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Patel NA, Acharya N, Borkar K. Transcatheter Uterine Artery Embolisation in Treating Secondary Haemorrhage Post Hysterectomy: A Life-Saving Approach. Cureus 2022; 14:e30249. [PMID: 36381840 PMCID: PMC9652743 DOI: 10.7759/cureus.30249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022] Open
Abstract
Hysterectomy, which is a surgical procedure to remove all or a part of the uterus, is one of the most commonly done procedures by a gynaecologist. However, it may be associated with a number of complications. Haemorrhage following hysterectomy is a life-threatening complication. One of the most common complications is haemorrhage, whether primary or secondary. The various options to treat secondary haemorrhage post hysterectomy are uterine artery embolization (UAE) or surgical re-exploration. Here, we present a case of secondary haemorrhage post hysterectomy treated with uterine artery embolization and describe the numerous advantages of UAE as a novel approach to stop bleeding post hysterectomy over the traditional surgical re-exploration method.
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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] [Track Full Text] [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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Bauer E, Scholz C, Schochter F, De Gregoriod N, Janni W, Widschwendter P. Hysterektomie – operative Innovationen in der Gynäkologie am Beispiel einer „alten“ Operation. DER GYNÄKOLOGE 2018. [DOI: 10.1007/s00129-018-4307-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Huang WY, Huang KH, Chang WC, Wu SC. Temporal trend and nationwide utility for hysterectomies in Taiwan, 1997-2010. Taiwan J Obstet Gynecol 2017; 55:659-665. [PMID: 27751412 DOI: 10.1016/j.tjog.2015.12.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study investigates the nationwide utilization and temporal trend of hysterectomies in Taiwan. MATERIALS AND METHODS The present study used the National Health Insurance Research Database that included claims of nearly the entire population in Taiwan since the inception of the National Health Insurance program in 1995. We analyzed age-adjusted rates of hysterectomies in Taiwan from 1997 through to 2010 and compared with the rates in 16 countries of the Organization for Economic Co-operation and Development. We also examined the utilization of various types of hysterectomies in Taiwan during this period. RESULTS There was a cross-country variation in the age-standardized rate of hysterectomy: 105 per 100,000 females in Spain, 156 per 100,000 females in Taiwan, 179 per 100,000 females in 16 Organization for Economic Co-operation and Development countries, and 325 per 100,000 females in the United States in 2008. The trend of the age-standardized rate of hysterectomy in Taiwan declined from 222.3 per 100,000 women in 1998 to 145.2 per 100,000 women in 2010. The most common type of hysterectomy during this period was total abdominal hysterectomy (51.2%). Subtotal hysterectomies increased by 117% (r2=0.89; p<0.01), from 672 in 1997 to 1458 in 2010; however, total hysterectomies decreased by 3.5% (r2=0.43; p=0.01), from 20,966 in 1997 to 20,230 in 2010. Laparoscopically assisted procedures (laparoscopic supracervical hysterectomy and laparoscopic hysterectomy) increased 4.98-fold (r2=0.23; p=0.09), from 1453 in 1997 to 8684 in 2010. By contrast, the proportion of conventional open hysterectomies (total abdominal hysterectomy, and subtotal or supracervical abdominal hysterectomy) decreased by 36.5% (r2=0.59; p<0.01), from 17,327 in 1997 to 10,994 in 2010. The proportion of vaginal hysterectomies decreased by 29.7% (r2=0.72; p<0.01), from 2858 in 1997 to 2010 in 2010. CONCLUSION As in most Western countries, hysterectomy rates in Taiwan declined by year. There was a marked shift in the types of hysterectomies from 1997 through to 2010 in Taiwan. Minimally invasive surgeries and supracervical hysterectomies were more commonly adopted.
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Affiliation(s)
- Wei-Yi Huang
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan; Research and Planning Division, Department of Health, Taipei City Government, Taiwan
| | - Kuo-How Huang
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Chun Chang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shiao-Chi Wu
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan.
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Serati M, Rizk D, Savatore S. In the footsteps of Bonney and Nichols: hysterectomy during surgical repair of pelvic organ prolapse. Int Urogynecol J 2016; 28:823-825. [PMID: 27704153 DOI: 10.1007/s00192-016-3163-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 09/09/2016] [Indexed: 11/30/2022]
Abstract
Based on the available urogynecological literature, the role of hysterectomy in the surgical strategy of pelvic organ prolapse (POP) repair remains controversial. Currently, there are no data to favor either the removal or preservation of the uterus in women with POP. The findings that hysterectomy may contribute to a higher success rate and to the development of urinary incontinence and/or female sexual dysfunction are not supported by evidence. It is not clear why both hysteropexy was sometimes performed in the presence of overt uterine prolapse and/or concomitant vaginal hysterectomy was often included in vaginal prolapse repair in the absence of uterine prolapse. In our opinion, it makes both anatomical and clinical sense to remove the uterus only (and always) when the uterus is one of the pelvic organs directly involved in the prolapse, but to preserve and suspend the uterus otherwise.
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Affiliation(s)
- Maurizio Serati
- Department of Obstetrics and Gynecology, Urogynecology Unit, University of Insubria, Piazza Biroldi 1, 21100, Varese, Italy.
| | - Diaa Rizk
- Department of Obstetrics and Gynecology, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Stefano Savatore
- Obstetrics and Gynecology Unit, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Milan, Italy
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Wu CJ, Tseng CW, Wu MP. Laparoscopic subtotal hysterectomy in the era of minimally invasive surgery. Gynecol Minim Invasive Ther 2015. [DOI: 10.1016/j.gmit.2014.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Bardens D, Solomayer E, Baum S, Rody A, Juhasz-Böss I. Comparison of Total and Supracervical Laparoscopic Hysterectomy for Benign Disease in a Collective of 200 Patients. J Gynecol Surg 2012. [DOI: 10.1089/gyn.2012.0016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- David Bardens
- Department of Obstetrics and Gynecology, Saarland University Clinic, Homburg/Saar, Germany
| | - Erich Solomayer
- Department of Obstetrics and Gynecology, Saarland University Clinic, Homburg/Saar, Germany
| | - Sascha Baum
- Department of Obstetrics and Gynecology, Saarland University Clinic, Homburg/Saar, Germany
| | - Achim Rody
- Department of Obstetrics and Gynecology, Saarland University Clinic, Homburg/Saar, Germany
| | - Ingolf Juhasz-Böss
- Department of Obstetrics and Gynecology, Saarland University Clinic, Homburg/Saar, Germany
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Trends in Various Types of Surgery for Hysterectomy and Distribution by Patient Age, Surgeon Age, and Hospital Accreditation: 10-Year Population-Based Study in Taiwan. J Minim Invasive Gynecol 2010; 17:612-9. [DOI: 10.1016/j.jmig.2010.04.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 04/12/2010] [Accepted: 04/23/2010] [Indexed: 11/18/2022]
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Long-term outcomes following laparoscopic and abdominal supracervical hysterectomies. Obstet Gynecol Int 2010; 2010:989127. [PMID: 20300594 PMCID: PMC2838221 DOI: 10.1155/2010/989127] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Accepted: 02/02/2010] [Indexed: 11/18/2022] Open
Abstract
Long-term outcomes, in terms of cervical stump symptoms and overall patient satisfaction, were studied in women both after abdominal (SAH) and laparosocopic (LSH) supracervical hysterectomies. Altogether, 134 women had SAH and 315 women LSH during 2004 and 2005 at our department. The response rate of this retrospective study was 79%. Persistent vaginal bleeding after the surgery was reported by 17% in the SAH group and 24% in the LSH group. Regular bleeding was reported by only 8% in both study groups, and the women rarely found the bleeding bothersome. The women reported a significant pain reduction after the surgery, but women having a hysterectomy because of pain and/or endometriosis should be informed about the possibility of persistent symptoms. The overall patient satisfaction after both procedures was high, but the patients should have proper preoperative information about the possibility of cervical stump symptoms after any supracervical hysterectomy.
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Yang Z, Cao YD, Hu LN, Wang ZB. Feasibility of laparoscopic high-intensity focused ultrasound treatment for patients with uterine localized adenomyosis. Fertil Steril 2009; 91:2338-43. [DOI: 10.1016/j.fertnstert.2008.03.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2007] [Revised: 03/05/2008] [Accepted: 03/06/2008] [Indexed: 11/29/2022]
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Lieng M, Qvigstad E, Istre O, Langebrekke A, Ballard K. Long-term outcomes following laparoscopic supracervical hysterectomy. BJOG 2008; 115:1605-10. [PMID: 18752588 DOI: 10.1111/j.1471-0528.2008.01854.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Evaluation of long-term outcomes following laparoscopic supracervical hysterectomy (LSH). DESIGN Retrospective postal questionnaire. SETTING Norwegian university teaching hospital. POPULATION A total of 315 consecutive patients. METHODS A questionnaire sent to all patients who underwent a LSH during 2004 and 2005. MAIN OUTCOME MEASURES Persistent vaginal bleeding and pelvic pain, patient acceptability of such symptoms and patient satisfaction following LSH. RESULTS A total of 240 women (78%) completed the questionnaire. About 24% reported experiencing vaginal bleeding up to 3 years following their hysterectomy, although this was rated as minimal in 90% of cases, resulting in a mean bothersome score of 1.1 (SD 2.0) on a 10-point visual analogue scale (VAS). Women operated on by less experienced surgeons were more likely to report vaginal bleeding following surgery (P = 0.02). About 74% of women reported having menstrual pain prior to surgery, with a mean score of 6.8 (SD 2.1) (10-point VAS). Up to 3 years following surgery, 38% continued to experience menstrual pain, although this was significantly less intense with a mean score of 3.5 (SD 2.2) (P < 0.01). While all women reported a decrease in the amount of pain experienced following the hysterectomy, those having a hysterectomy because of endometriosis reported significantly higher levels of menstrual/cyclical pain after surgery compared with women who had a hysterectomy for other reasons (P < 0.01). Ninety per cent of women reported being satisfied with their surgery. CONCLUSION Although vaginal bleeding and pelvic pain are frequently observed following LSH, these symptoms are significantly reduced and patient satisfaction is high.
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Affiliation(s)
- M Lieng
- Department of Gynaecology and Obstetrics, Ullevål University Hospital, Oslo, Norway.
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Abstract
OBJECTIVE To review postmenopausal hormone therapy for women who have undergone hysterectomy with or without bilateral oophorectomy and to make clinical recommendations regarding changes in regimens compared with those for women with their uterus in place. DESIGN We conducted a literature review, including a review of current guidelines. RESULTS When the uterus is absent, estrogen treatment is all that is needed when hot flashes and/or genital atrophic symptoms are associated with surgical or natural menopause. Reasons to add a progestogen to an estrogen-only therapy regimen after hysterectomy include the need to reduce the risk for unopposed estrogen-dependent conditions, chief among which are endometriosis or endometrial neoplasia. Multiple lines of evidence suggest that regimens containing both estrogen and progestogen versus estrogen alone are associated with a greater relative risk of breast cancer without additional improvement in relief of hot flashes or vaginal symptoms. When a bilateral oophorectomy is performed before natural menopause, the onset of menopausal symptoms, primarily vasomotor symptoms, genital tract atrophy, and/or a decline in sexual function, is rapid, and the symptoms are more severe. Thus, the need for a decision on the use of hormone therapy is accelerated. CONCLUSIONS The decision to use or not use menopausal hormone therapy in women without a uterus should involve an individualized risk/benefit analysis just as it should when the uterus is present. After hysterectomy, for most patients, current literature results favor not including a progestogen. Data suggest an attenuation of the potential cardiovascular benefit of estrogen therapy in this situation, yet no better protection against bone fractures and an increase in the risk for breast cancer when both estrogen and progestogen are used.
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Affiliation(s)
- Arthur F Haney
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, IL, USA
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Erian J, El-Shawarby SA, Hassan M, Wissa I, Chandakas S, Hill N. Laparoscopic subtotal hysterectomy using the plasma kinetic and lap loop systems: an alternative approach in the surgical management of women with uterine fibroids. Eur J Obstet Gynecol Reprod Biol 2007; 137:84-7. [PMID: 17291676 DOI: 10.1016/j.ejogrb.2007.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2006] [Revised: 01/08/2007] [Accepted: 01/09/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the safety and applicability of laparoscopic subtotal hysterectomy (LSH) using the plasma kinetic (PK) and lap loop systems as an alternative surgical approach in the management of uterine fibroids in women who have completed their families. STUDY DESIGN Sixty-two consecutive LSH were performed during this prospective study from March 2003 to March 2005 at Princess Royal University Hospital, Kent, UK. RESULTS All study patients had menorrhagia resistant to at least one form of therapy, with a mean duration of symptoms of 3.5 years. In addition, four patients had previous myomectomy. The mean number of fibroids removed was 2.7. The mean weight of the uterus was 141.9 g. The mean operative time was 46.8 min, and the mean blood loss was 126.6 mL. The overall perioperative complication rate was 4.8% with no visceral injury, or return to theatre. At follow-up, all patients were satisfied with surgery. CONCLUSION The study describes the first application of the PK and Lap Loop systems in LSH for the surgical management of uterine fibroids in women in whom fertility is not an issue, and its findings suggest that this minimally invasive technique is a safe, and valid alternative. Larger adequately-powered studies are however still required.
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Affiliation(s)
- John Erian
- Minimal Access Surgery Unit, Department of Obstetrics and Gynaecology, Princess Royal University Hospital, Orpington, Kent BR6 8ND, United Kingdom
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Istre O, Langebrekke A, Qvigstad E. Changing hysterectomy technique from open abdominal to laparoscopic: New trend in Oslo, Norway. J Minim Invasive Gynecol 2007; 14:74-7. [PMID: 17218234 DOI: 10.1016/j.jmig.2006.08.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2006] [Revised: 08/13/2006] [Accepted: 08/18/2006] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVE To evaluate the change in hysterectomy technique. DESIGN Retrospective study (Canadian Task Force classification XXX). SETTING University tertiary referring center in Norway. PATIENTS A total of 1963 women treated with hysterectomy over a 5-year period in Oslo. INTERVENTIONS The operative records and techniques were investigated in all treated patients. MEASUREMENTS AND MAIN RESULTS A total of 1963 hysterectomies were performed from 2001 through 2005. The operative patient records were investigated with the main focus on indication for surgery and the technique used in the operative procedure. In 2001, 62 (17.7%) laparoscopic hysterectomies were performed, while 256 (73.1%) of the hysterectomies were done with laparotomy. The operative technique has gradually changed during the last 5 years. In 2005, 220 (53.5%) of the surgical procedures were laparoscopic, 177 (43.1%) were done by laparotomy, while the vaginal approach in all these years was less than 10%. CONCLUSION From 2001 to 2005, a trend shift of the operative technique has been observed in Oslo, increasing the endoscopic hysterectomy rate from approximately 18% to 54%. During the same time, enlarged uteri with myomas equivalent to 10 to 12 weeks' gestation and endometrial cancer were more often treated by laparoscopic hysterectomy instead of open abdominal hysterectomy. With modern equipment and trained staff, more routine hysterectomies can be managed with laparoscopy.
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Affiliation(s)
- Olav Istre
- Department of Obstetrics and Gynecology, Ullevål University Hospital, University of Oslo, Oslo, Norway.
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