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Prša G, Serdinšek T, But I. Exploring the rationale of performing vaginal hysterectomy under local anaesthesia: A single-centre experience. Eur J Obstet Gynecol Reprod Biol 2024; 299:131-135. [PMID: 38865739 DOI: 10.1016/j.ejogrb.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 04/22/2024] [Accepted: 06/05/2024] [Indexed: 06/14/2024]
Abstract
INTRODUCTION Vaginal hysterectomy (VH) is usually performed under general (GA) or regional anaesthesia. In recent years, the possibility of performing vaginal hysterectomy under local anaesthesia (LA) has also been explored. Our aim was to compare intraoperative and early postoperative outcomes in women who underwent VH under LA with intravenous sedation or GA. METHODS In this retrospective study, we collected data of patients who underwent VH at our department from June 2021 to December 2022. For every patient, the following data was obtained: hospitalisation duration, type of anaesthesia (LA or GA), accompanying procedures, the dosage of used local anaesthetic in the LA group, maximal pain score for each day of hospitalisation after the procedure, procedure duration, intraoperative blood loss, and postoperative complication rate. Data was analysed using the SPSS Statistics programme. Statistical significance was set at p < 0.05. RESULTS Seventy patients were included in the study. The mean age was significantly higher in the LA group compared to GA group (73.8 ± 8.0 years vs. 67.1 ± 9.3 respectively, p-value = 0.003). LA was associated with statistically lower pain scores in the first two days after the procedure (p = 0.003), and shorter procedure duration (p-value <0.001) as well as hospitalisation duration (p < 0.001). Furthermore, the cumulative dosage of different analgesics used during hospitalisation was higher in the GA group. CONCLUSIONS Our results show that LA is a feasible option for patients undergoing VH. Vaginal surgical procedures under LA could be especially beneficial for older patients with medical comorbidities in whom GA would be particularly hazardous.
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Affiliation(s)
- Gregor Prša
- Department of Gynaecology and Obstetrics, General Hospital Murska Sobota, Ulica dr. Vrbnjaka 6, 9000 Murska Sobota, Slovenia
| | - Tamara Serdinšek
- Department of General Gynaecology and Urogynaecology, Clinic for Gynaecology and Perinatology, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia.
| | - Igor But
- Department of General Gynaecology and Urogynaecology, Clinic for Gynaecology and Perinatology, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia
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Zabihi F, Moeindarbari S, Khoroushi F, Mishan M, Ravankhah Moghaddam K. Vaginal artery pseudoaneurysm after a hysterectomy: A case report and review of the literature. Clin Case Rep 2024; 12:e9006. [PMID: 38947543 PMCID: PMC11211081 DOI: 10.1002/ccr3.9006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 03/30/2023] [Accepted: 02/20/2024] [Indexed: 07/02/2024] Open
Abstract
Key clinical message This was the first report of a pseudoaneurysm in a vaginal artery after hysterectomy, unlike other published studies that were of pseudoaneurysms in uterine or vaginal arteries after delivery. Abstract A 51-year-old woman presented with massive vaginal bleeding 7 days after a hysterectomy, which caused hemoglobin to drop. The patient was suspicious of having a vaginal artery pseudoaneurysm according to the sonography. Her bleeding was stopped after the ligation of her left internal iliac artery.
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Affiliation(s)
- Fariba Zabihi
- General Surgery DepartmentMashhad University of Medical SciencesMashhadIran
| | - Somayeh Moeindarbari
- Department of Obstetrics and Gynecology, Neonatal and Maternal Research CenterMashhad University of Medical SciencesMashhadIran
| | - Farzaneh Khoroushi
- Department of Radiology, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Mohammad Mishan
- Faculty of MedicineAbadan University of Medical SciencesAbadanIran
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Baekelandt JF, Stuart A, Wagenius J, Laenen A, Mol BW, Deprest J, Bosteels JJA. VaNoLaH trial: a study protocol-a multinational randomised controlled trial including two identical substudies comparing vaginal versus vNOTES (vaginal natural orifice transluminal surgery) hysterectomy or laparoscopic versus vNOTES hysterectomy. BMJ Open 2024; 14:e081979. [PMID: 38658010 PMCID: PMC11043683 DOI: 10.1136/bmjopen-2023-081979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 04/08/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION Hysterectomy is one of the most common surgeries performed in women. Minimally invasive methods are on the rise globally as they have been shown to decrease surgical morbidity compared with abdominal hysterectomy. Hysterectomy by vaginal natural orifice transluminal endoscopic surgery (vNOTES) is the latest innovation. It combines the vaginal approach and endoscopy via the vagina. Large pragmatic randomised controlled trials (RCTs) are lacking comparing outcomes after vNOTES, vaginal hysterectomy (VH) and laparoscopic hysterectomy (LH). METHODS Multicentre pragmatic RCT aiming to recruit 1000 women aged 18-75 years undergoing hysterectomy for benign disease. The RCT includes two identical substudies (groups A and B). If VH is considered safe and feasible, the patient will be randomised within group A (VH vs vNOTES). If VH is not considered safe or feasible, patients will be randomised within group B (LH vs vNOTES). ANALYSIS Primary outcome is the proportion of women leaving the hospital within 12 hours after surgery. Secondary outcomes are hospitalisation time, conversion rates, duration of the surgical procedure, intraoperative complications, postoperative complications and readmission. ETHICS AND DISSEMINATION The Ethical Board Committee at Imelda Hospital, Bonheiden, Belgium, has approved the research protocol 230704 (principal investigator). Before including patients, all centres will require local or national ethical approval. The results of the study will be published in international peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05971875.
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Affiliation(s)
| | - Andrea Stuart
- Obstetrics and Gynecology, Lund University Department of Clinical Sciences Lund, Lund, Sweden
- Department of Obstetrics and Gynecology, Helsingborg, Sweden
| | - Johanna Wagenius
- Obstetrics and Gynecology, Lund University Department of Clinical Sciences Lund, Lund, Sweden
- Department of Obstetrics and Gynecology, Helsingborg, Sweden
| | - Annouschka Laenen
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Leuven, Belgium
| | - Ben W Mol
- OB/GYN, School of Medicine, Monash University, Melbourne, Clayton, Victoria, Australia
| | - Jan Deprest
- Gynaecology, University Hospital Leuven, Leuven, Belgium
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Zhang W, Deng L, Yang F, Liu J, Chen S, You X, Gou J, Zi D, Li Y, Qi X, Wang Y, Zheng Y. Comparing the efficacy and safety of three surgical approaches for total hysterectomy (TSATH): protocol for a multicentre, single-blind, parallel-group, randomised controlled trial. BMJ Open 2024; 14:e074478. [PMID: 38199630 PMCID: PMC10807007 DOI: 10.1136/bmjopen-2023-074478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 11/16/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Hysterectomy is the most common surgical procedure in the field of gynaecology. The traditional multiport laparoscopy, transumbilical laparoendoscopic single-site surgery (TU-LESS) and transvaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy approaches have been implemented to varying degrees in clinical practice. At present, although their feasibility has been proven, there are no large randomised controlled studies on postoperative rehabilitation. This study aims to evaluate postoperative recovery and assess the safety and effectiveness of these three surgical approaches for total laparoscopic hysterectomy. METHOD AND ANALYSIS This is a multicentre, randomised, single-blind, three-arm, parallel-group, interventional clinical trial. Recruitment will be carried out in five tertiary hospitals in China. Patients diagnosed with benign uterine disease or precancerous lesions will be assigned to the vNOTES group, TU-LESS group and conventional laparoscopy group at a 1:1:1 ratio. The achievement rate of comprehensive indices of enhanced recovery after surgery (ERAS) within 24 hours postoperatively will be considered the primary outcome (the comprehensive indicators of ERAS include fluid intake, passing flatus, urination after catheter removal, ambulation and a Visual Analogue Scale score ≤3.) This study will use a non-inferiority test, with a power (1-ß) of 80% and a margin of -0.15, at a one-sided α of 0.0125. The sample size will be 480 patients (including an assumed 15% dropout rate), calculated according to the primary outcome. ETHICS AND DISSEMINATION This study was approved on 25 April 2022 by the Medical Ethics Committee of West China Second University Hospital (2022(057)), Sichuan University, Chengdu, China. All participants will be required to provide informed consent before their participation in the study. The results of the trial will be submitted for publication in a peer-reviewed journal and presented at international conferences. PROTOCOL VERSION V.3.0, 31 August 2023. TRIAL REGISTRATION NUMBER ChiCTR2200057405.
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Affiliation(s)
- Wenxi Zhang
- Department of Gynecologic Oncology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Li Deng
- Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Fan Yang
- Department of Gynecologic Oncology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Jianhong Liu
- Department of Gynecologic Oncology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Sijing Chen
- Department of Gynecologic Oncology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Xiaolin You
- Department of Gynecologic Oncology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Jiani Gou
- Department of Gynecologic Oncology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Dan Zi
- Department of Gynecology and Obstetrics, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Yonghong Li
- Department of Gynaecology and Obstetrics, The People's Hospital of Wenjiang Chengdu, Chengdu, Sichuan, China
| | - Xiaoxue Qi
- Department of Gynecology and Obstetrics, Chengdu First People's Hospital (Chengdu Integrated TCM&Western Medicine), Chengdu, Sichuan, China
| | - Yanzhou Wang
- Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Ying Zheng
- Department of Gynecologic Oncology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
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Azadi A, Masoud AT, Ulibarri H, Arroyo A, Coriell C, Goetz S, Moir C, Moberly A, Gonzalez D, Blanco M, Marchand G. Vaginal Hysterectomy Compared With Laparoscopic Hysterectomy in Benign Gynecologic Conditions: A Systematic Review and Meta-analysis. Obstet Gynecol 2023; 142:1373-1394. [PMID: 37944141 DOI: 10.1097/aog.0000000000005434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/17/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To compare surgical efficacy outcomes and complications after laparoscopic hysterectomy and vaginal hysterectomy performed for benign gynecologic conditions. DATA SOURCES We performed an online search in major databases, including PubMed, Scopus, Web of Science, ClinicalTrials.gov , and the Cochrane Library from 2000 until February 28, 2023. METHODS OF STUDY SELECTION We searched for randomized controlled trials (RCTs) that compared vaginal hysterectomy with laparoscopic hysterectomy in benign gynecologic conditions. We located 3,249 articles. After reviewing titles and abstracts, we identified 32 articles that were eligible for full-text screening. We excluded nine articles as not-RCT or not comparing vaginal hysterectomy with laparoscopic hysterectomy. Twenty-three articles were included in the final systematic review, with 22 articles included in the meta-analysis. TABULATION, INTEGRATION, AND RESULTS Twenty-three eligible RCTs included a total population of 2,408, with 1,105 in the vaginal hysterectomy group and 1,303 in the laparoscopic hysterectomy group. Blood loss and postoperative urinary tract infection rates were lower in the vaginal hysterectomy group than in the laparoscopic hysterectomy group (mean difference -68, 95% CI -104.29 to -31.7, P <.01, I2 =95% and odds ratio 1.73, 95% CI 0.92-3.26, P =.03, I2 =0%, respectively). Vaginal hysterectomy was associated with less total operative time, less recovery time, and greater postoperative pain on the day of surgery. Other complications, including conversion to laparotomy, visceral organ damage, or wound dehiscence, were uncommon. Because of insufficient data, we were not able to stratify by surgical indication. CONCLUSION Vaginal hysterectomy had a shorter total operative time and recovery time but greater postoperative pain on day of surgery compared with laparoscopic hysterectomy. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42023338538.
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Affiliation(s)
- Ali Azadi
- the Marchand Institute for Minimally Invasive Surgery, Mesa, and the College of Medicine, University of Arizona, and the School of Medicine, Creighton University, Phoenix, Arizona; and the Fayoum University Faculty of Medicine, Fayoum, Egypt
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Pickett CM, Seeratan DD, Mol BWJ, Nieboer TE, Johnson N, Bonestroo T, Aarts JW. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev 2023; 8:CD003677. [PMID: 37642285 PMCID: PMC10464658 DOI: 10.1002/14651858.cd003677.pub6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND Currently, there are five major approaches to hysterectomy for benign gynaecological disease: abdominal hysterectomy (AH), vaginal hysterectomy (VH), laparoscopic hysterectomy (LH), robotic-assisted hysterectomy (RH) and vaginal natural orifice hysterectomy (V-NOTES). Within the LH category we further differentiate the laparoscopic-assisted vaginal hysterectomy (LAVH) from the total laparoscopic hysterectomy (TLH) and single-port laparoscopic hysterectomy (SP-LH). OBJECTIVES To assess the effectiveness and safety of different surgical approaches to hysterectomy for women with benign gynaecological conditions. SEARCH METHODS We searched the following databases (from their inception to December 2022): the Cochrane Gynaecology and Fertility Specialised Register of Controlled Trials, CENTRAL, MEDLINE, Embase, CINAHL and PsycINFO. We also searched the trial registries and relevant reference lists, and communicated with experts in the field for any additional trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) in which clinical outcomes were compared between one surgical approach to hysterectomy and another. DATA COLLECTION AND ANALYSIS At least two review authors independently selected trials, assessed risk of bias and performed data extraction. Our primary outcomes were return to normal activities, satisfaction and quality of life, intraoperative visceral injury and major long-term complications (i.e. fistula, pelvic-abdominal pain, urinary dysfunction, bowel dysfunction, pelvic floor condition and sexual dysfunction). MAIN RESULTS We included 63 studies with 6811 women. The evidence for most comparisons was of low or moderate certainty. The main limitations were poor reporting and imprecision. Vaginal hysterectomy (VH) versus abdominal hysterectomy (AH) (12 RCTs, 1046 women) Return to normal activities was probably faster in the VH group (mean difference (MD) -10.91 days, 95% confidence interval (CI) -17.95 to -3.87; 4 RCTs, 274 women; I2 = 67%; moderate-certainty evidence). This suggests that if the return to normal activities after AH is assumed to be 42 days, then after VH it would be between 24 and 38 days. We are uncertain whether there is a difference between the groups for the other primary outcomes. Laparoscopic hysterectomy (LH) versus AH (28 RCTs, 3431 women) Return to normal activities may be sooner in the LH group (MD -13.01 days, 95% CI -16.47 to -9.56; 7 RCTs, 618 women; I2 = 68%, low-certainty evidence), but there may be more urinary tract injuries in the LH group (odds ratio (OR) 2.16, 95% CI 1.19 to 3.93; 18 RCTs, 2594 women; I2 = 0%; moderate-certainty evidence). This suggests that if the return to normal activities after abdominal hysterectomy is assumed to be 37 days, then after laparoscopic hysterectomy it would be between 22 and 25 days. It also suggests that if the rate of ureter injury during abdominal hysterectomy is assumed to be 0.2%, then during laparoscopic hysterectomy it would be between 0.2% and 2%. We are uncertain whether there is a difference between the groups for the other primary outcomes. LH versus VH (22 RCTs, 2135 women) We are uncertain whether there is a difference between the groups for any of our primary outcomes. Both short- and long-term complications were rare in both groups. Robotic-assisted hysterectomy (RH) versus LH (three RCTs, 296 women) None of the studies reported satisfaction rates or quality of life. We are uncertain whether there is a difference between the groups for our other primary outcomes. Single-port laparoscopic hysterectomy (SP-LH) versus LH (seven RCTs, 621 women) None of the studies reported satisfaction rates, quality of life or major long-term complications. We are uncertain whether there is a difference between the groups for rates of intraoperative visceral injury. Total laparoscopic hysterectomy (TLH) versus laparoscopic-assisted vaginal hysterectomy (LAVH) (three RCTs, 233 women) None of the studies reported satisfaction rates or quality of life. We are uncertain whether there is a difference between the groups for rates of intraoperative visceral injury or major long-term complications. Transvaginal natural orifice transluminal endoscopic surgery (V-NOTES) versus LH (two RCTs, 96 women) We are uncertain whether there is a difference between the groups for rates of bladder injury. Our other primary outcomes were not reported. Overall, adverse events were rare in the included studies. AUTHORS' CONCLUSIONS Among women undergoing hysterectomy for benign disease, VH appears to be superior to AH. When technically feasible, VH should be performed in preference to AH because it is associated with faster return to normal activities, fewer wound/abdominal wall infections and shorter hospital stay. Where VH is not possible, LH has advantages over AH including faster return to normal activities, shorter hospital stay, and decreased risk of wound/abdominal wall infection, febrile episodes or unspecified infection, and transfusion. These advantages must be balanced against the increased risk of ureteric injury and longer operative time. When compared to LH, VH was associated with no difference in time to return to normal activities but shorter operative time and shorter hospital stay. RH and V-NOTES require further evaluation since there is a lack of evidence of any patient benefit over conventional LH. Overall, the evidence in this review has to be interpreted with caution as adverse event rates were low, resulting in low power for these comparisons. The surgical approach to hysterectomy should be discussed with the patient and decided in the light of the relative benefits and hazards. Surgical expertise is difficult to quantify and poorly reported in the available studies and this may influence outcomes in ways that cannot be accounted for in this review. In conclusion, when VH is not feasible, LH has multiple advantages over AH, but at the cost of more ureteric injuries. Evidence is limited for RH and V-NOTES.
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Affiliation(s)
- Charlotte M Pickett
- Department of Obstetrics and Gynecology, University of California San Diego, La Jolla, California, USA
| | - Dachel D Seeratan
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | | | - Neil Johnson
- Obstetrics & Gynaecology, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Tijmen Bonestroo
- Department of Obstetrics and Gynecology, Rijnstate Hospital, Arnhem, Netherlands
| | - Johanna Wm Aarts
- Obstetrics and Gynaecology, Amsterdam University Medical Centers, Amsterdam, Netherlands
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Robinson WR, Mathias JG, Wood ME, Anderson LG, Howard AG, Carey ET, Nicholson WK, Carey TS, Myers ER, Stürmer T, Doll KM. Ethnoracial Differences in Premenopausal Hysterectomy: The Role of Symptom Severity. Obstet Gynecol 2023; 142:350-359. [PMID: 37473411 PMCID: PMC10351903 DOI: 10.1097/aog.0000000000005225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/13/2023] [Accepted: 03/10/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE To evaluate whether greater symptom severity can explain higher hysterectomy rates among premenopausal non-Hispanic Black compared with White patients in the U.S. South rather than potential overtreatment of Black patients. METHODS Using electronic health record data from 1,703 patients who underwent hysterectomy in a large health care system in the U.S. South between 2014 and 2017, we assessed symptom severity to account for differences in hysterectomy rates for noncancerous conditions among premenopausal non-Hispanic Black, non-Hispanic White, and Hispanic patients. We used Poisson generalized linear mixed modeling to estimate symptom severity (greater than the 75th percentile on composite symptom severity scores of bleeding, bulk, or pelvic pain) as a function of race-ethnicity. We calculated prevalence ratios (PRs). We controlled for factors both contra-indicating and contributing to hysterectomy. RESULTS The overall median age of non-Hispanic White (n=1,050), non-Hispanic Black (n=565), and Hispanic (n=158) patients was 40 years. The White and Black patients were mostly insured (insured greater than 95%), whereas the Hispanic patients were often uninsured (insured 58.9%). White and Black patients were mostly treated outside academic medical centers (nonmedical center: 63.7% and 58.4%, respectively); the opposite was true for Hispanic patients (nonmedical center: 34.2%). Black patients had higher bleeding severity scores compared with Hispanic and White patients (median 8, 7, and 4 respectively) and higher bulk scores (median 3, 1, and 0, respectively), but pain scores differed (median 3, 5, and 4, respectively). Black and Hispanic patients were disproportionately likely to have severe symptoms documented on two or more symptoms (referent: not severe on any symptoms) (adjusted PR [Black vs White] 3.02, 95% CI 2.29-3.99; adjusted PR [Hispanic vs White] 2.61, 95% CI 1.78-3.83). Although Black and Hispanic patients were more likely to experience severe symptoms, we found no racial and ethnic differences in the number of alternative treatments attempted before hysterectomy. CONCLUSION We did not find evidence of overtreatment of Black patients. Our findings suggest potential undertreatment of Black and Hispanic patients with uterine-sparing alternatives earlier in their disease progression.
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Affiliation(s)
- Whitney R Robinson
- Division of Women's Community and Population Health, Department of Obstetrics and Gynecology, Duke University School of Medicine, the Margolis Center for Health Policy, Duke University, and the Duke-UNC Alzheimer's Disease Research Center, Durham, the Department of Epidemiology and the Department of Biostatistics, Gillings School of Global Public Health, the Carolina Population Center, and the Department of Obstetrics and Gynecology and the Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; the Department of Prevention and Community Health, George Washington Milken Institute of Public Health, Washington, DC; and the Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington
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Eoh KJ, Lee YJ, Nam EJ, Jung HI, Kim YT. Clinical Relevance of Vaginal Cuff Dehiscence after Minimally Invasive versus Open Hysterectomy. J Clin Med 2023; 12:3001. [PMID: 37109333 PMCID: PMC10142584 DOI: 10.3390/jcm12083001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/10/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
This study aimed to evaluate the clinical relevance of vaginal cuff dehiscence following a hysterectomy. Data were prospectively collected from all patients who underwent hysterectomies at a tertiary academic medical center between 2014 and 2018. The incidence and clinical factors of vaginal cuff dehiscence after minimally invasive versus open hysterectomy were compared. Vaginal cuff dehiscence occurred in 1.0% (95% confidence interval [95% CI], 0.7-1.3%) of women who underwent either form of hysterectomy. Among those who underwent open (n = 1458), laparoscopic (n = 3191), and robot-assisted (n = 423) hysterectomies, vaginal cuff dehiscence occurred in 15 (1.0%), 33 (1.0%), and 3 (0.7%) cases, respectively. No significant differences in cuff dehiscence occurrence were identified in patients who underwent various modes of hysterectomies. A multivariate logistic regression model was created using the variables indication for surgery and body mass index. Both variables were identified as independent risk factors for vaginal cuff dehiscence (odds ratio [OR]: 2.74; 95% CI, 1.51-4.98 and OR: 2.20; 95% CI, 1.09-4.41, respectively). The incidence of vaginal cuff dehiscence was exceedingly low in patients who underwent various modes of hysterectomies. The risk of cuff dehiscence was predominantly influenced by surgical indications and obesity. Thus, the different modes of hysterectomy do not influence the risk of vaginal cuff dehiscence.
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Affiliation(s)
- Kyung Jin Eoh
- Department of Obstetrics and Gynecology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin 16995, Republic of Korea;
| | - Young Joo Lee
- Department of Obstetrics and Gynecology, Institute of Women’s Medical Life Science, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (Y.J.L.); (E.J.N.)
| | - Eun Ji Nam
- Department of Obstetrics and Gynecology, Institute of Women’s Medical Life Science, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (Y.J.L.); (E.J.N.)
| | - Hye In Jung
- Department of Obstetrics and Gynecology, Institute of Women’s Medical Life Science, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (Y.J.L.); (E.J.N.)
| | - Young Tae Kim
- Department of Obstetrics and Gynecology, Institute of Women’s Medical Life Science, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (Y.J.L.); (E.J.N.)
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9
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Casarin J, Ghezzi F, Mueller M, Ceccaroni M, Papadia A, Ferreira H, Uccella S, Malzoni M, Mabrouk M, Seracchioli R, Bordi G, Gisone BE, Vaineau C, Bogani G, Roviglione G, Arena A, Ambrosoli AL, Graf C, Bruni F, Bras R, Falcone F, Raimondo D, Giovanni AD, Cromi A. Surgical Outcomes and Complications of Laparoscopic Hysterectomy for Endometriosis: a multicentric cohort study. J Minim Invasive Gynecol 2023:S1553-4650(23)00126-7. [PMID: 37004810 DOI: 10.1016/j.jmig.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/22/2023] [Accepted: 03/25/2023] [Indexed: 04/03/2023]
Abstract
STUDY OBJECTIVE To investigate the postoperative morbidity of laparoscopic hysterectomy (LH) for endometriosis/adenomyosis in terms of operative outcomes and complications. DESIGN Retrospective multicentric cohort study. SETTING Eight European minimally invasive referral centers. PATIENTS Data from 995 patients with pathologically confirmed endometriosis and/or adenomyosis who underwent LH without concomitant urological and/or gastroenterological procedures from January 2010 to December 2020. INTERVENTIONS Total laparoscopic hysterectomy. MEASUREMENTS AND MAIN RESULTS Demographic patients' characteristics, surgical outcomes, and intraoperative and postoperative complications were evaluated. We considered major postoperative surgical-related complications any grade 2 or more events (Clavien-Dindo score) that occurred within 30 days from surgery. Univariate analysis and multivariable models fit with logistic regression were used to estimate the adjusted odds ratio (OR) and corresponding 95% CI for major complications. Median age at surgery was 44 years (28-54) and about half of them (505, 50.7%) were on medical treatment (estro-progestins, progestin or GnRh-analogues) at the time of surgery. In association with LH, posterior adhesiolysis was performed in 387 (38,9%) cases and deep nodule resection in 302 (30,0%). Intraoperative complications occurred in 3% of the patients and major postoperative complications were registered in 93 (9.3%). The multivariable analysis showed an inverse correlation between the occurrence of Clavien-Dindo >2 complications and age (OR 0.94, 95%CI 0.90-0.99), while previous surgery for endometriosis (OR 1.62, 95%CI 1.01-2.60) and intraoperative complications (OR 6.49, 95%CI 2.65-16.87) were found as predictors of major events. Medical treatment at the time of surgery has emerged as a protective factor (OR 0.50, 95%CI 0.31-0.81). CONCLUSION LH for endometriosis/adenomyosis is associated with non-negligible morbidity. Knowing the factors associated with higher risks of complications might be used for risk stratification and could help clinicians during preoperative counseling. The administration of estro-progestin or progesterone preoperatively might reduce the risks of postoperative complications following surgery.
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10
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Purohit R, Sharma JG, Meher D. A Vagino-Laparoscopic Strategy for Hysterectomy of Large Uteri to Ease Surgical Challenges. Int J Womens Health 2023; 15:369-379. [PMID: 36942049 PMCID: PMC10024491 DOI: 10.2147/ijwh.s400587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/02/2023] [Indexed: 03/15/2023] Open
Abstract
Purpose To develop a vagino-laparoscopic strategy for hysterectomy (VLH) to treat uteri with large fibroids at ≥ 16 weeks of gestation to ease surgical challenges. Patients and Methods This was an observational study conducted in our private general hospital on 64 consecutive cases involving uteri with large and benign fibroids at ≥ 16 weeks of gestation. We excluded cases with an associated ventro-fixed uterus and large cervical fibroids. Interventions The VLH strategy involves vaginal separation of the uterosacral with the uterine arteries followed by laparoscopic separation of the remaining upper pedicles. The uterus was then removed vaginally. Results The largest uteri receiving treatment was at 26 weeks of gestation and the mean uterus weight was 869.60 ± 275.10 g (range: 500-1900 g). The VLH strategy was successful in 63 (98.43%) cases irrespective of the configuration of the uterus. One case (1.56%) required mini-laparotomy conversion due to the need for adhesiolysis; this case exhibited extensive adhesion of the rectum to the posterior wall of the uterus due to a history of previous myomectomy of the posterior wall. There were no conversions due to failed laparoscopic exposure of the adnexal or uterine vascular pedicles, or due to uncontrolled intraoperative bleeding. There were no cases of urinary tract injury or other major complications. The vaginal detachment of uterosacral ligaments before the laparoscopic phase of the VLH strategy increased upwards mobility and dislodged the cervico-isthmic level of large uteri from the narrow lower aspect of the pelvis to the upper wider part of the pelvis; this eased the surgical challenges associated with such cases and avoided complications during laparoscopy. Conclusion We developed a vagino-laparoscopic strategy for hysterectomy that can ease the technical challenges associated with the majority of large uteri.
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Affiliation(s)
- Ramkrishna Purohit
- Purohit General Hospital, Bargarh, Odisha, India
- Correspondence: Ramkrishna Purohit, Purohit General Hospital, Bargarh, Odisha, 768028, India, Email
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11
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Horwood G, Singh S. Maximally Invasive Surgery for the Minimally Invasive Gynecologist. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2022.0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Geneviève Horwood
- Department of Obstetrics, Gynecology and Newborn Care, University of Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sukhbir Singh
- Department of Obstetrics, Gynecology and Newborn Care, University of Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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12
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Lysdal VK, Karampas G, Poulsen BB, Rudnicki M. Lateral coagulation of the uterine artery at its origin prior to total laparoscopic hysterectomy. A randomized control trial. J Gynecol Obstet Hum Reprod 2022; 51:102465. [DOI: 10.1016/j.jogoh.2022.102465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/25/2022]
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13
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Stark M, Malvasi A, Mynbaev O, Tinelli A. The Renaissance of the Vaginal Hysterectomy-A Due Act. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11381. [PMID: 36141653 PMCID: PMC9516991 DOI: 10.3390/ijerph191811381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
For many years, vaginal and abdominal hysterectomies were part of the routine procedures in many departments. Both of them lost their priority due to the introduction of endoscopy and robotic surgery. The disappearing abdominal hysterectomy is certainly reasonable, but the decline of using vaginal hysterectomy seems not to be justified, and it is an optimal example of the recent emergence of the Natural Orifice Surgery discipline. A modified method for vaginal hysterectomy is presented in order to encourage gynecologists to reconsider vaginal hysterectomy as a valid method. This method is the outcome of critical analyses of different vaginal hysterectomy methods. It is simple, reasonable, only ten steps, easy to learn, perform and teach, and proven to be a shorter operation with minimal blood loss and reduced need for analgesics when compared to the traditional way. Endoscopy or robotic surgery is not available everywhere. Therefore, it is important that gynecologists in low-resource settings be familiar with this simple method.
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Affiliation(s)
- Michael Stark
- The New European Surgical Academy (NESA), Unter den Linden 21, 10117 Berlin, Germany
- Laboratory of Human Physiology, Phystech BioMed School, Faculty of Biological & Medical Physics, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow 141701, Russia
| | - Antonio Malvasi
- The New European Surgical Academy (NESA), Unter den Linden 21, 10117 Berlin, Germany
- Laboratory of Human Physiology, Phystech BioMed School, Faculty of Biological & Medical Physics, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow 141701, Russia
| | - Ospan Mynbaev
- The New European Surgical Academy (NESA), Unter den Linden 21, 10117 Berlin, Germany
- Laboratory of Human Physiology, Phystech BioMed School, Faculty of Biological & Medical Physics, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow 141701, Russia
| | - Andrea Tinelli
- The New European Surgical Academy (NESA), Unter den Linden 21, 10117 Berlin, Germany
- Laboratory of Human Physiology, Phystech BioMed School, Faculty of Biological & Medical Physics, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow 141701, Russia
- Department of Obstetrics and Gynecology and CERICSAL (Centro di Ricerca Clinico Salentino), “Veris delli Ponti Hospital”, 73020 Scorrano, Lecce, Italy
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14
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Factors associated with surgical-site infection after total laparoscopic hysterectomy. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2022. [DOI: 10.1016/j.lers.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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15
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Robertson S, Ramirez I, Bou Zgheib N, Xiong Y, Hoffman MS. Preoperative Assessment of Candidacy for Vaginal Hysterectomy: A Clinical Study. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2021.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | - Mitchel S. Hoffman
- Gynecology Oncology Program, H. Lee Moffitt Cancer Center and Research Institute and University of South Florida Morsani College of Medicine, Tampa, Florida, USA
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16
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The Role of Hysterectomy in Modern Gynaecological Surgery. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9847163. [PMID: 35782083 PMCID: PMC9249513 DOI: 10.1155/2022/9847163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 06/14/2022] [Indexed: 12/03/2022]
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17
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Dogan H, Demir Çaltekin M, Günal A. Short-Term Effects of Connective Tissue Massage After Hysterectomy: A Randomized Controlled Study. J Manipulative Physiol Ther 2022; 45:9-19. [PMID: 35753879 DOI: 10.1016/j.jmpt.2022.03.013] [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: 03/19/2021] [Revised: 11/28/2021] [Accepted: 03/16/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the effects of connective tissue massage (CTM) on postoperative pain severity, first passage of flatus and the first defecation, and functionality in patients after total laparoscopic hysterectomy (TLH) or total abdominal hysterectomy (TAH). METHODS A total of 60 patients who underwent TLH or TAH were included in the study. Patients who underwent TLH were randomly grouped as TLH-CTM (n = 15) and TLH control (n = 16), and those who underwent TAH were randomly grouped as TAH-CTM (n = 14) and TAH control (n = 15). CTM was applied twice postoperatively at the third hour and after 24 hours. The pain severity scores and functional activity limitation levels of the patients were evaluated with the visual analog scale. The number of analgesics use and first passage of flatus and the first defecation were recorded. RESULTS The first passage of flatus and the first defecation after surgery were shorter in the TLH-CTM and TAH-CTM groups compared with the TLH and TAH control groups (P < 0.001). The first passage of flatus and the first defecation, pain intensity, and analgesics use of the TLH-CTM group were the lowest among all groups (P < 0.05). The improvement in functionality level in the TLH-CTM group was higher than those in the other groups (P < 0.05). CONCLUSION This study showed that CTM reduced postoperative pain severity, use of analgesics, first passage of flatus, and first defecation after TAH or TLH.
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Affiliation(s)
- Hanife Dogan
- Yozgat Bozok University, Sarıkaya School of Physiotherapy and Rehabilitation, Yozgat, Turkey.
| | - Melike Demir Çaltekin
- Yozgat Bozok University, Medical School, Department of Gynecology and Obstetrics, Yozgat, Turkey
| | - Ayla Günal
- Tokat Gaziosmanpaşa University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Tokat, Turkey
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18
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Ross JH, Park AJ. Female Pelvic Medicine and Reconstructive Surgery: Routes of Surgery and Related Differences Among Training Programs. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2022.0003] [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)
- James H. Ross
- Obstetrics/Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amy J. Park
- Obstetrics/Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
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19
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Marquini GV, de Oliveira LM, Martins SB, Takano CC, de Jarmy Di-Bella ZIK, Sartori MGF. Historical perspective of vaginal hysterectomy: the resilience of art and evidence-based medicine in the age of technology. Arch Gynecol Obstet 2022; 307:1377-1384. [PMID: 35589991 DOI: 10.1007/s00404-022-06607-z] [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: 02/14/2022] [Accepted: 05/01/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE The aim of this study was to describe, from a historical perspective, the relevance, resilience and outcomes of vaginal hysterectomy (VH) in gynecology in the age of technological scenario. METHODS The authors searched records from January 2011 to January 2021 on the following databases: Medline, EMBASE, and CENTRAL (The Cochrane Library) for combinations of the terms "vaginal hysterectomy," "outcomes" AND "history"; and before that period, if the search had historical relevance. INCLUSION CRITERIA randomized clinical trials; hysterectomy performed for benign gynecological conditions; and VH outcomes compared with Abdominal Hysterectomy (AH), Laparoscopic Hysterectomy (LH) or Robotic Hysterectomy (RH). RESULTS The VH combines sequences of reproducible techniques which have been developed over the years to safely and effectively overcome the limitations of difficult cases of vaginal extirpation from the uterus. CONCLUSION The authors support endoscopic surgical approaches in complex surgery for benign indications, urogynecology, and gynecologic oncology when appropriate. However, what makes the gynecological surgeon different from the general surgeon is the vaginal access. It is essential to continue to train residents in vaginal surgical skills and provide safe and cost-effective patient care. The art of technology is the resilience of keeping only the patient at the center of innovation.
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Affiliation(s)
- Gisele Vissoci Marquini
- Urogynecology and Vaginal Surgery Sector, Department of Gynecology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil.
| | - Leticia Maria de Oliveira
- Urogynecology and Vaginal Surgery Sector, Department of Gynecology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Sérgio Brasileiro Martins
- Urogynecology and Vaginal Surgery Sector, Department of Gynecology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Claudia Cristina Takano
- Urogynecology and Vaginal Surgery Sector, Department of Gynecology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | | | - Marair Gracio Ferreira Sartori
- Urogynecology and Vaginal Surgery Sector, Department of Gynecology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
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20
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de Nadai Filho N, Crispi Junior CP, de Freitas Fonseca M. Paracolpium Leiomyoma Misdiagnosed as Endometriosis: Case Report and Surgical Technique of a Laparoscopic Approach. Case Rep Obstet Gynecol 2022; 2022:7931391. [PMID: 35548783 PMCID: PMC9085306 DOI: 10.1155/2022/7931391] [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: 11/01/2021] [Revised: 03/27/2022] [Accepted: 04/19/2022] [Indexed: 11/18/2022] Open
Abstract
A 36-year-old Caucasian, nulliparous patient sought care at a private gynecology clinic after 6 months of attempting to conceive. During the initial consultation, the patient reported severe dysmenorrhea and deep dyspareunia. During the gynecological examination, a nodule in the left lateral vaginal fornix was palpable. The MRI showed a hypointense nodular lesion in the left paracolpium described as an endometriosis nodule. Laparoscopic resection of the nodule was indicated. The patient showed improvement in symptoms after surgical treatment. This case report describes the technique for laparoscopic approach to paracolpium tumors.
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Affiliation(s)
- Nilton de Nadai Filho
- Ministro Costa Cavalcanti Hospital, Foz do Iguaçu PR, Brazil
- Crispi Institute of Minimally Invasive Surgery, Rio de Janeiro, RJ, Brazil
- Fernandes Figueira National Institute for Women, Children and Youth Health, Rio de Janeiro, RJ, Brazil
| | | | - Marlon de Freitas Fonseca
- Crispi Institute of Minimally Invasive Surgery, Rio de Janeiro, RJ, Brazil
- Department of Women's Health-Fernandes Figueira National Institute for Women, Children and Youth Health-Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
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21
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Delecourt C, Tourette C, Crochet P, Pivano A, Hamouda I, Agostini A. Benefits of AirSeal® System in Laparoscopic Hysterectomy for Benign Condition: A Randomized Controlled Trial. J Minim Invasive Gynecol 2022; 29:1003-1010. [DOI: 10.1016/j.jmig.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/05/2022] [Accepted: 05/07/2022] [Indexed: 10/18/2022]
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22
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Zorrilla-Vaca A, Lasala JD, Mena GE. Updates in Enhanced Recovery Pathways for Gynecologic Surgery. Anesthesiol Clin 2022; 40:157-174. [PMID: 35236578 DOI: 10.1016/j.anclin.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Gynecologic surgery encompasses over a quarter of inpatient surgical procedures for US women, and current projections estimate an increase of the US female population by nearly 50% in 2050. Over the last decade, US hospitals have embraced enhanced recovery pathways in many specialties. They have increasingly been used in multiple institutions worldwide, becoming the standard of care for patient optimization. According to the last updated enhanced recovery after surgery (ERAS) guideline published in 2019, there are several new considerations behind each practice in ERAS protocols. This article discusses the most updated evidence regarding ERAS programs for gynecologic surgery.
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Affiliation(s)
- Andres Zorrilla-Vaca
- Department of Anesthesiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Javier D Lasala
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 409 13th floor, Houston, TX 77030, USA
| | - Gabriel E Mena
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 409 13th floor, Houston, TX 77030, USA.
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23
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陈 梦, 王 楠, 叶 艳, 王 铭, 李 震, 孟 元, 叶 明. [Robot-assisted laparoscopic total hysterectomy in a patient with giant uterine fibroids and complex pelvic adhesions: a case report]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2022; 42:305-308. [PMID: 35365458 PMCID: PMC8983356 DOI: 10.12122/j.issn.1673-4254.2022.02.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Indexed: 01/24/2023]
Abstract
We report a case of giant hysteromyoma and complex pelvic adhesion treated by robotic assisted laparoscopic total hysterectomy and bilateral salpingectomy. The patient was diagnosed with uterine fibroids after physical examination in 1998 but did not receive any treatment, and regular examinations reported progressive growth of the fibroids. Ultrasound suggested multiple uterine fibroids, and pelvic MRI indicated large uterine fibroids with bleeding. Robot-assisted laparoscopic total hysterectomy and bilateral salpingectomy were performed after relevant examinations, and the operation was completed smoothly. The patient was discharged 4 days after surgery with good appearance of the abdominal wall and good recovery during the follow-up. With its unique advantages, robot-assisted laparoscopy provides a minimally invasive surgical approach for giant hysterectomy with complex pelvic adhesions.
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Affiliation(s)
- 梦雨 陈
- />解放军总医院妇产医学部第一医学中心,北京 100853Department of Obstetrics and Gynecology, General Hospital of PLA, Beijing 100853, China
| | - 楠 王
- />解放军总医院妇产医学部第一医学中心,北京 100853Department of Obstetrics and Gynecology, General Hospital of PLA, Beijing 100853, China
| | - 艳箐 叶
- />解放军总医院妇产医学部第一医学中心,北京 100853Department of Obstetrics and Gynecology, General Hospital of PLA, Beijing 100853, China
| | - 铭洋 王
- />解放军总医院妇产医学部第一医学中心,北京 100853Department of Obstetrics and Gynecology, General Hospital of PLA, Beijing 100853, China
| | - 震 李
- />解放军总医院妇产医学部第一医学中心,北京 100853Department of Obstetrics and Gynecology, General Hospital of PLA, Beijing 100853, China
| | - 元光 孟
- />解放军总医院妇产医学部第一医学中心,北京 100853Department of Obstetrics and Gynecology, General Hospital of PLA, Beijing 100853, China
| | - 明侠 叶
- />解放军总医院妇产医学部第一医学中心,北京 100853Department of Obstetrics and Gynecology, General Hospital of PLA, Beijing 100853, China
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Prospective Evaluation of Laparoscopic Sacrocolpopexy with Concomitant Laparoscopic-Assisted Total Vaginal Hysterectomy. SURGERIES 2022. [DOI: 10.3390/surgeries3010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Sacrocolpopexy (SCP) with subtotal hysterectomy (SH) is a standard procedure for the treatment of utero-vaginal prolapse. Several disadvantages are associated with the remaining cervix; therefor, SCP with total hysterectomy (TH) may be preferred. According to some publications, SCP with concomitant TH is associated with higher rates of mesh extrusion. Our hypothesis is that mesh extrusion at the apex can be avoided through prevention of thermal injury and through vaginal cuff suturing when performing the laparoscopic sacrocolpopexy combined with a laparoscopic-assisted vaginal total hysterectomy (LAVH). (2) Methods: This prospective cohort study was performed from 2016 until January 2019 including women with a utero-vaginal prolapse undergoing laparoscopic SCP with LAVH. The SCP was performed utilizing a non-absorbable polypropylene macroporous mesh (EndoGYNious®). The primary outcome was the mesh extrusion rate after SCP with concomitant LAVH. The secondary outcome was the objective and functional outcome. (3) There were 50 women included in this prospective cohort. At follow up of 6–12 weeks postoperatively, no mesh extrusion was detected and objectified. Overall, all women showed excellent anatomical and functional outcome. The median time from surgery was 42 months. (4) Laparoscopic SCP with concomitant LAVH showed no increased risk of mesh extrusion and good objective and functional outcomes.
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Ulubay M, Kinci MF, Pay RE, Dede M. Electrosurgical bipolar vessel sealing versus conventional clamping and suturing for total abdominal hysterectomy. Pak J Med Sci 2022; 38:156-161. [PMID: 35035418 PMCID: PMC8713211 DOI: 10.12669/pjms.38.1.4197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 08/16/2021] [Accepted: 08/30/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives To compare the use of Electrosurgical bipolar vessel sealing LigaSure™ small jaw instrument (LSJI) with conventional suture ligation in total abdominal hysterectomy (TAH). Methods In this retrospective study 80 patients who underwent hysterectomy in the Gynecology and Obstetrics Department of Gulhane Education and Research Hospital between April 2017 and August 2018 were included. Two different groups that underwent Electrosurgical bipolar vessel sealing LigaSure™ small jaw instrument (LSJI) and conventional suture ligation in hysterectomy operation were analyzed retrospectively. The parameters evaluated and compared between the two groups include operation time, intraoperative blood loss, duration of hospitalization and incision length. Results Among the parameters we compared between the two groups, there was no statistically significant difference between the amount of intraoperative blood loss (p:0.68) and the incision length (p:0.65). Among the parameters we compared between the two groups, a statistically significant difference was observed between the operation time (p:0.016) and the duration of hospitalization (p:0.01). Conclusion Our comparison of LSJI vs. conventional ligation in hysterectomy revealed a significant difference only in operative time, where surgeries involving conventional ligation were shorter. On the other hand, incision length was evaluated in our study which has not been addressed in previous studies. There is also a need for multi-center studies that include more patients and evaluate cost-effectiveness.
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Affiliation(s)
- Mustafa Ulubay
- Mustafa Ulubay, Assistant Professor, University of Health Sciences, Gulhane Education and Research Hospital, Obstetrics and Gynecology Department, Ankara, Turkey
| | - Mehmet Ferdi Kinci
- Mehmet Ferdi KINCI, M.D, Mugla Sitki Kocman University Education and Research Hospital, Obstetrics and Gynecology Department, Mugla, Turkey
| | - Ramazan Erda Pay
- Ramazan Erda Pay, M.D, Bingol State Hospital, Obstetrics and Gynecology Department, Bingöl, Turkey
| | - Murat Dede
- Prof. Murat DEDE, Special Anadolu Health Center, Obstetrics and Gynecology Department, Istanbul, Turkey
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Wainger JJ, Yazdy GM, Handa VL. Abdominal hysterectomy and high frailty score are associated with complications among older patients. Int J Gynaecol Obstet 2021; 158:544-550. [PMID: 34787910 DOI: 10.1002/ijgo.14029] [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: 06/15/2021] [Revised: 10/28/2021] [Accepted: 11/16/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate effects of frailty and hysterectomy route on 30-day postoperative morbidity for older hysterectomy patients. METHODS Participants included patients in the American College of Surgeons' National Surgical Quality Improvement Program database aged 60 years or older and undergoing simple hysterectomy from 2014 to 2018. The Five-Factor Modified Frailty Index approximated frailty: women with scores of 3 or more, indicating more severe comorbidities, were considered frail. Logistic regression multivariable models with and without an interaction term were used to study the independent and interactive effects of frailty and route on postoperative complications. RESULTS Of 19 888 hysterectomies, 4356 (21.9%) were abdominal, 13 382 (67%) were laparoscopic, and 2150 (10.8%) were vaginal, with 251 (1.3%) frail patients. Frailty (odds ratio [OR] 1.89, 95% confidence interval [CI] 1.32-2.70, P = 0.001) and abdominal versus laparoscopic hysterectomy (OR 2.14, 95% CI 1.88-2.45, P < 0.001) increased complication odds. Assessing interaction, complication odds for abdominal versus laparoscopic hysterectomy were higher for frail patients (OR 4.12, 95% CI 1.96-8.67, P < 0.001) versus non-frail patients (OR 2.10, 95% CI 1.84-2.40). CONCLUSION Frail older patients have increased risk for hysterectomy complications, especially with abdominal hysterectomy versus laparoscopic hysterectomy. A frailty index can be a useful preoperative tool to guide counseling and route choice.
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Affiliation(s)
- Julia J Wainger
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Golsa M Yazdy
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Victoria L Handa
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Unal F, Atakul N, Turan H, Yaman Ruhi I. Evaluation of YouTube laparoscopic hysterectomy videos as educational materials during the COVID-19 era using the LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS) and LAP-VEGaS video assessment tool. J OBSTET GYNAECOL 2021; 42:1325-1330. [PMID: 34704513 DOI: 10.1080/01443615.2021.1962823] [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] [Indexed: 10/20/2022]
Abstract
With increasing numbers of laparoscopic hysterectomies, surgical trainees are compelled to learn more about endoscopy. Owing to coronavirus disease-related social distancing requirements, online education has gained prominence. Here, we aimed to investigate the laparoscopic hysterectomy video quality on YouTube using the LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS). YouTube was searched on June 7, 2020 using 'laparoscopic hysterectomy'. Three examiners evaluated videos using Global Operative Assessment of Laparoscopic Skills (GOALS). Subsequently, videos were assessed for their conformity to the LAP-VEGaS and LAP-VEGaS Video Assessment Tool. Interobserver reliability was estimated using intraclass coefficients and Cronbach's alpha. Cochran's Q test was used to determine correlations among quantitative data. The median GOALS score was 21.50. The observers' GOALS scores were significantly correlated. The results showed low conformity to the LAP-VEGaS. YouTube is the most used platform among trainees. The low YouTube video educational quality highlights the necessity for peer review, as trainees increasingly seek such resources during the pandemic.IMPACT STATEMENTWhat is already known on this subject? YouTube is the most commonly used online resource for educational material among surgical trainees. Online videos usually do not undergo a peer-review process. The LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS) may be used to assess the educational quality of surgical videos.What do the results of this study add? To our knowledge, this is the first study on the quality of laparoscopic hysterectomy videos available on YouTube and the first study to evaluate YouTube laparoscopic surgery videos using the LAP-VEGaS Video Assessment Tool (VAT). Our study revealed the low educational quality of YouTube laparoscopic hysterectomy videos. The LAP-VEGaS VAT seems to be a valid and practical tool for assessing online laparoscopic hysterectomy videos.What are the implications of these findings for clinical practice and/or further research? Medical communities, especially tertiary care or academic centres, may upload educational peer-reviewed videos for trainees seeking this type of resource, especially during the coronavirus disease pandemic, as surgical education alternatives are limited.
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Affiliation(s)
- Fehmi Unal
- Department of Obstetrics and Gynecology, Istanbul Teaching and Research Hospital, Istanbul, Turkey
| | - Nil Atakul
- Department of Obstetrics and Gynecology, Istanbul Teaching and Research Hospital, Istanbul, Turkey
| | - Hasan Turan
- Department of Gynecologic Oncology, Cam Sakura City Hospital, Istanbul, Turkey
| | - Irem Yaman Ruhi
- Department of Obstetrics and Gynecology, Istanbul Teaching and Research Hospital, Istanbul, Turkey
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Lysdal VK, Karampas G, Rudnicki M. Lateral closure of the uterine artery prior to laparoscopic hysterectomy: a systematic review. J OBSTET GYNAECOL 2021; 42:785-792. [PMID: 34689681 DOI: 10.1080/01443615.2021.1968810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
An alternative surgical technique with closure of the uterine artery at its origin, known as lateral approach prior to TLH, has been proposed and it may offer important benefits to both patients and surgeons. Our objectives were to review the current literature regarding surgical outcomes between lateral and conventional approach in relation to TLH. We followed the 'PRISMA' guidelines and conducted a systematic review, which involved searching PubMed and Embase databases for RCTs evaluating the topic. We identified four RCTs including 585 patients. Three of the four studies reported a significant lower bleeding during TLH with prior lateral approach. Operative time was also shorter in the lateral approach group compared to the conventional approach group in three studies.Our review provides evidence that lateral occlusion of the uterine arteries prior to total laparoscopic hysterectomy may be beneficial due to less blood loss and shorter perioperative time without compromising patient safety.
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Affiliation(s)
- Vibeke Kramer Lysdal
- Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark
| | - Grigorios Karampas
- Department of Obstetrics and Gynaecology, Skåne University Hospital, Malmö, Sweden
| | - Martin Rudnicki
- Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark
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Lambat Emery S, Boulvain M, Petignat P, Dubuisson J. Operative Complications and Outcomes Comparing Small and Large Uterine Weight in Case of Laparoscopic Hysterectomy for a Benign Indication. Front Surg 2021; 8:755781. [PMID: 34676242 PMCID: PMC8525797 DOI: 10.3389/fsurg.2021.755781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/06/2021] [Indexed: 11/30/2022] Open
Abstract
Study Objective: This study was performed to evaluate the association between uterine weight and operative outcomes in women undergoing laparoscopic hysterectomy for a benign indication. Methods: This is a secondary analysis of a randomized trial with data collected prospectively and retrospectively. The data of 159 women undergoing laparoscopic hysterectomy for a benign indication were analyzed. Women were divided in two groups according to the postoperative uterine weight: small uterus group (<250 grams) and large uterus group (≥250 grams). Operative complications were compared between the two groups. Operative outcomes (need for uterine morcellation, operative duration, estimated blood loss), postoperative pain, and hospital length of stay were also analyzed. Main Results: Operative complications were not significantly different between the two groups (37% in the large uterus group versus 41% in the small uterus group). Operative outcomes showed a significantly increased use of uterine morcellation in the large uterus group (61% in the large uterus group versus 10% in the small uterus group). The operative duration was 150 min in the small uterus group and 176 min in the large uterus group, which corresponds to an increase of 17% in the large uterus group. The mean pain score on the day of surgery was identical in both groups (VAS pain score 5), but significantly in favor of the large uterus group on day 1 postoperatively (VAS pain score 4 in the small uterus group and 3 in the large uterus group). There was no statistical difference between groups in the mean hospital stay (62 ± 37 hours in the small uterus group versus 54 ± 21 hours in the large uterus group). In terms of surgical indication, the small uterus group comprised more patients with endometriosis/adenomyosis (36%) and the large uterus group more patients with leiomyoma (93%). Conclusion: The results from this study show that, even if a large uterine weight is associated with increased uterine morcellation requirement and operative duration, a laparoscopic approach is safe and does not increase operative complications nor pain and/or length of hospital stay in women undergoing hysterectomy for a benign indication.
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Affiliation(s)
- Shahzia Lambat Emery
- Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | | | - Patrick Petignat
- Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Jean Dubuisson
- Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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de Kroon CD, de Jonge MM, Bosse T, van Asperen CJ. Response to Nahshon and Lavie. J Natl Cancer Inst 2021; 114:322-323. [PMID: 34424271 DOI: 10.1093/jnci/djab155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 08/05/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Cornelis D de Kroon
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marthe M de Jonge
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tjalling Bosse
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Christi J van Asperen
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
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Comparison of Surgical Outcomes After Total Laparoscopic Hysterectomy or Total Vaginal Hysterectomy for Large Uteri. Obstet Gynecol 2021; 137:445-453. [PMID: 33543889 DOI: 10.1097/aog.0000000000004274] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/19/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To compare surgical outcomes between total laparoscopic hysterectomy and total vaginal hysterectomy with uterine weight greater than 250 g. METHODS We conducted a retrospective cohort study using data from American College of Surgeons' National Quality Improvement Project Hysterectomy Specific Database. Women with uterine weight greater than 250 g undergoing hysterectomy for benign indications by total laparoscopic hysterectomy or total vaginal hysterectomy were matched by propensity scores, which were calculated using preoperative characteristics and uterine weight. Total vaginal hysterectomy was matched to total laparoscopic hysterectomy at a ratio of 1:2. Pairwise analysis was performed using Wilcoxon rank-sum and Fisher exact tests as appropriate. Multivariable logistic regression was performed to identify the independent effect of total vaginal hysterectomy on surgical outcomes. RESULTS There were 1,870 total vaginal hysterectomies that were matched to 3,740 total laparoscopic hysterectomies. No differences in preoperative demographics and comorbidities were seen for the patients. Uterine weight was similar for both groups: 376 g (interquartile range 293-501) for total vaginal hysterectomy and 384 g (interquartile range 302-515) for total laparoscopic hysterectomy (odds ratio [OR] 0.98, 95% CI 0.92-1.09). The rate of composite major complications was similar between total vaginal hysterectomy and total laparoscopic hysterectomy (4.3% vs 5.3%, OR 0.80, 95% CI 0.61-1.05). Intraoperative cystotomies were higher with total vaginal hysterectomy (0.8% vs 0.3%, OR 2.74, 95% CI 1.17-6.61), and ureteral injuries were more common with total laparoscopic hysterectomy (1.2% vs 0.2%, OR 0.12, 95% CI 0.02-0.38). Total vaginal hysterectomy operating time was significantly shorter compared with total laparoscopic hysterectomy (77 minutes, interquartile range 56-111 vs 122 minutes, interquartile range 91-164; OR 0.69, 95% CI 0.42-0.89). After adjusting for confounders, total vaginal hysterectomy was not found to be independently associated with major morbidity (adjusted odds ratio [aOR] 0.95, 95% CI 0.18-5.11) and was associated with a lower probability of operating times exceeding 2.5 hours (aOR 0.31, 95% CI 0.27-0.43). CONCLUSION In patients matched by uterine size and preoperative characteristics, total vaginal hysterectomy is not associated with an increased composite risk of major surgical morbidity or other adverse surgical outcomes.
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Abstract
Background and Objectives Laparoscopic hysterectomy provides patients and surgeons with benefits of less pain, quicker recovery, and better scar cosmesis. Previously, robotic surgical hysterectomy was reserved for patients with complicated disease issues. The objective of this case series was evaluating a new robotic surgical platform, Senhance Surgical System, as a surgical tool in common gynecological procedures. Methods The clinic routinely collects surgical and outcome data for all patients and procedures. Data on robotic surgery in hysterectomy, salpingectomy, endometriosis excision, and lysis of adhesions was evaluated. Results Fifteen consecutive patients that underwent gynecological surgery using the Senhance System were assessed. Average age was 47.27 years (31 - 63 years). Ten procedures were robotic total laparoscopic hysterectomy and 14 of 15 procedures had at least one salpingectomy. Average blood loss was 52.7 mL (10 - 100 mL). Pain scores at discharge averaged 1.42 and 2.73 at two weeks post-surgery. Minimal pain medication was used. Patient satisfaction with the surgery was 98% and satisfaction with scarring was 100%. Return to normal activities and to work averaged 7.93 and 11.1 days respectively. The haptic feedback and the platform visualization of the procedure was useful. The system provided more surgeon control over both camera and tools compared to previously used robotic systems and traditional laparoscopic surgery. Conclusion This initial experience with Senhance Surgical System provided a stable, precise surgical technique with enhanced visualization within the confined space of the abdomen during gynecological surgery. The initial results suggest high patient satisfaction with gynecological surgery and resulting scars. Further study is needed to validate the findings.
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Affiliation(s)
- Steven D McCarus
- Division of Gynecological Surgery, Advent Health Winter Park Hospital, Winter Park, FL
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Roman JD. Implementation of Total Laparoscopic Hysterectomy As the Default Technique and Lessons Learnt. Cureus 2021; 13:e16428. [PMID: 34414049 PMCID: PMC8364778 DOI: 10.7759/cureus.16428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Concerns about surgical complications and the paucity of surgical audits have been named as reasons for the slow implementation of total laparoscopic hysterectomy (TLH) in New Zealand and Australia, despite a majority of gynaecologists who would like to offer this less-invasive approach to their patients. Material and methods This study aims to assess the implementation of TLH as the default method of hysterectomy at a private institution in the Waikato region of New Zealand, and to identify factors related to the perioperative complications and to the failure to accomplish the above procedure laparoscopically in an unselected population. We present 1,287 cases collected over fourteen years with an emphasis on demographics, outcomes, indications for surgery, laparoscopic completion of the surgical procedure and perioperative major complications. Results One hundred and fifty patients (11.7%) were nulliparous and 378 patients (29.4%) had a history of the previous laparotomy. The mean theatre time and SD was 144.84 ± 20.48 min; the mean blood loss was 137.24 ± 69 mL; the mean hospital stay was 2.07 ± 0.31 days; the median uterine weight was 177 g and the biggest uterus removed laparoscopically weighed 1,510 g. Twelve cases were converted to laparotomy (0.93%). The uterine weight had a statistically significant association with the conversion rate. The main indications for surgery were menorrhagia and/or recurrent dysmenorrhoea in 662 patients (51.4%) and fibroid uterus in 228 patients (17.7%). Six patients (0.47%) required blood transfusions. There was a total of 74 perioperative complications (5.7%) and 16 major complications (1.24%). BMI and uterine weight had a statistically significant association with major complication rates. Seven patients (0.54%) were re-operated as a result of a complication. Conclusion The implementation of TLH as default is achievable and is a safe surgical option. BMI and uterine weight are factors associated significantly with major complications or conversion to laparotomy.
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Affiliation(s)
- Jose D Roman
- Gynaecology Department, Braemar Hospital, Hamilton, NZL
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Casarin J, Cromi A, Bogani G, Multinu F, Uccella S, Ghezzi F. Surgical morbidity of total laparoscopic hysterectomy for benign disease: Predictors of major postoperative complications. Eur J Obstet Gynecol Reprod Biol 2021; 263:210-215. [PMID: 34229185 DOI: 10.1016/j.ejogrb.2021.06.023] [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: 04/01/2021] [Revised: 05/24/2021] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To estimate rate of perioperative complications and to define risk factors of 30-day major (Clavien-Dindo ≥ 2) postoperative complications of total laparoscopic hysterectomy (TLH) for benign disease. STUDY DESIGN An uncontrolled single-center single-arm retrospective study. Data of consecutive patients who have undergone TLH for pathologically confirmed benign disease between January 2000 and December 2019 have been analyzed. Perioperative surgical outcomes, occurrence of postoperative complications, readmissions, and reoperations within 30 days from surgery were registered. Univariate and multivariable analyses were performed to determine the factors associated with major (Clavien-Dindo ≥ 2) postoperative complications. RESULTS Over the study period 3090 patients were included in the study. Conversion to open surgery occurred in 54 (1.7%) cases. Mean operative time for TLH was 87.7 (±1.7) minutes while mean estimated blood loss was 119.5 (+7.4) mL. Overall, postoperative complications were registered in 430 (13.9%) patients, and major events were observed in 208 (6.7%) of the cases. Same-hospital readmissions and reoperations within 30-day from surgery occurred in 78 (2.5%) and 28 (0.9%) patients, respectively. At multivariable analysis, endometriosis (odds ratio: 3.51, 95%CI:1.54-8.30, p = 0.02), the need for conversion to open surgery (odds ratio: 1.26, 98%CI:1.03-12.64, p < 0.001), and the occurrence of any intraoperative complication (odds ratio: 3.10, 95%CI: 1.45-21.61, p < 0.001) were found as independent risk factors for major postoperative complications. CONCLUSIONS Total hysterectomy performed via laparoscopy is associated with acceptable major postoperative complications rate. A huge effort should be made to minimize the occurrence of intraoperative complications and the need for conversion to open surgery. Patients undergoing TLH for endometriosis should be counselled about the increased risk of major postoperative events.
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Affiliation(s)
- J Casarin
- Obstetrics and Gynecology Department of the University of Insubria, Varese, Italy.
| | - A Cromi
- Obstetrics and Gynecology Department of the University of Insubria, Varese, Italy
| | - G Bogani
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - F Multinu
- Division of Gynecologic Surgery, IEO, European Institute of Oncology IRCSS, Milan, Italy
| | - S Uccella
- Obstetrics and Gynecology Department, University of Verona, Italy
| | - F Ghezzi
- Obstetrics and Gynecology Department of the University of Insubria, Varese, Italy
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Two-Layer Compared With One-Layer Vaginal Cuff Closure at the Time of Total Laparoscopic Hysterectomy to Reduce Complications. Obstet Gynecol 2021; 138:59-65. [PMID: 34259464 DOI: 10.1097/aog.0000000000004428] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 03/25/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To explore whether two-layer laparoscopic vaginal cuff closure at the time of laparoscopic hysterectomy is associated with a lower rate of postoperative complications compared with a standard one-layer cuff closure. METHODS A retrospective cohort study of total laparoscopic hysterectomies performed by fellowship-trained minimally invasive gynecologic surgeons between 2011 and 2017 was performed. Surgeons sutured the vaginal cuff laparoscopically, either in a two- or one-layer closure. The primary outcome was a composite of total postoperative complications, including all medical and surgical complications within 30 days and vaginal cuff complications within 180 days. Factors known to influence laparoscopic vaginal cuff complications including age, postmenopausal status, body mass index, tobacco use, and immunosuppressant medications were examined and controlled for, while surgeon skill, colpotomy technique, and suture material remained standardized. We conducted statistical analyses including χ2, Fisher exact test, logistic regression, and post hoc power calculations. RESULTS Of the 2,973 women who underwent total laparoscopic hysterectomies, 40.8% (n=1,213) of vaginal cuffs were closed with a two-layer closure and 59.2% (n=1,760) with a one-layer technique. Two-layer vaginal cuff closure was associated with decreased numbers of total postoperative complications (3.5% vs 5.7%; P<.01). The primary difference stemmed from lower vaginal cuff complications within 180 days (0.9% vs 2.6%; P<.01); no differences in 30-day medical and surgical postoperative complications were observed between the two groups (2.6% vs 3.1%; P=.77). No patients in the two-layer vaginal cuff closure cohort experienced a vaginal cuff dehiscence or mucosal separation compared with 1.0% in the one-layer group (P<.01). Compared with a one-layer closure, a two-layer closure was protective from postoperative complications (adjusted odds ratio 0.38, 95% CI 0.19-0.74). CONCLUSION Although postoperative complications with laparoscopic hysterectomies are rare, two-layer laparoscopic vaginal cuff closure is associated with lower total postoperative complications compared with a one-layer closure. The difference was primary driven by cuff complications.
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Bou Zgheib N. Major Intraoperative Injuries During Hysterectomy: Prevention, Recognition and Management. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2021.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Nadim Bou Zgheib
- Gynecologic Oncology Division, Marshall University School of Medicine, Huntington, West Virginia, USA
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Luchristt D, Brown O, Geynisman-Tan J, Mueller MG, Kenton K, Bretschneider CE. Timing of diagnosis of complex lower urinary tract injury in the 30-day postoperative period following benign hysterectomy. Am J Obstet Gynecol 2021; 224:502.e1-502.e10. [PMID: 33157065 DOI: 10.1016/j.ajog.2020.10.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/07/2020] [Accepted: 10/29/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Complex lower urinary tract injury resulting from hysterectomy is a rare but highly morbid complication. Although intraoperative recognition reduces the risk of serious sequelae, observational studies have shown that most complex lower urinary tract injuries are recognized in the postoperative period. To date, limited research exists describing the timing of diagnosis of complex lower urinary tract injury or risk factors associated with complex lower urinary tract injury diagnosed in the postoperative period. OBJECTIVE This analysis aimed to describe the time to diagnosis of complex lower urinary tract injury among women undergoing benign hysterectomy. We also aimed to identify the intraoperative risk factors for differences in type and timing of complex lower urinary tract injury in the 30-day postoperative period using a large prospective national surgical database. STUDY DESIGN This was a retrospective analysis using the National Surgical Quality Improvement Program hysterectomy data set from 2014 to 2018. All benign hysterectomies were included. Sociodemographic factors, health status, surgeon type, and other operative characteristics were extracted. A complex lower urinary tract injury was defined as at least 1 ureteral obstruction, ureteral fistula, or bladder fistula diagnosed within the first 30 days following surgery. Bivariate and multivariate logistic regression and cox proportional hazards assessed differences in odds of and time until diagnosis of complex lower urinary tract injury. Proportional hazard assumptions were evaluated with martingale residuals and supremum tests. Significance thresholds were 0.05 for all analyses. RESULTS In this study, 100,823 women met the inclusion criteria. Median time to diagnosis of complex lower urinary tract injury was 10 days (interquartile range, 3-19) and varied significantly based on type of injury (P<.01) with ureteral obstruction (6; interquartile range, 2-16) recognized earlier than ureteral fistula (12; interquartile range, 7-21) and bladder fistula (14; interquartile range, 4-23). In addition, 8.65% of complex lower urinary tract injury were diagnosed on the day of surgery. Total laparoscopic hysterectomy had the lowest rate of complex lower urinary tract injury in unadjusted and adjusted analysis, with abdominal hysterectomy (adjusted odds ratio, 2.02; 95% confidence interval, 1.21-3.36) and vaginal hysterectomy (adjusted odds ratio, 2.05; 95% confidence interval, 1.16-3.62) having greater odds of ureteral obstruction, whereas laparoscopic assisted vaginal hysterectomy had the greatest odds of fistula (adjusted odds ratio, 2.10; 95% confidence interval, 1.26-3.48). Concomitant apical suspension was associated with a 6-day reduction in median time to diagnosis (P=.01), and surgery with a gynecologic oncologist was associated with a 9.5-day increase in median time to diagnosis (P=.01). Cox proportional hazards analysis confirmed these findings when controlling for confounders. CONCLUSION Greater than 91% of complex lower urinary tract injury diagnoses in the National Surgical Quality Improvement Program hysterectomy database were diagnosed after the day of surgery. Route of hysterectomy, concomitant apical suspension, and primary surgeon specialty are associated with differences in both type of injury and time until diagnosis. These intraoperative risk factors should be considered when assessing for complex lower urinary tract injury in the 30-day postoperative period.
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Stanescu AD, Loghin MG, Ples L, Balan DG, Paunica I, Balalau OD. Therapeutic approach of uterine leiomyoma; choosing the most appropriate surgical option. JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2021. [DOI: 10.25083/2559.5555/6.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The most common benign pelvic tumor in young women is uterine leiomyoma. It is often asymptomatic, but can cause symptoms such as pelvic-abdominal pain, vaginal bleeding, urinary and intestinal transit disorders. If there is a suspicion of malignancy, it is necessary to perform fractional uterine curettage to establish the histopathological diagnosis.The surgical treatment of uterine leiomyoma includes several procedures: myomectomy, subtotal or total hysterectomy. The procedure will be chosen depending on the patient's particularities: BMI, uterine size, leiomyoma location, surgical history or other associated pathologies.Laparoscopic hysterectomy has a 45-minute shorter duration of intervention than vaginal hysterectomy, and the conversion rate to the open procedure is lower.Laparoscopically treated cases have fewer postoperative complications compared to other surgical procedures and have a shorter hospitalization and recovery time.The recurrence rate of uterine leiomyoma is similar for both laparoscopic and open abdominal approach, and the frequency of long-term complications such as adhesion syndrome or pelvic pain is higher after the latter.
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Cokan A, Krajnc K, Serdinšek T. Is There Still a Place for Hysterectomy for Treatment of Recurrent Squamous Intraepithelial Lesions? J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Andrej Cokan
- Clinic for Gynecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia
| | - Klavdija Krajnc
- Clinic for Gynecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia
| | - Tamara Serdinšek
- Clinic for Gynecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia
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Luchristt D, Brown O, Kenton K, Bretschneider CE. Trends in operative time and outcomes in minimally invasive hysterectomy from 2008 to 2018. Am J Obstet Gynecol 2021; 224:202.e1-202.e12. [PMID: 32791126 DOI: 10.1016/j.ajog.2020.08.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/30/2020] [Accepted: 08/07/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is a national shift toward laparoscopic hysterectomy as the predominant form of minimally invasive hysterectomy. Previous research suggests that vaginal hysterectomy is associated with lower operative time and improved outcomes; however, this has not been validated in a modern cohort of women. OBJECTIVE This analysis aims to evaluate whether total vaginal hysterectomy remains associated with lower operative times and fewer postoperative complications than total laparoscopic hysterectomy or laparoscopic-assisted vaginal hysterectomy, given recent shifts in clinical practice patterns and training experience. STUDY DESIGN A secondary analysis of the National Surgical Quality Improvement Program database was performed. Three primary outcomes were defined for the analysis: operative time, rate of major complications, and rate of minor complications. Secondary outcomes included changes in route of surgery over time. Descriptive analyses were performed for all outcomes of interest. Operative time, rate of major complications, and rate of minor complications were compared for each of the 3 forms of minimally invasive hysterectomy: total laparoscopic hysterectomy, laparoscopic-assisted vaginal hysterectomy, and total vaginal hysterectomy. Bivariate analyses were performed using analysis of variance, Kruskal-Wallis, Pearson chi-square, or Fisher exact tests where appropriate. Multivariable ordinary least squares and logistic regression were used to assess for overall differences in outcomes and trends over time, controlling for sociodemographic factors and medical comorbidities. Sensitivity analyses were performed using a propensity score-matched cohort created to balance groups across time. RESULTS A total of 161,626 women met criteria for inclusion. Rates of total vaginal hysterectomy dropped from 51% to 13% between 2008 and 2018, whereas rates of total laparoscopic hysterectomy increased from 12% to 68% (P<.001). In multivariable analyses, total laparoscopic hysterectomy and laparoscopic-assisted vaginal hysterectomy were associated with lower odds of major complications (adjusted odds ratio [95% confidence interval]: 0.813 [0.750-0.881] and 0.873 [0.797-0.957], respectively) and minor complications (adjusted odds ratio [95% confidence interval]: 0.723 [0.676-0.772] and 0.896 [0.832-0.964], respectively) than total vaginal hysterectomy. Temporal trends show an increase in total vaginal hysterectomy operative time and decreases in total laparoscopic hysterectomy and laparoscopic-assisted vaginal hysterectomy operative times over the 11-year analysis period (P<.001), although total vaginal hysterectomy continues to have the shortest median operative time overall. No temporal trends were observed in rates of complications. CONCLUSION This analysis highlights recent shifts in rates of minimally invasive hysterectomy. Alongside this change in practice pattern, this study also brings to light a resultant shift in the complication rates associated with each surgical approach, as laparoscopic hysterectomy has lower rates of complications than vaginal hysterectomy despite longer operative times.
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Affiliation(s)
- Douglas Luchristt
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Oluwateniola Brown
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kimberly Kenton
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - C Emi Bretschneider
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
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Alliende RI, Carrasco ÁM, Levancini M, Kovoor E, Guzmán-Rojas RA, Miranda-Mendoza I. 5,926 hysterectomies: complications described by Clavien-Dindo classification. J OBSTET GYNAECOL 2021; 41:1102-1106. [PMID: 33432854 DOI: 10.1080/01443615.2020.1835843] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Hysterectomy is the most common major gynaecological surgery. Due to its high volume, the analysis of its results is relevant. The objective of this study was to describe intraoperative complications and reoperations, for both benign and malignant causes, using the Clavien-Dindo classification (approved by local ethics committee, number 100220). Between 2000 and 2019, 5926 elective hysterectomies were performed, of which 90.2% were for benign aetiology and 9.8% for malignant causes. The abdominal route was 52.7%, vaginal 40.1% and laparoscopic 7.2%. Intraoperative complications and reoperations (grade III Clavien-Dindo) were 4% and 2.1%, respectively. Oncological surgery had significantly more intraoperative complications (10% vs. 3.4%) and reoperations (3.6% vs. 1.9%) than benign procedures. Noteworthy, intraoperative complications required a new operation in only 3.4% for malignant and 2.8% for benign surgery. Our data showed the relevance of detecting and rectifying intraoperative complications during surgery, which consequently leads to a lower reoperation rate, minimising postoperative morbidity and mortality for patients.Impact StatementWhat is already known on this subject? The surgical complications of hysterectomy, both intraoperative and postoperative, are extensively described. However, this information is not well systematised, in which elective and emergency surgery are mixed. In addition to the above, there are few documents comparing the results of hysterectomies due to benign versus malignant causes.What the results of this study add? Using the Clavien-Dindo classification, this study adds an organised description of intraoperative complications and reoperations of hysterectomy in the context of elective surgery. In addition, it provides information on the comparison between surgery for benign versus malignant causes, as well as information on intraoperative complications requiring a new operation.What the implications are of these findings for clinical practice and/or further research? These findings provide clear and orderly data about the risks of elective hysterectomy and showed the relevance of detecting and rectifying intraoperative complications during the procedure. This is useful for specialists to preoperatively identify the risks for each hysterectomy group and provide their patients with more detailed information during informed consent.
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Affiliation(s)
- Rodrigo I Alliende
- Department of Obstetrics and Gynecology, Hospital de la Florida, Santiago, Chile
| | - Álvaro M Carrasco
- Department of Obstetrics and Gynecology, Hospital de la Florida, Santiago, Chile
| | - Marco Levancini
- Department of Obstetrics and Gynecology, Hospital Padre Hurtado, Santiago, Chile.,Department of Obstetrics and Gynecology, Faculty of Medicine, Clínica Alemana de Santiago - Universidad del Desarrollo, Santiago, Chile
| | | | - Rodrigo A Guzmán-Rojas
- Department of Obstetrics and Gynecology, Hospital Padre Hurtado, Santiago, Chile.,Department of Obstetrics and Gynecology, Faculty of Medicine, Clínica Alemana de Santiago - Universidad del Desarrollo, Santiago, Chile.,Department of Obstetrics and Gynecology, Hospital Clinico Universidad de Chile, Santiago, Chile
| | - Ignacio Miranda-Mendoza
- Department of Obstetrics and Gynecology, Hospital Padre Hurtado, Santiago, Chile.,Department of Obstetrics and Gynecology, Faculty of Medicine, Clínica Alemana de Santiago - Universidad del Desarrollo, Santiago, Chile.,Department of Obstetrics and Gynecology, Hospital Clinico Universidad de Chile, Santiago, Chile
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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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Lowenstein L, Mor O, Matanes E, Lauterbach R, Boulus S, Weiner Z, Baekelandt J. Robotic Vaginal Natural Orifice Transluminal Endoscopic Hysterectomy for Benign Indications. J Minim Invasive Gynecol 2020; 28:1101-1106. [PMID: 33144242 DOI: 10.1016/j.jmig.2020.10.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/07/2020] [Accepted: 10/24/2020] [Indexed: 02/07/2023]
Abstract
STUDY OBJECTIVE The Hominis surgical system is a novel robot-assisted system, designed specifically for robotic vaginal natural orifice transluminal endoscopic surgery (RvNOTES). We presented our experience of the first 30 RvNOTES hysterectomies assessing the feasibility and safety of this technology. DESIGN A two-center prospective study. SETTING Academic tertiary referral centers. The ethics committees approved the study in both centers. PATIENTS Thirty women with benign indication for hysterectomy. INTERVENTION RvNOTES hysterectomy performed by the Hominis surgical system. MEASUREMENTS AND MAIN RESULTS The primary outcome of the study was the rate of conversion to open or conventional laparoscopic approaches. Secondary outcomes included intra- and postoperative adverse events, operative time, estimated blood loss, length of hospital stay, and 6-week follow-up assessment. A total of 15 women were enrolled at each site. The median age was 59 years (range: 37-79) and the median body mass index was 25.4 kg/m2 (range: 17.6-40.0). Twenty-four women (80%) had comorbidities. All the procedures were completed successfully without conversion to open abdominal, traditional vaginal, or conventional laparoscopic surgery. No intraoperative complications were observed. Median blood loss and procedure duration were 50 mL (range: 20-400) and 57 minutes (range: 24-88), respectively. Postoperative pain was minimal, with a median visual analog scale of 3 (range: 1-5) for the first 24 hours following surgery. The median hospital stay was 3 days (range: 2-8). According to the treating physicians' evaluations, the vaginal cuff was fully healed in all patients at the 6-week postoperative follow-up visit. CONCLUSIONS This is the first publication of robot-assisted vaginal hysterectomy using the Hominis surgical system. The positive results of this study show this new technology to be a safe and effective tool for vaginal natural orifice transluminal endoscopic surgery, enabling surgeons to operate vaginally with the known advantages of robotic modality.
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Affiliation(s)
- Lior Lowenstein
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel (Drs. Lowenstein, Mor, Matanes, Lauterbach, Boulus, Weiner).
| | - Omer Mor
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel (Drs. Lowenstein, Mor, Matanes, Lauterbach, Boulus, Weiner)
| | - Emad Matanes
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel (Drs. Lowenstein, Mor, Matanes, Lauterbach, Boulus, Weiner)
| | - Roy Lauterbach
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel (Drs. Lowenstein, Mor, Matanes, Lauterbach, Boulus, Weiner)
| | - Sari Boulus
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel (Drs. Lowenstein, Mor, Matanes, Lauterbach, Boulus, Weiner)
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel (Drs. Lowenstein, Mor, Matanes, Lauterbach, Boulus, Weiner)
| | - Jan Baekelandt
- Department of Gynecological Oncology and Endoscopy, Imelda Hospital, Bonheiden, Antwerpen, Belgium (Dr. Baekelandt)
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Das D, Sinha A, Yao M, Michener CM. Trends and Risk Factors for Vaginal Cuff Dehiscence after Laparoscopic Hysterectomy. J Minim Invasive Gynecol 2020; 28:991-999.e1. [PMID: 32920145 DOI: 10.1016/j.jmig.2020.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/15/2020] [Accepted: 09/08/2020] [Indexed: 12/16/2022]
Abstract
STUDY OBJECTIVE The primary objective was to assess the effect of the route of closure of the vaginal cuff on the incidence of vaginal cuff dehiscence (VCD) in laparoscopic hysterectomy (LH). The secondary objective was to assess patient- and surgical-risk factors associated with VCD, rate of perioperative complications by route of closure, and impact of surgeon volume on complications. DESIGN Retrospective chart review with case-control component. SETTING Tertiary care center (main hospital and regional hospitals). PATIENTS A total of 1278 women underwent LH or robot-assisted hysterectomy in 2016, and met the inclusion criteria. Independently, 26 cases of VCD were identified from 2009 through 2016. INTERVENTIONS A retrospective comparison of patients with vaginal cuff closure and laparoscopic cuff closure (LCC) undergoing LH or robot-assisted hysterectomy in 2016. Patients with VCD from 2009 through 2016 (n = 26) were matched by route of cuff closure to the next 7 patients who underwent hysterectomies (n = 182), who became controls. MEASUREMENTS AND MAIN RESULTS In 2016, there were 9 cases of VCD (0.70%). There was no significant difference in VCD between LCC (8/989; 0.81%) and vaginal cuff closure (1/289; 0.35%; p = .41). Seven VCD cases were performed by high-volume surgeons (>30 hysterectomies per year) who were more likely to perform LCC and use barbed suture. There were no significant differences in the rates of perioperative complications or surgeon volume between routes of cuff closure. The case-control patients differed in smoking status (p = .010) and history of prior laparotomy (p = .017). Logistic regression showed that increasing age (odds ratio 0.95; 95% confidence interval, 0.91-0.99) and increasing body mass index (odds ratio 0.98; 95% confidence interval, 0.83-0.97) were protective for VCD. CONCLUSION VCD is a rare but serious complication of LH. Despite previous studies, we did not find a significant difference in VCD or intra- and perioperative complications by route of cuff closure or surgeon volume. Given the lack of evidence favoring one route of cuff closure, we recommend that, to optimize patient outcomes, surgeons employ the closure technique that they are best accustomed to.
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Affiliation(s)
- Deepanjana Das
- Department of Obstetrics and Gynecology, Women's Health Institute (Drs. Das, Sinha, and Michener).
| | - Annika Sinha
- Department of Obstetrics and Gynecology, Women's Health Institute (Drs. Das, Sinha, and Michener)
| | - Meng Yao
- Department of Quantitative Health Sciences (Mr. Yao), Cleveland Clinic, Cleveland, Ohio
| | - Chad M Michener
- Department of Obstetrics and Gynecology, Women's Health Institute (Drs. Das, Sinha, and Michener)
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Misirlioglu S, Giray B, Vatansever D, Arslan T, Urman B, Taskiran C. Mini-plus percutaneous setting in total laparoscopic hysterectomy. MINIM INVASIV THER 2020; 31:284-290. [PMID: 32723200 DOI: 10.1080/13645706.2020.1794899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION We aimed to analyze the preliminary experience of a mini-plus percutaneous instrument (MpPc) setting in total laparoscopic hysterectomy (TLH). MATERIAL AND METHODS Forty-three women who underwent a mini-plus percutaneous total laparoscopic hysterectomy at a tertiary-care university-based teaching hospital and academic affiliated private hospital between May 2017 and 2018 were included. MpPc-TLH was performed through one optical trans-umbilical 5-mm trocar, one 5-mm ancillary port on the right side, either one 2.4-mm percutaneous endoscopic instrument or 3-mm mini-laparoscopic port on the right upper quadrant and if required one 3-mm ancillary port on the left lower quadrant. RESULTS A total of 43 patients were included, with a median age of 48 years (range, 38-71 years). Indication for surgery included uterine myomas (n = 20), benign adnexal mass (n = 7), endometrial intraepithelial neoplasia (n = 6), endometrial cancer (n = 5), adenomyosis with abnormal bleeding (n = 3), and high-grade cervical dysplasia (n = 2). The median operating time was 100 min (range, 60-180 min), and the median estimated blood loss was 30 ml (range, 20-60ml). The median postoperative abdominal pain Visual Analog Scale score was 3 (range, 0-6). CONCLUSIONS The preliminary data suggest that MpPc approach is a feasible and safe surgical modality for total laparoscopic hysterectomy.
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Affiliation(s)
- Selim Misirlioglu
- Department of Obstetrics and Gynecology, VKF Koc University Hospital, Istanbul, Turkey
| | - Burak Giray
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Zeynep Kamil Women and Children's Health Training and Research Hospital, Istanbul, Turkey
| | - Dogan Vatansever
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, VKF Koc University School of Medicine, Istanbul, Turkey
| | - Tonguc Arslan
- Women's Health Center, VKF American Hospital, Istanbul, Turkey
| | - Bulent Urman
- Women's Health Center, VKF American Hospital, Istanbul, Turkey.,Department of Obstetrics and Gynecology, VKF Koc University School of Medicine, Istanbul, Turkey
| | - Cagatay Taskiran
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, VKF Koc University School of Medicine, Istanbul, Turkey.,Women's Health Center, VKF American Hospital, Istanbul, Turkey
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Chapman GC, Slopnick EA, Roberts K, Sheyn D, Wherley S, Mahajan ST, Pollard RR. National Analysis of Perioperative Morbidity of Vaginal Versus Laparoscopic Hysterectomy at the Time of Uterosacral Ligament Suspension. J Minim Invasive Gynecol 2020; 28:275-281. [PMID: 32450226 DOI: 10.1016/j.jmig.2020.05.015] [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: 02/06/2020] [Revised: 05/12/2020] [Accepted: 05/17/2020] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE The objective of this study was to compare the morbidity of vaginal versus laparoscopic hysterectomy when performed with uterosacral ligament suspension. DESIGN Retrospective propensity-score matched cohort study. SETTING American College of Surgeons National Surgical Quality Improvement Program database. PATIENTS We included all patients who had undergone uterosacral ligament suspension and concurrent total vaginal hysterectomy (TVH-USLS) or total laparoscopic hysterectomy (TLH-USLS) from 2010 to 2015. We excluded those who underwent laparoscopic-assisted vaginal hysterectomy, abdominal hysterectomy, other surgical procedures for apical pelvic organ prolapse, or had gynecologic malignancy. INTERVENTIONS We compared 30-day complication rates in patients who underwent TVH-USLS versus TLH-USLS in both the total study population and a propensity score matched cohort. MEASUREMENTS AND MAIN RESULTS The study population consisted of 3,349 patients who underwent TVH-USLS and 484 who underwent TLH-USLS. Patients who underwent TVH-USLS had a significantly higher composite complication rate (11.4% vs 6.4%, odds ratio [OR] 1.9, 1.3-2.8; p <.01) and a higher serious complication rate (5.6% vs 3.1%, OR 1.8, 1.1-3.1; p = .02), which excluded urinary tract infection and superficial surgical site infection. The propensity score analysis was performed, and patients were matched in a 1:1 ratio between the TVH-USLS group and the TLH-USLS group. In the matched cohort, patients who underwent TVH-USLS had a higher composite complication rate than those who underwent TLH-USLS (10.3% vs 6.4%, OR 1.7, 95% confidence interval [CI], 1.1-2.7; p = .04), whereas the rate of serious complications did not differ between the groups (4.3% vs 3.1%, OR 1.4, 95% CI, 0.7-2.8; p = .4). On multivariate logistic regression, TVH-USLS remained an independent predictor of composite complications (adjusted OR 1.6, 95% CI, 1.0-2.6; p = .04) but not serious complications (adjusted OR 1.4, 95% CI, 0.7-2.8; p = .3). CONCLUSION In this large national cohort, TVH-USLS was associated with a higher composite complication rate than TLH-USLS, largely secondary to an increased rate of urinary tract infection. After matching, the groups had similar rates of serious complications. These data suggest that TLH-USLS should be viewed as a safe alternative to TVH-USLS.
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Affiliation(s)
- Graham C Chapman
- Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine (all authors); Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center (Drs. Chapman, Slopnick, Roberts, Wherley, and Mahajan); Department of Obstetrics and Gynecology, MetroHealth Medical Center (Drs. Chapman, Slopnick, Roberts, Sheyn, and Pollard), Cleveland, Ohio.
| | - Emily A Slopnick
- Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine (all authors); Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center (Drs. Chapman, Slopnick, Roberts, Wherley, and Mahajan); Department of Obstetrics and Gynecology, MetroHealth Medical Center (Drs. Chapman, Slopnick, Roberts, Sheyn, and Pollard), Cleveland, Ohio
| | - Kasey Roberts
- Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine (all authors); Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center (Drs. Chapman, Slopnick, Roberts, Wherley, and Mahajan); Department of Obstetrics and Gynecology, MetroHealth Medical Center (Drs. Chapman, Slopnick, Roberts, Sheyn, and Pollard), Cleveland, Ohio
| | - David Sheyn
- Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine (all authors); Department of Obstetrics and Gynecology, MetroHealth Medical Center (Drs. Chapman, Slopnick, Roberts, Sheyn, and Pollard), Cleveland, Ohio
| | - Susan Wherley
- Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine (all authors); Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center (Drs. Chapman, Slopnick, Roberts, Wherley, and Mahajan)
| | - Sangeeta T Mahajan
- Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine (all authors); Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center (Drs. Chapman, Slopnick, Roberts, Wherley, and Mahajan)
| | - Robert R Pollard
- Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine (all authors); Department of Obstetrics and Gynecology, MetroHealth Medical Center (Drs. Chapman, Slopnick, Roberts, Sheyn, and Pollard), Cleveland, Ohio
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Stoller N, Wertli MM, Zaugg TM, Haynes AG, Chiolero A, Rodondi N, Panczak R, Aujesky D. Regional variation of hysterectomy for benign uterine diseases in Switzerland. PLoS One 2020; 15:e0233082. [PMID: 32407404 PMCID: PMC7224542 DOI: 10.1371/journal.pone.0233082] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 04/26/2020] [Indexed: 01/09/2023] Open
Abstract
Background Hysterectomy is the last treatment option for benign uterine diseases, and vaginal hysterectomy is preferred over more invasive techniques. We assessed the regional variation in hysterectomy rates for benign uterine diseases across Switzerland and explored potential determinants of variation. Methods We conducted a population-based analysis using patient discharge data from all Swiss hospitals between 2013 and 2016. Hospital service areas (HSAs) for hysterectomies were derived by analyzing patient flows. We calculated age-standardized mean procedure rates and measures of regional variation (extremal quotient [EQ], highest divided by lowest rate) and systematic component of variation [SCV]). We estimated the reduction in the variance of crude hysterectomy rates across HSAs in multilevel regression models, with incremental adjustment for procedure year, age, cultural/socioeconomic factors, burden of disease, and density of gynecologists. Results Overall, 40,211 hysterectomies from 54 HSAs were analyzed. The mean age-standardized hysterectomy rate was 298/100,000 women (range 186–456). While the variation in overall procedure rate was moderate (EQ 2.5, SCV 3.7), we found a very high procedure-specific variation (EQ vaginal 5.0, laparoscopic 6.3, abdominal 8.0; SCV vaginal 17.5, laparoscopic 11.2, abdominal 16.9). Adjusted for procedure year, demographic, cultural, and sociodemographic factors, a large share (64%) of the variance remained unexplained (vaginal 63%, laparoscopic 85%, abdominal 70%). The main determinants of variation were socioeconomic/cultural factors. Burden of disease and the density of gynecologists was not associated with procedure rates. Conclusions Switzerland has a very high regional variation in vaginal, laparoscopic, and abdominal hysterectomy for benign uterine disease. After adjustment for potential determinants of variation including demographic factors, socioeconomic and cultural factors, burden of disease, and the density of gynecologists, two thirds of the variation remain unexplained.
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Affiliation(s)
- Nina Stoller
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- * E-mail:
| | - Maria M. Wertli
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tabea M. Zaugg
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Arnaud Chiolero
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Radoslaw Panczak
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Queensland Centre for Population Research, School of Earth and Environmental Sciences, The University of Queensland, Brisbane, Australia
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Chapman AD, Bashour M, Sagaria L, Gothard D, Ballas DA. Simulation-based Training Curriculum for the Management of Vaginal Cuff Dehiscence and Evisceration. Cureus 2020; 12:e6752. [PMID: 32140320 PMCID: PMC7039354 DOI: 10.7759/cureus.6752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective Vaginal cuff dehiscence with evisceration (VCDE) is a serious, life-threatening complication of hysterectomy. Due to the high volume of hysterectomies performed in the U.S each year, it is likely that a practitioner will encounter VCDE during their career. Due to its infrequent occurrence, residents receive little exposure to it during training. Delayed diagnosis of VCDE can impede proper management and lead to severe, long-term complications or death. Our goal was to provide an opportunity for resident physicians to identify VCDE and practice performing a reduction of prolapsed bowel and vaginal cuff repair through hands-on simulation in hopes that the simulation would improve the residents’ confidence and knowledge in recognizing and managing future VCDE cases. Methods Obstetrics and Gynecology residents postgraduate year (PGY) 1-4 participated in this study (n=13). Before and after the simulated case, a knowledge test covering VCDE recognition and management and a confidence survey were given to the participants. A gynecologic mannequin was modified by placing simulated bowel into the abdominal cavity with a portion extending through a vaginal cuff and protruding from the vaginal introitus. For the simulation, a hemodynamically unstable patient presented with findings consistent with a VCDE. Once the decision to proceed to surgery was made, participants were transferred to a simulated operating room where they performed a reduction of prolapsed bowel and vaginal cuff closure either laparoscopically or vaginally on the mannequin. A debriefing session was held post-simulation to discuss management and thought processes, as well as reflect on their performance and discuss improvement strategies for future cases. Finally, the residents participated in a brief didactic lecture on education about the incidence, presentation, and management of VCDE. Results Analysis of the knowledge questionnaires showed the median score and interquartile range (IQR) pre- and post-simulation was 15(12-28) and 20(19-22) respectively, with a median score increase (and IQR) of 5(3.5-8.5) (p=0.001). The confidence score had pre- and post-simulation median scores (and IQRs) of 28(20-34.5) and 40(37.5-46) respectively, with a median score increase (and IQR) of 15(8-20.5) (p=0.001). Conclusions Our intervention improved residents’ knowledge and confidence in recognizing VCDE, identifying the need for surgical management, and performing a reduction of prolapsed bowel and vaginal cuff repair.
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Affiliation(s)
- Amelia D Chapman
- Medicine, Ohio University Heritage College of Osteopathic Medicine, Warrensville Heights, USA
| | - Marla Bashour
- Medical Education and Simulation, Northeast Ohio Medical University, Rootstown, USA
| | - Lauren Sagaria
- Obstetrics and Gynecology, Summa Health System, Akron, USA
| | | | - Derek A Ballas
- Obstetrics and Gynecology, Summa Health System, Akron, USA
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Zhang Y, Kohn JR, Guan X. Single-Incision Hysterectomy Outcomes With and Without Robotic Assistance. JSLS 2020; 23:JSLS.2019.00046. [PMID: 31892789 PMCID: PMC6924503 DOI: 10.4293/jsls.2019.00046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective: To evaluate the differences in operative time and postoperative complications for total laparoscopic hysterectomy (TLH) performed using conventional laparoendoscopic single-site surgery (LESS) versus a robotic-assisted LESS approach. Methods: A retrospective study was conducted of all cases of conventional LESS TLH (n = 47) and robotic LESS TLH (n = 129) for benign gynecologic conditions performed from November 2014 to October 2017. Patient characteristics, operative time for hysterectomy, estimated blood loss, duration of hospitalization, and short-term postoperative complications were compared using appropriate parametric and nonparametric statistical tests. Results: Conventional LESS TLH cases had a 16.36-minute longer mean operative time for hysterectomy (P < .01). No difference was found in uterine weight, estimated blood loss, hospitalization, or incidence of postoperative complications when LESS TLH was performed with or without robotic assistance. When comparing uterine weight < 100 g, conventional LESS TLH cases had significantly greater operative time than the robotic LESS TLH cases (78.10 ± 23.97 minutes vs. 59.97 ± 35.17 minutes, P < .01). When comparing uterine weight > 100 g, conventional LESS TLH cases again had significantly greater operative time than the robotic LESS TLH cases (98.73 ± 50.16 minutes vs. 80.00 ± 42.97 minutes, P < .01). There was no difference in postoperative complications. Conclusion: Robotic single-incision laparoscopy can result in decreased operative time compared to a conventional LESS approach. Robotic-assisted and conventional LESS are similar in rate of postoperative complications, if performed by surgeons with abundant LESS experience.
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Affiliation(s)
- Yiming Zhang
- Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Jaden R Kohn
- Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Xiaoming Guan
- Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, Texas, USA
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Orhan A, Ozerkan K, Kasapoglu I, Ocakoglu G, Cetinkaya Demir B, Gunaydin T, Uncu G. Laparoscopic hysterectomy trends in challenging cases (1995–2018). J Gynecol Obstet Hum Reprod 2019; 48:791-798. [DOI: 10.1016/j.jogoh.2019.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/11/2019] [Accepted: 06/21/2019] [Indexed: 12/26/2022]
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