-
The Journal of Reproductive Medicine May 2009To compare the risk of ureteral compromise and of recurrent vault prolapse following vaginal vs. laparoscopic uterosacral vault suspension at the time of vaginal... (Comparative Study)
Comparative Study
OBJECTIVE
To compare the risk of ureteral compromise and of recurrent vault prolapse following vaginal vs. laparoscopic uterosacral vault suspension at the time of vaginal hysterectomy.
STUDY DESIGN
In this retrospective, cohort study, uterosacral ligament suspension was performed using either a vaginal or laparoscopic approach. The primary outcome was intraoperative ureteral compromise; secondary outcomes were postoperative anatomic result and recurrent prolapse. The Canadian Task Force Classification was II-2.
RESULTS
One hundred eighteen patients were included: 96 patients in the vaginal group and 22 patients in the laparoscopic group. Ureteral compromise was identified intraoperatively in 4 (4.2%) cases in the vaginal group; no ureteral compromise was observed in the laparoscopic group (p = 0.33). Failure at the apex, defined as stage > or = II for point C, was seen in 6.3% of patients in the vaginal group as compared with 0% in the laparoscopic group; this difference did not achieve statistical significance. Similarly, trends toward lower recurrent symptomatic vault prolapse (10% vs. 0%), any symptomatic prolapse recurrence (12.5% vs. 4.6%), and higher postoperative Pelvic Organ Prolapse Quantification point C were observed in the laparoscopic group (p > 0.05 for all).
CONCLUSION
Laparoscopic uterosacral vault suspension following vaginal hysterectomy is a safe alternative to the vaginal approach.
Topics: Cohort Studies; Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Intraoperative Complications; Laparoscopy; Ligaments; Middle Aged; Postoperative Complications; Recurrence; Retrospective Studies; Sacrum; Ureteral Diseases; Urinary Incontinence, Stress; Uterine Prolapse; Uterus; Vagina
PubMed: 19517690
DOI: No ID Found -
Ginekologia Polska 2018The aim of the study was to perform a comparative analysis of hysterectomy costs versus the operative technique based on the data of 656 patients operated at the...
OBJECTIVES
The aim of the study was to perform a comparative analysis of hysterectomy costs versus the operative technique based on the data of 656 patients operated at the Department of Obstetrics and Gynecology with Gynecological Oncology Subdivision, Brothers Hospitallers of Saint John of God Hospital, Katowice, between 2016 and 2018 (until May 31, 2018).
MATERIAL AND METHODS
This retrospective research involved 656 patients who underwent hysterectomy for non-oncological reasons. The patients were subdivided into three groups, depending on the operative method (transabdominal, laparoscopic or transvaginal). Next, treatment costs were compared, including the costs of hospitalization, operating block, operating block materials, drugs, anesthesia, and medical staff. The duration of the operation and the hospital stay were also analyzed as they significantly affected the final result.
RESULTS
Data analysis revealed that transvaginal hysterectomy generated the lowest costs. A positive relationship between low costs and the duration of surgery and hospitalization, which is significantly shortened in case of transvaginal hysterectomy, was confirmed.
CONCLUSIONS
1. The transvaginal approach is the most cost-effective technique of hysterectomy. 2. Apart from the financial advantage, transvaginal hysterectomy is also associated with shorter hospitalization and faster recovery. 3. Emphasis should be placed on training physicians in minimally invasive hysterectomies - especially the transvaginal approach - so that the greatest percentage of patients who are deemed eligible for hysterectomy could be operated using this minimally invasive technique.
Topics: Female; Health Care Costs; Humans; Hysterectomy; Hysterectomy, Vaginal; Laparoscopy; Minimally Invasive Surgical Procedures; Poland; Postoperative Complications; Retrospective Studies; Uterine Cervical Neoplasms; Women's Health
PubMed: 30618034
DOI: 10.5603/GP.a2018.0113 -
Cureus Dec 2019The rate of vaginal hysterectomy has decreased despite the procedure being the preferred hysterectomy method according to the American College of Obstetricians and...
The rate of vaginal hysterectomy has decreased despite the procedure being the preferred hysterectomy method according to the American College of Obstetricians and Gynecologists (ACOG). Physicians have reported that some of the main barriers to performing minimally invasive hysterectomy are the size and shape of the uterus, difficulty of accessibility to the uterus, and surgeons' lack of training and experience. A simulation model for vaginal uterine morcellation was created in an effort to increase surgeons' confidence and to encourage them to select vaginal hysterectomy for their patients. The Conner model, where polyvinyl chloride (PVC) piping is used to simulate the pelvis and vaginal canal, was used as the basis for the pelvis. A medium-density fiberboard (MDF) was used as a base, while a PVC piping structure was used to stimulate the pelvis. The uterus was created from a peanut (car-wash) sponge that was carved into a triangle shape. The reusable MDF/PVC model was built in approximately one hour and cost under USD 30. The sponge uterus was built in approximately 10 minutes and cost under USD 2. Senior residents and faculty who have previously performed uterine morcellation participated in our simulation. Resident physicians reported that they felt more confident in their skills after the simulation. Both resident and staff physicians reported that the model had created a realistic experience. We created a novel model for vaginal uterine morcellation that was reported to be realistic in the initial investigation and increased confidence in the procedure for physicians. The model is easy to create, affordable, and partially reusable.
PubMed: 31938645
DOI: 10.7759/cureus.6362 -
Acta Obstetricia Et Gynecologica... Sep 2011To develop a regression-based prediction equation for operative time and estimated blood loss in laparoscopically assisted vaginal hysterectomy (LAVH) for large uteri,...
OBJECTIVE
To develop a regression-based prediction equation for operative time and estimated blood loss in laparoscopically assisted vaginal hysterectomy (LAVH) for large uteri, as required, by combined laparoscopic in situ and vaginal morcellation.
DESIGN
Prospective study (Canadian Task Force classification II-1).
SETTING
University-affiliated hospitals.
SAMPLE
Fifty-six patients who underwent LAVH. Methods. Evaluation of all patients who had LAVH with laparoscopic in situ morcellation and vaginal morcellation during a 2-year period.
MAIN OUTCOME MEASURES
Operative time, estimated blood loss, total uterine weight by laparoscopic or vaginal morcellation, complications and length of hospital stay.
RESULTS
Mean operative time was 133 ± 22 minutes, and mean blood loss 133 ± 101 ml. Mean uterine weight was 383 ± 187 g by laparoscopic and 251 ± 103 g by vaginal morcellation. Greater total uterine weight and morcellation were associated with longer operative times. Blood loss correlated with uterine weight when vaginal morcellation was also used. A regression equation is presented for estimating the likely operating time and blood loss.
CONCLUSIONS
An increase in the operative time and a higher blood loss can be expected as the uterine weight increases and can be predicted taking morcellation methods into account.
Topics: Blood Loss, Surgical; Blood Volume; Female; Humans; Hysterectomy, Vaginal; Laparoscopy; Length of Stay; Patient Positioning; Time Factors; Treatment Outcome; Uterus
PubMed: 21615713
DOI: 10.1111/j.1600-0412.2011.01196.x -
Acta Obstetricia Et Gynecologica... Nov 2012To report our experience of treating women undergoing vaginal hysterectomy in an outpatient setting and to identify risk factors for hospital admission and women...
OBJECTIVE
To report our experience of treating women undergoing vaginal hysterectomy in an outpatient setting and to identify risk factors for hospital admission and women dissatisfied with care.
DESIGN
Prospective observational report.
SETTING
department of obstetrics and gynecology, university hospital in Norway.
SAMPLE
150 women who underwent vaginal hysterectomy at the outpatient clinic from February 2009 to April 2010.
METHODS
Perioperative data were collected prospectively and case notes were searched for complications. On the first postoperative day all women were contacted by telephone by a nurse. A visual analogue scale (VAS) was used to monitor pain and nausea during the stay at the outpatient clinic and the day after surgery. VAS was also used to specify the women's degree of satisfaction with care the day after surgery.
MAIN OUTCOME MEASURE
The number of women who could be discharged from the outpatient unit and had a satisfaction score of ≥7 the day after surgery.
RESULTS
Of the 150 women, 84% could be discharged after a mean observation period of 276 min (SD ± 80 min). The mean satisfaction score was 9.0, SD ± 1.4, and 92.6% of the women reported ≥7 points in the satisfaction score. No women with serious complications were sent home. Using a multivariable logistic regression model only pain at discharge was found as significant (p= 0.009) for admittance to hospital.
CONCLUSIONS
Vaginal hysterectomy is a feasible outpatient procedure and the majority of women were satisfied with the care they received.
Topics: Adult; Aged; Ambulatory Surgical Procedures; Analgesics; Female; Follow-Up Studies; Humans; Hysterectomy, Vaginal; Middle Aged; Nausea; Norway; Pain Measurement; Pain, Postoperative; Patient Admission; Patient Discharge; Patient Satisfaction; Postoperative Complications; Prospective Studies; Risk Factors
PubMed: 22774775
DOI: 10.1111/j.1600-0412.2012.01502.x -
Acta Obstetricia Et Gynecologica... 2007To compare the surgical outcomes of vaginal hysterectomy and prophylactic oophorectomy in women with a uterine size<12 weeks' gestation and 12-20 weeks' gestation,... (Comparative Study)
Comparative Study
BACKGROUND
To compare the surgical outcomes of vaginal hysterectomy and prophylactic oophorectomy in women with a uterine size<12 weeks' gestation and 12-20 weeks' gestation, without decensus.
METHODS
In this prospective comparative study, 241 consecutive vaginal hysterectomies were planned for women with benign disease of the uterus. All hysterectomies were performed by the same surgeon (author), and divided into 2 groups: a uterine weight >280 g (n=83, 280-1150 g) and a uterine weight <280 g (n=158). The 2 groups were compared for success rates of hysterectomy and bilateral oophorectomy vaginally, operative time, change in haemoglobin, haemorrhage, length of hospital stay, operative complications, and febrile morbidity.
RESULTS
All 241 hysterectomies were completed successfully vaginally, and no patients required laparotomy or additional procedures in both groups. No significant intra- and post-operative complications requiring admission to the hospital were encountered in either group. Mean operating time was significantly longer in the uteri >/=280-g group than in the <280-g group (69.4+/-24.4 versus 108.2+/-41.2 min, p<0.0001). The rate of intraoperative haemorrhage (8.43 versus 1.2%) and the change in haemoglobin were significantly higher in the >/=280-g group compared with the <280-g group (p<0.01). Significant positive linear correlation between uterine weight and operative time was seen in all 241 hysterectomies (p<0.001). The rate of bilateral oophorectomy was similar between the uteri >/=280-g group (89.8%) and the <280-g group (92.9%). The main intraoperative complication of the 241 vaginal hysterectomies was bladder injury that occurred in 1 case (0.4%) in the <280-g group. There were no statistically significant differences in intra- and post-operative complications, febrile morbidity, and postoperative hospital stay between the groups.
CONCLUSIONS
Our findings demonstrate that despite the prolonged operating time and increased intraoperative blood loss, vaginal hysterectomy can be safely performed on a large uterus. Routine bilateral prophylactic oophorectomy can be performed in all patients who have sufficiently long infundibulopelvic ligaments to permit removal of the entire ovary.
Topics: Adult; Aged; Female; Follow-Up Studies; Humans; Hysterectomy, Vaginal; Middle Aged; Organ Size; Ovariectomy; Prospective Studies; Treatment Outcome; Uterine Diseases; Uterus
PubMed: 17963064
DOI: 10.1080/00016340701657258 -
JSLS : Journal of the Society of... 2004We conducted retrospective and prospective clinical studies at the Columbus Hospital of Rome to point out changes in choosing the route for performing hysterectomy; to...
OBJECTIVES
We conducted retrospective and prospective clinical studies at the Columbus Hospital of Rome to point out changes in choosing the route for performing hysterectomy; to evaluate the feasibility of vaginal hysterectomy (VH) and oophorectomy, even in commonly considered contraindications to the vaginal route; to describe a method of laparoscopic oophorectomy following vaginal hysterectomy; and laparoscopic assistance in impossible vaginal hysterectomies.
METHODS
From November 1999 to November 2001, 226 patients (age 46.1+/-4.6 years, range 35 to 58) underwent hysterectomy for benign pathologies: 22 (9.7%) underwent total laparoscopic hysterectomy for the presence of severe endometriosis, limited access to the fornices, or immobile uterus with no lateral mobilization; 204 (90.3%) underwent vaginal hysterectomy. Patients with uterine prolapse were excluded. Uterine size, previous cesarean deliveries, pelvic surgeries and the requirement of prophylactic oophorectomy were not considered contraindications to the vaginal approach. We retrospectively analyzed 509 hysterectomies performed in the previous 2 years from 1997 through 1998.
RESULTS
During vaginal hysterectomy, adnexectomy was possible in 90.6% of the cases in which it was indicated (unilateral in 21.8% because of adnexal pathology) and was technically impossible in 9.3%. In 4 patients (1.9%), it was not possible to complete a vaginal hysterectomy, owing to the presence of thick adhesions obliterating the cul-de-sac, to severe endometriosis, or to other unforeseen circumstances. In these few patients with difficult access to the ovaries (2.9% of all VH) or with difficulties in mobilizing the uterus, we resorted to laparoscopy. The pneumoperitoneum was achieved with an insufflation tube inserted via the vagina into the abdominal cavity and packing the vagina. Thus, the risks associated with the insertion of the Veress needle were avoided. In all but 2 patients in whom conversion to laparotomy was necessary, laparoscopy was successfully completed. No major complications occurred. In the retrospective analysis of 509 hysterectomies, we determined that 29% were vaginal, 43% abdominal, and 28% laparoscopic (mostly LAVH). In the following years, LAVH allowed the conversion of a significant number of abdominal or laparoscopic hysterectomies to a vaginal route, showing that the vaginal approach was possible in most of cases.
CONCLUSIONS
The vaginal approach is feasible in more than 90% of cases even if oophorectomy is required. In the few cases with difficult access to ovaries or difficulties in mobilizing the uterus, the laparoscopic route can easily be adapted by packing the vagina and obtaining a pneumoperitoneum without the risk and loss of time of the insertion of the Veress needle. In this way, it is possible to avoid a great number of LAVH, reducing operating time and the risks of a concomitant procedure.
Topics: Adult; Feasibility Studies; Female; Humans; Hysterectomy, Vaginal; Laparoscopy; Middle Aged; Ovarian Diseases; Ovariectomy; Ovary; Prospective Studies; Retrospective Studies; Uterine Diseases; Uterus
PubMed: 15554277
DOI: No ID Found -
Surgical Indication and Approach are Associated with Transfusion in Hysterectomy for Benign Disease.JSLS : Journal of the Society of... 2022To identify pre-operative and intraoperative factors associated with the risk of red blood cell transfusion among women undergoing hysterectomy.
OBJECTIVE
To identify pre-operative and intraoperative factors associated with the risk of red blood cell transfusion among women undergoing hysterectomy.
METHODS
A retrospective cohort study of hysterectomy for benign indications between January 1, 2011 - December 31, 2017. Patients receiving blood transfusion within 30 days of surgery were compared to patients who did not receive any transfusion. Multivariate logistic regression analysis was performed to identify clinical and surgical variables associated with blood transfusion.
RESULTS
Among 171,940 women who underwent hysterectomy for benign indication, 4,667 (2.7%) required blood transfusion. The rate of transfusion was highest among patients with uterine fibroids (4.3%) and lowest in patients with genital prolapse (1.1%) (p < 0.05). Odds of blood transfusion were significantly elevated in patients undergoing hysterectomy for uterine fibroids compared to patients with genital prolapse (adjusted odds ratio [aOR] 1.36, 95% confidence interval [CI] 1.15 - 1.61). Other patient characteristics included body mass index, smoking, bleeding disorders, pre-operative sepsis, and American Society of Anesthesiologists score ≥ 2 (p < 0.05). Higher pre-operative hematocrit significantly decreased the risk of blood transfusion (aOR 0.84, 95% CI 0.84 - 0.85 per percent increase in hematocrit). Abdominal and vaginal hysterectomies were associated with greater odds of transfusion compared with laparoscopic approaches (aOR 5.06, 95% CI 4.70 - 5.44; aOR 1.87, 95% CI 1.67 - 2.10, respectively).
CONCLUSIONS
Certain patient comorbidities, surgical indication, and approach to hysterectomy are associated with increased risk of blood transfusion. These results may have implications for pre-operative patient counseling, perioperative care, and health system planning.
Topics: Blood Transfusion; Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Leiomyoma; Retrospective Studies
PubMed: 35655468
DOI: 10.4293/JSLS.2022.00013 -
Journal of the Turkish German... Feb 2019To determine perioperative outcome differences in patients undergoing vaginal hysterectomy based on uterine weight, vaginal delivery, and menopausal state.
OBJECTIVE
To determine perioperative outcome differences in patients undergoing vaginal hysterectomy based on uterine weight, vaginal delivery, and menopausal state.
MATERIAL AND METHODS
Retrospective chart review of 452 patients who underwent vaginal hysterectomy performed by a single surgeon. Patients’ age, vaginal delivery, uterine weight, previous pelvic surgery, previous cesarean delivery, removal of ovaries were compared, as well as estimated blood loss (EBL), operating room time (ORT), length of stay, intraoperative complications and postoperative complications. Multivariable logistic regression was used, and all data were analyzed at the level of p<0.05 statistical significance using SAS system software (SAS Institute Inc., Cary, NC), version 9.3.
RESULTS
The mean age was 57.13±11.52 years and the median vaginal delivery was 2. The uterine weight range was 16.6-1174.5 g (mean 169.79±183.94 g). The incidences of blood transfusion and bladder injury were 3.03% and 0.66%, respectively. Factors shown to be associated with longer ORT included greater uterine weight, removal of ovaries, posterior repair, tension-free vaginal tape sling, prolapse, and EBL >500 mL (p<0.001). The factors associated with EBL >500 mL were greater uterine weight (p=0.001), uterine myomas (p=0.016) and premenopausal state (p=0.014). The factors associated with conversion to laparotomy were greater uterine weight (p<0.001) and premenopausal state (p<0.001).
CONCLUSION
Vaginal hysterectomy is a safe and feasible approach for patients desiring hysterectomy regardless of uterine weight and vaginal delivery.
PubMed: 30209028
DOI: 10.4274/jtgga.galenos.2018.2018.0021 -
Obstetrics & Gynecology Science Mar 2018The present study aimed to determine the differences in outcomes between natural orifice transluminal endoscopic surgery-assisted vaginal hysterectomy (NAVH) and...
Postoperative outcomes of natural orifice transluminal endoscopic surgery-assisted vaginal hysterectomy and conventional laparoscopic-assisted vaginal hysterectomy: a comparative study.
OBJECTIVE
The present study aimed to determine the differences in outcomes between natural orifice transluminal endoscopic surgery-assisted vaginal hysterectomy (NAVH) and conventional laparoscopy-assisted vaginal hysterectomy (LAVH).
METHODS
We retrospectively reviewed the charts of patients who between July 2012 and September 2015, were diagnosed as having benign uterine disease such as uterine myoma, endometriosis, or adenomyosis and managed via NAVH or LAVH in a single-center (Eulji University Hospital). Data such as age, body weight, height, parity, operation time, intra/post-operative complications, and uterus weight were obtained from the clinical charts. NAVH and LAVH recipients were matched 1:3 in terms of baseline characteristics, and the 2 groups were compared regarding surgical outcomes.
RESULTS
Of the 160 patients with benign uterine disease included in the present study. Forty received NAVH and remaining 120 received LAVH. There were significant differences between the groups regarding operation time and hemoglobin change. Notably, although the operation time was shorter for LAVH, hemoglobin change was lower for NAVH. Additionally, although maximum hospitalization duration was shorter for LAVH, the average length of hospitalization was similar between NAVH and LAVH. There were no significant differences between the groups in terms of other variables.
CONCLUSION
NAVH may become a new alternative surgical method of choice for hysterectomy, as it represents a clinically feasible and safe approach; moreover is superior to LAVH in terms of bleeding loss.
PubMed: 29564318
DOI: 10.5468/ogs.2018.61.2.261