Hysterectomy For Benign Indications Research Articles

Effects of Pharmacologic Venous Thromboembolism (VTE) Prophylaxis in Benign Minimally Invasive Hysterectomy

Study Objective To evaluate if the addition of pharmacologic prophylaxis (heparin, low molecular weight heparin) for VTE is associated with adverse perioperative outcomes in minimally invasive surgery (MIS) hysterectomy for benign indications compared to mechanical prophylaxis alone. Design Retrospective cohort study. Setting Michigan Surgical Quality Collaborative (MSQC). Patients or Participants Patients who underwent a benign MIS hysterectomy (i.e. laparoscopic, vaginal, laparoscopic-assisted vaginal, or robotic-assisted laparoscopy) performed between July 2012 and June 2015 and received mechanical prophylaxis for thromboembolism. Interventions Patients were divided into cohorts who received mechanical prophylaxis alone (MPpx) or mechanical + pharmacologic prophylaxis (M+Pppx). Propensity score matching was used to minimize confounding due to differences in age, race, body mass index>40, hypertension, congestive heart failure, smoking, functional status, preoperative transfusion, preoperative anemia or thrombocytopenia, length of stay, and hospital teaching status. Outcomes evaluated in the propensity-matched cohorts were estimated blood loss, intraoperative time, postoperative blood transfusion, postoperative VTE, surgical site infection, reoperation, and readmission. Measurements and Main Results There were 1944 matched pairs of patients in the Mppx and M+Pppx cohorts. Intraoperative time was 21 minutes longer (168 minutes ± 63 min vs 189 ± 75 mins, p Conclusion Further research is needed into the addition of pharmacologicprophylaxis to mechanical prophylaxis and its association with longer operative time for benign minimally invasive hysterectomy. Given extremely low rates of VTE in both groups and no difference detected in other significant peri-operative outcomes using a large database, it seems reasonable to question routine use of pharmacologic prophylaxis in these patients.

Impact of Morcellation on Operative Time during Benign Laparoscopic Hysterectomy

Study Objective Estimate the impact of morcellation on operating room time during benign hysterectomy, while adjusting for other factors known to impact operative time. Design Retrospective cohort study. Setting Two medical centers in Boston, MA. Patients or Participants All patient undergoing laparoscopic or robotic hysterectomy for benign indications between November 2014 to December 2017. Interventions All patients underwent a hysterectomy by a laparoscopic or robotic, total or supracervical, approach and required morcellation for specimen removal. In all cases morcellation was manual and contained in a specimen bag. Laparoscopic hysterectomies with additional concomitant surgical procedures were excluded with the exception of salpingectomy, oophorectomy and cystoscopy. Data was collected with regards to patient demographics, surgical history, surgical indication, operative time, pathologic uterine weight and surgeon's annual hysterectomy volume. Measurements and Main Results A total of 959 patients met inclusion criteria. The mean operative time in the morcellation group was 146 ± 4 minutes vs. 109 ± 2 minutes in the group not requiring morcellation (p Conclusion Need for morcellation independently contributes to operative time when adjusting for other measures that can contribute to prolonged operating time. If intended, morcellation should be named in the operative procedure title to maximize efficiency of operative schedules.

Reduction of Postoperative Gastrointestinal Dysmotility Following Total Laparoscopic Hysterectomy: A Randomized Controlled Trial.

Study Objective To assess the effect of common bowel care regimens on return of bowel function following total laparoscopic hysterectomy (TLH). Design A prospective three-arm randomized controlled trial (Canadian Task Force Classification I). Setting Single academic-affiliated institution. Patients or Participants Women aged 18-85 years, without preexisting gastrointestinal disorders, undergoing TLH for benign indications. Interventions Patients were randomized to one of three arms using an equal allocation ratio to receive either no bowel care regimen (control group), docusate sodium, or polyethylene glycol 3350 (PEG) for the first five days following surgery. The primary outcome was time to first bowel movement postoperatively. Secondary outcomes were time to first flatus, total narcotic use in the first five days postoperatively, constipation score, and the Patient Assessment of Constipation Symptoms (PAC-SYM) questionnaire score. Measurements and Main Results There were no significant differences in time to first bowel movement postoperatively amongst those receiving no bowel care regimen, docusate sodium, or PEG (2.64 ± 1.19, 2.80 ± 1.08, 3.06 ± 1.18 days; p=0.436). Similarly, there were no significant differences in time to first flatus: 1.06 days (interquartile range 0.89-1.70) in the control group, 1.05 days (interquartile range 0.78-1.37) in the docusate sodium group, and 1.11 days (interquartile range 0.82-1.40) in the PEG group (p=0.975). Total narcotic use in the first five days postoperatively, constipation score, and the PAC-SYM score did not vary significantly amongst the groups. Body mass index (BMI) was a significant predictor of time to first bowel movement with an increased BMI associated with a shorter time to first bowel movement [HR 1.05 (1.01, 1.10); p=0.013]. Conclusion In those undergoing laparoscopic hysterectomy for benign indications without any preexisting gastrointestinal disorders, the prescription of a bowel care medication does not significantly affect return of bowel function.

Trends and Perioperative Outcomes across Elective Benign Hysterectomy Procedures from the ACS-NSQIP 2007-2017

Study Objective To delineate long-term national trends in the frequency of hysterectomy surgical routes, patient demographics, and perioperative morbidity with emphasis on extended length of stay and readmission rates. Design This retrospective cohort study evaluated 224,357 patients who underwent benign hysterectomy between 2007-2017. Setting In-patient hysterectomies performed at one of the participating hospitals in the American College of Surgeons- National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients or Participants The ASC-NSQIP database was used to recognize patients who underwent an elective benign hysterectomy between 2007-2017. Patients were identified using Current Procedural Terminology (CPT) and International Classification of Disease (ICD) codes. Interventions Laparoscopic, transvaginal, and abdominal hysterectomy for benign indications. Measurements and Main Results Summary statistics were used to evaluate shifts in patient characteristics and postoperative outcomes by hysterectomy route and year of surgery. Multivariable logistic regression analysis comparing laparoscopic to transvaginal and abdominal hysterectomies was performed, adjusting for patient characteristics and operative time. Variables of interest included age, Body Mass Index (BMI), American Society of Anesthesiologists (ASA) classification, uterine weight > 250 grams, Extended Length Of Stay (ELOS) and readmission. Our data shows that the rate of laparoscopic hysterectomy increased by more than 200% between 2007-2017 while that of transvaginal and abdominal hysterectomies decreased. Moreover, the mean age and rates of obesity amongst women undergoing hysterectomy increased steadily across all surgical routes, the sharpest increase in obesity noted amongst the laparoscopic hysterectomy group. In 2011, we noted a shift in the laparoscopic hysterectomy group, which by 2017, had 29% lower odds of ELOS as compared to the abdominal group (P Conclusion Although the benign surgical gynecology patient population is becoming increasingly complex, the risk of complications after hysterectomy is lowest when performed laparoscopically.

Patient Satisfaction with Initial Phone Call Vs. Office Visit Following Minimally Invasive Hysterectomy; A Randomized Controlled Trial

Study Objective The purpose of this study is to compare patient satisfaction on a 10 point scale between patients randomized to a phone call or clinic visit for the first assessment following minimally invasive hysterectomy. Design Eligible, consenting patients were enrolled at their preoperative visit and randomized at that time. Control patients had two office visits at 1-2 weeks and 6-8 weeks after surgery. Patients assigned to the study arm received a phone call 1-2 weeks after surgery, followed by a scheduled visit 6-8 weeks after surgery. Patients in both arms completed the SCAHPS survey after the 6-8 week visit. Setting Academic Hospital. Patients or Participants All women 18-75 undergoing minimally invasive hysterectomy for benign indications. Interventions The study arm had a phone call in lieu of an office visit at 1-2 weeks following surgery. Both arms were seen in clinic 6-8 weeks after surgery and completed an SCAPHS survey at that time. Measurements and Main Results The primary endpoint, patient satisfaction on a 1-10 point scale was 10 for both arms. Nearly all patients in the study stated that the number of office visits was just right. There were no major complications in either group. There were 7/50 patients who experienced minor complications including UTI, readmission within 30 days, and surgical site infections; however, this was not statistically significantly different between groups (p=.72) Patients in the study arm were more likely to have an unplanned emergency room or urgent care visit (5 vs 2); however, this did not reach statistical significance (p=0.25). Patients in the study arm were more likely to have unplanned office visits (3 vs 7), however this did not reach statistical significance. Conclusion Patients in both arms of this study were equally, highly satisfied. Consistent with findings in other specialties, phone calls are an acceptable and safe adjunct for postoperative assessments after MIH.

Disparities in Access to Minimally Invasive Hysterectomy in a Suburban Community Hospital: A Patient-Level Analysis

Study Objective Prior studies have identified differences in access to minimally invasive hysterectomy (MIH) based on demographic characteristics. These differences do not always persist when including patient-level information that may affect surgical decision-making. This study aims to identify racial or ethnic differences in access to MIH (laparoscopic or robotic) at our institution, as well as trends in access over time. Design Retrospective cohort study. Setting Suburban community hospital. Patients or Participants All adult women undergoing hysterectomy for benign indications, January 2015– December 2019. Exclusion criteria were a preoperative diagnosis of pelvic malignancy, concurrent sacrocolpopexy, emergent hysterectomy, or vaginal hysterectomy. Interventions N/A Measurements and Main Results A total of 1,632 patients were included in the analysis. 54% were non-Hispanic white, 17% non-Hispanic black, 21% Hispanic of any race, and 8% Asian, Native American, Pacific Islander or self-identified as “other”. Black and Hispanic women were significantly less likely to undergo MIH than white women, OR 0.490 (CI 0.371 – 0.646, p Conclusion This study identified a disparity in likelihood of undergoing MIH for non-white women. This was eliminated for black and “other” women after controlling for patient-level information but persisted in Hispanic women. Further study is warranted to better understand the factors underlying this finding.

Re: Urologic Injury and Fistula after Hysterectomy for Benign Indications.

Re: Urologic Injury and Fistula after Hysterectomy for Benign Indications.

Comparative Study of Ovarian Function in Patients Undergoing Hysterectomy With or Without Bilateral Complete Salpingectomy

Hysterectomy is one of the most common gynaecological procedures performed in clinical practice. Over the past decade, there is increasing evidence that the majority of high-grade serous ovarian cancers arise in the fallopian tube and not primarily in the ovary. This new theory has led to an opportunity to prevent epithelial ovarian cancer by the addition of the prophylactic bilateral salpingectomy in all surgical procedures for average-risk women, not carrying BRCA mutations, who completed their reproductive goal (American Cancer Society and the American College of Obstetricians and gynaecologists). The rising trend in salpingectomy has been associated with a rising concern over its potentially damaging effect on ovarian reserve due to possible concomitant damage of ovarian blood supply given the close proximity of tubal and ovarian arteries. In view of the above arguments the present study was planned to compare the effect on ovarian function in patients undergoing hysterectomy with or without bilateral complete salpingectomy. 50 premenopausal women planned for hysterectomy for benign indications were randomized to undergo hysterectomy with bilateral complete salpingectomy (group A) or hysterectomy alone (group B). Blood sample was collected on pre-operative period for baseline FSH, LH and Serum oestradiol (E2) level estimation. Group A (n = 25) patients underwent total hysterectomy with complete excision of the fallopian tubes bilaterally and in group B (n = 25) patients’ classical approach was done and ovaries and fallopian tubes were left in situ. Duration of surgery, change in haemoglobin on third post-operative day, post-op complications, and total duration of hospital stay was noted. The follow up of these patients was done 3 months after surgery and again blood sample was taken for serum FSH, LH and oestradiol (E2) level estimation. Baseline demographic and clinical characteristics were similar between the two groups. There was also no difference in operative outcomes such as operative time, intra-operative blood loss or complications between the two groups. Mean FSH, LH, and oestradiol values were unchanged after both the techniques. Bilateral complete opportunistic salpingectomy at the time of hysterectomy does not appear to have any short-term deleterious effects on ovarian function or increased surgical risk.

The impact of race on hysterectomy for benign indications.

To review current literature evaluating racial disparities in benign hysterectomy care in the United States. Evidence shows that black women are half as likely to undergo minimally invasive hysterectomy and have an increased risk of surgical complications compared with white women. Patient level differences including fibroids, prior surgical history, medical comorbidities, and obesity have been implied to account for the increased rate of abdominal hysterectomy in black patients; however, inequalities remain even after controlling for clinical differences. Societal factors including insurance status fail to fully account for disparities, though healthcare system factors, such as geographical region and access to a minimally invasive trained surgeon, continue to have a profound impact on the equity of care that patients receive. Disparities in hysterectomy route and outcomes by race and socioeconomic status exist and have persisted in the literature for over a decade despite a nationwide trend toward minimally invasive hysterectomy and improving surgical outcomes. These disparities are not fully accounted for by patient or health system factors. Successfully addressing these disparities will require a multipronged approach, which may include improved surgical training for residents, fellows, and practicing gynecologists, increasing referrals to high-volume minimally invasive gynecologic surgeons, and provider and patient education.

Prevalence of Inadequate Cervical Cancer Screening in Low-Income Older Women.

Objective: At age 65 years, cervical cancer screening is not recommended in women with an adequate history of negative screening tests in the previous 10 years if they do not have other high-risk factors for cervical cancer. The purpose of this study was to assess the proportion of older low-income women at a safety net urban hospital system without other risk factors for cervical cancer who should have cervical cancer screening because of an inadequate screening history, and to evaluate if they were triaged appropriately. Materials and Methods: Medical records from 200 women 65 years and older at the Gynecology clinic of John H. Stroger Hospital of Cook County were evaluated for adequate cervical cancer screening or hysterectomy to see if they could stop screening. Charts were reviewed to see if a screen was performed, and the results of that test and associated biopsies. Data using cytology alone and the cytology/human papillomavirus cotest were compared. Chi-square test was used. Results: Of 200 women included, the median age was 68.5 years, range 65-93 years. Of these women, 81 (40.5%) did not need testing because of adequate screening or hysterectomy for benign indications. There were 119 (59.5%) women who needed to continue testing because of inadequate screening. Of these women, 46 (38.7%) did not have appropriate testing carried out. Of 73 correctly screened women, 16 (21.9%) required biopsies, of which 11 demonstrated high-grade lesions or cancers. Conclusions: Many older women, especially low-income women, need to continue screening for cervical cancer because of inadequate screening histories. This is a group at increased risk for cervical cancer, and it is imperative that clinicians evaluate previous test results before exiting a woman from screening at age 65 years.

48: Association of Hispanic ethnicity with complications after benign hysterectomy

Hispanic patients have previously been shown to have a below-average complication rate following hysterectomy, but little is known about specific risks for this group.1 Our primary objective was to identify differences in rates of specific complications experienced by Hispanic patients following hysterectomy for benign indications as compared to non-Hispanic white patients. Our secondary objective was to compare route of hysterectomy and length of stay (LOS) between these groups. We performed a cohort study using National Surgical Quality Improvement Program (NSQIP) data. Our primary exposure was Hispanic race, with non-Hispanic white patients as the control. The NSQIP database contains prospectively-gathered, patient-level perioperative data from inpatient hospitals throughout the United States. Patients with gynecologic cancer diagnoses or who underwent staging procedures were excluded. Demographic data, postoperative complication rates, route of hysterectomy and LOS were compared between groups. Postoperative complication data were stratified by surgical route. Proportions were analyzed using two-sample tests, Student t-tests and contingency tables. 102,050 women were included. 15.0% were Hispanic and 85.0% were non-Hispanic white. Hispanic patients were more likely to have class 1 or 2 obesity (59.7 vs 49.8%), diabetes (10.9 vs 6.7%), and anemia (hematocrit <33: 14.1 vs 6.5%); p<0.01 for all. Hispanic patients were more likely to undergo abdominal hysterectomy (30.0 vs 19.1%, p<0.01) and to remain inpatient for 2-6 days (38.8 vs 24.0%, p<0.01). Hispanic patients were more likely to require blood transfusion following all routes of hysterectomy including abdominal hysterectomy (8.3 vs 5.9%, p= <0.01), laparoscopic hysterectomy (1.9 vs 0.6%, p= <0.01), vaginal hysterectomy (2.9 vs 1.4%, p= <0.01) and laparoscopic-assisted vaginal hysterectomy (2.4 vs 1.3%, p= <0.01). This difference remained significant only in patients without preoperative anemia when stratified by hematocrit. Hispanic patients had a decreased or equal rate of surgical site infection, pneumonia, pulmonary embolism, stroke, urinary tract infection, cardiac arrest, myocardial infarction, deep venous thrombosis, septic shock, death, unplanned reoperation, or readmission as compared with non-Hispanic white patients. Hispanic women were more likely to undergo open hysterectomy, had an increased length of stay, were more likely to have preoperative anemia and had a higher transfusion rate. Despite a higher rate of open surgery, Hispanic patients had a decreased or equivalent rate of major postoperative complications.1.Jacoby, V, Fujimoto, VY, Giudice, LC, Kupperman, M and Washington, AE. Racial and Ethnic Disparities in Benign Gynecologic Conditions and Associated Surgeries. Am J Obstet Gynecol. 2010 June; 202(6): 514-521.

44: Oxycodone use during the post-operative period after hysterectomy for benign indications

44: Oxycodone use during the post-operative period after hysterectomy for benign indications

38: Hospital revisits following hysterectomy for benign indications

38: Hospital revisits following hysterectomy for benign indications

Hysterectomy and sexual (dys)function: An analysis of sexual dysfunction after hysterectomy and a search for predictive factors

Objectives: Research about sexual function after hysterectomy is inconclusive. Possible predictive factors for sexual (dys)function are yet to be identified. The aim of this study is to assess the effect of hysterectomy on sexual function in women 3 and 12 months after hysterectomy for benign indications. Furthermore hypothesized predictive factors will be evaluated. Study Design: A prospective multicentre cohort study with follow-up at 3 and 12 months after hysterectomy was performed. To assess sexual function a short-form FSFI was used, a score ≤ 19 means sexual dysfunction). Linear mixed model repeated measure analysis was used to assess changes in sexual function in women who were sexually active at all three measure points (N = 260). Linear mixed model analyses were also used for the predictor analyses. Results: The FSFI score increased from 20.94 at baseline to 23.81 at 12 months post hysterectomy. The number of women experiencing sexual dysfunction was 86 (33.1 %). Women without preoperative sexual dysfunction had a significantly higher FSFI score 4.5 (95 % CI 3.5–5.6) one year after the operation than women indicating sexual dysfunction before surgery. Women who were living alone had a significantly higher FSFI score of 2.31 (0.7–4.0) when compared to women who were married or living together. Conclusion: FSFI score increases significantly after hysterectomy, which indicates a better sexual function after the operation. Sexual dysfunction before hysterectomy (FSFI score ≤ 19) and being married or living together are predictive factors for a lower FSFI score post hysterectomy.

Likelihood of incidental finding of gynecological cancer in women undergoing hysterectomy for benign indications

Likelihood of incidental finding of gynecological cancer in women undergoing hysterectomy for benign indications

Retrospective Analysis of Route Selection for Hysterectomy for Benign Indications at Ochsner Baptist Hospital.

Background: Hysterectomy, the most common gynecologic procedure in the United States, can be performed in a number of ways. A shift in surgical practice toward cost-effective and minimally invasive approaches provides an impetus to maximize early training in vaginal surgery for resident physicians.Methods: A total of 62 abdominal, 303 robotic, and 41 vaginal hysterectomies performed between January 1, 2015 and December 31, 2017 at Ochsner Baptist Hospital in New Orleans, LA, that met inclusion criteria were retrospectively reviewed with a previously published route selection algorithm. We applied the algorithm using preoperative and postoperative data collected via medical record review to determine if our practices favor minimally invasive approaches.Results: Analysis using preoperative variables identified 152 robotic cases that were vaginal hysterectomy candidates (50.2%). Postoperative analysis of the same cases identified 127 (41.9%) vaginal hysterectomy candidates. Among abdominal cases, 37 (59.7%) called for a less invasive approach by preoperative findings: 7 (11.3%) vaginal and 30 (48.4%) laparoscopic. The algorithm sorted only 25 of the 62 abdominal cases (40.3%) to the abdominal approach.Conclusion: Use of a hysterectomy route selection algorithm preoperatively improves identification of candidates for minimally invasive hysterectomy.

National Technicity on the Rise: Ten Year Minimally Invasive Hysterectomy Trends for Women with Benign Uterine Disease in Canada

Study Objective Hysterectomies are the most commonly performed gynecologic procedure and are associated with faster recovery and decreased complications when performed minimally invasively compared with abdominally. The objectives were to measure temporal trends in minimally invasive hysterectomy for Canada and each province/territory and to determine whether provincial/territorial differences exist. Design National population-based retrospective study using federal administrative data from the Canadian Institute for Health Information. Technicity index (proportion of vaginal and laparoscopic hysterectomies) was calculated. Cochrane-Armitage test was applied for temporal trends and 2-sided p-values Setting Canada Patients or Participants All patients undergoing hysterectomy for benign indications in Canada from FY2006/7 to FY2016/17 Interventions Hysterectomy Measurements and Main Results 369,740 hysterectomies were included (48.4% abdominal; 28.3% laparoscopic; 23.3% vaginal). Mean age was 48.5 years (SD 11.2 years), and indications for surgery were menstrual bleeding disorders (29.7%), fibroids (23.7%), pelvic organ prolapse(19.8%), other(17.4%), endometriosis(5.8%) and pelvic pain(3.6%). National technicity index (proportion of vaginal and laparoscopic hysterectomies) increased (40.5%⟶63.2%). Abdominal hysterectomy decreased (59.5%⟶36.8%); laparoscopic increased (10.8%⟶38.6%); while, vaginal decreased (29.7%⟶24.5%). (p Increasing technicity index was observed in all provinces, though with variable increase over time. (p Manitoba(36.9%⟶44.4%; RR1.50,95%CI[1.43-1.58]*), Nova Scotia(46.4%⟶48.5%; RR1.39[1.31-1.48]*), New Brunswick(43.7%⟶50.3%; RR1.34[1.26-1.44]*), Newfoundland(35.3%⟶55.2%; RR1.21[1.10-1.33]*), Ontario (39.4%⟶63.0%, RR1.00[reference])Quebec(42.0%⟶61.8%; RR1.03[0.99-1.07]), Prince Edward Island(54.9%⟶64.3%; RR0.96[0.81-1.15]), Alberta(34.0%⟶64.3%; RR0.96[0.92-1.01]), British Columbia(43.4%⟶72.1%; RR 0.75[0.71-0.79]*), Saskatchewan(47.7%⟶83.9%; RR0.44[0.39-0.49]*). Conclusion Minimally invasive hysterectomy for benign indication has increased significantly in Canada over the past decade. However, the increase reflects increasing use of laparoscopic hysterectomy with a declining use of vaginal hysterectomy. The variation between provinces represents a technicity gap that warrants further study and intervention.

Risk of Complication at the Time of Laparoscopic Hysterectomy; A Prediction Model Built from the National Surgical Quality Improvement Program (Nsquip) Database

Study Objective Create a prediction model for complication at the time of benign laparoscopic hysterectomy. Design Retrospective cohort study. Setting United States hospitals contributing to NSQUIP. Patients or Participants Patients undergoing laparoscopic hysterectomy for benign indications between 2014 and 2017. Interventions All patients underwent a hysterectomy by a laparoscopic approach. Data about peri-operative complications (intraoperative complications, readmission, reoperation, need for transfusion, operative time greater than 4 hours, postoperative medical complication or length of stay greater than 2 days) and uterine weight at the time of pathologic examination were collected retrospectively. Postoperative uterine weight was used as a proxy for preoperative uterine weight estimate. The sample was randomly split to create two patient populations, one for deriving the model and the other to validate the model. Measurements and Main Results A total of 33,123 women met inclusion criteria. The rate of composite complication was 9.5%. Complication rates were similar in the derivation and validation cohorts (9.4% vs 9.7%, p=0.3485). The logistic regression risk-prediction tool for hysterectomy complication identified 5 variables predictive of complication; history of prior laparotomy (increases odds of complication by 30%), predicted preoperative uterine weight (each 100 gram increase in weight increases the odds of complication by 0.06%) and race (when compared to white women, black women had a 30% increased odds and women of other races had a 24% increased odds of complication). Age and body mass index also had a statistically significant quadratic relationship with odds of complication. The c statistics for the derivation and validation cohorts were 0.57 and 0.55, respectively. The model is well calibrated, especially for patients at lowest risk of hysterectomy complication ( Conclusion The laparoscopic hysterectomy complication predictor model can be transformed into a user-friendly tool for predicting complications in patients planning hysterectomy, with a strength in identifying patients at low risk of complication. This model can be applied to clinical practice.

2885 Endosee(R) Cystoscopy: An Alternative for Evaluating Ureteral Patency Following Total Laparoscopic Hysterectomy

Video Objective To demonstrate an alternative method to evaluate for ureteral patency following benign hysterectomy. Design This is a retrospective cohort study of ten patients undergoing cystoscopy following benign hysterectomy to assess for ureteral patency. Setting This study took place at a single academic institution in the inpatient setting. Patients or Participants Patients were included in the study if they underwent total laparoscopic hysterectomy for benign indications from February 2019 to April 2019. Interventions Five patients underwent cystoscopy with traditional 70 degree rigid 17 French cystoscope. Five patients underwent cystoscopy with Endosee. Measurements and Main Results We compared cost, time, diameter size, and amount of bladder distending fluid required in patients undergoing traditional cystoscopy versus Endosee cystoscopy. The average cost for traditional cystoscopy was $246 and $165 (not including cost for hand piece) per case for Endosee cystoscopy. The average time for set-up and procedure was 7-12 minutes and 3 minutes for traditional and Endosee cystoscopy, respectively. The diameter of traditional cystoscope was 5.7 mm and 4.8 × 4.2 mm of Endosee cystoscope. Traditional cystoscope required approximately 200-300 mL distending fluid versus less than 60 mL distending fluid with Endosee. Conclusion Endosee cystoscopy is an efficient and reliable way to evaluate ureteral patency following benign total laparoscopic hysterectomy.

1439 Feasibility and Surgical Outcomes Associated with Reduced Port Robotic-Assisted Hysterectomy

Study Objective Demonstrate the safety, feasibility, and outcomes associated with the reduced port robotic-assisted hysterectomy (RPRH). Design We performed a retrospective cohort study of women undergoing a reduced-port robotic-assisted hysterectomy between 2012 and 2018 for benign indications. Setting A single academic university hospital. Patients or Participants Women who underwent a reduced port robotic-assisted hysterectomy for benign indications by a fellowship trained minimally invasive surgeon. Interventions A reduced port robotic-assisted hysterectomy for benign indications. Measurements and Main Results Women included were stratified into one of four groups based on uterine weight: Conclusion Reduced port robotic-assisted hysterectomy is a safe, effective, and efficient surgery for appropriately selected women. Outcomes appear similar across uterine weights with increased operative time, estimated blood loss, and odds of ureterolysis increasing as specimen weight increases.