Total Laparoscopic Hysterectomy Research Articles

Four-handed Technique for Total Laparoscopic Hysterectomy: An Italian Experience.

In our previous article, we proposed the novel four-handed technique (FHT) for total laparoscopic hysterectomy (TLH), which, according to us, is more helpful compared to the traditional TLH route. The objectives of the study were to analyze the FHT-TLH feasibility and efficiency by comparing some surgical outcomes recorded from 750 FHT-TLH performed in our hospital to literature data about the traditional TLH route and to underline the great opportunity this novel technique offers to the young specialists and residents to be more confident with gynecological laparoscopy. This was a retrospective analysis carried out by collecting data regarding patient characteristics and surgical outcomes (operative time, blood loss, surgical complications, use of analgesics, and length of hospitalization) from 750 hospital records of women who underwent FHT-TLH (with or without adnexectomy) due to benign or malignant pathology from January 2015 to December 2021 at our hospital. We performed a total of 750 FHT-TLH, with or without adnexectomy. The mean skin-to-skin operative time for a FHT-TLH was 50 min, and the mean blood loss was 150 mL. No visceral damage was caused during surgeries. Only two patients underwent exploratory laparotomy with total abdominal hysterectomy due to the inability to proceed laparoscopically. Nonsteroidal anti-inflammatory drugs were administered only twice a day as analgesics, with advantage. The mean length of stay in the hospital after the procedure was 1.5 days, with discharge on the evening of the 1st day after surgery. No major postoperative complications occurred. The only minor postoperative complication described, in just three patients, was cellulitis of the vaginal vault. Our FHT-TLH experience represents an alternative to the traditional TLH route, which allows to apply a minimally invasive approach with some advantages for patients compared to the traditional TLH route, such as early recovery and reduced operating time, blood loss, use of analgesics, and hospital stay. Moreover, it allows young specialists and residents to be more confident with gynecological laparoscopy, particularly when operating as the first assistant, to improve their laparoscopic surgical skills faster than the traditional TLH route allows them.

The Impact of Obesity on Total Laparoscopic Hysterectomy Outcomes: A retrospective Analysis Comparing class I, II Obese Women versus Nonobese in Benha University Hospital

The Impact of Obesity on Total Laparoscopic Hysterectomy Outcomes: A retrospective Analysis Comparing class I, II Obese Women versus Nonobese in Benha University Hospital

Comparison of surgical outcomes of da Vinci surgical systems X and Xi: A single-center study.

The da Vinci surgical systems (X and Xi) are fourth-generation systems marketed by Intuitive Inc. The X system is less expensive than the Xi system. This study compared the surgical outcomes of patients who underwent hysterectomy using the X and Xi systems. Data from 172 patients who underwent robot-assisted total hysterectomies by four surgeons between April 2019 and March 2023 were retrospectively analyzed in a single-center study. The patients were divided into two groups based on the surgical system used. Approval was granted by the Institutional Review Board of the Tottori University Hospital (22A134). All patients provided opt-out consent in accordance with the institutional guidelines. Operative time (126.6 ± 29.5 for X, 138.2 ± 38.5 for Xi, p = .227) and console time (92.9 ± 27.0 for X, 105.5 ± 34.7 for Xi, p = .089) were insignificantly shorter in group X than in group Xi after propensity score matching for age, body mass index, nulliparity, previous history of abdominal or pelvic surgery, preoperative diagnosis, and surgical approach. No significant differences between X and Xi were observed in a subgroup analysis of patients who underwent robot-assisted total laparoscopic hysterectomy without lymphadenectomy (operative time: 199.0 ± 26.5 for X, 221.5 ± 45.1 for Xi, p = .227; console time: 162.1 ± 25.0 for X, 178.3 ± 0.314 for Xi, p = .314). Perioperative outcomes for the X and Xi da Vinci surgical systems were equivalent. The cost-effective X system may allow the widespread use of robotic surgeries.

Transvaginal natural orifice transluminal endoscopic surgery (VNOTES) retroperitoneal sentinel lymph node BIOPSY compared with conventional laparoscopy in patients with endometrial cancer

IntroductionTo explore the possibility of treatment with VNOTES sentinel lymph node dissection concept in patients with endometrial cancer. MethodsPatients who underwent VNOTES sentinel lymph node biopsy with the Comba modification were compared to patients who underwent conventional laparoscopic sentinel lymph node biopsy performed by the same surgical team. A total of 38 patients who underwent sentinel lymph node biopsy + total laparoscopic hysterectomy and bilateral salpingo-oophorectomy (BSO) were compared with 19 patients who underwent VNOTES retroperitoneal sentinel lymph node biopsy + hysterectomy and BSO. Surgical steps were described. ResultsThe average operation time, perioperative blood loss, the number of sentinel lymph nodes, presence of complications, and preoperative-postoperative hemoglobin-hematocrit differences, tumor stages, grades, largest tumor diameter, depths of invasion, and histological subtypes were similar in both the VNOTES and conventional laparoscopy groups. The postoperative pain scores were lower and the hospital stay was shorter in the VNOTES group than in the conventional laparoscopy group. No disease recurrence had been detected in either group at the time of writing. ConclusionCompared to conventional laparoscopy, sentinel lymph node biopsy with the VNOTES technique provides similar surgical results and is more advantageous in terms of postoperative pain and hospital length of stay.

Comparative Analysis of Total Laparoscopic Hysterectomy Versus Non-descent Vaginal Hysterectomy for Benign Uterine Pathologies in Women: A Systematic Review.

Hysterectomy, which can be conducted through abdominal or vaginal routes, is one of the most common gynecological procedures performed worldwide. When the patient is not able to undergo a vaginal hysterectomy due to contraindications involving a narrow pelvis or endometriosis and technical difficulties, laparoscopic removal of the uterus is the recommended method over abdominal hysterectomy. Additionally, the type of surgery depends on the expertise of the surgeon. Therefore, this systematic review aimed to evaluate different measures related to total laparoscopic (TLH) versus non-descent vaginal hysterectomy (NDVH) in women with benign uterine pathologies. ScienceDirect, PubMed, and Google Scholar databases were searched from 2019 to 2023 for a literature review using keywords including "Non-descent Vaginal Hysterectomy," AND "Total Laparoscopic Hysterectomy," AND "Benign Uterine Pathologies." This systematic review includes five studies based on the selection criteria. The data were extracted and a quality assessment of the studies was performed. The review concluded that NDVH has an advantage over TLH as a scarless surgery performed in a very short period and with minimum blood loss with fewer complications and in terms of cost-effectiveness. However, the postoperative parameters and satisfaction with the TLH technique were better than the NDVH technique, but the procedure was much more time-consuming and needed laparoscopic surgical expertise. The duration of hospitalization in NDVH and TLH was nearly the same. Furthermore, both techniques could be employed for salpingo-oophorectomy or when there are adnexal masses and adhesions present; however, TLH may be the best course of action.

Total laparoscopic hysterectomy versus vaginal assisted laparoscopic hysterectomy for benign uterine conditions: A prospective trial.

Total laparoscopic hysterectomy versus vaginal assisted laparoscopic hysterectomy for benign uterine conditions: A prospective trial.

Laparoscopic surgery for endometrial cancer is oncologically safe and improves hospital stay duration: a retrospective single-center study over a 16-year period

ObjectiveTo investigate changes in surgical procedures and patient outcomes of patients diagnosed with endometrial cancer (EC) at a German university hospital between 1998 and 2014.MethodsA monocentric, retrospective review was conducted to identify patients diagnosed and treated with EC during the aforementioned period at the Department of Gynecology and Obstetrics at the University Hospital Kiel, Germany.Results303 patients were identified. Patient demographics, risk factors, histological subtypes and stages of EC remained consistent over time. The most common surgical procedure was total abdominal hysterectomy (TAH) (81.9%). In 2011, the institution carried out its first total laparoscopic hysterectomy (TLH) for EC, resulting in a significant increase in laparoscopic surgical procedures (2011–2014: N = 70; TAH 44.2%; TLH 51.4%). Although the total number of lymph node stagings remained consistent over time, there was a significant increase in the performance of simultaneous pelvic and para-aortic lymphonodectomy (LNE) compared to pelvic LNE alone (2.6 in 2001–2005 vs. 18.0% in 2011–2014, p ≤ 0.001). The duration of hospital stays significantly decreased over time, with a mean of 20.9 days in the first and 8.5 days in the last period. When comparing surgical procedures, TLHs resulted in significantly shorter postoperative stays with an average of 6.58 vs. 13.92 days for TAH. The surgical procedure performed did not affect 5-year overall survival rates in this study (84.9% for TAH and 85.3% for TLH, p = 0.85).ConclusionsOur retrospective single-center study demonstrates that laparoscopic surgery for endometrial cancer is oncologically safe and shortens hospital stays.

Surgical Considerations for Minimally Invasive Gynecologic Surgery in Patient With Skeletal Dysplasia

Skeletal dysplasias are a group of heritable diseases in which the bone and cartilage are affected. Despite their impact in anatomical structures, there are many gaps in knowledge between the relationship between skeletal dysplasias and minimal invasive gynecologic surgery. Here, we present a case of a 44-year-old patient with a history of skeletal dysplasia and abnormal uterine bleeding, due to uterine fibroids. As medical treatment failed, a laparoscopic surgery was performed. As expected, normal anatomical landmarks used in laparoscopy were lost as a result of severe scoliosis.Despite anesthesic and surgical difficulties, a successful total laparoscopic hysterectomy and bilateral salpingectomy was performed. Patients with these disorders need to have an individualized and interdisciplinary approach in gynecologic laparoscopic surgery

Hysterectomy Techniques and Outcomes for Benign Large Uteri: A Systematic Review.

To identify the optimal hysterectomy approach for large uteri in gynecologic surgery for benign indications from a perioperative morbidity standpoint. PubMed and Embase databases were searched from inception through September 19, 2022. Meta-analyses were conducted as feasible. This review included studies that compared routes of hysterectomy with or without bilateral salpingo-oophorectomy for large uteri (12 weeks or more or 250 g or more) and excluded studies with any concurrent surgery for pelvic organ prolapse, incontinence, gynecologic malignancy, or any obstetric indication for hysterectomy. The review included 25 studies comprising nine randomized trials, two prospective, and 14 retrospective nonrandomized comparative studies. Studies were at high risk of bias. There was lower operative time for total vaginal hysterectomy compared with laparoscopically assisted vaginal hysterectomy (LAVH) (mean difference 39 minutes, 95% CI, 18-60) and total vaginal hysterectomy compared with total laparoscopic hysterectomy (mean difference 50 minutes, 95% CI, 29-70). Total laparoscopic hysterectomy was associated with much greater risk of ureteral injury compared with total vaginal hysterectomy (odds ratio 7.54, 95% CI, 2.52-22.58). There were no significant differences in bowel injury rates between groups. There were no differences in length of stay among the laparoscopic approaches. For LAVH compared with total vaginal hysterectomy, randomized controlled trials favored total vaginal hysterectomy for length of stay. When rates of blood transfusion were compared between these abdominal hysterectomy and robotic-assisted total hysterectomy routes, abdominal hysterectomy was associated with a sixfold greater risk of transfusion than robotic-assisted total hysterectomy (6.31, 95% CI, 1.07-37.32). Similarly, single studies comparing robotic-assisted total hysterectomy with LAVH, total laparoscopic hysterectomy, or total vaginal hysterectomy all favored robotic-assisted total hysterectomy for reduced blood loss. Minimally invasive routes are safe and effective and have few complications. Minimally invasive approach (vaginal, laparoscopic, or robotic) results in lower blood loss and shorter length of stay, whereas the abdominal route has a shorter operative time. PROSPERO, CRD42021233300.

Retroperitoneal Müllerian Cyst Found Incidentally During Total Laparoscopic Hysterectomy: Is There a Role for MRI in Pre-Operative Evaluation?

Retroperitoneal cysts of Müllerian origin are rare and often discovered incidentally during surgical procedures or imaging studies. We present a case of a retroperitoneal cyst found during a total laparoscopic hysterectomy performed for myoma removal. A 40-year-old female presented with symptomatic myomas and underwent pre-operative evaluation, including pelvic ultrasound, which revealed no abnormalities apart from the myomas. A cyst was incidentally discovered in the retroperitoneal space during a total laparoscopic hysterectomy procedure. The cyst was excised and sent for histological examination, which confirmed its Müllerian origin. Retroperitoneal cysts of Müllerian origin are rare findings during TLH. This case report highlights the importance of thorough pre-operative evaluation and imaging studies and the significance of intraoperative awareness in identifying incidental findings. Further research is warranted to determine the optimal diagnostic imaging strategies for such cysts.

Not all operative time is created equal: operative time in relation to 30-day complications in benign laparoscopic hysterectomies

STUDY OBJECTIVE: To assess the relationship between operative time and specific 30-day postoperative complications across different intervals of operation duration in total laparoscopic hysterectomies (TLHs).DESIGN: A retrospective cohort study.SETTING: American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2011 to 2020.PATIENTS: 131,146 TLH cases.INTERVENTIONS: Eligible cases included benign laparoscopic hysterectomies with operative times between 20 and 499 min. We excluded cases involving disseminated cancer, emergency surgery, supracervical approaches, or concomitant procedures.MEASUREMENTS: Multivariable logistic regression analysis was used to evaluate the relationship between specific postoperative complications and operative time. Spline regression was used to analyze differences in the association between postoperative complications and operative time across different tertiles of operative duration.MAIN RESULTS: Multivariable logistic regression analysis demonstrated a significant association between operative time and complication occurrence for each complication type investigated, including unplanned readmission, urinary tract infections, superficial surgical site infections, blood transfusion administration, return to the operating room, and deep organ space infections. Multivariable logistic spline regression demonstrated that operative time contributed more strongly to the odds of a complication for shorter procedures than longer procedures. This relationship was more pronounced for major complications than minor complications.CONCLUSION: Operative time is a stronger risk factor for developing complications for shorter duration procedures than longer procedures. This is especially evident in major complications such as return to the operating room and deep organ space infections. Our results suggest that longer procedure duration may not affect the likelihood of a complication as much as previously thought, and operative times should not be a primary factor in deciding to convert to laparotomy or alter post-operative management.

Surgical Field Separation in Total Laparoscopic Hysterectomy.

We aimed to study whether separating the vaginal and abdominal surgical fields during total laparoscopic hysterectomy (TLH) is associated with surgical site infection rates. This was a retrospective cohort study of all patients who underwent TLH and any concomitant procedures with two minimally invasive gynecologic surgery subspecialists between January 2016 and May 2023. Among 680 included patients, the rate of infection was 0.8% with surgical field separation and 1.3% without (3/377 vs 4/303; odds ratio 0.60, 95% CI, 0.13-2.70). There was no statistical difference between groups; however, the difference in infection rates between groups was extremely small, which led to inadequate power. Our findings suggest that rates of infection after TLH are low, with or without surgical field separation. Treating the vagina, perineum, and abdomen as a single, continuous operative field during TLH may be an acceptable practice.

Asymptomatic endometrial cancer with Lynch syndrome; in a woman with primary infertility-A case report and literature review.

Lynch syndrome, also called hereditary non-polyposis colorectal cancer, is an autosomal dominant disorder characterized by germline pathogenic mutations in DNA mismatch repair genes-resulting in increased susceptibility to colorectal, endometrial, and other tumors. This case report presents an incidental finding of endometrial cancer with Lynch syndrome during investigation for primary infertility. A 34-year-old woman presented to the fertility clinic with unexplained primary infertility. Investigations showed possible endometrial polyp, 13 × 11 mm in size. Hysteroscopic polypectomy and endometrial biopsy revealed complex endometrial hyperplasia amounting to endometroid adenocarcinoma. The case was discussed at the West of Scotland Gynecology-Oncology MDT meeting-management options including fertility-sparing treatment or radical surgery were presented to the patient and she opted for the latter. A total laparoscopic hysterectomy with bilateral salpingo-oophorectomy was performed with pathology results consistent with well-differentiated endometroid adenocarcinoma Stage 1A. Peritoneal washings showed no malignant cells. Genetic testing confirmed a diagnosis of Lynch syndrome. On further questioning, it was revealed that the patient had a strong family history of colon cancer but had not previously met the criteria for genetic testing. She was referred to colorectal surgeons and underwent colonoscopy. This showed no abnormality; she was therefore scheduled for 2-yearly colonoscopic surveillance.

Total Laparoscopic Hysterectomy with Laparoscopic Lymphadenectomy versus Conventional Abdominal Hysterectomy with Lymphadenectomy for Early-Stage Endometrial Cancer: A Prospective Randomized Study

Total Laparoscopic Hysterectomy with Laparoscopic Lymphadenectomy versus Conventional Abdominal Hysterectomy with Lymphadenectomy for Early-Stage Endometrial Cancer: A Prospective Randomized Study

Bilateral ultrasound-guided quadratus lumborum block versus intravenous patient-controlled-analgesia ketamine for total abdominal laparoscopic hysterectomy

Background Total abdominal laparoscopic hysterectomy patients experience pain in various degrees mediated via the thoracic sympathetic trunk as well as parasympathetic afferent nerves. The bilateral quadratus lumborum block (QLB) was believed to provide somatic as well as visceral pain relief however the use of anesthetic agents is associated with increased side effects. IV-Patient-controlled analgesia ketamine is suggested to play an effective role in acute pain management. Also, it increases patient satisfaction with decreased side effects as it reduces the levels of the consumed opioids. Patient and methods This prospective study was done in Mansoura University hospitals from December 2022 to May 2023. The study was conducted on 100 patients. Our study included patients who were categorized into two groups. All patients underwent total abdominal laparoscopic hysterectomy with the first group underwent ultrasound-guided bilateral QLB and the second group administered IV ketamine via Patient-controlled analgesia for pain management. Results At 30 min postoperative there was no significant difference between the two groups regarding visual analog scale score. Visual analog scale score was significantly higher in group I after 1 h postoperative and until 36 h. Postoperative Morphine consumption was significantly lower in group I. Pruritis was significantly higher in group I. Bradycardia and hypotension were significantly higher in group II. Conclusion Bilateral QLB was more potent than intravenous ketamine.

Patient experiences with standard behavioral restrictions after total laparoscopic hysterectomy

Patient experiences with standard behavioral restrictions after total laparoscopic hysterectomy

Approach to the obliterated anterior Cul-De-Sac during a total laparoscopic hysterectomy

Approach to the obliterated anterior Cul-De-Sac during a total laparoscopic hysterectomy

Retrospective analysis between total laparoscopic and vNOTES hysterectomy in obese patients: single-center study.

Hysterectomy is one of the most common major gynecological surgeries, and it is performed for benign and malignant reasons. Currently, five types of hysterectomies are described: vaginal (VH), abdominal (AH), laparoscopic (LH), robotic, and vNOTES (vaginal natural orifice transluminal endoscopic surgery). This paper compares these two types of surgery in obese patients by analyzing the surgeries performed by our team. The research was conducted from January 2022 to December 2023 at the Department of Gynecology and Obstetrics of the General Hospital in Zadar. The study included female patients aged 18-75years with a BMI > 30kg/m2, regardless of parity, who were operated on for benign pathology. There were 24 patients included in total. One conversion was observed in the TLH group because of excessive bleeding. Median operative time (IQR) was significantly lower in the vNOTES group (p < 0.05) than in the TLH group 35 (10.9) vs 125 (74.0) min. The results concerning the duration of surgery, conversion rate, and postoperative bleeding and complications show that vNOTES hysterectomies seem to be feasible for obese patients. Further studies are needed to confirm these observations.

Key techniques for difficult bladder dissection during robotic assisted total laparoscopic hysterectomy

Key techniques for difficult bladder dissection during robotic assisted total laparoscopic hysterectomy

The impact of transversus abdominus plane (TAP) blocks for total laparoscopic hysterectomy on postoperative pain and recovery time: a retrospective analysis

The impact of transversus abdominus plane (TAP) blocks for total laparoscopic hysterectomy on postoperative pain and recovery time: a retrospective analysis