Hysterectomy For Benign Gynecologic Disease Research Articles

Vaginal Hysterectomy and Pelvic Organ Prolapse: History and Recent Developments.

Vaginal hysterectomy (VH) was described as far back as 120 CE. However, it was not till the mid-1900s when reconstructive procedures were introduced to mitigate the risk of, or treat, pelvic organ prolapse in relation to VH. Furthermore, routine hysterectomy, particularly VH, has long been advocated in prolapse surgery. However, this indication is now questionable. Literature review to provide an overview of current evidence and experts' opinion regarding the relationship between VH and pelvic organ prolapse. The review presents a historical perspective on the role of VH in the management of pelvic organ prolapse, the current debate on the usefulness of the procedure in this context, a practical guide on operative techniques used during VH and the impact of recent surgical developments on its use. Vaginal hysterectomy is a well-established technique that is still superior to laparoscopic hysterectomy for benign gynecological disease, although more surgically challenging. However, it is possible that some contemporary techniques, such as vaginal natural orifice transluminal endoscopic surgery, may overcome some of these challenges, and hence increase the number of hysterectomies performed via the vaginal route. Although patients should be counselled about uterine-sparing reconstructive surgery, vaginal hysterectomy continues to be a major surgical procedure in reconstructive pelvic floor surgery. Therefore, it is prudent to continue to train residents in vaginal surgical skills to ensure that they continue to provide safe, cost-effective, and comprehensive patient care.

Robotic-assisted hysterectomy for benign gynecologic disease in the United States: in-hospital use of opioid and non-opioid analgesics.

To compare the in-hospital opioid and non-opioid analgesic use among women who underwent robotic-assisted hysterectomy (RH) vs. open (OH), vaginal (VH), or laparoscopic hysterectomy (LH). Records of women in the United States who underwent hysterectomy for benign gynecologic disease were extracted from the Premier Healthcare Database (2013-2019). Propensity score methods were used to create three 1:1 matched cohorts stratified in inpatients [RH vs. OH (N = 16,821 pairs), RH vs. VH (N = 6149), RH vs. LH (N = 11,250)] and outpatients [RH vs. OH (N = 3139), RH vs. VH (N = 29,954), RH vs. LH (N = 85,040)]. Opioid doses were converted to morphine milligram equivalents (MME). Within matched cohorts, opioid and non-opioid analgesic use was compared. On the day of surgery, the percentage of patients who received opioids differed only for outpatients who underwent RH vs. LH or VH (maximum difference=1%; p<0.001). RH was associated with lower total doses of opioids in all matched cohorts (each p<0.001), with the largest difference observed between RH and OH: median (IQR) of 47.5 (25.0-90.0) vs. 82.5 (36.0-137.0) MME among inpatients and 39.3 (19.5-66.0) vs. 60.0 (35.0-113.3) among outpatients. After the day of surgery, fewer inpatients who underwent RH received opioids vs. OH (78.7 vs. 87.5%; p<0.001) or LH (78.6 vs. 80.6%; p<0.001). The median MME was lower for RH (15.0; 7.5-33.5) versus OH (22.5; 15.0-55.0; p<0.001). Minor differences were observed for non-opioid analgesics. RH was associated with lower in-hospital opioid use than OH, whereas the same magnitude of difference was not observed for RH vs. LH or VH.

Perioperative outcomes of transvaginal natural orifice transluminal endoscopic surgery and transumbilical laparoendoscopic single-site surgery in hysterectomy: A comparative study.

This study aimed to compare the perioperative outcomes of patients who underwent hysterectomy for benign gynecologic diseases using transvaginal natural orifice transluminal endoscopic surgery (vNOTES) or transumbilical laparoendoscopic single-site surgery (TU-LESS). A total of 314 patients who underwent hysterectomy for benign uterine disease at West China Second University Hospital between October 2018 and December 2021 were enrolled in this retrospective study. vNOTES (n = 157) and TU-LESS (n = 157) recipients were matched 1:1 in terms of uterine volume. The operation time, blood loss, postoperative decrease in hemoglobin, uterus weight, postoperative hospital stay, postoperative pain score at 12 h, postoperative indwelling catheter time, and other clinical indicators were compared between the two groups. All 314 patients successfully completed the surgery, and the two groups had similar baseline characteristics, with no statistical difference. Regarding intraoperative outcomes, the operation time was shorter in the vNOTES group than in the TU-LESS group (80 vs 100 min, P = 0.04), and there were no significant differences in intraoperative blood loss, intraoperative blood transfusion rate, postoperative decrease in hemoglobin, or uterine weight. Concerning postoperative outcomes, vNOTES hysterectomy was significantly superior to TU-LESS hysterectomy in terms of the length of hospital stay (3 vs 4 days, P < 0.001), visual analog scale score for pain at 12 h after surgery (P = 0.04), postoperative indwelling catheter time (39.5 vs 64.0 h, P < 0.001), and postoperative exhaust time (24.0 vs 42.0 h, P < 0.001). There were no significant differences in postoperative complications between the two groups. vNOTES and TU-LESS seem safe and feasible for hysterectomy, but vNOTES hysterectomy was more conducive to the postoperative rehabilitation of patients, with less trauma, less pain, and better cosmetic effects than TU-LESS hysterectomy. As an emerging surgical approach, more studies, including large-sample, multicenter, randomized controlled trials, are needed to validate our findings.

Discussion on the influence of optimizing the perioperative management on the recovery after laparoscopic hysterectomy.

The concept of enhanced recovery after surgery (ERAS) was first proposed by Professor Kehlet from the University of Copenhagen in Denmark in 1997. The aim is to optimize multiple perioperative management measures, promote rapid postoperative recovery, shorten hospital stay, and reduce surgical related costs, this article explores the effect of optimizing perioperative bowel preparation and diet management under the strategy of ERAS on the postoperative recovery of patients undergoing laparoscopic hysterectomy for benign gynecological diseases. We selected 90 patients who underwent laparoscopic total hysterectomy for benign gynecological diseases at Hebei General Hospital from June 2018 to June 2019, these patients are between the ages of 40 and 65. Divide these 90 patients into an experimental group and a control group using a random number table method (n = 45). The experimental group of patients applied the concept of accelerated rehabilitation surgery for perioperative intestinal preparation and dietary management. The control group patients received routine perioperative management. Compare the first postoperative exhaust time, first postoperative defecation time, incision healing status 7 days after surgery, and pelvic infection status 1 month after surgery between 2 groups of patients. The first postoperative exhaust time and first postoperative bowel movement time of the experimental group patients were shorter than those of the control group (P < .05), and the difference was statistically significant; The incidence of poor incision healing 7 days after surgery was lower than that of the control group (P < .05), and the difference was statistically significant; There was no statistically significant difference in the incidence of postoperative pelvic infection between the experimental group and the control group (P > .05). Perioperative intestinal preparation and dietary management under the concept of accelerated rehabilitation surgery can promote postoperative recovery of patients undergoing laparoscopic total hysterectomy, promote incision healing, and have good safety.

The learning curve of introduced robotic-assisted hysterectomy versus skilled laparoscopic hysterectomy for benign gynecologic diseases.

This study aimed to compare introduced robotic-assisted hysterectomy (RAH) and skilled total laparoscopic hysterectomy (TLH) for the treatment of benign gynecological diseases. Patients who underwent RAH or TLH by two surgeons at the Tottori University Hospital between January 2018 and May 2022 were included in this retrospective study. Inclusion criteria were patients with 100-300 g of uterine weight. The exclusion criteria were patients with stage IV endometriosis. Mean operative time and learning curve were compared among the first-half RAH, second-half RAH, and TLH groups. There were 40 eligible cases (first-half RAH: 20 cases, second-half RAH: 20 cases) in the RAH group and 44 cases in the TLH group. The total operative time (TOT) of the second half of RAH was significantly shorter than that of the first half of RAH (p = 0.021) and was comparable to that of the TLH group. The operative time (OT) of the second half of RAH was shorter than that of TLH (p = 0.023). The preparation time of TLH was shorter than that of the RAH group (p < 0.01). The learning curve of the TOT in RAH crossed that of TLH on the 31st case of RAH. In contrast, both curves of the OT crossed on the 11th case of RAH. The TOT of the introduced RAH was equivalent to that of skilled TLH in approximately 30 cases since the first RAH. Furthermore, the OT of RAH was comparable to that of TLH in approximately 10 cases of surgery since the first RAH.

Robotic Single-Site Hysterectomy in Gynecologic Benign Pathology: A Systematic Review of the Literature.

Background and objectives: Total hysterectomy is one of the most common gynecologic surgical procedures and it is mainly performed for benign pathologies. The introduction of robotic single-site surgery (RSS) as an acceptable alternative to laparoendoscopic surgery combines the advantages of robotics with the aesthetic result of a single incision. This study aims to review the existing literature on a single-site robotic hysterectomy in patients with benign pathologies and verify its safety and feasibility. Materials and Methods: Following the recommendations in the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement, FP and AR systematically screened the PubMed, Embase, and Scopus databases. No temporal or geographical limitation was discriminatory. Studies containing data about feasibility and safety were included. Results: From 219, only eight studies met the inclusion criteria, and a total of 212 patients were included with a mean patient age of 45.42 years old (range 28-49.5 years old) and a mean BMI of 25.74 kg/m2 (range 22-28.5 kg/m2). The mean presurgical time, including port placement and docking time, was 15.56 (range 3-30) minutes. Mean console time was reported in six studies and is 83.21 min (range 25-180 min). The mean operative time is 136.6 min (range 60-294 min) and the mean blood loss is 43.68 mL (range 15-300 mL). Only two patients in the total analyzed had intraoperative complications and no conversion to LPT occurred. The median hospital stay was 1.71 days (range 0.96-3.5 days). The postoperative complication rate was estimated at 1.4% (vaginal bleeding). Conclusions: Our review supports the safety and feasibility of robotic single-site hysterectomy for benign gynecological diseases.

8683 Robotic Single-Site Versus Laparoscopic Single-Site Hysterectomy in Benign Gynecologic Disease: A Single Surgeon's Experience

<h3>Study Objective</h3> The purpose of this study is to evaluate the feasibility and safety of robotic single-site hysterectomy (RSSH), and to compare postoperative outcomes between RSSH and laparoscopic single-site hysterectomy (LSSH) for benign gynecological disease. <h3>Design</h3> A retrospective study was conducted of all cases of RSSH and LSSH performed from January 2018 to February 2021. <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> Among 170 consecutive patients who had undergone total hysterectomy for benign gynecologic disease, surgical outcomes were compared between the RSSH group (n=92) and the LSSH group (n=78). <h3>Interventions</h3> RSSH was performed using the da Vinci Xi robotic system with Lab single®, and LSSH using a handmade globe port at the umbilicus. And all operations were performed by a single gynecologic oncologic surgeon. <h3>Measurements and Main Results</h3> All operations were completed with no additional port insertion or conversion to laparotomy. There were no significant differences in the characteristics of the patients between the 2 study groups. The uterus weight was 389 ± 190 in the RSSH group and 390 ± 225 in the LSSH group. Mean operation time was higher in the RSSH group than the LSSH group (85.3 ± 26.5 vs 73.6 ± 26.5 min, <i>p <</i> 0.0001). However, the postoperative pain score was lower in the RSSH group. The mean NRS score after 2 hours, 4 hours, 8 hours, and 12 hours was significantly lower than the LSSH group (<i>p <</i> 0.0001). Operative Mean hemoglobin drop (1.4 ± 0.9 vs 1.3 ± 1.0 g/dl, p = 0.122) and Mean postoperative day (3.1 ± 0.6 vs 3.1 ± 0.5 days, p = 0.943) did not significantly differ between two groups. <h3>Conclusion</h3> The RSSH using the da Vinci Xi system is feasible and safe in appropriately select patients with benign gynecologic disease. Additionally, prospective randomized clinical trials will be able to evaluate the potential benefits of Robotic single-site surgery.

Abdominal Hysterectomy for Benign Gynecological Diseases

OBJECTIVES This study aims to assess the Pap smear screening method’s accuracy in detecting precancerous lesions. METHODOLOGY After fulfilling the inclusion criteria patients were selected, the patient’s bladder was emptied and put in a dorsal position, and Cusco’s speculum was introduced after lubrication followed by insertion of Ayer’s spatula, applied on the transformational zone, and rotated in 360 degrees. Specimen smeared on glass slides and sent to the laboratory with fulfilled lab pre-requisite form. Patients were requested to follow up with a histopathology report. RESULTS Mean age of the patient was 38.111+9.461 years. Among the 77 patients whose samples were taken 15.4% were asymptomatic, 32.1% with vaginal discharge, 17.9% vaginal discharge,17.0% with intermenstrual bleeding and 16.7% were having lower abdominal pain with p value=0.087. Histopathology reports were interpreted upon follow-up visit among those 1.3% came out to be positive for malignancy, 76.6% negative for malignancy while 22.1% had an inadequate sample. CONCLUSION The most common method for screening for cervical cancer is the Pap smear, but its efficacy in detecting early precancerous lesions is very low, possibly due to laboratory error or false technique to a gynecologist of sample technique in our tertiary care hospital. Other screening methods should be used instead of conventional Pap smear.

SUBSTANTIAL VARIABILITY IN OVARIAN CONSERVATION AT HYSTERECTOMY FOR ENDOMETRIAL HYPERPLASIA

While ovarian conservation at hysterectomy for benign gynecologic disease has demonstrated mortality benefit in young patients, this benefit may be sustained up to age 65 years. There is a paucity of data regarding ovarian conservation in those with a diagnosis of endometrial hyperplasia, a premalignant uterine condition. The objective of the current study is to examine patient, hospital, treatment, and histology characteristics related to ovarian conservation at time of hysterectomy for endometrial hyperplasia.

Tips and Tricks for Vaginal Hysterectomy

Vaginal hysterectomy is the preferred route of hysterectomy for benign gynaecological disease. Unfortunately, rates of vaginal hysterectomy are declining due to decreasing training opportunities and provider comfort. This video reviews important steps of vaginal hysterectomy and provides tips to improve surgeon confidence. It discusses how to select candidates for vaginal hysterectomy including commonly misquoted contraindications. An approach, using the physical exam as guidance, is given for the anterior and posterior colpotomy and video footage is used to review how to troubleshoot the anterior entry.

Substantial variability in ovarian conservation at hysterectomy for endometrial hyperplasia

Although ovarian conservation at hysterectomy for benign gynecologic disease has demonstrated mortality benefit in young patients and this benefit may be sustained up to age 65 years, there is a scarcity of data regarding ovarian conservation in those with a diagnosis of endometrial hyperplasia, a premalignant uterine condition. This study aimed to examine patient, hospital, treatment, and histology characteristics related to ovarian conservation at the time of inpatient hysterectomy for endometrial hyperplasia. The Healthcare Cost and Utilization Project's National Inpatient Sample was retrospectively queried to examine patients aged ≤65 years with endometrial hyperplasia who had inpatient hysterectomy from January 2016 to December 2019. The exclusion criteria included concurrent gynecologic malignancy, adnexal pathology, and lymphadenectomy. Cases were grouped by adnexal surgery status (ovarian conservation or oophorectomy). A multivariable binary logistic regression model was used to identify independent characteristics for ovarian conservation. A classification tree was constructed with recursive partitioning analysis to examine utilization patterns of ovarian conservation. Overall, 3105 patients (31.1%) underwent ovarian conservation at hysterectomy among 9975 patients. The utilization of ovarian conservation decreased gradually until age 45 years and then markedly decreased by age 52 years (63.3%-15.3%; P<.001). In a multivariable analysis, younger age, non-White, urban nonteaching centers, and vaginal hysterectomy were associated with increased utilization of ovarian conservation, whereas endometrial hyperplasia with atypia, obesity, comorbidity, large bed capacity centers, and Midwest and South regions were associated with decreased utilization of ovarian conservation (all, P<.05). A classification tree identified 17 utilization patterns for ovarian conservation, ranging from 7.8% to 100.0% (absolute rate difference, 92.2%). The utilization of ovarian conservation at the time of inpatient hysterectomy in patients undergoing surgical management for endometrial hyperplasia started decreasing in their mid-40s and seemed to occur earlier than in benign hysterectomy. There was substantial variability in ovarian conservation at the time of hysterectomy for endometrial hyperplasia based on patient, hospital, surgical, and histology factors, suggesting the possible benefit of clinical practice guidelines for ovarian conservation in this population.

Paracervical block in laparoscopic hysterectomy for postoperative pain control: a randomized, multi-center, double-blind, placebo-controlled trial

Background: To determine the effect of a paracervical block in laparoscopic hysterectomy on postoperative pain relief. Method: A total of 86 patients scheduled for total laparoscopic hysterectomy for benign gynecologic diseases were randomly assigned to the experimental group (n = 43) and the control group (n = 43). Patients were received a paracervical injection that was either 10 mL of 0.5% bupivacaine with 1 : 200,000 epinephrine or 10 mL of normal saline. The primary outcome was the postoperative pain score which was assessed using a visual analog scale at 2, 4, 6, 8, and 12 hours after surgery. The secondary outcome was the postoperative rescue analgesic requirement within 12 hours after surgery. Results: Baseline characteristics were similar in both groups. Postoperative pain scores did not significantly differ between groups. Rescue analgesia requirements were also statistically similar in both groups. Conclusion: Adding a paracervical block with preemptive local analgesia in patients undergoing laparoscopic hysterectomy did not reduce postoperative pain and postoperative rescue analgesia requirements.

Evaluation of the learning curve and safety outcomes in robotic assisted vaginal natural orifice transluminal endoscopic hysterectomy: A case series of 84 patients.

To explore the learning curve and safety outcomes of robotic assisted transvaginal natural orifice transluminal endoscopic surgery (R-vNOTES) for hysterectomy in benign gynaecological diseases. A retrospective chart review of all patients undergoing R-vNOTES hysterectomy for benign gynaecological disease from 2019 to 2021. An academic tertiary care university hospital in Houston, TX, USA. 84 patients were identified that met the study requirements. The mean hysterectomy time was 77.27±2.89min. The median additional operation time was 63 (8-206)min. There were two conversions to robotic assisted single incision laparoscopy. Thirteen (15.48%) patients had an associated complication. Analysis of the learning curve suggests plateauing of hysterectomy time at approximately 10 cases and time for robot docking and port placement after 10-20 cases. R-vNOTES is a safe and effective route for hysterectomy. For a surgeon with experience in laparoscopic single site surgery and abdominal robotic surgery, they need to perform 10 cases of R-vNOTES hysterectomy and 10-20 cases in port placement and robotic docking to achieve proficiency.

Risk factors of vaginal cuff infection in women undergoing laparoscopic hysterectomy for benign gynecological diseases.

This study aimed to identify the risk factors for vaginal cuff infection after laparoscopic hysterectomy for benign gynecological diseases. We conducted a retrospective cohort study among 1559 Japanese women who underwent total laparoscopic hysterectomy (TLH) for benign indications between 2014 and 2018 at Teine Keijinkai Hospital in Sapporo, Japan. All patients received preoperative antibiotics based on appropriate timing, choice, and weight-based dosing. We assessed the risk factors of vaginal cuff infection after TLH, including demographic and clinical variables, and patient- and surgery-related factors, using univariable and multivariable logistic regression analyses. Among all the patients who underwent TLH, 71 cases of vaginal cuff infections (4.6%) were recorded. Univariate analyses showed that current smoking, pathological result of adenomyosis, use of Seprafilm as an antiadhesive material, white blood cell counts on postoperative day (POD) 2, C-reactive protein (CRP) level on POD2 and postoperative vaginal cuff hematoma were significantly associated with an increased risk of vaginal cuff infection. In multivariate analysis, current smoking, use of seprafilm, CRP level on POD2 and vaginal cuff hematoma were significantly associated with an increased risk of vaginal cuff infection. Current smoking, use of seprafilm, CRP level on POD2 and vaginal cuff hematoma were identified as significant risk factors of vaginal cuff infection in the 30 days after surgery in Japanese women who underwent TLH for benign indications.

Risk of Upper-body Adverse Events in Robot-assisted Total Laparoscopic Hysterectomy for Benign Gynecologic Disease

Recent studies suggest that prolonged Trendelenburg positioning during robot-assisted total laparoscopic hysterectomy (RA-TLH) may lead to fluid shifts and pulmonary, airway, head and neck, and cranial complications in the upper body. This study examined the upper-body complications during RA-TLH for benign gynecologic disease. Population-based retrospective study. The National Inpatient Sample. A total of 771 412 women who had total hysterectomy for benign gynecologic disease from October 2008 to September 2015, including 661 284 women who had total abdominal hysterectomy (TAH), 51 544 women who had traditional TLH, and 58 584 women who had RA-TLH. A multiple-group generalized boosted model to balance the measured baseline covariates across the 3 hysterectomy groups and a generalized estimating equation model to assess the effect size of complication risk (overall and upper-body complications). Women in the RA-TLH group were more likely to be older, white, and have a higher comorbidity index (all, p <.001). The overall rate of upper-body complications was 4.6% across the 3 groups. RA-TLH was not associated with increased risk of upper-body complications compared with traditional TLH (odds ratio [OR] 1.06; 95% confidence interval [CI], 0.90-1.26) or TAH (OR 0.98; 95% CI, 0.87-1.11). In contrast, RA-TLH was associated with decreased risk of overall perioperative complications compared with TAH (12.0% vs 18.6%; OR 0.64; 95% CI, 0.59-0.70; p <.001). RA-TLH and traditional TLH had similar risk of overall perioperative complications (12.0% vs 13.1%; OR 0.91; 95% CI, 0.8-1.02; p = .099). Women who developed upper-body complications had a higher perioperative mortality rate (0.4% vs <0.01%; OR 79.1; 95% CI, 36.0-174). The highest rates of complications (62.5%) were observed in morbidly obese women aged 70-79 with a comorbidity index of ≥4. In hysterectomy for benign gynecologic disease, RA-TLH was not associated with an increased risk of upper-body complications compared with TAH or traditional TLH. However, older age and higher comorbidity are key risk factors that increase the risk of upper-body complications which carry a disproportionally high mortality rate.

Peri-operative complications of Total laparoscopic hysterectomy for benign gynecological diseases in Fukuoka university

Peri-operative complications of Total laparoscopic hysterectomy for benign gynecological diseases in Fukuoka university

National trends and outcomes of morbidly obese women who underwent inpatient hysterectomy for benign gynecological disease in the USA

The US population has witnessed an epidemic expansion of obesity in the past several decades; nearly 50% of the population is projected to be obese by 2030 and 25% morbidly obese. This study examined trends, characteristics and outcomes of morbidly obese women who underwent benign hysterectomy. This is a population-based retrospective observational study querying the National Inpatient Sample from January 2012 to September 2015. The study population included 509395 women who underwent hysterectomy for benign gynecological disease: 430865 (84.6%) non-obese women, 50435 (9.9%) women with class I-II obesity and 28095 (5.5%) women with class III obesity. Main outcome measures were (i) cohort-level trends of obesity and perioperative complications assessed by piecewise linear regression with log transformation and (ii) patient-level perioperative complication risk by body habitus assessed with a generalized estimating equation after using a multiple-group generalized boosted model. The rate of class III obesity increased by 40.4%, higher than the rate of class I-II obesity (22.2%) (both, P<.001). In parallel, cohort-level rates of perioperative complication and prolonged hospitalization for ≥7days increased by 19.4% and 54%, respectively (P<.001). In a weighted model, class I-II obesity (16.4% vs 14.6%, odds ratio 1.15, 95% confidence interval 1.08-1.21) and class III obesity (19.2% vs 14.6%, odds ratio 1.39, 95% confidence interval 1.28-1.51) had a significantly increased risk of perioperative complications compared with non-obesity. Larger body habitus was associated with higher total charge (median, $35180, $36094 and $39382; all values cited in US dollars) and prolonged admission rate for ≥7days (2.9%, 3.1% and 3.9%) (both, P<.001). The rate of obesity, particularly morbid obesity, has significantly increased among women undergoing benign hysterectomy in the USA. Morbidly obese women had adverse perioperative outcomes, and the increasing number of morbidly obese women resulted in both an increased perioperative morbidity and total charges as a cohort. National and society-based approaches are necessary to reduce the obesity rate and hysterectomy morbidity.

Impact of Surgical Wait Time to Hysterectomy for Benign Gynecologic Disease

Study ObjectiveTo determine the impact of surgical wait time on healthcare use and surgical outcomes for patients undergoing hysterectomy for benign gynecologic indications.DesignRetrospective cohort study.SettingUrban, academic tertiary care center.PatientsPatients who underwent hysterectomy for benign disease between 2012 and 2018.InterventionsNone.Measurements and Main ResultsPatients were categorized into 2 groups, dichotomized by surgical wait times >30 days or ≤30 days. Healthcare use was measured by the number of discrete patient interactions with the healthcare system through phone calls, secure electronic messaging, and office and emergency room visits. Univariate and multivariable logistic regression models were performed to assess the association between surgical wait time and healthcare use and perioperative outcomes while controlling for confounders. A total of 277 patients were included in our analysis: 106 (38.3%) had surgical wait times >30 days (median 47 days, range 24–68 days), and 171 (67.1%) had surgical wait times ≤30 days (median 19 days; range 12–26 days). The groups did not differ by age, insurance status, substance use, or comorbid conditions. Patients in the group with surgical wait times >30 days were more likely to have increased healthcare use (69 of 106, 65% vs 43 of 171, 25%; odds ratio 5.55; 95% confidence interval, 3.27–9.41). There were no differences in intraoperative complications (9 of 106, 8% vs 19 of 171, 11%; p = .482) or postoperative complications (28 of 106, 26% vs 32 of 171, 19%; p = .13) between the groups; however, after controlling for potential confounders, patients with surgical wait times >30 days were 3.22 times more likely to be readmitted than patients with surgical wait times ≤30 days (95% confidence interval, 1.27–8.19).ConclusionA surgical wait time >30 days in patients undergoing a hysterectomy for benign disease is associated with increased healthcare use in the interim. Although patients who experience longer surgical wait times do not experience worse surgical outcomes, they may be at higher risk for readmission after surgery. Targeted interventions to optimize perioperative coordination of care for patients undergoing a hysterectomy for benign disease, especially those within vulnerable populations, are needed to improve quality of care, decrease any redundant or inefficient healthcare use, and reduce any unnecessary delays.

Opportunistic Salpingectomy: Current Practice in Hospital Setting in Bangladesh

Background: The fimbrial end of the fallopian tube has recently been suggested as the site of origin for epithelial ovarian cancers (EOC). Therefore, a change in practice with opportunistic salpingectomy (OS) at the time of hysterectomy has been advocated for prevention of ovarian cancer in a low-risk population.&#x0D; Objective: The aim of this study was to analyzethe current trend of performing opportunistic salpingectomy during gynaecological surgery for benign indicationsin a tertiary care hospital of Bangladesh.&#x0D; Materials and method: This retrospective observational study was conducted in the Department of Obstetrics &amp; Gynaecology, BIRDEM Women and Children Hospital, Dhaka, Bangladesh from October 2019 to March 2022. All relevant demographic and clinical information of 255 patients undergoing hysterectomy for benign gynaecological disease without involving the ovaries or adnexae were documented from hospital records after exclusion of patients with any gynecologic cancer or having any ovarian or adnexal pathology, and those who underwent hysterectomy due to pregnancy related conditions.&#x0D; Results: Mean age of the patients was 48.71 ± 8.31 years and the highest proportion of patients (49.0%) were in the 41-50 years of age group. Bilateral salpingo-oophorectomy was done in 131 cases (51.4%) with mean age of 51.95 ± 7.99 years and opportunistic salpingectomy was done in 72 cases (28.2%) with mean age of 42.68 ± 3.97 years. The rate of opportunistic salpingectomy statistically increased from 17.39% in 2019 to 36.17% in 2022.&#x0D; Conclusion: As seen throughout the world, the practice of opportunistic salpingectomy for prevention of ovarian cancer has also increased in Bangladesh in recent years.&#x0D; Delta Med Col J. Jul 2020;8(2): 75-82

Seven-year survival analysis in women with unsuspected uterine malignancy after laparotomic versus laparoscopic hysterectomy: A national claim data retrospective cohort study.

e18096 Background: The primary aim of this study was to compare the overall survival of women with unsuspected uterine malignancy (UUM) diagnosed after laparotomic versus laparoscopic hysterectomy for benign gynecological diseases. Methods: A national health insurance database was analyzed from January 2006 to December 2010 to estimate the incidence and mortality of UUM diagnosed after hysterectomy for benign gynecologic diseases using diagnostic and procedure codes. Results: From the database (24 million women annually), 157,232 women were extracted. These women were divided into a laparotomic group (n = 103,631) and a laparoscopic group (n = 53,601). The overall incidences of UUM, unsuspected endometrial cancer, and UUM other than endometrial cancer were 0.65%, 0.46%, and 0.19%, respectively. Women with UUM diagnosed after hysterectomy showed no difference in mean age, incidence of UUM, or socioeconomic status in either group. Kaplan-Meier survival analysis and Cox regression analysis showed that the laparoscopic group was associated with more favorable overall survival than the laparotomic group, especially in UUM other than endometrial cancer ( p &lt; 0.001). Conclusions: In women with UUM diagnosed after hysterectomy for presumed benign gynecological diseases, overall survival up to 7 years favors laparoscopic hysterectomy over laparotomic hysterectomy, and the incidence of UUM is relatively low. However, considering the devastating effect of intraperitoneal dissemination of UUM, surgeons should fully explain this issue to patients preoperatively and try to avoid intraperitoneal spread of tumor cells intraoperatively. [Table: see text]