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Benoit L, Delangle R, Van NT, Villefranque V, Koskas M, Belghiti J, Uzan C, Canlorbe G. [Feasibility and security of laparoscopic (± robotic) total hysterectomy in outpatient surgery: A French multicenter retrospective study]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:374-381. [PMID: 34979303 DOI: 10.1016/j.gofs.2021.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/14/2021] [Accepted: 12/20/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the feasibility and safety of total hysterectomy by laparoscopic approach (± robot assisted) in ambulatory. MATERIALS AND METHODS French three-center retrospective study including 165 patients who had laparoscopic (± robot assisted) total hysterectomy scheduled as outpatients from January 2016 to December 2020. Clinical and perioperative data were collected. Factors associated with outpatient failure and rehospitalization were evaluated. RESULTS The outpatient success rate was 92.7%. Factors associated with outpatient failure were incision time>13:00, large volume of blood loss, intraoperative complications with Oslo score≥2, uterine weight≥250g, indication for benign pathology, and robot-assisted approach. Among patients managed as outpatients, 7.2% were rehospitalized at a mean of 10 days from surgery. The factors associated with rehospitalization were the use of an effective antiaggregant or anticoagulant treatment and the use of intraoperative adhesiolysis. Four patients (2.6%) underwent revision surgery. CONCLUSION Minimally invasive hysterectomy can be performed as an outpatient procedure even in cases of malignant pathology. Age and body mass index are not associated with an increased risk of failure or re-hospitalization within one month.
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Affiliation(s)
- L Benoit
- Service de chirurgie et cancérologie gynécologique et mammaire, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - R Delangle
- Service de chirurgie et cancérologie gynécologique et mammaire, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - N T Van
- Service de chirurgie et cancérologie gynécologique et mammaire, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - V Villefranque
- Service de gynécologie obstétrique, Hôpital Simone-Veil, 95600 Eaubonne, France
| | - M Koskas
- Service de gynécologie obstétrique, Bichat, université de Paris, AP-HP, 75018 Paris, France
| | - J Belghiti
- Service de chirurgie et cancérologie gynécologique et mammaire, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - C Uzan
- Service de chirurgie et cancérologie gynécologique et mammaire, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Inserm UMR_S_938, Cancer Biology and Therapeutics, centre de recherche Saint-Antoine (CRSA), Sorbonne Université, 75012 Paris, France
| | - G Canlorbe
- Service de chirurgie et cancérologie gynécologique et mammaire, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Inserm UMR_S_938, Cancer Biology and Therapeutics, centre de recherche Saint-Antoine (CRSA), Sorbonne Université, 75012 Paris, France.
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Gauthier T, Lacorre A, Legendre G, Golfier F, Touboul C, Deffieux X, Sallee C. Should we perform subtotal hysterectomy associated with sacral colpopexy for genital prolapse to prevent the risk of endometrial cancer? Prog Urol 2021; 31:439-443. [PMID: 33867213 DOI: 10.1016/j.purol.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/20/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In a menopausal woman scheduled for curative surgery for pelvic organ prolapse (POP) by sacral colpopexy (SC), the question of concomitant hysterectomy is frequently considered by the surgeon. The risk of endometrial cancer (EC) exists in this population, and increases with age and body mass index. The French college of gynecologists and obstetricians (CNGOF) decided to issue good practice guidelines on subtotal hysterectomy (SH) for postmenopausal women scheduled for SC for POP. METHODS The CNGOF has decided to adopt the AGREE II and GRADE systems for grading scientific evidence. Each recommendation for practice was allocated a grade, which depends on the quality of evidence (QE) (clinical practice guidelines). RESULTS The prevalence of occult endometrial cancer (EC) found on pathological analysis after SH in this context (concomitant SH associated with SC) is low (<1%) (QE: high). Few studies have assessed the value of preoperative uterine exploration. Performing SH during SC is associated with its own risks, which may diminish the potential "carcinological prevention benefit". Uterine morcellation, performed by laparoscopy or a robot-assisted procedure, is associated with a low risk (<0.6%) of dissemination of an unknown sarcoma/EC (QE: moderate) A risk of dissemination of parasitic myomas (<0.5%) is also possible (QE: moderate). CONCLUSION It is not recommended to perform a subtotal hysterectomy associated with sacral colpopexy for the sole purpose of reducing the occurrence of endometrial cancer (Recommendation: STRONG [GRADE 1-]; the level of evidence was considered to be low and the risk-benefit balance was considered not to be favorable).
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Affiliation(s)
- T Gauthier
- Département de gynécologie et obstétrique, CHU de Limoges, INSERM, UMR-1248, 8, avenue Dominique-Larrey, 87000 Limoges, France.
| | - A Lacorre
- Département de gynécologie et obstétrique, CHU de Limoges, INSERM, UMR-1248, 8, avenue Dominique-Larrey, 87000 Limoges, France
| | - G Legendre
- Department of obstetrics and gynaecology, CHU d'Angers, 49000 Angers, France
| | - F Golfier
- Department of obstetrics and gynaecology, CHU de Lyon, 69000 Lyon, France
| | - C Touboul
- Department of obstetrics and gynaecology, AP-HP, GHU East, Tenon Hospital, 4, rue de la Chine, 75020 Paris, France
| | - X Deffieux
- Department of obstetrics and gynaecology, AP-HP, GHU South, Antoine-Béclere Hospital, 157, rue de la porte de Trivaux, 92140 Clamart, France
| | - C Sallee
- Département de gynécologie et obstétrique, CHU de Limoges, INSERM, UMR-1248, 8, avenue Dominique-Larrey, 87000 Limoges, France
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Dolivet E, Foulon A, Simonet T, Sanguin S, Turck M, Pizzoferrato AC, Fauvet R. AMeTHYST (AMbulatory HYsterectomy surgery). Feasibility of minimally invasive outpatient hysterectomy, a preliminary study. Eur J Obstet Gynecol Reprod Biol 2020; 252:412-417. [PMID: 32712532 DOI: 10.1016/j.ejogrb.2020.07.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/30/2020] [Accepted: 07/10/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Hysterectomy, one of the most frequent surgical procedures in women, is commonly performed by a minimally-invasive approach (laparoscopic or vaginal) as recommended by the French guidelines. The French authorities aim to have 66 % of all procedures performed as same-day surgery in 2020. The aim of this study was to evaluate the feasibility and identify factors associated with success or failure of same-day surgery for minimally-invasive hysterectomy. STUDY DESIGN We conducted a prospective double-center observational study at the Caen and Amiens University Hospitals between September 2017 and May 2018 including hospitalized patients managed for a laparoscopic or vaginal hysterectomy. Patients were younger than 70 and have no major medical problems. The patients were placed into a "fit" or "unfit" group according to their Post Anaesthetic Discharge Scoring System (PADSS) score 6 h post-surgery. All the patients were asked to complete an assessment questionnaire during their hospitalization. RESULTS Of the 50 included patients, half were placed in the "fit" group. A history of laparotomy was significantly predictive of failure of same-day discharge (p = 0.003) but not uterine size or Body Mass Index (BMI). The main barriers for discharge were pain (p<0.001) and postoperative nausea/vomiting (PONV) (p<0.001). Four patients, all in the "unfit" group, had Clavien-Dindo grade 1 postoperative complications. CONCLUSION Same-day minimally invasive hysterectomy is a feasible and safe procedure. Factors associated with same-day hysterectomy failure were laparotomy, pain and postoperative nausea/vomiting.
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Affiliation(s)
- Enora Dolivet
- Department of Gynaecology, Obstetrics, and Reproductive Medicine, University Hospital of CAEN, France; Surgery Department, Centre François Baclesse, Caen, France
| | - Arthur Foulon
- Department of Gynaecology, Obstetrics, and Reproductive Medicine, University Hospital of AMIENS, France
| | - Thérèse Simonet
- Department of Anesthesiae, University Hospital of CAEN, France
| | - Sophie Sanguin
- Department of Gynaecology, Obstetrics, and Reproductive Medicine, University Hospital of AMIENS, France
| | - Mélusine Turck
- Department of Gynaecology, Obstetrics, and Reproductive Medicine, University Hospital of CAEN, France
| | - Anne-Cécile Pizzoferrato
- Department of Gynaecology, Obstetrics, and Reproductive Medicine, University Hospital of CAEN, France
| | - Raffaèle Fauvet
- Department of Gynaecology, Obstetrics, and Reproductive Medicine, University Hospital of CAEN, France; Caen Normandie University, Inserm U1086 « ANTICIPE », Unité de Recherche Interdisciplinaire pour la Prévention et le Traitement des Cancers, Axe 2 : Biologie et Thérapies Innovantes des Cancers Localement Agressifs (BioTICLA), France.
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Chene G, Lamblin G, Lebail Carval K, Chabert P, Mellier G. [How I do… easily a vaginal hysterectomy? (Lyons school of vaginal surgery)]. ACTA ACUST UNITED AC 2018; 47:381-386. [PMID: 30482523 DOI: 10.1016/j.gofs.2018.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Indexed: 10/27/2022]
Affiliation(s)
- G Chene
- Département de gynécologie, hôpital Femme-Mère-Enfant, HFME, hospices civils de Lyon, 69000 Lyon, France; Université Claude-Bernard Lyon 1, EMR 3738, 69000 Lyon, France.
| | - G Lamblin
- Département de gynécologie, hôpital Femme-Mère-Enfant, HFME, hospices civils de Lyon, 69000 Lyon, France
| | - K Lebail Carval
- Département de gynécologie, hôpital Femme-Mère-Enfant, HFME, hospices civils de Lyon, 69000 Lyon, France
| | - P Chabert
- Département de gynécologie, hôpital Femme-Mère-Enfant, HFME, hospices civils de Lyon, 69000 Lyon, France
| | - G Mellier
- Département de gynécologie, hôpital Femme-Mère-Enfant, HFME, hospices civils de Lyon, 69000 Lyon, France
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Lamblin G, Thiberville G, Bansac Lamblin A, Moret S, Du-Mesnildot P, Rannou C, Ploton I, Chabert P, Chene G. [What haemostatic technique should we use for opportunistic salpingectomy during benign laparoscopic hysterectomy?]. ACTA ACUST UNITED AC 2017; 45:453-459. [PMID: 28757104 DOI: 10.1016/j.gofs.2017.06.017] [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: 04/28/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To compare ovarian function before and after laparoscopic hysterectomy with bilateral salpingectomy for benign lesions with two different systems of haemostasis. METHODS In this prospective randomized study comparing two types of energy used for coagulation in bilateral salpingectomy (group A: bipolar electric energy, versus group B: ultrasonic advanced energy [Harmonic®]), forty consecutive non-menopausal patients undergoing laparoscopic hysterectomy for benign lesions were included. Values of anti-Müllerian hormone (AMH), LH and FSH, antral follicle count (AFC) and ovarian vascularization on bilateral Doppler ultrasound, quality of life (questionnaire) were assessed preoperatively and at 1 and 3 months postoperatively. RESULTS Preliminary analysis showed shorter salpingectomy operating time (P<0.0001) and less bleeding (P<0.005) in group B. In group A, there was no statistical difference except a decrease in AFC at 1 and 3 months on the right ovary (P=0.04). In group B, AMH levels were significantly lower postoperatively at 3 months and LH levels were increased at 3 months (respectively P=0.02 et P=0.04). There was no statistical difference in the ultrasonographic data. Quality of life did not significantly differ in both groups. CONCLUSION Preliminary findings showed reduced AMH levels at 3months postoperatively in ultrasonic energy group whereas there was no significative menopausal symptoms. It seems important to continue this study in order to know the real effects of both energy systems on the ovarian function.
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Affiliation(s)
- G Lamblin
- Département de chirurgie gynécologique, Femme-Mère-Enfant hospital, 69000 Lyon-Bron, France
| | - G Thiberville
- Département de chirurgie gynécologique, Femme-Mère-Enfant hospital, 69000 Lyon-Bron, France
| | - A Bansac Lamblin
- Département de radiologie, Centre lyonnais imagerie féminine, 69000 Lyon, France
| | - S Moret
- Département de chirurgie gynécologique, Femme-Mère-Enfant hospital, 69000 Lyon-Bron, France
| | - P Du-Mesnildot
- Département de chirurgie gynécologique, Femme-Mère-Enfant hospital, 69000 Lyon-Bron, France
| | - C Rannou
- Département de radiologie, groupement hospitalier Est, 69000 Lyon-Bron, France
| | - I Ploton
- Département de biochimie, groupement hospitalier Est, 69000 Lyon-Bron, France
| | - P Chabert
- Département de chirurgie gynécologique, Femme-Mère-Enfant hospital, 69000 Lyon-Bron, France
| | - G Chene
- Département de chirurgie gynécologique, Femme-Mère-Enfant hospital, 69000 Lyon-Bron, France; Université Claude-Bernard Lyon-1, EMR 3738, 69000 Lyon, France.
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Clavé H, Clavé A. Safety and Efficacy of Advanced Bipolar Vessel Sealing in Vaginal Hysterectomy: 1000 Cases. J Minim Invasive Gynecol 2016; 24:272-279. [PMID: 27826116 DOI: 10.1016/j.jmig.2016.10.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 10/05/2016] [Accepted: 10/13/2016] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE To determine the safety and efficacy of advanced electrothermal bipolar vessel sealing (EBVS) during vaginal hysterectomy by evaluating urinary complications, overall complications, and reoperation rate. DESIGN A retrospective cohort (Canadian Task Force classification III). SETTING High-volume gynecologic surgeon practice, private hospital. PATIENTS One thousand consecutive patients who have undergone vaginal hysterectomy for benign conditions carried out with EBVS between January 2002 and December 2012. INTERVENTIONS Vaginal hysterectomy performed using an EBVS device. MEASUREMENTS AND MAIN RESULTS One thousand consecutive patients underwent vaginal hysterectomy with advanced EBVS between January 2002 and December 2012 with an average age of 51.4 ± 8.9 years (range, 31-88) and mean weight and body mass index of 57.4 ± 7.2 kg (range, 42-105) and 25.8 ± 4.2 kg/m2 (range, 19.1-38.9), respectively. Eighty-five percent of patients (852/1000) were healthy without any severe systemic disease. A single experienced surgeon performed all vaginal hysterectomies with EBVS, specifically by not applying traction during thermofusion to avoid hemorrhage, amputating the cervix to transform the uterus to an apple shape to facilitate a vaginal approach and rotation of the uterus, and placing bi-clamp forceps on the edge of the uterus and not at a 45- or 90-degree angle. Wound closure was completed with a continuous suture. Eleven urinary complications (1.1%) were recorded (10 bladder mechanical injuries and 1 vesicovaginal fistula). This was not statistically different from the rate of .64% previously reported in the FINHYST study (p = .15). The overall rate of complications was 5.3%, and 20 patients (2.0%) required reoperation. The presence of uterine scar tissue (odds ratio, 5.5; 95% confidence interval, 1.6-19.2) and larger uterus size (odds ratio, 2.5; 95% confidence interval, 1.01-19.2) were associated with a higher risk of urinary complications. CONCLUSION The use of EBVS during vaginal hysterectomy results in urinary and overall complication rates of 1.1% and 5.3%, respectively, statistically similar to previously reported series that did not use EBVS. The use of advanced EBVS is a safe and effective method of achieving hemostasis during vaginal hysterectomy.
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Affiliation(s)
- Henri Clavé
- Service de Chirurgie Gynécologique, Clinique Saint-George, Nice, France
| | - Arnaud Clavé
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; Service de Chirurgie Orthopédique, Hôpital de la Cavale Blanche, CHRU de Brest, Brest, France.
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Deffieux X, de Rochambeau B, Chêne G, Gauthier T, Huet S, Lamblin G, Agostini A, Marcelli M, Golfier F. [Hysterectomy for benign pathology: Guidelines for clinical practice]. ACTA ACUST UNITED AC 2015; 44:1219-27. [PMID: 26530174 DOI: 10.1016/j.jgyn.2015.09.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 09/18/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The objective of the study was to provide guidelines for clinical practice from the French college of obstetrics and gynecology (CNGOF), based on the best evidence available, concerning hysterectomy for benign pathology. METHODS Each recommendation for practice was allocated a grade which depends on the level of evidence (guidelines for clinical practice method). RESULTS Hysterectomy should be performed by a high volume surgeon (>10 procedures of hysterectomy per year) (grade C). Rectal enema stimulant laxatives are not recommended prior to hysterectomy (grade C). It is recommended to carry out vaginal disinfection using povidone iodine solution prior to an hysterectomy (grade B). Antibioprophylaxis is recommended during a hysterectomy, regardless of the surgical route (grade B). The vaginal or the laparoscopic routes are recommended for hysterectomy for benign pathology (grade B), even if the uterus is large and/or the patient is obese (grade C). The choice between these two surgical approaches depends on others parameters, such as the surgeon's experience, the mode of anesthesia and organizational constraints (operative duration and medico economic factors). Hysterectomy by vaginal route is not contraindicated in nulliparous women (grade C) or in women with previous c-section (grade C). No specific technique to achieve hemostasis is recommended with a view to avoid urinary tract injuries (grade C). In the absence of ovarian pathology and personal or family history of breast/ovarian carcinoma, it is recommended to conserve ovaries in pre-menopausal women (grade B). Subtotal hysterectomy is not recommended in order to diminish the risk of per- or postoperative complications (grade B). CONCLUSION The application of these recommendations should minimize risks associated with hysterectomy.
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Affiliation(s)
- X Deffieux
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère, AP-HP, 92140 Clamart, France.
| | - B de Rochambeau
- Service de gynécologie-obstétrique, hôpital Privé Marne-Chantereine, 77177 Brou-sur-Chantereine, France
| | - G Chêne
- Département de gynécologie-obstétrique, hôpital Femme-Mère-Enfant, CHU Lyon Est, université Claude-Bernard Lyon 1, 69000 Lyon, France
| | - T Gauthier
- Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, 87000 Limoges, France
| | - S Huet
- Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, 87000 Limoges, France
| | - G Lamblin
- Département de gynécologie-obstétrique, hôpital Femme-Mère-Enfant, CHU Lyon Est, université Claude-Bernard Lyon 1, 69000 Lyon, France
| | - A Agostini
- Service de gynécologie-obstétrique, hôpital la Conception, AP-HM, 13005 Marseille, France
| | - M Marcelli
- Service de gynécologie-obstétrique, hôpital la Conception, AP-HM, 13005 Marseille, France
| | - F Golfier
- Service de gynécologie-obstétrique, hospices civils de Lyon, centre hospitalier Lyon Sud, université Claude-Bernard Lyon 1, 69495 Pierre-Bénite cedex, France
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