Type Of Hysterectomy Research Articles

Variation of Chargemaster Price Listings for Hysterectomy Procedures across Five States

<h3>Study Objective</h3> A 2018 Executive Order calling for price transparency required hospitals to provide their chargemaster (list of prices) on their public websites in order to drive competition and lower prices. Our goal was to compare chargemaster prices listed for hysterectomy procedures from hospitals in five states. <h3>Design</h3> Hospital chargemasters were obtained between February to April 2020, across 5 states chosen to represent a range of demographics and health systems. Current Procedural Terminology (CPT) codes for abdominal hysterectomy (58150, 58152, 58180), vaginal hysterectomy (58260, 58262, 58290, 58291, 58263, 58267, 58270, 58292, 58293, 58294), and laparoscopic hysterectomy (58541, 58542, 58543, 58544, 58550, 58552, 58553, 58554, 58570, 58571, 58572, 58573) as well as procedure names were searched and pricing extracted. <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> N/A. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> 837 hospitals in 5 states were included. 105 chargemasters (12.5%) listed prices for abdominal, 106 (12.7%) vaginal, and 114 (13.6%) laparoscopic hysterectomies. Mean prices listed were significantly different for all types of hysterectomy across states (Table 1). Each type of hysterectomy had a wide range of prices listed (laparoscopic $49.00-$43,491.00, abdominal $61.45-$34,849.20, vaginal $6.00-$22,651.00). <h3>Conclusion</h3> Overall, few hospitals made price listings available for abdominal, vaginal, or laparoscopic hysterectomies and price listings varied widely for these procedures across states. Despite previous literature reporting vaginal hysterectomy to have the lowest direct cost and abdominal hysterectomy the highest (Kaaki et al 2020), this is not what these public chargemasters reflect to patients. Currently, chargemasters do not seem to be a reliable option for patients to shop for healthcare. Further investigation of chargemaster prices with hospital characteristics and quality metrics is imperative.

Surgical Steps of Total Laparoscopic Hysterectomy and Distinct Types of Energy

Study Objective Show different types of energy that can be used to perform laparoscopic hysterectomy and their particularities. Design Sequential demonstration of hysterectomy steps, using different types of energy (monopolar, bipolar, advanced bipolar and ultrasonic technology) through narrated footage. Setting The use of new generation energy sources in gynecological laparoscopy is steadily increasing. In addition to conventional monopolar and bipolar electrosurgery, many surgeons use advanced bipolar or devices that use ultrasonic technology to seal vessels and tissues. The choice of instrumentation may vary according to the complexity of the surgery, in addition to previous training or experience, in addition to the availability and cost of instrumentation, as well as the appeal of the pharmaceutical industry. Patients or Participants three different cases. Interventions The first surgery focus on the use of bipolar energy with cold scissors, we show how bipolar energy allows greater security in sealing the vessels, despite greater energy dispersion with moderate area of carbonized tissue. in sequence, the use of advanced bipolar energy, where there is less energy dispersion and carbonization of the tissue, either by reading the tissue's bioimpedance and subsequently cutting through the blade of the instrument itself. Finally on the last video we can see sealing and simultaneous cutting we the use of ultrasonic energy, with gain in agility but a reduction in the sealing depth. During colpotomy the use of monopolar energy coupled to the Hulk, presents a great dispersion of energy in the dome section, but guarantees agility and good cutting power. Measurements and Main Results With the technological expansion, new types of energy appeared to improve the surgical technique. Conclusion There is still difficulty in establishing a comparative plan between the new technologies. New clinical trials with adequate power with direct comparison of the various energy sources are needed to guide surgeons in choosing the most appropriate energy source for laparoscopic hysterectomy. Show different types of energy that can be used to perform laparoscopic hysterectomy and their particularities. Sequential demonstration of hysterectomy steps, using different types of energy (monopolar, bipolar, advanced bipolar and ultrasonic technology) through narrated footage. The use of new generation energy sources in gynecological laparoscopy is steadily increasing. In addition to conventional monopolar and bipolar electrosurgery, many surgeons use advanced bipolar or devices that use ultrasonic technology to seal vessels and tissues. The choice of instrumentation may vary according to the complexity of the surgery, in addition to previous training or experience, in addition to the availability and cost of instrumentation, as well as the appeal of the pharmaceutical industry. three different cases. The first surgery focus on the use of bipolar energy with cold scissors, we show how bipolar energy allows greater security in sealing the vessels, despite greater energy dispersion with moderate area of carbonized tissue. in sequence, the use of advanced bipolar energy, where there is less energy dispersion and carbonization of the tissue, either by reading the tissue's bioimpedance and subsequently cutting through the blade of the instrument itself. Finally on the last video we can see sealing and simultaneous cutting we the use of ultrasonic energy, with gain in agility but a reduction in the sealing depth. During colpotomy the use of monopolar energy coupled to the Hulk, presents a great dispersion of energy in the dome section, but guarantees agility and good cutting power. With the technological expansion, new types of energy appeared to improve the surgical technique. There is still difficulty in establishing a comparative plan between the new technologies. New clinical trials with adequate power with direct comparison of the various energy sources are needed to guide surgeons in choosing the most appropriate energy source for laparoscopic hysterectomy.

Presence of Pelvic Pain Does Not Influence Route of Benign Hysterectomy in Women Veterans

<h3>Study Objective</h3> To determine if compared with veterans with no pelvic pain, veterans with pelvic pain undergoing hysterectomy, are more likely to have a minimally invasive hysterectomy, and whether trends in receipt of minimally invasive hysterectomy differed between those with and without pelvic pain. <h3>Design</h3> Cross-sectional study of hysterectomies performed in veterans from 2007-2014. <h3>Setting</h3> Data was obtained from the Veterans Administration (VA) Corporate Data Warehouse and included hysterectomies performed within the VA (VA provided-healthcare) and in the community and paid for by the VA (VA paid-health care). <h3>Patients or Participants</h3> All women who had hysterectomy provided or paid for by VA for a benign indication were included. Veterans who had a hysterectomy for malignancy or cesarean hysterectomy were excluded. Indications for hysterectomy were identified using ICD-9 codes; pelvic pain codes included dyspareunia, dysmenorrhea, endometriosis, and pelvic congestion syndrome. <h3>Interventions</h3> Hysterectomy was categorized as abdominal or minimally invasive (laparoscopic, robotic, and vaginal). <h3>Measurements and Main Results</h3> A total of 6,830 veterans with hysterectomies were identified: 4,540 (66.5%) had a pelvic pain, of these, 2,643 (58.2%) were abdominal and 1,897 (41.8%) were minimally invasive. Abdominal hysterectomy was used in 58.2% (n=2,643) of veterans with pelvic pain and in 60.3% (n=1,381) of veterans without pelvic pain. After adjusting for age, race, BMI, and index year of hysterectomy, there was no statistical difference in receipt of minimally invasive hysterectomy between patients with and without pelvic pain (IRR 0.99, 95% CI 0.90, 1.08). Among those undergoing hysterectomy, similar increases in the percentage of those having a minimally invasive hysterectomy for those with and without pelvic were observed between 2007 to 2014 (pelvic pain: 71.4% to 49.6%, no pelvic pain 71.3% to 53.7%). <h3>Conclusion</h3> Similar to the general population, hysterectomy rates within the VA are declining, with minimally invasive hysterectomy rates increasing. Furthermore, among veterans, the presence of pelvic pain does not appear to contribute to hysterectomy type.

The Pregnant Surgical Patient

The most vulnerable time for a fetus is during embryogenesis in the first 8 to 10 weeks of pregnancy, when women may be unaware of their pregnancy. Once pregnancy is established, a standard approach to the pregnant patient is the optimal way to ensure medical and surgical decisions are made within the context of maintaining the safety of both mother and fetus. This review describes the approach to the pregnant patient for surgical conditions within the context of physiologic changes of the patient and fetus at each trimester, anesthesia and critical care in pregnancy, imaging and drugs safe for use in pregnancy, and nongynecologic surgery in the pregnant patient and specific surgical conditions. Tables outline the classification of abortion, the assessment of pregnancy viability, physiologic changes in pregnancy, laboratory changes in pregnancy, imaging modality and radiation dose, and antibiotics and safety in pregnancy. Figures include a diagram of types of hysterectomy, respiratory changes in pregnancy, and enlargement of the uterus. Algorithms outline the approach to abdominal pain in the pregnant patient and diagnosis and management of ectopic pregnancy. This review contains 5 figures, 6 tables, and 85 references.

Survival in Advanced Epithelial Ovarian Cancer Associated with Cardiovascular Comorbidities and Type 2 Diabetes Mellitus.

Background: Ovarian carcinoma (OC) is usually diagnosed at an advanced stage, necessitating a multimodal approach that includes surgery and systemic therapy. The incidence of OC is approximately five times higher in women over 65 years of age. Cardiovascular comorbidities and type 2 diabetes mellitus, both prevalent at this age, can influence therapeutic strategy and have an adverse effect on survival. Objectives: Our study aimed to determine the impact of cardiovascular diseases and diabetes mellitus on survival in advanced ovarian cancer. Materials and methods: From 2004 to 2012, we retrospectively studied 104 patients with advanced epithelial ovarian cancer (FIGO stage II–IV) who underwent surgical treatment at the Gynecology Clinic, St. Anna University Hospital, Varna, Bulgaria. Patients were followed for an average of 90 (52–129) months. We divided the study population into two groups: those with concurrent cardiovascular diseases and type 2 diabetes mellitus (CVD) and those without these comorbidities (No-CVD group). Overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) were compared between groups using Kaplan–Meier survival analysis. Cardiovascular comorbidities and diabetes mellitus were evaluated for their prognostic value for survival using multivariate Cox proportional regression analysis adjusted for age, stage of OC, grade and histological type of the tumor, ascites presence, residual tumor size (RT), performance status, and type of hysterectomy. Results: The Kaplan–Meier analysis showed reduced OS and DSS in the CVD group compared to the No-CVD group. The median OS was 24.5 months (95% CI 18.38 months) and 38 months (95% CI 26, not reached), respectively (Log-rank p = 0.045). The median DSS was 25.5 months (95% CI 19.39 months) and 48 months (95% CI 28, not reached), respectively (Log-rank p = 0.033). The Cox regression multivariate analysis established a lower (by 68%) overall survival rate for the CVD patient group than the No-CVD group, approaching statistical significance (HR 1.68, 95% CI 0.99, 2.86, p = 0.055). Cardiovascular diseases and diabetes were associated with a 79% reduction in DSS (HR 1.79, 95% CI 1.02, 3.13, p = 0.041) and a twofold increase in the risk of disease progression (HR 2.05, 95% CI 1.25, 3.37, p = 0.005). Conclusions: According to our study, cardiovascular comorbidities and diabetes may adversely affect OC survival. Optimal control of cardiovascular diseases, diabetes mellitus, and their risk factors may be beneficial for patients with advanced OC. Further research involving a larger patient population is necessary to establish these comorbidities as independent prognostic factors.

Impact of Hysterectomy on Quality of Life, Urinary Incontinence, Sexual Functions and Urethral Length.

The aim of the study was to evaluate the influence of different types of hysterectomy on UI symptoms, quality of life and sexual functions using dedicated questionnaires. We investigated a correlation between the urethral length (UL), UI symptoms and the length of the cervix (left after LSH and SH) with sexual functions. The study enrolled 500 consecutive women referred for hysterectomy: 121 underwent VH, 171 underwent LSH, 96 underwent SH, 68 underwent TAH, and 44 underwent TLH. The patients filled in the UI-specific questionnaires and FSFI before and 12 months after hysterectomy. The UL was measured by introital ultrasound before and 12 months after hysterectomy. Before surgery, 137 out of 399 (34.3%) patients had UI symptoms; afterwards, 139 (34.8%) indicated the same (p > 0.05). There was no statistically significant difference in the UL in the patients before and after the procedure, and the cervix length did not differ between patients after LSH and SH. When the entire investigated population was analyzed, a significant improvement of the QoL was found on the IIQ-7. Hysterectomy performed due to benign diseases has effects on UI regardless of the surgical technique used. The UI symptoms improved only in the patients after LSH. The UL measured 12 months after hysterectomy did not change.

Minimally invasive versus abdominal hysterectomy for endometrial carcinoma with glandular or stromal invasion of cervix

<h3>Objectives:</h3> To evaluate the feasibility of laparoscopic approach in endometrial cancer that extends to the cervix in the form of glandular extension and/or stromal invasion and compare with laparotomy. <h3>Methods:</h3> A retrospective, single-center cohort study was conducted using data between January 1, 2002 and December 31, 2017 at an urban tertiary academic medical center. We identified patients who were diagnosed with endometrial cancer FIGO stage I with endocervical glandular extension and FIGO stage II on final pathology. Operative and oncologic outcomes were compared between the patients who underwent minimally-invasive surgery (MIS) and those who underwent laparotomy. <h3>Results:</h3> Eighty-five patients with endometrial cancer were reviewed for the study. Among these patients, 25 patients underwent hysterectomy and surgical staging via MIS. There was no conversion from MIS to laparotomy. In the MIS group, shorter hospital stay (4.4 ± 2.3 days for MIS group vs. 7.1 ± 4.7 days for laparotomy group; <i>p</i>-value = 0.002) and less blood loss during the operations (200 mL vs. 400 mL, <i>p</i>-value < 0.001) were observed compared with the laparotomy group. In terms of pathological findings, there was no statistical difference in FIGO stage (IB and II), the rate of endometrioid histology, grade, tumor size, depth of myometrial invasion and lymph-vascular space invasion (LVSI) between the MIS and laparotomy groups. For the treatment, types of hysterectomy (Type 1 vs. 2 vs. 3) and the rate of adjuvant radiotherapy or chemotherapy were similar in both groups. In univariate analyses, no difference in disease-free and overall survival was observed between the two groups and these findings were reproduced in multivariate analysis. <h3>Conclusions:</h3> Among the women with endometrial cancer that involved the cervix without evidence of extrauterine disease, surgical treatment via MIS compared with laparotomy showed no difference in overall survival but better perioperative outcomes. These findings support the use of MIS for these patient group.

Do patients with FIGO stage II endometrioid endometrial carcinoma benefit from the addition of chemotherapy to adjuvant radiation therapy?

Objectives: Investigate the use and outcomes of adjuvant chemotherapy for patients with FIGO stage II endometrioid carcinoma of the uterus receiving adjuvant radiation therapy following hysterectomy. Methods: Patients without a history of another tumor diagnosed between 2010 and 2015 with pathological stage II endometrioid adenocarcinoma of the uterus with known tumor grade who underwent hysterectomy with at least 10 lymph nodes removed and received adjuvant radiation therapy with or without adjuvant chemotherapy and had at least one month of follow-up were identified in the National Cancer Database. Overall survival (OS) was compared with the log-rank test following generation of Kaplan-Meier curves. A Cox multivariate model was constructed to control for confounders. Results: A total of 1569 patients were identified; 50.1% received vaginal brachytherapy, 19.1% external beam radiation therapy and 30.8% combination of both. Chemoradiation was administered to 257 (16.4%) patients. Chemoradiation use for patients with grade 3 tumors was 38% compared to 10.2% and 9.5% for those with grade 2 and grade 1 tumors respectively, p<0.001. Patients who received chemoradiation were more likely to have lymph-vascular invasion (LVSI) (46.6% vs 28.9%, p<0.001), private insurance (56.4% vs 48.2%, p=0.03) and be treated in academic facilities (48.4% vs 41.8%, p=0.051). The two groups were comparable in terms of patient age, race, presence of comorbidities, type of radiotherapy administered, type of hysterectomy performed and tumor size, p>0.05. There was no difference in OS between patients who received chemoradiation or radiation alone p=0.60; 4-year OS rates were 85.3% and 87.4% respectively. Compared to radiation alone, chemoradiation was not associated with better OS for among patients with grade 3 tumors (p=0.88) or those with LVSI (p=0.57). After controlling for patient age, race, insurance, comorbidities, tumor size and presence of LVSI, chemoradiation was not associated with better survival compared to radiation alone (HR: 0.85, 95% CI 0.56, 1.30). Conclusions: The addition of chemotherapy to adjuvant radiation therapy was not associated with a survival benefit for patients with FIGO stage II endometrioid carcinoma. Investigate the use and outcomes of adjuvant chemotherapy for patients with FIGO stage II endometrioid carcinoma of the uterus receiving adjuvant radiation therapy following hysterectomy. Patients without a history of another tumor diagnosed between 2010 and 2015 with pathological stage II endometrioid adenocarcinoma of the uterus with known tumor grade who underwent hysterectomy with at least 10 lymph nodes removed and received adjuvant radiation therapy with or without adjuvant chemotherapy and had at least one month of follow-up were identified in the National Cancer Database. Overall survival (OS) was compared with the log-rank test following generation of Kaplan-Meier curves. A Cox multivariate model was constructed to control for confounders. A total of 1569 patients were identified; 50.1% received vaginal brachytherapy, 19.1% external beam radiation therapy and 30.8% combination of both. Chemoradiation was administered to 257 (16.4%) patients. Chemoradiation use for patients with grade 3 tumors was 38% compared to 10.2% and 9.5% for those with grade 2 and grade 1 tumors respectively, p<0.001. Patients who received chemoradiation were more likely to have lymph-vascular invasion (LVSI) (46.6% vs 28.9%, p<0.001), private insurance (56.4% vs 48.2%, p=0.03) and be treated in academic facilities (48.4% vs 41.8%, p=0.051). The two groups were comparable in terms of patient age, race, presence of comorbidities, type of radiotherapy administered, type of hysterectomy performed and tumor size, p>0.05. There was no difference in OS between patients who received chemoradiation or radiation alone p=0.60; 4-year OS rates were 85.3% and 87.4% respectively. Compared to radiation alone, chemoradiation was not associated with better OS for among patients with grade 3 tumors (p=0.88) or those with LVSI (p=0.57). After controlling for patient age, race, insurance, comorbidities, tumor size and presence of LVSI, chemoradiation was not associated with better survival compared to radiation alone (HR: 0.85, 95% CI 0.56, 1.30). The addition of chemotherapy to adjuvant radiation therapy was not associated with a survival benefit for patients with FIGO stage II endometrioid carcinoma.

Histopathological span of diseases in patients going through hysterectomies: an audit of 190 consecutive hysterectomy specimens in Multan

Introduction: Gynecological diseases affect women’s lives in numerous manners. They are frequent in all communities but the types of disorders and their presentations differ substantially in various regions and races. However, the studies and researches specifying these disorders in particular regions and communities are very low in number. Hysterectomy is one of the most frequently opted operations worldwide particularly in developing countries and hardly any studies are done about its epidemiology and prevalence in Multan region of Pakistan. Objective: The objective of this study is to assess the variety of histopathological diseases in patients undergoing hysterectomies in Multan region Design: Retrospective study including 190 hysterectomy specimens. Place and duration: Department of Histopathology Bakhtawar Amin Medical &amp; Dental College, Multan from January 2019 to December 2020. Methodology: Histopathology reports of all hysterectomy specimens removed due to gynecological disorders were included. All the relevant data like age, parity, clinical manifestations, indication and type of hysterectomy were recorded along with histopathological microscopic diagnosis of cervix, endometrium, myometrium, fallopian tubes and ovaries. The data was collected from medical track record, histopathological request form and histopathology report files. Results: A total of 190 hysterectomies were received in histopathology department. The mean age was 47.8 years (ranging from 25-75 years). Majority of the ladies were between age groups 41-50 years. The major presenting complaint was menstrual irregularity followed by abdominal pain. Out of 190 specimen, 170 (89.5%) of hysterectomies were done because of non neoplastic/ benign conditions. Chronic cervicitis, adenomyosis and leiomyomata were the most commonly noticed incidental findings. Conclusion: Hysterectomy is an extensively used therapeutic modality, largely for benign non neoplastic disorders to relieve the clinical symptoms and to enhance the living conditions. Presence of incidental diseases in majority of hysterectomy specimens indicates that for conclusive opinion, histopathological examination is must. Key words: Histopathology, hysterectomy, benign gynecological disorders, leiomyoma, adenomyosis

POST HYSTERECTOMY PHYSIOTHERAPEUTIC PROTOCOL FOR CORE MUSCLES AND PELVIC FLOOR MUSCULATURE STRENGTHENING IN CASE OF ADENOMYOSIS

Adenomyosis is an important gynecological condition. It is considered a benign uterine disorder that shows a pathological demonstration of the endometrial gland and stroma in the uterine myometrium. A 42 years old female patient presented with excessive bleeding during menses and irregular menstrual cycle with dysmenorrhea, for 7-8 months. The patient complains of pain for 7-8 months in the lower abdomen region, in the iliac fossa on both left and right side, and is insidious in onset. The patient went to a private hospital where she got diagnosed with adenomyosis and suggest removal of the uterus. The investigation was done which includes CBC, KFT, LFT, and USG abdomen and pelvis which reviled that patient is having Adenomyosis. Vaginal hysterectomy is the least invasive type of hysterectomy, which is having lesser costs and risks which can also be done in women having uterus weighing more than 280g. For managing postoperative complication of hysterectomy various physiotherapy intervention could be given which includes pelvic strengthening exercises, core strengthening, breathing exercises, and yoga poses. The study concluded that hysterectomy may result in post-surgical manifestations which can be effectively managed by early physiotherapy intervention which impacts on quality of life of the patient.

The significance of post-radiotherapy parametrial involvement and the necessity of parametrial resection in locally-recurrent or persistent cervical cancer developed after radiotherapy

ObjectiveTo retrospectively evaluated the prognostic significance of post-radiotherapy parametrial involvement (PMI), the necessity of parametrial resection, and the optimal salvage surgery in locally recurrent or persistent cervical cancer developed after radiotherapy. MethodsPatients who developed recurrent or persistent cervical cancer in a previously irradiated field and were subsequently treated with salvage surgery were identified, and the prognostic impact of post-radiotherapy PMI on patient's survival was first investigated. Then, the optimal salvage surgery for patients with post-radiotherapy PMI as well as the predictors for post-radiotherapy PMI were evaluated. ResultsA total of 60 patients underwent salvage surgery for recurrent or persistent diseases. Of these, 21 (35.0%) showed post-radiotherapy PMI (PMI-group). Patients in PMI-group showed significantly shorter progression-free survival (PFS) than those in non-PMI-group (p = 0.01). In both PMI-group and non-PMI-group, PFS was affected by the completeness of salvage surgery. In non-PMI-group, less radical surgery achieved similar therapeutic efficacy to more radical surgery (3-year PFS rates: 62.5% versus 54.1%, p = 0.91). In contrast, in PMI-group, not less radical surgery but more radical surgery achieved curative therapeutic efficacy (3-year PFS rate: 0% versus 28.9%). Maximum tumor diameter, deep stromal invasion, and LVSI were found to be predictors of post-radiotherapy PMI. ConclusionPost-radiotherapy PMI is an indicator of short survival after salvage surgery in patients with locally recurrent or persistent cervical cancer developed after radiotherapy. Both less radical and more radical surgery have curative therapeutic efficacies in patients without post-radiotherapy PMI, if the tumor could be resected with an adequate surgical margin. Thus, hysterectomy type should be tailored to the risk for post-radiotherapy PMI.

19 Perioperative outcomes of laparoscopic sacrocolpopexy with or without hysterectomy: A secondary analysis of the national surgical quality improvement program (NSQIP) database

Our objective was to compare 30-day postoperative complications in women undergoing minimally invasive sacrocolpopexy (MIS SCP) with and without a concomitant hysterectomy. Using the American College of Surgeons NSQIP database, we identified women undergoing MIS SCP between 2014 and 2018 using CPT codes. Women were then stratified into 2 groups: SCP only and SCP + Hyst. The primary outcome was the occurrence of any 30-day postoperative complication. Group comparisons were performed using Student’s t-test, Mann Whitney U test, and Chi-square test. Multivariable logistic regression was used to identify factors associated with the occurrence of any complication. A total of 8,553 women underwent MIS SCP, of which 5,123 (60%) had SCP + Hyst. When compared to the SCP only group, women in the SCP + Hyst group were younger (P < 0.001) and had fewer major medical comorbidities (P < 0.001) (Table1). Median operative time was longer in women who had SCP + Hyst compared to SCP alone (185 [129-241] versus 172 [130-224] minutes, P < 0.001). The rate of any 30-day postoperative complication was 5.9% and did not differ between groups (SCP 5.8% and SCP + Hyst 5.5%, P = 0.34). Likewise, organ space, deep, and superficial SSI did not differ between groups. The most common complication was urinary tract infection (3.4%). There was no difference in reoperation rates (SCP:1.7% vs SCP + Hyst: 1.4%, P = 0.35) or readmission rates (SCP: 2.9% vs SCP + Hyst 2.4%, P = 0.19) between groups. On multivariable logistic regression controlling for the covariates listed in Table 2, SCP + Hyst was not associated with increased odds of 30-day postoperative complications relative to women who underwent SCP alone. Similarly, type of laparoscopic hysterectomy (supracervical or total) did not impact the odds of postoperative complications. As urinary tract infection (UTI) was the most common complication, we performed a secondary analysis examining non-UTI complications. Similarly, on multivariable logistic regression, hysterectomy did not increase the odds of non-UTI complications. Complications rates in the first 30-day after minimally invasive SCP are low and concomitant hysterectomy does not seem to increase risk of early complications including SSI.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Evaluating the efficacy and safety of ureteral stent placement as a preoperative procedure for gynecological cancer surgeries: A retrospective cohort study.

To evaluate the efficacy and safety of ureteral stent placement (USP) as a preoperative procedure for gynecological cancer surgeries. This was a single-institution retrospective cohort study of 259 patients with gynecological cancer who underwent laparotomy. In 126 patients (USP+ group), a ureteral stent was inserted into the bilateral ureters after the induction of general anesthesia. The remaining 133 patients (USP- group) did not undergo USP. We compared operation time, blood loss, and frequency of laparotomy-related perioperative urinary complications between the groups. The stent was removed 5-7 days postoperatively. Patients were evaluated for signs of hydronephrosis at discharge. The Fisher's exact test was used to investigate the significance of differences in patient characteristics, and multivariate analysis was performed using a Cox proportional hazards model. A p-value of <0.05 was considered statistically significant. There were no significant differences in age and body mass index between the groups. Two patients in the USP- group experienced intraoperative ureteral injury. Total operation time and blood loss were significantly increased in the USP+ group. The risk of bladder tamponade and postoperative hydronephrosis was influenced by USP. USP was unaffected by a history of abdominal surgery, stage of tumor progression, lymphadenectomy type, or hysterectomy type. The incidence of bladder tamponade and hydronephrosis postoperatively was significantly higher in patients with USP than in those without USP.

Major Vascular Injury During Gynecologic Surgery

Vascular injury is a rare but potentially fatal complication of gynecologic surgery. Reported risk factors for vascular injury during abdominal surgery include obesity, adhesions, vascular aberrations, and surgery at low-volume surgical centers. Oncologic procedures pose inherent additional risk of injury related to operating in proximity to major vascular structures or tumor involving the pelvic sidewall. Here we review major vascular injuries that may occur during hysterectomy and other types of gynecologic surgeries, with a focus on risk factors, prevention, recognition, and intraoperative management. All pelvic vasculature is at risk. Efforts to prevent injury include gentle and directional opening of avascular planes, cautious dissection of tumor and adherent lymph nodes from vascular structures, prophylactic ligation when indicated, and careful placement of initial and subsequent laparoscopic trocars. Recognition and control of injury must be immediate. Venous injuries manifest as nonpulsatile but potentially torrential hemorrhage, whereas an arterial injury typically presents with pulsatile bleeding from an obvious source. Repair of a major vascular injury is accomplished with pressure with or without hemostatic agents, suturing, clipping, or cautery depending on the clinical situation. (J GYNECOL SURG 37:200)

Evisceration after vaginal cuff dehiscence: A case report and review

Introduction: Intestinal loop Evisceration (VE) complicates the 35- 67% Of Vaginal Cuff Dehiscence (VCD), constituting a medical emergency. In most cases, it is associated with genital prolapse in postmenopausal women with previous hysterectomy. Clinical case: 94-year-old patient with VE after VCD, associated with prolonged use of pessary as a treatment for vaginal cuff prolapse and enterocele, after laparotomic hysterectomy. Results: Vaginal repair was performed abdominally, due to the size and condition of the eviscerated loops, requiring intestinal resection. An omentum flap was attached to the vaginal cuff to improve healing and to try to occlude the Douglas space. Conclusions: VE requires vaginal, abdominal or mixed repair, generally deferring the definitive treatment of the prolapse to a second stage. We recommend being very careful with vaginal vault closure after any type of hysterectomy, avoiding electrosurgery, infection and bleeding, performing the colporrhaphy with bidirectional barbed suture or two layers with braided suture and facing enough tissue at the suture. Keywords: Vaginal evisceration; Vaginal cuff dehiscence; Complications after hysterectomy; Long-standing pessary.

Tailoring parametrectomy for early cervical cancer (Stage IA-IIA FIGO): a review on surgical, oncologic outcome and sexual function.

Cervical cancer is currently one of the most common cancers afflicting the female population worldwide and in industrialized countries the presence of screening and a specific diagnostic and therapeutic process has favored early diagnosis of cervical cancer. In literature have found that reducing the radicality on the parametria in early cervical cancer (ECC), reduces complications without impacting oncological outcomes, but the data in the literature are not yet clear. Searching on PubMed, we included 1473 articles from January 1974 to 2020. We identified all the studies that compared different type of radical hysterectomy in the primary surgical treatment of ECC. 16 articles were elected for the review. Modified radical hysterectomy (Piver II/Querleu-Morrow Type B) in ECC, if compared to CRH (Piver III/Querleu-Morrow Type C2), is not associated with worse cancer outcome and patient survival, but it is associated with a minor operating time, lower blood loss and minor bladder dysfunction. Nerve sparing radical hysterectomy approach (NSRH/Querleu-Morrow Type C1) compared to CRH (Piver III/Type C2) in the ECC, with our data we can confirm a non-inferiority regarding the oncological outcome. Reduced radicality on the parametrium offers positive effects on the quality of life (sexual life and bladder function) of patients without impacting on survival, oncological outcome.

Intestinal Loop Evisceration after Vaginal Cuff Dehiscence: A Case Report and Review

Background: Intestinal loop evisceration complicates 35-67% of vaginal cuff dehiscence, constituting a medical emergency. In most cases, it is associated with genital prolapse in postmenopausal women with previous hysterectomy. Complications associated with the use of a pessary are rare. They are usually due to loss of patient follow-up or negligent use of the device. Clinical presentation: We present the case of a 94-year-old patient who debuted with vaginal evisceration after vaginal cuff dehiscence, associated with prolonged use of pessary as a treatment for vaginal cuff prolapse and enterocele, after laparotomic hysterectomy. Vaginal repair was performed abdominally, due to the size and condition of the eviscerated loops, requiring intestinal resection. An omentum flap was attached to the vaginal cuff to improve healing and to try to occlude the Douglas space. Conclusions: EV requires vaginal, abdominal, or mixed repair, generally deferring definitive prolapse treatment to a second stage and we recommend being very careful with the closure of the vaginal vault after any type of hysterectomy

The role of perioperative ureteral stenting for urologic complications in radical surgery of cervical cancer.

This study aimed to establish the urologic complications of radical type C2 hysterectomy in cervical cancer patients with or without ureteral stenting. This prospective randomized study included 76 (100%) patients with clinically and pathologically established cervical cancer stages I and II treated with radical type C2 hysterectomy with pelvic lymph node dissection for the last 5 years (2014-2019). Patients were randomized into two groups (2:1 ratio): group II received perioperative ureteral stenting (n = 24, 31.6%) and group I did not (n = 52, 68.4%). Urologic complications observed during follow-up include intraoperative ureter and urinary bladder lesions and postoperative ureterovaginal and vesicovaginal fistulas. Of the 52 patients in group I who underwent surgery for cervical cancer, urologic complications were observed in 8 (10.5%) patients, 2 (2.6%) of whom underwent preoperative radiation therapy. In group II, urologic complications were observed in 2 (2.6%) patients, of which 1 (1.3%) received preoperative radiation therapy. Intraoperative urologic complications in group I (6.6%) included 3 (3.9%) ureteral lesions cases and 2 (2.6%) cases of urinary bladder lesions, wherein 1 patient received preoperative radiation therapy. One case of (1.3%) urinary bladder lesion was observed in group II. Postoperative complications were observed in 3 patients (3.9%) in group I, including 2 (2.6%) ureterovaginal fistula cases, wherein 1 (1.3%) patient received preoperative radiation therapy, and 1 (1.3%) case of vesicovaginal fistula. In group II, 1 (1.3%) patient who received perioperative radiotherapy developed postoperative vesicovaginal fistula. Urologic complications are extremely common during and after radical surgery (hysterectomy type C2) for cervical cancer. The cervical cancer stage had a significant effect on intra- and postoperative urologic complication rates in this study; however, no such effect was observed for preoperative radiation therapy and ureteral stenting, and significant differences were observed between the two study groups.

Vaginal Hysterectomy Rates Before and After Implementation of a Multiple-Tier Intervention.

To assess a multiple-tier intervention to increase vaginal hysterectomy rates. We performed a cohort study assessing hysterectomy performance before and after implementation of a multiple-tier intervention to increase vaginal hysterectomy rates at a single tertiary care medical center. This intervention involved resident and attending education and simulation, professional development, design of a clinical pathway to assist in hysterectomy decision making, and development of a surgical mentorship program. Data from 698 hysterectomies (253 preintervention and 445 postintervention) were included. The preintervention time period extended from January 1, 2016, to December 31, 2017 (24 months), and the postintervention period from January 1, 2018, to February 28, 2020 (26 months). The intervention was implemented over the month of December 2017 but was not complete until January 1, 2018. The preintervention and postintervention cohorts were similar in most demographic and clinical aspects. Postintervention, the proportion of vaginal hysterectomies was higher (26.5% vs 5.5%, odds ratio 6.2, 95% CI 3.52-11.35), including in those performed for reasons other than prolapse (6.8% vs 0%, P<.001). Logistic regression revealed that prolapse, uterine weight less than 250 g, and surgery during the postintervention cohort were significantly associated with vaginal hysterectomy. Operative complications did not differ significantly by hysterectomy type. Implementation of a multiple-tier intervention was associated with an increase in vaginal hysterectomies.

Adnexal surgery at the time of hysterectomy in women 65 years and older undergoing hysterectomy for prolapse: do practice trends differ by route of surgery?

The objective was to determine whether the rate of adnexal surgery varies by route of hysterectomy in women over the age of 65 undergoing hysterectomy for prolapse. We hypothesized that women undergoing vaginal hysterectomy would be less likely to undergo bilateral salpingo-oophorectomy (BSO) at the time of their hysterectomy for prolapse. This was a cross-sectional analysis using the National Inpatient Sample (NIS) database. Our primary outcome was concomitant adnexal surgery performed at the time of hysterectomy, classified into five groups: BSO, unilateral salpingo-oophorectomy (USO), bilateral salpingectomy (BS), other adnexal surgery, and no adnexal surgery. The study sample included women aged 65 years and older who underwent hysterectomy between 1 January 2009 and 31 December 2014 and with a diagnosis of genital prolapse. Of the 91,292 patients over the age of 65 who underwent a hysterectomy for prolapse, the majority of hysterectomies were vaginal (69%), followed by abdominal (13%), laparoscopic (11%), and robotic (7%). The number of women having a hysterectomy and undergoing a BSO was much lower for vaginal than for other hysterectomy types; 20.3% of women undergoing vaginal hysterectomies had a BSO, compared with 79.2% in abdominal, 81.8% in laparoscopic, and 73.8% in robotic-assisted procedures. Women who received vaginal hysterectomies were five times as likely (RR: 5.02, 95% CI: 4.70-5.35) to have no concomitant adnexal procedure compared with other routes of hysterectomy. Women over the age of 65 undergoing hysterectomy for prolapse are significantly less likely to have adnexal surgery if undergoing hysterectomy via vaginal route compared with the other routes.