Type Of Hysterectomy Research Articles

Short-term outcomes of minimally invasive total vs supracervical hysterectomy for uterine fibroids: a National Surgical Quality Improvement Program study

BackgroundUterine fibroids are the most common indication for benign hysterectomy in the United States, but data regarding the association of hysterectomy type and outcomes for this indication are lacking. ObjectiveWe aimed to describe the rate and odds of short-term (30 days) postoperative complications among patients undergoing minimally invasive total (TLH) compared to supracervical (LSCH) hysterectomy for uterine fibroids. Study DesignWe conducted a cohort study of prospectively collected data from the American College of Surgeons National Surgical Quality Improvement Program database from 2012-2020. We compared characteristics of women who underwent TLH and LSCH for uterine fibroids and identified risk factors associated with the occurrence of 30-days postoperative complications defined according to the Clavien-Dindo classification. Multivariable regression analysis including age, BMI, race, comorbidities, ASA classification, uterine weight and concomitant procedures, was performed to identify the adjusted odds of postoperative complications. The co-primary outcomes were the risk of (1) a composite of any postoperative complications and of (2) major postoperative complications according to surgical type. ResultsA total of 44,413 and 6,383 patients underwent minimally invasive TLH and LSCH respectively. Operative time was shorter (143.0 vs. 150.6 minutes, p<.001), and the proportion of uterine weight >250 g was lower (39.4% vs. 45.1%, p<.001) in the TLH group. The rates of any (6.6% vs. 5.3%, p<.001), and major (2.7% vs. 1.6%, p<.001) complications were higher in the TLH group, while minor complications rate was comparable (4.4% vs. 4.1%, p=.309). In multivariable regression analysis, LSCH was independently associated with lower risk of any [aOR 95% CI 0.79 (0.70-0.88)], and major [aOR 95% CI 0.55 (0.44-0.69)] complications compared to TLH. ConclusionCompared with TLH, LSCH is associated with a lower risk of short-term postoperative complications among patients with uterine fibroids. The current study findings can aid in shared decision-making prior to minimally invasive hysterectomy for uterine fibroids.

Survival After Simple Compared With Radical Hysterectomy for Patients With Early-Stage Cervical Cancer.

To assess the effect on overall survival of simple hysterectomy with lymph node staging compared with radical hysterectomy with lymph node staging for patients with early-stage cervical cancer. We conducted a retrospective cohort study of patients in the National Cancer Database diagnosed with early cervical carcinoma of 2 cm or smaller (stage IA1 with lymphovascular space invasion through IIA1, International Federation of Gynecology and Obstetrics staging) from 2010 to 2019. After 1:1 propensity score matching, we compared patients who underwent simple hysterectomy with lymph node staging and those with radical hysterectomy with lymph node staging. The variables used for matching were age, tumor size, race and ethnicity, lymphovascular space invasion, year of diagnosis, Charlson-Deyo comorbidity score, histology, and surgical approach. The primary outcome was overall survival at the end of follow-up. Secondary outcomes included 30-day readmission rate and 30- and 90-day mortality rates. In total, 4,167 patients met the inclusion criteria, of whom 2,637 patients (63.3%) underwent radical hysterectomy and lymph node staging and 1,530 patients (36.7%) underwent simple hysterectomy and lymph node staging. After propensity score matching, 1,529 patients in each group were included. There was no statistically significant difference in overall survival between patients who underwent simple hysterectomy and those who underwent radical hysterectomy (hazard ratio 1.25, 95% CI, 0.91-1.73, P=.17). Subgroup analysis by histology, lymphovascular space invasion, tumor size, and surgical approach did not reveal statistically significant differences in overall survival according to hysterectomy type. The hysterectomy groups also did not significantly differ in 30-day readmission rate (4.6% vs 4.2%, P=.73), 30-day mortality rate (0.1% vs 0%, P=.14), or 90-day mortality rate (0.1% vs 0.1%, P=.93). Patients with low-risk cervical cancer could undergo less radical surgery without a negative effect on their oncologic outcomes.

Prevalence of unexpected malignant disease in the histopathology of hysterectomy indicated for benign condition

To describe the prevalence of incidental malignant pathology following a hysterectomy performed for benign reasons. A descriptive cross-sectional study based on hospital records. Women who underwent hysterectomy for benign reasons at a general referral hospital between 2013 and 2021 were included. Women with obstetric hysterectomy were excluded. Measured variables: age, route of hysterectomy, type of hysterectomy, histopathological diagnosis of premalignant lesion or invasive cancer, type of cancer. Analysis: Descriptive, the prevalence of preneoplastic and neoplastic conditions was estimated for the overall period. Of 816 clinical records, 674 cases (87 %) met the inclusion criteria and were analyzed. The premenopausal population predominated. Twentysix cases of unexpected malignant disease were identified, yielding a prevalence of 3.8 %, and 13 cases of premalignant pathology (1.9 %). The most common origin was the cervix (40 %), followed by the ovary (33 %). Patients undergoing hysterectomy for benign conditions should be informed about the risk of unexpected injury. The importance of performing, in our context an adequate preoperative approach to rule out cervix uteri and ovarian cancer is emphasized. Follow-up studies of patients with unanticipated cancer are required to determine their treatment and prognosis in the region.

Uterine Cancer: A Nine-year Review from a Tertiary Hospital in Tamil Nadu

Background: With increasing uterine cancer in developing nations, there is a need for timely determination of the diagnosis, prognosis, and management options to reduce morbidity and mortality. Objective: To analyze the socio-demographic, etio-pathological features and management of uterine cancer and evaluate its correlation with grading/staging in our population. Methods: This retrospective descriptive study analyzed data from 97 histologically proven uterine cancer cases. Age, parity, symptoms, co-morbidities, body mass index (BMI), ultrasound features, histopathology type, stage and grade of the tumor, type of hysterectomy done, complications and mortality were analysed. Statistical analysis was done using ANOVA and chi-square test, and a p-value&lt;0.05 indicated statistical significance. Results: The mean age of diagnosis was 57.91 years, and the mean BMI was 29.32 Kg/m2. Majority of the patients were multiparous (42.27%), and only 10% were nulliparous. The disease was detected at an earlier age in nulliparous and obese women. Diabetes and hypertension were found in 75.25%. Most of the patients were detected with stage I cancer (80.6%). Patients diagnosed with uterine cancer on biopsy were treated with total abdominal hysterectomy with bilateral salpingo-oophorectomy andbilateral pelvic lymph node dissection (55.8%). Over 36% of patients received postop radiotherapy and/or chemotherapy. 21% patients were lost to follow-up and 12.37% died. Also, 24 cases had postoperative complications (wound infection). Conclusion: Uterine cancer is common among obese women with diabetes and hypertension. In nulliparous and the obese, the cancer was detected at an earlier age. Most of our patients had stage 1 disease, and 90% was endometroid cancer. The study highlights the importance of endometrial sampling before hysterectomy in perimenopausal women to avoid suboptimal surgery in patients diagnosed with uterine cancer after a simple hysterectomy.

Revisiting Querleu-Morrow Radical Hysterectomy: How to Apply the Anatomy of Parametrium and Pelvic Autonomic Nerves to Cervical Cancer Surgery?

In 2008, Querleu and Morrow proposed a novel classification of radical hysterectomy, which was quickly accepted by the professional oncogynecological community. The Querleu and Morrow (Q-M) classification of radical hysterectomy has provided a unique opportunity for uniform surgical and anatomical terminology. The classification offers detailed explanations of anatomical landmarks and resection margins for the three parametria of the uterus. However, there are still some disagreements and misconceptions regarding the terminology and anatomical landmarks of the Q-M classification. This article aims to highlight the surgical anatomy of all radical hysterectomy types within the Q-M classification. It discusses and illustrates the importance of anatomical landmarks for defining resection margins of the Q-M classification and reviews the differences between Q-M and other radical hysterectomy classifications. Additionally, we propose an update of the Q-M classification, which includes the implementation of parauterine lymphovascular tissue, paracervical lymph node dissection, and Selective-Systematic Nerve-Sparing type C2 radical hysterectomy. Type D was modified according to current guidelines for the management of patients with cervical cancer. The detailed explanation of the surgical anatomy of radical hysterectomy and the proposed update may help achieve surgical harmonization and precise standardization among oncogynecologists, which can further facilitate accurate and comparable results of multi-institutional surgical clinical trials.

Approaches for hysterectomy and implementation of robot-assisted surgery in benign gynaecological disease: A cost analysis study in a large university hospital

BackgroundAs a minimally invasive technique, robot-assisted hysterectomy (RAH) offers surgical advantages and significant reduction in morbidity compared to open surgery. Despite the increasing use of RAH in benign gynaecology, there is limited data on its cost-effectiveness, especially in a European context. Our goal is to assess the costs of the different hysterectomy approaches, to describe their clinical outcomes, and to evaluate the impact of introduction of RAH on the rates of different types of hysterectomy. MethodsA retrospective single-centre cost-analysis was performed for patients undergoing a hysterectomy for benign indications. Abdominal hysterectomy (AH), vaginal hysterectomy (VH), laparoscopic hysterectomy (LH), laparoscopically assisted vaginal hysterectomy (LAVH) and RAH were included. We considered the costs of operating room and hospital stay for the different hysterectomy techniques using the “Activity Centre–Care program model”. We report on intra- and postoperative complications for the different approaches as well as their cost relationship. ResultsBetween January 2014 and December 2021, 830 patients were operated; 67 underwent VH (8%), 108 LAVH (13%), 351 LH (42%), 148 RAH (18%) and 156 AH (19%).After the implementation and learning curve of a dedicated program for RAH in 2018, AH declined from 27.3% in 2014–2017, to 22.1% in 2018 and 6.9 % in 2019–2021.The reintervention rate was 3–4% for all surgical techniques. Pharmacological interventions and blood transfusions were performed after AH in 28%, and in 17–22% of the other approaches.AH had the highest hospital stay cost with an average of €2236.40. Mean cost of the hospital stay ranged from €1136.77-€1560.66 for minimally invasive techniques.The average total costs for RAH were €6528.10 compared to €4400.95 for AH. ConclusionImplementation of RAH resulted in a substantial decrease of open surgery rate. However, RAH remains the most expensive technique in our cohort, mainly due to high material and depreciation costs. Therefore, RAH should not be considered for every patient, but for those who would otherwise need more invasive surgery, with higher risk of complications. Future prospective studies should focus on the societal costs and patient reported outcomes, in order to do cost-benefit analysis and further evaluate the exact value of RAH in the current healthcare setting.

Intraperitoneal analgesia to reduce pain after laparoscopic hysterectomy: Randomized Controlled Trial

Background: Laparoscopic hysterectomy patients report high levels of postoperative pain and inadequate pain relief. This minimally invasive procedure is difficult to manage and leads to increased opioid use, limited mobility, and higher risks of complications, delayed rehabilitation and prolonged hospital stay. Objective: To determine the analgesic efficacy of bupivacaine’s intraperitoneal instillation (IP) with dexmedetomidine as an adjuvant for postoperative pain management in laparoscopic hysterectomy. Methods: This study is a randomized control clinical trial done at the Obstetrics and Gynecology Department, Ain Shams University Hospital, within 11 months (from September 2021 to August 2022). This study’s target population was all patients enrolled in laparoscopic hysterectomy. A total of 30 patients participated in this study, and we randomly divided it into two groups equally (15 patients per group). Results: There was no significant difference between groups regarding body mass index, age, parity, obstetric history, medical history, surgical history, indication of hysterectomy, type of hysterectomy, duration of surgery, and uterus size. Visual analog scores for patients at 1-, 6-, 12-, and 24-hours post-operatively increased significantly in Group B than in Group A. Furthermore, the time required for first rescue analgesia increased significantly more in Group A than in Group B. Group A required substantially less analgesic amount than Group B. Group A had significantly shorter hospital stays than Group B. There was no statistically significant difference between groups A and B in terms of adverse effects like nausea and vomiting (p&gt;0.05) although they were less frequent in group A. Conclusion: Intraperitoneal instillation of bupivacaine combined with dexmedetomidine during laparoscopic hysterectomy substantially reduces postoperative pain and the requirement for analgesics in the postoperative period, compared to the control group, with no adverse side effects.

Pre- vs Post-Operative Levator Ani Subtended Volume in Patients Undergoing Hysterectomy: A Comparative Imaging Study.

The effects of hysterectomy on pelvic floor function remain uncertain, with the levator ani muscle (LAM) playing a critical role in pelvic support. The levator ani subtended volume (LASV) is an objective measure of the LAM's anatomical volume, derived from magnetic resonance imaging (MRI). This study was aimed at assessing the consistency between MRI and computed tomography (CT) in quantifying LASV, and to investigate the effect of hysterectomy on the LAM. This retrospective study analyzed a cohort of 55 hysterectomy patients, utilizing pre-operative pelvic MRI and post-operative CT scans to measure the LASV. To evaluate the consistency between MRI and CT, the study employed the intraclass correlation coefficient and Bland-Altman agreement analysis in a subset of 32 patients with both pre-operative scans. A paired-samplet test was used to analyze LASV changes pre- and post-hysterectomy, and linear regression analysis was performed to account for potential risk factors that may influence post-operative LASV. High consistency between MRI and CT in measuring LASV was found, with an ICC of 0.911. We observed a significant increase in LASV following hysterectomy, with mean volume pre- and post-operatively of 16.66 cm3 and 18.87 cm3 respectively. Age and body mass index were significant predictors of post-hysterectomy LASV, whereas parity and the type of hysterectomy had no significant impact. Hysterectomy significantly affects the LAM, resulting in an increase in post-operative LASV. Moreover, this study verifies that MRI and CT can be used interchangeably for LASV measurements in clinical practice.

Evaluating for Racial Disparities in the Utilization of Minimally Invasive Hysterectomy for the Treatment of Uterine Leiomyoma

Introduction: Minimally invasive hysterectomy (MIH) for benign gynecologic indications has many patient advantages over traditional abdominal hysterectomy (AH) including decreased hospital stay, decreased mortality, and faster recovery. Although MIH has been shown to improve outcomes as compared with abdominal hysterectomy, racial and socioeconomic disparities can impact patient access to the minimally invasive procedure. Previous studies have demonstrated that Black and Hispanic-identifying patients are significantly less likely to receive a MIH when compared to White patients. One proposed contributor to this finding is the higher rate and delayed diagnosis of uterine leiomyoma in Black patients compared to White patients. This disparity could delay diagnosis, and cause a larger leiomyoma necessitating use of abdominal hysterectomy. Another explanation in disparity is the physician training at hospitals in underserved areas. This study aims to investigate if race impacts access to MIH for leiomyoma at Carle Foundation Hospital in Urbana, Illinois. Methods: This retrospective analysis studied patients from 2011-2020 who received a hysterectomy at Carle Foundation Hospital for a primary diagnosis of leiomyoma. MIH included laparoscopic, vaginal, and robotic-assisted. Hysterectomies for malignancy were excluded. The demographic data included age, race, body mass index (BMI), type of hysterectomy, insurance, history of previous obstetric and abdominal surgeries, and uterine weight. The race categories included White, Black, and Others. Hispanic and Asian patients were placed into the other category due to the limited sample size. Descriptive statistics were used to evaluate the demographic data. Odd ratios were calculated to determine if a patient received a MIH over an AH based on race. An adjusted odds ratio was calculated to account for BMI, uterine weight, history of cesarean section, and previous abdominal surgery. Results: A total of 324 hysterectomies from 2011-2020 were performed for leiomyoma. Abdominal hysterectomies accounted for 32.1% and MIH accounted for 68.9%, with 7.4% being laparoscopic, 5.6% being vaginal, and 55.9% being robotic-assisted. The average age of White patients was 46.7 years old, and was higher than Black patients, 43.6 years old (p&lt;.01). The average BMI of Black patients was 34.6 kg/m2, and was higher than White patients, 30.3 34.6 kg/m2 (p&lt;.01). More White patients had commercial insurance at 83.5% compared to Black patients at 48.1% (p&lt;.01). More Black patients had Medicaid or Medicare at 50.6% compared to White patients at 14.8% (p&lt;.01). Black patients had an average uterine weight at 579.8g compared to White patients at 438.6g (p&lt;.05). The majority (73.7%) of White patients received a MIH, with 26.3% receiving an AH. Forty five percent of Black patients received an AH while 54.5% received a MIH. Conclusion: At Carle Foundation Hospital during the years 2011-2020, a lower percentage of African American patients, compared to white patients, received a minimally invasive hysterectomy in the treatment of uterine leiomyoma. Further analysis will investigate for the odds ratios of each group receiving a MIH and will adjust for BMI, uterine weight, obstetric and abdominal surgical history.

Type and approach of hysterectomy and oncological survival of women with stage II cancer of endometrium: a large retrospective cohort study.

To explore the association between the Type and approach of hysterectomy and oncological survival of women with stage II cancer of the endometrium. 684 women with stage II endometrial cancer were included. Eligible cases were grouped by type of hysterectomy (simple hysterectomy or radical hysterectomy)and approach of hysterectomy (laparoscopy or laparotomy). The baseline characteristics were compared among groups. The survival outcomes (disease-free survival and overall survival) were calculated and compared among groups, and the underlying confounding factors were adjusted by the Cox proportional hazard regression analysis. The radical hysterectomy group and the simple hysterectomy group had 217 cases and 467 cases, respectively. Between the groups, the difference in 5-year disease-free survival (87.3% versus 87.9%, HR=0.97, P=0.87) and 5-year overall survival (83.8% versus 83.8%, HR=0.95, P=0.95) was not statistically significant. The laparotomy group and the laparoscopy group had 277 cases and 407 cases, respectively. Between the groups, the difference in 5-year disease-free survival (88.7% versus 87.1%, HR=1.22, P=0.34) and 5-year overall survival (85.5% versus 82.7%, HR=1.00, P=0.99) was not statistically significant. For long-term oncological survival, radical hysterectomy is not superior to total hysterectomy in stage II endometrial cancer. Also, for stage II cancer of the endometrium, laparoscopic hysterectomy is as oncologically safe as open hysterectomy.

Fear of Cancer and State Anxiety Among Women Undergoing Hysterectomy

Background Fear of cancer may develop after surgery in women who underwent surgery for suspected malignancy in preoperative examinations. It is important from a psychosocial point of view that the fear of cancer and the factors affecting anxiety are determined and necessary interventions are made. Objectives The aim of this study was to determine the level of state anxiety, fear of cancer, and influencing factors in women who had hysterectomies with a risk of cancer in the waiting period for the pathology result. Methods The research data were collected from 109 women who underwent hysterectomy while waiting for the pathology result on the third or fourth postoperative day. Patients completed the Personal Information Form, State-Trait Anxiety Inventory-I, and Cancer Worry Scale. Results Women who underwent hysterectomy with the risk of gynecological cancer had high levels of state anxiety and cancer fear after hysterectomy; type of hysterectomy significantly affected cancer fear (P = .022), and social support (P = .015), type of hysterectomy (P = .024), and family history of cancer (P = .022) significantly affected state anxiety. Conclusion The management of these women’s concerns can be improved if healthcare professionals know more about the factors affecting their state anxiety and fear. Implications for Practice Health professionals witness patients’ most private experiences and play a key role in providing care and support. This study may be foundational in the planning and implementation of nursing interventions to manage causes of anxiety and fear during this waiting period.

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.

Impact of COVID-19 pandemic on changing the ratio of abdominal, vaginal, and laparoscopic hysterectomies

Introduction/Objective. Coronavirus pandemic caused most hospitals in the world to suspend regular activities. The aim of this study was to analyze pandemic influence on patients who underwent hysterectomy with classical (abdominal) and minimally invasive surgery (laparoscopic and vaginal approach) at the Clinic for Gynecology and Obstetrics of the University Medical Centre of Serbia. Methods. There were 2446 hysterectomies for five-year period. The study analyzed number and types of hysterectomies before and during COVID-19 pandemic. Results. The total number of operated patients was most decreased in the first year of the pandemic. During pandemic, the number of vaginal and laparoscopic hysterectomies did not change, whereas there was an increase in the number of abdominal hysterectomies. Statistical significance (p &lt; 0.01) was found between abdominal and vaginal as well as between abdominal and endoscopic hysterectomies. Conclusion. The global pandemic impact on care of symptomatic patients with COVID-19 has led to the redeployment of staff and resources, which has significantly reduced the total number of operations in many hospitals around the world.

Ab. No. 182 A Case Series on Post Hysterectomy Quality of Life Check in Females of Select Rural Southern Haryana Villages

Introduction: Clinicians we will create the requisite awareness among the females and our clinical gentry on the importance of lading guidelines before such surgeries especially in cases with long-term recovery phase such as hysterectomy. The major reason of doing the study is the absolute lack of awareness in women of rural Haryana in the selected villages that led to the belief that women suffered the post hysterectomy bodily changes far more than before it. Methods: Selection criteria was purposive with our team visiting the villages of Bandhwari, Berka and Hajipur along with NSS team of K.R. Mangalam University, Sohna Road, Gurugram. Par-q and SF36 scale were used to qualitatively assess females’ quality of life index and their readiness to physical activity. Result: The result specifies that the PARQ and the SF36 are likely to positively correlate with age and region of women with hysterectomy. Conclusion: Females who had hysterectomy (type not specified) have had a moderate to severe impact on their physical health. Implications: This leads us to believe that the women who had undergone hysterectomy had in general been poorly informed of future implications. This led us to a revelation that females were poorly educated on the post-surgical changes in their body.

Histopathological Analysis of Hysterectomy Specimens in a Tertiary Care Centre: A Retrospective Study.

Introduction The uterus is a crucial reproductive organ that is susceptible to the development of several non-neoplastic and neoplastic diseases in women, greatly increasing morbidity and mortality. Although there are various therapeutic options, hysterectomy is still a popular treatment option throughout the world.Abnormal uterine bleeding, pelvic pain, pelvic inflammatory disease (PID), prolapse of the uterus, adenomyosis, endometriosis, fibroids, gynecological malignancies, and obstetric problems that require hysterectomy, all samples must be examined histopathologically.Histopathological examination of the specimens obtained after hysterectomy is important for both diagnosis and treatment. The current work aimed to identify the various clinical indications, analyze the clinicopathological correlation in hysterectomy specimens, and analyze the patterns of lesions in hysterectomy specimens. Materials and methods This study was conducted in the Department of Pathology at the Datta Meghe Medical College, Wanadongari, Nagpur, from February 2022 to January 2023. All types of hysterectomy specimens received during this year were examined, and the tissues were processed and stained with H&E. Histopathological examination was performed, and various lesions in the hysterectomy specimens were examined.The study included all forms of hysterectomy, including abdominal, vaginal, laparoscopic, and total abdominal hysterectomy. Results An analysis of 110 cases of hysterectomy revealed that abdominal hysterectomy was the type of hysterectomy in 79 (71.82%) cases, with a maximum age range of 35 to 45 years (42.72%). The proliferative phase endometrium was the most common endometrial pathology, accounting for 43 (39.09%) cases, followed by the atrophic endometrium in 35 (31.82%) cases. Leiomyoma was the most prevalent myometrial lesion, accounting for 52 (47.28%) cases, followed by adenomyosis, accounting for 23 (20.91%) cases. Chronic cervicitis was the most common incidental finding in the hysterectomy samples, accounting for 85 (77.28%) cases. Follicular cysts, representing 22 (20%) cases, were the most common ovarian lesions, followed by serous cystadenoma in seven (6.37%) cases. Two cases of malignant tumors were noted: one case of endometrial carcinoma and one case of mucinous cystadenocarcinoma of the ovary. In most cases, ranging from 70% to 100%, the final histopathological diagnosis supports the preoperative clinical diagnosis. Conclusion Hysterectomy is the most common major gynecological surgery performed under elective conditions. Although histological studies and clinical diagnoses are closely correlated, several lesions, including chronic cervicitis and adenomyosis, were discovered incidentally. Therefore, every hysterectomy specimen must undergo a thorough histological investigation, even if it appears superficially normal, to confirm the diagnosis and improve postoperative care.

Risk of postoperative mesh exposure following sacrocolpopexy with supracervical versus total concomitant laparoscopic hysterectomy.

The primary objective was to compare rates of mesh exposure in women undergoing minimally invasive sacrocolpopexy with concurrent supracervical vs total hysterectomy. We hypothesized there would be a lower risk of mesh exposure for supracervical hysterectomy. This was a retrospective cohort study using the Premier Healthcare Database. Women undergoing sacrocolpopexy with supracervical or total hysterectomy between 2010 and 2018 were identified using Current Procedural (CPT) codes. Complications were identified using CPT and diagnosis codes; reoperations were identified using CPT codes. Mesh exposures were measured over a 2-year period. A multivariable logistic regression was performed with a priori defined predictors of mesh exposure. This study includes 17,111 women who underwent minimally invasive sacrocolpopexy with concomitant supracervical or total hysterectomy (6708 (39%) vs 10,403 (61%)). Women who underwent supracervical hysterectomy were older (age 60 ± 11 vs 53 ± 13, p < 0.01) and less likely to be obese (4% vs 7%, p < 0.01). Postoperative mesh exposures within 2years were similar (supracervical n = 47, 0.7% vs total n = 65, 0.62%, p = 0.61). On logistic regression, obesity significantly reduced the odds of mesh exposure (OR 0.2, 95% CI 0.01, 0.8); concomitant slings increased odds (OR 1.91, 95% CI 1.28, 2.83). Supracervical hysterectomy was associated with higher rates of port site hernias (1.3% vs 0.65%, p < 0.01), but lower surgical site infections within 3months (0.81% vs 1.2%, p = 0.03). Reoperation for recurrent prolapse within 24months was similar (supracervical n = 94, 1.4% vs total n = 150, 1.4%, p = 0.88). Postoperative mesh exposure rates do not significantly differ based on type of concomitant hysterectomy in this dataset.

Racial Disparities in Hysterectomy Route for Benign Disease: Examining Trends and Perioperative Complications From 2007 to 2018 Using the NSQIP Database

(Abstracted from J Minim Invasive Gynecol 2023;30(8):627–634) One of the most common gynecological procedures performed within the United States, the trends of hysterectomy types have changed over the past 30 years, with the 1990s demonstrating predominantly abdominal hysterectomies, whereas current trends tend to favor minimally invasive hysterectomies (MIHs) using laparoscopic or vaginal routes. In addition, within the hysterectomy trend, it is notable that higher rates of abdominal hysterectomy and postoperative complications occur for Black and Hispanic women as seen across varying health care systems.

Clinical Audit of Hysterectomy in Rasheed Shekoni Federal University Teaching Hospital Dutse, North-West Nigeria

Background: Hysterectomy is a major and common gynecological procedure that involves the removal of the uterus for benign or malignant indications. The rate of hysterectomy varies from one region to another. Objective: To determine the prevalence, indications and clinical outcome of hysterectomy at Rasheed Shekoni Federal University Teaching Hospital. Materials and methods: The study was a 3-year retrospective review of hysterectomies, carried out between 1st July 2020 and 31st June 2023. Data analysis was carried out using IBM SPSS version 26. Measured variables were expressed in percentage. Test for association was done using chi-square, setting P-value at &lt;0.05. Results: A total of 56 hysterectomies were performed out of a total of 232 gynecological surgeries, giving a rate of 24.14%. The mean age was 51.72±12.2 years. The mean parity was 5.28±3.3. The rate of hysterectomy was highest (34.0%) among women aged 40 – 49 years. The commonest (29.8%) procedure was vaginal hysterectomy. The commonest (29.8%) indication for hysterectomy was utero-vaginal prolapse. The mean blood unit transfused was 1.2±1.2 units. The mean post-operative admission was 5.23± 2.2 days. Conclusion: Pelvic organ prolapse is the leading indication for hysterectomy and vaginal hysterectomy is the most common type of hysterectomy performed.

Repere anatomice în histerectomia radicală

Introduction. Customizing surgical radicality is a crucial element in contemporary cervical cancer surgery. Currently, anatomic structures are characterized based on many anatomic interpretations. In order to suggest its general applicability, this study proposes to standardize the definitions and anatomic landmarks of the various types of radical hysterectomy. Methodology. This paper is a literature review in which we selected relevant articles from PubMed database, starting with the year of publication 2010 until 2023, using the following keywords: “cervical cancer”, “radical hysterectomy”, “classification of radical hysterectomy”, “anatomic landmarks”, “tailoring surgery”, “nerve-sparing procedure”. Results. The lateral extent of resection serves as the basis for the updated Querleu-Morrow classification. The three-dimensional anatomic template used to define the resection limits is based on the precise anatomy of the paracolpium and parametrium. The main anatomic landmarks and avascular spaces of the pelvis serve as the basis for the oncologic procedures, including nerve-sparing techniques. There are four different types of radical hysterectomy, each type described with three-dimensional landmarks. There are three main objectives that never change: excising the central tumor with clear margins, removal of any possible lymph dissemination sites, and the control of metastatic disease. Conclusions. It is essential to base research evaluating radicality in the surgical treatment of cervical cancer on precise and generally accepted nomenclature and descriptions. Since the degree of parametrium excision affects late morbidity, particularly bladder and rectal dysfunctions, the thorough explanation and understanding of the many forms of radical hysterectomy are crucial.

Evaluation of nerve‑sparing radical hysterectomy introduction efficiency in the regional cancer center

The purpose of the study. To evaluate the immediate and long–term results of the introduction of nerve‑s paring radical hysterectomy into the practice of the center, namely, the frequency of complications, duration of surgery, blood loss, genitourinary disorders and compare the data obtained with the data of the world literature on this issue.Patients and methods. In the period from August 2019 to October 2022, 55 patients diagnosed with cervical carcinoma who underwent nerve‑ sparing radical hysterectomy type III/C1 were treated in the conditions of the regional clinical oncological dispensary. The age category ranged from 31 to 69 years, the average age was 47.3 years. The following postoperative indicators were analyzed: duration of surgery, blood loss, amount of residual urine, duration of hospital stay after surgery, complications, mortality, number of lymph nodes examined. The analysis of long‑term oncological results in patients with a follow‑up period of more than 12 months (42–12 months) was carried out, the frequency of relapses, the frequency of progression, and mortality from progression were estimated.Results. The obtained postoperative averages, such as: the duration of the operation, amounted to 286 minutes; blood loss – 216.1 ml, the volume of residual urine on the 5th day 52.4 ml, the duration of hospital stay after surgery 11.1 days, complications of the II degree according to Clavien–Dindo – 3.6 %, complications of the III degree according to Clavien‑ Dindo – 3.6 %, there was no postoperative mortality, the number of lymph nodes examined was 18.3. During the follow‑up period, the recurrence rate was 0 %, relapse‑free survival was 91 %, progression and mortality from progression were 7 % and 3.5 (4 and 2 patients), respectively. The effectiveness of the implementation of the methodology was evaluated by comparing it with the data given in the world literature on a similar issue. At the same time, it was found that the duration of the operation, blood loss, the frequency of complications and genitourinary disorders, the frequency of relapse and progression did not differ significantly from the data of the international literature.Conclusion. The introduction of the technology of nerve‑ sparing hysterectomy of the uterus type III/C1, in cervical cancer surgery is relatively safe and approachable in a regional oncology hospital.