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Bahall V, De Barry L, Singh K. Optimizing Total Laparoscopic Hysterectomy for the Geriatric Population: A Practical Case Study and Comprehensive Literature Review. Cureus 2023; 15:e46265. [PMID: 37908921 PMCID: PMC10615228 DOI: 10.7759/cureus.46265] [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] [Accepted: 09/30/2023] [Indexed: 11/02/2023] Open
Abstract
Elderly patients represent a large cohort of patients requiring gynaecological surgery for benign and malignant indications. In recent years, several conventional gynaecological procedures have shifted towards minimally invasive alternatives such as laparoscopy, hysteroscopy, and robotic surgery. A recent Surveillance, Epidemiology, and End Results (SEER) analysis compared the outcomes of 25,000 women undergoing laparotomy versus laparoscopic approach to hysterectomy and found that laparoscopy is associated with a shorter duration of hospitalization (three days versus five days), less postoperative complications (76%), less requirement for blood transfusion, reduced operational costs, faster recovery, and an overall safer surgical experience. Although geriatric patients are affected by age-related comorbidities, physiologic changes, and altered pharmacodynamics and pharmacokinetics of administered drugs, these patients benefit most from minimally invasive surgery. In this paper, we present a comprehensive account of the interdisciplinary perioperative approaches employed to accomplish a total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection in an 82-year-old patient who was diagnosed with grade I endometrial adenocarcinoma and multiple age-related medical comorbidities.
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Affiliation(s)
- Vishal Bahall
- Department of Obstetrics and Gynaecology, The University of the West Indies, St. Augustine, TTO
- Department of Obstetrics and Gynaecology, San Fernando General Hospital, San Fernando, TTO
| | - Lance De Barry
- Department of Obstetrics and Gynaecology, San Fernando General Hospital, San Fernando, TTO
| | - Keevan Singh
- Anaesthesia and Intensive Care Unit, Department of Clinical and Surgical Sciences, The University of the West Indies, San Fernando, TTO
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Subki AH, Agabawi AK, Hindi MM, Butt NS, Alsallum MS, Alghamdi RA, Subki SH, Alsallum F, Alharbi AA, Lodhi YI, Alandijani S, Al-Zaben F, Koenig HG, Oraif AM. How Relevant is Obstetrician and Gynecologist Gender to Women in Saudi Arabia? Int J Womens Health 2021; 13:919-927. [PMID: 34703321 PMCID: PMC8523902 DOI: 10.2147/ijwh.s284321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 08/03/2021] [Indexed: 11/27/2022] Open
Abstract
Background The patient–doctor relationship is one of the most important factors in determining the outcome of healthcare. The first step in establishing this relationship is choosing a physician. This study sought to identify patient preferences concerning the gender of their obstetrics and gynecology (OB-GYN) physician and the effect of religion and society on these choices. Methods A cross-sectional study was conducted at the OB-GYN outpatient clinics at King Abdulaziz University Hospital in Jeddah between February 2017 and June 2017. A total of 227 female patients were recruited. Eligible were women ages 18 years or older who had attended the clinic at least three times. A 30-item questionnaire was administered. Results Significantly, more female doctors were preferred for pelvic examination in lower income group (p=0.003), while male doctors were preferred for surgery (p=0.010) in higher income group. Significantly more male doctors were preferred for pelvic examination and gynecological surgery in >35-year age group (p=0.015 and p=0.017, respectively). With regard to predictors, embarrassment was the most significant factor reported for not choosing a male obstetrician/gynecologist (OB-GYN) in the younger age group. Nearly three-quarters (71.2%) of respondents with age ≤35 reported embarrassment as a factor for not choosing a male OB-GYN; 79.7% of this subgroup indicated that female doctors were more knowledgeable about women’s health issues. Conclusion Participants expressed a strong preference for female providers overall, although some women preferred male providers during certain circumstances (gynecologic surgery). Despite these gender preferences, more important to women in their choice of OB-GYN provider was the doctor’s experience, qualifications, and reputation. Such trends are consistent with those culturally similar countries and in line with trends worldwide. These findings have the potential to significantly impact the personal health for women in Saudi Arabia and elsewhere in the Middle East where religious and cultural traditions are so important in decision-making.
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Affiliation(s)
- Ahmed Hussein Subki
- Department of Internal Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | | | - Muhab Mohammed Hindi
- Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | | | - Rawan Ali Alghamdi
- Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Siham Hussein Subki
- Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fahad Alsallum
- Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | | | - Sultan Alandijani
- Department of Internal Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Faten Al-Zaben
- Department of Psychiatry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Harold G Koenig
- Department of Psychiatry, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Ayman M Oraif
- Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia
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