Laparoscopic-assisted Doderlein hysterectomy: retrospective analysis of 300 consecutive cases

Objective To assess the clinical outcomes of the Doderlein laparoscopic-assisted hysterectomy.
Design A retrospective study.
Setting Women's Endoscopic Laser Foundation at South Cleveland Hospital, Middlesbrough and St James's University Hospital, Leeds.
Population Three hundred consecutive women who had a laparoscopic-assisted Doderlein hysterectomy.
Methods Patients were identified from the laparoscopic hysterectomy theatre log at both sites. Case notes were requested and examined.
Main outcome measures Operative time, uterine weight, associated pelvic pathology, blood loss, hospital stay, intra-operative and post-operative complications.
Results The operations were performed by eight different surgeons, seven of whom were laparoscopic trainees. The mean operating time was 102 minutes (SD 30). Additional surgery including unilateral or bilateral salpingo-oophorectomy, was carried out in 247 patients (82%). The mean uterine weight was 140 g (SD 74). One hundred and thirty-two women (44%) had a normal pelvis at hysterectomy. The mean drop in haemoglobin and haematocrit was 1.46 g (SD 0.95) and 4.4% (SD 24), respectively. The overall complication rate was 18%, of which 6.2% were classed as major. The major complications included four cystotomies, five unscheduled laparotomies, seven post-operative blood transfusions, one pulmonary embolus and two re-operations (within six weeks). The mean hospital stay was three days.
Conclusions Laparoscopic-assisted Doderlein hysterectomy is an alternative to standard laparoscopic hysterectomy techniques. It has the advantage of being easy to learn and is associated with low complication rates, compared with other laparoscopic and traditional techniques for hysterectomy.     

Total laparoscopic hysterectomy with laparosonic coagulating shears: a retrospective report of 200 consecutive cases

Despite 10 years of intensive education and training in Australia only around 14% of hysterectomies are performed with laparoscopic assistance. In particular total laparoscopic hysterectomy (TLH) has a poor penetration rate because of perceived technical difficulties that include instrumentation, prolonged operating times and an increase in complications. We present a series of 200 consecutive cases of TLH with very good results and propose that because of the many advantages that this technique offers that it should become the standard procedure for benign uterine disease.     

Laparoscopy-assisted vaginal hysterectomy: report of seventy-five consecutive cases

Patients who underwent laparoscopy-assisted vaginal hysterectomy with or without adnexectomy experienced less fever, required less postoperative analgesia, were able to tolerate a full diet within 24 hours of surgery, and had a faster recovery and shorter hospital stay than patients who had abdominal or traditional vaginal hysterectomy.     

Laparoscopic-assisted vaginal hysterectomy versus abdominal hysterectomy in endometrial cancer.

OBJECTIVE: To see whether laparoscopy provides exact staging and effective treatment of endometrial cancer patients, compared with total abdominal hysterectomy, with shorter hospital stay, prompter recovery, and better quality of life. METHOD: This retrospective study identified 110 patients scheduled for surgery for early-stage endometrial cancer. Fifty-five (50%) were treated by laparoscopic-assisted vaginal hysterectomy (LAVH) and 55 (50%) by total abdominal hysterectomy (TAH). All patients underwent pelvic lymphadenectomy. The majority of patients (79%) had stage I disease. RESULTS: The mean number of lymph nodes removed was 17 for the LAVH group and 18.5 for the TAH group (p = 0.294). Compared with TAH, LAVH required a significantly longer operating time (220 vs. 175 min; p < 0.01); but shorter hospital stay (4 vs. 8.5 days; p < 0.001) and less estimated blood loss (177 cm3 vs. 285 cm3; p = 0.02). Overall, there were fewer post-operative complications in the LAVH group (6 vs. 11 cases; p < 0.001). Three TAH patients (5.4%) had recurrence of disease. No LAVH patients had recurrences and all are currently disease-free. CONCLUSION: These findings suggest LAVH gives correct staging of endometrial disease, like TAH, but with fewer complications and a slightly longer operating time.     

Laparoscopic-assisted vaginal hysterectomy with and without laparoscopic transsection of the uterine artery: an analysis of 1,255 cases

Introduction  

To evaluate the operative outcomes of patients managed by laparoscopic-assisted vaginal hysterectomy (LAVH) with and without laparoscopic transsection of the uterine artery for benign gynaecologic diseases.     

Laparoscopic assisted Doderlein hysterectomy: initial experience in a provincial Australian centre

Despite the theoretical advantages that laparoscopic hysterectomy techniques offer, this is not a commonly performed operation in Australia. The laparoscopically assisted Doderlein hysterectomy is a technique that offers significant advantages in speed, ease of performance, and low cost. We describe our technique and results of the first 36 cases performed for a range of clinical indications and uterine weights, using widely available and non-disposable equipment. Operating time (including adjunctive operations) varied from 48 to 165 minutes and no significant complications were encountered.     

Laparoscopic-assisted vaginal hysterectomy: A case control comparative study with total abdominal hysterectomy

We compared laparoscopic-assisted vaginal hysterectomy (LAVH) with total abdominal hysterectomy (TAH) in a case control study that evaluated length of operation, blood loss, length of hospital stay, drug requirements for pain, and postoperative pain and activity levels. Of 81 women who underwent nonradical hysterectomy for a primary diagnosis of pelvic pain between June 1 and December 31, 1992, 19 who underwent each procedure were chosen for inclusion in the study. Patients were matched in a case control manner for age, weight, diagnosis, and uterine weight. All 38 hysterectomies were completed without incident. When indicated, unilateral or bilateral oophorectomies were performed. The average surgery time for LAVH was 144 minutes and for TAH 98 minutes, a significant difference (p<0.005). There were no significant differences between estimated blood loss and change in hemoglobin from preoperative levels to postoperative day 1 levels between the groups. Women having TAH reported significantly more pain after their release from the hospital. There was no significant difference in pain during hospitalization apparently because patients who had TAH self-medicated to maintain acceptable levels. That group in fact used an average of 436 mg meperidine during their hospital stay, significantly more than the 197 mg used by the LAVH group (p<0.005). The length of stay was 2.125 days for LAVH and 3.542 days for TAH (p<0.001). On a scale of 1 to 10 (10 being complete normal activity) the activity level of women undergoing LAVH was 9.2 by day 14 compared with 6.4 for those having TAH (p<0.005). By the sixth postoperative week the latter group reported an activity level of only 8.5, indicating that the ability to function is much more severely limited after TAH than LAVH.     

Laparoscopic-assisted vaginal hysterectomy versus minilaparotomy hysterectomy: a prospective, randomized, multicenter study

STUDY OBJECTIVE: The aim of this study was to compare operative and early postoperative outcomes of laparoscopic-assisted vaginal hysterectomy (LAVH) and minilaparotomy in a randomized clinical trial including patients undergoing total hysterectomy for benign gynecologic disease and having 1 or more of the generally considered contraindications to vaginal route. DESIGN: Prospective, randomized, multicenter trial (Canadian Task Force classification I). SETTING: Departments of Gynecology from 3 major university hospitals in Rome. PATIENTS: Eighty-one patients who were candidates for abdominal hysterectomy. INTERVENTIONS: Laparoscopic-assisted vaginal hysterectomy and minilaparotomy hysterectomy. MEASUREMENTS AND MAIN RESULTS: Forty patients were randomized to LAVH and 41 to minilaparotomy. Characteristics of patients and indications for surgery in the 2 arms were comparable. In the minilaparotomy group, complications were as follows: 1 case (2.4%) of delayed laparotomy with 2 units of red blood cell transfusion, 2 cases (4.8%) of wound infection, and 3 cases (7.3%) of fever of unknown origin. No minor or major complications were observed in the LAVH group. Postoperative visual analog scale pain scores at days 1 and 2 were significantly lower in the LAVH group (p <.05). The complication rate between the 2 groups was significantly lower for LAVH (p = .026). CONCLUSION: Because LAVH was associated with significantly lower early postoperative pain scores and complication rates, in general LAVH should be preferred to minilaparotomy hysterectomy when the vaginal approach cannot be used.     

Hypogonadotropic hypogonadism: retrospective analysis of 19 cases.

OBJECTIVES: To survey the clinical data of patients with isolated gonadotropin deficiency. METHODS: We retrospectively surveyed the medical records of 19 patients with isolated gonadotropin deficiency aged 16-31 years (mean: 20 years). The major complaint was primary amenorrhea in 100% of the patients, with 42.1% of them also reporting absence of secondary sex traits, and 10% reporting anosmia or hyposmia. Seventy-four percent of the patients had been submitted to hormonal replacement therapy. RESULTS: Bone densitometry was determined in 5 patients and revealed lumbar spine osteopenia in 3 patients and femoral osteopenia in 1. An association with urologic malformations was detected in 10.5% of cases and an association with gynecologic malformations was detected in 31.6%. CONCLUSIONS: Isolated gonadotropin deficiency can be easily diagnosed but requires early estrogen replacement therapy because of a higher risk of osteopenia and consequently of osteoporosis. Concomitant urogenital malformations are frequent and should be investigated.     

Efficacy of laparoscopic subtotal hysterectomy in the management of menorrhagia: 400 consecutive cases

Study objective  To assess the safety and patient satisfaction of laparoscopic subtotal hysterectomy (LSH) using a standardised surgical technique.
Design  Prospective observational study.
Setting  Princess Royal University Hospital, Chelsfield Park Hospital and Sloane Hospital, Kent, UK.
Patients and materials  Four hundred consecutive women with menorrhagia underwent LSH. The procedure was performed using the Plasma Kinetic Bipolar Diathermy (Gyrus International Ltd, Berkshire, UK) for pedicle ligation and the Lap Loop system (Roberts Surgical Healthcare Ltd, Kidderminster, UK) to detach the cervix. An electromechanical morcellator (Morcellex; Ethicon Women's Health and Urology, Cincinnati, OH, USA) was used to remove the uterus from the abdominal cavity.
Main outcome measures  Patient satisfaction, morbidity rates and readmission rates.
Results  A total of 400 LSH were performed between February 2003 and November 2006. The principal clinical indication for hysterectomy was menorrhagia. The mean duration of surgery was 46.4 minutes. The mean operative blood loss was 126 ml. Concurrent surgery was performed in 141 women. Minor and major perioperative complications were encountered in 5% ( n = 20) of women. The major complication rate was 1.2% ( n = 5): three women (0.75%) with bladder perforation, two women (0.5%) with bowel injury and one woman (0.25%) with a vesicocervical fistula. Eight women (2%) suffered from cyclical vaginal bleeding postoperatively.
Conclusions  LSH is a safe and effective treatment for menorrhagia and other menstrual disorders when hysterectomy is indicated. Women appreciate the quick recovery period, reduced time off work and faster return to normal activity. Our data suggest that LSH can replace abdominal hysterectomy in selected cases.     

经阴道子宫切除术206例分析

我院于 1996年 1月至 1998年 12月按传统方法行非脱垂子宫切除术 96例 ,1999年 1月改进术式后至 2 0 0 0年6月施术 110例 ,兹予前后对照 ,报道如下。1　资料与方法1 1　临床资料　自 1996年 1月至 2 0 0 0年 6月我院共计经阴道切除非脱垂子宫 2 0 6例 ,年龄为 33～ 5 8岁 ,平均46 5岁。单纯子宫肌瘤 91例 (44 17% ) ,子宫腺肌病 5 2例 (2 5 2 4% ) ,子宫肌瘤合并腺肌病 40例 (19 41% ) ,子宫肥大症或子宫内膜增殖症 12例 (5 83% ) ,子宫肌瘤合并卵巢良性囊肿 8例 (3 88% ) ,早孕合并子宫肌瘤 3例(1 46 % )。以 1999年 1月至 2 0 0 0年 6…     

Laparoscopic-assisted vaginal hysterectomy vs abdominal hysterectomy for benign disease: a meta-analysis of randomized controlled trials

The objective of this meta-analysis was to assess whether laparoscopic-assisted vaginal hysterectomy achieves better clinical results compared with abdominal hysterectomy. Medline (PubMed), EMBASE, Web of Science, ProQuest, Cochrane Library and China Biological Medicine Database were searched to identify randomized controlled trials that compared laparoscopic-assisted vaginal hysterectomy with abdominal hysterectomy. Twenty-three trials were studied and the analysis was performed using Review Manager Version 5 and R Version 2.11.1. The results showed that laparoscopic-assisted vaginal hysterectomy was associated with a longer operation time, less blood loss, shorter hospital stay, smaller haemoglobin drop, less postoperative pain, quicker return to normal activities and fewer peri-operative complications. Quality of life is likely to be the key outcome to evaluate the approach for hysterectomy, but further research is needed. For suitable patients and surgeons, laparoscopic-assisted vaginal hysterectomy is a better choice than abdominal hysterectomy.     

在全子宫切除术后标本中发现的浸润性宫颈癌30例临床分析

目的:探讨全子宫切除术后发现浸润性宫颈癌的原因及处理。方法:回顾分析1999年~2003年收治的全子宫切除术后浸润性宫颈癌病例的临床病理资料。结果:4年间收治浸润性宫颈癌6683例,全子宫切除术后发现30例,占0·4%。30例患者中15例(50%)初次手术前进行常规的宫颈细胞学检查,其中7例(46·7%)宫颈细胞学检查结果异常,12例行宫颈组织学检查,诊断为宫颈上皮内瘤变(cervicalintraepithelialneopla-sia,CIN)10例。初次手术主要指征为子宫肌瘤和子宫腺肌症(16例,53·3%),CINⅡ~Ⅲ(10例,33·3%),其它(4例13·3%)。24例术后行补救性放疗,4例行再次手术治疗,2例未行进一步治疗。随访6~67个月(平均36月),3年、5年生存率分别为68·25%、61·43%,Cox比例风险模型分析发现组织学类型是影响预后的独立因素(P=0·00)。结论:对宫颈癌筛查缺乏认识和对异常的宫颈刮片或活检结果处理不当是全子宫切除术后发现浸润性宫颈癌的主要原因,放疗是可行的补救性治疗措施。     

Chronic plasma cell endometritis in hysterectomy specimens of HIV-infected women: a retrospective analysis.

OBJECTIVE: Abnormal uterine bleeding is a common and troublesome problem in human immunodeficiency virus (HIV)-infected women. We sought to evaluate endometrial pathology among HIV-infected women requiring hysterectomy to explore if endometritis may be common among these patients. METHODS: We performed a retrospective analysis of uterine pathology specimens obtained from HIV-infected and control patients requiring hysterectomy in two urban hospitals between 1988 and 1997 matched for age, surgical indication, and history of gonadotropin-releasing hormone (GnRH) use. Cases were evaluated for the presence of plasma cells and assigned a grade between 0 and 3. RESULTS: Indications included cervical dysplasia (4), carcinoma in situ (2), abnormal uterine bleeding (3), and adnexal mass (3). Some degree of abnormal uterine bleeding occurred in all cases. Plasma cell endometritis was twice as common in HIV-infected women compared to HIV-negative specimens (11/11 versus 11/22) (P < 0.05). Plasma cell endometritis was also of a higher grade in specimens from HIV-infected women than in controls (P = 0.001). CONCLUSION: Chronic endometritis was common and of a higher grade among HIV-infected women requiring hysterectomy in our series. Diagnosis and treatment of endometritis should be considered in HIV-infected women with uterine bleeding and/or tenderness. We speculate that antiretroviral and/or antimicrobial treatment for endometritis may effectively treat endometritis and eliminate the need for surgery in some HIV-infected women. We suggest that consideration and treatment of endometritis in HIV-1 infected women being evaluated for possible hysterectomy has the potential to reduce costs and morbidity for patients and providers who may be exposed during surgical procedures.     

子宫颈癌保留神经广泛性子宫切除术与传统广泛性子宫切除术的比较性研究

生活满意度(29%,7/24)明显好于RH患者(9%,6/69),两者比较,差异有统计学意义(P=0.042);NSRH患者排便正常,RH患者中有2例患者出现大便次数增多.结论 NSRH手术能有效保护早期宫颈浸润癌患者的盆腔自主神经功能,且安全可行.     

子宫颈癌保留神经广泛性子宫切除术与传统广泛性子宫切除术的比较性研究

生活满意度(29%,7/24)明显好于RH患者(9%,6/69),两者比较,差异有统计学意义(P=0.042);NSRH患者排便正常,RH患者中有2例患者出现大便次数增多.结论 NSRH手术能有效保护早期宫颈浸润癌患者的盆腔自主神经功能,且安全可行.