-
Cureus Mar 2024This study aims to evaluate the five-year experience of a single center regarding the total colpocleisis procedure.
OBJECTIVE
This study aims to evaluate the five-year experience of a single center regarding the total colpocleisis procedure.
METHODS
This is a retrospective review of 24 women who underwent total colpocleisis at the study center between January 2017 and January 2023. Every participant was informed about this study, and written consent was obtained from each participant who then took Pelvic Floor Distress Inventory-20 (PFDI-20), Body Appreciation Scale-2 (BAS-2) and Decision Regret Scale (DRS) questionnaires consecutively.
RESULTS
Eight patients (33.3%) underwent total colpocleisis, whereas 16 patients (66.7%) had concomitant colpocleisis and vaginal hysterectomy. The number of total colpocleisis cases did not change significantly with respect to the past years (p=0.117). The patients who underwent total colpocleisis and the patients who had concurrent colpocleisis and hysterectomy were statistically similar with respect to age, gravidity, chronic disease, blood group, American Society of Anesthesiologists classification, anesthesia type, surgery timing and preoperative and postoperative hemoglobin values (p>0.05 for all). Operative time was significantly shorter in patients who had colpocleisis alone (p=0.001). Both patient groups were also statistically similar in aspects of blood loss, transfusion need, hospital stay, postoperative complications and follow-up time as well as PFDI-20, BAS-2 and DRS scores (p>0.05 for all). Endometrial atrophy (56.3%), endometrial hyperplasia (18.8%) and adenomyosis (12.5%) were the most common histopathological findings detected in vaginal hysterectomy specimens.
CONCLUSION
The combination of vaginal hysterectomy and total colpocleisis appears as a safe and efficient approach which does not contribute to the surgery-related morbidity despite the significantly longer operative time.
PubMed: 38646315
DOI: 10.7759/cureus.56574 -
The Pan African Medical Journal 2024pelvic organ prolapse is a dynamic pathology that can worsen or regress especially postpartum and is the basis of several disorders that bother the patient and alter her...
INTRODUCTION
pelvic organ prolapse is a dynamic pathology that can worsen or regress especially postpartum and is the basis of several disorders that bother the patient and alter her quality of life. This study aims to determine the epidemiological, clinical, and therapeutic profile of pelvic organ prolapse in the town of Kananga.
METHODS
this is a cross-sectional study of cases of pelvic organ prolapse recorded during the mass campaign organized in the Bon-Berger Hospital of Tshikaji and Saint Georges Hospital of Katoka in the town of Kananga, from January 1 to July 31, 2023. Non-probability convenience sampling was used to select cases.
RESULTS
we recorded 138 cases of prolapse out of 572 patients. The prevalence of pelvic organ prolapse is 24.12% with an average monthly incidence of 19.71 (SD: 4.23) cases per month. The prevalence of recurrence of pelvic organ prolapse is 8.69%. The average age of patients is 54.86 (SD: 11.36) years with an average parity of 7.62 (SD: 1.8) deliveries. Its preoperative symptomatology consists of the intravaginal mass associated with digestive and urinary disorders in 97.00% (n=130), stage III hysterocele predominates in 68.70% (n=92), surgical treatment is the most practiced in 91.79% (n=123) and hysterectomy associated with the treatment of cystocele and rectocele by vaginal surgical access is the most practiced in 80.60% (n=108).
CONCLUSION
pelvic organ prolapse is a real public health problem in the city of Kananga, its symptoms are classic and its treatment is surgical via the vaginal route.
Topics: Humans; Cross-Sectional Studies; Female; Democratic Republic of the Congo; Pelvic Organ Prolapse; Middle Aged; Adult; Prevalence; Aged; Incidence; Quality of Life; Recurrence; Young Adult
PubMed: 38646133
DOI: 10.11604/pamj.2024.47.52.42470 -
International Journal of Women's Health 2024Studies involving minimally invasive hysterectomy and robotic sacrocolpopexy have demonstrated safety and feasibility of same-day discharge. There are limited data,...
PURPOSE
Studies involving minimally invasive hysterectomy and robotic sacrocolpopexy have demonstrated safety and feasibility of same-day discharge. There are limited data, however, on same-day discharge outcomes for vaginal hysterectomy and pelvic reconstruction. This study aimed to compare 30 and 90-day surgical outcomes between same-day discharge versus overnight stay following vaginal hysterectomy and apical suspension.
PATIENTS AND METHODS
This retrospective study evaluated surgeries performed over two time periods. Overnight stay was standard between December 2018 and February 2020. Same-day discharge was standard from December 2020 to February 2022. All patients who underwent vaginal hysterectomy with apical suspension were included. The primary outcome was to determine if there was an increase in 30-day readmission rates. Secondary outcomes included emergency department visits and reoperations within 30 days, the previous variables at 90 days, and the rate for successful same-day discharge.
RESULTS
A total of 324 patients were analyzed over the 30 months: 149 (46%) in the overnight stay group and 175 (54%) in the same-day discharge group. At 30 days, no difference was found between groups for readmissions (2.7% vs 4.0%, p = 0.56), emergency department visits (14.8% vs 14.9%, p = 1.0), or reoperations (2.0% vs.1.7%, p = 1.0). At 90 days, outcomes were also similar. Same-day discharge as standard practice was successful in 80% of patients.
CONCLUSION
In this retrospective two cohort study, the safety of same-day discharge following vaginal hysterectomy with apical suspension was demonstrated with no increased risk of 30 or 90-day readmissions, emergency visits, or reoperation rates. The majority (80%) of patients were discharged on the day of surgery, suggesting feasibility of this model.
PubMed: 38645981
DOI: 10.2147/IJWH.S451435 -
Gynecologic Oncology Reports Jun 2024Cervical stump malignancies are an uncommon finding post subtotal hysterectomy. Tumors arise from a primary cervical origin with an incidence of 1-5%. Other described...
BACKGROUND
Cervical stump malignancies are an uncommon finding post subtotal hysterectomy. Tumors arise from a primary cervical origin with an incidence of 1-5%. Other described malignancies can include uterine origin, ovarian origin or as metastases from another primary site. A uterine primary is an extremely rare entity and can result from remnant endometrial tissue at the stump apex.
CASE
70yo female with a history of remote supracervical hysterectomy for benign indication who presented with postmenopausal spotting. Endocervical curettage of the endocervical stump revealed a grade 2 endometrioid endometrial adenocarcinoma. She was taken to the operating for a robotic radical stump trachelectomy and sentinel lymph node dissection.
CONCLUSIONS
The surgical video delineates key surgical steps of robotic radical stump trachelectomy including robotic port placement and injection of ICG dye, adhesiolysis and restoration of normal anatomy, opening of the pelvic spaces and exposure of the retroperitoneum, identification and excision of pelvic sentinel lymph nodes, bladder dissection, ureterolysis and ligation of uterine remnant, ureteric tunnel dissection and mobilization of parametrial wing, delineation of a vaginal margin, colpotomy and specimen removal, and vaginal cuff closure.
PubMed: 38633672
DOI: 10.1016/j.gore.2024.101384 -
Ginekologia Polska Apr 2024To assess the impact of preoperative anxiety on pain and analgesic consumption in patients undergoing vaginal hysterectomy (VH) with general and spinal anesthesia.
OBJECTIVES
To assess the impact of preoperative anxiety on pain and analgesic consumption in patients undergoing vaginal hysterectomy (VH) with general and spinal anesthesia.
MATERIAL AND METHODS
A total of 200 participants, including 100 undergoing vaginal hysterectomy with general anesthesia (group 1) and 100 with spinal anesthesia (group 2), were enrolled. A visual analog scale (VAS) was used for the postoperative pain intensity.
RESULTS
The 1st hour, 6th hour, 12th hour, and 18th hour VAS scores were higher in vaginal hysterectomy with general anesthesia than in vaginal hysterectomy with spinal anesthesia.
CONCLUSIONS
Although participants undergoing VH with spinal anesthesia (preoperative state anxiety inventory score > 45) had lower pain intensity scores in the first 18 hours compared to those undergoing VH with general anesthesia, their postoperative analgesic requirements were similar.
PubMed: 38632877
DOI: 10.5603/gpl.94702 -
Acta Obstetricia Et Gynecologica... Jul 2024Many women experience bleeding disorders that may have an anatomical or unexplained origin. Although hysterectomy is the most definitive and common treatment, it is...
INTRODUCTION
Many women experience bleeding disorders that may have an anatomical or unexplained origin. Although hysterectomy is the most definitive and common treatment, it is highly invasive and resource-intensive. Less invasive therapies are therefore advised before hysterectomy for women with fibroids or bleeding disorders. This study has two aims related to treating bleeding disorders and uterine fibroids in the Netherlands: (1) to evaluate the regional variations in prevalence and surgical approaches; and (2) to assess the associations between regional rates of hysterectomies and less invasive surgical techniques to analyze whether hysterectomy can be replaced in routine practice.
MATERIAL AND METHODS
We completed a register-based study of claims data for bleeding disorders and fibroids in women between 2016 and 2020 using data from Statistics Netherlands for case-mix adjustment. Crude and case-mix adjusted regional hysterectomy rates were examined overall and by surgical approach. Coefficients of variation were used to measure regional variation and regression analyses were used to evaluate the association between hysterectomy and less invasive procedure rates across regions.
RESULTS
Overall, 14 186 and 8821 hysterectomies were performed for bleeding disorders and fibroids, respectively. Laparoscopic approaches predominated (bleeding disorders 65%, fibroids 49%), followed by vaginal (bleeding disorders 24%, fibroids 5%) and abdominal (bleeding disorders 11%, fibroids 46%) approaches. Substantial regional differences were noted in both hysterectomy rates and the surgical approaches. For bleeding disorders, regional hysterectomy rates were positively associated with endometrial ablation rates (β = 0.11; P = 0.21) and therapeutic hysteroscopy rates (β = 0.14; P = 0.31). For fibroids, regional hysterectomy rates were positively associated with therapeutic hysteroscopy rates (β = 0.10; P = 0.34) and negatively associated with both embolization rates (β = -0.08; P = 0.08) and myomectomy rates (β = -0.03; P = 0.82).
CONCLUSIONS
Regional variation exists in the rates of hysterectomy and minimally invasive techniques. The absence of a significant substitution effect provides no clear evidence that minimally invasive techniques have replaced hysterectomy in clinical practice. However, although the result was not significant, embolization could be an exception based on its stronger negative association.
Topics: Humans; Female; Netherlands; Hysterectomy; Registries; Leiomyoma; Adult; Middle Aged; Practice Patterns, Physicians'; Uterine Neoplasms; Minimally Invasive Surgical Procedures; Laparoscopy; Uterine Hemorrhage
PubMed: 38629485
DOI: 10.1111/aogs.14844 -
Acta Obstetricia Et Gynecologica... Jul 2024The current standard treatment for endometrial cancer is a laparoscopic hysterectomy with adnexectomies and bilateral sentinel node resection. A retroperitoneal vNOTES...
INTRODUCTION
The current standard treatment for endometrial cancer is a laparoscopic hysterectomy with adnexectomies and bilateral sentinel node resection. A retroperitoneal vNOTES sentinel node resection has several theoretical potential advantages. These include being less invasive, leaving no visible scars, operating without Trendelenburg, and therefore offering the anesthetic advantage of easier ventilation in obese patients and following the natural lymph node trajectory from caudally to cranially and therefore a lower risk of missing the sentinel node. The aim of this study is to determine the feasibility of a retroperitoneal vNOTES approach to sentinel lymph node dissection for staging of endometrial cancer.
MATERIAL AND METHODS
A prospective multicenter case series was performed in four hospitals. A total of 64 women with early-stage endometrial carcinoma suitable for surgical staging with sentinel lymph node removal were operated via a transvaginal retroperitoneal vNOTES approach. The paravesical space was entered through a vaginal incision after injecting the cervix with indocyanine green. A vNOTES port was placed into this space and insufflation of the retroperitoneum was performed. Sentinel lymph nodes were identified bilaterally using near-infrared light followed by endoscopic removal of these nodes.
RESULTS
A total of 64 women with early-stage endometrial cancer underwent sentinel lymph node removal by retroperitoneal vNOTES technique. All patients also underwent subsequent vNOTES hysterectomy and bilateral salpingo-oophorectomy. The median age was 69.5 years, median total operative time was 126 min and the median estimated blood loss was 80 mL. In 97% of the cases bilateral sentinel nodes could be identified. A total of 60 patients had negative sentinel nodes, three had isolated tumor cells and one had macroscopically positive sentinel nodes. No complications with sequel occurred.
CONCLUSIONS
This prospective multicenter case series demonstrates the feasibility of the vNOTES approach for identifying and removing sentinel lymph nodes in women with endometrial carcinoma successfully and safely. vNOTES allows sole transvaginal access with exposure of the entire retroperitoneal space, following the natural lymph trajectory caudally to cranially, and without the need for a Trendelenburg position.
Topics: Female; Humans; Endometrial Neoplasms; Prospective Studies; Middle Aged; Neoplasm Staging; Retroperitoneal Space; Aged; Sentinel Lymph Node Biopsy; Lymph Node Excision; Laparoscopy; Feasibility Studies; Adult; Sentinel Lymph Node
PubMed: 38623778
DOI: 10.1111/aogs.14843 -
Cureus Mar 2024Uterine prolapse is a manifestation of pelvic organ prolapse distinguished by the descent of the uterus from its normal anatomical position into the vaginal canal....
Uterine prolapse is a manifestation of pelvic organ prolapse distinguished by the descent of the uterus from its normal anatomical position into the vaginal canal. Vaginal hysterectomy is a surgical intervention performed to excise the uterus via the vaginal canal. Hysterectomy is correlated with various complications; thus, prompt mobilization and engagement in physiotherapy are imperative postoperatively. This is a case report of a 78-year-old female who reported a persistent sensation of something protruding from her vagina over the past two years. Investigations revealed a third-degree uterocervical descent, leading to the decision for a vaginal hysterectomy. Commencing on Day 5 post-surgery, early mobilization and a comprehensive physiotherapeutic regimen were implemented, encompassing breathing exercises, upper limb mobility exercises, core strengthening routines, pelvic floor exercises, and postural correction. Evaluation using the Modified Oxford Pelvic Floor Muscle Contraction Scale, Pelvic Floor Impact Questionnaire (PFIQ), and World Health Organization Quality of Life (WHO-QOL) demonstrated notable improvement. The findings suggest that promoting early mobilization and facilitating the rehabilitation of pelvic musculature, along with core strengthening through physiotherapy, plays a pivotal role in expediting recovery and enhancing the overall quality of life for hysterectomy patients, potentially alleviating difficulties in performing daily activities.
PubMed: 38618382
DOI: 10.7759/cureus.56057 -
Quantitative Imaging in Medicine and... Apr 2024Hysterectomy places a considerable physical and mental burden on young female patients with congenital cervical and complete vaginal atresia. Thus, it is necessary to...
BACKGROUND
Hysterectomy places a considerable physical and mental burden on young female patients with congenital cervical and complete vaginal atresia. Thus, it is necessary to develop a method to detach the obstruction and simultaneously preserve the vagina and uterus in these patients. This study sought to evaluate the efficacy and safety of laparoscopic vaginoplasty using peritoneal flaps and cervicoplasty in patients with congenital cervical and complete vaginal atresia.
METHODS
Between April 2013 and June 2022, nine patients with congenital cervical and complete vaginal atresia at Henan Provincial People's Hospital were enrolled in this prospective study. All patients were treated with laparoscopic vaginoplasty using peritoneal flaps and cervicoplasty. Baseline clinical data (e.g., age and uterus size) were collected. The surgical success rate and adverse events were assessed.
RESULTS
The nine enrolled patients had a median age of 15.0 [interquartile range (IQR), 14.0-18.0] years, and five of these patients had pelvic adhesions. The surgeries were successful in all (9/9) patients, with the vagina, uterus, and a normal menstrual cycle being preserved. After a median follow-up duration of 48 months, the neovaginas had a median length of 7.5 cm. Postoperative complications occurred in three of patients and were cured with the appropriate treatment. The five married patients reported being satisfied with their sex life.
CONCLUSIONS
The study preliminarily demonstrated the efficacy of laparoscopic vaginoplasty using peritoneal flaps and cervicoplasty in patients with congenital cervical and complete vaginal atresia. However, due to the small sample size, lack of a control group, and relatively high incidence of adverse events, further studies are still needed to verify these results. Regardless, our findings establish an approach for preserving both the vagina and uterus for patients with congenital cervical and complete vaginal atresia.
PubMed: 38617156
DOI: 10.21037/qims-23-1226 -
BMJ Surgery, Interventions, & Health... 2024To evaluate if vaginal metronidazole for 5 days before hysterectomy decreases postoperative infections and patient issues.
OBJECTIVES
To evaluate if vaginal metronidazole for 5 days before hysterectomy decreases postoperative infections and patient issues.
DESIGN
This randomized trial compared vaginal metronidazole for 5 days before a scheduled hysterectomy to no intervention. Sample size calculation was based on a 20% difference in issues and infection (30% incidence and 10% in the intervention arm) with 80% power and an alpha error of 0.05 and indicated 62 subjects needed in each arm.
SETTING
Outpatient gynecology clinics at a single academic institution.
PARTICIPANTS
154 subjects were screened for eligibility between July 2020 and September 2022. 133 underwent hysterectomy including 68 subjects (51.1%) randomized to the metronidazole and 65 (48.9%) controls. Overall, the population was racially and ethnically diverse. There was no significant difference in characteristics between the two groups.
INTERVENTIONS
Vaginal metronidazole for 5 days before hysterectomy.
MAIN OUTCOME MEASURES
Postoperative patient issues and documented postoperative infections at 4-8 weeks after surgery.
RESULTS
There was no difference in the composite rate of patient-reported issues and/or documented postoperative infection (53/133 (39.8%) with no difference between groups (29/68 (42.6%) vs 24/65 (36.9%), p=0.50). There was no difference in patient-reported issues which was 51/133 (38.3%) with no difference between groups (28/68 (41.2%) vs 23/65 (33.8%), p=0.49) or in documented infections with a rate of 25/133 (18.8%) with no significant difference between groups (15/68 (22.0%) vs 10/65 (15.4%), p=0.33). In the intervention arm, the compliance rate was 73.5% for all 5 days of vaginal metronidazole, and a per-protocol analysis was performed which resulted in no significant difference between groups.
CONCLUSIONS
There is insufficient evidence to suggest a significant benefit of preoperative vaginal metronidazole to prevent surgical site infections and postoperative patient issues in patients undergoing hysterectomy.
TRIAL REGISTRATION NUMBER
ClinicalTrials.gov, NCT04478617.
PubMed: 38596254
DOI: 10.1136/bmjsit-2023-000241