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Vaginal hysterectomy versus laparoscopically assisted vaginal hysterectomy for large uteri between 280 and 700 g: a randomized controlled trial. Arch Gynecol Obstet 2017; 296:77-83. [DOI: 10.1007/s00404-017-4397-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 05/09/2017] [Indexed: 11/25/2022]
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2
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An evaluation of laparoscopic hysterectomy alone versus in combination with laparoscopic myomectomy for patients with uterine fibroids. Eur J Obstet Gynecol Reprod Biol 2017; 210:132-138. [DOI: 10.1016/j.ejogrb.2016.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 12/02/2016] [Accepted: 12/04/2016] [Indexed: 12/16/2022]
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3
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Total Laparoscopic Hysterectomy in Patients with Large Uteri: Comparison of Uterine Removal by Transvaginal and Uterine Morcellation Approaches. BIOMED RESEARCH INTERNATIONAL 2016; 2016:8784601. [PMID: 27419141 PMCID: PMC4933852 DOI: 10.1155/2016/8784601] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 04/20/2016] [Indexed: 12/18/2022]
Abstract
The aim of this study was to compare the clinical results of total laparoscopic hysterectomy (TLH) for large uterus with uterus size of 12 gestational weeks (g.w.) or greater through transvaginal or uterine morcellation approaches. We retrospectively collected the clinical data of those undergoing total laparoscopic hysterectomies between January 2004 and June 2012. Intraoperative and postoperative outcomes were compared between patients whose large uterus was removed through transvaginal or morcellation approaches. The morcellation group has significantly shorter mean operation time and uterus removal time and smaller incidence of intraoperative complications than the transvaginal group (all P < 0.05). No statistical significant difference regarding the mean blood loss, uterine weight, and length of hospital stay was noted in the morcellation and transvaginal groups (all P > 0.05). In two groups, there was one patient in each group who underwent conversion to laparotomy due to huge uterus size. With regard to postoperative complications, there was no statistical significant difference regarding the frequencies of pelvic hematoma, vaginal stump infection, and lower limb venous thrombosis in two groups (all P > 0.05). TLH through uterine morcellation can reduce the operation time, uterus removal time, and the intraoperative complications and provide comparable postoperative outcomes compared to that through the transvaginal approaches.
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Takeda A, Hayashi S, Imoto S, Nakamura H. Gasless single-port laparoscopic-assisted vaginal hysterectomy for large uteri weighing 500g or more. Eur J Obstet Gynecol Reprod Biol 2016; 203:239-44. [PMID: 27352286 DOI: 10.1016/j.ejogrb.2016.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 05/26/2016] [Accepted: 06/11/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the safety and feasibility of gasless transumbilical single-port laparoscopic-assisted vaginal hysterectomy (LAVH) for the management of large uteri weighing 500g or more. STUDY DESIGN We conducted a retrospective comparative study of women with large uteri, each undergoing gasless multi-port or single-port LAVH. Preoperatively, gonadotropin-releasing hormone agonist was administered and autologous blood was donated except for cases requiring immediate surgery. Additionally, intraoperative blood salvage and donation was performed in select cases. In single-port LAVH, a wound retractor was used to make a working port through umbilical incision. After the surgical view was secured using an abdominal wall-lift device, the surgical procedures were performed using conventional laparoscopic instruments. In select cases, temporary endovascular occlusion of the bilateral internal iliac arteries was performed to reduce intraoperative hemorrhaging. RESULTS Of the 650 women managed by multi-port or single-port LAVH, 55 and 67 women each with uteri weighing 500g or more, respectively, were included. In single-port LAVH group, the median age was 47 years. Twelve women were nulliparous and 3 women with 2 cesarean deliveries each, had never had a vaginal delivery. The most frequent surgical indication was uterine myoma. In the single-port LAVH group, the surgical procedures included LAVH alone (n=36), LAVH and bilateral salpingo-oophorectomy (n=22), LAVH and unilateral salpingo-oophorectomy (n=8), and LAVH and appendectomy (n=1). Extensive adhesiolysis was required in eight cases. The median extirpated tissue weight was 652g with a median estimated intraoperative blood loss of 450mL. A significant positive linear correlation was observed between the operative time or estimated blood loss and the extirpated uterine weigh. Although excessive bleeding exceeding 1000mL was noted in 15 cases, a transfusion of bank blood was not required by using preoperatively donated autologous blood and intraoperative autologous blood salvage and donation. Extended hospitalization was required in six cases. The median surgical duration in the single-port LAVH group was significantly longer than that in the multi-port LAVH group. CONCLUSION Gasless single-port LAVH is a feasible alternative that can yield similar major surgical outcomes as multi-port LAVH, with potential cosmetic benefit.
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Affiliation(s)
- Akihiro Takeda
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan.
| | - Shotaro Hayashi
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
| | - Sanae Imoto
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
| | - Hiromi Nakamura
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
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Driessen SRC, Sandberg EM, la Chapelle CF, Twijnstra ARH, Rhemrev JPT, Jansen FW. Case-Mix Variables and Predictors for Outcomes of Laparoscopic Hysterectomy: A Systematic Review. J Minim Invasive Gynecol 2015; 23:317-30. [PMID: 26611613 DOI: 10.1016/j.jmig.2015.11.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 11/10/2015] [Accepted: 11/12/2015] [Indexed: 12/14/2022]
Abstract
The assessment of surgical quality is complex, and an adequate case-mix correction is missing in currently applied quality indicators. The purpose of this study is to give an overview of all studies mentioning statistically significant associations between patient characteristics and surgical outcomes for laparoscopic hysterectomy (LH). Additionally, we identified a set of potential case-mix characteristics for LH. This systematic review was conducted according to the Meta-Analysis of Observational Studies in Epidemiology guidelines. We searched PubMed and EMBASE from January 1, 2000 to August 1, 2015. All articles describing statistically significant associations between patient characteristics and adverse outcomes of LH for benign indications were included. Primary outcomes were blood loss, operative time, conversion, and complications. The methodologic quality of the included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. The included articles were summed per predictor and surgical outcome. Three sets of case-mix characteristics were determined, stratified by different levels of evidence. Eighty-five of 1549 identified studies were considered eligible. Uterine weight and body mass index (BMI) were the most mentioned predictors (described, respectively, 83 and 45 times) in high quality studies. For longer operative time and higher blood loss, uterine weight ≥ 250 to 300 g and ≥500 g and BMI ≥ 30 kg/m(2) dominated as predictors. Previous operations, adhesions, and higher age were also considered as predictors for longer operative time. For complications and conversions, the patient characteristics varied widely, and uterine weight, BMI, previous operations, adhesions, and age predominated. Studies of high methodologic quality indicated uterine weight and BMI as relevant case-mix characteristics for all surgical outcomes. For future development of quality indicators of LH and to compare surgical outcomes adequately, a case-mix correction is suggested for at least uterine weight and BMI. A potential case-mix correction for adhesions and previous operations can be considered. For both surgeons and patients it is valuable to be aware of potential factors predicting adverse outcomes and to anticipate this. Finally, to benchmark clinical outcomes at an international level, it is of the utmost importance to introduce uniform outcome definitions.
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Affiliation(s)
- Sara R C Driessen
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Evelien M Sandberg
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Claire F la Chapelle
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Andries R H Twijnstra
- Department of Obstetrics and Gynecology, Bronovo Hospital, The Hague, The Netherlands
| | - Johann P T Rhemrev
- Department of Obstetrics and Gynecology, Bronovo Hospital, The Hague, The Netherlands
| | - Frank Willem Jansen
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands; Department BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands.
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Hysterectomy via transvaginal natural orifice transluminal endoscopic surgery for nonprolapsed uteri. Surg Endosc 2014; 29:100-7. [DOI: 10.1007/s00464-014-3639-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 05/22/2014] [Indexed: 11/25/2022]
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Sesti F, Cosi V, Calonzi F, Ruggeri V, Pietropolli A, Di Francesco L, Piccione E. Randomized comparison of total laparoscopic, laparoscopically assisted vaginal and vaginal hysterectomies for myomatous uteri. Arch Gynecol Obstet 2014; 290:485-91. [DOI: 10.1007/s00404-014-3228-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 03/24/2014] [Indexed: 10/25/2022]
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Wu KY, Lertvikool S, Huang KG, Su H, Yen CF, Lee CL. Laparoscopic hysterectomies for large uteri. Taiwan J Obstet Gynecol 2012; 50:411-4. [PMID: 22212310 DOI: 10.1016/j.tjog.2011.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2011] [Indexed: 10/14/2022] Open
Abstract
Laparoscopic hysterectomies increase recently due to several advantages of minimally invasive surgery. Controversy exists for laparoscopic hysterectomies for large uteri weighing >500g because some reports show increased complications and morbidities and high laparoconversion rate in the past. With familiarity of laparoscopic procedures and progress in surgical techniques, the issue should be discussed and reviewed by evidence again. Hence, we conducted a systematic review of laparoscopic hysterectomies for large uteri.
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Affiliation(s)
- Kai-Yun Wu
- Department of Obstetrics and Gynecology, Chang Gung University College of Medicine, Kwei-Shan, Tao-Yuan, Taiwan
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Roy KK, Subbaiah M, Singla S, Kumar S, Sharma JB, Mitra DK. Role of serum interleukin-6 in comparing surgical stress after laparoscopic-assisted vaginal hysterectomy and non-descent vaginal hysterectomy for large uteri. Arch Gynecol Obstet 2011; 285:671-6. [PMID: 21789517 DOI: 10.1007/s00404-011-2001-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 07/08/2011] [Indexed: 01/10/2023]
Abstract
AIMS AND OBJECTIVES To compare the perioperative inflammatory response using interleukin-6 (IL-6) in patients of laparoscopic-assisted vaginal hysterectomy (LAVH) and non-descent vaginal hysterectomy (NDVH) for large uteri with benign disease. MATERIALS AND METHODS Twenty women with benign uterine disease and failed medical management with size of uterus ranging from 300 to 1,500 g (12-24 weeks) were randomized into two equal groups for either technique of hysterectomy, LAVH and NDVH. Venous blood levels of IL-6 were measured preoperatively and 3, 24 and 72 h after beginning of surgery. Statistical analysis was done using SPSS15 software. RESULTS No statistically significant difference was present in demographic characteristics, operating time, and uterine weight between the two groups. No major complications were encountered. The increase in serum interleukin 6 levels from preoperative value to the value at 3 h postoperatively was found to be significantly higher in LAVH group when compared with NDVH group indicating greater tissue handling and trauma in LAVH group. CONCLUSION Non-descent vaginal hysterectomy appears to be better than laparoscopic-assisted vaginal hysterectomy for large uteri in terms of inflammatory response.
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Affiliation(s)
- Kallol Kumar Roy
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.
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Kondo W, Bourdel N, Marengo F, Azuar AS, Tran-ba-Vang X, Roman H, Jardon K, Pouly JL, Rabischong B, Botchorishvili R, Mage G, Canis M. Surgical Outcomes of Laparoscopic Hysterectomy for Enlarged Uteri. J Minim Invasive Gynecol 2011; 18:310-3. [DOI: 10.1016/j.jmig.2011.01.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 01/08/2011] [Accepted: 01/13/2011] [Indexed: 10/18/2022]
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Wong WSF, Lee TCE, Lim CED. Novel Vaginal “Paper Roll” Uterine Morcellation Technique for Removal of Large (>500 g) Uterus. J Minim Invasive Gynecol 2010; 17:374-8. [DOI: 10.1016/j.jmig.2010.02.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2009] [Revised: 01/26/2010] [Accepted: 02/03/2010] [Indexed: 11/17/2022]
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Experience with laparoscopic-assisted vaginal hysterectomy for the enlarged uterus. Arch Gynecol Obstet 2009; 280:425-30. [PMID: 19184075 DOI: 10.1007/s00404-009-0944-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2008] [Accepted: 01/09/2009] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The aim of this study is to evaluate the effect of uterine weight on the perioperative and postoperative outcomes of laparoscopically assisted vaginal hysterectomy (LAVH) for benign gynecological conditions. METHODS In a retrospective observational study, 367 patients underwent LAVH (type I laparoscopic hysterectomy) for benign disorders at the Department of Gynecology at the Istanbul Bakirkoy Women and Children Hospital. Patients were divided into two groups with uterine weight <500 g and uterine weight > or =500 g. Outcome measures for both groups were studied comparatively in terms of length of operative time, pain score, amount of blood loss, requirement of blood transfusion, and length of hospital stay. RESULTS There were no differences in patients' mean age, parity, gravidity, rate of postmenopausal state, previous pelvic surgery, and body mass index. The most common indications for surgery were myoma and abnormal uterine bleeding. The duration of operation, estimated blood loss and requirement of blood transfusion were significantly less for <500 g group than for > or =500 g group. Three women in the <500 g group sustained a blood loss in excess of 500 ml. By comparison, 18 women in the > or =500 g group sustained a blood loss in excess of 500 ml (P = 0.000). Total complication rate was 8.7%. Postoperative ileus and febrile morbidity were the most common complications. No significant difference was noted in overall complications between groups (P = 0.13). During the vaginal part of the procedure bladder injury occurred in one patient who had uterine weight > or =500 g. CONCLUSION LAVH is a safe and efficient way to manage benign uterine disease and despite the increased operating time and blood loss, LAVH can be safely performed for enlarged uterus.
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Liang CC, Lee CL, Chang TC, Chang YL, Wang CJ, Soong YK. Postoperative urinary outcomes in catheterized and non-catheterized patients undergoing laparoscopic-assisted vaginal hysterectomy—a randomized controlled trial. Int Urogynecol J 2008; 20:295-300. [DOI: 10.1007/s00192-008-0769-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Accepted: 10/28/2008] [Indexed: 12/14/2022]
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Laparoscopic-Assisted Vaginal Hysterectomy with In Situ Morcellation for Large Uteri. J Minim Invasive Gynecol 2008; 15:559-65. [DOI: 10.1016/j.jmig.2008.06.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Revised: 05/26/2008] [Accepted: 06/01/2008] [Indexed: 11/18/2022]
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Soong YK, Yu HT, Wang CJ, Lee CL, Huang HY. Urinary tract injury in laparoscopic-assisted vaginal hysterectomy. J Minim Invasive Gynecol 2007; 14:600-5. [PMID: 17848321 DOI: 10.1016/j.jmig.2007.05.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2007] [Revised: 05/10/2007] [Accepted: 05/12/2007] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE To evaluate the incidence and characteristics of urinary tract injury after laparoscopic-assisted vaginal hysterectomy (LAVH). DESIGN A retrospective study that evaluated all cases of urinary tract injury at the time of LAVH in an 11-year period. Parameters including surgical indication, site of injury, time of diagnosis, method of treatment, and long-term follow-up were analyzed. (Canadian Task Force classification II-2). SETTING Tertiary care university hospital. PATIENTS A total of 38 urinary tract injuries were found in 7725 LAVH. INTERVENTION LAVH and repair of urinary tract injuries with transvaginal or transabdominal approach. MEASUREMENTS AND MAIN RESULTS The incidence of urinary tract injury after LAVH was 4.9/1000 procedures: 3.9/1000 for urinary bladder injury and 1.0/1000 for ureteral injury. Prior cesarean section was the most common risk factor for bladder injuries. Ninety-six percent (29/30) of urinary bladder injuries were detected and treated during surgery. Half (4/8, 50%) of the ureteral injuries were identified during surgery. Of the 38 complications, 28 (75.7%) occurred in surgery. CONCLUSION Most urinary tract injuries in LAVH were identified during surgery and are associated with the surgeon's experience. Bladder injury can be repaired either transvaginally or abdominally; ureteral injury can be repaired abdominally.
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Affiliation(s)
- Yung-Kuei Soong
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Kwei-Shan, Tao-Yuan, Taiwan.
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Choi JS, Kyung YS, Kim KH, Lee KW, Han JS. The four-trocar method for performing laparoscopically-assisted vaginal hysterectomy on large uteri. J Minim Invasive Gynecol 2006; 13:276-80. [PMID: 16825066 DOI: 10.1016/j.jmig.2006.04.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2005] [Revised: 03/22/2006] [Accepted: 04/13/2006] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE To assess the feasibility and efficacy of laparoscopically-assisted-vaginal hysterectomy (LAVH) for a large uterus with the new trocar technique. DESIGN Retrospective clinical study (Canadian Task Force classification III). SETTING University teaching hospital. PATIENTS Thirty-four women with a large uterus (>500 g). INTERVENTION LAVH with Choi's 4-trocar method. MEASUREMENTS AND MAIN RESULTS We reviewed the medical records of 34 patients for age, parity, history of previous abdominal surgery, operative indications, histopathologic diagnosis, mean operative time, weight of the removed uterus, change in the hemoglobin level, hospital stay, and occurrence of any complications. The patient's median age was 45 years (range 36-51 years), median parity was 2 (range 0-3), and 18 patients (52.9%) had a previous operative history. The most common operative indication was a palpable abdominal mass, and the most common histopathologic diagnosis was leiomyoma. The median operative time was 62.5 minutes (range 35-245 minutes), and the median weight of the removed uterus was 615.0 g (range 500-1200 g). The median change in hemoglobin level was 1.4 g/dL (range 0-5 g/dL). The median hospital stay was 4.0 days (range 2-6 days). The only complication was superficial port site bleeding (1 patient). None of the operations were switched to total abdominal hysterectomy. CONCLUSION Choi's 4-trocar method provided an excellent operative field during LAVH for a large uterus.
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Affiliation(s)
- Joong Sub Choi
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Wang CJ, Yuen LT, Yen CF, Lee CL, Soong YK. A simplified method to decrease operative blood loss in laparoscopic-assisted vaginal hysterectomy for the large uterus. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 2004; 11:370-3. [PMID: 15559351 DOI: 10.1016/s1074-3804(05)60053-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED STUDY OBJECTIVE. To evaluate the role of oxytocin in decreasing operative blood loss in laparoscopic-assisted vaginal hysterectomy (LAVH) for the large uterus (weight > or = 500 g). DESIGN Prospective clinical study (Canadian Task Force classification II-2). SETTING Tertiary care university hospital. PATIENTS Eighty-eight women scheduled for a hysterectomy for large benign uterine tumors. INTERVENTION Two ampules of oxytocin (10 u/mL/amp) were added to 1000 mL of saline solution running at the rate of 40 mU/min during the course of LAVH. MEASUREMENTS AND MAIN RESULTS Blood loss and blood transfusion rate were significantly greater in the group without oxytocin infusion (group B) than in the group with oxytocin infusion (group A), with 485.7 +/- 321.6 mL versus 364.1 +/- 173.2 mL (p <.05) and 26.7% versus 6. 1% (p <.05), respectively. There was no significant difference in average age, body weight, and number of vaginal deliveries and cesarean sections between the two groups. There also was no significant difference in mean uterine weight, postoperative stay, and complications between the two groups. CONCLUSION Oxytocin infusion can cause uterine contractions that decrease uterine perfusion. It is a safe and inexpensive method to help decrease operative blood loss during LAVH for the large uterus.
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Affiliation(s)
- Chin-Jung Wang
- Division of Gynecologic Endoscopy, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fu-Hsin Street, Kwei-Shan Tao-Yuan, Taiwan
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