Hysterectomy For Benign Uterine Pathology Research Articles

The female upper reproductive tract harbors endogenous microbial profiles.

The female reproductive tract harbours unique microbial communities (known as microbiota) which have been associated with reproductive functions in health and disease. While endometrial microbiome studies have shown that the uterus possesses higher bacterial diversity and richness compared to the vagina, the knowledge regarding the composition of the Fallopian tubes (FT) is lacking, especially in fertile women without any underlying conditions. To address this gap, our study included 19 patients who underwent abdominal hysterectomy for benign uterine pathology, and 5 women who underwent tubal ligation as a permanent contraceptive method at Hospital Clínico Universitario Virgen de la Arrixaca (HCUVA). We analyzed the microbiome of samples collected from the FT and endometrium using 16S rRNA gene sequencing. Our findings revealed distinct microbiome profiles in the endometrial and FT samples, indicating that the upper reproductive tract harbors an endogenous microbiome. However, these two sites also shared some similarities, with 69% of the detected taxa Being common to both. Interestingly, we identified seventeen bacterial taxa exclusively present in the FT samples, including the genera Enhydrobacter, Granulicatella, Haemophilus, Rhizobium, Alistipes, and Paracoccus, among others. On the other hand, 10 bacterial taxa were only found in the endometrium, including the genera Klebsiella, Olsenella, Oscillibacter and Veillonella (FDR <0.05). Furthermore, our study highlighted the influence of the endometrial collection method on the findings. Samples obtained transcervically showed a dominance of the genus Lactobacillus, which may indicate potential vaginal contamination. In contrast, uterine samples obtained through hysterescopy revealed higher abundance of the genera Acinetobacter, Arthrobacter, Coprococcus, Methylobacterium, Prevotella, Roseburia, Staphylococcus, and Streptococcus. Although the upper reproductive tract appears to have a low microbial biomass, our results suggest that the endometrial and FT microbiome is unique to each individual. In fact, samples obtained from the same individual showed more microbial similarity between the endometrium and FT compared to samples from different women. Understanding the composition of the female upper reproductive microbiome provides valuable insights into the natural microenvironment where processes such as oocyte fertilization, embryo development and implantation occur. This knowledge can improve in vitro fertilization and embryo culture conditions for the treatment of infertility.

Outcomes of Laproscopic Hysterectomies: An assessment of a learning curve experience of a Gynae laparoscopic surgeries

Among the most frequent gynecological operations conducted is the hysterectomy. Objective: To determine the outcome of TLH in benign uterine pathology of up to 12-week size uterus. Methods: It was a prospective case series carried out at Obstetrics and Gynecology department of Memon medical institute hospital, Karachi from January 2019 to January 2021. All patients who underwent laparoscopic hysterectomy secondary to benign utero- ovarian pathology were consecutively enrolled. Demographic characteristics of the patients along with the presence of co-morbidities, hospital admission details, surgical procedure and intra and post-operative complications were noted. The surgery performed with similar technique in all cases. If patients were deemed to be fit for release after 48 hours following surgery, they were discharged. The postoperative follow-ups were performed at 10th, 30th, and 3 months. Results: Of 50 patients, the mean age was 50.5 years. The main indication of hysterectomy is adenomyosis diagnosed in 20 patients. There were 4 laparoscopic assisted vaginal hysterectomies and 46 were total laparoscopic hysterectomies. History of previous laparotomies was observed in 12, previous cesarean and bilateral tubal ligation in 6 each, history of mesh repair of umbilical hernia in 4 while history of VP shunt was observed in 2 patients. Eight patients converted into laparotomy due to technical difficulty in controlling hemorrhage of uterine artery. Total rate of intra and post-operative complications was 40%. Conclusion: Laparoscopic approach for hysterectomy is a safe alternative to conventional hysterectomy for benign uterine pathology of up to 12 weeks size uterus.

Impact of different intraoperative CO2 pressure levels (8 and 15 mmHg) during laparoscopic hysterectomy performed due to benign uterine pathologies on postoperative pain and arterial pCO2: a prospective randomised controlled clinical trial

To compare the effects of two different intraoperative CO2 pressures (8 and 15mmHg) during laparoscopic hysterectomy for benign uterine pathologies in terms of postoperative abdominal and shoulder pain, laparoscopy-mediated vegetative alterations, pain medication requirement, arterial CO2 pressure (pCO2 ), surgical parameters, and safety. Prospective randomised controlled study. German university hospital. Female patients undergoing laparoscopic hysterectomy for benign uterine pathologies. Patients were randomised to a standard pressure (SP; 15mmHg, control) or low-pressure (LP; 8mmHg, experimental) group. Primary outcomes were postoperative abdominal and shoulder pain intensities, measured via numeric rating scale (NRS) and vegetative parameters (fatigue, nausea, vomiting, bloating) at 3, 24, and 48hours postoperatively. Secondary outcomes were pain medication requirement (mg) and arterial pCO2 (mmHg). Surgical parameters and intra- and postoperative complications were also recorded. In total, 178 patients were included. Patients in the LP group (n=91) showed significantly lower postoperative abdominal and shoulder pain scores, fewer vegetative alterations, lower pain medication requirements, a shorter postoperative hospitalization, and lower intra- and postoperative arterial pCO2 values compared with the SP group (n=87; P≤0.01). No differences in intra- and postoperative complications were observed between groups. Low-pressure laparoscopy seems to be an effective and safe technique for the reduction of postoperative pain and laparoscopy-induced metabolic and vegetative alterations following laparoscopic hysterectomy for benign indications. Low-pressure laparoscopy seems to be an effective and safe technique for reduction of pain following laparoscopic hysterectomy.

Vault prolapse occurrence after total laparoscopic hysterectomy and total abdominal hysterectomy performed for benign indications, is there a difference? A systematic review of the literature

Aim: To systematically review published data on vault prolapse occurrence after total laparoscopic hysterectomy versus abdominal hysterectomy for benign uterine pathology. Materials and Methods: Medline and PubMed were searched for clinical studies reporting on vault prolapse occurrence after laparoscopic or abdominal hysterectomy. The studies included were randomized and non-randomized clinical trials reporting on the occurrence of vaginal vault prolapse as a long-term complication of either abdominal or laparoscopic hysterectomy for nonmalignant conditions. Results: The search yielded only one study reporting on vaginal cuff prolapse after laparoscopic assisted vaginal hysterectomy (LAVH) or total abdominal hysterectomy (TAH). The additional articles that were retrieved using the ‘search for related articles’ function as well as from references of eligible studies were 581. Of these, 473 studies were excluded by title, 45 by abstract, 32 by full text, seven for which the full text could not be retrieved, and 24 by language. For this study two groups of women were followed up after LAVH (n=150) and TAH (n=146). No statistically significant difference in the likelihood of vault prolapse was revealed between the two groups (p = 0.592).Conclusion: In the literature, various measures are recommended to avoid vaginal vault prolapse such as the suspension of the vaginal apex to the cardinal and uterosacral ligament or to the sacrospinous ligaments at the time of hysterectomy. More studies are needed with a greater number of cases and longer follow up to assess whether abdominal or laparoscopic hysterectomy is more appropriate to prevent vaginal vault prolapse.

Laparoscopic assisted vaginal hysterectomy versus total abdominal hysterectomy for benign uterine pathology: Outcome and complications

Laparoscopic assisted vaginal hysterectomy versus total abdominal hysterectomy for benign uterine pathology: Outcome and complications

Influence of the Preoperative Decision-Making Process on the Postoperative Outcome after Hysterectomy for Benign Uterine Pathologies.

Introduction: The aim of this study was to assess whether the preoperative decision-making process might influence treatment success in premenopausal women undergoing hysterectomy for benign uterine pathologies Materials and Methods: All premenopausal women treated with hysterectomy for benign uterine pathologies between April 2011 and June 2013 at a tertiary university center were enrolled in this prospective observational cohort study. Five parameters of the preoperative decision-making process were assessed upon their correlation with postoperative quality of life, sexual function and patients' satisfaction. These outcome measures were assessed for the pre- and postoperative (six months after surgery) status using two validated questionnaires (EQ-5D and "female sexual function index" (FSFI). Patients' satisfaction with the postoperative outcome was assessed with a self-developed questionnaire. Results: 255 of 402 (63 %) patients completed the study. A correlation between the co-variables "interval between first counseling and decision to surgery", "subjectively perceived quality of the preoperative counseling" and "certainty in the decision for the intervention" and postoperative outcomes were found. The co-variables "person mainly responsible for election of hysterectomy mode" and "discussion of decision for surgery with others" showed no influence on postoperative patients-reported outcomes. Conclusion: We found a correlation between certain parameters of the preoperative decision-making process and postoperative patient-reported sexual function, quality of life and patients' satisfaction in premenopausal women undergoing hysterectomy for benign uterine pathologies. An optimization of these factors could contribute to an improvement in treatment outcomes.

A Simplified Laparoscopic Approach to Repair Vesicovaginal Fistula: The M.S. Ramaiah Technique

To describe a simplified laparoscopic approach for the management of vesicovaginal fistula (VVF), with the specific aim of decreasing laparoscopic intracorporeal suturing and to highlight our results with this simplified approach. A retrospective chart review was carried out to all patients who underwent VVF repair at our institute by the "simplified laparoscopic approach" between January 2011 and August 2014. Preoperative evaluation consisted of intravenous urography, micturating cystography, and cystoscopy. Patients with malignant fistulas, history of pelvic irradiation, or co-existent ureteric fistulas were excluded. The procedure consisted of an initial cystoscopy to intubate bilateral ureteric orifices with ureteric catheter, as well as the fistula with a ureteric catheter of different color. A 3-port technique was used. The simplified laparoscopic approach consisted of limited cystotomy, single-layer bladder closure with 3-0 V-Loc barbed suture and omental patch over the vaginal opening. A total of 22 patients were included in the analysis. Mean interval before surgery was 2.5 months. One patient had previous failed transvaginal repair. Transvaginal hysterectomy for benign uterine pathology constituted the predominant etiology of VVF in this series. Mean fistula size was 7 mm. Mean operative time was 75 minutes. All patients were continent at catheter removal at postoperative day 14 and remained symptom free in the follow-up period. The simplified laparoscopic approach of VVF repair produces excellent results with minimal morbidity.

Total laparoscopic hysterectomy for benign uterine pathologies: obesity does not increase the risk of complications

This study was designed to investigate the intra-operative characteristics and the risk of intra- and post-operative complications in cases of total laparoscopic hysterectomy (TLH) in overweight, obese and non-obese patients. This cohort study includes all patients undergoing TLH for benign pathologies between January 1993 and June 2007 in Cochin university hospital (Paris). Demographic and surgical data were analysed. A comparison between overweight and obese patients versus non-obese patients and multivariate analyses were performed. Of 1460 patients undergoing TLH, 101 patients (6.9%) had a BMI of 30 or higher and 338 (23.2%) were overweight. After adjustment with respect to the patients' characteristics and past history (age, parity, past history of laparotomies, previous Cesarean section, menopausal status), no significant difference was found whether in terms of intra-operative (haemorrhage, transfusion, thrombosis, ureter, bladder or bowel injuries) or post-operative complications (hyperthermia, infections, fistula). Concerning the intra- and post-operative characteristics of these patients, only a significantly longer operating time was noted in the case of obesity (RR = 1.80; CI 95%: 1.16-2.81). In our experience, provided that the operating technique is meticulous, the intra- and post-operative complications are not increased in the case of obesity, although the operating time is longer.

Pattern of mental ill health morbidities following hysterectomy for benign gynaecological disorders among Nigerian women

Objectiveto compare the pre and post hysterectomy mental ill health (MIH) status and also, to determine whether there is any association with the surgical indication.MethodologyAn observational study, conducted among women scheduled for hysterectomy at the University College Hospital, Ibadan from January till June 2005. The MIH morbidities were assessed using a validated general health questionnaire (GHQ) before and after the surgery by trained research assistant. The score of 4 and above was used as the cut off. Cross tabulations were performed to detect any association and also to compare pre and post hysterectomy mental health status. The level of statistical significance was set at P < 0.05.ResultsOf the 50 women recruited, 45 participated in the study. The age range of the participants was 35 to 63 years with a mean of 48.6 (SD = 0.6) years. Anxiety related disorder was present in 20 (44.4%), and depression in 3 (6.7%) before hysterectomy. Post surgery, there was significant increase in those with anxiety by 6.8% and a reduction in the proportion of depressive illness by 2.3%. Uterine fibroid as a preoperative diagnosis, had significant association among those with anxiety related disorder (68.4%) and depression (10.5%).ConclusionThis study suggests that mental ill health may complicates hysterectomy for benign uterine pathology among Nigerian women, and that anxiety related disorders increases after operation with the highest proportion in those with clinical diagnosis of Uterine Fibroid. We recommend adequate preoperative counseling using properly trained psychologists when affordable to minimize these morbidities.

Hysterectomy for Benign Uterine Pathology Among Women Without Previous Vaginal Delivery

To evaluate the feasibility and the complication rate of vaginal hysterectomy in benign uterine pathology (except for uterine prolapse) among patients without previous vaginal delivery. A review of the medical records in patients without previous vaginal delivery who underwent hysterectomies between January 1995 and June 2004 was carried out. Patients were divided into two different groups: group 1 included patients with first-intention abdominal hysterectomy; group 2 included patients with vaginal approach further stratified into 2a without and 2b with laparoscopic assistance. Three hundred patients without previous vaginal delivery underwent hysterectomy during this period. Vaginal hysterectomy was planned in 75.7% of cases. Success rate for planned vaginal hysterectomies was 92.1%. The mean weight of uteri extracted by vaginal and abdominal approaches were 326 g and 1,047 g, respectively (P<.001). The mean operative time was significantly longer in the laparoscopic-assisted approach (160 minutes) than in the abdominal approach (120 minutes), and significantly shorter in exclusively vaginal (75 minutes) than in other procedures (P<.001). The use of the laparoscopic assistance in hysterectomy decreased significantly over the period of the study (P<.001). The mean duration of hospital stay was significantly shorter in group 2 than in group 1 (3.8 days compared with 6.2 days, P<.001), but no differences were noted between subgroups 2a and 2b. Vaginal hysterectomy should not be contraindicated in patients lacking previous vaginal delivery. In these particular patients, most of the procedures can be performed by vaginal approach, with the benefit of limiting the costs and the duration of hospital stay.

Total laparascopic hysterectomy at The Aga Khan University Hospital, Nairobi

To determine the outcomes of total laparoscopic hysterectomy at the Aga Khan University Hospital, Nairobi. To create awareness on the availability of the procedure and to recommend the procedure as a suitable option to total abdominal hysterectomy. A retrospective case analysis. Private practice in a private hospital set up. One hundred and twelve laparoscopic hysterectomies were performed at the Aga Khan University Hospital, Nairobi. These cases have been reviewed, analysed and presented between May, 2000 and May, 2007. Total laparoscopic hysterectomies done. All cases performed at other hospitals in Nairobi and Mombasa, and all cases where the author was not the principal surgeon. The ages ranged from 36 to 74 years, the mean age being 48 years. The patients parity ranged from 0 to 9. Fifty seven point one percent of the patients presented with heavy prolonged periods with clots. Of all the cases performed 54.4% gave a history of a previous laparotomy or Caesarian section. The uterine size by clinical assessment ranged from bulky to 28 weeks. The operating times ranged from 25 to 240 minutes, scope in to scope out. The average hospital stay for patients undergoing total laparoscopic hysterectomies was 2.1 days. There were no intraoperative complications encountered. The majority of the uteri weighed between 101-300 g (50.8%). Laparoscopic surgery is now well accepted by specialists and patients. Where facilities allow advocating total laparoscopic hysterectomy for benign uterine pathology can be considered as a suitable option to abdominal hysterectomy.

Laparoscopic assisted vaginal hysterectomy for benign uterine pathology: is it time to change?

To determine the acceptability and outcome of laparoscopic assisted vaginal hysterectomy at the Aga Khan Hospital, Nairobi. A retrospective case analysis. Two hundrend and twenty nine cases of laparoscopic assisted hysterectomy were undertaken at various hospitals in the presence of the principal author from May 2000 to December 2003. Of these 149 (65.06%) were performed at the Aga Khan Hospital, Nairobi. These cases have been reviewed, analysed and presented. All cases performed at the various other hospitals were excluded, along with those cases of laparoscopic assisted vaginal hysterectomy which are now being performed by other consultants obstetricians and gynaecologists, on their own and who have now learnt the technique Over the last three years, 149 cases of laparoscopic assisted vaginal hysterectomy were undertaken at the Aga Khan Hospital, Nairobi. Annual case load increased from three cases in 2000, to 71 cases by December, 2003. Fifty one percent of the patients were between 46 to 50 years of age, while 93.9% were para 2 + 0 and above. Menorrhagia was the presenting complaint in 55.7%. The operative procedure was performed in 91 to 120 minutes in 58.3% of the cases. Hospital stays were two nights in 95.3%. The complications encountered were bladder injury (3.4%), bowel injury (1.3%), port site herniation (0.67%) and a delayed recognition of bladder injury (0.67%). In Kenya, laparoscopic surgery is gradually being accepted by gynaecologists and general surgeons. The conversion from total abdominal hysterectomy to laparoscopic assisted vaginal hysterectomy for benign uterine pathology is now becoming more popular amongst gynaecologists and patients. With time laparoscopic assistance during hysterectomy will become the norm.

HISTERECTOMIA VAGINAL Y CORRECCION DE INCONTINENCIA URINARIA CON TVT (TENSION-FREE VAGINAL TAPE)

SUMMARY We present 24 patients with stress incontinence of urine (SIU) corrected surgically with TVT (Tensionfree Vaginal Tape), and vaginal hysterectomy for benign uterine pathology. The average age was of 48.7 years (range 40-60), 75% of patients were multiparous. More frequently associated gynecological pathology was complete genital prolapse 53.8%. SIU was present in 62.5% of cases and mixed in 37.5%. The complete surgery took an average of 90 mins (60-120), the blood loss was estimated at a mean of 125 mililiter. The average of staying was of 5 days. There were 3 patients with bladder injury.

Laparoscopic‐assisted vaginal hysterectomy for benign uterine pathologies: could this be the first‐line treatment?

Hysterectomy is traditionally performed by the abdominal route, and is frequently done for benign uterine pathologies. Laparoscopic procedures have been used widely because of advances in technological development and increased laparoscopic experience. We therefore wished to evaluate the role of laparoscopic hysterectomy in comparison with traditional abdominal hysterectomy. A prospective study.Department of Obstetrics and Gynaecology, Akdeniz University School of Medicine, Turkey.We recorded details from all patients between 1998 and 2000 with indications for hysterectomy on account of benign uterine pathologies. Both types of hysterectomy were performed throughout this period. The operating times, complications and analgesia dosage were compared.In all 84 patients underwent hysterectomy. Of these patients, 38 (45.2%) had laparoscopic‐assisted vaginal hysterectomy, 34 (40.4%) had total abdominal and 12 (14.2%) had vaginal hysterectomy. Laparoscopic hysterectomy showed the advantages of shorter hospital stay, less analgesic medication and earlier postoperative recovery. Laparoscopic hysterectomy, with the advantages of laparoscopic surgery, was the preferable approach to hysterectomy for benign uterine pathology in this series. It can replace traditional hysterectomy in patients who are suitable for laparoscopic surgery.

Should Uterine Size Alone Require Laparoscopic Assistance? Vaginal Hysterectomy for a 2003-g Uterus

The main determinants of suitability for vaginal hysterectomy for benign uterine pathology in the medically stable patient are uterine mobility and adequate vaginal exposure. The removal of a 2,003-g fibroid uterus by total vaginal hysterectomy by morcellation in a woman suffering from severe menometrorraghia is reported.

Total laparoscopic hysterectomy for benign uterine pathologies with reusable instruments: a safe, reproducible and cost‐effective procedure

With the technique of total laparoscopic hysterectomy described in this paper all the instruments are re‐usable and haemostasis is secured with bipolar coagulation. It is a safe technique whose cost is comparable to that of vaginal or abdominal hysterectomies. The routine use of disposable equipment and automatic disposable staplers for laparoscopic hysterectomies is very debatable as the considerable increase in cost is not accompanied by any benefit for patients or society.

Transvaginal ultrasound in the diagnosis of diffuse adenomyosis.

The purpose of this study is to evaluate the diagnostic capability of transvaginal ultrasound in detecting diffuse adenomyosis. One hundred and seventy-five women, mean age 45.8 years (range 37-62), were studied by TV ultrasound before hysterectomy for benign uterine pathology. The sonographer diagnosed adenomyosis in 19 patients, whereas the pathologist diagnosed adenomyosis in 15 women making ex novo diagnoses in 2 cases. The sensitivity of TV ultrasound was 86.6%, the specificity 96.2%, the positive predictive value 68.4%, and the negative predictive value 98%. In conclusion, this study showed that TV ultrasound is an important and advanced tool in the diagnosis of diffuse adenomyosis.