-
Medicine May 2020To review the results of a novel method of subtotal hysterectomy, called anterograde vaginal subtotal hysterectomy (AVSH), and to compare them with those of laparoscopic... (Comparative Study)
Comparative Study
To review the results of a novel method of subtotal hysterectomy, called anterograde vaginal subtotal hysterectomy (AVSH), and to compare them with those of laparoscopic subtotal hysterectomy (LSH).We recruited 100 women with non-prolapsed uteruses and benign lesions of the uterus who required surgery. Of these, 60 underwent AVSH and 40 underwent LSH. Clinical data included average operation time, average volume of bleeding, postoperative anal exsufflation time, operative complications, average length of hospital stay and average hospital maintenance fee.There were no significant differences in terms of average operation time, average length of hospital stay, or operative complications between the AVSH and LSH groups. The AVSH group showed early postoperative anal exsufflation (P = .000), and had a low average hospital maintenance fee (P = .000). The AVSH group showed a higher perioperative bleeding volume than the LSH group (P = .001), which may be a result of the relatively amateur AVSH technique.AVSH is a minimally invasive, safe and feasible surgical procedure, with favorable early postoperative anal exsufflation and a low average hospital maintenance fee.
Topics: Adult; Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Laparoscopy; Middle Aged; Treatment Outcome; Uterine Diseases
PubMed: 32481265
DOI: 10.1097/MD.0000000000020006 -
Deutsches Arzteblatt International May 2010The advantages and disadvantages of the various surgical techniques for hysterectomy are currently a topic of debate, with particular controversy over leaving the cervix... (Comparative Study)
Comparative Study
BACKGROUND
The advantages and disadvantages of the various surgical techniques for hysterectomy are currently a topic of debate, with particular controversy over leaving the cervix in situ in the laparoscopic supracervical hysterectomy (LASH) procedure.
METHODS
In a retrospective single-center study, medical history and clinical characteristics were compared in patients who had undergone hysterectomy for benign disease in the period 2002-2008 at the Department of Obstetrics and Gynecology, Erlangen University Hospital. Postoperative satisfaction and the frequency of secondary operations for prolapse or incontinence in women with surgery between 2002 and 2007 were surveyed by means of a questionnaire.
RESULTS
The longest hospital stay was observed after abdominal hysterectomy (AH; 10 days), followed by vaginal hysterectomy (VH; 7.8 days) and laparoscopy-assisted vaginal hysterectomy (LAVH; 7.2 days). The shortest stays in hospital were seen after LASH (5.9 days) and total laparoscopic hysterectomy (TLH; 5.7 days). The shortest operating time was noted with VH (87 min) and the longest with LAVH (122 min). The lowest rates of blood loss were with LASH (1.38 g/dL) and TLH (1.51 g/dL). The highest rate of postoperative complications occurred after AH (8.9%). No differences were found in relation to postoperative satisfaction or surgery for prolapse or incontinence.
CONCLUSION
No postoperative benefits were found for leaving the cervix in situ when performing LASH. However, this was not a controlled randomized study.
Topics: Adult; Blood Loss, Surgical; Cervix Uteri; Female; Germany; Humans; Hysterectomy; Hysterectomy, Vaginal; Laparoscopy; Length of Stay; Middle Aged; Patient Satisfaction; Postoperative Complications; Reoperation; Retrospective Studies; Urinary Incontinence; Uterine Prolapse
PubMed: 20539807
DOI: 10.3238/arztebl.2010.0353 -
Medicine Apr 2018The endometrial carcinoma (EC) is the most frequently occurring female genital cancer. The authors performed this network meta-analysis to compare operative time and the... (Meta-Analysis)
Meta-Analysis Review
A network meta-analysis of comparison of operative time and complications of laparoscopy, laparotomy, and laparoscopic-assisted vaginal hysterectomy for endometrial carcinoma.
BACKGROUND
The endometrial carcinoma (EC) is the most frequently occurring female genital cancer. The authors performed this network meta-analysis to compare operative time and the incidence of bowel injury and wound infection of 3 operative approaches (laparoscopy, laparotomy, and laparoscopic-assisted vaginal hysterectomy [LAVH]) in the treatment of EC.
METHODS
The Cochrane Library, PubMed, and Embase databases were searched. Randomized controlled trials (RCTs) for EC from the day of databases establishment to February 2017 were included. Direct and indirect evidences were combined to calculate the combined weighted mean difference (WMD) or odd ratio values and the surface under the cumulative ranking curve (SUCRA) value of 3 operative approaches in the treatment of EC.
RESULTS
A total of 9 qualified RCTs were included into the study. The results showed that laparotomy had a shorter-operative time than LAVH (WMD = -40.36, 95% confidence interval = -75.03 to -2.57). However, there was no significant difference in the incidence of bowel injury and wound infection among 3 operative approaches. Besides, the SUCRA values indicated that laparotomy had the shortest operative time but the incidence of bowel injury and wound infection was relatively higher.
CONCLUSION
The results from this study indicate that laparotomy had highest incidence of bowel injury and wound infection but shortest operative time among 3 operative approaches in the treatment of EC.
Topics: Endometrial Neoplasms; Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Hysteroscopy; Intestines; Operative Time; Postoperative Complications; Randomized Controlled Trials as Topic; Surgical Wound Infection
PubMed: 29703003
DOI: 10.1097/MD.0000000000010474 -
Acta Obstetricia Et Gynecologica... May 2023Hysterectomy may have an effect on the pelvic floor. Here, we evaluated the rates and risks for pelvic organ prolapse (POP) surgeries and visits among women with a...
INTRODUCTION
Hysterectomy may have an effect on the pelvic floor. Here, we evaluated the rates and risks for pelvic organ prolapse (POP) surgeries and visits among women with a history of hysterectomy for benign indication excluding POP.
MATERIAL AND METHODS
In this retrospective cohort study 3582 women who underwent hysterectomy in 2006 were followed until the end of 2016. The cohort was linked to the Finnish Care Register to catch any prolapse-related diagnoses and operation codes following the hysterectomy. Different hysterectomy approaches were compared according to the risk for a prolapse, including abdominal, laparoscopic, laparoscopic-assisted vaginal and vaginal. The main outcomes were POP surgery and outpatient visit for POP, and Cox regression was used to identify risk factors (hazard ratios [HR]).
RESULTS
During the follow-up, 58 women (1.6%) underwent a POP operation, of which a posterior repair was the most common (n = 39, 1.1%). Outpatient visits for POP symptoms occurred in 92 (2.6%) women of which posterior wall prolapses (n = 58, 1.6%) were the most common. History of laparoscopic-assisted vaginal hysterectomy were associated with risk for POP operation (HR 3.0, p = 0.02), vaginal vault prolapse operation (HR 4.3, p = 0.01) and POP visits (HR 2.2, p < 0.01) as compared to the approach of abdominal hysterectomy. History of vaginal deliveries and concomitant stress urinary continence operation were associated with the risk for a POP operation (HR 4.4 and 11.9) and POP visits (HR 3.9 and 7.2).
CONCLUSIONS
Risk for POP operations and outpatient visits for POP symptoms in hysterectomized women without a preceding POP seems to be small at least 10 years after hysterectomy. History of LAVH, vaginal deliveries and concomitant stress urinary incontinence operations increased the risk for POP operations after hysterectomy. These data can be utilized in counseling women considering hysterectomy for benign indication.
Topics: Female; Humans; Male; Follow-Up Studies; Retrospective Studies; Hysterectomy; Hysterectomy, Vaginal; Pelvic Organ Prolapse
PubMed: 37014706
DOI: 10.1111/aogs.14542 -
Ginekologia Polska 2021Vaginal hysterectomy is one of the oldest but still rarely used minimally invasive techniques. Although new surgical methods making use of robots in laparoscopy have...
OBJECTIVES
Vaginal hysterectomy is one of the oldest but still rarely used minimally invasive techniques. Although new surgical methods making use of robots in laparoscopy have been introduced recently, when compared with vaginal hysterectomy, these approaches do not offer significant benefits for the patients and the doctors operating on them. The purpose of this study was a thorough analysis of vaginal removal of non-prolapsed uterus with benign pathology.
MATERIAL AND METHODS
The analysis included data of 1148 women who underwent vaginal hysterectomy in the Clinic of Surgical, Endoscopic and Oncological Gynecology between 2002 and 2014. A group of patients operated on were assessed, and data from the surgeries were obtained paying attention to such aspects as the operating time, the evaluation of morphotic blood elements, the type of perioperative complications, and the length of postoperative hospital stay. Additionally, all vaginal hysterectomies were divided into groups and analyzed taking into consideration uterus weight.
RESULTS
Vaginal hysterectomy was performed even in cases of earlier abdominal surgeries. The mean operating time was and 69.51 ± 28.32 minutes. The patients left hospital after 2.93 days on average. The mean uterus weight was 179.69 ± 113.54 g. What is important, the enlarged uterus was not a significant obstacle during the surgery. In case of heavy uteri of more than 580g, when the fundus of the uterus reached above the navel, the attention was drawn to the need for careful preparatory procedures, which reduced the number of perioperative complications and thus had a significant influence on the length of the operation (p = 0.0170).
CONCLUSIONS
Vaginal hysterectomy is an operating technique which is relatively easy to perform and safe for the patients because it involves a slight decrease of morphotic blood elements and a small number of mid- and postoperative complications. Vaginal hysterectomy is not a contraindication in case of large uteri, even those of more than 1000 g; however, in such cases, a longer operating time and an increased number of perioperative complications must be taken into consideration.
Topics: Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Laparoscopy; Length of Stay; Organ Size; Postoperative Complications; Retrospective Studies; Urogenital Abnormalities; Uterus
PubMed: 33844245
DOI: 10.5603/GP.a2021.0021 -
Gynecologic Oncology Dec 2020The aim of this study was to compare survival outcomes of total abdominal radical hysterectomy (TARH) versus laparoscopy-assisted radical vaginal hysterectomy (LARVH) in... (Comparative Study)
Comparative Study
Comparison of long-term survival of total abdominal radical hysterectomy and laparoscopy-assisted radical vaginal hysterectomy in patients with early cervical cancer: Korean multicenter, retrospective analysis.
PURPOSE
The aim of this study was to compare survival outcomes of total abdominal radical hysterectomy (TARH) versus laparoscopy-assisted radical vaginal hysterectomy (LARVH) in stage IA2-IB2 cervical cancer.
METHODS
812 patients who underwent RH between 2008 and 2017 were evaluated in 3 institutions. Progression-free survival (PFS) and overall survival (OS) were analyzed with Kaplan-Meier method and compared by log-rank test. The clinical noninferiority of the LARVH to TARH was assessed with a margin of -7.2%. Noninferiority was demonstrated if the low limit of 95% confidence interval (CI) exceeded its predefined margin.
RESULTS
258 patients were treated with TARH and 252 patients with LARVH. TARH and LARVH group had similar 5-year PFS (84.4% vs 86.6%, p = 0.467) and OS rates (85.8% vs 88.0%, p = 0.919). Noninferiority of LARVH to TARH were confirmed with 5-year PFS and OS difference rates of 2.2% (95% CI -2.9-7.3, p = 0.001) and 2.2% (95% CI -2.7-7.1, p = 0.001), respectively. In subgroup of patients with tumors size >2 cm, 5-year PFS (77.6% vs 79.0%, p = 0.682) and OS rates (79.2% vs 81.5%, p = 0.784) did not differ statistically between the two groups. Noninferiority of LARVH to TARH were also confirmed with 5-year PFS and OS difference rates of 1.4% (95% CI -7.0-9.8, p = 0.046) and 2.3% (95% CI -5.8-10.4, p = 0.027), respectively.
CONCLUSION
LARVH showed significant noninferiority for PFS and OS versus TARH in early cervical cancer, suggesting the potential oncologic safety of LARVH.
Topics: Adult; Aged; Conversion to Open Surgery; Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Laparoscopy; Middle Aged; Neoplasm Staging; Progression-Free Survival; Republic of Korea; Retrospective Studies; Survival Rate; Uterine Cervical Neoplasms
PubMed: 33041070
DOI: 10.1016/j.ygyno.2020.09.035 -
Urogynecology (Philadelphia, Pa.) May 2023The impact of a persistently enlarged genital hiatus (GH) after vaginal hysterectomy with uterosacral ligament suspension on prolapse outcomes is currently unclear.
IMPORTANCE
The impact of a persistently enlarged genital hiatus (GH) after vaginal hysterectomy with uterosacral ligament suspension on prolapse outcomes is currently unclear.
OBJECTIVES
This secondary analysis of the Study of Uterine Prolapse Procedures Randomized trial was conducted among participants who underwent vaginal hysterectomy with uterosacral ligament suspension. We hypothesized that women with a persistently enlarged GH size would have a higher proportion of prolapse recurrence.
STUDY DESIGN
Women who underwent vaginal hysterectomy with uterosacral ligament suspension as part of the Study of Uterine Prolapse Procedures Randomized trial (NCT01802281) were divided into 3 groups based on change in their preoperative to 4- to 6-week postoperative GH measurements: (1) persistently enlarged GH, 2) improved GH, or (3) stably normal GH. Baseline characteristics and 2-year surgical outcomes were compared across groups. A logistic regression model for composite surgical failure controlling for advanced anterior wall prolapse and GH group was fitted.
RESULTS
This secondary analysis included 81 women. The proportion with composite surgical failure was significantly higher among those with a persistently enlarged GH (50%) compared with a stably normal GH (12%) with an unadjusted risk difference of 38% (95% confidence interval, 4%-68%). When adjusted for advanced prolapse in the anterior compartment at baseline, the odds of composite surgical failure was 6 times higher in the persistently enlarged GH group compared with the stably normal group (95% confidence interval, 1.0-37.5; P = 0.06).
CONCLUSION
A persistently enlarged GH after vaginal hysterectomy with uterosacral ligament suspension for pelvic organ prolapse may be a risk factor for recurrent prolapse.
Topics: Female; Humans; Hysterectomy, Vaginal; Uterine Prolapse; Uterus; Pelvic Organ Prolapse; Ligaments
PubMed: 36701331
DOI: 10.1097/SPV.0000000000001309 -
The Cochrane Database of Systematic... Jul 2009The three approaches to hysterectomy for benign disease are abdominal hysterectomy (AH), vaginal hysterectomy (VH), and laparoscopic hysterectomy (LH). Laparoscopic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The three approaches to hysterectomy for benign disease are abdominal hysterectomy (AH), vaginal hysterectomy (VH), and laparoscopic hysterectomy (LH). Laparoscopic hysterectomy has three further subdivisions depending on the part of the procedure performed laparoscopically.
OBJECTIVES
To assess the most beneficial and least harmful surgical approach to hysterectomy for women with benign gynaecological conditions.
SEARCH STRATEGY
We searched the Cochrane Menstrual Disorders and Subfertility Group Specialised Register of controlled trials (15 August 2008), CENTRAL (The Cochrane Library 2008, Issue 3), MEDLINE (1950 to August 2008), EMBASE (1980 to August 2008), Biological Abstracts (1969 to August 2008), the National Research Register, and relevant citation lists.
SELECTION CRITERIA
Only randomised controlled trials comparing one surgical approach to hysterectomy with another were included.
DATA COLLECTION AND ANALYSIS
Independent selection of trials and data extraction were employed following Cochrane guidelines.
MAIN RESULTS
There were 34 included studies with 4495 women. The benefits of VH versus AH were speedier return to normal activities (mean difference (MD) 9.5 days), fewer febrile episodes or unspecified infections (odds ratio (OR) 0.42), and shorter duration of hospital stay (MD 1.1 days). The benefits of LH versus AH were speedier return to normal activities (MD 13.6 days), lower intraoperative blood loss (MD 45 cc), a smaller drop in haemoglobin (MD 0.55 g/dl), shorter hospital stay (MD 2.0 days), and fewer wound or abdominal wall infections (OR 0.31) at the cost of more urinary tract (bladder or ureter) injuries (OR 2.41) and longer operation time (MD 20.3 minutes). The benefits of LAVH versus TLH were fewer febrile episodes or unspecified infection (OR 3.77) and shorter operation time (MD 25.3 minutes). There was no evidence of benefits of LH versus VH and the operation time (MD 39.3 minutes) as well as substantial bleeding (OR 2.76) were increased in LH. For some important outcomes, the analyses were underpowered to detect important differences or they were simply not reported in trials. Data were absent for many important long-term outcome measures.
AUTHORS' CONCLUSIONS
Because of equal or significantly better outcomes on all parameters, VH should be performed in preference to AH where possible. Where VH is not possible, LH may avoid the need for AH however the length of the surgery increases as the extent of the surgery performed laparoscopically increases. The surgical approach to hysterectomy should be decided by the woman in discussion with her surgeon in light of the relative benefits and hazards.
Topics: Female; Genital Diseases, Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Laparoscopy; Randomized Controlled Trials as Topic
PubMed: 19588344
DOI: 10.1002/14651858.CD003677.pub4 -
American Journal of Obstetrics and... Nov 2017The American Congress of Obstetricians and Gynecologists recommends that "the surgeon and patient discuss the potential benefits of the removal of the fallopian tubes... (Observational Study)
Observational Study
BACKGROUND
The American Congress of Obstetricians and Gynecologists recommends that "the surgeon and patient discuss the potential benefits of the removal of the fallopian tubes during a hysterectomy in women at population risk of ovarian cancer who are not having an oophorectomy," resulting in an increasing rate of salpingectomy at the time of hysterectomy. Rates of salpingectomy are highest for laparoscopic and lowest for vaginal hysterectomy.
OBJECTIVE
The primary objective of this study was to determine the feasibility of bilateral salpingectomy at the time of vaginal hysterectomy. Secondary objectives included identification of factors associated with unsuccessful salpingectomy and assessment of its impact on operating time, blood loss, surgical complications, and menopausal symptoms.
STUDY DESIGN
This was a multicenter, prospective study of patients undergoing planned vaginal hysterectomy with bilateral salpingectomy. Baseline medical data along with operative findings, operative time, and blood loss for salpingectomy were recorded. Uterine weight and pathology reports for all fallopian tubes were reviewed. Patients completed the Menopause Rating Scale at baseline and at postoperative follow-up. Descriptive analyses were performed to characterize the sample and compare those with successful and unsuccessful completion of planned salpingectomy using Student t test, and χ test when appropriate. Questionnaire scores were compared using paired t tests.
RESULTS
Among 77 patients offered enrollment, 74 consented (96%), and complete data were available regarding primary outcome for 69 (93%). Mean age was 51 years. Median body mass index was 29.1 kg/m; median vaginal parity was 2, and 41% were postmenopausal. The indications for hysterectomy included prolapse (78%), heavy menstrual bleeding (20%), and fibroids (11%). When excluding conversions to alternate routes, vaginal salpingectomy was successfully performed in 52/64 (81%) women. Mean operating time for bilateral salpingectomy was 11 (±5.6) minutes, with additional estimated blood loss of 6 (±16.3) mL. There were 8 surgical complications: 3 hemorrhages >500 mL and 5 conversions to alternate routes of surgery, but none of these were due to the salpingectomy. Mean uterine weight was 102 g and there were no malignancies on fallopian tube pathology. Among the 17 patients in whom planned bilateral salpingectomy was not completed, unilateral salpingectomy was performed in 7 patients. Reasons for noncompletion included: tubes high in the pelvis (8), conversion to alternate route for pathology (4), bowel or sidewall adhesions (3), tubes absent (1), and ovarian adhesions (1). Prior adnexal surgery (odds ratio, 2.9; 95% confidence interval, 1.5-5.5; P = .006) and uterine fibroids (odds ratio, 5.8; 95% confidence interval, 1.5-22.5; P = .02) were the only significant factors associated with unsuccessful bilateral salpingectomy. Mean menopause scores improved after successful salpingectomy (12.7 vs 8.6; P < .001).
CONCLUSION
Vaginal salpingectomy is feasible in the majority of women undergoing vaginal hysterectomy and increases operating time by 11 minutes and blood loss by 6 mL. Women with prior adnexal surgery or uterine fibroids should be counseled about the possibility that removal may not be feasible.
Topics: Adult; Blood Loss, Surgical; Feasibility Studies; Female; Humans; Hysterectomy, Vaginal; Leiomyoma; Menorrhagia; Middle Aged; Operative Time; Ovarian Neoplasms; Postoperative Complications; Prophylactic Surgical Procedures; Prospective Studies; Salpingectomy; Uterine Neoplasms; Uterine Prolapse
PubMed: 28734829
DOI: 10.1016/j.ajog.2017.07.017 -
American Journal of Obstetrics and... Nov 2021Prolapse recurrence after transvaginal surgical repair is common; however, its mechanisms are ill-defined. A thorough understanding of how and why prolapse repairs fail...
BACKGROUND
Prolapse recurrence after transvaginal surgical repair is common; however, its mechanisms are ill-defined. A thorough understanding of how and why prolapse repairs fail is needed to address their high rate of anatomic recurrence and to develop novel therapies to overcome defined deficiencies.
OBJECTIVE
This study aimed to identify mechanisms and contributors of anatomic recurrence after vaginal hysterectomy with uterosacral ligament suspension (native tissue repair) vs transvaginal mesh (VM) hysteropexy surgery for uterovaginal prolapse.
STUDY DESIGN
This multicenter study was conducted in a subset of participants in a randomized clinical trial by the Eunice Kennedy Shriver National Institute of Child Health and Human Development Pelvic Floor Disorders Network. Overall, 94 women with uterovaginal prolapse treated via native tissue repair (n=48) or VM hysteropexy (n=46) underwent pelvic magnetic resonance imaging at rest, maximal strain, and poststrain rest (recovery) 30 to 42 months after surgery. Participants who desired reoperation before 30 to 42 months were imaged earlier to assess the impact of the index surgery. Using a novel 3-dimensional pelvic coordinate system, coregistered midsagittal images were obtained to assess study outcomes. Magnetic resonance imaging-based anatomic recurrence (failure) was defined as prolapse beyond the hymen. The primary outcome was the mechanism of failure (apical descent vs anterior vaginal wall elongation), including the frequency and site of failure. Secondary outcomes included displacement of the vaginal apex and perineal body and change in the length of the anterior wall, posterior wall, vaginal perimeter, and introitus of the vagina from rest to strain and rest to recovery. Group differences in the mechanism, frequency, and site of failure were assessed using the Fisher exact tests, and secondary outcomes were compared using Wilcoxon rank-sum tests.
RESULTS
Of the 88 participants analyzed, 37 (42%) had recurrent prolapse (VM hysteropexy, 13 of 45 [29%]; native tissue repair, 24 of 43 [56%]). The most common site of failure was the anterior compartment (VM hysteropexy, 38%; native tissue repair, 92%). The primary mechanism of recurrence was apical descent (VM hysteropexy, 85%; native tissue repair, 67%). From rest to strain, failures (vs successes) had greater inferior displacement of the vaginal apex (difference, -12 mm; 95% confidence interval, -19 to -6) and perineal body (difference, -7 mm; 95% confidence interval, -11 to -4) and elongation of the anterior vaginal wall (difference, 12 mm; 95% confidence interval, 8-16) and vaginal introitus (difference, 11 mm; 95% confidence interval, 7-15).
CONCLUSION
The primary mechanism of prolapse recurrence following vaginal hysterectomy with uterosacral ligament suspension or VM hysteropexy was apical descent. In addition, greater inferior descent of the vaginal apex and perineal body, lengthening of the anterior vaginal wall, and increased size of the vaginal introitus with strain were associated with anatomic failure. Further studies are needed to provide additional insight into the mechanism by which these factors contribute to anatomic failure.
Topics: Aged; Female; Gynecologic Surgical Procedures; Humans; Hysterectomy, Vaginal; Imaging, Three-Dimensional; Magnetic Resonance Imaging; Middle Aged; Pelvis; Recurrence; Treatment Failure; Uterine Prolapse
PubMed: 34087229
DOI: 10.1016/j.ajog.2021.05.041