Laparoscopic Radical Hysterectomy versus Abdominal Radical Hysterectomy: A Non-randomized Study

This study compared results obtained with laparoscopic radical hysterectomy (LRH) versus abdominal radical hysterectomy (ARH) to determine the applicability of LRH as an alternative for treatment of early stage cervical cancer. A class III LRH technique is described. Between January 1994 and November 1996, 49 radical hysterectomies were performed at Notre-Dame Hospital for Stage IA₂ and IB₁ cervical cancer. Three patients were excluded from the study because LRH was offered as an alternative only when the Quetelet Index (QI) was equal to or less than 33. Twenty-three patients were scheduled for LRH and 23 for ARH. Both groups were comparable for age, QI, stage, tumour diameter and histology. The mean operating time was 390 minutes for LRH and 240 minutes for ARH (p = 0.0001 ). Blood loss was less in the LRH group (475 cc versus 1,060 cc, p = 0.0001). One LRH patient required an immediate laparotomy to secure haemostasis. In the LRH group, one eventration occurred as well as two unusual neurological complications. The post-operative stay was shorter for LRH (p = 0.0265). The numbers of para-aortic and pelvic nodes obtained were comparable. There were three recurrences, one in the LRH group and two in the ARH group. The average follow-up was 49 months in both groups. With experience, the mean operating time, complication rate, need for analgesia and length of hospital stay decreased considerably with the LRH procedure. Cosmetic results were superior. This procedure remains time consuming and difficult to perform, limiting its applicability as an alternative to ARH for the treatment of early stage cervical cancer. Ongoing research is suggested.     

腹腔镜与开腹次全子宫切除术比较研究

目的:探讨腹腔镜次全子宫切除与开腹次全子宫切除的优缺点。方法:80例因子宫肌瘤等需次全子宫切除的患者,根据患者意愿,分为腹腔镜组和开腹组,每组40例,分析2种手术的手术时间、出血量、术后病率、肠功能恢复、平均住院天数等情况。结果:腹腔镜组平均手术时间为45.5±10.6min,明显短于开腹组(51.64±10.2min),P<0.05;腹腔镜组平均出血量为95.7±20.2ml,明显少于开腹组(123.3±27.7ml),P<0.01;腹腔镜组术后病率为7.5%(3/40),明显少于开腹组的25.0%(10/40);腹腔镜组术后平均排气时间为21.5±2.2h,明显少于开腹组(28.9±4.7h),P<0.05;腹腔镜组术后平均住院时间为4.2±1.5d,明显少于开腹组(6.6±0.5d),P<0.01。术后6个月随访时,除开腹组有2例伤口愈合不良外,其余无并发症。结论:腹腔镜次全子宫切除较开腹的优势更趋明显,如果腹腔镜操作技巧熟练,在腹腔镜下进行次全子宫切除是一种理想的术式。     

Transversus Abdominis Plane Block for Post Hysterectomy Pain: A Systematic Review and Meta-Analysis

The objective of this study was to address the efficacy of transversus abdominis plane (TAP) blocks in pain management among women who undergo elective hysterectomy for benign pathology in both open and minimally invasive surgeries. We performed a systematic review by searching for bibliographic citations from Medline, Embase, and Cochrane Library. MeSH headings for TAP blocks and hysterectomy were combined and restricted to the English language. We included randomized controlled trials comparing TAP blocks with placebo or no block in patients who underwent elective hysterectomy. Pain was measured using a visual analog scale (VAS) on a scale of 0 to 100. We calculated pooled mean differences in VAS and total morphine consumption at 2 and 24 hours by performing a random effects meta-analysis. Fourteen studies met the inclusion criteria, comprising 855 participants. At 2 hours mean VAS scores for patients who underwent TAP blocks were significantly lower after both total abdominal hysterectomy (TAH) (mean difference, ?14.97; 95% confidence interval [CI], ?20.35 to ?9.59) and total laparoscopic hysterectomy (TLH; mean difference, ?18.16; 95% CI, ?34.78 to ?1.53) compared with placebo or no block. Pain scores at 24 hours for patients who underwent TAP blocks were significantly lower after both TAH (?10.09; 95% CI, ?17.35 to ?2.83) and TLH (?9.12; 95% CI, ?18.12 to ?.13) compared with placebo or no block. Mean difference in morphine consumption was ?9.53?mg (95% CI, ?15.43 to ?3.63) for TAH and ?3.15?mg (95% CI, ?8.41 to 2.12) for TLH. In conclusion, TAP blocks provide significant postoperative early and delayed pain control compared with placebo or no block among women who undergo hysterectomy. There was reduced morphine consumption among patients who underwent TAH but not TLH. (Registration: International Prospective Register of Systematic Reviews ID: CRD42016036791.)     

全子宫切除术后远期女性性生活现状的调查研究

目的:了解全子宫切除术后远期女性性生活现状。方法:对因妇科良性疾病行全子宫切除术具有完整随访资料的68例患者进行随访调查,随访内容:妇科检查、性生活质量问卷调查,包括中国女性性生活质量问卷和女性性功能指数(FSFI)问卷。结果:全子宫切除术后7年,48例(70.6%)对目前性生活满意;36例(52.9%)能够与伴侣在性问题上进行有效的沟通交流;41例(60.3%)存在不同程度的性交痛及对性生活厌恶、焦虑、恐惧、担忧等负性情绪;45例(66.2%)性唤起满意,能够经常体验到性高潮;42例(61.8%)对自慰有正确的认识;38例(55.9%)对自己的形象满意。68例患者中国女性性生活质量问卷总分平均127.45±20.20分,FSFI问卷总分平均60.71±11.33分。中国女性性生活质量问卷总分、标准分总分、性满意度、性交流与调适、性反应以及性体像与患者收入呈正相关(r=0.432,P=0.007;r=0.338,P=0.038;r=0.356,P=0.028;r=0.475,P=0.003;r=0.421,P=0.009;r=0.324,P=0.047)。FSFI问卷总分、性欲、性唤起与患者年龄呈中度负相关(...     

Total Laparoscopic Hysterectomy for Endometriosis and an Arteriovenous Malformation

Study Objective

To show laparoscopic management of an arteriovenous malformation in a patient with deep pelvic endometriosis

不同子宫切除术式对女性排便功能的影响

目的探讨不同子宫切除术式对女性排便功能的影响.方法75例患者分为全子宫切除组(A组)60例,次全子宫切除组(B组)15例,对两组术后排便次数、排便难易程度的变化进行计数分析.结果75例子宫切除术后有52%的患者排便次数改变,A组术后排便次数减少发生率为53.33%,B组为20%,两者有显著性差异(P＜0.05).子宫切除术后有49.33%的患者排便难易程度改变,A组术后排便费力发生率为48.33%,B组为13.33%,两者有显著性差异(P＜0.05).结论子宫切除术后可影响女性排便功能,全子宫切除患者较次全子宫切除患者更明显.因此,次全子宫切除术是一种可选择的手术.     

Women's Sexual Behavior,Body Image and Satisfaction with Surgical Outcomes after Hysterectomy: A Comparison of Vaginal and Abdominal Surgery

The aim of this study was to investigate the impact of vaginal and abdominal hysterectomy on women's sexual behavior, sexual dysfunction, body image and satisfaction with surgery. A prospective study was conducted on 90 women to evaluate the outcomes of hysterectomy. Data were collected prior to surgery, three months and two years after surgery, using self-report questionnaires. The results showed significant differences in women's sexual behavior and sexual dysfunction before and after hysterectomy, independent of the surgical procedure performed. Women in both groups reported improvements in sexual desire, sexual activity and sexual intercourse three months and two years after surgery. Sexual dysfunction such as dyspareunia, vaginismus, lack of orgasm and loss of sexual interest diminished significantly after surgery. Regression analyses revealed that postmenopausal status, severity of gynecological complaints and frequency of sexual intercourse were the most important factors for improved sexual outcomes. Women in the abdominal group were dissatisfied with their body image because of the abdominal scar, experienced more pain and had a longer period of recovery from surgery compared to women in the vaginal group. According to the results, sexual behavior alone is not an important factor in choosing vaginal or abdominal hysterectomy. However, sexual behavior was important in both groups when evaluating outcomes after hysterectomy.     

Robotic Single-Incision Transumbilical Total Hysterectomy Using a Single-Site Robotic Platform: Initial Report and Technique

The benefits of laparoscopic surgery over open abdominal surgery have been well documented. Efforts continue for development of strategies that further reduce the size of abdominal incisions and the number of trocars used. Laparoendoscopic single-site surgery (LESS) is a promising approach that can further enhance cosmetic satisfaction and reduce the risks of laparoscopic surgery. Loss of triangulation, instrument crowding and clashing, poor visualization, and ergonomic problems are the most challenging issues associated with the use of LESS. The combination of LESS and the robotic system seems to be a promising choice to overcome the technical difficulties of LESS. The da Vinci Single-Site Surgical Platform is a novel semi-rigid robotic operating system. We present our initial clinical experience with robotic-assisted single-incision transumbilical total hysterectomy using the novel da Vinci Single-Site Surgical Platform.     

Single-Site Robotic Total Hysterectomy: Standardization of Technique and Surgical Outcomes

Study ObjectivesTo evaluate the safety and feasibility of robotic single-site total hysterectomy and to compare the outcomes of newly implemented robotic single-site bipolar and external vessel-sealing device.DesignRetrospective study (Canadian Task Force classification II-1).SettingUniversity hospital.PatientsTwenty-four patients with benign indications for hysterectomy.InterventionsAll patients underwent robotic-assisted single-incision transumbilical total hysterectomy using the novel da Vinci Single-Site Platform. Vaginal cuff closures were performed intracorporeally using the same technique in all cases.Measurements and Main ResultsThe median age of the patients was 49.5 years (range, 40–61), and body mass index was 28.5 (range, 21–34). Blood loss was 22.5 mL (range, 7–120 mL). Docking time was 5.5 minutes (range, 3-10 minutes), console time was 74.5 minutes (range, 60–160 minutes), vaginal cuff closure time was 25 minutes (range, 16–41 minutes), and total operative time was 98.5 minutes (range, 71–183 minutes). When 2 groups were created according to the energy devices used during the procedures, console time in the newly implemented bipolar group was shorter than in the external sealing device group (69.5 minutes vs 77 minutes; p = .03); however, no differences were found for uterus removal time (50.5 minutes vs 53.5 minutes; p = .13). Differences were observed in vaginal cuff closure time (18.5 minutes vs 23 minutes; p = .01).ConclusionRobotic single-site total hysterectomy using a newly implemented bipolar grasping instrument and even with intracorporeal cuff closure is a safe and feasible procedure in appropriately selected patients.     

腹腔镜下子宫悬吊术与阴式全子宫切除合并骶棘韧带悬吊术治疗盆腔器官脱垂的术后疗效比较

目的:探讨盆腔器官脱垂(POP)患者在接受腹腔镜下子宫悬吊术(LUS)或阴式全子宫切除术合并骶棘韧带悬吊术(TVH-SSLF)后的疗效。方法:共纳入符合条件接受手术的POP患者共86例,43例接受LUS术(LUS组),43例接受TVH-SSLF术(TVH-SSLF组);对比分析两组手术时间、术中出血量、住院时间、生活质量评分。采用PFIQ-7量表及PFDI-20量表进行评估调查。结果:所有患者手术顺利完成。LUS组患者失血量(47.44±29.12 ml)显著低于TVH-SSLF组(62.33±22.34 ml)(P<0.05);两组手术时间[75(65,90)分钟vs 75(65,80)分钟]、住院时间[6(6,7)天vs 6(5,7)天]差异无统计学意义(P>0.05)。PFDI-20术前与术后各分值比较差异有统计学意义(P<0.05)。两组PFDI-20问卷仅术后3个月的POPDI-6中LUS组得分均值(0.047±0.138分)显著高于TVH-SSLF组(0.004±0.025分)(P<0.05)。除此之外,两组术前、术后1个月、3个月、6个月的其他各分类项及总分比较,差异均无统计学意义(P>0.05)。PFIQ-7问卷除了第7个问题“挫折感”的肠道直肠症状TVH-SSLF组得分显著高于LUS组(0.090±0.294分vs 0.000±0.000分,P<0.05)外,其他各分类项以及总评分比较,差异均无统计学意义(P>0.05)。结论:LUS在术后恢复和症状改善上与TVH-SSLF无明显差异,对于有子宫保留意愿、无妇科恶性肿瘤的患者是一个安全、更优的选择。     

Total versus subtotal hysterectomy: an observational study with one-year follow-up

The aim of this study was to compare total and subtotal abdominal hysterectomy for benign indications, with regard to urinary incontinence, postoperative complications, quality of life (SF-36), constipation, prolapse, satisfaction with sexual life, and pelvic pain at 1-year postoperative. Eighty women chose total and 105 women chose subtotal abdominal hysterectomy. No significant differences were found between the 2 operation methods in any of the outcome measures at 12 months. Fourteen women (15%) from the subtotal abdominal hysterectomy group experienced vaginal bleeding and three women had their cervix removed.     

Hysterectomy for benign gynaecological disease

Despite the advent of newer, and in some instances less invasive, interventions for the management of abnormal uterine bleeding, hysterectomy remains the most commonly performed major gynaecological operation. It continues to score highest in satisfaction rates. It is therefore imperative that all aspects of this operation are reviewed on a regular basis. For example, all evidence suggests that the vaginal route is the safest, most cost-effective approach affording rapid recovery, yet the majority of hysterectomies are still performed by the abdominal route. Newer approaches such as robotic surgery have captured the imagination of the enthusiasts, yet this approach is hugely expensive, and there are no data justifying its use over the laparoscopic or indeed the conventional approach. Quality of life should remain the principal outcome measure for hysterectomy for benign disease, and therefore the impact of the various approaches to hysterectomy should address this outcome. Complications of any new approach should be addressed, and the question that continues to elude an answer, namely why there are such widely and wildly varying rates of hysterectomy between surgeons in one hospital, between hospitals in one region, between the regions and between countries, should continue to be addressed, and perhaps one day the definitive study that will answer the question will be undertaken.     

Comparison of the Use of LigaSure,HALO PKS Cutting Forceps,and ENSEAL Tissue Sealer in Total Laparoscopic Hysterectomy: A Randomized Trial

Study ObjectiveThere are many instruments with different energy modalities or with different properties that are available for use in total laparoscopic hysterectomy. The aim of the study was to compare the use of LigaSure (Valleylab, Boulder, CO), HALO PKS cutting forceps (Gyrus-ACMI, Maple Grove, MA), and ENSEAL tissue sealer (SurgRx, Inc. Redwood City, CA) in total laparoscopic hysterectomy with respect to operation time and blood loss as main outcomes. Perioperative complications, return of gastrointestinal activity, and hospitalization time were assessed as secondary outcomes.DesignRandomized prospective study (Canadian Task Force classification I).SettingAdana Numune Training and Research Hospital.PatientsForty-five patients with the indication of hysterectomy were randomized into 3 groups for total laparoscopic hysterectomy. Patients with malignancies, having 3 or more previous abdominal surgeries, a uterus larger than 12 weeks of gestation, and who had to undergo additional surgical procedures during the same operation were excluded.InterventionsTotal laparoscopic hysterectomy.Measurements and Main ResultsOperations were completed in all 15 patients in the LigaSure and HALO PKS Cutting Forceps groups with the planned instruments. In 2 patients in the ENSEAL group, bleeding could not be controlled with ENSEAL, and additional instruments were used. One patient in the ENSEAL group had bladder injury. The mean operation time and blood loss were 52.4 ± 12.8, 51.86 ± 14.11, and 55.7 ± 15.7 minutes (p > .05) and 138 ± 54.3, 118 ± 63.3, and 218 ± 115.9 mL (p < .05) in the LigaSure, HALO PKS, and ENSEAL groups, respectively. Changes in hemoglobin/hematocrit levels, return of gastrointestinal activity, and hospitalization time did not differ between groups.ConclusionThese 3 novel bipolar platforms had similar results in total laparoscopic hysterectomy. These instruments were not determined to be independent predictors of operating time and amount of blood loss.     

Effect of a single preoperative dose of sublingual misoprostol on intraoperative blood loss during total abdominal hysterectomy

Objective

To investigate whether use of preoperative misoprostol can reduce blood loss during total abdominal hysterectomy (TAH).

Methods

In a randomized double-blind placebo-controlled trial at a tertiary care hospital in Kolkata, India, between March 2011 and April 2012, women (n = 132) undergoing TAH with or without bilateral salpingo-oophorectomy for symptomatic myomas were randomly allocated to receive either 400 μg of misoprostol or placebo 30 minutes before surgery. The primary outcome measure was intraoperative blood loss was. The secondary outcomes were postoperative drop in hemoglobin, need for blood transfusion, and incidence of adverse effects.

Results

The 2 groups were similar with regard to demographic and clinical characteristics. There was a significant reduction of blood loss during TAH after sublingual administration of misoprostol compared with placebo before surgery (356 mL vs 435 mL; P = 0.049). The mean postoperative hemoglobin concentration was higher (10.5 g/dL vs 9.5 g/dL; P < 0.001) and the postoperative drop in hemoglobin was smaller (1.1 g/dL vs 1.9 g/dL; P = 0.004) in the misoprostol group than in the placebo group. No significant adverse effects occurred in either group.

Conclusion

The results showed that a single dose of misoprostol administered before abdominal hysterectomy resulted in a significant reduction of blood loss with minimal adverse effects.Clinical Trial Registry India (www.ctri.nic.in): CTRI/2011/091/000216.     

Surgical Outcome and Cost Comparison Between Total Vaginal Hysterectomy and Laparoscopic Hysterectomy for Uteri Weighing >500 g

Study ObjectiveTo compare surgical outcomes and overall costs of less invasive methods of hysterectomy to treat benign disease including total vaginal hysterectomy (TVH) and total laparoscopic hysterectomy (TLH) in women with a uterus weighing >500 g.DesignRetrospective review of medical records (Canadian Task Force classification III).SettingUniversity-associated hospital.PatientsOne hundred three women with a uterus weighing >500 g who had undergone either total vaginal hysterectomy (TVH) (n = 52) or total laparoscopic hysterectomy (TLH) (n = 51).Measurements and Main ResultsCost data were extracted from the hospital billing system. Patient characteristics, surgical outcomes, and hospital costs were compared between the 2 groups. Patient characteristics were similar in both groups except for a history of surgery (TVH 11.5%, and TLH 37.3%; p = .01). Insofar as surgical outcomes, mean (SD) operative time was shorter in the TVH group compared with the TLH group (110.00 [28.68] minutes vs 180.47 [51.32] minutes; p < .001), and hospital stay was longer (8.08 [0.68] days vs 7.45 [1.03] days; p < .001). Other surgical outcomes including estimated blood loss (p = .20) and decrease in hemoglobin (p = .12) did not differ between the 2 groups. Total hospital costs (converted from Korean won to US dollars) were significantly lower in the TVH group than in the TLH group ($2076.59 [$666.58] vs $2744.03 [$715.76]; p < .001).ConclusionOur data suggest that TVH is a safe and economic procedure even in women with a uterus weighing >500 g. Skilled surgeons should preferentially consider TVH for treatment of benign uterine disease, regardless of uterine size.     

Laparoscopic hysterectomy versus total abdominal hysterectomy: a comparative study

OBJECTIVE: The objective of this study was to compare the intraoperative and short-term postoperative complications of laparoscopic hysterectomy and total abdominal hysterectomy. STUDY DESIGN: Retrospective study of 167 women who had laparoscopic hysterectomy and 119 women who had total abdominal hysterectomy. For assessing the learning curve, the laparoscopic hysterectomies were further subdivided to the first 30 hysterectomies and the later hysterectomies. For data analysis Student's t-test, chi2-test and Fisher's exact test were used. RESULTS: There were no statistically significant differences between the two groups for age, body mass index, previous abdominal surgery, uterine weight, first postoperative day hemoglobin drop, blood transfusion and major or minor complications rate. Operation time was significantly longer for laparoscopic than abdominal hysterectomy (156+/-40 and 91.2+/-33 min, respectively; P<0.001) but the length of hospital stay was significantly shorter (3.9 and 6.55 days, respectively; P<0.001). The conversion rate of laparoscopic hysterectomy was 1.8% (three cases). CONCLUSIONS: Laparoscopic hysterectomy can be safely done even during the learning curve with a low and reasonable complication rate, and a shorter hospital stay but with longer operation time. As experience is gained the operation time, complication rate and hospital stay are decreased.