Laparoscopic Supracervical Hysterectomy Research Articles

Association of maximum uterine diameter with postoperative complications in laparoscopic supracervical hysterectomy: A retrospective cohort study.

To determine the maximum uterine diameter threshold associated with an elevated risk of complications following laparoscopic supracervical hysterectomy (LSH). This was a retrospective cohort study from a single tertiary referral center. We enrolled patients who underwent LSH for benign indications at our hospital between January 2013 and June 2023. The primary outcome was the occurrence of surgical complications within the 30-day timeframe of hysterectomy. The covariate included the year of the procedure, patient age, body mass index, parity, American Society of Anesthesiologists classification, comorbidities, history of previous abdominal and pelvic surgery, and preoperative anemia, blood loss, surgical time, hospital stay and pathology. The exclusion criteria comprised those who underwent hysterectomy for malignancy, individuals who underwent total vaginal hysterectomy or laparoscopically assisted vaginal hysterectomy, and those with missing data on uterine maximum diameter, study outcomes, or covariates. We included a final sample of 120 patients, revealing a median uterine diameter of 9.12 cm, with 9.2% experiencing complications. The median uterine weight among 40 patients was 275 g. Receiver operating characteristic (ROC) curve analysis suggested a potential cutoff of 11.55 cm for predicting complications, with an area under the ROC curve of 0.67. Multivariate logistic regression confirmed a significant association between uterine diameter exceeding the cutoff and increased complication risk (OR 33.925, 95% CI: 2.294-501.690, P = 0.0103). A correlation (r = 0.762, P < 0.001) between uterine weight and diameter indicated the latter's suitability for preoperative assessment of uterine weight. The maximum uterine diameter with an optimal cutoff of 11.55 cm was associated with increased complication risk.

Large leiomyomatosis peritonealis disseminata with ascites and pleural effusion eight years after laparoscopic supracervical hysterectomy: an extremely rare case and review of literature

Large leiomyomatosis peritonealis disseminata with ascites and pleural effusion eight years after laparoscopic supracervical hysterectomy: an extremely rare case and review of literature

Adenomyoma recurrence 7 years after laparoscopic supracervical hysterectomy: A case report and literature review.

Adenomyosis, a gynecological condition characterized by endometrial tissue within the uterine myometrium, often leads to menstrual pain and heavy bleeding, significantly affecting the quality of life. The primary treatment for adenomyosis and leiomyomas is hysterectomy. However, in rare instances, these conditions can recur in the cervical stump following a hysterectomy.Here, we present a case of cervical adenomyoma development after a prior laparoscopic supracervical hysterectomy. A 47-year-old woman sought medical attention due to increased vaginal bleeding. She had undergone a laparoscopic supracervical hysterectomy 7 years earlier to address uterine myoma and adenomyosis. Just 1 month posthysterectomy, a pelvic ultrasound revealed the presence of a cervical stump measuring approximately 4.0 × 4.0 cm. Subsequent follow-up ultrasounds documented the gradual growth of the cervical mass. Two years ago, a recurrent myoma was identified, and the patient experienced intermittent vaginal bleeding. Over 7 years, the cervical mass increased from 4 to 7 cm. Preadmission pelvic ultrasonography confirmed the existence of cervical adenomyoma measuring 7 × 6 cm. Consequently, the patient underwent a laparoscopic trachelectomy. Intraoperatively, an enlarged cervix, approximately 7 × 6 cm in size, containing adenomyoma was observed. A gross examination of the specimen indicated hypertrophic muscle tissue and hemorrhagic foci. Subsequent histopathological examination confirmed the presence of adenomyoma. Remarkably, the patient exhibited no recurrence over the subsequent 8 months. The case presented here highlights the potential occurrence of cervical adenomyoma following a supracervical hysterectomy. Management options include hormone therapy and surgical excision. Furthermore, annual follow-up comprising ultrasound and pap smear evaluations is recommended for patients with supracervical hysterectomies to detect and address possible recurrences.

Contained specimen morcellation during robotics-assisted laparoscopic supracervical hysterectomy for pelvic organ prolapse.

Robotics-assisted laparoscopic supracervical hysterectomy (RALSH) with concomitant apical robotics-assisted POP repair provides advantages of minimally invasive procedures; however specimen removal without intraperitoneal spillage of potential pathology remains challenging. The primary aim of our study is to determine the factors affecting contained manual morcellation (CMM) of specimens during RALSH for POP surgery. The secondary aim of the study is to report complications associated with CMM and on specimen pathology. A total of 67 sequential patients underwent RALSH with concomitant robotics-assisted sacrocolpopexy or uterosacral vaginal suspension. Factors analyzed to affect CMM were specimen weight, length of skin and fascia incisions, patient age, body mass index (BMI), and estimated blood loss (EBL). Median CMM time was 11min (1 to 46) and specimen weight 62g (19 to 711). Median patient age was 56years (36 to 83), and patient BMI was 28 (18 to 44). Median EBL was 50ml (10 to 150). Median skin and fascial incision lengths were 3cm (1.5 to 7), and 3.5cm (1.5 to 8). CMM time was significantly dependent on specimen weight (p < 0.0001) and length of rectus fascia incision (p < 0.0126). There was no gross tissue spillage or bag ruptures. Uterine pathology revealed normal tissue (26%), leiomyoma (47%), adenomyosis (49%), and endometriosis (14%). 4.5% of specimens had evidence of microscopic neoplasm, and 5years after surgery patients were cancer free. Contained manual extraction of the uterus and/or adnexae at the time of RALSH for POP surgery is a viable, safe, and efficient method of specimen removal.

Advanced cervical stump cancer after laparoscopic subtotal hysterectomy: a case report of imaging, laparoscopic staging and treatment approach

BackgroundAdvanced cancer of the cervical stump, occurring years after a laparoscopic supracervical hysterectomy (LASH), is a rare but serious clinical condition. Many patients who undergo a LASH are unaware of this possible complication. Upon diagnosis of advanced cervical stump cancer, a holistic approach including imaging, laparoscopic surgery and multimodal oncological therapy is required.Case presentationA 58-year-old patient presented to our department with the suspicion of advanced cervical stump cancer eight years after LASH. She reported pelvic pain, irregular vaginal bleedings and irregular discharge. Gynaecological examination revealed a locally advanced tumor of the uterine cervix with suspicion of infiltration of the left parametria and bladder. After thorough diagnostic imaging and laparoscopic staging, the tumor stage was determined as FIGO IIIB and the patient was treated with combined radiochemotherapy. The patient presented with tumor recurrence 5 months after the completion of therapy and she is currently being treated with multichemotherapy and immunotherapy regimens as palliative treatment.ConclusionPatients should be made aware about the risk of cervical stump carcinoma after LASH and the necessity for regular screening. Cervical cancer after LASH is often diagnosed at advanced stages and the treatment requires an interdisciplinary approach.

First experiences with a diode laser in major gynecological laparoscopic procedures show lack of benefit and impaired feasibility

PurposeThe aim of this study is to evaluate feasibility and potential benefit of a diode laser in major laparoscopic procedures in gynecology.MethodsBetween 2018 and 2020, a total of 42 cases were enrolled in this study comparing standard electrosurgery with diode laser-supported therapy in laparoscopic supracervical hysterectomy (LASH), total laparoscopic hysterectomy (TLH), or laparoscopic myoma enucleation (LME). Dual wavelength 45 W diode laser light was used to cut and coagulate during laparoscopy in the prospective interventional arm consisting of 11 cases, while 31 matching patients who received conventional treatment with monopolar/bipolar current for the same interventions were retrospectively identified in our laparoscopy database. Recruitment in the prospective interventional laser diode arm was terminated after only 11 patients (instead of planned 50) due to intense hemorrhage and massive smoke development.ResultsA total of 42 cases were analyzed (11 LME, 19 LASH, and 12 TLH). Strong smoke development was evident in all 11 cases in the diode laser arm. It was necessary to convert to bipolar or monopolar current in all hysterectomies (n = 9) with initial diode laser implementation due to increased bleeding and smoke development. Conventional current sources had to be used in LMEs (n = 2) due to excessive bleeding and poor visibility during enucleation of the fibroid. A significant difference (p < 0.0001) was observed regarding smoke development when comparing the laser arm with the control arm.ConclusionWe found a 45-W diode laser to be inferior to electrosurgical techniques for major laparoscopic gynecologic surgeries regarding bleeding control and smoke development.

Prophylactic Salpingectomy during Hysterectomy for Benign Disease: A Prospective Study to Evaluate High-Grade Serous Ovarian Carcinoma Precursors

Recent findings suggest that high-grade serous ovarian cancer can originate in the fallopian tube. Not only has that made the identification of precursor lesions pivotal in early detection and prevention of these cancers, prophylactic salpingectomy alongside hysterectomy for benign indications has been increasingly proposed as well. The present prospective single-center study included 273 women who underwent opportunistic salpingectomy alongside laparoscopic supracervical hysterectomy. Uterine and tubal histopathological results as well as intra- and postoperative complications were evaluated. The complication rate was 3.3%, of which none were caused by salpingectomy. Uterine histopathology diagnosed 181 patients (66.8%) with uterine myomas, 60 patients (22.1%) with adenomyosis, 29 patients (10.7%) with adenomyomatosis, and, 1 patient (0.4%) without pathological abnormality. p53 signatures were detected in 221 right fallopian tubes (80.9%) and in 229 left tubes (83.9%). In total, 8 patients showed bilateral STIL (2.9%), whereas in 1 patient (0.4%) STIL was detected in the left tube only. No STIC were detected. Laparoscopic opportunistic salpingectomy is demonstrated to be both safe and feasible. It appears to be promising to reduce the risk for ovarian cancer, yet more studies are needed to undoubtedly confirm this.

Comparison of Different Laparoscopic Sacropexy Procedures for Advanced Uterine Prolapse: A Retrospective Analysis

To compare the long-term outcomes and complications of 3 different variants of laparoscopic sacropexy. Single-center retrospective cohort study. A tertiary university hospital. A total of 483 patients with advanced uterine prolapse who underwent laparoscopic sacrohysteropexy (LSH), laparoscopic supracervical hysterectomy with concomitant laparoscopic sacrocervicopexy (LSCH+LSC), or total laparoscopic hysterectomy with concomitant laparoscopic sacrocolpopexy (TLH+LSC). Demographic data, Pelvic Organ Prolapse Quantification scores, questionnaire results, surgical conditions, postoperative outcomes, and complications were all extracted from medical and follow-up records. Between April 2012 and December 2020, 277 women underwent LSH, 95 women underwent LSCH+LSC, and 111 women underwent TLH+LSC. LSH procedures were associated with statistically significantly least blood loss and least postoperative hospital days and catheterization days (all p <.001). During the median follow-up of 32 months (13-117 months), analysis of the data revealed notable anatomic correction in all groups regarding Pelvic Organ Prolapse Quantification measurements (p <.001), and the anatomic cure rate showed no significant difference among these 3 groups (p=.273). No statistically significant differences were detected for prolapse recurrence (p=.171) and functional improvements among these groups. Neither intraoperative injuries (p=.098) nor total postoperative complications (p=.218) differed considerably, whereas the rate of severe postoperative complications (p <.001) including mesh exposure (p=.004) was significantly higher in the TLH+LSC group than that in the other groups. LSH is the appropriate choice for women with uterine prolapse without contraindications for uterine preservation. For patients with benign uterine lesions and a normal cervix, LSCH+LSC is a safer approach that provides similar anatomic results and improved quality of life scores that are similar to those of TLH+LSC. For patients with lesions in the uterus and cervix, TLH+LSC should be selected.

Behandlungsoptionen bei Meno-Metrorrhagie

Heavy and irregular menstrual bleeding (menorrhagia/metrorrhagia; MM) is common and affects between 10 and 30% of women of reproductive age. MM is associated with numerous clinical symptoms and a significant reduction in quality of life. The most important etiological factors of MM include endometrial polyps, myomas, adenomyosis, hyperplasia/malignancy, hereditary or acquired coagulation disorders, ovulatory dysfunction, and iatrogenic causes. The only definitive and therefore most effective treatment of MM is hysterectomy. Alternatives are uterus-conserving ablative approaches, e.g. endometrial resection (RS) and endometrial ablation (EA). In the case of hysterectomy, laparoscopic supracervical hysterectomy (LASH) is the method of first choice, if there are no specific reasons to remove the cervix. Conservative, non-surgical therapies of MM are available, including levonorgestrel-releasing intrauterine devices, oral/parenteral progestogens, oral/parenteral combination contraceptives, tranexamic acid, non-steroidal antirheumatics, selective progesterone receptor modulators, and gonadotropin releasing hormone agonists/antagonists.

Transvaginal Specimen Extraction: Novel Techniques and Strategies for Success

<h3>Study Objective</h3> To review the benefits of transvaginal specimen extraction, to demonstrate applications of this technique in laparoscopic gynecologic surgery, and to discuss strategies for successful transvaginal extraction and colpotomy closure. <h3>Design</h3> Educational video highlighting surgical techniques. <h3>Setting</h3> Academic medical center. <h3>Patients or Participants</h3> We present four cases of patients undergoing transvaginal specimen extraction during laparoscopic gynecologic surgery. <h3>Interventions</h3> Transvaginal specimen extraction performed via colpotomy or through a dilated cervix. <h3>Measurements and Main Results</h3> We present a stepwise approach to making a posterior colpotomy for transvaginal specimen extraction: 1) Identify the uterosacral ligaments and rectum, 2) expose and delineate the colpotomy site, 3) ensure maintenance of pneumoperitoneum, and 4) make an incision no wider than the borders of the uterosacral ligaments, using a judicious amount of energy. We demonstrate multiple applications of this approach using a variety of instruments and energy sources. Additionally, we present a case of transcervical specimen extraction through a dilated cervix following laparoscopic supracervical hysterectomy. <h3>Conclusion</h3> We have demonstrated a variety of techniques and applications for transvaginal specimen extraction. This approach represents a safe and effective alternative to mini-laparotomy or power morcellation.

Safety of Three-Dimensional versus Two-Dimensional Laparoscopic Hysterectomy during the COVID-19 Pandemic.

The COVID-19 pandemic has resulted in a significant decrease in the number of surgical procedures performed. Therefore, it is important to use surgical methods that carry the lowest possible risk of virus transmission between the patient and the operating theater staff. Safety evaluation of three-dimensional (3D) versus two-dimensional (2D) laparoscopic hysterectomy during the COVID-19 pandemic. 44 patients were assigned to a prospective case-control study. They were divided either to 3D (n = 22) or 2D laparoscopic hysterectomy (n = 22). Fourteen laparoscopic supracervical hysterectomies (LASH) and eight total laparoscopic hysterectomies (TLH) were performed in every group. The demographic data, operating time, change in patients' hemoglobin level and other surgical outcomes were evaluated. 3D laparoscopy was associated with a significantly shorter operating time than 2D. (3D vs. 2D LASH 70 ± 23 min vs. 90 ± 20 min, p = 0.0086; 3D vs. 2D TLH 72 ± 9 min vs. 85 ± 9 min, p = 0.0089). The 3D and 2D groups were not significantly different in terms of change in serum hemoglobin level and other surgical outcomes. Due to a shorter operating time, 3D laparoscopic hysterectomy seems to be a safer method both for both the surgeon and the patient. Regarding terms of possible virus transmission, it may be particularly considered the first-choice method during the COVID-19 pandemic.

The hysterectomy: influence of the surgical method in benign disease on convalescence and quality of life

PurposeThe aim of this study was to evaluate the postoperative course after different methods of hysterectomy for benign diseases with special emphasis on time to recovery and patient-centred aspects such as postoperative quality of life and satisfaction.MethodsA collective of 242 women who had undergone vaginal hysterectomy (VH), laparoscopic supracervical hysterectomy (LASH) or total laparoscopic hysterectomy (TLH) for various benign conditions was studied in this retrospective investigation. Patients completed a standardised questionnaire addressing quality of life, recovery and sick leave as well as general questions on their postoperative course after hysterectomy.ResultsA total of 242 cases were analysed (82 VH, 92 LASH and 68 TLH). The data demonstrate significant differences in regard to age between groups. The present study shows shorter hospitalisation with laparoscopy, with LASH patients returning to work at least one week earlier on average. There were no relevant differences in the overall postoperative course during the index hospital stay. In the long run, laparoscopic patients were not more satisfied with their choice than VH patients.ConclusionNo significant long-term differences could be observed in terms of quality of life and overall postoperative satisfaction between VH and LH groups. In regard to socioeconomic aspects, laparoscopic approaches were associated with shorter hospitalisation and LASH patients returning to work at least one week earlier on average. Contrary to these data on objective recovery; however, a laparoscopic approach did not lead to patient-perceived, i.e. subjective improvement of time to full recovery.

A Rare Case of Tumefactive Endomyometriosis of the Liver

A 40-year-old woman presented to the emergency department with new-onset chest pain. Her medical history included laparoscopic supracervical hysterectomy involving morcellation of uterine myomas performed 8 years ago and biopsy-proven “disseminated peritoneal leiomyomatosis” involving the liver. Computed tomography revealed known hepatic and omental masses that increased in size (Fig. 1). The patient underwent multiteam surgery for removal of the hepatic and the omental masses, with bilateral salpingectomy and cervix trachelectomy.

Containment Bag Use Among Women Who Undergo Hysterectomy With Laparoscopic Power Morcellation.

To estimate trends in use of laparoscopic power morcellators in women undergoing minimally invasive hysterectomy and to examine use of containment systems in these patients in relation to safety guidance from the U.S. Food and Drug Administration (FDA). We examined data that were recorded in the Premier Healthcare Database from patients who underwent laparoscopic supracervical hysterectomy from 2010 to 2018. Patients were stratified based on use of laparoscopic power morcellators. The cohort was further stratified as either pre-FDA guidance (2010 quarter 1-2014 quarter 1) or post-FDA guidance (2014 quarter 2-2018 quarter 2). Interrupted time series analyses were performed to determine the effect of FDA guidance on the use of laparoscopic power morcellators and containment bags. Among 67,115 patients, laparoscopic power morcellator use decreased from 66.7% in 2013 quarter 4 to 13.3% by 2018 quarter 2. The likelihood of laparoscopic power morcellator use decreased by 9.5% for each quarter elapsed in the post-FDA warning period (risk ratio [RR] 0.91, 95% CI 0.90-0.91). Containment bag use rose from 5.2% in 2013 quarter 4 to 15.2% by 2018 quarter 2. The likelihood of containment bag use increased by 3% for each quarter elapsed in the post-FDA warning period (RR 1.03, 95% CI 1.02-1.05). Among women who had laparoscopic power morcellator use, uterine cancers or sarcomas were identified in 54 (0.17%) before the FDA guidance compared with seven (0.12%) after the guidance ( P =.45). Containment bags were used in 11.1% of women with uterine cancers or sarcomas before the FDA guidance compared with 14.3% after the guidance ( P =.12). The perioperative complication rate was 3.3% among women who had laparoscopic power morcellator use without a containment bag compared with 4.5% ( P =.001) in those with a containment bag (aRR 1.35, 95% CI 1.12-1.64). Use of laparoscopic power morcellators has decreased over time. Containment bag use increased after the FDA's 2014 guidance; however, most procedures employing laparoscopic power morcellators are still performed without a containment bag.

Mesh complications after total vs supracervical laparoscopic hysterectomy at time of minimally invasive sacrocolpopexy.

Our objective was to compare mesh exposure rates (4 months and 1 year) after total (TLH) vs supracervical (SLH) laparoscopic hysterectomy at time of minimally invasive sacrocolpopexy (SCP). Secondary outcomes included 30-day complications and midurethral mesh exposure rates. This a retrospective cohort study at a tertiary care referral center from 2011 to 2018. Subjects were identified using Current Procedural Terminology codes. Demographics, operative characteristics, and perioperative complications were abstracted from medical records. Four hundred three women met the inclusion criteria: 91 SLH+SCP and 312 TLH+SCP. Median follow-up was 52 weeks with an overall mesh exposure rate of 1.5%. Follow-up was available for 90% of patients at 4 months and 51% at 1 year. Half of patients had lightweight mesh (n = 203), and half had ultralightweight mesh (n = 200). Vaginal mesh fixation was performed with permanent suture in 86% (n = 344) and delayed absorbable suture in 14% (n = 56) of patients. At 4 months, vaginal mesh exposure rates did not differ between groups (0% SLH vs 1% TLH, p = 1.00). All mesh exposures in the study period occurred with lightweight mesh in the TLH arm. No differences were noted in 1-year mesh exposure rates, 30-day perioperative complications (p = 0.57), or midurethral mesh exposure rates at 4 months (p = 0.35) and 1 year (p = 1.00) between groups. Short-term mesh exposure following SCP with ultralightweight and lightweight polypropylene mesh is rare regardless of type of hysterectomy and much lower than reported in earlier studies with heavier weight mesh. These data suggest TLH at the time of SCP is a safe option in appropriately counseled patients.

There is no hierarchy: The choice of operation should be left to women: Against the motion: "Endometrial ablation should always be considered as a primary treatment, with supracervical laparoscopic hysterectomy or similar procedures a last resort".

There is no hierarchy: The choice of operation should be left to women: Against the motion: "Endometrial ablation should always be considered as a primary treatment, with supracervical laparoscopic hysterectomy or similar procedures a last resort".

Total surgical time in laparoscopic supracervical hysterectomy with laparoscopic in-bag-morcellation compared to laparoscopic supracervical hysterectomy with uncontained morcellation.

A possible solution to the problem of cell dissemination through laparoscopic uncontained morcellation during laparoscopic supracervical hysterectomy (LASH) is the use of laparoscopic in-bag morcellation. One criticism regarding the use of in-bag morcellation is the additional surgical time associated with this procedure. In this retrospective study we compared the total surgical time in LASH with laparoscopic in-bag morcellation (107 cases from 2016-2018) and LASH with uncontained morcellation (47 cases from 2015-2017). All surgeries were performed in the same department of minimally invasive gynaecological surgery by a total of three experienced surgeons for the indication of bleeding disorder and / or dysmenorrhea. We measured and compared total surgical time, surgical outcome, blood loss and complications in LASH with in-bag morcellation and with uncontained morcellation. Total surgical time in both procedures do not show a significant difference. Considering the learning curve in laparoscopic bag use, the total surgical time in LASH with laparoscopic in-bag morcellation is shorter than total surgical time in LASH with uncontained morcellation. Laparoscopic in-bag morcellation consumes time for bag use and handling, but saves time as it eliminates the need for meticulous sampling of lost tissue fragments and the complex lavage of the peritoneal cavity after morcellation. There is no difference between both groups in terms of blood loss, complications and surgical results. We conclude that LASH with in-bag morcellation is not related to additional surgical time when compared to LASH with uncontained morcellation.

The influence of persistent bleeding after supracervical hysterectomy on depressive and anxious symptoms: a prospective bicenter study.

Postoperative spotting is a frequent adverse symptom after laparoscopic supracervical hysterectomy (LSH). The conical excision (eLSH) reduces the postoperative spotting rate, but data in a larger collective are still rare and inconsistent. The influence of persistent bleeding on the anxious and depressive symptoms has not been analyzed yet. 311 patients, who underwent a laparoscopic supracervical hysterectomy with conical excision (n = 163), or with straight cervical resection (n = 148) were included. Anxious and depressive symptoms and postoperative spotting were recorded before operation, at 3 month follow-up and at 1 year follow-up in both operative groups using a validated questionnaire (German version of Hospital Anxiety and Depression Scale, HADS-D) and additional questions concerning the frequency and impact of bleeding. Statistical analysis included the impairment of bleeding as well as its impact on depressive and anxious symptoms for both groups. 11.5% after eLSH and 15.5% after LSH reported spotting after 1 year. Supracervical hysterectomy significantly improves depressive and anxious symptoms at 3 and at 12 month follow-up for both groups (p < 0.001) independent on residual spotting. Patients with a preoperative continuous bleeding showed a maximum benefit independent on operative method. Laparoscopic supracervical hysterectomy has a positive effect on anxious and depressive symptoms in the short-term and intermediate-term follow-up. The conical excision of the cervical stump reduces postoperative spotting rate, but has no explicit advantage on symptoms of depression or anxiety, irrespective of residual postoperative spotting.

Trends in Same-Day Discharge Rate After Minimally Invasive Sacrocolpopexy and Propensity Score-Matched Analysis of Postoperative Complication Rates Using the National Surgical Quality Improvement Program Database.

The primary aim of this study was to review trends in the same-day discharge (SDD) rate after minimally invasive sacrocolpopexy (MISCP). The secondary aim was to compare the composite 30-day postoperative complication rates between propensity score-matched SDD and admitted cohorts. This was a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program database from 2015 to 2019. Patients who underwent MISCP were identified by Current Procedural Terminology codes. Concurrent hysterectomy, anterior or posterior repairs, rectopexy, and midurethral sling were also identified. Multivariable logistic regression and propensity score matching were performed. A total of 12,762 MISCP patients were captured: 3,968 underwent MISCP only, 4,065 underwent MISCP with total laparoscopic hysterectomy, 734 underwent MISCP with laparoscopically assisted vaginal hysterectomy, and 3,995 underwent MISCP with laparoscopic supracervical hysterectomy. Overall, the SDD rate was 16.3%, with an increase from 12.3% in 2015 to 23.1% in 2019. Multivariable logistic regression showed that admitted patients were more likely to be older, to be of Black race, have an American Society of Anesthesiologists classification of 3 or 4, have hypertension requiring medication, have longer operative time, and have undergone concurrent anterior or posterior repair, rectopexy, or sling. After propensity score matching, the composite postoperative complication rates were similar between the 2 cohorts (5.7% vs 6.4%, P = 0.818). However, superficial surgical site infection was more likely in the SDD cohort (adjusted odds ratio, 2.3; P < 0.001) and blood transfusion in the admitted cohort (adjusted odds ratio, 11.9; P = 0.0.34). The rate of SDD after MISCP seems to be increasing. Composite postoperative complication rates are similar between SDD and admitted cohorts.

Recurrence of prolapse after total vs supracervical laparoscopic hysterectomy at time of minimally invasive sacrocolpopexy

To determine if type of hysterectomy, total laparoscopic hysterectomy (TLH) vs supracervical laparoscopic hysterectomy (SLH), at the time of sacrocolpopexy (SCP) impacts prolapse outcomes at 1 year. The primary outcome was prolapse recurrence as defined as prolapse of greater than or equal to stage II in any compartment. The secondary outcome was a composite surgical success, with success defined as no mesh exposure and no prolapse at or beyond the hymen noted by exam. This is a retrospective study comparing prolapse recurrence rates in patients undergoing TLH or SLH with SCP at a tertiary care referral center from 2011 to 2018. Subjects were identified using Current Procedural Terminology codes for TLH, SLH, and SCP. Patient demographics, operative characteristics, and perioperative complications were abstracted from medical records. Primary outcome was prolapse recurrence at 1-year. Group comparisons were performed using student’s t-test, chi square Fisher’s exact test, and Mann Whitney tests as appropriate. A p value of <.05 was considered significant. We performed a multivariate logistic regression model to see if type of hysterectomy remained associated with prolapse recurrence at 1 year while controlling for potential confounding factors. 403 women undergoing SCP met inclusion criteria; 91 SLH and 312 TLH. No clinically significant differences in demographic characteristics were noted between groups. Median follow-up was 52 weeks (IQR 17-52 weeks). Half of patients had lightweight mesh (n=203), while the other half had ultralightweight mesh (n=200). Vaginal mesh fixation was done with permanent suture in 86% (n=344) and with delayed absorbable suture in 14% (n=56) of patients. Follow up data for prolapse recurrence was available for 90% (n=361) of patients at 4 months and 48% (n=193) of patients at 1 year. At 4 months, women undergoing SLH were more likely to have recurrent prolapse ≥ stage II at any compartment (35% SLH vs 17% TLH, p=.002). At 1 year, there was no difference in prolapse recurrence by route of laparoscopic hysterectomy (34% SLH vs 29% TLH, p=0.57). There was no difference in composite surgical success between groups at 1 year (86% SLH vs 84% TLH, p=0.82). Recurrence most commonly involved the posterior compartment (80% Ap, Bp points), followed by both anterior and posterior (11% Aa, Ba, Ap, Bp points), anterior (7%, Aa, Ba points), and apical (2% C point). On multivariate logistic regression controlling for pre-operative POP-Q stage, mesh type, and higher BMI, type of hysterectomy was not associated with an increased likelihood of prolapse recurrence. Prolapse outcomes at 1-year following SLH and TLH at time of SCP are similar. Surgeons should decide when to perform a SLH vs TLH based on individualized assessment of patient factors and shared decision-making.View Large Image Figure ViewerDownload Hi-res image Download (PPT)