Vaginal Hysterectomy For Benign Conditions Research Articles

Association Between Experimental Pain Thresholds and Trajectories of Postoperative Recovery Measures After Benign Hysterectomy.

Quantitative sensory testing (QST) can be applied to quantify the sensitivity to different painful stimuli. This study aims to evaluate the association between preoperative pressure and thermal pain thresholds and trajectories of measurements of postoperative recovery (patient-reported daily maximum and average pain intensity, sum score of symptoms, and analgesic consumption) after benign hysterectomy. A prospective, longitudinal single-blinded, observational multicenter study was conducted in five hospitals in the southeast of Sweden between 2011 and 2017. A total of 406 women scheduled for abdominal or vaginal hysterectomy for benign conditions were enrolled in the study. QST measuring pressure (PPT), heat (HPT), and cold pain thresholds (CPT) were performed preoperatively. The cut-off levels for dichotomizing the pain thresholds (low/high) were set at the 25-percentile for PPT and HPT and the 75-percentile for CPT. The Swedish Postoperative Symptom Questionnaire was used to measure postoperative pain and other symptoms of discomfort (symptom sum score) on 13 occasions for six weeks postoperatively. Daily analgesic consumption of opioids and non-opioids was registered. A CPT above the 75-percentile was associated with high postoperative maximum pain intensity (p = 0.04), high symptom sum score (p = 0.03) and greater consumption of non-opioids (p = 0.03). A HPT below the 25-percentile was only associated with greater consumption of non-opioids (p = 0.02). PPT was not associated with any of the outcome measures. CPT seemed to be predictive for postoperative pain and symptoms of discomfort after benign hysterectomy. Preoperative QST may be used to individualize the management of postoperative recovery for low pain threshold individuals.

Feasibility of Prophylactic Bilateral Salphingectomy during Vaginal Hysterectomy- A Prospective Longitudinal Cohort Study

Introduction: Fallopian tubes are not commonly removed during vaginal hysterectomy because of inadequate surgical training or fear of increased morbidity. Aim: The primary objective of this study was to estimate the proportion of planned bilateral salpingectomies successfully completed vaginally. Materials and Methods: This was a prospective, interventional longitudinal cohort study conducted in the Department of Obstetrics and Gynaecology at ESI, PGIMSR, Basaidarapur, New Delhi. From December 2018 to November 2019, all women undergoing vaginal hysterectomy for benign conditions were offered prophylactic salpingectomy. Operative time, blood loss and reason for non completion for salpingectomy were recorded. Patients were followed-up for six weeks. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) 17.0. Continuous variables were described with mean and the categorical variables were described with frequencies and percentages. Results: Thirty-five patients were enrolled in the study. The most common indications for vaginal hysterectomy for benign conditions included uterovaginal prolapse in 21 (60%) patients and adenomyosis and fibroids in 10 (30%) and 4 (10%) patients respectively. Of the 35 patients, vaginal salpingectomy was successful in 31 (88.5%) patients. Factors which led to non completion of salpingectomy were pelvic adhesions and atrophic ovaries in 2 (5.7%) patients each. Mean operating time for bilateral vaginal salpingectomy was 14.05±2.75 minutes. Mean Estimated Blood Loss (EBL) for bilateral salpingectomy was 19.86±6.88 mL. Conclusion: Bilateral prophylactic salpingectomy with vaginal hysterectomy for benign conditions is feasible in most of the patients. Routine salpingectomy should be offered to women undergoing vaginal hysterectomy for benign conditions to prevent risk of ovarian carcinoma in future.

Feasibility of early discharge following vaginal hysterectomy with a bipolar electrocoagulation device

To evaluate the safety and efficacy of vaginal hysterectomy for benign conditions (excluding prolapse) using the BiClamp (Erbe Elektromedizin, Tübingen, Germany) bipolar electrocoagulation system. The present study was a prospective audit of a consecutive case series of patients who underwent vaginal hysterectomy for benign conditions, performed using the BiClamp between March 1, 2015, and June 30, 2016, at Norfolk and Norwich University Hospital, Norwich, UK. Surgeries performed for benign conditions were eligible, excluding prolapse; severe endometriosis with pelvic adhesions was an exclusion criterion. Patient demographics and past history were recorded, along with intraoperative findings and adverse events. Follow-up data were obtained via telephone interviews 24hours after surgery and a nurse-led postoperative clinic 8weeks postoperatively. The series included 75 patients; 32 (43%) were discharged on the same day as surgery and 70 (93%) within 23hours. There were two patients who experienced vault hematomas and remained admitted for more than 24hours. There was one intraoperative bladder injury that was repaired vaginally. No delayed adverse events occurred within 8weeks. No patient required patient-controlled analgesia or an epidural injection for postoperative analgesia. Patients experienced low postoperative pain following BiClamp treatment and 93% were was discharged within 23hours.

Safety and Efficacy of Advanced Bipolar Vessel Sealing in Vaginal Hysterectomy: 1000 Cases

Study ObjectiveTo determine the safety and efficacy of advanced electrothermal bipolar vessel sealing (EBVS) during vaginal hysterectomy by evaluating urinary complications, overall complications, and reoperation rate. DesignA retrospective cohort (Canadian Task Force classification III). SettingHigh-volume gynecologic surgeon practice, private hospital. PatientsOne thousand consecutive patients who have undergone vaginal hysterectomy for benign conditions carried out with EBVS between January 2002 and December 2012. InterventionsVaginal hysterectomy performed using an EBVS device. Measurements and Main ResultsOne thousand consecutive patients underwent vaginal hysterectomy with advanced EBVS between January 2002 and December 2012 with an average age of 51.4 ± 8.9 years (range, 31–88) and mean weight and body mass index of 57.4 ± 7.2 kg (range, 42–105) and 25.8 ± 4.2 kg/m2 (range, 19.1–38.9), respectively. Eighty-five percent of patients (852/1000) were healthy without any severe systemic disease. A single experienced surgeon performed all vaginal hysterectomies with EBVS, specifically by not applying traction during thermofusion to avoid hemorrhage, amputating the cervix to transform the uterus to an apple shape to facilitate a vaginal approach and rotation of the uterus, and placing bi-clamp forceps on the edge of the uterus and not at a 45- or 90-degree angle. Wound closure was completed with a continuous suture. Eleven urinary complications (1.1%) were recorded (10 bladder mechanical injuries and 1 vesicovaginal fistula). This was not statistically different from the rate of .64% previously reported in the FINHYST study (p = .15). The overall rate of complications was 5.3%, and 20 patients (2.0%) required reoperation. The presence of uterine scar tissue (odds ratio, 5.5; 95% confidence interval, 1.6–19.2) and larger uterus size (odds ratio, 2.5; 95% confidence interval, 1.01–19.2) were associated with a higher risk of urinary complications. ConclusionThe use of EBVS during vaginal hysterectomy results in urinary and overall complication rates of 1.1% and 5.3%, respectively, statistically similar to previously reported series that did not use EBVS. The use of advanced EBVS is a safe and effective method of achieving hemostasis during vaginal hysterectomy.

Electrosurgical bipolar vessel sealing versus conventional clamping and suturing for vaginal hysterectomy: a randomised controlled trial

Please cite this paper as: Lakeman M, The S, Schellart R, Dietz V, ter Haar J, Thurkow A, Scholten P, Dijkgraaf M, Roovers J. Electrosurgical bipolar vessel sealing versus conventional clamping and suturing for vaginal hysterectomy: a randomised controlled trial. BJOG 2012;119:1473–1482. Objective To compare the effects of electrical bipolar vessel sealing and conventional suturing on postoperative pain, recovery, costs and micturition symptoms in women undergoing vaginal hysterectomy. Design Randomised controlled trial. Setting Eight teaching hospitals in the Netherlands. Population One hundred women scheduled to undergo vaginal hysterectomy for benign conditions excluding pelvic organ prolapse. Methods Women were randomised to vessel sealing or conventional surgery. The quality of life related to pelvic floor function was assessed using validated questionnaires before surgery and 6 months after surgery. Pain scores and recovery were assessed using a diary, including daily visual analogue scale scores, starting from the day before surgery until 6 weeks after surgery. Main outcome measures Visual analogue scale pain scores, surgery time, blood loss, complications, quality of life related to pelvic floor function and costs. Results The evening after surgery, women in the vessel-sealing group reported significantly less pain (5.7 versus 4.5 on a scale of 0–10, P = 0.03), but after that pain scores were similar. Operation duration was shorter for vessel sealing (60 versus 71 minutes, P = 0.05). Blood loss and hospital stay did not differ. We observed no major difference in costs between the two interventions (2903 versus 3102 €, P = 0.26). Changes in micturition and defecation symptoms were not affected by the surgical technique used. Conclusion Using vessel sealing during vaginal hysterectomy resulted in less pain on the first postoperative day, shorter operating time, similar morbidity and similar pelvic floor function. No major differences in costs were found between the two interventions.

Electrosurgical bipolar vessel sealing versus conventional clamping and suturing for vaginal hysterectomy: a randomised controlled trial

Please cite this paper as: Lakeman M, The S, Schellart R, Dietz V, ter Haar J, Thurkow A, Scholten P, Dijkgraaf M, Roovers J. Electrosurgical bipolar vessel sealing versus conventional clamping and suturing for vaginal hysterectomy: a randomised controlled trial. BJOG 2012;119:1473–1482.Objective To compare the effects of electrical bipolar vessel sealing and conventional suturing on postoperative pain, recovery, costs and micturition symptoms in women undergoing vaginal hysterectomy.Design Randomised controlled trial.Setting Eight teaching hospitals in the Netherlands.Population One hundred women scheduled to undergo vaginal hysterectomy for benign conditions excluding pelvic organ prolapse.Methods Women were randomised to vessel sealing or conventional surgery. The quality of life related to pelvic floor function was assessed using validated questionnaires before surgery and 6 months after surgery. Pain scores and recovery were assessed using a diary, including daily visual analogue scale scores, starting from the day before surgery until 6 weeks after surgery.Main outcome measures Visual analogue scale pain scores, surgery time, blood loss, complications, quality of life related to pelvic floor function and costs.Results The evening after surgery, women in the vessel‐sealing group reported significantly less pain (5.7 versus 4.5 on a scale of 0–10, P = 0.03), but after that pain scores were similar. Operation duration was shorter for vessel sealing (60 versus 71 minutes, P = 0.05). Blood loss and hospital stay did not differ. We observed no major difference in costs between the two interventions (2903 versus 3102 €, P = 0.26). Changes in micturition and defecation symptoms were not affected by the surgical technique used.Conclusion Using vessel sealing during vaginal hysterectomy resulted in less pain on the first postoperative day, shorter operating time, similar morbidity and similar pelvic floor function. No major differences in costs were found between the two interventions.

The effects of vault drainage on postoperative morbidity after vaginal hysterectomy for benign gynaecological disease: a randomised controlled trial

To evaluate the efficacy of vault drainage in reducing the immediate postoperative morbidity associated with vaginal hysterectomy carried out for benign gynaecological conditions. Randomised controlled trial. A tertiary referral gynaecology centre in UK. A total of 272 women who underwent vaginal hysterectomy for benign conditions between March 2005 and June 2010. The 272 women were randomised to have a drain inserted or not inserted, 'drain' or 'no drain', respectively, before vault closure during vaginal hysterectomy, using a sealed envelope technique. The surgical procedures were performed using the surgeons' standard technique and postoperative care was delivered according to the unit's protocol. The primary outcome measure was reduction in postoperative febrile morbidity. Secondary outcome measures were hospital readmission rate, blood transfusion, change in postoperative haemoglobin and length of stay. In all, 135 women were randomised to have a drain and 137 to 'no drain'. There were no differences in the incidence of febrile morbidity, length of stay, change in haemoglobin or need for postoperative blood transfusion between the two groups. The routine use of vault drain at vaginal hysterectomy for benign disorders has no significant effect on postoperative morbidity. The use of vault drain in this context is not recommended.

LigaSure versus Conventional Suture Ligature for Vaginal Hysterectomy: a Randomized Controlled Trial

Introduction: Vaginal hysterectomy is considered to be the method of choice for removal of the uterus. Of particular concern for the vaginal surgeon is the ability to access, visualize, and legate structures while maintaining adequate hemostasis. Surgical hemostasis can be secured by a variety of methods, including mechanical means (sutures) or vessel coagulation (diathermy). Electro-surgical vessel sealing (LigaSure) is a new hemostatic system based on the combination of pressure and bipolar electrical energy and is able to seal vessels up to 7 mm in diameter. Objective: To assess the safety and efficacy of using the LigaSure vessel sealing system for securing the pedicles during vaginal hysterectomy in comparison with the conventional method of securing the pedicles by suture ligation. Design: Prospective randomized controlled trial. Setting: Obstetrics and Gynecology departments (Al-Kharj University Hospital- KSA, Enjab Hospital - UAE and Gulf Medical College and Research Centre- UAE). Methods: 80 patients undergoing vaginal hysterectomy for benign conditions were randomized to either LigaSure group (n=40) or Suture group (n=40). Main outcome measures: The primary outcome measures were the operative time and blood loss while the secondary outcome measures were the hospital stay and intra- and post-operative complications. Results: Patients in the LigaSure group had a significantly reduced operating time (37.1 ± 8.9 min vs. 63.8 ± 10.9 min; P < 0.001), operative blood loss (125.5 ± 33.2 mL vs. 264.6 ± 70.4 mL; P < 0.001), requirement of surgical sutures(1.2 ± 0.4 units vs. 8.2 ± 0.4 units; p < 0.001), pain status (2.0 ± 0.6 vs. 3.7 ± 0.7; P < 0.001), and hospital stay (30.3 ± 2.5 h vs. 45.7 ±10.5 h; P < 0.001) compared to the control group. The overall complication rate in the study was 10 % (8/80), and did not differ between patients of the LigaSure and control group. Conclusion: The use of LigaSure device can reduce operative time. It allows faster, safe and effective hemostasis compared with the conventional suture ligature. It also reduces the operative blood loss, pain status and hospital stays.

LigaSure versus Conventional Suture Ligature for Vaginal Hysterectomy: a Randomized Controlled Trial

Introduction: Vaginal hysterectomy is considered to be the method of choice for removal of the uterus. Of particular concern for the vaginal surgeon is the ability to access, visualize, and legate structures while maintaining adequate hemostasis. Surgical hemostasis can be secured by a variety of methods, including mechanical means (sutures) or vessel coagulation (diathermy). Electro-surgical vessel sealing (LigaSure) is a new hemostatic system based on the combination of pressure and bipolar electrical energy and is able to seal vessels up to 7 mm in diameter. Objective: To assess the safety and efficacy of using the LigaSure vessel sealing system for securing the pedicles during vaginal hysterectomy in comparison with the conventional method of securing the pedicles by suture ligation. Design: Prospective randomized controlled trial. Setting: Obstetrics and Gynecology departments (Al-Kharj University Hospital- KSA, Enjab Hospital - UAE and Gulf Medical College and Research Centre- UAE). Methods: 80 patients undergoing vaginal hysterectomy for benign conditions were randomized to either LigaSure group (n=40) or Suture group (n=40). Main outcome measures: The primary outcome measures were the operative time and blood loss while the secondary outcome measures were the hospital stay and intra- and post-operative complications. Results: Patients in the LigaSure group had a significantly reduced operating time (37.1 ± 8.9 min vs. 63.8 ± 10.9 min; P < 0.001), operative blood loss (125.5 ± 33.2 mL vs. 264.6 ± 70.4 mL; P < 0.001), requirement of surgical sutures(1.2 ± 0.4 units vs. 8.2 ± 0.4 units; p < 0.001), pain status (2.0 ± 0.6 vs. 3.7 ± 0.7; P < 0.001), and hospital stay (30.3 ± 2.5 h vs. 45.7 ±10.5 h; P < 0.001) compared to the control group. The overall complication rate in the study was 10 % (8/80), and did not differ between patients of the LigaSure and control group. Conclusion: The use of LigaSure device can reduce operative time. It allows faster, safe and effective hemostasis compared with the conventional suture ligature. It also reduces the operative blood loss, pain status and hospital stays.

Predicting the development of stress urinary incontinence 3 years after hysterectomy

Introduction and hypothesisWe aimed to develop a prediction rule to predict the individual risk to develop stress urinary incontinence (SUI) after hysterectomy.MethodsProspective observational study with 3-year follow-up among women who underwent abdominal or vaginal hysterectomy for benign conditions, excluding vaginal prolapse, and who did not report SUI before surgery (n = 183). The presence of SUI was assessed using a validated questionnaire.ResultsSignificant prognostic factors for de novo SUI were BMI (OR 1.1 per kg/m2, 95% CI 1.0–1.2), younger age at time of hysterectomy (OR 0.9 per year, 95% CI 0.8–1.0) and vaginal hysterectomy (OR 2.3, 95% CI 1.0–5.2). Using these variables, we developed the following rule to predict the risk of developing SUI: 32 + BMI − age + (7.5 × route of surgery).ConclusionsWe defined a prediction rule that can be used to counsel patients about their individual risk on developing SUI following hysterectomy.

Effectiveness of vaginal hysterectomy for benign conditions in semi-urban hospital: report from Maroua-Cameroon

We assessed the effectiveness of vaginal hysterectomy for benign uterine conditions in Northern Cameroon. This is a case series study of 29 elective vaginal hysterectomies carried out between February 2005 and June 2007 in Maroua, Cameroon. Hysterocele was found as the only or associated indication in 17 (58.6%) patients, symptomatic uterine fibroids in 4 (13.8%) and other indications in 8 (27.6%) patients. The mean duration of the operation was 132 minutes and the mean blood loss at surgery was 150 ml. Twenty-five of the 28 (89.3%) women had less than seven days of hospitalisation. There was a negative correlation (r = -0.45, P = 0.015) between duration of the surgery and the order of operation. One urinary tract and one wound infection were observed. Two patients had conversion to laparotomy. This study has shown that vaginal hysterectomy is a safe and feasible method of hysterectomy in a semi-urban hospital.

Efficacy of using electrosurgical bipolar vessel sealing during vaginal hysterectomy in patients with different degrees of operative difficulty: A randomised controlled trial

Objective To assess the efficacy of electrosurgical bipolar vessel sealing using the LigaSure ® system during vaginal hysterectomy in comparison with conventional suture ligation method. Study design 103 patients undergoing vaginal hysterectomy for benign conditions were randomised to either LigaSure ® or Suture groups. Each group was divided into two subgroups according to the degree of surgical difficulty. Results Participants in the LigaSure ® had shorter procedure time (52.5 min vs. 90 min; p < 0.001) and less blood loss (230 ml vs. 360 ml; p < 0.001). Complication rates were not statistically different between the two groups. The advantage of the LigaSure ® system in reducing the operative blood loss was more pronounced in the more difficult procedures. Conclusion The LigaSure ® system reduces the operating time (by reducing pedicle-securing time) and blood loss without increasing the post-operative complication rates of vaginal hysterectomy. This beneficial effect was found to be more pronounced in difficult procedures.

Evaluation of closure versus non-closure of vaginal vault after vaginal hysterectomy

SummaryThis randomised prospective study in 53 women having vaginal hysterectomy for benign conditions compared a closed vault technique with an open technique. Twenty-seven had the vault closed (group A) whereas 26 patients had an open vault (group B). The primary outcomes include, vault haematoma (as detected by ultrasound on day 3) and fever. Secondary outcomes are haemorrhage, urinary tract infection, urinary retention and vault granulation tissue. The study did not show any statistical difference between either group. Prolapse of the fallopian tube was recorded in one case in the open vault group. A randomised controlled study on a larger scale is recommended.

Operative injuries during vaginal hysterectomy

Objective: To evaluate incidence, characteristics and consequences of urinary and intestinal tract injuries during vaginal hysterectomy for benign conditions. Study Design: From January 1970 to December 1996, 3076 vaginal hysterectomies with or without additional procedures, were performed for benign conditions in our department. We retrospectively analyzed operative injury cases. Results: Incidence of urinary and intestinal tract injuries were 1.7 and 0.5%, respectively. Concerning urinary tract injuries, we observed only one ureteral lesion, all others being bladder lacerations (54 cases). The bladder lacerations occured during the hysterectomy step of the surgery in 61% of cases and during the additional procedures in 39%. All bladder injuries were recognized and treated during the primary operation. We observed four cases of vesico-vaginal fistula as a consequence of these injuries; all fistulas occured after bladder laceration during the hysterectomy step of the surgical procedure. Intestinal tract injuries (16 cases) were rectal lacerations occuring during the hysterectomy step of the surgery (31% of cases) and during the additional procedures (69%). All rectal injuries were recognized and repaired during the primary operation and all healed without sequellae. Conclusion: Operative injuries during vaginal hysterectomy are relatively rare. They are easily recognized and treated during the primary operation without important sequellae.

PREVENTION OF THROMBOSIS AFTER PELVIC SURGERY BY BRITISH DEXTRAN 70

Abstract The prophylactic effect of dextran 70 ('Lomodex 70') against postoperative leg-vein thrombosis was investigated by a double-blind controlled clinical trial. Dextran 70 administered during and immediately after operation over a six- hour period, which started at the initiation of anaesthesia, produced a highly significant reduction in the frequency of thrombosis after abdominal and vaginal hysterectomy for benign conditions. Thrombosis was diagnosed by both the 125 I-fibrinogen-screening test and phlebography. Of 75 control patients undergoing abdominal hysterectomy 11 developed postoperative thrombosis (15%), and in 63 patients treate with dextran 70 no thrombosis occurred. Of 65 control patients undergoing vaginal hysterectomy postoperative thrombosis occurred in 4 (6%); while of 57 patients treated with dextran 70, 1 had thrombosis. Of the 16 patients who had postoperative thrombosis 5 had no known predisposing factors. No evidence of increased bleeding at operation was found. Results indicate that dextran 70 administered during and immediately after hysterectomy for benign conditions is more effective and safe than oral anticoagulants in preventing postoperative deep-vein thrombosis.

PREVENTION OF THROMBOSIS AFTER PELVIC SURGERY BY BRITISH DEXTRAN 70

The prophylactic effect of dextran 70 ('Lomodex 70') against postoperative leg-vein thrombosis was investigated by a double-blind controlled clinical trial. Dextran 70 administered during and immediately after operation over a six- hour period, which started at the initiation of anæsthesia, produced a highly significant reduction in the frequency of thrombosis after abdominal and vaginal hysterectomy for benign conditions. Thrombosis was diagnosed by both the 125I-fibrinogen-screening test and phlebography. Of 75 control patients undergoing abdominal hysterectomy 11 developed postoperative thrombosis (15%), and in 63 patients treate with dextran 70 no thrombosis occurred. Of 65 control patients undergoing vaginal hysterectomy postoperative thrombosis occurred in 4 (6%); while of 57 patients treated with dextran 70, 1 had thrombosis. Of the 16 patients who had postoperative thrombosis 5 had no known predisposing factors. No evidence of increased bleeding at operation was found. Results indicate that dextran 70 administered during and immediately after hysterectomy for benign conditions is more effective and safe than oral anticoagulants in preventing postoperative deep-vein thrombosis.

Vaginal hysterectomy for benign conditions (500 cases): Flämrich: p. 537

Vaginal hysterectomy for benign conditions (500 cases): Flämrich: p. 537