Hysterectomy For Benign Gynecologic Disease Research Articles

HALON—hysterectomy by transabdominal laparoscopy or natural orifice transluminal endoscopic surgery: a randomised controlled trial (study protocol)

IntroductionNatural orifice transluminal endoscopic surgery (NOTES) uses natural body orifices to access the cavities of the human body to perform surgery. NOTES limits the magnitude of surgical trauma and has...

Subsequent Oophorectomy and Ovarian Cancer after Hysterectomy for Benign Gynecologic Conditions at Chiang Mai University Hospital.

This study was undertaken to determine the incidence of subsequent oophorectomy due to ovarian pathology or ovarian cancer in women with prior hysterectomy for benign gynecologic conditions at Chiang Mai University Hospital. Medical records of women who underwent hysterectomy for benign gynecologic diseases and pre-cancerous lesions between January 1, 2004 and December 31, 2013 at Chiang Mai University Hospital were retrospectively reviewed. The incidence and indications of oophorectomy following hysterectomy were analyzed. During the study period, 1,035 women had hysterectomy for benign gynecologic conditions. Of these, 590 women underwent hysterectomy with bilateral salpingo-oophorectomy and 445 hysterectomy with bilateral ovarian preservation or unilateral salpingo-oophorectomy. The median age was 47 years (range, 11-75 years). Ten women (2.45 %) had subsequent oophorectomy for benign ovarian cysts. No case of ovarian cancer was found. The mean time interval between hysterectomy and subsequent oophorectomy was 43.1 months (range, 2-97 months) and the mean follow-up time for this patient cohort was 51 months (range, 1.3-124.9 months). According to our hospital-based data, the incidence of subsequent oophorectomy in women with prior hysterectomy for benign gynecologic conditions is low and all present with benign conditions.

Trends and Complications in Bilateral Salpingectomy and Hysterectomy for Benign Disease in the United States [7G

INTRODUCTION: Recent literature has shown that bilateral salpingectomy (BS) may reduce the risk of ovarian cancer. However, little evidence exists in the United States on the rates and risks of complications associated with this procedure. We sought to examine current rates and common medical and surgical complications associated with BS with hysterectomy for benign indications in the United States. METHODS: We conducted a retrospective cohort study from the National Inpatient Sample (NIS) database. Patients undergoing hysterectomy for benign gynecological disease during 1998–2012 were identified. First, rates of BS were tested for trends over time. Second, risks of complications with BS were identified. Finally, surgical approaches for hysterectomy with BS were compared based on complications. RESULTS: During the study period 7,009,330 hysterectomies were performed for benign indications. Of these 103,966 had BS with an increase in rate from 1.0% to 5.1% between 1998 and 2012. BS procedures were associated with a significant increased risk of complications (aOR 1.063, P=.01). An abdominal approach had the greatest risk of complications (aOR 1.585, P<.001). There was no difference in risk of complications between a laparoscopic or vaginal approach (aOR 1.093, P=.244). CONCLUSION: Opportunistic BS completed with hysterectomies for benign indications are increasing; yet overall rates are still very low. There is a small statistically significant increase in risk of complications with BS as opposed to hysterectomy alone in benign cases. There is not a significantly increased risk of complications between the vaginal and laparoscopic approach.

Robotic Trachelectomy After Supracervical Hysterectomy for Benign Gynecologic Disease

Background and Objectives:A renewed interest in the supra cervical approach to hysterectomy has created a cohort of patients with a retained cervix at risk of persistent symptoms requiring a subsequent trachelectomy. The objective of this study was to evaluate the efficacy of robotic trachelectomy after a previous supracervical hysterectomy.Methods:This is a retrospective chart review of women who had robotic trachelectomy after supracervical hysterectomy for benign gynecologic disease from January 2009 through October 2014.Results:Eleven patients underwent robotic trachelectomy for benign conditions during the observed period. Prior supracervical hysterectomy had been performed for pelvic pain (8/11, 73%), abnormal uterine bleeding (7/11, 64%), and dysmenorrhea (5/11, 45%). In 10 of 11 patients, the symptoms leading to robotic trachelectomy were the same as those leading to supracervical hysterectomy. The time from hysterectomy to recurrence of symptoms ranged from 0.5 to 26 months (median, 6), whereas the time interval from previous surgery to robotic trachelectomy ranged from 1 to 57 months (median, 26). Mean age and body mass index at robotic trachelectomy were 42 ± 5.4 years and 32 ± 6.1 kg/m2. Mean length of surgery was 218 ± 88 minutes (range, 100–405). There was 1 major postoperative complication involving bladder perforation and subsequent vesicovaginal fistula (VVF). Endometriosis was seen in 27% of pathologic specimens and cervicitis in another 27%; 45% showed normal tissue histology. In 6 (55%) cases, symptoms leading to trachelectomy resolved completely after surgery, and the other 5 (45%) patients reported a significant improvement.Conclusions:Although trachelectomy can be a challenging surgery, our experience suggests that the robotic approach may be a valuable means of achieving safe and reproducible outcomes.

An Audit of Indications, Surgical Approach and Complications of Hysterectomy for Benign Gynecological Disease at a Tertiary Level Teaching Hospital in India

An Audit of Indications, Surgical Approach and Complications of Hysterectomy for Benign Gynecological Disease at a Tertiary Level Teaching Hospital in India

A Retrospective Review: Vaginal versus Abdominal Hysterectomy for Benign Gynecological Diseases in a Tertiary Canter

The aims are to review respectively 229 cases of hysterectomy and to find the factor affecting the decision of vaginal hysterectomy. Data collected from medical charts include age, nationality, parity, menopause, history of Dilation and curettage. The following data were obtained: the clinical presentation and the indication for hysterectomy. Postoperative complication includes the estimated blood loss, the number of days in hospital and ICU admission recorded. The route of hysterectomy found that 187 (82%) were abdominal and only 42 (18%) were vaginal. Factors significantly associated with the choice of vaginal approach: age, parity, smaller uterine size and prolapse. Factors affecting the decision of vaginal hysterectomy for treatment of benign diseases are identified as follows: if the age is more than 35 years or if the women already reach menopause, the presenting symptoms are not vaginal bleeding but prolapsed uterus and uterine size is less than 12 weeks.

Robotic Trachelectomy After Supracervical Hysterectomy for Benign Gynecologic Disease

Robotic Trachelectomy After Supracervical Hysterectomy for Benign Gynecologic Disease

Surgical approach to hysterectomy for benign gynaecological disease.

The four approaches to hysterectomy for benign disease are abdominal hysterectomy (AH), vaginal hysterectomy (VH), laparoscopic hysterectomy (LH) and robotic-assisted hysterectomy (RH). To assess the effectiveness and safety of different surgical approaches to hysterectomy for women with benign gynaecological conditions. We searched the following databases (from inception to 14 August 2014) using the Ovid platform: Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO. We also searched relevant citation lists. We used both indexed and free-text terms. We included randomised controlled trials (RCTs) in which clinical outcomes were compared between one surgical approach to hysterectomy and another. At least two review authors independently selected trials, assessed risk of bias and performed data extraction. Our primary outcomes were return to normal activities, satisfaction, quality of life, intraoperative visceral injury and major long-term complications (i.e. fistula, pelvi-abdominal pain, urinary dysfunction, bowel dysfunction, pelvic floor condition and sexual dysfunction). We included 47 studies with 5102 women. The evidence for most comparisons was of low or moderate quality. The main limitations were poor reporting and imprecision. Vaginal hysterectomy (VH) versus abdominal hysterectomy (AH) (nine RCTs, 762 women)Return to normal activities was shorter in the VH group (mean difference (MD) -9.5 days, 95% confidence interval (CI) -12.6 to -6.4, three RCTs, 176 women, I(2) = 75%, moderate quality evidence). There was no evidence of a difference between the groups for the other primary outcomes. Laparoscopic hysterectomy (LH) versus AH (25 RCTs, 2983 women)Return to normal activities was shorter in the LH group (MD -13.6 days, 95% CI -15.4 to -11.8; six RCTs, 520 women, I(2) = 71%, low quality evidence), but there were more urinary tract injuries in the LH group (odds ratio (OR) 2.4, 95% CI 1.2 to 4.8, 13 RCTs, 2140 women, I(2) = 0%, low quality evidence). There was no evidence of a difference between the groups for the other primary outcomes. LH versus VH (16 RCTs, 1440 women)There was no evidence of a difference between the groups for any primary outcomes. Robotic-assisted hysterectomy (RH) versus LH (two RCTs, 152 women)There was no evidence of a difference between the groups for any primary outcomes. Neither of the studies reported satisfaction rates or quality of life.Overall, the number of adverse events was low in the included studies. Among women undergoing hysterectomy for benign disease, VH appears to be superior to LH and AH, as it is associated with faster return to normal activities. When technically feasible, VH should be performed in preference to AH because of more rapid recovery and fewer febrile episodes postoperatively. Where VH is not possible, LH has some advantages over AH (including more rapid recovery and fewer febrile episodes and wound or abdominal wall infections), but these are offset by a longer operating time. No advantages of LH over VH could be found; LH had a longer operation time, and total laparoscopic hysterectomy (TLH) had more urinary tract injuries. Of the three subcategories of LH, there are more RCT data for laparoscopic-assisted vaginal hysterectomy and LH than for TLH. Single-port laparoscopic hysterectomy and RH should either be abandoned or further evaluated since there is a lack of evidence of any benefit over conventional LH. Overall, the evidence in this review has to be interpreted with caution as adverse event rates were low, resulting in low power for these comparisons. The surgical approach to hysterectomy should be discussed and decided in the light of the relative benefits and hazards. These benefits and hazards seem to be dependent on surgical expertise and this may influence the decision. In conclusion, when VH is not feasible, LH may avoid the need for AH, but LH is associated with more urinary tract injuries. There is no evidence that RH is of benefit in this population. Preferably, the surgical approach to hysterectomy should be decided by the woman in discussion with her surgeon.

Drospirenone induces decidualization in human eutopic endometrial stromal cells and reduces DNA synthesis of human endometriotic stromal cells

To investigate the invitro effect of drospirenone on human eutopic endometrial (EuSC) and ectopic endometriotic stromal cells (EcSC). Comparative and laboratory study. The experimental procedures were approved by the Institutional Review Board of the University of Tokyo (registration no. 0324-4). University research laboratory. Eight patients undergoing hysterectomy for benign gynecologic disease and 19 patients undergoing cystectomy or adnectomy for endometriosis. EuSC and EcSC were treated with drospirenone. For the analysis of decidualization of EuSC, cells were observed using microscopy, and the production of PRL was measured using enzyme immunoassay. For the analysis of DNA synthesis of EcSC, 5-bromo-2'-deoxyuridine incorporation was measured by ELISA. Cells in apoptosis were detected and measured by flow cytometry. Drospirenone induced decidualization in EuSC, and the induction was negated by RU486. Drospirenone reduced DNA synthesis on EcSC, and this reduction was negated by RU486 or P receptor silencing, but not by aldosterone or mineralocorticoid receptor silencing. Drospirenone did not cause EcSC to undergo apoptosis. Our study demonstrates the direct effects of drospirenone: decidualization of EuSC and reduced DNA synthesis of EcSC, but it does not cause EsSC apoptosis.

Factors associated with 30-day hospital readmission after hysterectomy.

To analyze factors associated with 30-day readmission among women who underwent hysterectomy for uterine cancer and benign indications. We used the National Surgical Quality Improvement Project database to perform a cohort study of women who underwent hysterectomy from 2011 to 2012. Patients were stratified by surgical indication (uterine cancer or benign indications). Multivariable logistic regression models were constructed to determine factors associated with 30-day readmission. Model fit statistics were used to evaluate the importance of demographic factors, preoperative comorbidities, and postoperative complications on readmission. The rate of 30-day readmission was 6.1% among 4,725 women with uterine cancer and 3.4% after hysterectomy for benign gynecologic disease in 36,471 patients. In a series of multivariable models, postoperative complications including wound complications, infections, and pulmonary emboli and myocardial infarctions were the factors most strongly associated with readmission. Compared with women without a complication, complications increased the readmission rate from 2.5 to 20.3% for women with uterine cancer and from 1.5 to 15.1% for those without cancer. Among women with uterine cancer, postoperative complications explained 34.3% of the variance in readmission compared with 5.9% for demographic factors and 2.2% for preoperative comorbidities. For patients with benign diseases, complications accounted for 32.1%, preoperative conditions 1.2%, and demographic factors 2.5% of the variance in readmission. Efforts to reduce readmission should be directed at initiatives to reduce complications and improve the care of women who experience a complication.

Considerations to improve the evidence-based use of vaginal hysterectomy in benign gynecology.

Vaginal hysterectomy fulfills the evidence-based requirements as the preferred route of hysterectomy for benign gynecologic disease. Despite proven safety and effectiveness, the vaginal approach for hysterectomy has been and remains underused in surgical practice. Factors associated with underuse of vaginal hysterectomy include challenges during residency training, decreasing case numbers among practicing gynecologists, and lack of awareness of evidence supporting vaginal hysterectomy. Strategies to improve resident training and promote collaboration and referral among practicing physicians and increasing awareness of evidence supporting vaginal hysterectomy can improve the primary use of this hysterectomy approach.

Vaginal hysterectomy: past, present, and future.

Vaginal hysterectomy is the oldest and least invasive of the hysterectomy techniques and fulfills the evidence-based requirements as the preferred route of hysterectomy for benign gynecologic disease. Currently, vaginal hysterectomy is commonly utilized for treating uterine prolapse, but despite proven safety and effectiveness, the use of vaginal hysterectomy for treating non-prolapse conditions has been and remains underutilized in surgical practice. Improving the use of vaginal hysterectomy in the future will likely depend on addressing the key issues of training and maintaining skills in the technique and increasing awareness of the scientific evidence supporting its use.

An Economic Analysis of Robotically Assisted Hysterectomy

To perform an econometric analysis to examine the influence of procedure volume, variation in hospital accounting methodology, and use of various analytic methodologies on cost of robotically assisted hysterectomy for benign gynecologic disease and endometrial cancer. A national sample was used to identify women who underwent laparoscopic or robotically assisted hysterectomy for benign indications or endometrial cancer from 2006 to 2012. Surgeon and hospital volume were classified as the number of procedures performed before the index surgery. Total costs as well as fixed and variable costs were modeled using multivariable quantile regression methodology. A total of 180,230 women, including 169,324 women who underwent minimally invasive hysterectomy for benign indications and 10,906 patients whose hysterectomy was performed for endometrial cancer, were identified. The unadjusted median cost of robotically assisted hysterectomy for benign indications was $8,152 (interquartile range [IQR] $6,011-10,932) compared with $6,535 (IQR $5,127-8,357) for laparoscopic hysterectomy (P<.001). The cost differential decreased with increasing surgeon and hospital volume. The unadjusted median cost of robotically assisted hysterectomy for endometrial cancer was $9,691 (IQR $7,591-12,428) compared with $8,237 (IQR $6,400-10,807) for laparoscopic hysterectomy (P<.001). The cost differential decreased with increasing hospital volume from $2,471 for the first 5 to 15 cases to $924 for more than 50 cases. Based on surgeon volume, robotically assisted hysterectomy for endometrial cancer was $1,761 more expensive than laparoscopy for those who had performed fewer than five cases; the differential declined to $688 for more than 50 procedures compared with laparoscopic hysterectomy. The cost of robotic gynecologic surgery decreases with increased procedure volume. However, in all of the scenarios modeled, robotically assisted hysterectomy remained substantially more costly than laparoscopic hysterectomy.

Predictors of Surgical Site Infection in Women Undergoing Hysterectomy for Benign Gynecologic Disease: A Multicenter Analysis Using the National Surgical Quality Improvement Program Data

Study ObjectiveTo estimate the rate and predictors of surgical site infection (SSI) after hysterectomy performed for benign indications and to identify any association between SSI and other postoperative complications. DesignRetrospective cohort study (Canadian Task Force classification II-2). SettingNational Surgical Quality Improvement Program data. PatientsWomen who underwent abdominal or laparoscopic hysterectomy performed for benign indications from 2005 to 2011. InterventionsUnivariable and multivariable logistic regression analyses were used to identify predictors of SSI and its association with other postoperative complications. Odds ratios were adjusted for patient demographic data, comorbidities, preoperative laboratory values, and operative factors. Measurements and Main ResultsOf 28 366 patients, 758 (3%) were diagnosed with SSI. SSI occurred more often after abdominal than laparoscopic hysterectomy (4% vs 2%; p < .001). Among patients who underwent abdominal hysterectomy, predictors of SSI included diabetes, smoking, respiratory comorbidities, overweight or obesity, American Society of Anesthesiologists class ≥3, perioperative blood transfusion, and operative time >180 minutes. Among those who underwent laparoscopic hysterectomy, predictors of SSI included perioperative blood transfusion, operative time >180 minutes, serum creatinine concentration ≥2 mg/dL, and platelet count ≥350 000 cells/mL3. For patients with deep or organ/space SSI, significant predictors included perioperative blood transfusion and American Society of Anesthesiologists class ≥3 for abdominal hysterectomy, and non-white race, renal comorbidities, preoperative or perioperative blood transfusion, and operative time >180 minutes for laparoscopic hysterectomy. SSI was associated with longer hospital stay and higher rates of repeat operation, sepsis, renal failure, and wound dehiscence. SSI was not associated with increased 30-day mortality. ConclusionsSSI occurred more often after abdominal hysterectomy than laparoscopic hysterectomy performed to treat benign gynecologic disease. SSI was associated with increased postoperative complications but not mortality. Several risk factors for SSI after each abdominal and laparoscopic hysterectomy were identified in this study.

Timing of urinary catheter removal after uncomplicated total abdominal hysterectomy: a prospective randomized trial

ObjectiveTo assess whether immediate (0h), intermediate (after 6h) or delayed (after 24h) removal of an indwelling urinary catheter after uncomplicated abdominal hysterectomy can affect the rate of re-catheterization due to urinary retention, rate of urinary tract infection, ambulation time and length of hospital stay. Study designProspective randomized controlled trial conducted at Suez Canal University Hospital, Egypt. Two hundred and twenty-one women underwent total abdominal hysterectomy for benign gynecological diseases and were randomly allocated into three groups. Women in group A (73 patients) had their urinary catheter removed immediately after surgery. Group B (81 patients) had the catheter removed 6h post-operatively while in group C (67 patients) the catheter was removed after 24h. The main outcome measures were the frequency of urinary retention, urinary tract infections, ambulation time and length of hospital stay. ResultsThere was a significantly higher number of urinary retention episodes requiring re-catheterization in the immediate removal group compared to the intermediate and delayed removal groups (16.4% versus 2.5% and 0% respectively). Delayed urinary catheter removal was associated with a higher incidence of urinary tract infections (15%), delayed ambulation time (10.3h) and longer hospital stay (5.6 days) compared to the early (1.4%, 4.1h and 3.2 days respectively) and intermediate (3.7%, 6.8h and 3.4 days respectively) removal groups. ConclusionsRemoval of the urinary catheter 6h postoperatively appears to be more advantageous than early or late removal in cases of uncomplicated total abdominal hysterectomy.

Ovarian Conservation Versus Removal at the Time of Hysterectomy for Benign Gynecological Diseases

Hysterectomy for benign gynecological diseases is a common surgical procedure. Prophylactic bilateral oophorectomy is often recommended concurrent with hysterectomy to decrease the risk of ovarian cancer. Oophorectomy before menopause leads to an abrupt decrease in endogenous estrogen and androgen production leading to different health problems. So women undergoing hysterectomy for benign gynecological diseases are presented with the choice of ovarian conservation or removal. The purpose of this review article is to summarize and critically evaluate the existing evidences regarding the impact of ovarian conservation versus removal on specific health issues of the individual. Information was collected by searching pub med for related studies, abstracts and articles. Studies have shown that benefits of elective oophorectomy also include reduction of breast cancer and development of residual ovary syndrome. On the other hand bilateral oophorectomy is associated with increased risk of cardiovascular disease, osteoporosis, cognitive impairment, dementia, depression, anxiety and decreased sexual function. Estrogen was commonly prescribed after bilateral oophorectomy to treat menopausal symptoms. But recent studies have shown more harm than benefit in postmenopausal hormone therapy. So the decision making regarding elective oophorectomy at the time of hysterectomy for benign indications has become complex. The approach to such decision will include counseling regarding risks and benefits of the procedure and shared decision making between the clinician and the patient. The beneficial effect on ovarian cancer must be weighed against the risks of ovarian hormone withdrawal.

Comparison of Robotic and Laparoscopic Hysterectomy for Benign Gynecologic Disease

The laparoscopic approach has many advantages over open abdominal hysterectomy and is widely used. However, there are several limitations to laparoscopic hysterectomy (LH). These include a steep learning curve, longer operating times, counterintuitive hand movement, 2-dimensional visualization, and

Analysis of the learning curve for robotic hysterectomy for benign gynaecological disease

The objective was to evaluate the learning curve for performing a robotic hysterectomy to treat benign gynaecological disease. Thirty-six patients underwent robotic hysterectomy for benign indications. A systematic chart review of consecutive cases was conducted. The collected data included age, BMI, operating time, set-up time, docking time, uterine weight, blood loss, intraoperative complications, postoperative complications, conversions to laparotomy and length of hospital stay. The mean operating, set-up and docking times were 169 ± 54.5, 52.9 ± 12.4 and 7.8 ± 7.6 min, respectively. The learning curve analysis revealed a decrease in both docking and operating times, with both curves plateauing after case 9. The learning curve analysis revealed a decrease in docking time and operating time after case 9, suggesting that there might be a fast, learning curve for experienced laparoscopic surgeons to master robotic hysterectomy, and that the docking process does not have a significant negative influence on the overall operating time.

Changes in tissue composition of the vaginal wall of premenopausal women with prolapse

The objective of this study was to compare histological and biochemical features of the (normal) precervical anterior vaginal wall and the prolapsed anterior vaginal wall of women with pelvic organ prolapse (POP). These data were compared to tissue of the precervical anterior vaginal wall of age-matched controls without POP to identify possible intrinsic and acquired effects. Biopsies were collected from the apex of the anterior vaginal cuff after hysterectomy from a control group of 13 premenopausal women undergoing hysterectomy for benign gynecological diseases, and a case group of 13 premenopausal women undergoing prolapse surgery (cystocele POP-Quantification stage ≥2). In women with POP an additional full-thickness vaginal wall sample was taken from the POP site during anterior colporrhaphy. Histomorphometric and biochemical analysis were performed for different components of the extracellular matrix. There were no differences between case and control group in the precervical vaginal wall tissue with respect to the different components of the extracellular matrix and the biochemical parameters. However, there was a tendency toward a higher amount of collagen III and elastin, and a significant increase of smooth muscle cells and pyridinoline collagen cross-links in the POP site compared to the non-POP site of the same POP patient. Our findings suggest that the changes seen in connective tissue in the anterior vaginal wall of women with POP are the effect, rather than the cause, of POP.

The Study on Postoperative Pain after Total Laparoscopic and Vaginal Hysterectomy for Benign Gynecologic Disease

Myomectomy is common gynecologic procedure performed for the conservative management of leiomyomas. The surgical removal of myomas can be associated with a considerable amount of intra-operative blood loss, which represents an important morbidity that may be associated with the procedure. The purpose of this video presentation is to demonstrate various preoperative and intraoperative measures that may decrease blood loss during a myomectomy. A particular emphasis was placed on demonstrating the evidence-based strategies that have been shown to decrease blood loss in minimally-invasive abdominal myomectomies. The strategies that are covered in this video presentation include the preoperative use of medications, temporary and permanent uterine artery occlusion, injection of vasopressin and use of barbed suture for closure of the uterine defect.