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Deutsches Arzteblatt International May 2015
Topics: Antineoplastic Agents; Female; Humans; Hysterectomy, Vaginal; Laparoscopy; Leiomyoma; Uterine Neoplasms
PubMed: 26037470
DOI: 10.3238/arztebl.2015.0328b -
Archives of Gynecology and Obstetrics Aug 2021Vaginal cuff dehiscence (VCD) is one of the major surgical complications following hysterectomy with data on incidence rates varying largely and studies assessing risk...
PURPOSE
Vaginal cuff dehiscence (VCD) is one of the major surgical complications following hysterectomy with data on incidence rates varying largely and studies assessing risk factors being sparse with contradictive results. The aim of this study was to assess the incidence rate of and risk factors for VCD in a homogenous cohort of women treated for benign uterine pathologies via total laparoscopic hysterectomy (TLH) with standardized follow-up.
METHODS
All patients undergoing TLH at the Department of Gynecology and Obstetrics, Saarland University Hospital between November 2010 and February 2019 were retrospectively identified from a prospectively maintained service database.
RESULTS
VCD occurred in 18 (2.9%) of 617 patients included. In univariate and multivariate analyses, a lower level of surgeon laparoscopic expertise (odds ratio 3.19, 95% confidence interval (CI) 1.0-9.38; p = 0.03) and lower weight of removed uterus (odds ratio 0.99, 95% CI 0.98-0.99; p = 0.02) were associated positively with the risk of VCD.
CONCLUSION
In this homogenous cohort undergoing TLH, laparoscopic expertise and uterine weight influenced the risk of postoperative VCD. These findings might help to further reduce the rate of this complication.
Topics: Female; Germany; Hospitals; Humans; Hysterectomy; Hysterectomy, Vaginal; Incidence; Laparoscopy; Postoperative Complications; Retrospective Studies; Risk Factors; Surgical Wound Dehiscence
PubMed: 33938997
DOI: 10.1007/s00404-021-06064-0 -
European Review For Medical and... Feb 2022An increasing number of robotic hysterectomies are being performed and the most common indication is fibroids. Fibroid uterus is common indication for hysterectomy for...
OBJECTIVE
An increasing number of robotic hysterectomies are being performed and the most common indication is fibroids. Fibroid uterus is common indication for hysterectomy for enlarged uteri. The role of robotic approach for complex pathologies as enlarged uterus is still debatable. The study aimed to analyze the feasibility of robotic hysterectomy in patients with enlarged uteri and the impact of uterine weight on surgical outcomes and on operative time length.
PATIENTS AND METHODS
One hundred and thirty-eight patients who underwent robotic hysterectomy for benign indications at the 2nd Division of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria Pisana, University of Pisa were consecutively enrolled.
RESULTS
Data of patients undergoing robotic surgery for benign indications were collected. Patients were stratified in two groups based on their uterine weight, to analyze the effective impact of uterine weight and dimension on surgical performance, operative time and postoperative outcomes. Conversion rate was 0%. Median uterine weight was 615 g (range 400-1900 g). Median total operating time was 131 minutes (range 70-255 minutes). Increase in uterine weight significantly increased operative times (p=0.003) and morcellation time (p=0.001). On the other hand, operative time was just partially influenced by route for removal of the uterus (p=0.085) but significantly affected by uterine weight (p=0.008), previous surgeries (p=0.003) and BMI of the patient (p=0.005).
CONCLUSIONS
Robotic hysterectomy is feasible and safe for challenging cases as large uteri. This technique could enable patients with outsized uteri, not suitable for vaginal hysterectomy, to undergo minimally invasive surgery with excellent results. Larger studies to investigate and compare robotic with other surgical approaches for difficult hysterectomies are needed to confirm these data.
Topics: Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Laparoscopy; Leiomyoma; Organ Size; Postoperative Complications; Retrospective Studies; Robotic Surgical Procedures; Urogenital Abnormalities; Uterus
PubMed: 35253179
DOI: 10.26355/eurrev_202202_28115 -
BMJ (Clinical Research Ed.) Jun 2005To evaluate the most appropriate surgical method of hysterectomy (abdominal, vaginal, or laparoscopic) for women with benign disease. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate the most appropriate surgical method of hysterectomy (abdominal, vaginal, or laparoscopic) for women with benign disease.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
Cochrane Menstrual Disorders and Subfertility Group Trials Register, Cochrane Central Register of Controlled Trials, Medline, Embase, and Biological Abstracts.
SELECTION OF STUDIES
Only randomised controlled trials were selected; participants had to have benign gynaecological disease; interventions had to comprise at least one hysterectomy method compared with another; and trials had to report primary outcomes (time taken to return to normal activities, intraoperative visceral injury, and major long term complications) or secondary outcomes (operating time, other immediate complications of surgery, short term complications, and duration of hospital stay).
RESULTS
27 trials (total of 3643 participants) were included. Return to normal activities was quicker after vaginal than after abdominal hysterectomy (weighted mean difference 9.5 (95% confidence interval 6.4 to 12.6) days) and after laparoscopic than after abdominal hysterectomy (difference 13.6 (11.8 to 15.4) days), but was not significantly different for laparoscopic versus vaginal hysterectomy (difference -1.1 (-4.2 to 2.1) days). There were more urinary tract injuries with laparoscopic than with abdominal hysterectomy (odds ratio 2.61 (95% confidence interval 1.22 to 5.60)), but no other intraoperative visceral injuries showed a significant difference between surgical approaches. Data were notably absent for many important long term patient outcome measures, where the analyses were underpowered to detect important differences, or they were simply not reported in trials.
CONCLUSIONS
Significantly speedier return to normal activities and other improved secondary outcomes (shorter duration of hospital stay and fewer unspecified infections or febrile episodes) suggest that vaginal hysterectomy is preferable to abdominal hysterectomy where possible. Where vaginal hysterectomy is not possible, laparoscopic hysterectomy is preferable to abdominal hysterectomy, although it brings a higher chance of bladder or ureter injury.
Topics: Female; Humans; Hysterectomy; Intraoperative Complications; Laparoscopy; Length of Stay; Randomized Controlled Trials as Topic; Treatment Outcome; Urinary Tract
PubMed: 15976422
DOI: 10.1136/bmj.330.7506.1478 -
JSLS : Journal of the Society of... 2011To compare the incidence of perioperative complications and postoperative healthcare utilization and costs in laparoscopic supracervical hysterectomy (LSH) versus... (Comparative Study)
Comparative Study
OBJECTIVES
To compare the incidence of perioperative complications and postoperative healthcare utilization and costs in laparoscopic supracervical hysterectomy (LSH) versus laparoscopic-assisted vaginal hysterectomy (LAVH) patients.
METHODS
Women 18 years with LSH or LAVH were extracted using a large national commercial claims database from 1/1/2007 through 9/30/2008. Outcome was perioperative complications and gynecologic-related postoperative resource use and costs. Multivariate analysis was performed to compare postsurgical outcomes between the cohorts.
RESULTS
The final sample consisted of 6,198 LSH patients and 14,181 LAVH patients. LSH patients were significantly more likely to have dysfunctional uterine bleeding and leiomyomas and less likely to have endometriosis and prolapse as the primary diagnosis, and also significantly more likely to have a uterus that weighed 250 grams than LAVH patients. Compared with LAVH patients, LSH patients had significantly lower overall infection rates (7.4% versus 6.2%, P .002) and lower total gynecologic related postoperative costs ($252 versus $385, P .001, within 30 days of follow-up and $350 versus $569, P .001, within 180 days of follow-up). Significant cost differences remained following multivariate adjustment for patient characteristics.
CONCLUSIONS
LSH patients demonstrated fewer perioperative complications and lower GYN-related postoperative costs compared to LAVH patients.
Topics: Adolescent; Adult; Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Incidence; Laparoscopy; Middle Aged; Multivariate Analysis; Postoperative Complications; Treatment Outcome; United States
PubMed: 22643499
DOI: 10.4293/108680811X13176785203716 -
JSLS : Journal of the Society of... 2013The aim of our study is to evaluate the role of electrosurgery and vaginal closure technique in the development of postoperative vaginal cuff dehiscence.
BACKGROUND AND OBJECTIVES
The aim of our study is to evaluate the role of electrosurgery and vaginal closure technique in the development of postoperative vaginal cuff dehiscence.
METHODS
From prospective surgical databases, we identified 463 patients who underwent total laparoscopic hysterectomy (TLH) for benign disease and 147 patients who underwent laparoscopic-assisted vaginal hysterectomy (LAVH) for cancer. All TLHs and LAVHs were performed entirely by use of electrosurgery, including colpotomy. Colpotomy in the TLH group was performed with Harmonic Ace Curved Shears (Ethicon Endo-Surgery, Cincinnati, OH, USA), and in the LAVH group, it was performed with a monopolar electrosurgical pencil. The main surgical difference was vaginal cuff closure--laparoscopically in the TLH group and vaginally in the LAVH group.
RESULTS
Although patients in the LAVH group were at increased risk for poor healing (significantly older, higher body mass index, more medical comorbidities, higher blood loss, and longer operative time), there were no vaginal cuff dehiscences in the LAVH group compared with 17 vaginal cuff dehiscences (4%) in the TLH group (P = .02).
CONCLUSION
It does not appear that the increased vaginal cuff dehiscence rate associated with TLH is due to electrosurgery; rather, it is due to the vaginal closure technique.
Topics: Adult; Aged; Aged, 80 and over; Colpotomy; Electrosurgery; Female; Humans; Hysterectomy, Vaginal; Laparoscopy; Middle Aged; Prospective Studies; Surgical Wound Dehiscence; Treatment Outcome; Vagina
PubMed: 24018078
DOI: 10.4293/10860813X13693422518515 -
Archives of Gynecology and Obstetrics Oct 2015Some studies suggest that also regarding the patient with a body mass index (BMI) ≥35 kg/m(2) the minimally invasive approach to hysterectomy is superior. However,... (Review)
Review
PURPOSE
Some studies suggest that also regarding the patient with a body mass index (BMI) ≥35 kg/m(2) the minimally invasive approach to hysterectomy is superior. However, current practice and research on the preference of gynaecologists still show that the rate of abdominal hysterectomy (AH) increases as the BMI increases. A systematic review with cumulative analysis of comparative studies was performed to evaluate the outcomes of AH, laparoscopic hysterectomy (LH) and vaginal hysterectomy (VH) in very obese and morbidly obese patients (BMI ≥35 kg/m(2)).
METHODS
PubMed and EMBASE were searched for records on AH, LH and VH for benign indications or (early stage) malignancy through October 2014. Included studies were graded on level of evidence. Studies with a comparative design were pooled in a cumulative analysis.
RESULTS
Two randomized controlled trials, seven prospective studies and 14 retrospective studies were included (2232 patients; 1058 AHs, 959 LHs, and 215 VHs). The cumulative analysis identified that, compared to LH, AH was associated with more wound dehiscence [risk ratio (RR) 2.58, 95 % confidence interval (CI) 1.71-3.90; P = 0.000], more wound infection (RR 4.36, 95 % CI 2.79-6.80; P = 0.000), and longer hospital admission (mean difference 2.9 days, 95 % CI 1.96-3.74; P = 0.000). The pooled conversion rate was 10.6 %. Compared to AH, VH was associated with similar advantages as LH.
CONCLUSIONS
Compared to AH, both LH and VH are associated with fewer postoperative complications and shorter length of hospital stay. Therefore, the feasibility of LH and VH should be considered prior the abdominal approach to hysterectomy in very obese and morbidly obese patients.
Topics: Adult; Female; Genital Diseases, Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Laparoscopy; Length of Stay; Middle Aged; Morbidity; Obesity; Obesity, Morbid; Operative Time; Postoperative Complications; Treatment Outcome
PubMed: 25773357
DOI: 10.1007/s00404-015-3680-7 -
JPMA. the Journal of the Pakistan... Apr 2024This retrospective cohort study analysed the trends and complications of vaginal hysterectomy conducted at Services Hospital, Lahore, from January 1, 2015 to December...
This retrospective cohort study analysed the trends and complications of vaginal hysterectomy conducted at Services Hospital, Lahore, from January 1, 2015 to December 31, 2020. Demographics, indications, surgery duration, complications (haemorrhage, urological or rectal problems, infection), and hospital stay were recorded. Out of 819 hysterectomies performed for benign gynaecological conditions, 112 (13.68%) were vaginal hysterectomies. Non-descent vaginal hysterectomy (NDVH) accounted for 33(29.46%) and uterine prolapse for 79(70.53%) of the cases. Mean age was 52.35±8.74 years, parity was 5.01±1.32, intraoperative haemorrhage was 796.87±450.1 ml, surgery duration was 48.61±12.28 minutes, and hospital stay was 2.58±0.41 days. Complications occurred in 19(16.97%) of the cases, while 93(83.03%) cases had no complications. Outcomes were comparable between NDVH and vaginal hysterectomy for prolapse (p=0.552). This indicates that vaginal hysterectomy is a safe procedure with minimal complications and quick recovery for uterine prolapse and non-descent uterus. However, a declining trend was observed over the study period.
Topics: Humans; Female; Hysterectomy, Vaginal; Middle Aged; Retrospective Studies; Tertiary Care Centers; Uterine Prolapse; Postoperative Complications; Adult; Operative Time; Length of Stay; Pakistan; Blood Loss, Surgical; Gynecology
PubMed: 38751279
DOI: 10.47391/JPMA.9728 -
Journal of Minimally Invasive Gynecology Jun 2022To evaluate whether the addition of pharmacologic prophylaxis to mechanical prophylaxis for venous thromboembolism (VTE) is associated with changes in perioperative...
STUDY OBJECTIVE
To evaluate whether the addition of pharmacologic prophylaxis to mechanical prophylaxis for venous thromboembolism (VTE) is associated with changes in perioperative outcomes in hysterectomy for benign indications.
DESIGN
Retrospective cohort study.
SETTING
Michigan Surgical Quality Collaborative database.
PATIENTS
Patients who underwent hysterectomy between July 2012 and June 2015 when VTE prophylaxis data were collected.
INTERVENTIONS
Patients who received mechanical prophylaxis alone were compared with those receiving dual prophylaxis (mechanical and pharmacologic). Minimally invasive surgeries (MIS) included laparoscopic, vaginal, robotic-assisted, and laparoscopic-assisted vaginal hysterectomies and were analyzed separately from abdominal (ABD) hysterectomy.
MEASUREMENTS AND MAIN RESULTS
Propensity score matching was used to minimize confounding because of the differences in demographic and perioperative characteristics. The primary outcome was estimated blood loss (EBL). The secondary outcomes were operative time, postoperative blood transfusion, VTE, surgical site infection, reoperation, readmission, and death. There were 1803 matched pairs in the MIS analysis. In the ABD hysterectomy analysis, 2:1 matching was used with a total of 1168 patients receiving mechanical prophylaxis alone matched to 616 patients receiving dual prophylaxis. EBL was higher by 54.5 mL (95% confidence interval [CI], 16.9-92.1) in those receiving dual prophylaxis in the ABD hysterectomy analysis but did not differ between groups in the MIS analysis. Operative time was significantly longer with dual prophylaxis in both MIS (18.3 minutes; 95% CI, 13.8-22.8) and ABD (15.3 minutes; 95% CI, 9.0-21.6) surgical approaches. There was no difference in other secondary outcomes.
CONCLUSION
The addition of pharmacologic prophylaxis to mechanical prophylaxis in benign hysterectomy was associated with longer operative time, regardless of surgical approach and increased EBL in ABD hysterectomy. Given very low rates of VTE, no difference in other perioperative outcomes, and possible harm, it seems reasonable to encourage individualized rather than routine use of pharmacologic prophylaxis in patients undergoing benign hysterectomy receiving mechanical prophylaxis.
Topics: Anticoagulants; Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Laparoscopy; Postoperative Complications; Retrospective Studies; Venous Thromboembolism
PubMed: 35227913
DOI: 10.1016/j.jmig.2022.02.009 -
MMWR. CDC Surveillance Summaries :... Aug 1997In the United States, approximately 600,000 hysterectomies are performed each year, and the procedure is the second most frequently performed major surgical procedure...
PROBLEM/CONDITION
In the United States, approximately 600,000 hysterectomies are performed each year, and the procedure is the second most frequently performed major surgical procedure among reproductive-aged women.
REPORTING PERIOD COVERED
1980-1993.
DESCRIPTION OF SYSTEM
This surveillance system uses data obtained from CDC's National Hospital Discharge Survey (NHDS) to describe the epidemiology of hysterectomy. The NHDS is an annual probability sample of discharges from non-Federal, short-stay hospitals in the United States.
RESULTS
In the United States during 1980-1993, an estimated 8.6 million women aged > or =15 years had a hysterectomy. The overall rate of hysterectomy declined slightly from 1980 (7.1 hysterectomies per 1,000 women) to 1987 (6.6 per 1,000 women). The redesign of the NHDS in 1988 resulted in a decrease in estimated rates (i.e., the average annual rate for 1988-1993 was 5.5 per 1,000 women). Rates differed by age, with women aged 40-44 years most likely to have this procedure. Overall annual rates of hysterectomy did not differ significantly by race. The diagnosis most often associated with hysterectomy was uterine leiomyoma; during 1988-1993, this diagnosis accounted for 62% of hysterectomies among black women, 29% among white women, and 45% among women of other races. During 1988-1993, the percentage of hysterectomies performed by the vaginal route increased significantly; furthermore, an increasingly higher percentage of vaginal hysterectomies were accompanied by bilateral oophorectomy. From 1991 through 1993, laparoscopy was associated more frequently with vaginal hysterectomy than in previous years.
INTERPRETATION
The rate of hysterectomy decreased slightly during the first half of the 14-year surveillance period, then leveled off during the second half. The increase in simultaneous coding of laparoscopy and vaginal hysterectomy on hospital discharge forms probably reflected the growing use of laparoscopically assisted vaginal hysterectomy.
ACTIONS TAKEN
Continued surveillance for hysterectomy will enable changes in clinical practice (e.g., the use of LAVH) to be identified, and information derived from the surveillance system may assist in directing biomedical assessment priorities (e.g., to determine the reasons for race-specific differences in the prevalence of uterine leiomyoma).
Topics: Adolescent; Adult; Aged; Endometrial Hyperplasia; Endometriosis; Female; Humans; Hysterectomy; Middle Aged; Population Surveillance; United States; Uterine Neoplasms
PubMed: 9259214
DOI: No ID Found