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BMC Women's Health Jun 2019There are various surgical approaches of hysterectomy for benign indications. This study aimed to compare vaginal hysterectomy (VH) and laparoscopic hysterectomy (LH)... (Meta-Analysis)
Meta-Analysis
BACKGROUND
There are various surgical approaches of hysterectomy for benign indications. This study aimed to compare vaginal hysterectomy (VH) and laparoscopic hysterectomy (LH) with respect to their complications and operative outcomes.
METHODS
We selected randomised controlled trials that compared VH with LH for benign gynaecological indications. We included studies published after January 2000 in the following databases: Medline, EMBASE, and CENTRAL (The Cochrane Library). The primary outcome was comparison of the complication rate. The secondary outcomes were comparisons of operating time, blood loss, intraoperative conversion, postoperative pain, length of hospital stay and duration of recuperation. We used Review Manager 5.3 software to perform the meta-analysis.
RESULTS
Eighteen studies of 1618 patients met the inclusion criteria. The meta-analysis showed no differences in overall complications, intraoperative conversion, postoperative pain on the day of surgery and at 48 h, length of hospital stay and recuperation time between VH and LH. VH was associated with a shorter operating time and lower postoperative pain at 24 h than LH.
CONCLUSIONS
When both surgical approaches are feasible, VH should remain the surgery of choice for benign hysterectomy.
Topics: Female; Gynecology; Humans; Hysterectomy; Hysterectomy, Vaginal; Laparoscopy; Length of Stay; Operative Time; Pain, Postoperative; Postoperative Complications
PubMed: 31234852
DOI: 10.1186/s12905-019-0784-4 -
Hospital Medicine (London, England :... Jan 2001Vaginal hysterectomy represents the ultimate minimal access hysterectomy. The indications for the procedure extend well beyond those of prolapse. Good training and... (Review)
Review
Vaginal hysterectomy represents the ultimate minimal access hysterectomy. The indications for the procedure extend well beyond those of prolapse. Good training and advances in surgical technique allow the removal of enlarged fibroid uteri as well as vaginal oophorectomy. This article also considers the complications which may follow.
Topics: Female; Humans; Hysterectomy, Vaginal; Ovariectomy; Postoperative Complications; Uterine Cervical Neoplasms; Uterine Prolapse; Uterine Cervical Dysplasia
PubMed: 11211459
DOI: 10.12968/hosp.2001.62.1.1502 -
Bailliere's Clinical Obstetrics and... Mar 1997Hysterectomy is the most common non-pregnancy-related surgical procedure performed in the USA. The ratio of abdominal operations to vaginal operations is 3:1, which... (Review)
Review
Hysterectomy is the most common non-pregnancy-related surgical procedure performed in the USA. The ratio of abdominal operations to vaginal operations is 3:1, which probably reflects surgeon's experience and practice styles, the absence of clear guidelines for selecting a surgical route, lack of patient knowledge about the options, and inappropriate decision-making. With the trend toward evidence-based and outcome-based practice, the indications and contraindications for abdominal, vaginal, and laparoscopically-assisted hysterectomy must be examined critically. In the author's extensive experience the rates of abdominal, vaginal, and laparoscopically-assisted procedures are 1.9, 88.7, and 9.4%, respectively. Techniques useful in vaginal hysterectomy with or without simultaneous oophorectomy, the pros and cons of simultaneous incidental appendectomy, and methods of protecting the ureter are discussed.
Topics: Appendectomy; Contraindications; Female; Humans; Hysterectomy, Vaginal; Ovariectomy; Practice Guidelines as Topic; Ureter
PubMed: 9155938
DOI: 10.1016/s0950-3552(97)80052-1 -
European Journal of Obstetrics,... Sep 2017Laparoscopic and vaginal hysterectomies are common gynaecological procedures. Same-day discharge is usual care in various gynaecological procedures like laparoscopic... (Review)
Review
OBJECTIVES
Laparoscopic and vaginal hysterectomies are common gynaecological procedures. Same-day discharge is usual care in various gynaecological procedures like laparoscopic sterilisation and laparoscopic oophorectomies. In major procedures like vaginal or laparoscopic hysterectomy patients are usually admitted overnight. We systematically reviewed the literature to identify complications, risk factors for (re)admittance, financial consequences and patient satisfaction of same-day discharge after a vaginal or laparoscopic hysterectomy.
METHODS
We systematically searched PubMed, UptoDate, Embase, Cochrane and CINAHL database from inception until July 16th 2016. We selected randomized controlled trials, prospective and retrospective cohort studies assessing the safety and feasibility of same-day discharge after vaginal or laparoscopic hysterectomy. The outcome parameters that were assessed were admission rate, re-admission rate, minor and major complications, patient satisfaction and financial consequences.
RESULTS
27 articles were included in the systematic review. All studies provided data about the admission rate and therefore failure of same-day discharge. Eleven prospective studies were included which compromised a total of 2391 hysterectomies. The percentage of overnight admissions was median 9.3% [0-25%]. Eight retrospective studies, which screened their patients before undergoing an outpatient hysterectomy, showed in 1500 subjects a mean admission rate of 10% [4,4-64%]. Four retrospective studies, which considered a large total cohort of 142,799 hysterectomies had a mean admission rate of 59,7% [48-79%]. The overall re-admission rate was low, varying from 0.73-4.0%. Minor complications were reported in respectively 4,3% and 7,3% in prospective respectively retrospective trials. Major complications were described in 0.7%-3.6% of all cases. Generally high satisfaction rates were reported in the observational trials.
CONCLUSIONS
Same-day discharge after laparoscopic and vaginal hysterectomy seems feasible in a pre-selected, healthy population. It is associated with a low (re)admission rate, low complication rate and a reduction in hospital costs. Patient satisfaction seems generally high.
Topics: Ambulatory Surgical Procedures; Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Laparoscopy; Outpatients; Patient Readmission; Postoperative Complications; Treatment Outcome
PubMed: 28810192
DOI: 10.1016/j.ejogrb.2017.07.015 -
Minerva Ginecologica Feb 2014Hysterectomy is one of the most commonly performed procedures in the United States. It is a unique procedure with multiple routes of access and multiple operative... (Review)
Review
Hysterectomy is one of the most commonly performed procedures in the United States. It is a unique procedure with multiple routes of access and multiple operative techniques. While focus has shifted towards minimally invasive techniques, the vaginal hysterectomy should be ranked first in this category, as it represents an original natural orifice surgery. Vaginal hysterectomy offers the least invasive approach to hysterectomy, with the lowest associated risks and costs. Despite these benefits, vaginal hysterectomy has experienced a decline in the last two decades. This decline is likely due to both the prevalence of fibroid uterus as a major indication for hysterectomy, and the decline of vaginal surgical skills among gynecologic surgeon due to more recent focus on laparoscopic proficiency. While vaginal hysterectomy is not risk-free, and is not the best option for all diagnoses, it should be given first-line consideration when planning to perform a benign hysterectomy. The purpose of this review is to understand the origins and evolution of the vaginal hysterectomy, the evidence-based benefits of this route of surgery, and best practice methods to ensure that patients receive safe and effective surgical treatment.
Topics: Clinical Competence; Evidence-Based Medicine; Female; Humans; Hysterectomy, Vaginal; Laparoscopy; Leiomyoma; Minimally Invasive Surgical Procedures; Uterine Neoplasms
PubMed: 24569402
DOI: No ID Found -
Missouri Medicine 2015
Review
Topics: Female; History, 20th Century; History, 21st Century; Humans; Hysterectomy, Vaginal
PubMed: 26821444
DOI: No ID Found -
European Journal of Obstetrics,... Dec 2018This project was established by the International Society for Gynecologic Endoscopy (ISGE) to provide evidence-based recommendations on the selection of women in whom... (Review)
Review
OBJECTIVE
This project was established by the International Society for Gynecologic Endoscopy (ISGE) to provide evidence-based recommendations on the selection of women in whom vaginal hysterectomy can be safely performed.
STUDY DESIGN
The ISGE Task Force for vaginal hysterectomy for non-prolapsed uterus defined key clinical questions that led the literature search and formulation of recommendations. The search included Medline/PubMed and Cochrane Database. English language articles were reviewed from January 2003 to January 2018, in conjunction with reviews published by the American College of Obstetricians and Gynecologists (ACOG) and the American Association of Gynecologic Laparoscopists (AAGL). The bibliographies of selected works were also checked to acquire additional data where relevant. The available information was graded by the level of evidence using the approach developed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Working Group. For each clinical question, the ISGE recommendations were defined in accordance with the evidence quality.
RESULTS
Six recommendations on patient selection for vaginal hysterectomy, including two grade 1B and four grade 2B recommendations were established.
CONCLUSION
Vaginal hysterectomy for non-prolapsed uterus is the treatment of choice for many gynaecological patients in whom hysterectomy is indicated. It may be safely executed, and thus, should be offered to a large group of appropriately selected women, who today are operated in the main by the abdominal or laparoscopic approach. All efforts should be directed towards teaching the technique of vaginal hysterectomy during residency.
Topics: Evidence-Based Medicine; Female; Humans; Hysterectomy, Vaginal; Patient Selection; Uterus
PubMed: 30447552
DOI: 10.1016/j.ejogrb.2018.10.058 -
Obstetrics and Gynecology Dec 2023To compare surgical efficacy outcomes and complications after laparoscopic hysterectomy and vaginal hysterectomy performed for benign gynecologic conditions. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To compare surgical efficacy outcomes and complications after laparoscopic hysterectomy and vaginal hysterectomy performed for benign gynecologic conditions.
DATA SOURCES
We performed an online search in major databases, including PubMed, Scopus, Web of Science, ClinicalTrials.gov , and the Cochrane Library from 2000 until February 28, 2023.
METHODS OF STUDY SELECTION
We searched for randomized controlled trials (RCTs) that compared vaginal hysterectomy with laparoscopic hysterectomy in benign gynecologic conditions. We located 3,249 articles. After reviewing titles and abstracts, we identified 32 articles that were eligible for full-text screening. We excluded nine articles as not-RCT or not comparing vaginal hysterectomy with laparoscopic hysterectomy. Twenty-three articles were included in the final systematic review, with 22 articles included in the meta-analysis.
TABULATION, INTEGRATION, AND RESULTS
Twenty-three eligible RCTs included a total population of 2,408, with 1,105 in the vaginal hysterectomy group and 1,303 in the laparoscopic hysterectomy group. Blood loss and postoperative urinary tract infection rates were lower in the vaginal hysterectomy group than in the laparoscopic hysterectomy group (mean difference -68, 95% CI -104.29 to -31.7, P <.01, I2 =95% and odds ratio 1.73, 95% CI 0.92-3.26, P =.03, I2 =0%, respectively). Vaginal hysterectomy was associated with less total operative time, less recovery time, and greater postoperative pain on the day of surgery. Other complications, including conversion to laparotomy, visceral organ damage, or wound dehiscence, were uncommon. Because of insufficient data, we were not able to stratify by surgical indication.
CONCLUSION
Vaginal hysterectomy had a shorter total operative time and recovery time but greater postoperative pain on day of surgery compared with laparoscopic hysterectomy.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, CRD42023338538.
Topics: Humans; Female; Hysterectomy, Vaginal; Laparoscopy; Hysterectomy; Postoperative Complications; Pain, Postoperative; Genital Diseases, Female
PubMed: 37944141
DOI: 10.1097/AOG.0000000000005434 -
Journal of Obstetrics and Gynaecology :... Jan 2022Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) is a minimally invasive, scar-free technique that uses a vaginal colpotomy to access the peritoneal...
Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) is a minimally invasive, scar-free technique that uses a vaginal colpotomy to access the peritoneal cavity. Hysterectomy via vNOTES has shown to be technically feasible and safe, with shorter hospital stay and lower postoperative pain scores. Moreover, vNOTES adds the advantages of endoscopy to those of vaginal surgery and thereby broadens the indications of a conventional vaginal hysterectomy. Virginity has been contraindicated for vNOTES so far, as vaginal accessibility can be severely reduced in virgin women. Therefore, cases of vNOTES hysterectomy in virgin patients have never been reported in the literature. The objective of this study is to assess the technical feasibility and safety of hysterectomy in virgin women. We performed a retrospective analysis of patient files of all vNOTES hysterectomies performed on virgin women in our centre (Imelda Hospital, Bonheiden, Belgium) from July 2016 until June 2020 ( = 9). Despite limited vaginal accessibility, vNOTES hysterectomy was successfully performed in all nine patients, without conversion to laparoscopy or laparotomy and without clinically relevant complications. In this first IDEAL stage 1 study, vaginal NOTES hysterectomy appears to be technically feasible and safe in virgin women.Impact statement Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) is an emerging, minimally invasive technique that offers a safe alternative to laparoscopy and open surgery. Besides better cosmetics (scar-free technique), advantages of vNOTES hysterectomy include shorter hospital stay and less postoperative pain compared to laparoscopic hysterectomy. Moreover, vNOTES adds the benefits of endoscopy (visualisation of anatomy) to conventional vaginal hysterectomy. Virginity has been contraindicated for vNOTES so far, because the absence of uterine descent and narrow vagina in virgins is thought to complicate the vaginal approach. Therefore, vNOTES hysterectomy has never been reported in virgin patients. In this study, we are the first to report the feasibility of performing a vNOTES hysterectomy in virgin patients. The results show that, in experienced hands, indications for vNOTES can be broadened and include virgin women. This first report of vNOTES hysterectomy in virgin patients is only a small but important step in the evaluation of safety and efficacy of this emerging technique. Further research is needed to assess reproducibility of the findings and to carefully determine indications and contraindications of vNOTES.
Topics: Adult; Belgium; Feasibility Studies; Female; Humans; Hysterectomy, Vaginal; Laparoscopy; Middle Aged; Natural Orifice Endoscopic Surgery; Retrospective Studies; Sexual Abstinence; Treatment Outcome; Vagina
PubMed: 33892619
DOI: 10.1080/01443615.2020.1867972 -
International Journal of Environmental... Sep 2022For many years, vaginal and abdominal hysterectomies were part of the routine procedures in many departments. Both of them lost their priority due to the introduction of...
For many years, vaginal and abdominal hysterectomies were part of the routine procedures in many departments. Both of them lost their priority due to the introduction of endoscopy and robotic surgery. The disappearing abdominal hysterectomy is certainly reasonable, but the decline of using vaginal hysterectomy seems not to be justified, and it is an optimal example of the recent emergence of the Natural Orifice Surgery discipline. A modified method for vaginal hysterectomy is presented in order to encourage gynecologists to reconsider vaginal hysterectomy as a valid method. This method is the outcome of critical analyses of different vaginal hysterectomy methods. It is simple, reasonable, only ten steps, easy to learn, perform and teach, and proven to be a shorter operation with minimal blood loss and reduced need for analgesics when compared to the traditional way. Endoscopy or robotic surgery is not available everywhere. Therefore, it is important that gynecologists in low-resource settings be familiar with this simple method.
Topics: Female; Gynecology; Humans; Hysterectomy; Hysterectomy, Vaginal; Retrospective Studies; Robotic Surgical Procedures; Vagina
PubMed: 36141653
DOI: 10.3390/ijerph191811381