Effect Of Laparoscopic Hysterectomy Research Articles

Effect of Laparoscopic Hysterectomy on Female Sexual Functions by Comparing their Preoperative and Post-Operative Sexual Performances using Female Sexual Function Index

Background: Hysterectomy is the most commonly performed gynecological procedure. It can affect female sexual functions in a number of ways mainly because of disruption of local nerve and blood supply and intimate anatomical relationship of pelvic organs. We intend to evaluate the effect of total laparoscopic hysterectomy (TLH) on female sexual function by comparing their preoperative and postoperative sexual performances using female sexual function index (FSFI). Materials and methods: The study was carried out in 50 hysterectomised patients over the duration of one year. Their sexual functions were assessed preoperatively prior to their admission in hospital. Then once hysterectomy is done, their postoperative sexual performances were assessed over the last four weeks period at least four months after their hysterectomy, using FSFI. Results: Out of 50 patients, 39 patients had undergone TLH with ovarian conservation and 11 had undergone TLH with bilateral salpingoophorectomy (BSO). Out of 50 participants, 27 had scores of less than 26 using FSFI, but after hysterectomy, 14 participants had scores of less than 26. The overall score using FSFI was improved from 24.26±2.2 to 28.11±2.2 (p-value <0.0001). Conclusion: Women can be positively reassured that hysterectomy performed for benign reasons does not negatively affect sexuality. TLH is less invasive in terms of causing damage to various pelvic nerves and vessels and hence causes less-to-no effect on female sexual functions. Key words: Hysterectomy, Sexual functions, Dyspareunia, Libido

Clinical studies about patients with laryngeal mask airway of laparoscopy total hysterectomy

Objective To observe the sedation and analgesia in surface anesthesia in conscious glossopharyngeal LMA for the clinical effect of laparoscopic hysterectomy. Methods 90 patients undergoing elective laparoscopic total hysterectomy were randomly divided into three groups, 30 cases in each group.The observation group(group A): sedation, analgesia, full surface anesthesia, control group 1(B group) control group 2 (group C) were treated with endotracheal intubation under general anesthesia.At intubation and pull tube stage, the patients' reaction, hemodynamic changes, pneumoperitoneum 1 h blood gas and perioperative complications were observed. Results The mean arterial pressure(MAP) and heart rate(HR) of A group were (92.7±10.6)mmHg and (82.8±12.1)/min.Those of B group were (98.4±11.6)mmHg, (89.1±11.4)/min, C group were (111.2±12.5)mmHg, (104.1±13.2)/min, those in A group and B group were better than C group(A group and C group, t=6.18, 6.52, P<0.01; B group and C group, t=4.11, 4.71, all P<0.01). The pulse oxygen saturation(SpO2) and peak airway pressure(Paw) of A group were (99.6±0.4) and (17.3±2.1)mmHg, those in group B were (99.5±0.5)% and (17.6±2.0)mmHg, group C were (99.5±0.5)% and (22.5±2.8)mmHg.The differences between A group and B group were statistically significant(compared with C group, t=14.3, 8.14, all P<0.01; B group and C group, t=12.7, 7.78, all P<0.01). The incidence rates of perioperative complications and adverse reactions of A, B, C groups were 27%, 33%, 67%, that in C group was significantly higher than A group and B group(χ2=9.64, 6.67, all P<0.01). Conclusion The laryngeal mask airway was used for laparoscopic total hysterectomy under the condition of sedation and analgesia, and it can shorten the time of the whole body, prevent the difficulty of intubation, emergency airway and anesthesia related complications. Key words: Laparoscopy; Hysterectomy; Anesthesia and analgesia

The effect of laparoscopic hysterectomy with salpingectomy on ovarian function: the results of randomized clinical trial

The effect of laparoscopic hysterectomy with salpingectomy on ovarian function: the results of randomized clinical trial

Costs and Effects of Abdominal versus Laparoscopic Hysterectomy: Systematic Review of Controlled Trials

ObjectiveComparative evaluation of costs and effects of laparoscopic hysterectomy (LH) and abdominal hysterectomy (AH).Data sourcesControlled trials from Cochrane Central register of controlled trials, Medline, Embase and prospective trial registers.Selection of studiesTwelve (randomized) controlled studies including the search terms costs, laparoscopy, laparotomy and hysterectomy were identified.MethodsThe type of cost analysis, perspective of cost analyses and separate cost components were assessed. The direct and indirect costs were extracted from the original studies. For the cost estimation, hospital stay and procedure costs were selected as most important cost drivers. As main outcome the major complication rate was taken.FindingsAnalysis was performed on 2226 patients, of which 1013 (45.5%) in the LH group and 1213 (54.5%) in the AH group. Five studies scored ≥10 points (out of 19) for methodological quality. The reported total direct costs in the LH group ($63,997) were 6.1% higher than the AH group ($60,114). The reported total indirect costs of the LH group ($1,609) were half of the total indirect in the AH group ($3,139). The estimated mean major complication rate in the LH group (14.3%) was lower than in the AH group (15.9%). The estimated total costs in the LH group were $3,884 versus $3,312 in the AH group. The incremental costs for reducing one patient with major complication(s) in the LH group compared to the AH group was $35,750.ConclusionsThe shorter hospital stay in the LH group compensates for the increased procedure costs, with less morbidity. LH points in the direction of cost effectiveness, however further research is warranted with a broader costs perspective including long term effects as societal benefit, quality of life and survival.

Effect of Laparoscopic Hysterectomy on the Vascularization of the Lower Urinary Tract

Introduction: The aim of this prospective study was to evaluate the changes in the vascularization of the lower urinary tract following laparoscopic hysterectomy (LH). Methods: Seventy women undergoing LH not under the indication of a uterine myoma were included. All subjects underwent urinalysis, pelvic examination, and introital color Doppler ultrasonography and completed a urinary questionnaire before and 6 months after LH. One-hour pad tests and urodynamic studies were performed in clinically incontinent women pre- and postoperatively. Results: Evaluation of the Doppler velocimetric parameters of bladder neck and periurethral vessels before and after LH, including number of vessels, pulsatility index, systolic peak, and minimum diastole, revealed no statistically significant differences (p > 0.05). In addition, the prevalence of stress urinary incontinence (SUI) decreased significantly from 37.1% (n = 26) preoperatively to 17.1% (n = 12) postoperatively (p < 0.01). A total of 19 patients reported no further SUI following LH. Their urinary leakages on the pad tests had all <10 g before surgery. When we analyzed the data of the women reporting no further SUI (n = 19) and de novo SUI (n = 5) following LH, the changes in the pulsatility index also showed no significant difference from the pre-LH values (p > 0.05). Conclusions: The results of our study suggest that LH has little impact on the blood flow of bladder neck and urethra. Although some women experienced relief of the symptoms of mild or de novo SUI after LH, this being unrelated to changes in the vascularization of the lower urinary tract.