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Alkatout I, Mazidimoradi A, Günther V, Salehiniya H, Allahqoli L. Total or Subtotal Hysterectomy for the Treatment of Endometriosis: A Review. J Clin Med 2023; 12:jcm12113697. [PMID: 37297893 DOI: 10.3390/jcm12113697] [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: 04/07/2023] [Revised: 05/07/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVE The purpose of the review was to evaluate and compare outcomes after total or subtotal hysterectomy in women with endometriosis or adenomyosis. METHODS We searched four electronic databases: Medline (PubMed), Scopus, Embase, and Web of Science (WoS). The first aim of the study was to compare outcomes after total and subtotal hysterectomy in women with endometriosis, and the second aim was to compare the two procedures in women with adenomyosis. Publications that reported short- and long-term outcomes after total and subtotal hysterectomy were included in the review. The search was not subject to any limitation in terms of time or method. RESULTS After screening 4948 records, we included 35 studies published from 1988 to 2021; the studies were based on various methodologies. With regard to the first aim of the review, we found 32 eligible studies and divided these into the following four categories: postoperative short- and long-term outcomes, recurrence of endometriosis, quality of life and sexual function, and patient satisfaction after total or subtotal hysterectomy in women with endometriosis. Five investigations were deemed eligible for the second aim of the review. No differences were seen in terms of postoperative short- and long-term outcomes after subtotal or total hysterectomy in women with endometriosis or adenomyosis. CONCLUSIONS Preservation or removal of the cervix in women with endometriosis or adenomyosis appears to have no effect on short- or long-term outcomes, recurrence of endometriosis, quality of life and sexual function, or patient satisfaction. Nevertheless, we lack randomized blinded controlled trials on these aspects. Such trials will be needed to enhance our comprehension of both surgical approaches.
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Affiliation(s)
- Ibrahim Alkatout
- Kiel School of Gynaecological Endoscopy, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 24, 24105 Kiel, Germany
| | - Afrooz Mazidimoradi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz 7134814336, Iran
| | - Veronika Günther
- Kiel School of Gynaecological Endoscopy, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 24, 24105 Kiel, Germany
| | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand 9717853577, Iran
| | - Leila Allahqoli
- Midwifery Department, Ministry of Health and Medical Education, Tehran 1467664961, Iran
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Spüntrup C, Banerjee M, Piana J, Hellmich M, Bojahr J, Bojahr B, Albus C, Noé G. The influence of persistent bleeding after supracervical hysterectomy on depressive and anxious symptoms: a prospective bicenter study. Arch Gynecol Obstet 2022; 306:127-132. [PMID: 35229204 DOI: 10.1007/s00404-022-06446-y] [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: 09/21/2021] [Accepted: 02/09/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Postoperative spotting is a frequent adverse symptom after laparoscopic supracervical hysterectomy (LSH). The conical excision (eLSH) reduces the postoperative spotting rate, but data in a larger collective are still rare and inconsistent. The influence of persistent bleeding on the anxious and depressive symptoms has not been analyzed yet. METHODS 311 patients, who underwent a laparoscopic supracervical hysterectomy with conical excision (n = 163), or with straight cervical resection (n = 148) were included. Anxious and depressive symptoms and postoperative spotting were recorded before operation, at 3 month follow-up and at 1 year follow-up in both operative groups using a validated questionnaire (German version of Hospital Anxiety and Depression Scale, HADS-D) and additional questions concerning the frequency and impact of bleeding. Statistical analysis included the impairment of bleeding as well as its impact on depressive and anxious symptoms for both groups. RESULTS 11.5% after eLSH and 15.5% after LSH reported spotting after 1 year. Supracervical hysterectomy significantly improves depressive and anxious symptoms at 3 and at 12 month follow-up for both groups (p < 0.001) independent on residual spotting. Patients with a preoperative continuous bleeding showed a maximum benefit independent on operative method. CONCLUSION Laparoscopic supracervical hysterectomy has a positive effect on anxious and depressive symptoms in the short-term and intermediate-term follow-up. The conical excision of the cervical stump reduces postoperative spotting rate, but has no explicit advantage on symptoms of depression or anxiety, irrespective of residual postoperative spotting.
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Affiliation(s)
- Carolin Spüntrup
- Department of Obstetrics and Gynecology, Rheinlandklinikum Dormagen, Dormagen, Germany.
- Department for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Germany.
- Pelvic School Saarbrücken, Hohe Wacht 77, Saarbrücken, Germany.
| | - M Banerjee
- Department of Orthopedic Surgery and Sports Traumatology, Atos Media Park Clinic, Cologne, Germany
- University of Witten/Herdecke, Witten, Germany
| | - J Piana
- Department of Obstetrics and Gynecology, Rheinlandklinikum Dormagen, Dormagen, Germany
| | - M Hellmich
- Institute for Medical Statistics and Epidemiology, University of Cologne, Cologne, Germany
| | | | | | - C Albus
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - G Noé
- Department of Obstetrics and Gynecology, Rheinlandklinikum Dormagen, Dormagen, Germany
- University of Witten/Herdecke, Witten, Germany
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Cooper K, Breeman S, Scott NW, Scotland G, Hernández R, Clark TJ, Hawe J, Hawthorn R, Phillips K, Wileman S, McCormack K, Norrie J, Bhattacharya S. Laparoscopic supracervical hysterectomy compared with second-generation endometrial ablation for heavy menstrual bleeding: the HEALTH RCT. Health Technol Assess 2020; 23:1-108. [PMID: 31577219 DOI: 10.3310/hta23530] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Heavy menstrual bleeding (HMB) is a common problem that affects many British women. When initial medical treatment is unsuccessful, the National Institute for Health and Care Excellence recommends surgical options such as endometrial ablation (EA) or hysterectomy. Although clinically and economically more effective than EA, total hysterectomy necessitates a longer hospital stay and is associated with slower recovery and a higher risk of complications. Improvements in endoscopic equipment and training have made laparoscopic supracervical hysterectomy (LASH) accessible to most gynaecologists. This operation could preserve the advantages of total hysterectomy and reduce the risk of complications. OBJECTIVES To compare the clinical effectiveness and cost-effectiveness of LASH with second-generation EA in women with HMB. DESIGN A parallel-group, multicentre, randomised controlled trial. Allocation was by remote web-based randomisation (1 : 1 ratio). Surgeons and participants were not blinded to the allocated procedure. SETTING Thirty-one UK secondary and tertiary hospitals. PARTICIPANTS Women aged < 50 years with HMB. Exclusion criteria included plans to conceive; endometrial atypia; abnormal cytology; uterine cavity size > 11 cm; any fibroids > 3 cm; contraindications to laparoscopic surgery; previous EA; and inability to give informed consent or complete trial paperwork. INTERVENTIONS LASH compared with second-generation EA. MAIN OUTCOME MEASURES Co-primary clinical outcome measures were (1) patient satisfaction and (2) Menorrhagia Multi-Attribute Quality-of-Life Scale (MMAS) score at 15 months post randomisation. The primary economic outcome was incremental cost (NHS perspective) per quality-adjusted life-year (QALY) gained. RESULTS A total of 330 participants were randomised to each group (total n = 660). Women randomised to LASH were more likely to be satisfied with their treatment than those randomised to EA (97.1% vs. 87.1%) [adjusted difference in proportions 0.10, 95% confidence interval (CI) 0.05 to 0.15; adjusted odds ratio (OR) from ordinal logistic regression (OLR) 2.53, 95% CI 1.83 to 3.48; p < 0.001]. Women randomised to LASH were also more likely to have the best possible MMAS score of 100 (68.7% vs. 54.5%) (adjusted difference in proportions 0.13, 95% CI 0.04 to 0.23; adjusted OR from OLR 1.87, 95% CI 1.31 to 2.67; p = 0.001). Serious adverse event rates were low and similar in both groups (4.5% vs. 3.6%). There was a significant difference in adjusted mean costs between LASH (£2886) and EA (£1282) at 15 months, but no significant difference in QALYs. Based on an extrapolation of expected differences in cost and QALYs out to 10 years, LASH cost an additional £1362 for an average QALY gain of 0.11, equating to an incremental cost-effectiveness ratio of £12,314 per QALY. Probabilities of cost-effectiveness were 53%, 71% and 80% at cost-effectiveness thresholds of £13,000, £20,000 and £30,000 per QALY gained, respectively. LIMITATIONS Follow-up data beyond 15 months post randomisation are not available to inform cost-effectiveness. CONCLUSION LASH is superior to EA in terms of clinical effectiveness. EA is less costly in the short term, but expected higher retreatment rates mean that LASH could be considered cost-effective by 10 years post procedure. FUTURE WORK Retreatment rates, satisfaction and quality-of-life scores at 10-year follow-up will help to inform long-term cost-effectiveness. TRIAI REGISTRATION Current Controlled Trials ISRCTN49013893. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 53. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kevin Cooper
- NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Suzanne Breeman
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Neil W Scott
- Medical Statistics Team, University of Aberdeen, Aberdeen, UK
| | - Graham Scotland
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK.,Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Rodolfo Hernández
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - T Justin Clark
- Birmingham Women's NHS Foundation Trust, Birmingham Women's Hospital, Birmingham, UK
| | - Jed Hawe
- Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - Robert Hawthorn
- NHS Greater Glasgow and Clyde, Southern General Hospital, Glasgow, UK
| | - Kevin Phillips
- Hull and East Yorkshire Hospitals NHS Trust, Castle Hill Hospital, Cottingham, UK
| | - Samantha Wileman
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Kirsty McCormack
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Usher Institute of Population Health Sciences & Informatics, University of Edinburgh, Edinburgh, UK
| | - Siladitya Bhattacharya
- NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, UK.,Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Sandström A, Bixo M, Johansson M, Bäckström T, Turkmen S. Effect of hysterectomy on pain in women with endometriosis: a population-based registry study. BJOG 2020; 127:1628-1635. [PMID: 32437082 DOI: 10.1111/1471-0528.16328] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess pain symptoms before and after hysterectomy in women with endometriosis. DESIGN A population-based registry study. SETTING Sweden. POPULATION Women aged 18-45 years who underwent hysterectomy for endometriosis between 2010 and 2015. METHODS Pain symptoms before hysterectomy and 12 months after surgery were collected from the Swedish National Quality Register for Gynaecological Surgery (GynOp). Pain symptoms were also assessed by follow-up surveys after a median follow-up period of 63 months. MAIN OUTCOME MEASURES Pelvic or lower abdominal pain after hysterectomy. RESULTS The study included 137 women. The proportion of women experiencing pain of any severity decreased by 28% after hysterectomy (P < 0.001). The proportion of women with severe pain symptoms decreased by 76% after hysterectomy (P < 0.001). The majority of women (84%) were satisfied with the surgical result. Presence of severe pain symptoms after the hysterectomy was associated with less satisfaction (P < 0.001). Pain symptoms after surgery, patient satisfaction and the patient's perceived improvement were not significantly different between women whose ovarian tissue was preserved and women who underwent bilateral oophorectomy. CONCLUSIONS We observed a significant, long-lasting reduction in pain symptoms after hysterectomy among women with endometriosis. Hysterectomy, with the possibility of ovarian preservation, may be a valuable option for women with endometriosis who suffer from severe pain symptoms. TWEETABLE ABSTRACT Hysterectomy is a valuable option for women with endometriosis and severe pain symptoms.
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Affiliation(s)
- A Sandström
- Department of Clinical Sciences, Obstetrics and Gynaecology, Umea University, Umea, Sweden.,Department of Obstetrics and Gynaecology, Sundsvall County Hospital, Sundsvall, Sweden
| | - M Bixo
- Department of Clinical Sciences, Obstetrics and Gynaecology, Umea University, Umea, Sweden
| | - M Johansson
- Department of Clinical Sciences, Obstetrics and Gynaecology, Umea University, Umea, Sweden
| | - T Bäckström
- Department of Clinical Sciences, Obstetrics and Gynaecology, Umea University, Umea, Sweden
| | - S Turkmen
- Department of Clinical Sciences, Obstetrics and Gynaecology, Umea University, Umea, Sweden.,Department of Obstetrics and Gynaecology, Sundsvall County Hospital, Sundsvall, Sweden
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Borendal Wodlin N. Risk Factors for Impaired Patient-Reported Satisfaction and Increased Length of Hospital Stay Following Hysterectomy on Benign Indications in Premenopausal Women: a Study From the Swedish National Register for Gynecological Surgery. Geburtshilfe Frauenheilkd 2020; 80:288-299. [PMID: 32139918 PMCID: PMC7056403 DOI: 10.1055/a-1005-0039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 08/23/2019] [Accepted: 08/28/2019] [Indexed: 11/24/2022] Open
Abstract
Introduction The aims of the study were to evaluate the impact of intra- and postoperative complications on satisfaction one year after hysterectomy for benign conditions, to determine risk factors for low patient satisfaction and to analyze whether complications were associated with the length of hospital stay. Material and Methods A retrospective study of 27 938 women from the Swedish National Register for Gynecological Surgery undergoing hysterectomy for benign conditions between January 2004 and June 2016. Data were obtained from prospectively collected pre-, peri- and postoperative forms. Statistical analyses were performed using multivariable logistic regression models. Crude and adjusted odds ratios and 95% confidence intervals are presented. Results More than 90% were satisfied with the hysterectomy. Dissatisfaction was associated with complications. Pelvic pain as indication, preoperatively having less expectations to get rid of symptoms or being alleviated from surgery, and current smoking were also risk factors for low patient satisfaction. Vaginal and abdominal subtotal hysterectomies were associated with high satisfaction. Occurrence of complications intra- and postoperatively before discharge was associated with increased length of hospital stay, as well as occurrence and severity of complications reported after discharge from hospital. Conclusions Complications were strongly associated with lower patient satisfaction. Preoperative expectations of surgery, indication, mode of surgery and life-style factors had impact on the satisfaction. Patient-centered information to ensure realistic expectations and prevention of complications seem to be essential to gain optimal patient satisfaction with surgery.
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Affiliation(s)
- Ninnie Borendal Wodlin
- Children and Womenʼs Health, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Science, Linköping University, Linköping, Sweden
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Odejinmi F, Aref-Adib M, Liou N, Sideris M, Mallick R. Rethinking the Issue of Power Morcellation of Uterine Fibroids: Is Morcellation the Real Problem or Is this Another Symptom of Disparity in Healthcare Provision? In Vivo 2020; 33:1393-1401. [PMID: 31471384 DOI: 10.21873/invivo.11616] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/24/2019] [Accepted: 07/04/2019] [Indexed: 12/11/2022]
Abstract
Power morcellation remains one of the most significant developments in minimal access surgery over the past decade, allowing many more patients to benefit from the least invasive surgical route. However, its use is not without controversy, particularly with regards to the risks of an undiagnosed leiomyosarcoma. Increased media and, in particular, on-going social media coverage since events in 2014 have only served to intensify the debate, culminating in the Food and Drug Administration essentially 'banning' its use in the USA. Practice however continues to vary and this technique remains widely used in Europe and in particular the UK. The aim of this article was to review the development of power morcellation in gynaecology and the underlying risks, including that of undiagnosed leiomyosarcoma, as well as appraise the evolving literature on patient awareness and informed consent and the wider implications of morcellation restriction.
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Affiliation(s)
| | | | - Natasha Liou
- Whipps Cross Hospital, Barts Health NHS Trust, London, U.K
| | - Michail Sideris
- Women's Health Research Unit, Queen Mary University of London, London, U.K
| | - Rebecca Mallick
- Princess Royal Hospital, Brighton and Sussex University Hospitals NHS Trust, Haywards Heath, U.K.
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Prevesical peritoneum interposition to prevent risk of rectovaginal fistula after en bloc colorectal resection with hysterectomy for endometriosis: Results of a pilot study. J Gynecol Obstet Hum Reprod 2019; 49:101649. [PMID: 31760180 DOI: 10.1016/j.jogoh.2019.101649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 10/10/2019] [Accepted: 10/18/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the risk of rectovaginal fistula after en bloc hysterectomy and colorectal resection (H-CR) for endometriosis using prevesical peritoneum interposition. STUDY DESIGN A retrospective study conducted at Tenon University Hospital, expert center in endometriosis, from June 2016 to June 2018. Patients undergoing H-CR with prevesical peritoneum interposition without protective defunctioning stoma were included. RESULTS Of the 160 patients who underwent surgery with colorectal resection for endometriosis during the study period, 27 had H-CR (15 with segmental and 12 with discoïd colorectal resection) and were included. The median age (range) was 45 years (41-47.5). Eight patients (13 %) were nulliparous. All procedures were performed by laparoscopy. Parametrial resection was performed in 14 cases (52 %). Associated bowel procedures were ileocecal resection (n = 5) and appendectomy (n = 2). Median follow-up (range) was 14.6 months (10.5-20.2). Nine (33.3 %) patients experienced intra- or postoperative complications including one grade I, four grade II, two grade IIIA and two grade IIIB complications (Clavien-Dindo classification). Seven patients (26 %) experienced postoperative voiding dysfunction. One suspicion of rectovaginal fistula associated with pelvic abscess was diagnosed 4 weeks after surgery but not confirmed during a second operation. CONCLUSION Despite the small sample size, the present pilot study supports the practice of prevesical peritoneum interposition to limit the risk of rectovaginal fistula in patients who undergo H-CR for deep endometriosis.
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Cooper K, Breeman S, Scott NW, Scotland G, Clark J, Hawe J, Hawthorn R, Phillips K, MacLennan G, Wileman S, McCormack K, Hernández R, Norrie J, Bhattacharya S. Laparoscopic supracervical hysterectomy versus endometrial ablation for women with heavy menstrual bleeding (HEALTH): a parallel-group, open-label, randomised controlled trial. Lancet 2019; 394:1425-1436. [PMID: 31522846 PMCID: PMC6891255 DOI: 10.1016/s0140-6736(19)31790-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 06/21/2019] [Accepted: 07/12/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Heavy menstrual bleeding affects 25% of women in the UK, many of whom require surgery to treat it. Hysterectomy is effective but has more complications than endometrial ablation, which is less invasive but ultimately leads to hysterectomy in 20% of women. We compared laparoscopic supracervical hysterectomy with endometrial ablation in women seeking surgical treatment for heavy menstrual bleeding. METHODS In this parallel-group, multicentre, open-label, randomised controlled trial in 31 hospitals in the UK, women younger than 50 years who were referred to a gynaecologist for surgical treatment of heavy menstrual bleeding and who were eligible for endometrial ablation were randomly allocated (1:1) to either laparoscopic supracervical hysterectomy or second generation endometrial ablation. Women were randomly assigned by either an interactive voice response telephone system or an internet-based application with a minimisation algorithm based on centre and age group (<40 years vs ≥40 years). Laparoscopic supracervical hysterectomy involves laparoscopic (keyhole) surgery to remove the upper part of the uterus (the body) containing the endometrium. Endometrial ablation aims to treat heavy menstrual bleeding by destroying the endometrium, which is responsible for heavy periods. The co-primary clinical outcomes were patient satisfaction and condition-specific quality of life, measured with the menorrhagia multi-attribute quality of life scale (MMAS), assessed at 15 months after randomisation. Our analysis was based on the intention-to-treat principle. The trial was registered with the ISRCTN registry, number ISRCTN49013893. FINDINGS Between May 21, 2014, and March 28, 2017, we enrolled and randomly assigned 660 women (330 in each group). 616 (93%) of 660 women were operated on within the study period, 588 (95%) of whom received the allocated procedure and 28 (5%) of whom had an alternative surgery. At 15 months after randomisation, more women allocated to laparoscopic supracervical hysterectomy were satisfied with their operation compared with those in the endometrial ablation group (270 [97%] of 278 women vs 244 [87%] of 280 women; adjusted percentage difference 9·8, 95% CI 5·1-14·5; adjusted odds ratio [OR] 2·53, 95% CI 1·83-3·48; p<0·0001). Women randomly assigned to laparoscopic supracervical hysterectomy were also more likely to have the best possible MMAS score of 100 than women assigned to endometrial ablation (180 [69%] of 262 women vs 146 [54%] of 268 women; adjusted percentage difference 13·3, 95% CI 3·8-22·8; adjusted OR 1·87, 95% CI 1·31-2·67; p=0·00058). 14 (5%) of 309 women in the laparoscopic supracervical hysterectomy group and 11 (4%) of 307 women in the endometrial ablation group had at least one serious adverse event (adjusted OR 1·30, 95% CI 0·56-3·02; p=0·54). INTERPRETATION Laparoscopic supracervical hysterectomy is superior to endometrial ablation in terms of clinical effectiveness and has a similar proportion of complications, but takes longer to perform and is associated with a longer recovery. FUNDING UK National Institute for Health Research Health Technology Assessment Programme.
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Affiliation(s)
- Kevin Cooper
- NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, UK.
| | - Suzanne Breeman
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Neil W Scott
- Medical Statistics Team, University of Aberdeen, Aberdeen, UK
| | - Graham Scotland
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK; Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Justin Clark
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Jed Hawe
- Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - Robert Hawthorn
- NHS Greater Glasgow and Clyde, Southern General Hospital, Glasgow, UK
| | - Kevin Phillips
- Hull and East Yorkshire Hospitals NHS Trust, Castle Hill Hospital, Cottingham, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Samantha Wileman
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Kirsty McCormack
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Rodolfo Hernández
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, Centre for Population Health Sciences, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
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Thurston J, Murji A, Scattolon S, Wolfman W, Kives S, Sanders A, Leyland N. No 377- Indications gynécologiques bénignes de l'hystérectomie. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:558-574. [DOI: 10.1016/j.jogc.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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10
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Thurston J, Murji A, Scattolon S, Wolfman W, Kives S, Sanders A, Leyland N. No. 377-Hysterectomy for Benign Gynaecologic Indications. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:543-557. [DOI: 10.1016/j.jogc.2018.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Ajao MO, Oliveira Brito LG, Wang KC, Cox MKB, Meurs E, Goggins ER, Gu X, Vitonis AF, Einarsson JI, Cohen SL. Persistence of Symptoms After Total vs Supracervical Hysterectomy in Women with Histopathological Diagnosis of Adenomyosis. J Minim Invasive Gynecol 2018; 26:891-896. [PMID: 30205164 DOI: 10.1016/j.jmig.2018.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/31/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
Abstract
STUDY OBJECTIVE To compare symptom persistence in women with adenomyosis based on retention or removal of the cervix at the time of hysterectomy. DESIGN Retrospective cohort study and follow-up survey (Canadian Task Force classification xx). SETTING Tertiary care academic hospital in Boston, Massachusetts. PATIENTS Women (n = 1580) who underwent laparoscopic hysterectomy for benign indications between 2008 and 2012 at Brigham and Women's Faulkner Hospital and Brigham and Women's Hospital. INTERVENTION Retrospective chart review and follow-up survey. MEASUREMENTS AND MAIN RESULTS Among the 1580 women contacted, 762 (48%) responded to the postoperative symptom resolution survey. Of these 762 women, 623 agreed to participate in the study. Menopausal women or those who had undergone bilateral salpingo-oophorectomy were excluded. Adenomyosis was identified on histopathologic evaluation of the uterus in 171 of the remaining 443 women (39%). Compared with women without adenomyosis, those with adenomyosis were older on average (mean age, 46.6 ± 6.8 years vs 45.0 ± 5.5 years; p = .009) and more likely to report that abnormal bleeding and pain led to their hysterectomy (87.7% vs 79.8%; p = .03 and 64.9% vs 51.4%; p = .009, respectively). The rates of total and supracervical hysterectomies were similar in the 2 groups. Following surgery, women with adenomyosis were less likely than those without adenomyosis to report persistent pain (adjusted odds ratio [aOR], 0.43; 95% confidence interval [CI], 0.20-0.93; p = .03). Persistent bleeding was similar in the 2 groups (aOR, 0.97; 95% CI, 0.49-1.93; p = .94). Among women with adenomyosis, multivariable logistic regression showed no difference in persistence of symptoms with cervical removal or retention at the time of hysterectomy. CONCLUSION Compared with women without adenomyosis, those with histopathologically proven adenomyosis were less likely to report persistent pain following hysterectomy. Retention of the cervix does not appear to increase the risk of symptom persistence or postprocedure patient satisfaction.
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Affiliation(s)
- Mobolaji O Ajao
- Division of Minimally Invasive Gynecologic Surgery (Drs. Ajao, Oliveira Brito, Wang, Einarsson, and Cohen and Ms. Cox, Ms. Meurs, Ms. Goggins, and Ms Gu) and Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Luiz G Oliveira Brito
- Division of Minimally Invasive Gynecologic Surgery (Drs. Ajao, Oliveira Brito, Wang, Einarsson, and Cohen and Ms. Cox, Ms. Meurs, Ms. Goggins, and Ms Gu) and Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Karen C Wang
- Division of Minimally Invasive Gynecologic Surgery (Drs. Ajao, Oliveira Brito, Wang, Einarsson, and Cohen and Ms. Cox, Ms. Meurs, Ms. Goggins, and Ms Gu) and Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mary K B Cox
- Division of Minimally Invasive Gynecologic Surgery (Drs. Ajao, Oliveira Brito, Wang, Einarsson, and Cohen and Ms. Cox, Ms. Meurs, Ms. Goggins, and Ms Gu) and Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Elsemieke Meurs
- Division of Minimally Invasive Gynecologic Surgery (Drs. Ajao, Oliveira Brito, Wang, Einarsson, and Cohen and Ms. Cox, Ms. Meurs, Ms. Goggins, and Ms Gu) and Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Emily R Goggins
- Division of Minimally Invasive Gynecologic Surgery (Drs. Ajao, Oliveira Brito, Wang, Einarsson, and Cohen and Ms. Cox, Ms. Meurs, Ms. Goggins, and Ms Gu) and Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Xiangmei Gu
- Division of Minimally Invasive Gynecologic Surgery (Drs. Ajao, Oliveira Brito, Wang, Einarsson, and Cohen and Ms. Cox, Ms. Meurs, Ms. Goggins, and Ms Gu) and Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Allison F Vitonis
- Obstetrics and Gynecology Epidemiology Center (Ms. Vitonis), Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jon I Einarsson
- Division of Minimally Invasive Gynecologic Surgery (Drs. Ajao, Oliveira Brito, Wang, Einarsson, and Cohen and Ms. Cox, Ms. Meurs, Ms. Goggins, and Ms Gu) and Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sarah L Cohen
- Division of Minimally Invasive Gynecologic Surgery (Drs. Ajao, Oliveira Brito, Wang, Einarsson, and Cohen and Ms. Cox, Ms. Meurs, Ms. Goggins, and Ms Gu) and Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
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Single port access laparoscopic subtotal hysterectomy using contained manual morcellation: Experience from a tertiary referral center in Taiwan. Taiwan J Obstet Gynecol 2018; 57:28-31. [PMID: 29458899 DOI: 10.1016/j.tjog.2017.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2017] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To describe the surgical outcomes of single port access laparoscopic subtotal hysterectomy (LSH) using in-bag manual morcellation and evaluate the feasibility of this procedure. MATERIALS AND METHODS Thirty patients with symptomatic leiomyoma or adenomyosis were enrolled. A 2-cm transverse incision was made at the umbilicus and single port apparatus (LagiPort) was applied. After dissection of vesicouterine peritoneum from the uterus, the uterine ligaments and vessels were secured and transected by Gyrus PK cutting forceps. Cervical amputation at the level of internal os was made by SupraLoop (Karl Storz). The uterine corpus was put into an Endobag before morcellation. The opening of Endobag was exteriorized from the umbilical incision and the uterine corpus was removed in a contained manner by manual morcellation with a scalpel. RESULTS This procedure was successfully performed on all patients. Neither laparotomic conversion nor additional port was needed. The mean age and mean BMI of the patients were 43.63 years and 24.02 kg/㎡. The mean operative time was 148 min and the estimated blood loss in most patients was less than 150 ml. The median weight of uterine corpus was 214 g. No intraoperative complications occurred in any patient. One patient was diagnosed with unexpected endometrioid adenocarcinoma FIGO grade 1 postoperatively. One patient reported cyclic bleeding and underwent a transvaginal trachelectomy 17 months later. CONCLUSION Single port access LSH using contained manual morcellation represents a safe and feasible alternative to conventional LSH using open power morcellation.
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Berlit S, Tuschy B, Wuhrer A, Jürgens S, Buchweitz O, Kircher AT, Sütterlin M, Lis S, Hornemann A. Sexual functioning after total versus subtotal laparoscopic hysterectomy. Arch Gynecol Obstet 2018; 298:337-344. [PMID: 29948170 DOI: 10.1007/s00404-018-4812-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 06/06/2018] [Indexed: 12/24/2022]
Abstract
AIM To evaluate postoperative sexual functioning and the influence of patients' expectations on the change in sexuality following laparoscopic total (TLH) versus subtotal hysterectomy (LASH). METHODS A total of 120 women undergoing laparoscopic hysterectomy were preoperatively enrolled in this bicentric prospective study. Sexual functioning (SF) was evaluated using the female sexual function index (FSFI). Additionally, participants filled in a standardised questionnaire concerning expected changes in SF after surgery. At 3, 6 and 12 months following surgery, women were asked again to assess their level of SF (FSFI). Data of women who participated in at least one FSFI follow-up assessment were analysed (n = 92). We compared the change in SF after surgery between patients with TLH (n = 46) and LASH (n = 46). Additionally, we calculated regression analyses with the patients' expectations as a predictor for change in FSFI scores. RESULTS Comparing the change of FSFI scores after surgery in both collectives revealed differences only 3 months after surgery, as improvement was stronger for the LASH collective compared to the THL group (p = 0.006). There were no changes comparing collectives after 6 (p = 0.663) and 12 (p = 0.326) months. Concerning patients' expectations, for the LASH group baseline SF (p < 0.001), but not expectations (p = 0.567) predicted the strength of change at each of the follow ups: a lower level of baseline SF was linked to a stronger improvement after surgery. For the THL collective, both baseline SF (p < 0.001) as well as patients' expectations (3 months: p = 0.077, 6 months: p = 0.37, 12 months: p = 0.024) predicted the strength of change: both, a lower level of baseline SF and higher expectations towards an improvement predicted a stronger improvement. CONCLUSION The preservation of the cervix does not show an advantage in improving SF after surgery. Both methods induce a comparable improvement in long-time SF, especially in patients with an impaired sexuality pre-surgery. Furthermore, patients' expectations concerning this matter seem to have an impact on the postoperative outcome; therefore, this circumstance should be considered in future projects.
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Affiliation(s)
- Sebastian Berlit
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Benjamin Tuschy
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Anne Wuhrer
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Sven Jürgens
- Ambulatory Day Clinic Altonaer Strasse, Hamburg, Germany
| | - Olaf Buchweitz
- Ambulatory Day Clinic Altonaer Strasse, Hamburg, Germany
| | - Anna-Theresa Kircher
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Marc Sütterlin
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Stefanie Lis
- Institute of Psychiatric and Psychosomatic Psychotherapy, Medical Faculty Mannheim, Heidelberg University, Central Institute of Mental Health, Mannheim, Germany
| | - Amadeus Hornemann
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Niro J, Panel P. [Interest of hysterectomy with or without bilateral oophorectomy in the surgical treatment of endometriosis: CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018. [PMID: 29530555 DOI: 10.1016/j.gofs.2018.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE In women with symptomatic endometriosis and no desire for pregnancy, hysterectomy with or without bilateral oophorectomy is often presented as a definitive solution to their symptoms. Despite this radical treatment, it should be known that nearly 15% of these patients will have persistent pain. Thus the objective of this review was to determine the interest of total hysterectomy with or without bilateral oophorectomy for the treatment of deep endometriosis. METHOD The research was conducted from the US National Library of Medicine's National Institutes of Health from the following keywords: endometriosis, hysterectomy, oophorectomy, ovariectomy, radical treatment. Only articles written in English have been selected. RESULTS AND RECOMMENDATIONS Hysterectomy with or without bilateral oophorectomy, associated with endometriotic lesions exeresis could decrease the rate of recurrence and surgical reoperations compared to resection alone endometriosis lesions (NP4). In women with no desire for pregnancy, the benefit-risk balance of a hysterectomy, with or without bilateral oophorectomy, may be discussed in order to reduce the risk of recurrence of endometriotic disease (Expert Agreement). Taking into account the multiple adverse effects of early menopause on expectancy and quality of life (NP2), ovarian preservation should be discussed with the patient in case of hysterectomy for deep endometriosis (Expert Agreement). The use of menopausal hormone therapy (THM) does not appear to increase the symptoms of endometriosis after surgical castration (NP3). THM is not contraindicated in postmenopausal women with endometriosis (grade C).
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Affiliation(s)
- J Niro
- Service de gynécologie-obstétrique, centre hospitalier de Versailles, 177 route de Versailles, 78157 cedex Le Chesnay, France.
| | - P Panel
- Service de gynécologie-obstétrique, centre hospitalier de Versailles, 177 route de Versailles, 78157 cedex Le Chesnay, France
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Oliveira MAP, Crispi CP, Brollo LC, Crispi CP, De Wilde RL. Surgery in adenomyosis. Arch Gynecol Obstet 2017; 297:581-589. [PMID: 29197987 DOI: 10.1007/s00404-017-4603-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 11/20/2017] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Adenomyosis is defined as the presence of endometrial glands and stroma within the myometrium. The true prevalence is unknown and has been reported to range from 1 to 70%. It has a significantly negative impact on women's quality of life, causing abnormal uterine bleeding, dysmenorrhea, and chronic pelvic pain. The definitive treatment for adenomyosis is hysterectomy, although it does not contemplate patients who wish to preserve their fertility. The aim of this paper is to discuss the latest evidence on the surgical techniques for the treatment of adenomyosis published in medical-scientific databases. METHOD A comprehensive literature search for articles published from 1996 to 2017 related to surgery for adenomyosis was made in Pubmed, Medline, the Cochrane Library, and Google Scholar, in English, by the following MeSH terms: adenomyosis, surgery, pathogenesis, dysmenorrhea and infertility. RESULTS There is extensive evidence on several surgical approaches for the improvement of adenomyosis-related symptoms; however, there is no robust evidence that they are effective for infertility. CONCLUSION The management of adenomyosis is quite complex and controversial. Complications after extensive uterine reconstruction, such as uterine rupture, should be considered and discussed with the patient. There are still limited data to support surgery effectiveness, especially for infertility, and further well-designed studies are required.
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Affiliation(s)
- Marco Aurelio Pinho Oliveira
- Department of Gynecology, State University of Rio de Janeiro, Rio de Janeiro, Brazil. .,, Rua Dois de Dezembro 78/803, Flamengo, Rio de Janeiro, Brazil.
| | | | - Leila Cristina Brollo
- Department of Gynecology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Rudy Leon De Wilde
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, Pius Hospital, University Hospital for Gynecology, Carl von Ossietzky University Medical School, Oldenburg, Germany
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Borendal Wodlin N. Intraoperative cervical treatment does not affect the prevalence of vaginal bleeding 1 year postoperatively after subtotal hysterectomy. A register study from the Swedish National Register for Gynecological Surgery. Acta Obstet Gynecol Scand 2017; 96:1430-1437. [PMID: 28865144 DOI: 10.1111/aogs.13229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 08/28/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The objectives were to establish the prevalence of persistent vaginal bleeding following subtotal hysterectomy, to analyze the effect of intraoperative cervical treatment on the occurrence of persistent vaginal bleeding, and to evaluate the impact of persistent vaginal bleeding on the patient-reported opinion concerning result of surgery and medical condition. MATERIAL AND METHODS Retrospective study with data from the Swedish National Register for Gynecological Surgery including 5240 women undergoing subtotal hysterectomy for benign conditions between January 2004 and June 2016. Demographic and clinical data were obtained from the pre- and perioperative forms. Data concerning occurrence of persistent vaginal bleeding, rating of medical condition and contentment with result of surgery were collected from the 1-year inquiry form. Statistical analyses were performed with multivariable logistic regression models. The results are presented as adjusted odd ratios and 95% confidence intervals. RESULTS Persistent vaginal bleeding occurred in 18.6%. Intraoperative cervical treatment did not affect the frequency of persistent vaginal bleeding (adjusted odds ratio 1.48; 95% confidence interval 0.93-2.37). More than 90% were satisfied with the result of the hysterectomy, but women with persistent vaginal bleeding were less content compared with those without persistent vaginal bleeding (adjusted odds ratio 0.42; 95% confidence interval 0.26-0.67). The self-perception of the medical condition did not differ between the women with and without persistent vaginal bleeding (adjusted odds ratio 1.16; 95% confidence interval 0.33-4.12). CONCLUSIONS Nearly two in ten women may expect persistent vaginal bleeding following subtotal hysterectomy, and cervical treatment intraoperatively did not affect this. More than 90% were satisfied with the result but women with persistent vaginal bleeding were less content. Preoperative information on this risk of persistent vaginal bleeding may be important when choosing hysterectomy technique.
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Affiliation(s)
- Ninnie Borendal Wodlin
- Department of Obstetrics and Gynecology and Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Science, Linköping University, Linköping, Sweden
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Berlit S, Lis S, Jürgens S, Buchweitz O, Hornemann A, Sütterlin M, Tuschy B. Postoperative sexual functioning in total versus subtotal laparoscopic hysterectomy: what do women expect? Arch Gynecol Obstet 2017; 296:513-518. [PMID: 28685227 DOI: 10.1007/s00404-017-4452-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/26/2017] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate sexual functioning and expected changes in sexual functioning in women with planned total versus subtotal laparoscopic hysterectomy. METHODS A total of 120 women undergoing laparoscopic hysterectomy were preoperatively enrolled in this study with a cross-sectional design. Full data sets were available for 112 patients, so that 56 patients with planned total laparoscopic hysterectomy (TLH) and 56 women with planned laparoscopic supracervical hysterectomy (LASH) were preoperatively assessed. Sexual functioning was evaluated using the female sexual function index (FSFI). Additionally, participants filled in a standardised questionnaire concerning expected changes on sexual function after the procedure. Demographic parameters, expectations concerning postoperative sexuality and FSFI scores were analysed and compared in women undergoing TLH and LASH. RESULTS There were no significant differences concerning demographic parameters and FSFI scores comparing collectives. Sexuality in general was considered more important in women undergoing LASH (2.88 ± 0.83 vs. 2.48 ± 0.89; p = 0.011). Also, in 29 patients (52%) opting for LASH and 8 (14%) patients undergoing TLH a potential change in postoperative sexuality had an impact on their choice for a subtotal/total hysterectomy, respectively (p < 0.001). CONCLUSION Patients' expectations concerning preservation of the cervix and postoperative sexuality appear to have the potential to bias investigations comparing total with subtotal hysterectomy. Hence, future research focusing on this issue should be accomplished incorporating patients' expectations stratified by mode of intervention.
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Affiliation(s)
- Sebastian Berlit
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Stefanie Lis
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | | | | | - Amadeus Hornemann
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Marc Sütterlin
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Benjamin Tuschy
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Tsafrir Z, Aoun J, Papalekas E, Taylor A, Schiff L, Theoharis E, Eisenstein D. Risk factors for trachelectomy following supracervical hysterectomy. Acta Obstet Gynecol Scand 2017; 96:421-425. [DOI: 10.1111/aogs.13099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 01/12/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Ziv Tsafrir
- Division of Minimally Invasive Gynecology; Department of Obstetrics and Gynecology; Henry Ford Health System; Detroit MI USA
| | - Joelle Aoun
- Division of Minimally Invasive Gynecology; Department of Obstetrics and Gynecology; Henry Ford Health System; Detroit MI USA
| | - Eleni Papalekas
- Department of Obstetrics and Gynecology; Beaumont Health System; Royal Oak MI USA
| | - Andrew Taylor
- Division of Biostatistics; Public Health Sciences; Henry Ford Health System; Detroit MI USA
| | - Lauren Schiff
- Division of Advanced Laparoscopy and Pelvic Pain; Department of Obstetrics and Gynecology; University of North Carolina; Chapel Hill NC USA
| | - Evan Theoharis
- Division of Minimally Invasive Gynecology; Department of Obstetrics and Gynecology; Henry Ford Health System; Detroit MI USA
| | - David Eisenstein
- Division of Minimally Invasive Gynecology; Department of Obstetrics and Gynecology; Henry Ford Health System; Detroit MI USA
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McGurk L, Oliver R, Odejinmi F. Laparoscopic supracervical hysterectomy for the larger uterus (>500 g): a case series and literature review. Arch Gynecol Obstet 2016; 295:397-405. [PMID: 27848016 DOI: 10.1007/s00404-016-4237-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 11/08/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND In clinical practice, the current trend for surgical hysterectomy for the large uterus is by laparotomy, where vaginal hysterectomy is not feasible. The benefits of a laparoscopic approach to hysterectomy are well documented, but limited literature is available on laparoscopic hysterectomy in the larger uterus. A supracervical hysterectomy should be considered for women, where there is no contraindication to a residual cervix. OBJECTIVE To compare surgical outcomes for laparoscopic supracervical hysterectomy (LSH) in the large uterus (equal or greater than 500 g) compared with normal (<500 g), results were compared to the limited literature on this topic. METHODS AND STUDY DESIGN A retrospective review was undertaken of 207 women who underwent an LSH between 2005 and 2015 at Whipps Cross University hospital. The operative outcome of patients undergoing surgery, for uteri both greater than 500 g and less than 500 g, was analysed. Data included patient demographics, intra-operative details, and complications. A literature search was performed using keywords 'laparoscopic supracervical hysterectomy' and 'laparoscopic sub-total hysterectomy' which yielded six informative articles. RESULTS In the study group of 207 patients, 67 had a large uterus (56 patients 500-1000 g, 11 patients >1000 g). The operation time and intra-operative blood loss were both greater in the larger uterus cohort (P < 0.0001 and P = 0.0021, respectively). The hospital stay and intra-operative complication rate were similar for the two study cohorts (six for the study, n = 207). Review of the literature revealed six relevant studies evaluating patients with uteri greater than 500 g. There was an agreement between all the studies that a larger uterus resulted in an increase in both intra-operative time and blood loss, but this did not translate to increase in hospital stay or intra-operative complications. CONCLUSION The use of LSH for the larger uterus is feasible and safe due to the low level of operative complications as demonstrated in our study and following a review of the literature.
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Affiliation(s)
- Lauren McGurk
- Department of Obstetrics and Gynaecology, Whipps Cross University Hospital, Barts Health NHS Trust, Whipps Cross Road, Leytonstone, London, E11 1NR, England, UK.
| | - Reeba Oliver
- Department of Obstetrics and Gynaecology, Whipps Cross University Hospital, Barts Health NHS Trust, Whipps Cross Road, Leytonstone, London, E11 1NR, England, UK
| | - Funlayo Odejinmi
- Department of Obstetrics and Gynaecology, Whipps Cross University Hospital, Barts Health NHS Trust, Whipps Cross Road, Leytonstone, London, E11 1NR, England, UK
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Ala-Nissilä S, Haarala M, Järvenpää T, Mäkinen J. Long-term follow-up of the outcome of supracervical versus total abdominal hysterectomy. Int Urogynecol J 2016; 28:299-306. [PMID: 27640066 DOI: 10.1007/s00192-016-3143-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 08/28/2016] [Indexed: 02/03/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Hysterectomy for benign indications can be performed either as a supracervical or a total procedure. It is controversial whether removing the cervix is beneficial or not. This study aimed at comparing long-term outcomes after supracervical (n = 107) and total (n = 105) abdominal hysterectomy. METHODS Two prospective questionnaire-based studies were conducted among the original 212 patients operated on between February 1978 and May 1979 at Turku University Hospital, Finland. In the first study in 1997, a nonvalidated questionnaire was mailed to 193 patients to inquire about any postoperative symptoms. In the second study in 2011, a validated questionnaire and an invitation to a follow-up visit were sent to 153 women. During the visit, pelvic support was assessed using the Pelvic Organ Prolapse Quantification system. Additionally, hospital records were reviewed to identify any gynecological operations at both evaluation times. RESULTS In the first evaluation, the response rate was 94 %, and in the second, the rate was 62 %. Objective evaluation was possible in 75 women in 2011, 37 in the supracervical group and 38 in the total hysterectomy group. There were no significant differences in the rates of subjective urinary and sexual symptoms or subsequent operations for urinary incontinence and genital prolapse between women in the supracervical group and women in the total hysterectomy group. Four patients in the supracervical group required a re-operation: three for a prolapsed cervical stump and one for a cervical abscess. CONCLUSIONS Supracervical and total hysterectomies resulted in similar postoperative outcomes regarding subjective symptoms and subsequent gynecological operations during a follow-up of 33 years. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov ( www.clinicaltrials.gov ): NCT02166749.
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Affiliation(s)
- Seija Ala-Nissilä
- Department of Obstetrics and Gynecology, Turku University Hospital, FI-20520, Turku, Finland.
| | - Mervi Haarala
- Department of Obstetrics and Gynecology, Turku University Hospital, Vakka-Suomi Hospital, Uusikaupunki, Finland
| | - Tuija Järvenpää
- Department of Obstetrics and Gynecology, Turku University Hospital, Vakka-Suomi Hospital, Uusikaupunki, Finland
| | - Juha Mäkinen
- Department of Obstetrics and Gynecology, Turku University Hospital, FI-20520, Turku, Finland
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Krentel H, De Wilde R. Complications in Laparoscopic Supracervical Hysterectomy(LASH), especially the morcellation related. Best Pract Res Clin Obstet Gynaecol 2016; 35:44-50. [DOI: 10.1016/j.bpobgyn.2015.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 11/05/2015] [Indexed: 01/17/2023]
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Sasaki KJ, Cholkeri-Singh A, Sulo S, Miller CE. Persistent bleeding after laparoscopic supracervical hysterectomy. JSLS 2016; 18:JSLS.2014.00206. [PMID: 25516706 PMCID: PMC4266229 DOI: 10.4293/jsls.2014.002064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: In our clinical experience, there seemed to be a correlation between cervical stump bleeding and adenomyosis. Therefore, we wanted to conduct a study to determine whether there was an actual correlation and to identify other risk factors for persistent bleeding after a laparoscopic supracervical hysterectomy. Methods: The study included women who underwent laparoscopic supracervical hysterectomy from January 1, 2003, through December 31, 2012. Data were collected on age, postmenopausal status, body mass index (BMI), uterine weight, indication for hysterectomy, concomitant bilateral salpingo-oophorectomy (BSO), presence of endometriosis, surgical ablation of the endocervix, adenomyosis, presence of endocervix in the specimen, and postoperative bleeding. Results: The study included 256 patients, of whom 187 had no postoperative bleeding after the operation, 40 had bleeding within 12 weeks, and 29 had bleeding after 12 weeks. The 3 groups were comparable in BMI, postmenopausal status, uterine weight, indication for hysterectomy, BSO, surgical ablation of the endocervix, adenomyosis, and the presence of endocervix. However, patients who had postoperative bleeding at more than 12 weeks were significantly younger (P = .002) and had a higher rate of endometriosis (P < .001). Conclusions: Risks factors for postoperative bleeding from the cervical stump include a younger age at the time of hysterectomy and the presence of endometriosis. Therefore, younger patients and those with endometriosis who desire to have no further vaginal bleeding may benefit from total hysterectomy over supracervical hysterectomy. All patients who are undergoing supracervical hysterectomy should be counseled about the possible alternatives, benefits, and risks, including continued vaginal bleeding from the cervical stump and the possibility of requiring future treatment and procedures.
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Affiliation(s)
- Kirsten J Sasaki
- Department of Obstetrics and Gynecology, Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - Aarathi Cholkeri-Singh
- Department of Obstetrics and Gynecology, Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - Suela Sulo
- James R. and Helen D. Russell Institute for Research and Innovation, Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - Charles E Miller
- Department of Obstetrics and Gynecology, Advocate Lutheran General Hospital, Park Ridge, IL, USA
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Additional uses of a vaginal fornices delineator. Am J Obstet Gynecol 2015; 213:433.e1-3. [PMID: 26099811 DOI: 10.1016/j.ajog.2015.06.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 06/12/2015] [Indexed: 11/24/2022]
Abstract
A vaginal fornices delineator was introduced in the mid-90s by a gynecologic surgeon named Charles Koh as a device that would facilitate total laparoscopic hysterectomy. It is also used in robot-assisted and traditional laparoscopic hysterectomies. The delineator delineates the vaginal fornices and provides improved visualization of vital structures during a hysterectomy. The determination of the anatomic level of the cervix is vital in the identification of the inferior borders of a total hysterectomy and to avoid injury to the ureters and uterine vessels. As such, we describe 3 gynecologic surgeries in which the identification of this level was suboptimal. Our solution was to utilize a vaginal fornices delineator as the cervical "guide" to enhance this visualization and to allow for a complete and safe surgical outcome. The following surgical scenarios and the surgical facilitation provided by the vaginal fornices delineator will be presented: (1) a postpartum cesarean hysterectomy complicated by a large lower uterine fibroid tumor that distorts the cervix, (2) a robotic-assisted placement of an abdominal cerclage in a first-trimester pregnancy, (3) abdominal hysterectomy complicated by a necrotizing uterine infection and the associated difficulty in the identification of the cervicouterine junction.
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Berner E, Qvigstad E, Myrvold AK, Lieng M. Pain reduction after total laparoscopic hysterectomy and laparoscopic supracervical hysterectomy among women with dysmenorrhoea: a randomised controlled trial. BJOG 2015; 122:1102-11. [DOI: 10.1111/1471-0528.13362] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2014] [Indexed: 11/28/2022]
Affiliation(s)
- E Berner
- Department of Gynaecology; Oslo University Hospital; Oslo Norway
| | - E Qvigstad
- Department of Gynaecology; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - AK Myrvold
- Department of Pathology; Oslo University Hospital; Oslo Norway
| | - M Lieng
- Department of Gynaecology; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
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Wu CJ, Tseng CW, Wu MP. Laparoscopic subtotal hysterectomy in the era of minimally invasive surgery. Gynecol Minim Invasive Ther 2015. [DOI: 10.1016/j.gmit.2014.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Yunker A, Curlin H, Banet N, Fadare O, Steege J. Does the uterine cervix become abnormally reinnervated after subtotal hysterectomy and what is the association with future trachelectomy? J Minim Invasive Gynecol 2014; 22:261-7. [PMID: 25460319 DOI: 10.1016/j.jmig.2014.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 10/10/2014] [Accepted: 10/14/2014] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE To compare nerve fiber density in the cervices removed by trachelectomy from women with pelvic pain with those cervices removed for nonpain indications. DESIGN Retrospective cohort study (Canadian Task Force classification II-2). SETTING Two university hospitals. PATIENTS Subjects who underwent trachelectomy during a 10-year time frame were identified. INTERVENTIONS Two tissue sections were obtained from each preserved cervix specimen and stained for S100 antibody. The numbers of S100-immunoreactive peripheral nerve fibers were assessed in 6 high-powered fields (HPFs) per tissue section (12 total HPFs per patient). Information collected included patient characteristics and surgical findings. We excluded any patients with dysplasia/cancer and those without an available adequate specimen. MEASUREMENTS AND MAIN RESULTS We evaluated the cervix specimens from 35 patients who underwent trachelectomy for pain (n = 25, group 1) and nonpain (n = 10, group 2) indications in addition to control cervices (n = 15, group 3) from benign hysterectomies performed for nonpain indications. There were increased numbers of nerve fibers in trachelectomy patients with pain versus those without pain (group 1 vs group 2, p = .02). There were also increased numbers of nerve fibers in both trachelectomy groups compared with the control group (group 1 vs group 3, p < .01; group 2 vs group 3, p = .04). Adjusted average cervical nerve counts/HPF were 17.8 (95% confidence interval [CI], 13.2-22.3) for pain-indicated trachelectomies, 11.5 (95% CI, 4.8-18.2) for nonpain, and 6.3 (95% CI, 0.8-11.8) for controls. Regardless of trachelectomy indication, adjusted average nerve counts/HPF were 17.7 (95% CI, 13.4-22.0) for patients with endometriosis and 14.6 (95% CI, 12.2-17.1) for patients without endometriosis. CONCLUSION Nerve fibers in the cervical stump after supracervical hysterectomy are significantly increased in women undergoing trachelectomy for pain indications compared with those who underwent trachelectomy for nonpain indications and controls. Although not statistically significant, endometriosis may be an independent risk factor for increased nerve fibers. These histopathologic observations may support the idea that the cervix should be removed in women undergoing hysterectomy for chronic pelvic pain or endometriosis.
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Affiliation(s)
| | | | - Natalie Banet
- University of North Carolina Medical Center, Chapel Hill, North Carolina
| | | | - John Steege
- University of North Carolina Medical Center, Chapel Hill, North Carolina
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Brucker SY, Taran FA, Bogdanyova S, Ebersoll S, Wallwiener CW, Schönfisch B, Krämer B, Abele H, Neis F, Sohn C, Gawlik S, Wallwiener D, Wallwiener M. Patient-reported quality-of-life and sexual-function outcomes after laparoscopic supracervical hysterectomy (LSH) versus total laparoscopic hysterectomy (TLH): a prospective, questionnaire-based follow-up study in 915 patients. Arch Gynecol Obstet 2014; 290:1141-9. [DOI: 10.1007/s00404-014-3318-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 06/11/2014] [Indexed: 10/25/2022]
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Jin K. Patient Satisfaction, Vaginal Bleeding, Sexual Function following Laparoscopic Supracervical Hysterectomy. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2014; 20:148-154. [PMID: 37684790 DOI: 10.4069/kjwhn.2014.20.2.148] [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: 09/10/2023] Open
Abstract
PURPOSE This study was done to evaluate postoperative patient satisfaction, vaginal bleeding, and sexual function in women after laparoscopic supracervical hysterectomy (LSH). METHODS A retrospective study was conducted using a questionnaire mailed to 131 women who underwent LSH between 2008 and 2011at the Department of Obstetrics &Gynecology, D University Hospital in Chungnam province. Indication for LSH was uterine myoma. The questionnaire contained questions on overall postoperative satisfaction, influence on quality of life of vaginal bleeding, and sexual satisfaction following surgery. Data were collected from March to July 2013 and 109 (83.2%) patients returned the questionnaire. RESULTS Most women reported being very satisfied (90.8%) or satisfied (7.3%), but 2 women (1.8%) were not satisfied with LSH. Four patients (3.4%) reported experiencing vaginal bleeding but with no negative influence on quality of life. Of sexually active women, 82 patients (90.1%) reported improvements in sexual function, 8 patients (8.8%) reported "no change", and one patient (1.1%) reported a deterioration. CONCLUSION Results of this study indicate that LSH is associated with a high degree of patient satisfaction, no negative influence on quality of life from vaginal bleeding, and improvement in sexual function to a minimum 2 years after the procedure.
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Affiliation(s)
- Keon Jin
- Department of Obstetrics and Gynecology, Dankook University College of Medicine, Cheonan, Korea
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Pelvic Pain and Patient Satisfaction After Laparoscopic Supracervical Hysterectomy: Prospective Trial. J Minim Invasive Gynecol 2014; 21:406-11. [DOI: 10.1016/j.jmig.2013.10.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 10/22/2013] [Accepted: 10/23/2013] [Indexed: 11/18/2022]
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AAGL Practice Report: Practice Guidelines for Laparoscopic Subtotal/Supracervical Hysterectomy (LSH). J Minim Invasive Gynecol 2014; 21:9-16. [DOI: 10.1016/j.jmig.2013.08.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 08/02/2013] [Indexed: 10/26/2022]
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Nesbitt-Hawes EM, Maley PE, Won HR, Law KS, Zhang CS, Lyons SD, Ledger W, Abbott JA. Laparoscopic Subtotal Hysterectomy: Evidence and Techniques. J Minim Invasive Gynecol 2013; 20:424-34. [DOI: 10.1016/j.jmig.2013.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 01/15/2013] [Accepted: 01/17/2013] [Indexed: 10/27/2022]
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Nouri K, Demmel M, Greilberger U, Fischer EM, Seemann R, Egarter C, Ott J. Prospective cohort study and meta-analysis of cyclic bleeding after laparoscopic supracervical hysterectomy. Int J Gynaecol Obstet 2013; 122:124-7. [PMID: 23731507 DOI: 10.1016/j.ijgo.2013.03.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Revised: 03/07/2013] [Accepted: 04/25/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate a modified technique of laparoscopic supracervical hysterectomy (LSH) on rates of postoperative cyclic bleeding (PCB). METHODS A retrospective study was conducted of 173 women who underwent LSH with bipolar electrocoagulation of the endocervical canal at Landeskrankenhaus Wolfsberg, Wolfsberg, Austria, between January 1, 2005, and December 31, 2009. Long-term follow-up was assessed using a questionnaire. A systematic literature review and a meta-analysis of 13 studies that reported on PCB after LSH were also conducted. RESULTS In all, 164 women (94.8%) had uneventful intraoperative and postoperative courses. By contrast, 9 of 146 premenopausal women (6.2%) experienced PCB. The meta-analysis (n=1822) revealed an overall PCB rate of 7.1%. Bipolar electrocoagulation of the endocervical canal was the most effective method for prevention of PCB (bleeding rate, 2.9%) followed by unipolar electrocoagulation (bleeding rate, 9.9%). Uterine resection below the internal cervical orifice was more effective for preventing PCB (13 of 633 women; 2.1%) than either amputation at this site or above this site (27 of 537 women [5.0%] and 88 of 640 women [13.8%]). CONCLUSION Bipolar coagulation of the endocervical canal and extensive resection with amputation below the level of the internal cervical orifice were effective for reducing rates of PCB.
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Affiliation(s)
- Kazem Nouri
- Department of Gynecology and Obstetrics, Landeskrankenhaus Wolfsberg, Wolfsberg, Austria
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A prospective, randomized clinical comparison between UltraCision and the novel sealing and cutting device BiCision in patients with laparoscopic supracervical hysterectomy. Surg Endosc 2013; 27:3852-9. [DOI: 10.1007/s00464-013-2994-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 04/23/2013] [Indexed: 12/31/2022]
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Berner E, Qvigstad E, Langebrekke A, Lieng M. Laparoscopic Supracervical Hysterectomy Performed With and Without Excision of the Endocervix: A Randomized Controlled Trial. J Minim Invasive Gynecol 2013; 20:368-75. [DOI: 10.1016/j.jmig.2013.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 01/14/2013] [Accepted: 01/16/2013] [Indexed: 10/27/2022]
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Massive delayed vaginal hemorrhage after laparoscopic supracervical hysterectomy. Case Rep Obstet Gynecol 2012; 2012:871041. [PMID: 22919525 PMCID: PMC3420099 DOI: 10.1155/2012/871041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 06/29/2012] [Indexed: 11/25/2022] Open
Abstract
Background. A known complication of supracervical hysterectomy is cyclical bleeding
from the retained cervix when functioning endometrial tissue is not totally removed. We present a rare case of delayed postoperative vaginal hemorrhage after supracervical hysterectomy. Case. A 44-year-old woman presented on postoperative day 15 after laparoscopic supracervical hysterectomy with massive vaginal hemorrhage requiring emergent re-operation. Her bleeding was controlled with vaginally placed sutures. Ultrasound confirmed no intraperitoneal free fluid. The etiology was thought to be induced by postoperative tissue necrosis from cautery applied to the endocervical canal during the original surgery. Conclusion. Delayed vaginal hemorrhage from a retained cervix is a rare complication of laparoscopic supracervical hysterectomy. Caution should be exercised when cauterizing the endocervical canal as induced tissue necrosis may increase the risk of postoperative bleeding.
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Chu CM, Acholonu UC, Chang-Jackson SCR, Nezhat FR. Leiomyoma Recurrent at the Cervical Stump: Report of Two Cases. J Minim Invasive Gynecol 2012; 19:131-3. [DOI: 10.1016/j.jmig.2011.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Revised: 10/10/2011] [Accepted: 10/12/2011] [Indexed: 12/01/2022]
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Place de l’hystérectomie supracervicale et de l’abord cœlioscopique pour fibromes symptomatiques. ACTA ACUST UNITED AC 2011; 40:944-52. [DOI: 10.1016/j.jgyn.2011.09.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Benson AD, Kramer BA, Wayment RO, Schwartz BF. Supracervical robotic-assisted laparoscopic sacrocolpopexy for pelvic organ prolapse. JSLS 2011; 14:525-30. [PMID: 21605516 PMCID: PMC3083043 DOI: 10.4293/108680810x12924466008006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Supracervical robotic-assisted laparoscopic sacrocolpopexy was found to be an effective repair of apical vaginal defects in patients with pelvic organ prolapse who had not undergone previous hysterectomy. Background: Supracervical robotic-assisted laparoscopic sacrocolpopexy (SRALS) is a new surgical treatment for pelvic organ prolapse that secures the cervical remnant to the sacral promontory. We present our initial experience with SRALS in the same setting as supracervical robotic-assisted hysterectomy (SRAH). Methods: Women with vaginal vault prolapse and significant apical defects as defined by a Baden-Walker score of ≥3 who had not undergone hysterectomy were offered SRALS in combination with SRAH. A chart review was performed to analyze operative and perioperative data. Outcome data also included patients who underwent robotic-assisted laparoscopic sacrocolpopexy (RALS) without any other procedure. Results: Thirty-three patients underwent RALS, including 12 patients who underwent SRALS. All SRALS were performed following SRAH in the same setting. The mean follow-up for the RALS and SRALS patients was 38.4 months and 20.7 months, respectively. One patient in the RALS group had an apical recurrence. There were no recurrences in the SRALS group. Conclusions: SRALS is effective for repair of apical vaginal defects in patients with significant pelvic organ prolapse who have not undergone previous hysterectomy. Complications are few and recurrences rare in short- and medium-term follow-up. Greater follow-up and numbers are needed to further establish the role of this procedure.
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Affiliation(s)
- Aaron D Benson
- Division of Urology, Southern Illinois University, Springfield, Illinois 62794-9665, USA
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Schmidt T, Eren Y, Breidenbach M, Fehr D, Volkmer A, Fleisch M, Rein DT. Modifications of Laparoscopic Supracervical Hysterectomy Technique Significantly Reduce Postoperative Spotting. J Minim Invasive Gynecol 2011; 18:81-4. [DOI: 10.1016/j.jmig.2010.09.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 09/23/2010] [Accepted: 09/30/2010] [Indexed: 11/25/2022]
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Maina WC, Morris EP. Management of women requesting subtotal hysterectomy. MENOPAUSE INTERNATIONAL 2010; 16:152-5. [PMID: 21156852 DOI: 10.1258/mi.2010.010038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Subtotal hysterectomy (SH), which is also referred to as supracervical hysterectomy, is a common gynaecological procedure in which the uterus is removed and the cervix is retained. There is continuing debate about the advantages and disadvantages of SH compared with total abdominal hysterectomy. Persistent vaginal bleeding and the need for continued cervical screening appear to be the main disadvantages of SH. The procedure is often combined with removal of the ovaries. Women should be counselled appropriately prior to removal of their ovaries. Following an internal audit of practice of hormone replacement therapy (HRT) prescription within our own unit, we discovered that there were inconsistencies in the prescription of HRT following SH which led us to investigate this matter further. We concluded that evidence is lacking to guide HRT prescription following SH and bilateral oophorectomy and propose content that can help produce guidelines for the counselling of women prior to SH and prescription of HRT.
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Affiliation(s)
- William C Maina
- Department of Obstetrics and Gynaecology, Norfolk and Norwich University Hospital, Colney Lane, Norfolk NR18 0XF, UK.
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Past, Present, and Future of Hysterectomy. J Minim Invasive Gynecol 2010; 17:421-35. [DOI: 10.1016/j.jmig.2010.03.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Revised: 03/03/2010] [Accepted: 03/07/2010] [Indexed: 11/18/2022]
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Long-term outcomes following laparoscopic and abdominal supracervical hysterectomies. Obstet Gynecol Int 2010; 2010:989127. [PMID: 20300594 PMCID: PMC2838221 DOI: 10.1155/2010/989127] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Accepted: 02/02/2010] [Indexed: 11/18/2022] Open
Abstract
Long-term outcomes, in terms of cervical stump symptoms and overall patient satisfaction, were studied in women both after abdominal (SAH) and laparosocopic (LSH) supracervical hysterectomies. Altogether, 134 women had SAH and 315 women LSH during 2004 and 2005 at our department. The response rate of this retrospective study was 79%. Persistent vaginal bleeding after the surgery was reported by 17% in the SAH group and 24% in the LSH group. Regular bleeding was reported by only 8% in both study groups, and the women rarely found the bleeding bothersome. The women reported a significant pain reduction after the surgery, but women having a hysterectomy because of pain and/or endometriosis should be informed about the possibility of persistent symptoms. The overall patient satisfaction after both procedures was high, but the patients should have proper preoperative information about the possibility of cervical stump symptoms after any supracervical hysterectomy.
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van Evert JS, Smeenk JMJ, Dijkhuizen FPHLJ, de Kruif JH, Kluivers KB. Laparoscopic subtotal hysterectomy versus laparoscopic total hysterectomy: a decade of experience. ACTA ACUST UNITED AC 2009; 7:9-12. [PMID: 20234836 PMCID: PMC2837242 DOI: 10.1007/s10397-009-0529-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Accepted: 09/21/2009] [Indexed: 10/26/2022]
Abstract
At present, there are only few data on the surgical outcomes of laparoscopic hysterectomy (LH). Up till now, it has been unclear whether there is a difference in number of complications among the subcategories of laparoscopic total hysterectomy and laparoscopic subtotal hysterectomy (LSH). Therefore, we have performed a retrospective analysis to evaluate the peri- and postoperative outcomes in women undergoing LSH versus LH. This multi-centre retrospective cohort study (Canadian Task Force classification II-2) was conducted in multi-centres (two teaching hospitals and one university medical centre) in the Netherlands, all experienced in minimally invasive gynaecology. In a multi-centre retrospective cohort study we compared the long-term outcomes of laparoscopic subtotal hysterectomy and laparoscopic total hysterectomy (including laparoscopic assisted vaginal hysterectomy, laparoscopic hysterectomy and total laparoscopic hysterectomy). All laparoscopic hysterectomies from the last 10 years (January 1998 till December 2007) were included. Patient characteristics, intra- and postoperative complications, operating time and duration of hospital stay were recorded. The minimum follow-up was 6 months. A total of 390 cases of laparoscopic hysterectomies were included in the analysis: 192 laparoscopic subtotal hysterectomies and 198 laparoscopic total hysterectomies. Patient characteristics such as age and parity were equal in the groups. The overall number of short-term and long-term complications was comparable in both groups: 17% and 15%. Short-term complications (bleeding, fever) were 3% in the LSH group and 12% in the LH group. Long-term complications were (tubal prolapse and cervical stump reoperations) 15% in the LSH group and 3% in the LH group. Laparoscopic subtotal hysterectomy as compared with the different types of laparoscopic total hysterectomy is associated with more long-term postoperative complications, whereas laparoscopic total hysterectomy is associated with more short-term complications.
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Zanagnolo V, Magrina JF. Robotic Radical Trachelectomy after Supracervical Hysterectomy for Cut-Through Endometrial Adenocarcinoma Stage IIB: A Case Report. J Minim Invasive Gynecol 2009; 16:655-7. [DOI: 10.1016/j.jmig.2009.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Revised: 06/09/2009] [Accepted: 06/11/2009] [Indexed: 10/20/2022]
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Gupta S, Saha A. The place of subtotal/supracervical hysterectomy in current practice. BJOG 2009; 116:863-4; author reply 864-5. [DOI: 10.1111/j.1471-0528.2009.02132.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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