Abdominal Supracervical Hysterectomy Research Articles

Giant Uterine Fibroid in a Low Resources Setting: A Case Report

Background: Uterine leiomyomas represent the most common benign tumors of the female reproductive tract. Giant uterine leiomyomas are exceedingly rare neoplasm and represents a great diagnostic and therapeutic challenge. The aim of this publication is that though the present era is of advanced technology and minimally invasive surgery but this may not be available everywhere and feasible in every case. Diagnosis and management of giant uterine myoma should permit greater management flexibility with safe options, which must be tailored to the individual clinical situation.Case presentation: A 45-year old woman presented with a 12-month history of progressive increasing abdominal size, prolonged menstrual bleeding, menorrhagia, gradual weight gain, vague abdominal pressure sensations, dysmenorrhea, abdominal and pelvic pain, frequent urination, relative constipation and symptom of anemia but not in failure. Physical examination, laboratory evaluation and a trans-abdominal ultrasound were done and findings suggested a giant abdominal-pelvic mass. Abdominal supracervical hysterectomy with bilateral salpingo-oophorectomy was performed. Histologically, the specimen was 16.2 Kg uterine leiomyoma measuring 30/24/20 cm, intramural and subserosal myomatous, cellular leiomyoma that occurred without secondary changes, necrosis, cellular atypia, or mitosis.The patient’s postoperative progress was uneventful and she was discharged from the hospital on the seventh postoperative day.Conclusion: In uterine leiomyomas patient, the preferred imaging modality for initial evaluation is ultrasonography because it is the least invasive and most cost effective investigation especially in low resource settings where magnetic resonance imaging (MRI) and computed tomography (CT) Scan are usually not available and majority of the patients cannot afford its cost. The chosen treatment should be individualized, both severity of symptoms and patients desire to preserve fertility are very important. There is no single best approach to uterine fibroid treatment. However, women with giant uterine fibroids are best treated surgically and require adequate pre-operative preparations and an experienced skillful surgeon.
 Keywords: Giant uterine leiomyoma, diagnosis, supracervical hysterectomy.

Vesicoureteral Injury during Benign Hysterectomy: Minimally Invasive Laparoscopic Surgery versus Laparotomy

The findings of previous studies have been inconsistent as to whether benign hysterectomy via minimally invasive laparoscopic surgery increases the risk of vesicoureteral injury when compared with laparotomy. The objectives of our study were to (1) examine the rate of vesicoureteral injury on benign hysterectomy by the surgical approach and (2) compare the risk of vesicoureteral injury specifically between minimally invasive laparoscopic and abdominal hysterectomy on a populational level. Retrospective population-based observational study. The National Inpatient Sample. A total of 501110 women who had undergone hysterectomy for benign gynecologic diseasebetween January 2012 and September 2015 were included as follows: total abdominal hysterectomy (TAH, n = 284 365 [56.7%]), total laparoscopic hysterectomy (TLH, n = 60 410 [12.1%]), abdominal supracervical hysterectomy (Abd-SCH, n = 55 655 [11.1%]), laparoscopic-assisted vaginal hysterectomy (LAVH, n = 45 620 [9.1%]), total vaginal hysterectomy (TVH, n = 34 865 [7.0%]), and laparoscopic supracervical hysterectomy (LSC-SCH, n = 20 195 [4.0%]). A comprehensive risk assessment for vesicoureteral injury by hysterectomy mode was performed, adjusting for patient demographics and gynecologic disease types. Propensity score inverse probability of treatment weighing was used to compare (1) TLH versus TAH and (2) LSC-SCH versus Abd-SCH with generalized estimating equations. In a sensitivity analysis, gynecologic disease-specific injury risk and vaginal route-specific injury risk (LAVH vs TVH) were assessed. Vesicoureteral injury was reported in 1045 (0.21%) women overall. LAVH (0.28%) had the highest bladder injury rate, whereas LSC-SCH had the lowest (0.10%) (p <.001). TLH (0.13%) had the highest ureteral injury rate, whereas TAH had the lowest (0.04%) (p <.001). In propensity score inverse probability of treatment weighing models, compared with TAH, TLH was associated with an increased risk of ureteral injury (odds ratio [OR] 3.95, 95% confidence interval [CI] 2.03-7.67, p <.001) but not bladder injury (OR 1.04, 95% CI 0.57-1.90, p = .897). Risk of ureteral injury was particularly high when TLH was performed for endometriosis (OR 6.15, 95% CI 1.18-31.9, p = .031) or for uterine myoma (OR 4.15, 95% CI 2.13-8.11, p <.001). In contrast, for supracervical or vaginal hysterectomy, minimally invasive laparoscopic approaches were not associated with an increased risk of vesicoureteral injury (LSC-SCH vs Abd-SCH: OR 0.62, 95% CI 0.19-1.98, p = .419; LAVH vs TVH: OR 1.21, 95% CI 0.63-2.33, p = .564). The risk of vesicoureteral injury on benign hysterectomy is low overall regardless of hysterotomy modalities but varies widely with the surgical approach. Compared with TAH, TLH may be associated with an increased risk of ureteral injury.

Vesico-Ureteral Injury During Benign Hysterectomy: Minimally-Invasive Laparoscopic Surgery Versus Laparotomy

Study Objective Previous studies have been inconsistent as to whether benign hysterectomy via minimally-invasive laparoscopic surgery increases risk of vesico-ureteral injury when compared to laparotomy. We examined the impact of surgical approach (minimally-invasive laparoscopy versus laparotomy) on vesico-ureteral injury during inpatient hysterectomy for benign gynecological disease. Design Retrospective population-based observational study. Setting The Nationwide Inpatient Sample. Patients or Participants 501,110 women who underwent hysterectomy for benign gynecological disease from 1/2012-9/2015 were included: total abdominal hysterectomy (TAH, n=284,365 [56.7%]), total laparoscopic hysterectomy (TLH, n=60,410, [12.1%]), abdominal supra-cervical hysterectomy (Abd-SCH, n=55,655 [11.1%]), laparoscopic-assisted vaginal hysterectomy (LAVH, n=45,620 [9.1%]), total vaginal hysterectomy (TVH, n=34,865 [7.0%]), and laparoscopic supracervical hysterectomy (LSC-SCH n=20,195 [4.0%]). Interventions A comprehensive risk assessment for vesico-ureteral injury by hysterectomy mode was performed, adjusting for patient demographics and gynecologic disease types. Propensity score inverse probability of treatment weighing (PS-IPTW) was used to compare (i) TLH versus TAH and (ii) LSC-SCH versus Abd-SCH with generalized estimating equations. Measurements and Main Results Vesico-ureteral injury was reported in 1,045 (0.21%) women overall. LAVH (0.28%) had the highest bladder injury rate, whereas laparoscopic SCH had the lowest (0.10%) (P<0.001). TLH (0.13%) had the highest ureteral injury rate, whereas TAH had the lowest (0.04%) (P<0.001). In PS-IPTW models, TLH was associated with increased risk of ureteral injury (odds ratio [OR] 3.95, 95% confidence interval [CI] 2.03-7.67, P<0.001) but not bladder injury (OR 1.04, 95%CI 0.57-1.90, P=0.897) compared to TAH. In contrast, LSC-SCH was not associated with increased risk of vesico-ureteral injury when compared to Abd-SCH (OR 0.62, 95%CI 0.19-1.98, P=0.419). Conclusion The risk of vesico-ureteral injury varies widely by the surgical approach to benign hysterectomy but is overall low regardless of modality. TLH may be associated with an increased risk of ureteral injury when compared to TAH. Previous studies have been inconsistent as to whether benign hysterectomy via minimally-invasive laparoscopic surgery increases risk of vesico-ureteral injury when compared to laparotomy. We examined the impact of surgical approach (minimally-invasive laparoscopy versus laparotomy) on vesico-ureteral injury during inpatient hysterectomy for benign gynecological disease. Retrospective population-based observational study. The Nationwide Inpatient Sample. 501,110 women who underwent hysterectomy for benign gynecological disease from 1/2012-9/2015 were included: total abdominal hysterectomy (TAH, n=284,365 [56.7%]), total laparoscopic hysterectomy (TLH, n=60,410, [12.1%]), abdominal supra-cervical hysterectomy (Abd-SCH, n=55,655 [11.1%]), laparoscopic-assisted vaginal hysterectomy (LAVH, n=45,620 [9.1%]), total vaginal hysterectomy (TVH, n=34,865 [7.0%]), and laparoscopic supracervical hysterectomy (LSC-SCH n=20,195 [4.0%]). A comprehensive risk assessment for vesico-ureteral injury by hysterectomy mode was performed, adjusting for patient demographics and gynecologic disease types. Propensity score inverse probability of treatment weighing (PS-IPTW) was used to compare (i) TLH versus TAH and (ii) LSC-SCH versus Abd-SCH with generalized estimating equations. Vesico-ureteral injury was reported in 1,045 (0.21%) women overall. LAVH (0.28%) had the highest bladder injury rate, whereas laparoscopic SCH had the lowest (0.10%) (P<0.001). TLH (0.13%) had the highest ureteral injury rate, whereas TAH had the lowest (0.04%) (P<0.001). In PS-IPTW models, TLH was associated with increased risk of ureteral injury (odds ratio [OR] 3.95, 95% confidence interval [CI] 2.03-7.67, P<0.001) but not bladder injury (OR 1.04, 95%CI 0.57-1.90, P=0.897) compared to TAH. In contrast, LSC-SCH was not associated with increased risk of vesico-ureteral injury when compared to Abd-SCH (OR 0.62, 95%CI 0.19-1.98, P=0.419). The risk of vesico-ureteral injury varies widely by the surgical approach to benign hysterectomy but is overall low regardless of modality. TLH may be associated with an increased risk of ureteral injury when compared to TAH.

Temporal trend and nationwide utility for hysterectomies in Taiwan, 1997–2010

ObjectiveThis study investigates the nationwide utilization and temporal trend of hysterectomies in Taiwan. Materials and MethodsThe present study used the National Health Insurance Research Database that included claims of nearly the entire population in Taiwan since the inception of the National Health Insurance program in 1995. We analyzed age-adjusted rates of hysterectomies in Taiwan from 1997 through to 2010 and compared with the rates in 16 countries of the Organization for Economic Co-operation and Development. We also examined the utilization of various types of hysterectomies in Taiwan during this period. ResultsThere was a cross-country variation in the age-standardized rate of hysterectomy: 105 per 100,000 females in Spain, 156 per 100,000 females in Taiwan, 179 per 100,000 females in 16 Organization for Economic Co-operation and Development countries, and 325 per 100,000 females in the United States in 2008. The trend of the age-standardized rate of hysterectomy in Taiwan declined from 222.3 per 100,000 women in 1998 to 145.2 per 100,000 women in 2010. The most common type of hysterectomy during this period was total abdominal hysterectomy (51.2%). Subtotal hysterectomies increased by 117% (r2=0.89; p<0.01), from 672 in 1997 to 1458 in 2010; however, total hysterectomies decreased by 3.5% (r2=0.43; p=0.01), from 20,966 in 1997 to 20,230 in 2010. Laparoscopically assisted procedures (laparoscopic supracervical hysterectomy and laparoscopic hysterectomy) increased 4.98-fold (r2=0.23; p=0.09), from 1453 in 1997 to 8684 in 2010. By contrast, the proportion of conventional open hysterectomies (total abdominal hysterectomy, and subtotal or supracervical abdominal hysterectomy) decreased by 36.5% (r2=0.59; p<0.01), from 17,327 in 1997 to 10,994 in 2010. The proportion of vaginal hysterectomies decreased by 29.7% (r2=0.72; p<0.01), from 2858 in 1997 to 2010 in 2010. ConclusionAs in most Western countries, hysterectomy rates in Taiwan declined by year. There was a marked shift in the types of hysterectomies from 1997 through to 2010 in Taiwan. Minimally invasive surgeries and supracervical hysterectomies were more commonly adopted.

Ectopic pregnancy after hysterectomy may not be so uncommon: A case report and review of the literature.

BackgroundEctopic pregnancy after hysterectomy is a very uncommon event, but its frequency is increasing. Since first reported by Wendler in 1895, 71 cases of post-hysterectomy have been reported.CaseA woman, 2 years after an abdominal supracervical hysterectomy, presented with a ruptured fallopian tube ectopic pregnancy.ConclusionAny woman, even after hysterectomy but with ovaries in situ, who presents with an acute abdomen or abdominal–pelvic pain should be screened for pregnancy.

Quality of life assessment in women after cervicosacropexy with polypropylene mesh for pelvic organ prolapse: a preliminary study.

Aim of the studyAim of the study was to assess the changes in the subjective perception of quality of life in patients who underwent abdominal cervicosacropexy for pelvic organ prolapse.Material and methodsForty patients with diagnosed pelvic organ prolapse (Pelvic Organ Prolapse – Quantification [POPQ] stage IV or IIIC) underwent abdominal supracervical hysterectomy and cervicosacropexy. The questionnaire concerning the quality of life was filled in before and 6 months after the surgery.ResultsIn all patients, an accurate prolapse correction was achieved. In 42% of patients, stress urinary incontinence (SUI) was diagnosed prior to surgery, while after the surgery in 38.24% (p > 0.05). In 50% of women, symptoms of overactive bladder (OAB) occurred pre-surgery. These symptoms were reported by 17.65% of patients postoperatively (p < 0.05). Urinary retention was observed in 32.36% before and in 2.5% after the surgery (p < 0.05). The average score of the quality of sexual life was 5.75 (SD 2.52, 95% CI: 4.41-7.1) before and increased to 7.93 (SD 1.77, 95% CI: 6.9-8.95) after the procedure (p < 0.05). The mean score of the overall quality of life in relation to POP before and after the procedure was 2.77 (SD 2.39, 95% CI: 1.87-8.64) and 9.03 (SD 1.08, 95% CI: 8.66-9.43), respectively (p < 0.001).ConclusionsThese results show a highly significant improvement of the quality of life in patients who underwent abdominal cervicosacropexy for POP. The change in quality of their sexual life, reduced OAB and urinary retention rates, as well as improvement of the esthetic self-perception may have contributed to this positive effect.

Giant Uterine Leiomyoma Mimicking Pregnancy

A 39-year-old woman gravida 0, para 0 presented to our surgical department with a 4-month history of progressive constipation, increasing abdominal size, back pain, vague abdominal pressure sensations and urinary frequency. At admission, she stated that she was pregnant and this child was “a gift from God’’. Medical history revealed several hospitalizations due to mental illness. Blood tests and gynecological consultation excluded pregnancy. Physical examination revealed a 36-week-sized uterus (Figure 1). Transabdominal ultrasound and computed tomographic scanning suggested a giant abdominopelvic mass without ascites, metastases, or enlarged pelvic or para-aortic lymph nodes. After psychological support, the patient consented to surgical treatment. An exploratory laparotomy with a midline incision revealed a giant mass that protruded from the incision (Figure 2). Abdominal supracervical hysterectomy with bilateral salpingo-oophorectomy was performed (Figure 3). Macroscopically, the specimen was a 28.1 kg uterine leiomyoma measuring 62×39×21 cm (Figure 4), well circumscribed, with solid nodules that were white or tan, with a whorled appearance on histological cuts. The postoperative course was uneventful and the patient was discharged on the 10th postoperative day.Figure 3Abdominal supracervical hysterectomy with bilateral salpingo-oophorectomy.View Large Image Figure ViewerDownload (PPT)Figure 4The 28.1 kg uterine leiomyoma measured 62×39×21 cm.View Large Image Figure ViewerDownload (PPT) By definition, giant uterine leiomyomas weigh more than 11.4 kg and are very rare. They represent a great diagnostic and therapeutic challenge because of the often atypical presentation and the possibility of underlying malignancy, mainly leiomyosarcoma. A history of growing abdominal mass, back pain, and urinary disturbances is almost universally present. Imaging such as computed tomography and magnetic resonance imaging, along with evaluation of tumor markers, can provide clues for the histological status of the tumor. Because there is potential for underlying malignancy, the treatment of choice is transabdominal hysterectomy with bilateral oophorectomy.

Unexpected malignancies after laparoscopic-assisted supracervical hysterectomies (LASH): an analysis of 1,584 LASH cases

The objective of this research was to identify the rate of unexpected malignancies after laparoscopic-assisted supracervical hysterectomies (LASH) and describe the therapy regime. The research is based on a retrospective chart analysis of patients undergoing a simple hysterectomy in the gynecological endoscopy department of a general hospital in Germany. 2,577 simple hysterectomies conducted between March 2005 and March 2010 were sub-classified in different types of hysterectomies (vaginal-, abdominal-, total-, abdominal supracervical hysterectomy, LAVH, and LASH). This study focuses on the LASH sub-group of 1,584 patients and does not make any comparisons to other operative approaches. Out of the 1,584 patients, 87.8 % (n = 1,391) received preoperative screening to exclude dysplasia or malignancy based on the policy of the German Association for gynecology and obstetrics (DGGG). The screening includes cytology (Pap-smear) and preoperative ultrasound of the uterus or dilatation and curettage (d&c). Unexpected malignancies were found in 0.25 % (n = 4) of the patients pre-screened according to DGGG protocol. Out of the four malign patients, two had endometrial cancer. Two patients had leiomyosarcoma. The study shows that there is a small probability of unexpected malignancies even in correctly pre-screened patients for LASH procedures. Yet in the short-term (28-52 months), malign patients remain recurrence free after treatment. LASH is therefore a good procedure for assumed benign disease.

Robot-assisted laparoscopic trachelectomy after supracervical hysterectomy

To present a case of successful robotic assisted laparoscopic trachelectomy. Case report. Tertiary care facility. A 40-year-old female with history of severe endometriosis and adhesions presented with persistent pain and bleeding after abdominal supracervical hysterectomy after failed attempt for laparoscopic-assisted vaginal hysterectomy and total abdominal hysterectomy. Robot-assisted laparoscopic trachelectomy and treatment of associated pelvic disease. Successful completion of robot-assisted trachelectomy. There were no intraoperative or postoperative complications and minimal blood loss. At 10 months' follow-up the patient was doing well with resolution of her symptoms. Robotic surgery may bridge the gap between laparotomy and laparoscopy for trachelectomy in complicated cases.

Supracervical and total abdominal hysterectomy trends in New York State: 1990-1996.

To describe practice trends for total abdominal hysterectomy (TAH) and supracervical abdominal hysterectomy (SCH) in New York State and to identify fiscal features associated with these two operations, all inpatient discharges for TAH and SCH performed for benign indications from 1990 to 1996 were reviewed using the Statewide Planning and Resource Cooperative System, a centralized data reporting system. For each year examined, the number of TAHs and SCHs performed, the procedure rates adjusted for the total New York State female population, and the per diem charge (calculated from mean institutional charge as a function of average length of stay) were evaluated. While the TAH rate declined in New York State, from 34.0 in 1990 to 28.4 in 1996 (P = .01), the SCH rate increased nearly five-fold during the same period, from 0.62 to 3.07 (P = .0003). Patients tended to be discharged later following SCH than for TAH, although by 1996, the LOS for both operations was equivalent. The per diem institutional charge for SCH was consistently higher than for TAH in each year studied. The changes in charge and relative frequency of TAH and SCH in New York State invite further study to describe these trends more fully.

Laparoscopic removal of cervical stump after abdominal supracervical hysterectomy for endometriosis

Laparoscopic removal of cervical stump after abdominal supracervical hysterectomy for endometriosis

Urinary Tract Injuries After Hysterectomy

Objective: To evaluate the nationwide incidence and characteristics of urinary tract injuries after laparoscopic hysterectomy, total abdominal hysterectomy, supracervical abdominal hysterectomy, and vaginal hysterectomy. Methods: We analyzed retrospectively 142 urinary tract injuries after hysterectomy, reported to the National Patient Insurance Association in Finland from 1990 through 1995. The Finnish Hospital Discharge Register collects data on procedures from all hospitals, and 62,379 hysterectomies were carried out during the study period. Results: The total incidence of ureteral injury after all hysterectomies was 1.0 of 1000 procedures: 13.9 of 1000 after laparoscopic, 0.4 of 1000 after total abdominal, 0.3 of 1000 after supracervical abdominal, and 0.2 of 1000 after vaginal hysterectomy. Difficulties during an operation with a ureteral injury were encountered in 51%, 76%, 100%, and 100%; the failure rates of primary repair of a ureteral injury were 5%, 12%, 0%, and 0%; and the convalescence times after a ureteral injury were 86 days, 94 days, 71 days, and 47 days after laparoscopic, abdominal, supracervical abdominal, and vaginal hysterectomies, respectively. The incidence of bladder injury was 1.3 of 1000 procedures. Sixty-five percent of reported bladder injuries were fistulas, giving an incidence of vesicovaginal fistula of 0.8 of 1000 procedures after all hysterectomies: 2.2 of 1000 after laparoscopic, 1.0 of 1000 after total abdominal, 0 of 1000 after supracervical abdominal, and 0.2 of 1000 after vaginal hysterectomy. Difficulties during an operation with a bladder injury were encountered in 53%, 37%, 100%, and 0%; the failure rates of primary repair of a simple bladder injury were 5%, 18%, 0%, and 0%; the failure rates of primary repair of a vesicovaginal fistula were 17%, 20%, 0%, and 0%; and the convalescence times after a bladder injury were 51 days, 118 days, 71 days, and 99 days after laparoscopic, abdominal, supracervical abdominal, and vaginal hysterectomy, respectively. Conclusion: The risk of ureteral injury is higher after laparoscopic hysterectomy compared with traditional hysterectomies.

Initial experience with supracervical laparoscopic hysterectomy and removal of the cervical transformation zone

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.

Arteriovenous fistula following hysterectomy

1. 1. Acquired arteriovenous fistulas are commonly caused by traumatic penetrating objects. It is not generally known that arteriovenous fistulas may be a complication following a routine surgical procedure. 2. 2. A review of some of the cases reported in the literature is presented. 3. 3. A review of the literature failed to produce a case of an arteriovenous fistula involving the ovarian artery and vein, as reported herein. 4. 4. A case of an arteriovenous fistula involving the right ovarian artery and vein seventeen years after supracervical abdominal hysterectomy is reported. A surgical cure is obtained.