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Journal of Patient-centered Research... 2019Previous reports indicate many women may not have a firm grasp on likely outcomes of different hysterectomy procedures. This study aimed to assess women's self-reported...
PURPOSE
Previous reports indicate many women may not have a firm grasp on likely outcomes of different hysterectomy procedures. This study aimed to assess women's self-reported expectations of how they think their anatomy will change after hysterectomy.
METHODS
Women scheduled for hysterectomy at a tertiary care hospital, for non-oncological reasons, reported their planned procedure type and the organs they understood would be removed 2 weeks prior to surgery. Patient reports and electronic medical records were reviewed, and kappa statistics (κ) were calculated to assess agreement for all women and within subgroups.
RESULTS
Most of the 456 study participants (mean age: 48.02 ± 8.29 years) were either white/Caucasian (n=238, 52.2%) or African American (n=196, 43.0%). Among the 145 participants who reported a partial hysterectomy, 130 (89.7%) women indicated that their uterus would be removed and 52 (35.9%) reported that their cervix would be removed. Of those whose response was total hysterectomy (n=228), 208 (91.2%) participants reported their uterus would be removed and 143 (62.7%) reported their cervix would be removed. Among 144 women reporting a planned partial hysterectomy, only 15 (10.4%, κ=0.05) had a partial hysterectomy recorded in the electronic medical record. Among the 228 women who reported a planned total hysterectomy, 6.1% (κ=0.05) had a different procedure. While 125 participants reported planned ovary removal, only 93 (74.4%, κ=0.55) had an oophorectomy. Similarly, 290 participants reported planned fallopian tube removal, with 276 (95.2%, κ=0.06) having a salpingectomy.
CONCLUSIONS
A considerable proportion of women undergoing hysterectomy do not accurately report the organs that are planned be removed during their hysterectomy. This work demonstrates the need to improve patient understanding of their clinical care and its implications.
PubMed: 31414021
DOI: 10.17294/2330-0698.1658 -
Best Practice & Research. Clinical... Apr 2021The incidence of abnormally invasive placenta (AIP) or currently called placenta accreta spectrum (PAS) disorders has increased worldwide over the last few decades.... (Review)
Review
The incidence of abnormally invasive placenta (AIP) or currently called placenta accreta spectrum (PAS) disorders has increased worldwide over the last few decades. Although the exact physiopathology is not yet well established, there is consensus that an increase in the Caesarean section rates, uterine surgery and the advanced maternal age are important contributory factors. Traditionally, the treatment for PAS has been a peripartum hysterectomy. Conservative measures have been reported in the literature include an intentional retention of the placenta (IRP) or partial myometrial excision. We present an alternative conservative approach, the Triple P procedure. It involves three main steps: perioperative localization of the upper placental edge, pelvic devascularization and the placental non-separation with myometrial excision followed by the repair of the myometrial defect. The aim of this approach is to reduce the intra- and post-operative complications associated with a peripartum hysterectomy, to reduce the time of surgery and to minimize common complications of placental retention, such as infection, sepsis secondary postpartum haemorrhage and coagulopathy.
Topics: Cesarean Section; Female; Humans; Hysterectomy; Placenta Accreta; Placenta Previa; Postpartum Hemorrhage; Pregnancy
PubMed: 32771462
DOI: 10.1016/j.bpobgyn.2020.07.009 -
Journal of Obstetrics and Gynaecology... Feb 2016An institution wide strategic plan was established to improve minimally invasive surgery (MIS) across all surgical divisions at The Ottawa Hospital (TOH). The primary...
OBJECTIVE
An institution wide strategic plan was established to improve minimally invasive surgery (MIS) across all surgical divisions at The Ottawa Hospital (TOH). The primary objective of this study is to determine the change in MIS hysterectomy rate between 2005 and 2012 at this centre. Secondary objectives include determining the impact on overall length of stay (LOS) in hospital, complications, return to hospital, operating room time, and cost.
METHODS
We performed a retrospective analysis of all hysterectomies for benign disease performed at TOH between 2005 and 2012. Cases were excluded if they were related to pregnancy or classified as "partial hysterectomy." The outcomes and cost of the approaches were compared.
RESULTS
A total of 4337 hysterectomy cases were reviewed. The MIS hysterectomy rate increased from 40.1% in 2005 to 74.2% in 2012. There was a decrease in mean LOS from 2.5 to 1.6 days. This translated to a saving of 1898 inpatient bed days. Compared with laparotomy, laparoscopic hysterectomy was associated with a reduced risk of transfusion and a reduced risk of ileus, and vaginal hysterectomy was associated with an increased risk of postoperative abscess. There was no difference in rates of returning to hospital or other complications between women undergoing abdominal hysterectomy and women undergoing MIS hysterectomy (which included both laparoscopic and vaginal approaches). The mean (SD) cost per approach was $7241 ($1985), $4532 ($1718), and $5637 ($1579) for abdominal hysterectomy, vaginal hysterectomy, and laparoscopic hysterectomy, respectively.
CONCLUSION
The initiatives implemented at TOH in 2007 resulted in a significant increase in the MIS hysterectomy rate, a decrease in mean LOS, and substantial theoretical cost savings for the hospital.
Topics: Female; Humans; Hysterectomy; Laparotomy; Length of Stay; Minimally Invasive Surgical Procedures; Ontario; Postoperative Complications; Retrospective Studies
PubMed: 27032738
DOI: 10.1016/j.jogc.2015.12.004 -
Gynecology and Minimally Invasive... 2022To safely perform minimally invasive hysterectomy (MIH), including laparoscopic hysterectomy and robot-assisted hysterectomy, partial ureterolysis, or visualizing only...
To safely perform minimally invasive hysterectomy (MIH), including laparoscopic hysterectomy and robot-assisted hysterectomy, partial ureterolysis, or visualizing only the ureter without dissection is often inadequate. Moreover, careless blunt dissection could injure the blood vessels. We present our surgical method for ureterolysis using sharp dissection during MIH. First, the outer portion of the ureter is dissected. Dissecting between the pelvic sidewall and the posterior leaf of the broad ligament creates a pararectal space outside the ureter, enabling the easy identification of the ureter running on the posterior leaf. Second, the inner portion of the ureter is dissected. After determining the location of the ureter, a better partial dissection of the ureter can be performed from the posterior leaf, instead of dissecting along the entire circumference. If fine surgery has to be performed, the ureter can be dissected by enclosing it within its sheath. We primarily perform dissections using a monopolar device, which allows a sharp dissection. Furthermore, in our method, we often include the dissection of the ureteral tunnel. It is important to understand the anatomy and membrane structure of the ureter in each patient and adjust the extent of ureterolysis based on individual differences.
PubMed: 36158285
DOI: 10.4103/gmit.gmit_129_21 -
Blood Coagulation & Fibrinolysis : An... Jun 2016The main objective of the study is to compare the impacts of laparoscopic hysterectomy and total abdominal hysterectomy on the functions of coagulation and fibrinolysis...
The main objective of the study is to compare the impacts of laparoscopic hysterectomy and total abdominal hysterectomy on the functions of coagulation and fibrinolysis system. Seventy-five patients who had undergone hysterectomy were randomly divided into laparoscopic hysterectomy group (n = 38) and total abdominal hysterectomy group (n = 37). The prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen, D-dimer, von Willebrand factor, α-granule membrane protein-140, thrombin-activated fibrinolysis inhibitor (TAFI) and platelet count were detected at preoperative 24 h (N0), postoperative 24 h (N1) and postoperative 48 h (N2). Compared with N0, values of PT, APTT and TT were significantly decreased at N1 in both groups, whereas von Willebrand factor, platelet count and α-granule membrane protein-140 levels at N1 were significantly increased (P < 0.05). There was no significant difference between N0 and N2 (P > 0.05). Compared with N0, fibrinogen, D-dimer and TAFI levels in both groups were significantly higher at N1 (P < 0.05), and there was no significant difference between N0 and N2 (P > 0.05). The intergroup comparison showed no significant difference of above indexes between two groups (P > 0.05). The univariate analysis showed that TAFI was negatively correlated with TT (r = -0.365, P < 0.01), APTT (r = -0.183, P < 0.05) and PT (r = -0.121, P < 0.05), whereas not correlated with other indicators. Laparoscopic hysterectomy may increase the risk of postoperative venous thrombosis.
Topics: Adult; Blood Coagulation; Carboxypeptidase B2; Female; Fibrin Fibrinogen Degradation Products; Fibrinogen; Humans; Hysterectomy; Laparoscopy; Middle Aged; P-Selectin; Partial Thromboplastin Time; Platelet Count; Postoperative Complications; Prothrombin Time; Retrospective Studies; Risk; Thrombin Time; Venous Thrombosis; von Willebrand Factor
PubMed: 26761585
DOI: 10.1097/MBC.0000000000000447 -
The British Journal of Surgery Jul 2022Robotic surgery was integrated into some healthcare systems despite there being few well designed, real-world studies on safety or benefit. This study compared the...
BACKGROUND
Robotic surgery was integrated into some healthcare systems despite there being few well designed, real-world studies on safety or benefit. This study compared the safety of robotic with laparoscopic, thoracoscopic, and open approaches in common robotic procedures.
METHODS
This was a population-based, retrospective study of all adults who underwent prostatectomy, hysterectomy, pulmonary lobectomy, or partial nephrectomy in Ontario, Canada, between 2008 and 2018. The primary outcome was 90-day total adverse events using propensity score overlap weights, and secondary outcomes were minor or major morbidity/adverse events.
RESULTS
Data on 24 741 prostatectomy, 75 473 hysterectomy, 18 252 pulmonary lobectomy, and 6608 partial nephrectomy operations were included. Relative risks for total adverse events in robotic compared with open surgery were 0.80 (95 per cent c.i. 0.74 to 0.87) for radical prostatectomy, 0.44 (0.37 to 0.52) for hysterectomy, 0.53 (0.44 to 0.65) for pulmonary lobectomy, and 0.72 (0.54 to 0.97) for partial nephrectomy. Relative risks for total adverse events in robotic surgery compared with a laparoscopic/thoracoscopic approach were 0.94 (0.77 to 1.15), 1.00 (0.82 to 1.23), 1.01 (0.84 to 1.21), and 1.23 (0.82 to 1.84) respectively.
CONCLUSION
The robotic approach is associated with fewer adverse events than an open approach but similar to a laparoscopic/thoracoscopic approach. The benefit of the robotic approach is related to the minimally-invasive approach rather than the platform itself.
Topics: Adult; Female; Humans; Laparoscopy; Male; Nephrectomy; Ontario; Retrospective Studies; Robotic Surgical Procedures
PubMed: 35612961
DOI: 10.1093/bjs/znac119 -
Reviews on Recent Clinical Trials 2015Gestational trophoblastic disease is a spectrum of neoplastic abnormalities arising from fetal trophoblastic tissue. The range of the diseases in this group varies from... (Review)
Review
INTRODUCTION
Gestational trophoblastic disease is a spectrum of neoplastic abnormalities arising from fetal trophoblastic tissue. The range of the diseases in this group varies from relatively benign Hydatidifom mole (complete and partial mole) to highly malignant choriocarcinoma.
METHODS
We have reviewed the available literature and discussed the management and follow up based on the current understanding of the natural history, extent and the prognosis of the disease. Key observations: Depending on the underlying pathology the disease can subside, progress or even metastasize and lead to death, if left untreated. The treatment of the disease is relatively simple and the disease is highly curable by single or multi agent chemotherapy. Appropriate and timely treatment not only saves the women from morbidity and death but also can help preserve their fertility.
CONCLUSIONS
Management of Gestational disease should ideally be done in a specialized multi-disciplinary environment and the outcome of treatment in majority of the cases is very satisfactory.
Topics: Adult; Chemotherapy, Adjuvant; Combined Modality Therapy; Female; Gestational Trophoblastic Disease; Humans; Hydatidiform Mole; Hysterectomy; Neoplasm Invasiveness; Neoplasm Staging; Pregnancy; Prognosis; Radiotherapy, Adjuvant; Randomized Controlled Trials as Topic; Survival Analysis; Uterine Neoplasms
PubMed: 26411957
DOI: 10.2174/1574887110666150923111731 -
Veterinary Medicine, Small Animal... Nov 1972
Topics: Animals; Dogs; Female; Hysterectomy; Sterilization, Reproductive
PubMed: 4484973
DOI: No ID Found -
Journal of Pediatric and Adolescent... Jun 2016The objective of this study was to report 2 cases of the combined congenital anomalies of complete vaginal atresia and partial cervical agenesis, and highlight the...
BACKGROUND
The objective of this study was to report 2 cases of the combined congenital anomalies of complete vaginal atresia and partial cervical agenesis, and highlight the limitations of magnetic resonance imaging for definitive initial diagnosis, and consequently the importance of early definitive management, to avoid life-threatening sepsis. Herein we provide a retrospective case audit of two patients with congenital abnormalities between 2005 and 2013 who were treated in a quaternary statewide pediatric and adolescent gynecology center.
CASES
Two patients with the combined congenital anomalies of complete vaginal agenesis and partial cervical agenesis highlight the difficulties encountered with the limitations of magnetic resonance imaging in accuracy of diagnosis, as well as development of life-threatening sepsis that requires hysterectomy. Both patients were initially imaged as having distended endometrial cavities and cervical canals with what was thought to be an obstructive upper vaginal septum and absent lower vagina. Both required initial neovagina creation, however the cervices were never clinically or surgically visualized.
SUMMARY AND CONCLUSION
Partial cervical agenesis is a relatively rare form of Müllerian abnormality which, if not diagnosed and definitively treated early, can have significant morbidity and mortality. Although magnetic resonance imaging is the diagnostic imaging gold standard for Müllerian abnormalities, it is important to recognize the limitations of this modality, the potential sequelae of these limitations, and to appreciate the importance of early accurate diagnosis and treatment of this condition. Importantly, if the imaging diagnosis does not completely correlate with the clinical and surgical findings, then a high suspicion of complete or partial cervical agenesis is prudent, because the consequences of nondefinitive early treatment can be life-threatening and potentially fatal.
Topics: Abdominal Pain; Adolescent; Cervix Uteri; Female; Humans; Hysterectomy; Magnetic Resonance Imaging; Retrospective Studies; Vagina; Vaginal Diseases
PubMed: 26620386
DOI: 10.1016/j.jpag.2015.11.004 -
Critical Reviews in Oncology/hematology Dec 2003Functional disorders of the lower urinary tract are the most common long-term complications following radical surgery for cancer of the uterine cervix (8-80%). These... (Review)
Review
Functional disorders of the lower urinary tract are the most common long-term complications following radical surgery for cancer of the uterine cervix (8-80%). These disturbances were associated to the partial interruption of the autonomic fibers innervating the bladder during the resection of anterior, lateral and posterior parametrium and vaginal cuff. The pathophysiology of these changes is actually debated. The nature of the surgical damage appears to be a decentralization rather than a complete denervation and bladder dysfunctions may be either the unmasking of intrinsic detrusor activity, characterized by a loss of beta-adrenergic innervation and a consequent alfa-adrenergic hyperinnervation or the influence of remaining sympathetic innervation. No data on long-term bladder function in patients who underwent class 4 radical hysterectomy have been reported. In our experience on long-term vesical function in 38 patients with locally advanced cervical cancer treated with neoadjuvant chemotherapy and 4 Piver type radical hysterectomy, urinary symptoms were reported in 11 patients (29%), while a normal urodynamic finding was recorded in only nine patients (24%). The most common bladder dysfunction was the storage dysfunction (47%). The voiding dysfunction was present in one patient (3%) and stress urinary incontinence in 20 patients (53%). The parametrial and vaginal resections were compared among the urodynamic diagnosis The size of lateral parametria measured on the giant sections did not differ among the groups of urodynamic diagnosis, while the length of vagina removed was significantly longer in patients with detrusor dysfunctions (storage and voiding dysfunctions) than in patients with normal diagnosis or genuine stress incontinence.
Topics: Autonomic Pathways; Female; Humans; Hysterectomy; Urinary Bladder; Urination Disorders; Uterine Cervical Neoplasms
PubMed: 14693341
DOI: 10.1016/s1040-8428(03)00125-2