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The Cochrane Database of Systematic... Aug 2015The four approaches to hysterectomy for benign disease are abdominal hysterectomy (AH), vaginal hysterectomy (VH), laparoscopic hysterectomy (LH) and robotic-assisted... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The four approaches to hysterectomy for benign disease are abdominal hysterectomy (AH), vaginal hysterectomy (VH), laparoscopic hysterectomy (LH) and robotic-assisted hysterectomy (RH).
OBJECTIVES
To assess the effectiveness and safety of different surgical approaches to hysterectomy for women with benign gynaecological conditions.
SEARCH METHODS
We searched the following databases (from inception to 14 August 2014) using the Ovid platform: Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO. We also searched relevant citation lists. We used both indexed and free-text terms.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) in which clinical outcomes were compared between one surgical approach to hysterectomy and another.
DATA COLLECTION AND ANALYSIS
At least two review authors independently selected trials, assessed risk of bias and performed data extraction. Our primary outcomes were return to normal activities, satisfaction, quality of life, intraoperative visceral injury and major long-term complications (i.e. fistula, pelvi-abdominal pain, urinary dysfunction, bowel dysfunction, pelvic floor condition and sexual dysfunction).
MAIN RESULTS
We included 47 studies with 5102 women. The evidence for most comparisons was of low or moderate quality. The main limitations were poor reporting and imprecision. Vaginal hysterectomy (VH) versus abdominal hysterectomy (AH) (nine RCTs, 762 women)Return to normal activities was shorter in the VH group (mean difference (MD) -9.5 days, 95% confidence interval (CI) -12.6 to -6.4, three RCTs, 176 women, I(2) = 75%, moderate quality evidence). There was no evidence of a difference between the groups for the other primary outcomes. Laparoscopic hysterectomy (LH) versus AH (25 RCTs, 2983 women)Return to normal activities was shorter in the LH group (MD -13.6 days, 95% CI -15.4 to -11.8; six RCTs, 520 women, I(2) = 71%, low quality evidence), but there were more urinary tract injuries in the LH group (odds ratio (OR) 2.4, 95% CI 1.2 to 4.8, 13 RCTs, 2140 women, I(2) = 0%, low quality evidence). There was no evidence of a difference between the groups for the other primary outcomes. LH versus VH (16 RCTs, 1440 women)There was no evidence of a difference between the groups for any primary outcomes. Robotic-assisted hysterectomy (RH) versus LH (two RCTs, 152 women)There was no evidence of a difference between the groups for any primary outcomes. Neither of the studies reported satisfaction rates or quality of life.Overall, the number of adverse events was low in the included studies.
AUTHORS' CONCLUSIONS
Among women undergoing hysterectomy for benign disease, VH appears to be superior to LH and AH, as it is associated with faster return to normal activities. When technically feasible, VH should be performed in preference to AH because of more rapid recovery and fewer febrile episodes postoperatively. Where VH is not possible, LH has some advantages over AH (including more rapid recovery and fewer febrile episodes and wound or abdominal wall infections), but these are offset by a longer operating time. No advantages of LH over VH could be found; LH had a longer operation time, and total laparoscopic hysterectomy (TLH) had more urinary tract injuries. Of the three subcategories of LH, there are more RCT data for laparoscopic-assisted vaginal hysterectomy and LH than for TLH. Single-port laparoscopic hysterectomy and RH should either be abandoned or further evaluated since there is a lack of evidence of any benefit over conventional LH. Overall, the evidence in this review has to be interpreted with caution as adverse event rates were low, resulting in low power for these comparisons. The surgical approach to hysterectomy should be discussed and decided in the light of the relative benefits and hazards. These benefits and hazards seem to be dependent on surgical expertise and this may influence the decision. In conclusion, when VH is not feasible, LH may avoid the need for AH, but LH is associated with more urinary tract injuries. There is no evidence that RH is of benefit in this population. Preferably, the surgical approach to hysterectomy should be decided by the woman in discussion with her surgeon.
Topics: Female; Genital Diseases, Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Laparoscopy; Randomized Controlled Trials as Topic; Recovery of Function; Robotic Surgical Procedures
PubMed: 26264829
DOI: 10.1002/14651858.CD003677.pub5 -
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 -
Acta Obstetricia Et Gynecologica... Mar 2014
Topics: Female; Gynecology; Humans; Hysterectomy
PubMed: 25032252
DOI: 10.1111/aogs.12335 -
Minnesota Medicine Mar 2012Hysterectomy is widely used for treating a variety of gynecologic conditions. Most hysterectomies are elective and are performed to treat benign indications for which...
Hysterectomy is widely used for treating a variety of gynecologic conditions. Most hysterectomies are elective and are performed to treat benign indications for which there are other effective alternatives. Observational studies are increasingly highlighting the effects of hysterectomy and concomitant oophorectomy on a variety of long-term health outcomes including fracture risk, pelvic floor dysfunction, all-cause mortality, cardiovascular disease, and neurologic function. Individualizing therapy and discussing appropriate alternatives to hysterectomy is an important responsibility for all health care providers.
Topics: Cross-Sectional Studies; Female; Genital Diseases, Female; Humans; Hysterectomy; Leiomyoma; Menorrhagia; Minnesota; Patient Education as Topic; Treatment Outcome; Uterine Artery Embolization; Uterine Neoplasms; Utilization Review
PubMed: 22611818
DOI: No ID Found -
Annals of Surgical Oncology Oct 2017One of the most important principles in modern cervical cancer surgery is the concept of tailoring surgical radicality. In practice, this means abandoning the...
BACKGROUND
One of the most important principles in modern cervical cancer surgery is the concept of tailoring surgical radicality. In practice, this means abandoning the "one-fits-all" concept in favor of tailored operations. The term "radical hysterectomy" is used to describe many different procedures, each with a different degree of radicality. Anatomic structures are subjected to artificial dissection artifacts, as well as different interpretations and nomenclatures. This study aimed to refine and standardize the principles and descriptions of the different classes of radical hysterectomy as defined in the Querleu-Morrow classification and to propose its universal applicability.
METHODS
All three authors independently examined the current literature and undertook a critical assessment of the original classification. Images and pathologic slides demonstrating different types of radical hysterectomy were examined to document a consensual vision of the anatomy. The Cibula 3-D concept also was included in this update.
RESULTS
The Querleu-Morrow classification is based on the lateral extent of resection. Four types of radical hysterectomy are described, including a limited number of subtypes when necessary. Two major objectives remain constant: excision of central tumor with clear margins and removal of any potential sites of nodal metastasis.
CONCLUSION
Studies evaluating radicality in the surgical management of cervical cancer should be based on precise, universally accepted descriptions. The authors' updated classification presents standardized, universally applicable descriptions of different types of hysterectomies performed worldwide, categorized according to degree of radicality, independently of theoretical considerations.
Topics: Female; Humans; Hysterectomy; Lymph Node Excision; Prognosis; Uterine Cervical Neoplasms
PubMed: 28785898
DOI: 10.1245/s10434-017-6031-z -
Deutsches Arzteblatt International Apr 2016Hysterectomy is the second most common operation in obstetrics and gynecology after Cesarean section. Until now, there has not been any German clinical guideline with... (Review)
Review
BACKGROUND
Hysterectomy is the second most common operation in obstetrics and gynecology after Cesarean section. Until now, there has not been any German clinical guideline with recommendations concerning the indications for hysterectomy for benign uterine conditions, in consideration of the available uterus-preserving alternative treatments.
METHODS
We systematically searched the Medline database in 2013, in 2014, and in December 2015, focusing on aggregate evidence, and assessed the retrieved literature. The guideline recommendations were developed by a consensus process with structured independent moderation.
RESULTS
30 systematic reviews and 8 randomized controlled trials were analyzed. Among the study patients treated with either hysterectomy (by any technique) or an organ-preserving alternative, at least 75-94% were satisfied with their treatment. Vaginal hysterectomy was associated with lower complication rates, shorter procedure duration, and more rapid recovery than abdominal hysterectomy and is therefore the preferred technique. If vaginal hysterectomy is not possible, a laparoscopic approach should be considered. Abdominal hysterectomy should be reserved for special indications. In 2012, the frequency of abdominal hysterectomy in Germany, Austria, and Switzerland was lower than elsewhere in the world, at 15.7% , 28.0% , and 23.9% , respectively. Uterus-preserving techniques were associated with higher reintervention rates compared to hysterectomy (11-36% vs 4-10% ).
CONCLUSION
The main objective is to reduce the frequency of abdominal hysterectomy. Patients should be counseled and made aware of uterus-sparing alternatives to hysterectomy so that they are able to make informed decisions.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Evidence-Based Medicine; Female; Germany; Gynecology; Humans; Hysterectomy; Middle Aged; Obstetrics; Practice Guidelines as Topic; Treatment Outcome; Uterine Diseases; Young Adult
PubMed: 27146592
DOI: 10.3238/arztebl.2016.0242 -
Acta Obstetricia Et Gynecologica... Mar 2022The first live birth after uterus transplantation occurred in Sweden in 2014. Uterus transplantation has repeatedly, and at many centers worldwide, proven to be a...
INTRODUCTION
The first live birth after uterus transplantation occurred in Sweden in 2014. Uterus transplantation has repeatedly, and at many centers worldwide, proven to be a feasible treatment for absolute uterine factor infertility. Hysterectomy in live donors and transplantation are well described in numerous reports. However, there are no reports of hysterectomy in the recipient after uterus transplantation, which will occur at either graft failure, after childbirth, or after numerous failed pregnancy attempts. We present the first report of hysterectomy in recipients after uterus transplantation with detailed analyses of findings in conjunction with graft failures.
MATERIAL AND METHODS
An analysis of recipient hysterectomies (n = 10), performed in 2012-2020, was conducted. Data from the international uterus transplantation registry (ISUTx registry) were extracted, and medical records were systematically reviewed, to collect and compile characteristics of recipients and donors, as well as pre-, per-, and postoperative data, including clinical course of graft failures.
RESULTS
Hysterectomy in recipients was performed in conjunction with cesarean section (n = 3), 3-6 months after cesarean section (n = 3), or after failed pregnancy attempts (n = 1) or graft failure (n = 3). The durations of anesthesia (2 h 36 min to 7 h 35 min) and hysterectomy surgery (1 h 42 min to 5 h 52 min) ranged widely, with long perioperative interruptions for insertion of ureteral catheters in two cases. Adhesions to the uterus were abundant, the majority being mild. Three uteri that subsequently showed graft failure (hysterectomy at 1, 3, and 8 months post transplantation) showed histological signs of ischemia in biopsies taken 1-week post-transplant and early signs of central hypoperfusion by Doppler ultrasound. In these graft failure explants, there were no epithelial linings in the uterine cavity or in the cervix. The inner uterine wall was severely ischemic and/or necrotic, whereas outer parts were partly viable. There were signs of moderate atherosclerosis of uterine arteries but no rejection. Mild postoperative complications were frequent (6/10), with one supravaginal hematoma requiring surgical drainage.
CONCLUSIONS
Hysterectomy after uterus transplantation is a complex and time-consuming procedure, and perioperative ureteral catheters may be helpful. Histopathology of early cervical biopsies showing ischemic signs may indicate subsequent irreversible damage, leading to graft failure.
Topics: Cervix Uteri; Cesarean Section; Female; Graft Rejection; Humans; Hysterectomy; Infertility, Female; Living Donors; Pregnancy; Uterus
PubMed: 34907538
DOI: 10.1111/aogs.14304 -
JSLS : Journal of the Society of... 2015Surgical site infection (SSI) is a common complication of hysterectomy. Minimally invasive hysterectomy has lower infection rates than abdominal hysterectomy. The lower... (Review)
Review
BACKGROUND
Surgical site infection (SSI) is a common complication of hysterectomy. Minimally invasive hysterectomy has lower infection rates than abdominal hysterectomy. The lower SSI rates reflect the role and benefit in infection control of having minimal incisions, rather than a large anterior abdominal wall incision. Despite the lower rates, SSI after laparoscopic hysterectomy is not uncommon.In this article, we review pre-, intra-, and postoperative risk factors for infection. Rates of postoperative fever after laparoscopic hysterectomy and when evaluation for infection is warranted in a febrile patient are also reviewed.
DATABASE
PubMed was searched for English-only articles using National Library of Medicine Medical Subject Headings(MESH) terms and keywords including but not limited to "postoperative," "surgical site," "infection," "fever," "laparoscopic," "laparoscopy," and "hysterectomy."
CONCLUSIONS
Reducing hospital-acquired infections such as SSI is one of the more effective ways of improving patient safety. Knowledge and understanding of risk factors for infection following laparoscopic hysterectomy enable the gynecologic surgeon or hospital to implement targeted preventive measures.
Topics: Female; Humans; Hysterectomy; Incidence; Laparoscopy; Risk Factors; Surgical Wound Infection; United States
PubMed: 26390531
DOI: 10.4293/JSLS.2015.00065 -
Revista Brasileira de Ginecologia E... Jan 2022To compare the outcomes of emergency and planned peripartum hysterectomies.
OBJECTIVE
To compare the outcomes of emergency and planned peripartum hysterectomies.
METHODS
The present retrospective cross-sectional study was conducted in two hospitals. Maternal and neonatal outcomes were compared according to emergency and planned peripartum hysterectomies.
RESULTS
A total of 34,020 deliveries were evaluated retrospectively, and 66 cases of peripartum hysterectomy were analyzed. Of these, 31 were cases of planned surgery, and 35 were cases of emergency surgery. The patients who underwent planned peripartum hysterectomy had a lower rate of blood transfusion (83.9% versus 100%; = 0.014), and higher postoperative hemoglobin levels (9.9 ± 1.3 versus 8.3 ± 1.3; < 0.001) compared with the emergency hysterectomy group. The birth weight was lower, although the appearance, pulse, grimace, activity, and respiration (Apgar) scores were higher in the planned surgery group compared with the emergency cases.
CONCLUSION
Planned peripartum hysterectomy with an experienced team results in less need for transfusion and improved neonatal outcomes compared with emergency peripartum hysterectomy.
Topics: Cross-Sectional Studies; Female; Humans; Hysterectomy; Infant, Newborn; Peripartum Period; Retrospective Studies
PubMed: 35092953
DOI: 10.1055/s-0041-1736303 -
Tidsskrift For Den Norske Laegeforening... Oct 2020Hysterectomy is a common gynaecological procedure. No Norwegian guidelines for the choice of hysterectomy surgical method exist, but international guidelines recommend...
BACKGROUND
Hysterectomy is a common gynaecological procedure. No Norwegian guidelines for the choice of hysterectomy surgical method exist, but international guidelines recommend minimally invasive surgery. The objective of this study was to investigate the kinds of surgical methods that were used for hysterectomies in the period 2008-18. Furthermore, we wished to identify the scope of robot-assisted hysterectomies and to find out whether salpingectomies are undertaken on a benign indication in Norway.
MATERIAL AND METHOD
The study is based on data from the Norwegian Patient Registry. Relevant variables for all gynaecological hysterectomies in Norway in the period 2008-18 were collected at the individual level.
RESULTS
During the study period, 53 178 hysterectomies were registered in the Norwegian Patient Registry. The proportion of hysterectomies that were performed with minimally invasive techniques increased from 41 % to 73 % during the study period. Robot-assisted hysterectomies accounted for 15 % of the total in 2018. The number of concomitant salpingectomies also increased during the period, and were performed in more than half of all hysterectomies undertaken on a benign indication.
INTERPRETATION
Norwegian gynaecologists largely follow international guidelines and recommendations regarding minimally invasive hysterectomy and salpingectomy. Although the total proportion of minimally invasive hysterectomies is now relatively high, there are considerable variations between the different health trusts.
Topics: Female; Gynecology; Humans; Hysterectomy; Laparoscopy; Minimally Invasive Surgical Procedures; Norway; Retrospective Studies
PubMed: 33070594
DOI: 10.4045/tidsskr.20.0167