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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 -
JSLS : Journal of the Society of... 2012To estimate the incidence of operative complications and compare operative cost and overall cost of different methods of benign hysterectomy including abdominal,... (Comparative Study)
Comparative Study
BACKGROUND AND OBJECTIVES
To estimate the incidence of operative complications and compare operative cost and overall cost of different methods of benign hysterectomy including abdominal, vaginal, laparoscopic, and robotic techniques.
METHODS
We performed a retrospective cohort analysis (Canadian Task Force classification II-2) of all patients who underwent a hysterectomy for benign reasons in 2009 at a single urban academic tertiary care center using the χ(2) test and Student t test. A multivariate regression analysis was also performed for predictors of costs. Cost data were gathered from the hospital's billing system; the remainder of data was extracted from patient's medical records.
RESULTS
In 2009, 688 patients underwent a benign hysterectomy; 185 (26.9%) hysterectomies were abdominal, 135 (19.6%) vaginal, 352 (51.5%) laparoscopic, and 14 (2.0%) robotic. The rate of intraoperative complication was 1.7% for abdominal, 0.8% for vaginal, 0.3% for laparoscopic, and 0 for robotic. Mean total patient costs were $43,622 for abdominal, $31,934 for vaginal, $38,312 for laparoscopic, and $49,526 for robotic hysterectomies. Costs were significantly influenced by method of hysterectomy, operative time, and length of stay.
CONCLUSION
Though complication rates did not vary significantly among minimally invasive methods of hysterectomy, patient costs were significantly influenced by the method of hysterectomy.
Topics: Cost of Illness; Costs and Cost Analysis; Female; Genital Diseases, Female; Hospital Costs; Humans; Hysterectomy; Hysterectomy, Vaginal; Laparoscopy; Length of Stay; Middle Aged; Retrospective Studies; Robotics; United States
PubMed: 23484557
DOI: 10.4293/108680812X13462882736736 -
Acta Obstetricia Et Gynecologica... Mar 2011We evaluated the operative and postoperative morbidity among 103 women who underwent total laparoscopic hysterectomy and 107 others who underwent laparoscopically... (Comparative Study)
Comparative Study
We evaluated the operative and postoperative morbidity among 103 women who underwent total laparoscopic hysterectomy and 107 others who underwent laparoscopically assisted vaginal hysterectomy. Blood loss was significantly greater in the assisted vaginal hysterectomy group (178.0 ± 12.1 ml) than in the total hysterectomy group (130.2 ± 10.7 ml) (p < 0.001). Despite higher uterine weight in the total hysterectomy group, the operative time of both techniques was similar. The complications of both hysterectomies were also comparable. The results from our study suggest that the complication rates of laparoscopically assisted vaginal hysterectomy and total hysterectomy are similar. However, laparoscopically assisted vaginal hysterectomy is associated with increased blood loss.
Topics: Adult; Blood Loss, Surgical; Comorbidity; Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Laparoscopy; Length of Stay; Middle Aged; Postoperative Complications; Uterine Diseases; Women's Health
PubMed: 21306312
DOI: 10.1111/j.1600-0412.2010.01047.x -
JSLS : Journal of the Society of... 2014The goal of this study is to obtain updated surveillance statistics for hysterectomy procedures in the United States and identify factors associated with undergoing a...
BACKGROUND AND OBJECTIVES
The goal of this study is to obtain updated surveillance statistics for hysterectomy procedures in the United States and identify factors associated with undergoing a minimally invasive approach to hysterectomy.
METHODS
A cross-sectional analysis of the 2009 United States Nationwide Inpatient Sample was performed. Subjects included all women aged 18 years or older who underwent hysterectomy of any type. Logistic regression and multivariate analyses were performed to assess the proportion of hysterectomies performed by various routes, as well as factors associated with undergoing minimally invasive surgery (laparoscopic, vaginal, or robotic).
RESULTS
A total of 479,814 hysterectomies were performed in the United States in 2009, 86.6% of which were performed for benign indications. Among the hysterectomies performed for benign indications, 56% were completed abdominally, 20.4% were performed laparoscopically, 18.8% were performed vaginally, and 4.5% were performed with robotic assistance. Factors associated with decreased odds of a minimally invasive hysterectomy included the following: minority race (P<.0001), fibroids (P<.0001), concomitant adnexal surgery (P<.0001), self-pay (P=.01) or Medicaid as insurer (P<.0001), and increased severity of illness (P<.0001). Factors associated with increased odds of a minimally invasive hysterectomy included the following: age>50 years (P<.0001), prolapse or menstrual disorder (P<.0001), median household income of $48,000-$62,999 (P=.007) or ≥$63,000 (P=.009), and location in the West (P=.02). A length of stay>1 day was most common in abdominal hysterectomy cases (96.1%), although total mean charges were highest for robotic cases ($38,161).
CONCLUSION
The US hysterectomy incidence in 2009 decreased from prior years' reports, with an increasing frequency of laparoscopic and robotic approaches. Racial and socioeconomic factors influenced hysterectomy mode.
Topics: Adolescent; Adult; Aged; Cross-Sectional Studies; Female; Humans; Hysterectomy, Vaginal; Incidence; Laparoscopy; Leiomyoma; Middle Aged; Postoperative Complications; Robotics; United States; Uterine Neoplasms
PubMed: 25392662
DOI: 10.4293/JSLS.2014.00096 -
Mayo Clinic Proceedings Feb 2010To explore the influence of referral bias on complication rates after vaginal hysterectomy. (Comparative Study)
Comparative Study
OBJECTIVE
To explore the influence of referral bias on complication rates after vaginal hysterectomy.
PATIENTS AND METHODS
Community-based (local) and referral patients had benign indications and underwent vaginal hysterectomy from January 1, 2004, through December 31, 2005. We retrospectively evaluated patient characteristics, surgical procedures, and complications that occurred within 9 weeks after the index surgery. Complications were defined as admission to the intensive care unit, reoperation, hospital readmission, or medical intervention.
RESULTS
Of 736 patients, 361 (49.0%) were referred from outside the immediate 7-county area. Compared with local patients, referral patients were older (mean age, 54.5 vs 49.3 years; P<.001) and had lower body mass index (mean, 27.6 vs 28.7 kg/m2; P=.02). More referral patients had cardiovascular disease (4.2% vs 0.5%; P=.001) and prior myocardial infarctions (1.9% vs 0%; P=.007). Referral patients also had higher American Society of Anesthesiologists scores (score of 3 or 4, 12.6% vs 7.0%; P=.01) and longer length of hospitalization (mean, 2.6 vs 2.2 days; P<.001), and more underwent pelvic reconstruction (52.1% vs 41.3%; P=.004). Fewer referral patients had private insurance (74.5% vs 89.6%; P<.001). Despite these differences, overall complication rates were similar for referral and local patients (33.4% vs 29.7%; P=.28).
CONCLUSION
Although referral patients had more comorbid conditions than local patients, the groups had similar complication rates after vaginal hysterectomy.
Topics: Academic Medical Centers; Age Factors; Bias; Body Mass Index; Comorbidity; Critical Care; Female; Humans; Hysterectomy, Vaginal; Insurance, Health; Length of Stay; Middle Aged; Minnesota; Patient Readmission; Patient Selection; Referral and Consultation; Reoperation; Retrospective Studies; Risk Factors; Statistics, Nonparametric; Treatment Outcome
PubMed: 20118390
DOI: 10.4065/mcp.2009.0299 -
Case Reports in Women's Health Jul 2021Pelvic inflammatory disease after hysterectomy is rare and the underlying route of infection is highly heterogeneous. We report the case of a 52-year-old woman with a...
Pelvic inflammatory disease after hysterectomy is rare and the underlying route of infection is highly heterogeneous. We report the case of a 52-year-old woman with a history of vaginal hysterectomy for uterine prolapse admitted to the emergency department with acute abdominal pain and fever. Vaginal discharge and pelvic tenderness were evident in the clinical examination. Ultrasound and computed tomography scans showed a cystic pelvic mass in contact with the vaginal cuff, suggesting the diagnosis of pelvic inflammatory disease. Laparoscopic examination revealed a bilateral tubo-ovarian abscess firmly attached and fistulized to the vaginal cuff, and after tubal removal and antibiotic coverage the patient had an optimal recovery. We performed a review of the case reports published on this subject, and concluded that pelvic inflammatory disease should not be excluded in patients with a history of hysterectomy when symptoms and findings are compatible.
PubMed: 34178608
DOI: 10.1016/j.crwh.2021.e00335 -
Obstetrics and Gynecology Apr 2020To evaluate the rate of vaginal hysterectomy and outcomes after initiation of a prospective decision-tree algorithm to determine the optimal surgical route of...
OBJECTIVE
To evaluate the rate of vaginal hysterectomy and outcomes after initiation of a prospective decision-tree algorithm to determine the optimal surgical route of hysterectomy.
METHODS
A prospective algorithm to determine optimal route of hysterectomy was developed, which uses the following factors: history of laparotomy, uterine size, and vaginal access. The algorithm was implemented at our institution from November 24, 2015, to December 31, 2017, for patients requiring hysterectomy for benign indications. Expected route of hysterectomy was assigned by the algorithm and was compared with the actual route performed to identify compliance compared with deviation. Surgical outcomes were analyzed.
RESULTS
Of 365 patients who met inclusion criteria, 202 (55.3%) were expected to have a total vaginal hysterectomy, 57 (15.6%) were expected to have an examination under anesthesia followed by total vaginal hysterectomy, 52 (14.2%) were expected to have an examination under anesthesia followed by robotic-assisted total laparoscopic hysterectomy, and 54 (14.8%) were expected to have an abdominal or robotic-laparoscopic route of hysterectomy. Forty-six procedures (12.6%) deviated from the algorithm to a more invasive route (44 robotic, two abdominal). Seven patients had total vaginal hysterectomy when robotic-assisted total laparoscopic hysterectomy or abdominal hysterectomy was expected by the algorithm. Overall, 71% of patients were expected to have a vaginal route of hysterectomy per the algorithm, of whom 81.5% had a total vaginal hysterectomy performed; more than 99% of the total vaginal hysterectomies attempted were successfully completed.
CONCLUSION
Vaginal surgery is feasible, carries a low complication rate with excellent outcomes, and should have a place in gynecologic surgery. National use of this prospective algorithm may increase the rate of total vaginal hysterectomy and decrease health care costs.
Topics: Adult; Algorithms; Decision Support Techniques; Decision Trees; Female; Gynecology; Humans; Hysterectomy; Predictive Value of Tests; Prospective Studies
PubMed: 32168206
DOI: 10.1097/AOG.0000000000003725 -
Acta Obstetricia Et Gynecologica... Jun 2022Vaginal natural orifice transluminal endoscopic surgery (NOTES) is a novel technique for minimally invasive gynecological surgery. Adequate training and standardization... (Review)
Review
Vaginal natural orifice transluminal endoscopic surgery (NOTES) is a novel technique for minimally invasive gynecological surgery. Adequate training and standardization are key elements to patient safety and quality of care. Based on consensus statements and expert opinion; we report a step-by-step guidance for hysterectomy via natural orifice transluminal endoscopy. A detailed description is presented of pre- and postoperative care, and the instruments and equipment used, and surgical steps are illustrated by photographic images. This report can guide surgeons in their training to perform a hysterectomy via NOTES.
Topics: Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Laparoscopy; Minimally Invasive Surgical Procedures; Natural Orifice Endoscopic Surgery; Surgeons; Vagina
PubMed: 35451501
DOI: 10.1111/aogs.14367 -
Ginekologia Polska 2017To assess the safety and efficacy of electrosurgical bipolar vessel sealing during vaginal hysterectomy in morbidly obese patients MATERIAL AND METHODS: A total of 105...
OBJECTIVES
To assess the safety and efficacy of electrosurgical bipolar vessel sealing during vaginal hysterectomy in morbidly obese patients MATERIAL AND METHODS: A total of 105 morbidly obese patients who underwent vaginal hysterectomy due to benign gynecologic pathologies between January 2010 and April 2017 were included in the study. Patients were divided into two groups according to whether conventional suture ligation technique (n = 64) or electrosurgical bipolar vessel sealing (n = 41) were used during vaginal hysterectomy. The surgical procedure was performed with the same technique in both study groups. The primary outcomes were duration of surgery and estimated blood loss. The secondary outcomes were intra-operative complications and post-operative complications.
RESULTS
The duration of surgery and estimated blood loss in the vessel sealing group was significantly less than in the conventional suture group (p < 0.05). No significant difference was present between the two groups in the rate of intra-operative and post-operative complications.
CONCLUSIONS
The primary outcome of our study is that the EBVS system can be used equally and even more effectively in some aspects; and as safe an alternative approach to conventional suture ligation technique during vaginal hysterectomies performed specifically on morbidly obese patients with reduced operation times and blood loss, and without increasing the complication rates.
Topics: Blood Loss, Surgical; Cohort Studies; Electrosurgery; Female; Humans; Hysterectomy, Vaginal; Ligation; Middle Aged; Obesity, Morbid; Postoperative Complications; Retrospective Studies; Safety; Suture Techniques
PubMed: 29192412
DOI: 10.5603/GP.a2017.0096 -
BioMed Research International 2022LACC trial demonstrated inferiority of laparoscopic approach for the treatment of early-stage cervical cancer. There are still limited data from retrospective trials... (Observational Study)
Observational Study
BACKGROUND
LACC trial demonstrated inferiority of laparoscopic approach for the treatment of early-stage cervical cancer. There are still limited data from retrospective trials regarding whether survival outcomes after laparoscopic radical hysterectomy are equivalent to those after open abdominal radical hysterectomy. In this study, we present results of combined vaginal radical laparoscopic hysterectomy in the treatment of early-stage cervical cancer.
METHODS
This retrospective study was carried out at the Department of Gynecology in Mathilden Hospital (Herford, Germany). Between January 2008 and April 2018, all the patients with invasive cervical cancer who underwent combined vaginal assisted radical laparoscopic hysterectomy (VARLH) without the use of any uterine manipulator were enrolled to the study.
RESULTS
A total number of 124 patients with diagnosis of invasive cervical cancer were enrolled in the study. All of the patients underwent minimally invasive surgery and were divided according to FIGO 2019: stage IA (25.9%), IB1 (25.0%), IB2-IIB (28.4%), and III/IV (20.7%). Overall, the mean age of the patients was 51.84 years. After a study collection, a median follow-up was 45.6 (range 23.7-76.5) months. The 3- and 5-year disease-free survival rates for early-stage cervical cancer were both 98%, and the 3- and 5-year overall survival rates were 100% and 97%, respectively. We have not observed any recurrence in our study group of patients with early-stage cervical cancer.
CONCLUSIONS
Combined VARLH can be considered a safe and effective procedure for the treatment of early-stage cervical cancer. Surgical strategy with oncological principles determines the quality and long-term success of the operation in early cervical cancer regardless of laparoscopic approach.
Topics: Adult; Aged; Disease-Free Survival; Female; Follow-Up Studies; Humans; Hysterectomy, Vaginal; Laparoscopy; Middle Aged; Retrospective Studies; Survival Rate; Uterine Cervical Neoplasms
PubMed: 35047636
DOI: 10.1155/2022/5163886