeon to perform a port-reducing procedure. Patients were more likely to be allocated for a TPH if they were younger (37.8 vs 44.7, P = .005), had a lower body mass index (29.0 vs 32.5, P = .07), smaller uterus (143.1 vs 672.3 g, P < .001), and were white (56.8% and 22.4%, P < .001). Conclusions. The TPH is a novel port-reducing hysterectomy that is safe in a subset of patients with small uteri and limited surgical history who require no other surgical interventions at the time of hysterectomy.
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Affiliation(s)
- Paul Tyan
- 1 University of North Carolina, Chapel Hill, NC, USA
| | - James Robinson
- 2 Georgetown University, Washington, DC, USA.,3 MedStar Washington Hospital Center, Washington, DC, USA
| | | | - Jessica Li
- 5 George Washington University, Washington, DC, USA
| | - Alex Gu
- 5 George Washington University, Washington, DC, USA
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Predictors of Overnight Admission after Minimally Invasive Hysterectomy in the Expert Setting. J Minim Invasive Gynecol 2019; 26:122-128. [DOI: 10.1016/j.jmig.2018.04.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/19/2018] [Accepted: 04/20/2018] [Indexed: 11/22/2022]
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Briët JM, Mourits MJ, van Leeuwen BL, van den Heuvel ER, Kenkhuis MJ, Arts HJ, de Bock GH. Age should not be a limiting factor in laparoscopic surgery: a prospective multicenter cohort study on quality of life after laparoscopic hysterectomy. Clin Interv Aging 2018; 13:2517-2526. [PMID: 30587944 PMCID: PMC6296188 DOI: 10.2147/cia.s172965] [Citation(s) in RCA: 1] [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
Purpose A prospective, multicenter cohort study was performed on the implementation of laparoscopic hysterectomy (LH) in the Netherlands. The aim of this study was to evaluate the impact of LH on quality of life (QOL) with respect to age up to 6 months postoperatively. Patients and methods Women with an indication for LH, either for benign conditions or early-stage low-risk endometrial cancer were included. QOL was measured before and 6 weeks and 6 months after surgery, using the 36-item Short Form Health Survey. Mean QOL values were compared to an unselected, female, Dutch reference population. A longitudinal linear mixed model was applied to assess changes in QOL over time after LH and to determine if in patients ≥65 years of age QOL scores were different. Results Data on 116 patients were available for analysis. The median age was 54 years at time of surgery (range 34-83) with an interquartile range of 43-65 years. Six months after LH, all QOL values were higher than before surgery and were equal to or higher than those of the reference population. Older women tend to score higher on QOL preoperatively, and these scores remain high postoperatively. Conclusion After LH, QOL improves. Older women report higher QOL values preoperatively and QOL is still high 6 months after the operation. Age does not confer a negative impact on QOL following LH and should not be the reason to refrain from laparoscopic surgery.
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Affiliation(s)
- Justine M Briët
- Department of Gynecologic Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands,
| | - Marian Je Mourits
- Department of Gynecologic Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands,
| | - Barbara L van Leeuwen
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Edwin R van den Heuvel
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Monique Ja Kenkhuis
- Department of Gynecologic Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands,
| | - Henriette Jg Arts
- Department of Gynecologic Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands,
| | - Geertruida H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Melnyk A, Vani K, Rindos NB. Post-Uterine Fibroid Embolization Sepsis: A Case Report and Review of the Literature. J Gynecol Surg 2018. [DOI: 10.1089/gyn.2018.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alexandra Melnyk
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Specialties, Minimally Invasive Gynecologic Surgery, Magee–Womens Hospital of University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Kavita Vani
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Specialties, Minimally Invasive Gynecologic Surgery, Magee–Womens Hospital of University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Noah B. Rindos
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Specialties, Minimally Invasive Gynecologic Surgery, Magee–Womens Hospital of University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Associations between Race/Ethnicity, Uterine Fibroids, and Minimally Invasive Hysterectomy in the VA Healthcare System. Womens Health Issues 2018; 29:48-55. [PMID: 30293778 DOI: 10.1016/j.whi.2018.08.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 07/25/2018] [Accepted: 08/21/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND In the general population, Black and Latina women are less likely to undergo minimally invasive hysterectomy than White women, which may be related to racial/ethnic variation in fibroid prevalence and characteristics. Whether similar differences exist in the Department of Veterans Affairs Healthcare System (VA) is unknown. METHODS Using VA clinical and administrative data, we identified all women veterans undergoing hysterectomy for benign indications in fiscal years 2012-2014. We identified hysterectomy route (laparoscopic with/without robot-assist, vaginal, abdominal) by International Classification of Diseases, 9th edition, codes. We used multinomial logistic regression to estimate associations of race/ethnicity with hysterectomy route and tested whether associations varied by fibroid diagnosis using an interaction term. Models adjusted for age, income, body mass index, gynecologic diagnoses, medical comorbidities, whether procedure was performed or paid for by VA, geographic region, and fiscal year. RESULTS Among 2,744 identified hysterectomies, 53% were abdominal, 29% laparoscopic, and 18% vaginal. In multinomial models, racial/ethnic differences were present among veterans with but not without fibroid diagnoses (p value for interaction < .001). Among veterans with fibroids, Black veterans were less likely than White veterans to have minimally invasive hysterectomy (laparoscopic vs. abdominal relative risk ratio [RRR], 0.52; 95% CI, 0.38-0.72; vaginal vs. abdominal RRR, 0.58; 95% CI, 0.43-0.73). Latina veterans were as likely as White veterans to have laparoscopic as abdominal hysterectomy (RRR, 1.34; 95% CI, 0.87-2.07) and less likely to have vaginal than abdominal hysterectomy (RRR, 0.32; 95% CI, 0.15-0.69). CONCLUSIONS Receipt of minimally invasive hysterectomy among women veterans with fibroids varied by race/ethnicity. Further investigation of the underlying mechanisms and potential interventions to increase minimally invasive hysterectomy among minority women veterans is needed.
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Trends in Route of Hysterectomy after the Implementation of a Comprehensive Robotic Training Program. Minim Invasive Surg 2018; 2018:7362489. [PMID: 30310699 PMCID: PMC6166379 DOI: 10.1155/2018/7362489] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 08/06/2018] [Accepted: 08/27/2018] [Indexed: 12/13/2022] Open
Abstract
Objective To evaluate trends in surgical approach for hysterectomy following the introduction and implementation of a comprehensive robotic surgery program. Methods A retrospective review of all hysterectomies done at two institutions, a community hospital and a suburban, tertiary-care teaching hospital, in the same health system over a five-year period, January 2010 through December 2014. A robotic surgery training program was implemented during the first year of the study and trends in route of hysterectomy were evaluated in the subsequent years. Results A total of 5175 patients undergoing hysterectomy, for both benign and malignant indications, were included in the study. There was a significant decrease in the percent of cases performed through an abdominal approach at both the community and teaching hospitals (19.3% decline at each institution). There was an inversely related significant increase in the percent of robotic procedures at both the community and teaching hospitals (44.5% and 17%, respectively). A decrease in number of cases performed vaginally over this period was only noted in the community hospital site (25.2% decrease), and there was a slightly higher rate of vaginal hysterectomies at the teaching hospital over this study period (21.9% in 2010, 24.1% in 2014). Conclusion The decrease in number of abdominal and laparoscopic hysterectomies and increase in number of robotic hysterectomies that was seen are consistent with national trends. The initiation of a robotic training program did not prevent the proliferation of use of the robot but did aim to ensure proficiency on the robot prior to gaining privileges for patient use. This type of comprehensive training and monitoring program could be applied to future technologic advances to ensure a standard level of surgical proficiency. Trends in route of hysterectomy are clearly multifactorial and involve patient, provider, and location-specific factors that are likely to continue to change.
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Changes in Hysterectomy Route and Adnexal Removal for Benign Disease in Australia 2001-2015: A National Population-Based Study. Minim Invasive Surg 2018; 2018:5828071. [PMID: 29955395 PMCID: PMC6000851 DOI: 10.1155/2018/5828071] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 04/07/2018] [Accepted: 04/26/2018] [Indexed: 01/21/2023] Open
Abstract
Objective Hysterectomy rates have fallen over recent years and there remains debate whether salpingectomy should be performed to reduce the lifetime risk of ovarian cancer. We examined trends in adnexal removal and route of hysterectomy in Australia between 2001 and 2015. Methods Data were obtained from the national procedural dataset for hysterectomy approach (vaginal, VH; abdominal, AH; and, laparoscopic, LH) and rates of adnexal removal, as well as endometrial ablation. The total female population in two age groups (“younger age group,” 35 to 54 years, and “older age group,” 55 to 74 years) was obtained from the Australian Bureau of Statistics. Results The rate of hysterectomy fell in both younger (61.7 versus 45.2/10000/year, p < 0.005) and older (38.8 versus 33.2/10000/year, p < 0.005) age groups. In both age groups there were significant decreases in the incidence rates for VH (by 53% in the younger age group and 29% in the older age group) and AH (by 53% and 55%, respectively). The rates of LH increased by 153% in the younger age group and 307% in the older age group. Overall, the proportion of hysterectomies involving adnexal removal increased (31% versus 65% in the younger age group, p < 0.005; 44% versus 58% in the older age group, p < 0.005). The increase occurred almost entirely after 2011. Conclusion Hysterectomy is becoming less common, and both vaginal and abdominal hysterectomy are being replaced by laparoscopic hysterectomy. Removal of the adnexae is now more common in younger women.
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Borahay MA, Tapısız ÖL, Alanbay İ, Kılıç GS. Outcomes of robotic, laparoscopic, and open hysterectomy for benign conditions in obese patients. J Turk Ger Gynecol Assoc 2018; 19:72-77. [PMID: 29699956 PMCID: PMC5994808 DOI: 10.4274/jtgga.2018.0018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objective: To compare outcomes of robotic-assisted (RAH), total laparoscopic hysterectomy (LH), and total abdominal hysterectomy (TAH) for benign conditions in obese patients. Material and Methods: Retrospective cohort (Class II-2) analysis. All obese patients who underwent RAH, LH or TAH for benign conditions by a single surgeon at the University of Texas Medical Branch between January 2009 and December 2011 were identified and their charts reviewed. The patients’ characteristics, operative data, and post-operative outcomes were collected and statistically analyzed. Results: A total of 208 patients who underwent RAH (n=51), LH (n=24) or TAH (n=133) were analyzed. There were no significant differences among the groups in demographic characteristics, indications for surgery or pathologic findings. RAH and LH were associated with lower estimated blood loss (EBL) (p<0.001) and shorter length of hospital stay (LOS) (p<0.001) compared with TAH. In addition, RAH and LH had lower intraoperative and early postoperative (≤6 weeks) complications compared with TAH (p=0.002). However, the procedure time was longer in RAH and LH (p<0.001). No significant differences were noted among the groups for late post-operative complications (after 6 weeks) or unscheduled post-operative visits. Conclusion: Minimally invasive hysterectomy appears to be safe in obese patients with the advantages of less EBL, fewer intraoperative complications, and shorter LOS.
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Affiliation(s)
- Mostafa A Borahay
- Department of Obstetrics and Gynecology, Johns Hopkins University, Maryland, USA,Department of Obstetrics and Gynecology, University of Texas Medical Branch, Texas, USA
| | - Ömer Lütfi Tapısız
- Department of Obstetrics and Gynecology, University of Health Sciences, Etlik Zübeyde Hanım Women’s Diseases Training and Research Hospital, Ankara, Turkey
| | - İbrahim Alanbay
- Department of Obstetrics and Gynecology, University of Health Sciences, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Gökhan Sami Kılıç
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Texas, USA
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3 mm Senhance robotic hysterectomy: a step towards future perspectives. J Robot Surg 2018; 12:575-577. [DOI: 10.1007/s11701-018-0778-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 01/12/2018] [Indexed: 10/18/2022]
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Moawad G, Liu E, Song C, Fu AZ. Movement to outpatient hysterectomy for benign indications in the United States, 2008-2014. PLoS One 2017; 12:e0188812. [PMID: 29190666 PMCID: PMC5708798 DOI: 10.1371/journal.pone.0188812] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 10/30/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The past decade has witnessed adoption of conservative gynecologic treatments, including minimally invasive surgery (MIS), alongside steady declines in inpatient hysterectomies. It remains unclear what factors have contributed to trends in outpatient benign hysterectomy (BH), as well as whether these trends exacerbate disparities. MATERIALS AND METHODS Retrospective cohort of 527,964 women ≥18 years old who underwent BH from 2008 to 2014. BH surgical approaches included: open/abdominal hysterectomy (AH), vaginal hysterectomy (VH), laparoscopic hysterectomy (LH), and robotic-assisted hysterectomy (RH). Quarterly frequencies were calculated by care setting and surgical approach. We used multilevel logistic regression (MLR) using the most recent year of data (2014) to examine the influence of patient-, physician-, and hospital-level preoperative factors and surgical approaches on outpatient migration. RESULTS From 2008-2014, surgical approaches for LH and RH increased, which coincided with decreases in VH and AH. Overall, a 44.2% shift was observed from inpatient to outpatient settings (P<0.0001). Among all outpatient visits MIS increased, particularly for RH (3.6% to 41.07%). We observed increases in the proportion of non-Hispanic Black and Medicaid patients who obtained MIS in 2014 vs. 2008 (P<0.001). Surgical approach (51.8%) and physician outpatient MIS experience (19.9%) had the greatest influence on predicting outpatient BH. Compared with LH, RH was associated with statistically significantly higher likelihood of outpatient BH overall (OR 1.23; 95% CI, 1.16-1.31), as well as in sub-analyses of more complex cases and hospitals that performed ≥1 RH (P<0.05). CONCLUSION From 2008-2014, rates of LH and RH significantly increased. A significant shift from inpatient to outpatient setting was observed. These findings suggest that RH may facilitate the shift to outpatient BH, particularly for patients with complexities. The adoption of MIS in outpatient settings may improve access to disadvantaged patient groups.
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Affiliation(s)
- Gaby Moawad
- George Washington University, Washington, DC, United States of America
| | - Emelline Liu
- Intuitive Surgical, Inc, Sunnyvale, California, United States of America
| | - Chao Song
- Intuitive Surgical, Inc, Sunnyvale, California, United States of America
| | - Alex Z. Fu
- Georgetown University Medical Center, Washington, DC, United States of America
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Katon JG, Gray K, Callegari L, Gardella C, Gibson C, Ma E, Lynch KE, Zephyrin L. Trends in hysterectomy rates among women veterans in the US Department of Veterans Affairs. Am J Obstet Gynecol 2017; 217:428.e1-428.e11. [PMID: 28578175 DOI: 10.1016/j.ajog.2017.05.057] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 05/09/2017] [Accepted: 05/23/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prior studies demonstrate a higher prevalence of hysterectomy among veterans compared with nonveterans. While studies identify overall decreasing hysterectomy rates in the United States, none report rates of hysterectomy among women veterans. Given the increasing numbers of women veterans using Veterans Affairs health care, there is an ongoing need to ensure high-quality gynecology care. Therefore, it is important to examine current hysterectomy trends, including proportion of minimally invasive surgeries, among veterans using Veterans Affairs health care. OBJECTIVE Our objective was to describe hysterectomy trends and utilization of minimally invasive hysterectomy in the Veterans Affairs healthcare system. STUDY DESIGN This longitudinal study used Veterans Affairs clinical and administrative data from fiscal year 2008 to 2014 to identify hysterectomies provided or paid for by Veterans Affairs. Crude and age-adjusted hysterectomy rates were calculated by indication (benign or malignant), mode (abdominal, laparoscopic, vaginal, robotic assisted, unspecified), and source of care (provided vs paid for by Veterans Affairs). Mode and indication for hysterectomy were classified using International Classification of Diseases, ninth revision, codes. The distribution of hysterectomy mode in each year was calculated by indication and source of care. RESULTS Between fiscal year 2008 and fiscal year 2014, the total hysterectomy rate decreased from 4.0 per 1000 to 2.6 per 1000 unique women veteran Veterans Affairs users. Age-adjusted rates of abdominal hysterectomy for benign indications decreased over the study period from 1.54 per 1000 (95% confidence interval, 1.40-1.69) to 0.77 per 1000 (95% confidence interval, 0.69-0.85) for procedures provided by Veterans Affairs and 0.77 per 1,000 (95% confidence interval, 0.69-0.85) to 0.29 per 1,000 (95% confidence interval, 0.23-0.34) for those paid for by Veterans Affairs. Among hysterectomies for benign indications provided by (n = 5296) or paid for (n = 2610) by Veterans Affairs, the percentage of hysterectomies performed abdominally decreased from 67.2% to 46.8% and from 68.9% to 57.6%, respectively. CONCLUSION These findings suggest that gynecology care provided within Veterans Affairs has kept pace with national trends in reducing hysterectomy rates and increasing utilization of minimally invasive surgical techniques.
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Affiliation(s)
- Jodie G Katon
- Health Services Research and Development Center of Innovation for Veteran-Centered and Value Driven Care, US Department of Veterans Affairs, Veterans Affairs Puget Sound Healthcare System, Seattle, WA; Department of Health Services, University of Washington School of Public Health, Seattle, WA.
| | - Kristen Gray
- Health Services Research and Development Center of Innovation for Veteran-Centered and Value Driven Care, US Department of Veterans Affairs, Veterans Affairs Puget Sound Healthcare System, Seattle, WA; Department of Health Services, University of Washington School of Public Health, Seattle, WA
| | - Lisa Callegari
- Health Services Research and Development Center of Innovation for Veteran-Centered and Value Driven Care, US Department of Veterans Affairs, Veterans Affairs Puget Sound Healthcare System, Seattle, WA; Department of Health Services, University of Washington School of Public Health, Seattle, WA; Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA
| | - Carolyn Gardella
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA; Veterans Affairs Puget Sound Healthcare System Medical Center, Seattle, WA
| | - Carolyn Gibson
- San Francisco Veterans Affairs Health Care System, San Francisco, CA; Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Erica Ma
- Health Services Research and Development Center of Innovation for Veteran-Centered and Value Driven Care, US Department of Veterans Affairs, Veterans Affairs Puget Sound Healthcare System, Seattle, WA
| | - Kristine E Lynch
- Department of Veterans Affairs, Salt Lake City Health Care System, Salt Lake City, UT; Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Laurie Zephyrin
- Women's Health Services, Veterans Affairs Office of Patient Care Services, Washington, DC; Department of Obstetrics and Gynecology, New York University Langone School of Medicine, New York, NY
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Keurentjes JHM, Briët JM, de Bock GH, Mourits MJE. Surgical volume and conversion rate in laparoscopic hysterectomy: does volume matter? A multicenter retrospective cohort study. Surg Endosc 2017; 32:1021-1026. [PMID: 28842767 PMCID: PMC5772131 DOI: 10.1007/s00464-017-5780-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 07/28/2017] [Indexed: 11/05/2022]
Abstract
Background A multicenter, retrospective, cohort study was conducted in the Netherlands. The aim was to evaluate whether surgical volume of laparoscopic hysterectomies (LHs) performed by proven skilled gynecologists had an impact on the conversion rate from laparoscopy to laparotomy. Methods In 14 hospitals, all LHs performed by 19 proven skilled gynecologists between 2007 and 2010 were included in the analysis. Surgical volume, conversion rate and type of conversion (reactive or strategic) were retrospectively assessed. To estimate the impact of surgical volume on the conversion rate, logistic regressions were performed. These regressions were adjusted for patient’s age, Body Mass Index (BMI), ASA classification, previous abdominal surgery and the indication (malignant versus benign) for the LH. Results During the study period, 19 proven skilled gynecologists performed a total of 1051 LHs. Forty percent of the gynecologists performed over 20 LHs per year (median 17.3, range 5.4–49.5). Conversion to laparotomy occurred in 5.0% of all LHs (53 of 1051); 38 (3.6%) were strategic and 15 (1.4%) were reactive conversions. Performing over 20 LHs per year was significantly associated with a lower overall conversion rate (ORadjusted 0.43, 95% CI 0.24–0.77), a lower strategic conversion rate (ORadjusted 0.32, 95% CI 0.16–0.65), but not with a lower reactive conversion rate (ORadjusted 0.96, 95% CI 0.33–2.79). Conclusion A higher annual surgical volume of LHs by proven skilled gynecologists is inversely related to the conversion rate to laparotomy, and results in a lower strategic conversion rate.
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Affiliation(s)
- José H M Keurentjes
- Department of Gynaecologic Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Justine M Briët
- Department of Gynaecologic Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marian J E Mourits
- Department of Gynaecologic Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Lonky NM, Mohan Y, Chiu VY, Park J, Kivnick S, Hong C, Hudson SM. Hysterectomy for benign conditions: Complications relative to surgical approach and other variables that lead to post-operative readmission within 90 days of surgery. WOMEN'S HEALTH (LONDON, ENGLAND) 2017; 13:17-26. [PMID: 28660800 PMCID: PMC5557180 DOI: 10.1177/1745505717714657] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 05/11/2017] [Accepted: 05/15/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine variables associated with hysterectomy-related complications, relative to surgical approach and other variables, that lead to readmission within 90 days of surgery. METHODS We conducted an observational cohort study for which data were extracted from electronic health records. Data were extracted of all patients (n = 3106) who underwent hysterectomies at 10 Kaiser Permanente Southern California medical centers between June 2010 and September 2011. Patients who were pregnant or had a cancer diagnosis were excluded from the study. To identify univariate associations between examined variables and procedure type, chi-square tests for categorical variables and t-tests or analysis of variance for continuous variables were used. Generalized estimating equations methods were used to test associations between independent variables and primary outcomes of interest. Statistical significance was determined using a p-value <.05. RESULTS Of 3106 patients, 109 experienced 168 post-operative complications. The most common post-operative complications were related to pelvic abscesses, bowel obstruction, or severe ileus, and the vaginal cuff. Pelvic abscesses were most frequent among total laparoscopic hysterectomy and total abdominal hysterectomy cases (p = .002), and vaginal cuff complications were most frequent among total laparoscopic hysterectomy cases (p = .015). Patients who underwent total vaginal hysterectomy (odds ratio = 2.13, confidence interval = 1.15-3.92), laparoscopic supracervical hysterectomy (odds ratio = 3.11, confidence interval = 1.13-8.57), and total laparoscopic hysterectomy (odds ratio = 5.60, confidence interval = 2.90-10.79) experienced increased occurrence of post-operative complications resulting in readmission. Other variables associated with an increased risk for readmission included high estimated blood loss (201-300 mL and 301+ mL, relative to 0-50 mL; odds ratio = 2.28, confidence interval = 1.24-4.18 and odds ratio = 2.63, confidence interval = 1.67-4.14) and long length of stay of 3 days or more (relative to 0 days; odds ratio = 2.93, confidence interval = 1.28-6.69). Pelvic specimen weight in the 151-300 g and 501+ g ranges appeared protective (odds ratio = 0.40, confidence interval = 0.25-0.64 and odds ratio = 0.54, confidence interval = 0.33-0.90). In a sub-analysis of 1294 patients, 74 hospital operative complications directly related to hysterectomy were identified among 59 patients. The most common hospital operative complications were excessive bleeding associated with surgery or injury to nearby structures. Among the sub-sample of 1294 patients, those with hospital operative complications were more likely to experience post-operative complications that lead to readmission (odds ratio = 3.82, confidence interval = 1.55-9.43, p = .004). CONCLUSION The observed increased risk of complications among patients of Black race, who underwent laparoscopic supracervical hysterectomy or total laparoscopic hysterectomy, who experienced more than 300 mL surgical blood loss, who suffered hospital operative complications, and those whose hospitalization was 3 days or greater, offers an opportunity for higher scrutiny and preventive measures during usual hysterectomy care to prevent later readmission.
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Affiliation(s)
- Neal M Lonky
- Department of Obstetrics and Gynecology, Kaiser Permanente Southern California, Anaheim, CA, USA
| | - Yasmina Mohan
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Vicki Y Chiu
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Jeanna Park
- University of California, Irvine, CA, USA
- Department of Obstetrics and Gynecology, University of Illinois, Chicago, IL, USA
| | - Seth Kivnick
- Department of Obstetrics and Gynecology, Kaiser Permanente Southern California, Los Angeles, CA, USA
| | - Christina Hong
- Department of Obstetrics and Gynecology, Kaiser Permanente Southern California, Anaheim, CA, USA
| | - Sharon M Hudson
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
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Huang CC, Huang YT, Chueh PJ, Wu MP. The laparoscopic approach is more preferred among nurses for benign gynecologic conditions than among nonmedical working women: A nationwide study in Taiwan. Taiwan J Obstet Gynecol 2017; 55:229-34. [PMID: 27125406 DOI: 10.1016/j.tjog.2015.10.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2015] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To compare the use of laparoscopy and laparotomy for hysterectomy in treating benign gynecological conditions in nurses and nonmedical working women. MATERIALS AND METHODS A nationwide population-based study was conducted using data from inpatient expenditures of Taiwan's National Health Insurance Research Datasets between 2008 and 2011. All women undergoing total hysterectomies via laparoscopy and laparotomy between the ages of 20 years and 65 years were identified. A generalized equation estimation model was used to compare the differences in laparoscopic hysterectomy (LH) and total abdominal hysterectomy (TAH) between the two groups. RESULTS There were 1226 nurses, and 36,624 nonmedical working women, serving as controls, in the present study. The LH rate, as compared to the TAH rate, was significantly higher among nurses than among controls (56% vs. 52%, p = 0.006). A multivariate analysis indicated that nurses were significantly more likely to undergo LH (odds ratio, 1.12; 95% confidence interval, 1.01-1.26) than TAH. Nurses were more often treated at medical centers or high-volume hospitals, and were more often treated by high-volume gynecologists. CONCLUSION Compared to nonmedical working women, nurses are more likely to undergo LH rather than TAH. These differences may suggest the influence of medical knowledge and physician-patient interaction on the decision to undergo laparoscopy, in addition to patients' medical conditions.
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Affiliation(s)
- Chun-Che Huang
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Yu-Tung Huang
- Master Degree Program in Aging and Long-Term Care, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Ju Chueh
- Department of Obstetrics and Gynecology, Chi Mei Foundation Hospital, Tainan, Taiwan
| | - Ming-Ping Wu
- Department of Obstetrics and Gynecology, Chi Mei Foundation Hospital, Tainan, Taiwan; Department of Obstetrics and Gynecology, College of Medicine, Taipei Medical University, Taipei, Taiwan; Center of General Education, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
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Alston MJ, Metz TD, Fothergill R, (Meg) Autry A, Wagner SA, Allshouse AA, Stephenson-Famy A. Factors Influencing Residency Program Selection by Medical Students Pursuing Obstetrics and Gynecology. J Grad Med Educ 2017; 9:123-127. [PMID: 28261407 PMCID: PMC5319611 DOI: 10.4300/jgme-d-16-00148.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Little is known about the factors that influence medical student selection of obstetrics and gynecology (ob-gyn) residency programs. OBJECTIVE We assessed the factors influencing residency program selection by fourth-year medical students pursuing ob-gyn training. METHODS A voluntary, anonymous, 19-question survey of residency selection factors was distributed to all fourth-year medical students interviewing at 1 of 5 academic ob-gyn departments for a residency position during the 2013-2014 interview season. Participants were surveyed about the relative importance (not important, somewhat important, important) of various residency selection factors, including operative experience, exposure to subspecialties, curricular experience, access to fellowships, and administrative aspects of residency, including adherence to duty hour restrictions. RESULTS Of 322 potential respondents, 262 (81%) completed the survey. Surgical training and training in laparoscopic surgery were deemed "important" by nearly all respondents (98%, 258 of 262, and 97%, 253 of 262, respectively). Factors that were considered "not important" by a significant group of respondents included maternity/paternity leave policies (22%, 58 of 259); opportunity for international rotations/electives (20%, 51 of 259); exposure to quality and safety initiatives (13%, 34 of 259); and training in abortion (13%, 34 of 262). CONCLUSIONS Fourth-year medical students identified surgical training as the most important factor in selecting an ob-gyn residency, a finding that is particularly relevant as decreasing and changing surgical volumes affect residency training in this specialty.
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Affiliation(s)
| | | | | | | | | | | | - Alyssa Stephenson-Famy
- Corresponding author: Alyssa Stephenson-Famy, MD, University of Washington School of Medicine, Department of Obstetrics & Gynecology, Box 356460, Seattle, WA 98195-6460, 206.543.3729, fax 206.543.3915,
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Abstract
Within the last 10 years there have been significant advances in minimal-access surgery. Although no emerging technology has demonstrated improved outcomes or fewer complications than standard laparoscopy, the introduction of the robotic surgical platform has significantly lowered abdominal hysterectomy rates. While operative time and cost were higher in robotic-assisted procedures when the technology was first introduced, newer studies demonstrate equivalent or improved robotic surgical efficiency with increased experience. Single-port hysterectomy has not improved postoperative pain or subjective cosmetic results. Emerging platforms with flexible, articulating instruments may increase the uptake of single-port procedures including natural orifice transluminal endoscopic cases.
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Desai VB, Guo XM, Fan L, Wright JD, Xu X. Inpatient Laparoscopic Hysterectomy in the United States: Trends and Factors Associated With Approach Selection. J Minim Invasive Gynecol 2017; 24:151-158.e1. [DOI: 10.1016/j.jmig.2016.08.830] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 08/24/2016] [Accepted: 08/27/2016] [Indexed: 10/21/2022]
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Callegari LS, Gray KE, Zephyrin LC, Harrington LB, Gerber MR, Cochrane BB, Weitlauf JC, Bean-Mayberry B, Bastian LA, Mattocks KM, Haskell SG, Katon JG. Hysterectomy and Bilateral Salpingo-Oophorectomy: Variations by History of Military Service and Birth Cohort. THE GERONTOLOGIST 2016; 56 Suppl 1:S67-77. [PMID: 26768393 DOI: 10.1093/geront/gnv666] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Little is known about hysterectomy and bilateral salpingo-oophorectomy (BSO), which are associated with both health risks and benefits, among women Veterans. PURPOSE OF THE STUDY To compare the prevalence of hysterectomy with or without BSO, and early hysterectomy, between postmenopausal Veterans and non-Veterans. DESIGN AND METHODS We used baseline data from the Women's Health Initiative Clinical Trial and Observational Study. Multinomial logistic regression models examined differences in the prevalence of hysterectomy (neither hysterectomy nor BSO, hysterectomy without BSO, and hysterectomy with BSO) between Veterans and non-Veterans. Generalized linear models were used to determine whether early hysterectomy (before age 40) differed between Veterans and non-Veterans. Analyses were stratified by birth cohort (<65, ≥65 years at enrollment). RESULTS The unadjusted prevalence of hysterectomy without BSO was similar among Veterans and non-Veterans in both birth cohorts (<65: 22% vs 21%; ≥65: 22% vs 21%). The unadjusted prevalence of hysterectomy with BSO was equivalent among Veterans and non-Veterans in the >65 cohort (21%), but higher among Veterans in the <65 cohort (22% vs 19%). In adjusted analyses, although no differences were observed in the >65 cohort, Veterans in the <65 cohort had higher odds of hysterectomy without BSO (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.03, 1.36) and with BSO (OR 1.26, 95% CI 1.10, 1.45), as well as elevated risk of early hysterectomy (relative risk 1.32, 95% CI 1.19, 1.47), compared with non-Veterans. IMPLICATIONS Aging women Veterans may have higher prevalence of hysterectomy and BSO than non-Veterans. This information contributes to understanding the health needs and risks of women Veterans and can inform clinical practice and policy for this population.
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Affiliation(s)
- Lisa S Callegari
- Department of Obstetrics and Gynecology, University of Washington, Seattle. VA Puget Sound Health Care System, Health Services Research and Development (HSR&D), Seattle, Washington.
| | - Kristen E Gray
- VA Puget Sound Health Care System, Health Services Research and Development (HSR&D), Seattle, Washington. Department of Health Services, University of Washington School of Public Health, Seattle
| | - Laurie C Zephyrin
- VA Office of Patient Care, Women's Health Services, Washington, DC. VA New York Harbor. Department of Obstetrics and Gynecology, New York University Langone School of Medicine. Department of Veterans Affairs, Veterans Health Administration, Washington, DC
| | - Laura B Harrington
- Department of Epidemiology, University of Washington School of Public Health, Seattle
| | - Megan R Gerber
- VA Boston Healthcare System, Massachusetts. Department of Medicine, Boston University School of Medicine, Massachusetts
| | - Barbara B Cochrane
- de Tornyay Center for Healthy Aging, University of Washington School of Nursing, Seattle. Fred Hutchinson Cancer Research Center, Public Health Sciences, Seattle, Washington
| | - Julie C Weitlauf
- VA Palo Alto Health Care System, California. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, California
| | - Bevanne Bean-Mayberry
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Health Care System, California. Division of General Internal Medicine, David Geffen School of Medicine, University of California Los Angeles
| | - Lori A Bastian
- VA Connecticut, West Haven. Division of General Internal Medicine, University of Connecticut, Farmington
| | - Kristin M Mattocks
- VA Central Western Massachusetts, Leeds. University of Massachusetts Medical School, Worcester
| | - Sally G Haskell
- VA Office of Patient Care, Women's Health Services, Washington, DC. VA Connecticut Health Care System, New Haven
| | - Jodie G Katon
- VA Puget Sound Health Care System, Health Services Research and Development (HSR&D), Seattle, Washington. Department of Health Services, University of Washington School of Public Health, Seattle. VA Office of Patient Care, Women's Health Services, Washington, DC
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Comparison of postoperative vaginal length and sexual function after abdominal, vaginal, and laparoscopic hysterectomy. Int J Gynaecol Obstet 2015; 132:39-41. [DOI: 10.1016/j.ijgo.2015.07.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 06/23/2015] [Accepted: 09/24/2015] [Indexed: 11/23/2022]
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