Laparoscopic Subtotal Hysterectomy Research Articles

Gynaecology Case Reports

replacement of the myometrium by adenomyosis. Th e fallopian tubes appeared macroscopically normal. Haematoxylin and eosin (H & E) staining showed classical features of adenomyosis with endometrial glands and myometrial hyperplasia throughout the uterus. Routine histology of the fallopian tubes was normal. Immunohistochemical staining of the uterus of full thickness samples from the endometrium to the serosa with anti-S100 confi rmed widespread absence of nerves at the endometrial – myometrial interface, and, throughout the adenomyosis. Th e isthmus of both fallopian tubes showed complete loss of nerves in the inner layer of longitudinal smooth muscle (Figure 1). Case report 2 A 48-year-old, Chinese woman presented with a 5-year history of painful, irregular periods. Ten years previously, she had a left ovarian cystectomy, myomectomy and sterilisation. Five years previously, she underwent hysteroscopy and curettage for simple endometrial hyperplasia. She had two previous vaginal deliveries and a mid-trimester miscarriage requiring surgical evacuation of the uterus. CA125 was normal; ultrasound examination demonstrated adenomyosis and a small right, ovarian cyst. She underwent laparoscopic subtotal hysterectomy with bilateral salpingectomy and right ovarian cystectomy. Th e postoperative course was uncomplicated. Histology confi rmed a uterus weighing 160 g and extensive adenomyosis. Th ere was evidence of collateral sprouting of nerve bundles and abnormal nerves in the subserosal and subendometrial layers of the uterus. Th e fallopian tubes showed loss of nerves in the inner longitudinal muscle layer (Figure 1). Th e Ethics Committee of the Women ’ s Hospital, University of Zhejiang gave permission for these studies. Discussion Th ese reports confi rm previous observations of absence of nerves at the endometrial – myometrial interface and throughout the proliferating columns of adenomyosis in diff erent clinical presenta

Comparison of the tissue alterations induced by electric energy and by suture materials used during laparoscopic subtotal hysterectomy (LSH)

Comparison of the tissue alterations induced by electric energy and by suture materials used during laparoscopic subtotal hysterectomy (LSH)

Implantation endometrioma at port site after laparoscopic abdominal supracervical hysterectomy

Objective To report three instances of implantation endometriomas occurring after laparoscopic subtotal hysterectomy. Subjects Three patients who developed implantation endometriomas at the site of insertion of the morcellator used in laparoscopic subtotal hysterectomy are described. At one hospital this occurred in two patients out of 54, giving an incidence of 4%. Conclusion Implantation endometriosis may be a risk associated with morcellation of the uterus at laparoscopic subtotal hysterectomy.

Hystérectomie Subtotale par Laparoscopie : Une Première Série Canadienne de Cent Cas

One hundred consecutive laparoscopic sub-total hysterectomies have been performed by the author between October 1995 and November 1997. Mean weight of the uterus excised was 101.1 ± 74g and the mean length of the intervention was 1 hr 19 ± 23 min. The mean difference between the haemoglobin level before and after the surgery was -13.4 ± 8 g/l, and only few analgesics were necessary during the postoperative period. Women were hospitalized for a mean of 2.6 ± 0.9 days, and one serious uninary tract complication requiring a second intervention was reported. During the same period, the author performed 72 conventional hysterectomies. When the two groups were compared, the sub-total hysterectomy performed by laparoscopy did not increase the operative time, minimized operative blood loss and reduced significantly the postoperative use of analgesics together with the duration of the hospitalization.

Pain after hysterectomy: a comparison between four currently available procedures

Objective To compare the postoperative pain of four types of hysterectomy. Design Prospective study. Setting Cairo University Faculty of Medicine Hospital and the authors' private practice. Subjects A total of 427 patients underwent hysterectomies for different indications. Interventions Patients were assigned to either total abdominal hysterectomy, laparoscopic‐assisted vaginal hysterectomy, subtotal laparoscopic hysterectomy, or vaginal hysterectomy. Measures Linear pain score 12 and 24 h after surgery, dose of meperidine required in the first 24 h, multidimensional pain score 8 days after surgery, and dyspareunia assessed after 3 months of surgery. Results Both laparoscopic procedures were followed by the least postoperative pain and earliest return to work. Subtotal laparoscopic hysterectomy was followed by the least dyspareunia. Abdominal hysterectomy was followed by the highest pain score and latest return to normal physical activity. Conclusion Laparoscopic hysterectomy had the best patient acceptance, with the least postoperative pain.

Complications of 174 laparoscopic hysterectomies.

The case records of 174 patients who underwent laparoscopic hysterectomy between September, 1992 and April, 1995 were retrospectively reviewed. The mean age of the group was 45.4 (range 17.8-68.5) years, mean weight 70.2 (50-121) kg and mean parity 2.3 (0-4). Laparoscopic hysterectomy (i.e. uterine arteries secured laparoscopically) was performed in 98 patients, laparoscopically assisted vaginal hysterectomy in 70, and laparoscopic subtotal hysterectomy in 6. Bilateral or unilateral oophorectomy were performed in 40 cases. The mean operating time was 131 (45-285) minutes and mean hospitalization 2.6 (1-11) days. Endoscopic stapling devices were used in 135 cases, biopolar diathermy in 117, sutures and ties in 84, and the harmonic scalpel in 29. The overall complication rate was 16%. Seven cases (4%) required conversion to laparotomy. These included 2 inadvertent cystotomies (1 after 2 Caesarean sections), 3 cases of dense uterovesical adhesions following previous surgery and 2 instances of excessive uterine size (> 16 weeks). The mean follow-up period was 2.2 (1-18) months. One patient had a shortened vagina requiring dilatation and another had vault granulations requiring diathermy treatment. Overall 98.3% of patients were satisfied with their surgery.

Laparoscopic hysterectomy

We describe the use of laparoscopic techniques in hysterectomy, and the epidemiology of hysterectomy. We review the advantages and complications of total laparoscopic hysterectomy and subtotal laparoscopic hysterectomy. Finally, we discuss long-term outcomes and the cost of these techniques.

Subtotal vaginal hysterectomy

SummaryFive women requiring hysterectomy for benign indications and with normal cervical cytology, underwent the new procedure of subtotal (supracervical) vaginal hysterectomy combined with salpingo-oophorectomy in two cases. Using the Doderlein-Kronig approach, an anterior colpotomy was made and the uterine fundus delivered into the vagina. The ovarian and uterine pedicles were ligated in turn before amputating the uterine body from the cervix. The cervical incision was then repaired and the vaginal incision closed. Operative times ranged from 35 to 150 min, one procedure being prolonged by difficulty with bladder dissection following two previous Caesarean sections. Subtotal vaginal hysterectomy is an alternative to abdominal and laparoscopic subtotal hysterectomy, which avoids two of the disadvantages of these techniques, the need for abdominal incisions and the need for laparoscopic expertise.