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Agarwal M, Sinha S, Singh S, Haripriya H, Simran S. Vaginal Vault Closure Following Total Laparoscopic Hysterectomy: Laparoscopic versus Conventional Technique - A Comparative Study. Gynecol Minim Invasive Ther 2024; 13:90-94. [PMID: 38911314 PMCID: PMC11192275 DOI: 10.4103/gmit.gmit_8_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/16/2023] [Accepted: 06/01/2023] [Indexed: 06/25/2024] Open
Abstract
Objectives Vault closure is the final step to hysterectomy, protecting the abdominal cavity from the exterior environment. Thus, closure becomes crucial in preventing ascend of infection to the peritoneal cavity. Our study aims to compare vault closure between laparoscopic and vaginal routes, their operating time, and postoperative complications. Materials and Methods The ambispective comparative study was done in a tertiary care teaching center from June 2016 to December 2022. Three hundred and forty-four patients were included in the study that underwent a total laparoscopic hysterectomy. Interventions - Patients who had laparoscopic vault closure were in Group 1 (N = 198) and those who had vaginal closure were in Group 2 (N = 146). The results were compared. It included age, body mass index of the patient, the indication of surgery, intraoperative blood loss, size of the uterus, time taken during vault closure, and postoperative complications. Results The time taken by laparoscopic vault repair was significantly less than vaginal repair (19.7 ± 13.3 min vs. 30.1 ± 6.6 min, P < 0.001). There was postoperative vault infection (2.7%), vault hematoma (1.3%), and no vault prolapse seen in vaginal repair. The organisms isolated were mainly Pseudomonas aeruginosa, Escherichia coli, and Klebsiella. Conclusion Laparoscopic vault closure has shown significantly improved results compared to vaginal route repair.
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Affiliation(s)
- Mukta Agarwal
- Department of Obstetrics and Gynecology, AIIMS, Patna, Bihar, India
| | - Shivangni Sinha
- Department of Obstetrics and Gynecology, AIIMS, Patna, Bihar, India
| | - Smita Singh
- Department of Obstetrics and Gynecology, AIIMS, Patna, Bihar, India
| | - H. Haripriya
- Department of Community and Family Medicine, AIIMS, Patna, Bihar, India
| | - S Simran
- Department of Obstetrics and Gynecology, AIIMS, Patna, Bihar, India
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Alhusayni MA, Alghamdi TM, Almutairi WA, Alhamyani AS, Alosaimi FG, Mahfouz MEM. The Effect of Body Mass Index on Patients' Length of Stay Post-appendectomy. Cureus 2023; 15:e46430. [PMID: 37927725 PMCID: PMC10621998 DOI: 10.7759/cureus.46430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND AND AIM Appendicitis is defined as the appendix's inflammation, which requires an appendectomy for treatment. Obesity is one of the risk factors for post-surgical complications in appendicitis. This study aimed to explore obesity's influence on hospital length of stay among patients with appendicitis in Taif, Saudi Arabia. METHODS The study subjects consisted of both children and adults with appendicitis who were admitted to the hospital during 2021 and 2022. The patients were divided into three groups according to body mass index (BMI) following the WHO criteria: normal weight (BMI = 18.5-24.9 kg/m2), overweight (BMI = 25-29.9 kg/m2), and obesity (BMI ≥10 kg/m2). Data collection was conducted retrospectively by reviewing the medical records of patients diagnosed with appendicitis. The data collection included demographic characteristics of the patients, clinical presentation data, examination data, findings of the diagnostic approaches, management data, and complications after surgery (mainly intra-abdominal abscess formation). Prior to conducting the study, ethical approval was obtained from the Institutional Review Board of the Saudi Ministry of Health. RESULTS The study included 238 patients who were diagnosed with appendicitis with an age range from 4 to 74 years and a mean (SD) age of 20.24 years (12.69). Based on BMI categories, 174 patients (73.1%) were classified as non-obese (BMI < 25), 53 patients (22.3%) were overweight (BMI 25-29.9), and 11 patients (4.6%) were obese (BMI ≥ 30). Most patients were presented with fever (51.7%), anorexia (72.7%), and pain in the right lower quadrant (70.2%). According to blood pressure, the mean (SD) of systolic and diastolic blood pressure was 117.8 (14.14) and 71.03 (9.89), respectively. All cases underwent abdominal ultrasound; non-visualization of the appendix was the most common finding observed (80.3%). Appendicitis was managed among most patients with appendectomy (89.5%), and open appendectomy was the most frequent surgery performed (73.2%). The mean of hospital length of stay was 1.64 (0.73) days. There was no significant correlation between patients' BMI and hospital length of stay (p = 0.429). The mean hospital length of stay of females (1.76) was higher than that of males (1.53) (p = 0.003). Moreover, a statistically significant mean difference was observed in hospital length of stay between patients managed conservatively (1.96) and those who underwent operative management (1.60 days) (p < 0.001). CONCLUSION This study provides insights into the effect of obesity on patients with appendicitis who underwent an appendectomy in Taif, Saudi Arabia. The study found that obesity was not a risk factor for a prolonged hospital length of stay after appendectomy. Further studies with larger sample sizes are needed to explore other factors that may influence the outcomes of appendectomy in patients with appendicitis, such as the impact of obesity on long-term complications and recurrence rates.
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Isono-Taniguchi R, Tsubamoto H, Inoue K, Ueda T, Saeki S, Takimoto Y, Wakimoto Y, Shibahara H. Weight-Loss Interventions and Levonorgestrel Intrauterine System Implantation for Early-Stage Endometrial Cancer and Atypical Endometrial Hyperplasia to Reduce Perioperative Risk of Severely Obese Patients. Gynecol Minim Invasive Ther 2023; 12:175-178. [PMID: 37807990 PMCID: PMC10553596 DOI: 10.4103/gmit.gmit_98_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/20/2023] [Accepted: 03/22/2023] [Indexed: 10/10/2023] Open
Abstract
Endometrial cancer (EC) and atypical endometrial hyperplasia (AEH) are associated with obesity, which increases the perioperative morbidity and surgical difficulties in laparoscopic and robotic surgery. Weight-loss interventions (WLIs) are likely to reduce morbidity; however, delayed surgery may cause cancer progression. To minimize the tumor progression, levonorgestrel intrauterine system (LNG-IUS) with minimal side effects was used until the planned surgery. During 2016 and 2021, we conducted preoperative management of WLI using LNG-IUS for seven highly obese women with a body mass index (BMI) ≥35 kg/m2 who had AEH and EC with Grade 1 and no myometrial invasion on magnetic resonance imaging. In three of the seven patients, the BMI decreased by more than 5. Two patients with AEH achieved remission after LNG-IUS placement and requested conservative management. Five patients with EC underwent laparoscopic hysterectomy, without perioperative complications.
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Affiliation(s)
- Roze Isono-Taniguchi
- Department of Obstetrics and Gynecology, Hyogo Medical Univesity, Nishinomiya, Hyogo, Japan
| | - Hiroshi Tsubamoto
- Department of Obstetrics and Gynecology, Hyogo Medical Univesity, Nishinomiya, Hyogo, Japan
| | - Kayo Inoue
- Department of Obstetrics and Gynecology, Hyogo Medical Univesity, Nishinomiya, Hyogo, Japan
| | - Tomoko Ueda
- Department of Obstetrics and Gynecology, Hyogo Medical Univesity, Nishinomiya, Hyogo, Japan
| | - Shinichiro Saeki
- Department of Obstetrics and Gynecology, Hyogo Medical Univesity, Nishinomiya, Hyogo, Japan
| | - Yumi Takimoto
- Department of Obstetrics and Gynecology, Hyogo Medical Univesity, Nishinomiya, Hyogo, Japan
| | - Yu Wakimoto
- Department of Obstetrics and Gynecology, Hyogo Medical Univesity, Nishinomiya, Hyogo, Japan
| | - Hiroaki Shibahara
- Department of Obstetrics and Gynecology, Hyogo Medical Univesity, Nishinomiya, Hyogo, Japan
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Schützendübel M, Boosz A, Baev E, Häberle L, Müller A. Learning laparoscopic hysterectomy: analysis of different surgeons' individual learning curves. Arch Gynecol Obstet 2023; 307:1065-1072. [PMID: 36580116 DOI: 10.1007/s00404-022-06893-7] [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: 10/12/2022] [Accepted: 12/13/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The aim of this study was to examine the development of surgical skills among surgeons learning total laparoscopic hysterectomy (TLH), using differences in complication rates between surgeons with different levels of experience and analyzing the development of individual operating times. STUDY DESIGN This retrospective, single-center cohort study included 576 total laparoscopic hysterectomy procedures conducted between January 2015 and December 2019 at the municipal hospital in Karlsruhe, Germany. All TLHs were performed by eight surgeons, two of whom were experienced and six inexperienced. Complications were graded using the Clavien-Dindo classification. RESULTS No differences in complication rates were seen between experienced and inexperienced surgeons. With growing numbers of procedures, most surgeons quickly became faster, leading to reduced operating times. However, experienced surgeons who had performed more than 100 procedures also became faster, not reaching a time plateau after adjustment for weight of the uterus, presurgery score, and adnexal score. CONCLUSIONS Learning laparoscopic hysterectomy in routine practice is safe for patients, and surgeons rapidly become faster as growing numbers of procedures are performed. Operating times for experienced surgeons who have carried out more than 100 operations also improve, and a time plateau is not reached.
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Affiliation(s)
- Malte Schützendübel
- Department of Obstetrics and Gynecology, Karlsruhe Municipal Hospital, Moltkestrasse 90, 76133, Karlsruhe, Germany.
- Friedrich Alexander University of Erlangen-Nürnberg, Erlangen, Germany.
| | - Alexander Boosz
- Department of Obstetrics and Gynecology, Karlsruhe Municipal Hospital, Moltkestrasse 90, 76133, Karlsruhe, Germany
| | - Evgeni Baev
- Department of Obstetrics and Gynecology, Karlsruhe Municipal Hospital, Moltkestrasse 90, 76133, Karlsruhe, Germany
| | - Lothar Häberle
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Andreas Müller
- Department of Obstetrics and Gynecology, Karlsruhe Municipal Hospital, Moltkestrasse 90, 76133, Karlsruhe, Germany
- Friedrich Alexander University of Erlangen-Nürnberg, Erlangen, Germany
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Does uterus volume affect the total laparoscopic hysterectomy outcomes? JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.7280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background/Aim: Increased uterus weight, high body mass index (BMI), and history of abdominal surgeries increase the risk of complications in total laparoscopic hysterectomy (TLH), similar to other types of surgery. However, there are conflicting reports about improving technology. This study aimed to retrospectively investigate the clinical features and postoperative results of TLH cases regarding uterine volume performed for benign reasons in our clinic.
Methods: In this retrospective cohort study, 252 patients were included. The demographic data of all patients, including BMI, pre-operative uterine volumes, operation times, number of cesarean sections, history of lower abdominal operation, indications, pre-operative and postoperative hemoglobin differences, complications, length of hospital stay, and final pathologies were reviewed. The uterine volume was measured using the prolate ellipsoid formula before surgery, using the maximum length and anteroposterior and transverse diameters of the uterine corpus. The normal uterine volume with these measurements (8 cm long, 4 cm high, and 5 cm wide) was estimated as 83.2 cm3. The patients were classified into two groups according to uterine volume (normal volume ≤ 83.2 or above). Surgical outcomes of patients were compared between groups.
Results: Two-hundred-fifty-two women were included in the study. The mean uterine volumes of groups 1 and 2 were 53.66 cm3 (2.25) and 296.33 cm3 (6.25), respectively. In group 1, the mean operation time was 111.14 (6) min, compared to 118.2 (3.06) min in group 2; there was no significant difference (P = 0.164). The mean postoperative hospital stays of groups 1 and 2 were 3.21 (0.15) and 3.34 (0.09) days, respectively, and there was no significant difference (P = 0.706). The mean blood loss values of groups 1 and 2 were 1.34 g/dl (0.19) and 1.16 g/dl 0.06), respectively.
Conclusion: According to our results, TLH is a safe method even in patients with a larger uterus; operating time, blood loss, and postoperative hospital stays did not differ according to uterine volume.
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Shu M, Sosa J, Reyes HD, Eddib A, Eswar A. The role of minimally invasive gynecologic surgeons in the era of subspecialties: when to refer and consult. Curr Opin Obstet Gynecol 2022; 34:190-195. [PMID: 35895960 DOI: 10.1097/gco.0000000000000795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Minimally invasive gynecologic surgery (MIGS) is a subspecialty focus of obstetrics and gynecology with focused expertise on complex benign gynecologic disorders. To date, no formal recommendations have been made in defining a referral system for MIGS. This article reviews the evidence regarding common disorders and procedures and their outcomes, and posits a basis for MIGS referral. RECENT FINDINGS In instances where intraoperative and perioperative features may pose clinical challenges to the surgeon and ultimately the patient, the literature suggests the following scenarios may have adverse outcomes, and therefore, benefit from the skills of MIGS subspecialists: fibroids - at least five myomas, myoma size at least 9 cm, and suspected myoma weight at least 500 g; endometriosis - presence of endometrioma(s), suspected stage III/IV endometriosis, and requirement for advanced adjunct procedures; hysterectomy - uteri at least 250 g or 12 weeks estimated size, at least three prior laparotomies, obesity, and complex surgical history with suspected adhesive disease. SUMMARY A referral system for MIGS subspecialists has proven benefits for both the gynecologic surgical community as well as the patients and their outcomes. This article provides evidence for collaboration with MIGS especially as it relates to leiomyomatous uteri, endometriosis, and complex hysterectomies.
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Affiliation(s)
- Michael Shu
- Kaleida Health, Minimally Invasive Gynecologic Surgery, Williamsville
- University at Buffalo, The State University of New York (SUNY)
| | - J'Leise Sosa
- Kaleida Health, Minimally Invasive Gynecologic Surgery, Williamsville
- University at Buffalo, The State University of New York (SUNY)
- GPPC Women's Health, Buffalo
| | - Henry D Reyes
- Kaleida Health, Minimally Invasive Gynecologic Surgery, Williamsville
- University at Buffalo, The State University of New York (SUNY)
- Great Lakes Cancer Care
| | - Abeer Eddib
- Kaleida Health, Minimally Invasive Gynecologic Surgery, Williamsville
- University at Buffalo, The State University of New York (SUNY)
- Western New York Urology Associates, Amherst
| | - Alexander Eswar
- Kaleida Health, Minimally Invasive Gynecologic Surgery, Williamsville
- University at Buffalo, The State University of New York (SUNY)
- Invision Health, Williamsville, New York, USA
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Sehnal B, Klat J, Herboltova P, Hanacek J, Fanta M, Valha P, Hruda M, Vasicka I, Halaska MJ. Comparison of complications in very obese women undergoing hysterectomy - Abdominal vs laparoscopic approach with short- and long-term follow-up. Eur J Obstet Gynecol Reprod Biol 2022; 276:148-153. [PMID: 35908409 DOI: 10.1016/j.ejogrb.2022.07.005] [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: 04/09/2022] [Revised: 06/08/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Surgical treatment of obese female patients represents a real challenge. Over the last decade, minimally invasive techniques for hysterectomy have emerged. These approaches reduce the invasiveness of standard surgical procedures while maintaining efficacy and feasibility. OBJECTIVE To evaluate the rates of perioperative, early, mid-term and late postoperative complications in very obese [body mass index (BMI) ≥ 35 and < 40 kg/m2] and severely obese (BMI ≥ 40 kg/m2) women who underwent total (non-radical) hysterectomy. DESIGN A prospective comparative multi-centre non-randomized study. METHODS In total, 328 consecutive total (non-radical) hysterectomies were performed at seven teaching gynaecological centres. Of these, 153 (46.6%) were performed using an open laparotomy (LT) approach and 175 (53.4%) were performed laparoscopically (LS). All data were collected by medical specialists at the pre-operative examination prior to surgery, during surgery and three times postoperatively (during hospital stay, at 6-week follow-up and 6 months following surgery). Another analysis considered a total of 206 women who underwent laparoscopic hysterectomy. The subjects were divided according to BMI into 120 very obese women (BMI ≥ 35 and < 40 kg/m2) and 86 severely obese women (BMI ≥ 40 kg/m2). RESULTS The total number of composite perioperative complications was significantly lower in the LS group (p = 0.006). Composite complications occurred significantly more often in patients in the LT group compared with the LS group in the early (p < 0.001) and mid-term (p < 0.001) postoperative periods. In the late postoperative period, the total number of composite postoperative complications did not differ significantly between the groups (p < 0.396). Among 206 patients who underwent laparoscopic hysterectomy, the number of complications was generally low; the rates of composite perioperative (p = 0.393), early (p = 0.642), mid-term (p = 0.738) and late (p = 1) postoperative complications were generally low; and frequency did not differ significantly with BMI. CONCLUSION The LS approach does not increase intra-operative morbidity associated with surgery, and has significantly better outcomes in terms of the postoperative complication rate.
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Affiliation(s)
- Borek Sehnal
- First Faculty of Medicine, Charles University, Department of Gynecology and Obstetrics, University Hospital Bulovka, Prague, Czech Republic
| | - Jaroslav Klat
- University Hospital and University of Ostrava, Department of Obstetrics and Gynecology, Ostrava, Czech Republic
| | | | - Jiri Hanacek
- Institute for the Care of Mother and Child, 3rd Medical Faculty, Charles University, Prague, Czech Republic
| | - Michael Fanta
- 1st Faculty of Medicine, Charles University, Department of Gynecology and Obstetrics, General Faculty Hospital, Prague, Czech Republic
| | - Petr Valha
- Hospital Ceske Budejovice, Budweis, Czech Republic
| | - Martin Hruda
- 3rd Medical Faculty, Charles University, Prague, Czech Republic; University Hospital Kralovske Vinohrady, Department of Obstetrics and Gynaecology, Prague, Czech Republic
| | - Ian Vasicka
- First Faculty of Medicine, Charles University, Department of Gynecology and Obstetrics, University Hospital Bulovka, Prague, Czech Republic
| | - Michael J Halaska
- 3rd Medical Faculty, Charles University, Prague, Czech Republic; University Hospital Kralovske Vinohrady, Department of Obstetrics and Gynaecology, Prague, Czech Republic.
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Dumont S, Van Trappen P. The clinical and financial impact of introducing robotic-assisted hysterectomy in a tertiary referral centre: A direct cost analysis of consecutive hysterectomies during a decade. Int J Med Robot 2021; 18:e2343. [PMID: 34655461 DOI: 10.1002/rcs.2343] [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: 07/20/2021] [Revised: 09/16/2021] [Accepted: 10/15/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Economic data and the clinical impact of introducing robotic-assisted hysterectomy in a European setting are scarce with conflicting findings. METHODS In this retrospective cohort study, the cost and complication rate of the different approaches of hysterectomy are investigated, both benign and (pre)malignant indications were included. RESULTS 844 patients were included: 323 (38.3%) patients underwent robotic-assisted hysterectomy (RAH), 317 (37.5%) total abdominal hysterectomy (TAH), and 204 (24.2%) total laparoscopic hysterectomy (TLH). TAH dropped from 67.2% to 25.5% of procedures, whilst RAH rose to 41.8% of cases. The total hospitalisation cost was for RAH €5208.39 (±€916.91), for TAH €5846.61 (±€4464.37) and for TLH €3790.06 (±€1267.05). The postoperative complication rate of TAH (9.1%) was significantly higher in comparison with TLH and RAH (5.4% and 3.1%, respectively, p = 0.005). CONCLUSIONS RAH has replaced TAH in most cases, especially for large uteri, early-stage endometrial cancer and in selected endometriosis cases, resulting in reduced morbidity with lower hospitalisation costs. The indications for TLH remained, including menorrhagia, adenomyosis and persistent cervical dysplasia.
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Affiliation(s)
- Sander Dumont
- Department of Gynecology and Gynecological Oncology, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium.,Department of Gynecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Philippe Van Trappen
- Department of Gynecology and Gynecological Oncology, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium
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Khoiwal K, Kapoor N, Gaurav A, K R, Reddy KK, Chaturvedi J. The Effect of Body Mass Index on Peri-operative Parameters of Total Laparoscopic Hysterectomy: An Institutional Experience. Cureus 2021; 13:e15558. [PMID: 34277181 PMCID: PMC8270063 DOI: 10.7759/cureus.15558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 11/10/2022] Open
Abstract
Objectives Worldwide, there is an increase in the obese population and laparoscopic surgery is now becoming one of the preferred modes of surgery. Therefore, it is important to examine its feasibility and safety in overweight and obese women. The study was aimed to evaluate the effects of body mass index (BMI) on intraoperative and postoperative parameters in patients undergoing total laparoscopic hysterectomy (TLH). Materials and methods A retrospective data analysis was conducted over a period of two years among women who underwent TLH. Data were grouped as per their BMI into Normal, Overweight, and Obese groups. Baseline demographic and clinical characteristics, intraoperative outcomes including operative time, estimated blood loss, hemoglobin difference, the need for blood transfusion, conversion to laparotomy, uterine weight, intraoperative and postoperative complications, postoperative pain, duration of hospital stay, and readmission were noted. Results Baseline demographic characteristics were similar in all three groups. Operative time was comparable among the groups. However, a weak positive correlation was found between operative time and total BMI value, which was statistically significant (p = 0.039). For every 1 kg/m2 increase in BMI, operative time increased by 2.35 minutes. Other intraoperative parameters were comparable among all the groups except hemoglobin difference, which was significantly higher in obese women. Postoperative parameters were similar among all groups. Conclusion Total laparoscopic hysterectomy is a safe, efficient, and feasible surgical approach in higher BMI groups. This approach provides advantages over open surgery of early recovery, short hospital stay, and less postoperative pain to obese women.
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Affiliation(s)
- Kavita Khoiwal
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Nirali Kapoor
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Amrita Gaurav
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Rupendra K
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Kranti Kumar Reddy
- Preventive Medicine, All India Institute of Medical Sciences, Rishikesh, IND
| | - Jaya Chaturvedi
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, Rishikesh, IND
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Lin CH, Long CY, Huang KH, Lo TS, Wu MP. Surgical Trend and Volume Effect on the Choice of Hysterectomy Benign Gynecologic Conditions. Gynecol Minim Invasive Ther 2021; 10:1-9. [PMID: 33747766 PMCID: PMC7968603 DOI: 10.4103/gmit.gmit_68_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/11/2020] [Accepted: 09/03/2020] [Indexed: 11/04/2022] Open
Abstract
With the advance of minimally invasive surgery (MIS), the surgical trends of hysterectomy changed significantly during past 2 decades. Total number (age-standardized) of all types of hysterectomy decreased, which may be due to the availability of some other alternatives, e.g. hysteroscopy, laparoscopic myomectomy. However, laparoscopic hysterectomy (LH) still remains the mainstream of surgical treatment. LH significantly increases for benign gynecologic conditions in Taiwan and worldwide. The increase of LH was accompanied with decrease of TAH; VH kept stationary, and SAH increased slightly. The increase in popularity of LH and SAH; provides evidence of surgical trends and a paradigm shift for hysterectomy. This time-frame shift suggests LH has reached a u during the later years. Older patients tend to receive AH, while middle-aged women tend to receive LH. Oder surgeons tend to perform AH, while younger surgeons tend to perform LH. However, all type hysterectomy and LH were more commonly performed by older surgeons aged over 50 years. It means both patients and surgeons became older during the time-frames. The above phenomena may also happen due to less young surgeons entered in the gynecologic practice. Most of the LHs were performed by high-volume surgeons, however, there is a shift from high-volume, to medium- and low-volume surgeons. The above scenario may be due to the wide spread of LH techniques. Surgical volume has important impacts on both complications and costs. The high-volume surgeons have lower complications, which result in lower costs. In the future, how to increase the use of LH, to improve the training and monitoring system deserves more attentions.
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Affiliation(s)
- Chung-Hong Lin
- Department of Obstetrics and Gynecology, Chi Mei Hospital, Chiali, Taiwan
- Division of Urogynecology, Department of Obstetrics and Gynecology, Chi Mei Medical Center, Tainan, Taiwan
| | - Cheng-Yu Long
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Obstetrics and Gynecology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuan-Hui Huang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Tsia-Shu Lo
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Ping Wu
- Division of Urogynecology, Department of Obstetrics and Gynecology, Chi Mei Medical Center, Tainan, Taiwan
- Department of Obstetrics and Gynecology, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
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Isono W, Tsuchiya A, Honda M, Saito A, Tsuchiya H, Matsuyama R, Fujimoto A, Kawamoto M, Nishii O. A retrospective study of 323 total laparoscopic hysterectomy cases for various indications and a case report treating caesarean scar pregnancy. J Med Case Rep 2020; 14:243. [PMID: 33308278 PMCID: PMC7734823 DOI: 10.1186/s13256-020-02585-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/12/2020] [Indexed: 11/12/2022] Open
Abstract
Background The application of laparoscopic surgeries has been increasing, and various uterine diseases in addition to leiomyoma/adenomyoma have become indications for total laparoscopic hysterectomy (TLH). Therefore, data acquisition and analysis of TLH procedures, including TLH for rare uterine diseases, have become important for improving surgical procedures and patient selection. To determine the prevalence of and risk factors for the occurrence of intraoperative and postoperative complications of TLH, we performed a multivariate analysis of the records in our hospital. Methods We retrospectively reviewed the medical records of 323 patients who underwent TLH for the treatment of leiomyoma/adenomyoma (278 cases), low-grade (pre)malignant uterine tumours (40 cases) and other rare uterine diseases (5 cases) from January 1, 2015, to December 31, 2019. Of the rare uterine diseases, one case of caesarean scar pregnancy for which TLH was performed is introduced as a case report. To assess the effects of 11 representative factors, including patient characteristics, uterus and leiomyoma sizes, indications for TLH and others, we performed a multivariate logistic regression analysis. Results Among the 323 cases, 20 intraoperative complications and 15 postoperative complications were reported. In the multivariate analysis, “ovarian tumour” and “heavy uterus” were positively associated and “nulliparity” was negatively associated with intraoperative complications. There were no significant risk factors for postoperative complications. The only risk factor for operative complications directly related to the resected uterus was “heavy uterus”. Therefore, we could perform TLH relatively safely for patients with other indications besides leiomyoma/adenomyoma. Conclusions Considering the factors detected in this analysis, the indications for TLH may be expanded. Owing to the increase in TLH for indications other than leiomyoma/adenomyoma, a more accurate determination of the treatment approach can be achieved.
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Affiliation(s)
- Wataru Isono
- Department of Obstetrics and Gynaecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, 5-1-1 Kawasaki, Futago Takatsu-ku, Futago, Kanagawa, 213-8507, Japan.
| | - Akira Tsuchiya
- Department of Obstetrics and Gynaecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, 5-1-1 Kawasaki, Futago Takatsu-ku, Futago, Kanagawa, 213-8507, Japan
| | - Michiko Honda
- Department of Obstetrics and Gynaecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, 5-1-1 Kawasaki, Futago Takatsu-ku, Futago, Kanagawa, 213-8507, Japan
| | - Ako Saito
- Department of Obstetrics and Gynaecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, 5-1-1 Kawasaki, Futago Takatsu-ku, Futago, Kanagawa, 213-8507, Japan
| | - Hiroko Tsuchiya
- Department of Obstetrics and Gynaecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, 5-1-1 Kawasaki, Futago Takatsu-ku, Futago, Kanagawa, 213-8507, Japan
| | - Reiko Matsuyama
- Department of Obstetrics and Gynaecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, 5-1-1 Kawasaki, Futago Takatsu-ku, Futago, Kanagawa, 213-8507, Japan
| | - Akihisa Fujimoto
- Department of Obstetrics and Gynaecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, 5-1-1 Kawasaki, Futago Takatsu-ku, Futago, Kanagawa, 213-8507, Japan
| | - Masashi Kawamoto
- Department of Diagnostic Pathology, University Hospital Mizonokuchi, Teikyo University School of Medicine, 5-1-1 Kawasaki, Takatsu-ku, Futago, Kanagawa, 213-8507, Japan
| | - Osamu Nishii
- Department of Obstetrics and Gynaecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, 5-1-1 Kawasaki, Futago Takatsu-ku, Futago, Kanagawa, 213-8507, Japan
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Robotic-Assisted Laparoscopic Hysterectomy for Endometrial Hyperplasia or Grade 1 Endometrial Adenocarcinoma: A 10-year, Single-Centre Experience. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 43:557-563. [PMID: 33259942 DOI: 10.1016/j.jogc.2020.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe the outcomes of patients undergoing robotic-assisted laparoscopic hysterectomy for grade-1 endometroid endometrial cancer or endometrial hyperplasia at our centre. METHODS Retrospective chart review was completed for 160 patients who underwent robotic-assisted laparoscopic hysterectomy by 5 general gynaecologists in a tertiary care setting between September 2008 and September 2018. Outcomes collected included operative time, estimated blood loss, length of stay, perioperative complications, readmissions, and recurrences. Subgroup analysis was completed after stratifying by body mass index (BMI; 3 groups: A, <40 kg/m2; B, 40-50 kg/m2; and C, >50 kg/m2). Subgroups were compared with ANOVA or Fisher exact test. RESULTS The intraoperative complication rate was 3%. The rate of conversion to laparotomy was 2%, and the rate of bowel injury, 1%. The postoperative complication rate was 8%. The rate of major postoperative complications was 4%, and 3% of patients required readmission postoperatively. The mean BMI was 43 (range 21-71) kg/m2. There were no differences in perioperative complication, readmission, or recurrence rates between subgroups. Groups B and C were more likely to have had an ASA of 3-4, suggesting a higher burden of comorbidity. Operating room time, procedure time, and estimated blood loss were higher in group C. CONCLUSION Despite this cohort's mean BMI falling within the category of class III obesity, complication and conversion rates were similar to those reported in the literature and did not increase with BMI, despite an increased comorbidity burden. These results suggest that robotic surgery is a safe and effective method for providing minimally invasive surgery to a technically challenging population.
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Sukgen G, Türkay Ü. Effects of Total Abdominal Hysterectomy and Total Laparoscopic Hysterectomy on Urinary Tract Dysfunction. Gynecol Minim Invasive Ther 2020; 9:113-117. [PMID: 33101910 PMCID: PMC7545048 DOI: 10.4103/gmit.gmit_43_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 12/05/2019] [Accepted: 02/19/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives: The aim of this study is to compare the urinary tract dysfunction rates of total abdominal hysterectomy (TAH) and total laparoscopic hysterectomy. Materials and Methods: Turkish patients who underwent TAH and laparoscopic hysterectomy were invited to participate in this study. In this study, 140 patients were examined who underwent hysterectomy in gynecology clinic between 2013 and 2018. The post residual urine volumes of patients were measured in the preoperative period and 8th week of the postoperative period as urodynamic evaluation (with office cystometry and Q tip test). Statistical analysis was performed using Kruskal–Wallis Mann–Whitney U test by using SPSS 22.0 statistical program. Results: No statistical significance (P > 0.05) was found between age, parity, menopause, and obesity in our patients who underwent TAH and laparoscopic hysterectomy with high postvoid residual values in the postoperative period. Conclusion: In this study, no statistical significance was found between the hysterectomy techniques on urinary tract dysfunction. It can be said that laparoscopy should be more preferable in correctly selected patients for minimal dysfunctional complications.
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Affiliation(s)
- Gökmen Sukgen
- Private Practice Clinics, Sukgen Gynecology and Obstetrics Clinic, Adana, Turkey
| | - Ünal Türkay
- Department of Gynecology and Obstetrics, Derince Training and Research Hospital, University of Health Sciences, Derince, Kocaeli, Turkey
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Wasinghon P, Huang KG, Lai SY. Total Laparoscopic Hysterectomy of an Endocervical Pyomyoma Over Previous Cesarean Section Wound. Gynecol Minim Invasive Ther 2020; 9:101-103. [PMID: 32676290 PMCID: PMC7354753 DOI: 10.4103/gmit.gmit_103_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 09/20/2019] [Accepted: 03/18/2020] [Indexed: 11/06/2022] Open
Abstract
A 41-year-old female, G2P2, who experienced menorrhagia for 1 month, had had a history of myoma uteri for the previous 5 years. The computed tomography showed a leiomyoma mass of approximately 8 cm. She underwent a total laparoscopic hysterectomy with bilateral salpingectomy. This pyomyoma originated in the endocervix over the cesarean section wound. The postoperative care was uneventful. Pyomyoma is a rare condition and is even rarer in premenopausal patients without a history of pregnancy or uterine instrumentation. The spontaneous pyomyoma at the endocervical leiomyoma demonstrated an unusual case in the absence of risk factors. Pyomyoma could be considered as a diagnosis in patients without fever, history of fibroids, and no other identifiable sources of infection.
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Affiliation(s)
- Phornsawan Wasinghon
- Department of Obstetrics and Gynecology, Buddhachinnaraj Hospital, Phitsanulok, Thailand.,Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuan-Gen Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Siew-Yen Lai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung, Taiwan
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An analysis of 635 consequetive laparoscopic hysterectomy patients in a tertiary referral hospital. J Gynecol Obstet Hum Reprod 2020; 49:101645. [DOI: 10.1016/j.jogoh.2019.101645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 08/16/2019] [Accepted: 10/03/2019] [Indexed: 11/17/2022]
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