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Satorres E, Orive A, Ruiz C, Monleón J. [Uterine fibroid surgical treatment]. Med Clin (Barc) 2023; 161 Suppl 1:S22-S26. [PMID: 37923510 DOI: 10.1016/j.medcli.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/07/2023] [Accepted: 07/08/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Elena Satorres
- Servicio de Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Alba Orive
- Servicio de Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Carmen Ruiz
- Servicio de Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Javier Monleón
- Servicio de Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, España.
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Mokshagundam S, Harvey L, Crispens M, Heft J, Slocum P, Wang L, Zimmerman C. Vaginal Hysterectomy for the Treatment of Endometrial Cancer and Endometrial Intraepithelial Hyperplasia in Superobese Patients. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0219] [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)
- Shilpa Mokshagundam
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lara Harvey
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marta Crispens
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jessica Heft
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Paul Slocum
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Li Wang
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carl Zimmerman
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Rudnicki M, Shayo BC, Mchome B. Is abdominal hysterectomy still the surgery of choice in sub-Saharan Africa? Acta Obstet Gynecol Scand 2021; 100:715-717. [PMID: 33459353 DOI: 10.1111/aogs.14087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/06/2021] [Accepted: 01/13/2021] [Indexed: 11/28/2022]
Abstract
A trend toward minimally invasive surgery is increasing worldwide. However, reports on the extent and the role of vaginal or laparoscopic hysterectomy in benign gynecologic surgery in sub-Saharan Africa are scarce. Our commentary aims to highlight the existing gaps and potential barriers to implementation of vaginal or laparoscopic hysterectomy and suggests how to introduce and expand minimally invasive gynecologic surgery in this region. Little documentation exists in the literature to account for the role of minimally invasive surgery in the sub-Saharan Africa. Hysterectomy for benign reasons is commonly performed by the abdominal approach. This approach is accompanied by significant complications, prolonged hospitalization, and longer recovery duration. Our commentary highlights the importance of investigating region-specific barriers to the practice of minimally invasive gynecologic surgery in sub-Saharan Africa.
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Affiliation(s)
- Martin Rudnicki
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Benjamin C Shayo
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Moshi, Tanzania.,Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Bariki Mchome
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Moshi, Tanzania.,Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Chrysostomou A, Djokovic D, Edridge W, van Herendael BJ. Evidence-based practical guidelines of the International Society for Gynecologic Endoscopy (ISGE) for vaginal hysterectomy. Eur J Obstet Gynecol Reprod Biol 2020; 252:118-126. [PMID: 32599477 DOI: 10.1016/j.ejogrb.2020.06.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/10/2020] [Accepted: 06/15/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The study was established by the International Society for Gynecologic Endoscopy (ISGE) to provide evidence-based recommendations in the steps that should be undertaken in successfully performing a vaginal hysterectomy for a non-prolapsed uterus. MATERIAL AND METHODS The ISGE Task Force for vaginal hysterectomy for the non-prolapsed uterus defined key clinical questions regarding the surgical technique, which led the Medline/PubMed and the Cochrane Database literature search. Identified pertinent articles, published in English from 1997 to 2019, were analysed. The available information was graded by the level of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Working Group approach. The recommendations were developed through multiple cycles of literature analysis and expert discussion. RESULTS Six recommendations were established: 1. A circular incision at the level of cervico-vaginal junction is recommended (grade IC). 2. The posterior peritoneum should be opened first (grade IC). 3. Clamping and cutting the uterosacral and cardinal ligaments before or after getting access into anterior peritoneum is recommended (grade IC). 4. Routine closure of the peritoneum during vaginal hysterectomy is not recommended (grade IB). 5. Vertical or horizontal closure of the vaginal vault following vaginal hysterectomy is recommended (grade IC). 6. To insert a vaginal plug following vaginal hysterectomy is not recommended (grade IB). CONCLUSION Vaginal hysterectomy for a non-prolapsed uterus should be the preferential route for removing the uterus when hysterectomy is indicated. The ISGE provides evidence-based practical guidelines on how vaginal hysterectomy for non-prolapsed uterus should be undertaken. All efforts should be directed in teaching the surgical technique of vaginal hysterectomy during residency.
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Affiliation(s)
- Andreas Chrysostomou
- Department of Obstetrics and Gynaecology, University of the Witwatersrand, Johannesburg, South Africa
| | - Dusan Djokovic
- Department of Obstetrics and Gynecology, Nova Medical School - Faculdade de Ciências Médicas, Nova University of Lisbon, Lisbon, Portugal; Department of Obstetrics and Gynecology, Hospital S. Francisco Xavier - CHLO, Lisbon, Portugal.
| | - William Edridge
- Chris Hani Baragwanath Hospital, Soweto, University of Witwatersrand, Johannesburg, South Africa
| | - Bruno J van Herendael
- Stuivenberg General Hospital, Ziekenhuis Netwerk Antwerpen (ZNA), Antwerp, Belgium; Università degli Studi dell'Insubria, Varese, Italy
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Obermair A, Armfield NR, Graves N, Gebski V, Hanna GB, Coleman MG, Hughes A, Janda M. How to train practising gynaecologists in total laparoscopic hysterectomy: protocol for the stepped-wedge IMAGINE trial. BMJ Open 2019; 9:e027155. [PMID: 31072858 PMCID: PMC6528001 DOI: 10.1136/bmjopen-2018-027155] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Hysterectomy is the most common major gynaecological procedure in women and minimally invasive approaches should be used wherever possible; total laparoscopic hysterectomy (TLH) is one such surgical approach which allows removal of the uterus entirely laparoscopically. However, lack of surgical training opportunities is impeding its increased adoption. This study will formally test a surgical outreach training model to equip surgeons with the skills to provide TLH as an alternative to total abdominal hysterectomy (TAH). METHODS AND ANALYSIS Stepped wedge implementation trial of a surgical training programme for practising obstetrician gynaecologist specialists in four hospitals. PRIMARY OUTCOMES Change in the proportion of hysterectomies performed by TAH, measured between preintervention and postintervention; we aim to reduce TAH by at least 30% in 75% of the trainees. SECONDARY OUTCOMES (1) Number of hospitals screened, eligible, agree to training and complete the training; (2) number of surgeons screened for eligibility, eligible, agree to training, who complete training and achieve proficiency; (3) proportion of trainees achieving proficiency in correct theatre setup, vascular exposure, mobilisation and surgery closure; change in proportion proficient over time; (4) adverse events (conversion from TLH to TAH, anaesthetic incident, intraoperative visceral injury, red cell transfusions, hospital stay >7 days, incidental finding of malignancy, unplanned readmission, admission to intensive care, return to theatre, postoperative pulmonary embolism or deep vein thrombosis, development of a fistula, vault haematoma, vaginal vault dehiscence or pelvic infection); (5) hospital length-of-stay; (6) cost-effectiveness and (7) trainee surgeon proficiency with TLH. ETHICS AND DISSEMINATION The study has been approved by the Royal Brisbane and Women's Hospital Human Research Ethics Committee and has received site-specific approval from all participating hospitals. Results will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT03617354; Pre-results.
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Affiliation(s)
- Andreas Obermair
- Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
- Queensland Centre for Gynaecological Cancer, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia
| | - Nigel R Armfield
- Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
| | | | - Val Gebski
- CTC, University of Sydney, Sydney, New South Wales, Australia
| | - George B Hanna
- Department of Surgery & Cancer, Faculty of Medicine, Imperial College, London, UK
| | - Mark G Coleman
- Department of Surgery, University Hospitals Plymouth NHS Trust, Derriford Hospital, Plymouth, UK
| | - Anne Hughes
- Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
| | - Monika Janda
- Centre of Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
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Augusto KL, Brilhante AVM, Modesto GCD, Saboia DM, Rocha CFC, Karbage SAL, de Magalhães TF, Bezerra LRPS. Costs and mortality rates of surgical approaches to hysterectomy in Brazil. Rev Saude Publica 2018; 52:25. [PMID: 29561962 PMCID: PMC6257415 DOI: 10.11606/s1518-8787.2018052000129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 04/24/2017] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To analyze the costs of hysterectomies performed in Brazil due to benign conditions, and to assess its hospital admittance and mortality rates. METHODS A retrospective cohort was carried out from January 2010 to December 2014, analyzing all hysterectomies (n = 428,346) registered on the DATASUS database between January 2010 and December 2014. Data were collected through a structured questionnaire and analyzed using the SPSS 20.0 for Windows. RESULTS Hospital admissions were 300,231 for total abdominal hysterectomies, 46,056 for vaginal hysterectomies, 29,959 for subtotal abdominal hysterectomies and 1,522 for laparoscopic hysterectomies. Mortality rates were 0.26%, 0.09%, 0.07% and 0.05% for subtotal, total abdominal, laparoscopic, and vaginal hysterectomies, respectively. Among the procedures studied, total abdominal hysterectomies had the most costs (R$217,802,574.77), followed by vaginal hysterectomies (R$24,173,490.00), subtotal abdominal hysterectomies (R$19.253.300,00) and laparoscopic hysterectomies (R$794,680.40). CONCLUSIONS Total abdominal hysterectomies had the highest overall costs mainly because it was the most commonly performed technique. Mortality rates were greatest in subtotal abdominal hysterectomies; this, however, may be due to bias related to missing data in our database.
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Affiliation(s)
- Kathiane Lustosa Augusto
- Universidade Federal do Ceará. Faculdade de Medicina. Maternidade Escola Assis Chateaubriand. Fortaleza, CE, Brasil
| | | | | | - Dayana Maia Saboia
- Universidade Federal do Ceará. Programa de Pós-Graduação em Enfermagem. Fortaleza, CE, Brasil
| | | | - Sara Arcanjo Lino Karbage
- Universidade Federal do Ceará. Faculdade de Medicina. Maternidade Escola Assis Chateaubriand. Fortaleza, CE, Brasil
| | - Thaís Fontes de Magalhães
- Universidade Federal do Ceará. Programa de Pós-Graduação em Ciências Clínico-Cirúrgicas. Fortaleza, CE, Brasil
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Safety of Manual Morcellation After Vaginal or Laparoscopic-assisted Vaginal Hysterectomy. J Minim Invasive Gynecol 2016; 23:542-7. [DOI: 10.1016/j.jmig.2016.01.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 01/06/2016] [Accepted: 01/08/2016] [Indexed: 11/19/2022]
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Kim JH, Lee YH, Chong GO, Lee YS, Cho YL, Hong DG. Total vaginal and single-port total laparoscopic hysterectomy for uterine benign diseases. MINIM INVASIV THER 2016; 25:148-53. [PMID: 26902788 DOI: 10.3109/13645706.2016.1141102] [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] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study aimed to review the surgical outcomes and health-related quality of life (HRQOL) of total vaginal (TVH) and single-port total laparoscopic hysterectomy (SP-TLH) for uterine benign diseases. STUDY DESIGN This study included 121 patients who had undergone TVH or SP-TLH for uterine benign diseases between April 2011 and July 2012. Surgical outcomes, complications, and HRQOL were reviewed in the two groups. Preoperative and postoperative HRQOL data from the 36-item Short Form questionnaire (SF-36) were recorded for all patients. RESULTS TVH was performed more often for the patients who had fewer previous operations (p = 0.32). In the TVH, there were fewer combined surgical procedures (p < 0.01), shorter operation times (p < 0.01), shorter vaginal stump suture times (p = 0.03) and lower complication rates (p < 0.01) than in SP-TLH. Overall, all SF-36 scales improved after surgery, except for the Social Functioning scale. There was no significant difference in any of the scales between the two groups. CONCLUSIONS TVH has equivalent effects on HRQOL as SP-TLH. SP-TLH is preferred for the cases with complicated and combined procedures.
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Affiliation(s)
- Ji Hyun Kim
- a Department of Obstetrics and Gynecology , Kyungpook National University Medical Center, Graduate School of Medicine , Daegu , South Korea
| | - Yoon Hee Lee
- a Department of Obstetrics and Gynecology , Kyungpook National University Medical Center, Graduate School of Medicine , Daegu , South Korea
| | - Gun Oh Chong
- a Department of Obstetrics and Gynecology , Kyungpook National University Medical Center, Graduate School of Medicine , Daegu , South Korea
| | - Yoon Soon Lee
- a Department of Obstetrics and Gynecology , Kyungpook National University Medical Center, Graduate School of Medicine , Daegu , South Korea
| | - Young Lae Cho
- a Department of Obstetrics and Gynecology , Kyungpook National University Medical Center, Graduate School of Medicine , Daegu , South Korea
| | - Dae Gy Hong
- a Department of Obstetrics and Gynecology , Kyungpook National University Medical Center, Graduate School of Medicine , Daegu , South Korea
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Purohit R, Joshi S, Sharma JG. Adnexectomy During Vaginal Hysterectomy for Benign Indications Using Bipolar Hemostasis of Lateral Pedicles and Transvaginal Adnexa Mobilization. J Gynecol Surg 2015. [DOI: 10.1089/gyn.2014.0088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ramkrishna Purohit
- Department of Obstetrics and Gynaecology, Purohit General Hospital, Odisha, India
| | - Shikha Joshi
- Department of Obstetrics and Gynaecology, Purohit General Hospital, Odisha, India
| | - Jay Gopal Sharma
- Department of Obstetrics and Gynaecology, Purohit General Hospital, Odisha, India
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Insufflation with humidified and heated carbon dioxide in short-term laparoscopy: a double-blinded randomized controlled trial. BIOMED RESEARCH INTERNATIONAL 2015; 2015:412618. [PMID: 25722977 PMCID: PMC4324813 DOI: 10.1155/2015/412618] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 01/07/2015] [Indexed: 11/18/2022]
Abstract
Background. We tested the hypothesis that warm-humidified carbon dioxide (CO2) insufflation would reduce postoperative pain and morphine requirement compared to cold-dry CO2 insufflation. Methods. A double-blinded, randomized, controlled trial was conducted to compare warm, humidified CO2 and cold-dry CO2. Patients with benign uterine diseases were randomized to either treatment (n = 48) or control (n = 49) group during laparoscopically assisted vaginal hysterectomy. Primary endpoints of the study were rest pain, movement pain, shoulder-tip pain, and cough pain at 2, 4, 6, 24, and 48 hours postoperatively, measured by visual analogue scale. Secondary outcomes were morphine consumption, rejected boli, temperature change, recovery room stay, and length of hospital stay. Results. There were no significant differences in all baseline characteristics. Shoulder-tip pain at 6 h postoperatively was significantly reduced in the intervention group. Pain at rest, movement pain, and cough pain did not differ. Total morphine consumption and rejected boli at 24 h postoperatively were significantly higher in the control group. Temperature change, recovery room stay, and length of hospital were similar. Conclusions. Warm, humidified insufflation gas significantly reduces postoperative shoulder-tip pain as well as morphine demand. This trial is registered with Clinical Trial Registration Number
DRKS00003853 (German Clinical Trials Register (DRKS)).
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Analysis of hysterectomies for patients with uterine leiomyomas in China in 2010. Int J Gynaecol Obstet 2014; 129:71-4. [DOI: 10.1016/j.ijgo.2014.10.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 10/22/2014] [Accepted: 12/16/2014] [Indexed: 11/20/2022]
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Predicting the success of vaginal surgery: a quantitative risk assessment model for future investigation. Eur J Obstet Gynecol Reprod Biol 2013; 171:343-7. [PMID: 24139132 DOI: 10.1016/j.ejogrb.2013.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 08/17/2013] [Accepted: 09/17/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To introduce a model incorporating expected risks for a vaginal procedure based on objective measurements of a patient's characteristics and propose it as a potential tool to assist in the selection of candidates for vaginal surgery. STUDY DESIGN A quantitative model consisting of 13 clinical variables identified as risk factors in a prospective vaginal procedure was developed. Medical records of 315 women undergoing a set of routine gynecological surgeries via the vaginal, laparoscopic, and abdominal routes were obtained during January 2010 and November 2011. These surgeries included hysterectomy, myomectomy, bilateral or unilateral salpingo-oophorectomy and adnexal cystectomy. After that, each patient was scored according to the model. Sensitivity and specificity of the model were analyzed in one data set (cohort I) by receiver operating characteristic (ROC) curve and independently validated in a second data set (cohort II). RESULTS 175 patients were included in cohort I while the other 140 patients formed cohort II. The intra- and post-operative complication rates were 0.6% and 0%, respectively. A vaginal procedure was predicted with good accuracy (AUC=0.852). The sensitivity was 86.0% and specificity was 72.0% at an optimal cut-off point of score=3. The predication accuracy of this model was further validated in cohort II and reached as high as 85.7%. Furthermore, the score was significantly associated with the volume of estimated blood loss and the duration of operation time (P<0.05). CONCLUSION Our quantitative risk assessment model predicts safe vaginal surgery with good accuracy. Predictive tools based on such a model could help surgeons to optimize patient selection and thus contribute to reducing costs while enhancing patients' satisfaction. We invite other researchers to modify and validate the model in other populations.
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