Different Types Of Hysterectomy Research Articles

Approaches for hysterectomy and implementation of robot-assisted surgery in benign gynaecological disease: A cost analysis study in a large university hospital

BackgroundAs a minimally invasive technique, robot-assisted hysterectomy (RAH) offers surgical advantages and significant reduction in morbidity compared to open surgery. Despite the increasing use of RAH in benign gynaecology, there is limited data on its cost-effectiveness, especially in a European context. Our goal is to assess the costs of the different hysterectomy approaches, to describe their clinical outcomes, and to evaluate the impact of introduction of RAH on the rates of different types of hysterectomy. MethodsA retrospective single-centre cost-analysis was performed for patients undergoing a hysterectomy for benign indications. Abdominal hysterectomy (AH), vaginal hysterectomy (VH), laparoscopic hysterectomy (LH), laparoscopically assisted vaginal hysterectomy (LAVH) and RAH were included. We considered the costs of operating room and hospital stay for the different hysterectomy techniques using the “Activity Centre–Care program model”. We report on intra- and postoperative complications for the different approaches as well as their cost relationship. ResultsBetween January 2014 and December 2021, 830 patients were operated; 67 underwent VH (8%), 108 LAVH (13%), 351 LH (42%), 148 RAH (18%) and 156 AH (19%).After the implementation and learning curve of a dedicated program for RAH in 2018, AH declined from 27.3% in 2014–2017, to 22.1% in 2018 and 6.9 % in 2019–2021.The reintervention rate was 3–4% for all surgical techniques. Pharmacological interventions and blood transfusions were performed after AH in 28%, and in 17–22% of the other approaches.AH had the highest hospital stay cost with an average of €2236.40. Mean cost of the hospital stay ranged from €1136.77-€1560.66 for minimally invasive techniques.The average total costs for RAH were €6528.10 compared to €4400.95 for AH. ConclusionImplementation of RAH resulted in a substantial decrease of open surgery rate. However, RAH remains the most expensive technique in our cohort, mainly due to high material and depreciation costs. Therefore, RAH should not be considered for every patient, but for those who would otherwise need more invasive surgery, with higher risk of complications. Future prospective studies should focus on the societal costs and patient reported outcomes, in order to do cost-benefit analysis and further evaluate the exact value of RAH in the current healthcare setting.

Survival Impacts of Perineural Invasion on Patients Under Different Radical Hysterectomies Due to Early Cervical Cancer.

ObjectiveCervical cancer is a common gynecological malignancy. In addition to the open radical hysterectomy (ORH) and laparoscopic radical hysterectomy (LRH), laparoscopic nerve-sparing radical hysterectomy (LNSRH) could be another treatment option since it could preserve urinary, colorectal, and sexual functions. However, LNSRH might result in early cancer metastasis and recurrence due to inadequate tumor resection. Additionally, whether LNSRH should be considered based on perineural invasion (PNI) status remains controversial. To assess different types of hysterectomy on the outcome of early cervical cancer with PIN.MethodsA retrospective study was performed in early cervical cancer patients who received ORH, LRH, or LNSRH between January 2012 and December 2019. Age, FIGO cancer stages, histopathological types, tumor size, histological grade, invasion depth, lymph node metastasis, lymphovascular space invasion, and PNI were documented. Disease-free survival (DFS) and overall survival (OS) were recorded.ResultsA total of 174 patients were included, with 33, 69, and 72 patients received LRH, ORH, and LNSRH, respectively. Twenty-one patients (12.1%) had PNI. DFS (P = 0.000) and OS (P = 0.022) periods were shortened in positive PNI patients than in negative PNI patients (P = 0.000 and 0.022, respectively). In patients with positive PNI, lymph node metastasis, but not the surgery type, was an independent risk factor for DFS and OS (P = 0.000).ConclusionEarly cervical cancer patients with PNI had shorter postoperative DFS and OS periods. In these patients, lymph node metastasis, but not the type of hysterectomy, was independently associated with DFS and OS.

Effects of different types of hysterectomies on postoperative urodynamics and lower urinary tract symptoms

PurposeTo evaluate the effects of different hysterectomies—simple hysterectomy (SH) and radical hysterectomy (RH) with or without radiation therapy (RT) on urodynamics and lower urinary tract symptoms (LUTS).Materials and MethodsAmong patients who underwent urodynamic study between 2009 and 2019, those with RH history due to cervical cancer and SH for uterine myoma were included. Clinical parameters were compared after adjusting clinically significant baseline variables with multivariate regression.ResultsA total of 289 patients (RH-only, n=57; RH+RT, n=72; SH, n=160) were included. Age at hysterectomy, gap between urodynamic study and hysterectomy, body mass index, hypertension and vaginal delivery history were adjusted. Stress urinary incontinence was more likely to occur in SH group (p<0.001), while urgency urinary incontinence was more prevalent in patients with history of RH (odds ratio [OR] 6.4, 95% confidence interval 2.171–18.855; p=0.001). There was no difference in OR of mixed urinary incontinence. Higher proportion of RH patients complained of recurrent urinary tract infection and voiding symptoms requiring intermittent catheterization. On urodynamic study, RH groups had lower maximal flow rate, larger post-void residual, decreased bladder sensation and impaired detrusor contractility (all p<0.001) than SH group. Adjuvant RT resulted in decreased compliance and decrease in volume of the first sense to void.ConclusionsPredominant LUTS differed among patients after different types of hysterectomy. RH resulted in inefficient bladder emptying, leading to recurrent urinary tract infection and voiding symptoms requiring intermittent catheterization. Adjuvant RT exacerbated bladder compliance and increased bladder sensation.

Impact of Hysterectomy on Quality of Life, Urinary Incontinence, Sexual Functions and Urethral Length.

The aim of the study was to evaluate the influence of different types of hysterectomy on UI symptoms, quality of life and sexual functions using dedicated questionnaires. We investigated a correlation between the urethral length (UL), UI symptoms and the length of the cervix (left after LSH and SH) with sexual functions. The study enrolled 500 consecutive women referred for hysterectomy: 121 underwent VH, 171 underwent LSH, 96 underwent SH, 68 underwent TAH, and 44 underwent TLH. The patients filled in the UI-specific questionnaires and FSFI before and 12 months after hysterectomy. The UL was measured by introital ultrasound before and 12 months after hysterectomy. Before surgery, 137 out of 399 (34.3%) patients had UI symptoms; afterwards, 139 (34.8%) indicated the same (p > 0.05). There was no statistically significant difference in the UL in the patients before and after the procedure, and the cervix length did not differ between patients after LSH and SH. When the entire investigated population was analyzed, a significant improvement of the QoL was found on the IIQ-7. Hysterectomy performed due to benign diseases has effects on UI regardless of the surgical technique used. The UI symptoms improved only in the patients after LSH. The UL measured 12 months after hysterectomy did not change.

Does the extension of the type of hysterectomy contribute to the local control of endometrial cancer?

ObjectiveTo examine the necessity and sufficiency of different types of hysterectomy for the surgical treatment of endometrial cancer.MethodsThis was a multicenter collaborative study conducted by 11 institutions. Among patients with stage I–III endometrial cancer who underwent surgery as the initial treatment (only chemotherapy was provided if adjuvant therapy was needed) from 2001 to 2012, we retrospectively examined the type of hysterectomy, clinicopathological factors, recurrence rate over a maximum period of 5 years, and the site of recurrence. The local recurrence rate was examined by univariate and multivariate analyses.ResultsAmong 1335 patients, 982 (73.6%) underwent simple hysterectomy (SH) and 353 (26.4%) underwent modified radical hysterectomy (mRH) and were observed for a mean duration of 51.8 months. No significant difference was observed in the rate of local recurrence between the SH and mRH groups (p = 0.928). In multivariate analysis, clinicopathological factors independently associated with localized recurrence included postmenopausal status [hazard ratio (HR) 5.036, 95% confidence interval (CI) 1.506–16.841, p = 0.009], with stages II (HR 3.337, 95% CI 1.701–6.547, p < 0.001) and III (HR 2.445, 95% CI 1.280–4.668, p = 0.007), vs stage I and histological type 2 (HR 1.610, 95% CI 0.938–2.762, p = 0.001).ConclusionsFor endometrial cancer patients requiring surgery, the selection of a more extensive type of hysterectomy did not reduce the rate of local recurrence. Therefore, there is little significance in performing mRH in such cases.

Surgical Trends and Time Frame Comparison of Surgical Types of Hysterectomy: A Nationwide, Population-based 15-year Study

To investigate the surgical trends among different types of hysterectomy (abdominal, vaginal, laparoscopic, and subtotal) over a 15-year period in Taiwan. A retrospective cohort study. A population-based National Health Insurance Research Database. Women undergoing various types of hysterectomy for noncancerous lesions. Data for this study were extracted from the inpatient expenditures by admissions files of Taiwan's National Health Insurance Research Database from 1998 through 2012 and divided into three 5-year time frames: first (1998-2002), second (2003-2007), and third (2008-2012). The variables included types of hysterectomy, patient age, gynecologist age and sex, hospital accreditation level, and surgical volume. Chi-square and trend tests were used to examine the association between the variables. A total of 329 438 patients who underwent various types of hysterectomy were identified; 306 257 were included in the study. During the 15-year period, 45% underwent total abdominal hysterectomy, 41% underwent laparoscopic hysterectomy (LH), 9.8% underwent vaginal hysterectomy, and 4.2% underwent subtotal abdominal hysterectomy. The frequency of LHs increased from 35.9% in the first period to 43.9% in the second period and remained at 44.2% in the third period. During the same time period, there was a decrease in the frequency of total abdominal hysterectomies. Typically, younger patients underwent LHs by gynecologists with large volume surgical practices and medical centers. This 15-year study describes an increase of LHs and subtotal abdominal hysterectomies over time and provides evidence of surgical trends and a paradigm shift of hysterectomies. Surgical skills and performance extended from high- to low-surgical volume gynecologists and from medical centers to regional and local hospitals. This shift may have a great influence on patient and health care provider choice of treatment.

Vaginal cuff dehiscence is observed in a higher rate after total laparoscopic hysterectomy compared with other types of hysterectomy.

Recently, it has been suggested that the occurrence of posthysterectomy vaginal cuff dehiscence has increased. Consequently, we evaluated the incidence of vaginal cuff dehiscence after different types of hysterectomies. Our hypothesis is that vaginal cuff dehiscence is more often associated with total laparoscopic hysterectomy (TLH) than other types of uterine removal. A total of 13645 hysterectomies from 1992 to 2015 were evaluated in the Turku University Hospital district, Finland. The primary outcome was occurrence of vaginal dehiscence after different types of hysterectomy. The hysterectomy and postoperative vaginal dehiscence trends were analyzed as the secondary outcome. In a subanalysis of dehiscence cases, women's characteristics and perioperative vaginal cuff opening and closure techniques were compared between conventional hysterectomies (vaginal, abdominal, and laparoscopic with vaginal closure) and TLH. Altogether, 22 cases of vaginal cuff dehiscence were included. Most cases (n=15) occurred after TLH (n=1104), resulting in an incidence of 1.27%. After conventional laparoscopic hysterectomy with vaginal closure (n=2853), vaginal (n=4150), and abdominal (n=5538) hysterectomies, the incidence rates were 0.11%, 0.05%, and 0.02%, respectively. Compared to abdominal hysterectomy, which was associated with the lowest incidence rate, vaginal dehiscence after TLH had an odds ratio (OR) 71.1 (9.34-541.38, P<0.001). In the subanalysis of possible underlying factors, the technique of opening of the vaginal cuff with or without electrocoagulation, duration of operation, and occurrence of postoperative infection or hematoma prior to VCD were observed differences between TLH and conventional hysterectomies. Compared with other types of hysterectomies, vaginal dehiscence was observed at the highest rate after TLH. Studies are needed to define if vaginal opening technique contributes to the risk of dehiscence.

Ureteral injuries during different types of hysterecomy: A 7-year series at a single university center

ObjectivesAccidental ureteral injury with gynaecologic surgery, especially hysterectomy, represents a high risk of patient morbidity. The incidence may vary from centre to centre. As the introduction of new minimally invasive surgical techniques and instruments may have affected the incidence of ureteral injury, we de novo analysed the incidence data for the last seven years. Study designIncidence of ureteral injury was analysed stratifying the data according to the type of hysterectomy (n = 3071). The incidence rate was reported as a confidence interval (CI). Ureteral injuries were classified as direct or indirect. ResultsFifteen ureteral injuries were registered. The highest incidence was evidenced for radical hysterectomy (CI: 0.82–3.99), followed by laparoscopic radical hysterectomy (CI: 0–11.9). The incidence of direct ureteral injury was 26.6%, half of which were identified during the operative procedure. In 26.7% of the operations resulting in ureteral injury, heat-generating instruments were used. ConclusionsThe incidence of ureteral injury during different types of hysterectomy was low. The majority of injuries were indirect. These were injuries which resulted from a micro-trauma, and developed due to the delayed necrosis of the ureteral wall. Laparoscopic approach to radical and simple hysterectomy didn‘t substantially raise the incidence of ureteral injury.

Complication Rate of Laparoscopic Hysterectomies in Denmark, 2011-2016.

Background and Objectives:After the U. S. Food and Drug Administration's recommendation against the use of power morcellation for tissue extraction in minimally invasive hysterectomy, the number of procedures completed laparoscopically declined in favor of open surgery laparotomy. We conducted a retrospective cohort study comparing perioperative and long-term outcomes, including complications associated with laparoscopic hysterectomy before and after the FDA recommendation.Methods:We included procedures performed in Danish government hospitals (GHs) and a hospital specializing in minimally invasive gynecological surgery (MIGS). Different types of hysterectomy over the period from January 2011 through May 2016 were examined.Results:Hysterectomies were analyzed from GHs (n = 21,495) and from a hospital specializing in MIGS (n = 749). In the GHs, we found a decrease in open hysterectomy from 40% in 2011 to 20% in 2016. In the MIGS hospital, 4 of 749 (0.05%) open hysterectomies were performed during the 6 years; however, there was a change in operative technique. After the FDA recommendation, there was a shift from laparoscopic subtotal hysterectomy (LSH) to total laparoscopic hysterectomy (TLH) from 32% in 2011 to 82% by May 2016. Containment bags were used in LSH and large-uterus TLH after the 2014 advisory. Significantly more complications occurred in the GHs than in the MIGS hospital: 3224/21,495 (15%) vs 53/749 (7.0%), respectively.Conclusion:The rate of minimally invasive hysterectomies continues to increase. However, after 2014, many of the morcellation techniques have been replaced by a minilaparotomy to extract the uterus at the end of surgery, compared to the use of the contained morcellation in 100% of cases in the MIGS hospital. There was a major difference in complication rates between the hospitals that is partly explainable by the challenge in training residents and the low operative volume of surgeons in GHs.

2017 Update on the Querleu-Morrow Classification of Radical Hysterectomy.

One of the most important principles in modern cervical cancer surgery is the concept of tailoring surgical radicality. In practice, this means abandoning the "one-fits-all" concept in favor of tailored operations. The term "radical hysterectomy" is used to describe many different procedures, each with a different degree of radicality. Anatomic structures are subjected to artificial dissection artifacts, as well as different interpretations and nomenclatures. This study aimed to refine and standardize the principles and descriptions of the different classes of radical hysterectomy as defined in the Querleu-Morrow classification and to propose its universal applicability. All three authors independently examined the current literature and undertook a critical assessment of the original classification. Images and pathologic slides demonstrating different types of radical hysterectomy were examined to document a consensual vision of the anatomy. The Cibula 3-D concept also was included in this update. The Querleu-Morrow classification is based on the lateral extent of resection. Four types of radical hysterectomy are described, including a limited number of subtypes when necessary. Two major objectives remain constant: excision of central tumor with clear margins and removal of any potential sites of nodal metastasis. Studies evaluating radicality in the surgical management of cervical cancer should be based on precise, universally accepted descriptions. The authors' updated classification presents standardized, universally applicable descriptions of different types of hysterectomies performed worldwide, categorized according to degree of radicality, independently of theoretical considerations.

Risk factors for surgical site infection after hysterectomy.

The aim of the study was to define the clinical and laboratory characteristics of patients who had surgical site infection (SSI) after hysterectomy. This study was a retrospective cohort study. The patient data of 840 subjects who had undergone any type of hysterectomy and reported SSI after surgery were obtained from the archives of a tertiary referral center. The different types of hysterectomy procedures performed on these patients included total abdominal hysterectomy (TAH), laparoscopic hysterectomy (LH), and vaginal hysterectomy (VH). In addition, age, body mass index (BMI), preoperative and postoperative blood parameters, gravidity, and parity were also documented. TAH, LH, and VH were performed on 63.2% (n = 531), 21.6% (n = 181), and 15.2% (n = 128) of patients, respectively. Overall, SSIs were observed in 3.7% (n = 31) of all hysterectomy patients. Among them, 4.5% of TAH patients, 1.7% of LH patients, and 3.1% of VH patients had SSIs after the hysterectomy operation. Analysis of the data revealed that the patients with SSIs had significantly higher BMIs, lower preoperative hemoglobin, lower postoperative hemoglobin and hematocrit, and higher postoperative platelet counts compared to patients who did not have any SSIs. High BMI, blood loss during surgery, low hematocrit levels, and resulting anemia increased the incidence of SSI after hysterectomy. Among the different types of hysterectomy, LH was found to be relatively better than TAH and VH in preventing the occurrence of SSI.

Effects of morcellation on long-term outcomes in patients with uterine leiomyosarcoma.

Clinical long-term outcomes of women with uterine leiomyosarcoma (ULMS) with different types of hysterectomy (open abdominal, vaginal, laparoscopic and switch from laparoscopic to open abdominal) were compared according to morcellation and other factors. The clinical cancer registry Regensburg (Germany) registered 64 patients between 2004 and 2013 with ULMS. A retrospective cohort analysis was performed using the Kaplan-Meier method to estimate 5-year overall survival (OAS), recurrence-free survival (RFS) and recurrence rates. To compare surgery with or without morcellation log rank test was used. To adjust for age, FIGO stage, grading and other factors multivariable Cox regression models were applied to estimate hazard ratios (HR). In the cohort of 64 patients 15 underwent morcellation, preferably during laparoscopic surgery. Although numbers were small we performed analysis for OAS and RFS. Median OAS for morcellation was 10.6vs. 6.4years for non morcellation. 5y-OAS was 76.0% for morcellation compared to 54.8% in patients without morcellation (p=0.115). Cox regression models rendered an unadjusted (univariable) HR 0.428 for morcellation vs. non-morcellation (p=0.125) and an adjusted (multivariable) HR 0.644 (p=0.406). 5y-RFR was 64.0% compared to 42.8% in patients without morcellation (p=0.104; unadjusted HR 0.484, p=0.111; adjusted HR 0.607, p=0.306). In general, the prognosis of patients with ULMS is poor. In our cohort, women who underwent hysterectomy with morcellation had a better cumulative OAS and RFS than women without morcellation. Although we adjusted for differences between women with and without morcellation regarding age, grading and stage, there were no statistically significant differences between the groups.

Urinary incontinence after hysterectomy- does type of surgery matter?

The aim of the study was to assess the effect of different types of hysterectomy on the development of postoperative urinary incontinence (UI). The study group consisted of 392 women who underwent supracervical laparoscopic hysterectomy (SLH), total abdominal hysterectomy (TAH), supervical abdominal hysterectomy (SH), or vaginal hysterectomy (VH) for benign indications 2010 and 2013. The patients reported no UI-related complaints before surgery. UI status was assessed 12 months postoperatively using the cough test and the 24-hour pad test. UI developed within 12 months after surgery in 149 (38%) out of 392 women. No statistically significant correlation between the type of treatment and UI incidence was detected. The percentage of patients affected by UI did not differ between the study groups. Hysterectomy constitutes a risk factor for the development of urinary incontinence but the occurrence of postoperative UI does not depend on the type of surgery.

Problemas sexuales derivados de la histerectomía

IntroductionHysterectomy is the second most widely performed surgical procedure in women of reproductive age and sometimes has physical and psychological effects that affect sexual functioning. The aim of this study was to review the literature on possible sexual problems after different types of hysterectomy. Material and methodsWe conducted a literature search in the databases Medline, CINAHL and Scopus and obtained 111 articles, of which only 12 met the inclusion criteria. Nine studies were prospective and 3 were retrospective, performed in women of any age who had undergone hysterectomy whether for benign or malignant causes. The articles were published between 2007 and 2013 in English, Spanish or Portuguese with the keywords ‘hysterectomy’ and ‘sexuality’. ResultsThe 12 studies analyzed included 3 types of hysterectomies: subtotal, total, or radical, either abdominal, vaginal or laparoscopic. These studies identified the sexual problems most affecting women who had undergone a hysterectomy, irrespective of cause. ConclusionSexual problems are common after hysterectomy. The greatest dysfunction is caused by vaginal hysterectomy. Factors such as age and the existence of a depressive disorder also contribute to dysfunction.

Effects of patient position on lower extremity venous pressure during different types of hysterectomy.

To explore the effects of different types of hysterectomy on lower extremity venous pressure. Ninety-nine patients with benign uterine diseases who were indicated for hysterectomy were included in the present prospective study. Patients were divided into three groups according to their preferences: (i) total laparoscopic hysterectomy (TLH) group (n = 36); (ii) transvaginal hysterectomy (TVH) group (n = 32); and (iii) transabdominal hysterectomy (TAH) group (n = 31). Lower extremity venous pressure was monitored using a pressure sensor during the surgery. Compared with the supine position (TAH group, lower extremity venous pressure of intraoperative 16.50 cmH2 O), lower extremity venous pressure of the improved lithotomy position (TLH group, lower extremity venous pressure of intraoperative 53.27 cmH2 O) and conventional lithotomy position (TVH group, lower extremity venous pressure of intraoperative 42.09 cmH2 O) were significantly increased (P < 0.01).Venous pressure was reduced when patients lowered their heads by 15° or 5° in modified or conventional lithotomy positions, respectively (P < 0.01). Venous pressure was increased significantly after the establishment of pneumoperitoneum in the TLH group (P < 0.01). Modified lithotomy position (TLH group) and conventional lithotomy position (TVH group) and CO2 pneumoperitoneum may result in increased lower extremity venous pressure during hysterectomy. Furthermore, elevated venous pressure can be altered by changing the intraoperative position. Specifically, intraoperative positioning of the lower extremities represents a modifiable risk factor for deep venous thrombosis.

Common postoperative pulmonary complications after hysterectomy for benign indications

The purpose of this study was to estimate the incidence of postoperative pulmonary complications after hysterectomy for benign indications. This was a retrospective cohort study of all women who underwent hysterectomy for benign indications at the Cleveland Clinic from Jan. 1, 2001, to Dec. 31, 2009. Exclusion criteria incorporated patients who underwent hysterectomy for premalignant or malignant conditions. Pulmonary complications were defined as postoperative pneumonia, respiratory failure, atelectasis, and pneumothorax based on International classification of diseases, ninth revision, codes. In the 9-year study period, 3226 women underwent hysterectomy for benign indications (abdominal, 38.4%; vaginal, 39.3%; laparoscopic, 22.3%). Ten of the 3226 women (0.3%; 95% confidence interval, 0.17-0.57%) who underwent hysterectomy were identified with postoperative pulmonary complications. Among the different types of hysterectomy, the incidence of pulmonary complications was not different (total abdominal hysterectomy, 0.9%; vaginal hysterectomy, 0.12%; laparoscopic hysterectomy, 0.9%; P = .8). The incidence of postoperative pulmonary complications after hysterectomy for benign indications is low.

Procedure-specific Guidelines

We thank for Drs. Stites-Hallett and Larson for their comments regarding our article on postoperative pain management.1First, we agree that there are different types of hysterectomy (e.g. , open abdominal, radical abdominal, laparoscopic-assisted vaginal, and simple vaginal) and nephrectomy procedures. Unfortunately, our discussion on nephrectomy left out the word “laparoscopic.” An open nephrectomy will have the same problems as an open colonic resection, where postoperative epidural analgesia is in fact evidence-based. According to the PROSPECT Web site,*the group has concluded, on the basis of the available literature on single modality analgesic interventions for hysterectomy procedures, that in low-risk patients, postoperative epidural analgesia is not cost-beneficial compared with simply using systemic multimodal nonopioid analgesics. However, it may be considered in high-risk patients. Drs. Stites-Hallett and Larson quote many earlier studies on the metabolic benefits of postoperative epidural analgesia; at the time they were published, they were important. However, with modern fast-track methodology,2the hospital stay has been minimized, and recovery no longer requires continuous epidural analgesia after hysterectomy procedures. It is true that there are some obvious benefits from intraoperative epidural analgesia with respect to pain control and prevention of postoperative nausea and vomiting in the early recovery period. Yet the use of effective multimodal nonopioid analgesia from the time the patient emerges from anesthesia has obviated the need for more invasive analgesic techniques such as epidural analgesia. For more extensive hysterectomies in high-risk patients, a different approach may be appropriate. However, the intention of our article was to give our view based upon the most recent literature. As with practice guidelines, well-argued considerations can justify deviation from these very broad recommendations in specific situations.†University of Texas Southwestern Medical Center at Dallas, Dallas, Texas. paul.white@utsouthwestern.edu

Retrospective Review of 716 Women Who Underwent Different Types of Hysterectomy

Study Objective: The aim of this study is to compare the operative parameters of different types of hysterectomy in 716 patients.

Clinimetric properties of 3 instruments measuring postoperative recovery in a gynecologic surgical population

General, health-related quality-of-life questionnaires and recovery-specific questionnaires have been used to measure recovery in surgical patients. The aim of this study was to evaluate the clinimetric properties of 3 recovery instruments and to examine whether recovery-specific instruments are useful. The Quality of Recovery-40 (QoR-40), Recovery Index-10 (RI-10), and RAND-36 health survey were used to measure recovery in women undergoing different types of hysterectomy in the first 12 weeks after operation. Construct validity was assessed by testing predefined hypotheses. The changes observed during the postoperative period were used as indicators for responsiveness. One hundred and sixty-one women were included. Response rate and internal consistency were found satisfactory. The highest number of hypotheses used for assessment of construct validity was confirmed in the RI-10. The RI-10 was more responsive compared with the QoR-40 and the RAND-36. Because construct validity and responsiveness were greatest in the RI-10, we conclude that this short recovery-specific instrument is useful in studies evaluating postoperative recovery. We recommend the use of the RI-10, unless the immediate postoperative days are of interest in which the QoR-40 was valid.

Quality of life and surgical outcome after total laparoscopic hysterectomy versus total abdominal hysterectomy for benign disease: A randomized, controlled trial

Study objective Minimally invasive surgery aims to achieve at least a similar clinical effectiveness with a quicker recovery than traditional open techniques. Although there have been numerous randomized clinical trials comparing laparoscopic hysterectomy with hysterectomy by laparotomy, only a few studies have compared quality of life after different types of hysterectomy. None of these studies evaluated total laparoscopic hysterectomy. In this paper, we report on a randomized comparison of quality of life after total laparoscopic versus total abdominal hysterectomy. Design Randomized, controlled trial (Canadian Task Force classification I). Setting Single-center teaching hospital in The Netherlands. Patients Patients scheduled for hysterectomy for a benign condition, in whom a vaginal hysterectomy was not possible and laparoscopic hysterectomy was feasible (mobile uterus not exceeding the size of 18 weeks’ gestation). Interventions Abdominal versus laparoscopic hysterectomy. Measurements and main results Patients completed the Dutch version RAND-36 health survey preoperatively as well as at 5 time points in the first 12 weeks after surgery. The primary outcome of the study was quality of life as measured by the RAND-36. A linear mixed model was used for statistical analysis while accounting for baseline values. Secondary outcomes were hospital stay and complications. There were 88 patients eligible, of whom 59 gave consent for randomization. Twenty-seven women were allocated to the laparoscopic arm and 32 to the abdominal arm. We found a significant treatment effect favoring laparoscopic hysterectomy in the RAND-36 scale for vitality. Laparoscopic hysterectomy performed better on all other scales of the RAND-36, but these differences were not statistically significant. Conclusions Laparoscopic hysterectomy results in more postoperative vitality when compared with abdominal hysterectomy. For this reason, all women with a benign condition requiring abdominal hysterectomy, in whom the laparoscopic approach is feasible, should have the chance to choose laparoscopic hysterectomy.