Comparison of Lower Urinary Tract Function Before and After Undergoing Open Abdominal Hysterectomy: A Prospective Cohort Study

Robot-assisted laparoscopic radical hysterectomy: Comparison with total laparoscopic hysterectomy and abdominal radical hysterectomy; one surgeon's experience at the Norwegian Radium Hospital

A randomized study of total abdominal, vaginal and laparoscopic hysterectomy

Aim: To systematically review published data on vault prolapse occurrence after total laparoscopic hysterectomy versus abdominal hysterectomy for benign uterine pathology. Materials and Methods: Medline and PubMed were searched for clinical studies reporting on vault prolapse occurrence after laparoscopic or abdominal hysterectomy. The studies included were randomized and non-randomized clinical trials reporting on the occurrence of vaginal vault prolapse as a long-term complication of either abdominal or laparoscopic hysterectomy for nonmalignant conditions. Results: The search yielded only one study reporting on vaginal cuff prolapse after laparoscopic assisted vaginal hysterectomy (LAVH) or total abdominal hysterectomy (TAH). The additional articles that were retrieved using the ‘search for related articles’ function as well as from references of eligible studies were 581. Of these, 473 studies were excluded by title, 45 by abstract, 32 by full text, seven for which the full text could not be retrieved, and 24 by language. For this study two groups of women were followed up after LAVH (n=150) and TAH (n=146). No statistically significant difference in the likelihood of vault prolapse was revealed between the two groups (p = 0.592).Conclusion: In the literature, various measures are recommended to avoid vaginal vault prolapse such as the suspension of the vaginal apex to the cardinal and uterosacral ligament or to the sacrospinous ligaments at the time of hysterectomy. More studies are needed with a greater number of cases and longer follow up to assess whether abdominal or laparoscopic hysterectomy is more appropriate to prevent vaginal vault prolapse.

Scores and Misses With New Technology—Walking the Narrow Path of Evidence

Summary Selection of an appropriate surgical method for hysterectomy in an individual patient is currently an issue that remains open and debatable. This study aimed to analyze perioperative outcomes in gynecologic patients who underwent laparoscopic hysterectomy at a single institution during a 6-year period and to compare the data for simple hysterectomy patients treated with different surgical approaches. The study included a retrospective analysis of demographics, pre- and post-operative characteristics of 1,023 patients, operated on using four types of simple hysterectomy approaches: 635 laparoscopic hysterectomies (62.1%), 289 total abdominal hysterectomies (28.3%), 45 total vaginal hysterectomies (4.4%) and 54 robotic-assisted hysterectomies (5.3%). For the laparoscopic hysterectomy group, the mean operative time was shorter as compared to the abdominal and vaginal hysterectomy groups (p<0.05), as well as a significantly shorter hospital length-of-stay when compared to the abdominal, robotic or vaginal hysterectomy groups (p<0.05). Regression analysis revealed significant linear correlation between operative time and body-mass index of laparoscopic hysterectomy patients (R2 =0.008; p=0.026). Complications emergence and hemotransfusion often prolonged the mean operative time significantly by 17.8 min (p=0.002) and 15.5 min, respectively (p<0.001). The rate of major complications was significantly higher in the laparoscopic vs. abdominal groups (p<0.05). Clinical outcomes in patients operated on with laparoscopic hysterectomy were better than in those operated with total abdominal and vaginal hysterectomy in terms of operative time and hospital length-of-stay. Prospective randomized multi-center studies would be desirable to further define the place of the modern minimally invasive hysterectomy approaches.

To assess the feasibility and outcome of laparoscopic supracervical hysterectomy with removal of the cervical transformation zone. A prospective clinical study. The department of Gynaecology, Royal Surrey County Hospital, Guildford. Eleven consecutive women who were on the waiting list for abdominal hysterectomy and fulfilled the selection criteria. Laparoscopic supracervical hysterectomy using a modification of the classical abdominal supracervical hysterectomy technique with removal of the cervical transformation zone. Operating time, blood loss, duration of hospital stay, time to full recovery and complications. All 11 procedures were successfully completed laparoscopically. The mean operating time was 111 min, and mean blood loss was 185 ml. The mean duration of hospital stay was three days, and the mean time to full recovery was 20 days. There were no major complications. Laparoscopic supracervical hysterectomy appears to result in a shorter hospital stay and more rapid recovery than total abdominal hysterectomy. This shortened convalescence is of benefit to the patient. The operation appears to be safe when carried out by surgeons experienced in laparoscopic surgery. A randomised comparative study with total abdominal hysterectomy is currently being undertaken.

Postmenopausal vaginal bleeding is a rare presentation of Krukenberg tumor (KT). Here we report a very unusual presentation of gastric cancer in a postmenopausal female patient, who presented with complaint of vaginal bleeding. She was found to have KT of the left ovary after total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO). She was subsequently diagnosed with primary gastric cancer. To the best of our knowledge, this is the first case report of KT with a primary T1a gastric cancer and no evidence of metastasis anywhere else except for large ovarian mass.

Minimally invasive hysterectomy for stage IA cervical carcinoma: a survival analysis of the National Cancer database

ABSTRACTOBJECTIVETo analyze the costs of hysterectomies performed in Brazil due to benign conditions, and to assess its hospital admittance and mortality rates.METHODSA retrospective cohort was carried out from January 2010 to December 2014, analyzing all hysterectomies (n = 428,346) registered on the DATASUS database between January 2010 and December 2014. Data were collected through a structured questionnaire and analyzed using the SPSS 20.0 for Windows.RESULTSHospital admissions were 300,231 for total abdominal hysterectomies, 46,056 for vaginal hysterectomies, 29,959 for subtotal abdominal hysterectomies and 1,522 for laparoscopic hysterectomies. Mortality rates were 0.26%, 0.09%, 0.07% and 0.05% for subtotal, total abdominal, laparoscopic, and vaginal hysterectomies, respectively. Among the procedures studied, total abdominal hysterectomies had the most costs (R$217,802,574.77), followed by vaginal hysterectomies (R$24,173,490.00), subtotal abdominal hysterectomies (R$19.253.300,00) and laparoscopic hysterectomies (R$794,680.40).CONCLUSIONSTotal abdominal hysterectomies had the highest overall costs mainly because it was the most commonly performed technique. Mortality rates were greatest in subtotal abdominal hysterectomies; this, however, may be due to bias related to missing data in our database.

A proof-of-concept randomized phase 2 non-inferiority trial on simple versus modified radical hysterectomy in IA2-IB1 cervical cancer ≤2cm (LESSER)

From 1965 through 1980, 193 patients with histologically proven endometrial carcinoma, FIGO-AJC Stage I-III, received preoperative radiation therapy. One hundred forty-two patients had Stage I (G1:41, G2:68, G3:33), 47 Stage II, and 4 Stage III endometrial carcinoma. All patients were treated with preoperative radiation therapy (intracavitary application, external pelvic irradiation or both) followed by total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO). They were followed from 3 to 18 years (median, 6.2 years) after the completion of the treatment and none was lost to follow-up. Overall 5-year actuarial disease-free survival was 85%. The interval between the completion of radiation therapy and TAH-BSO ranged from 3 days to 123 days (median, 40 days). Five-year and 10-year survivals were 95% among 65 patients who did not have residual cancer in the hysterectomy specimen compared to 75% and 70%, respectively, among 128 patients who had positive hysterectomy specimens (P less than 0.01). The presence or absence of residual carcinoma in the surgical specimen after preoperative irradiation was the only important prognostic variable. The most significant factors associated with residual cancer cells were the interval from the completion of radiation therapy to TAH-BSO (P less than 0.001) and the method of preoperative irradiation in patients with Stage I Grade 3 and Stage II external pelvic irradiation was less frequently associated with residual cancer than intracavitary applications (P = 0.043). With one exception, all patients who failed had residual cancer in the hysterectomy specimen. The depth of myometrial invasion of residual tumor in the hysterectomy specimen after preoperative irradiation was correlated to the frequency of failures (P = less than 0.05). Failures were distributed equally among the pelvis, para-aortic nodes, and distant sites. Complications of treatment were infrequent (7%) and were mild; no fatal complications were seen. The data suggest an optimal interval for hysterectomy is 29 to 42 days after completion of radiation therapy in unfavorable carcinomas of the endometrium. These patients also benefit from external pelvic irradiation with or without intracavitary applications as this therapy provides the highest probability there will be no residual cancer cells in the surgical specimen.

Clinical stage I endometrial cancer: Results of adjuvant irradiation and patterns of failure

Preoperative radiation therapy in clinical stage II endometrial carcinoma

Omission of lymphadenectomy is possible for low-risk corpus cancer

Effective Treatment of Stage I Uterine Papillary Serous Carcinoma with High Dose-Rate Vaginal Apex Radiation ( 192Ir) and Chemotherapy