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At least 235 records · Page 13Linked to original sources
PubMed1994

[Vaginal hysterectomy. The experience at the Instituto Nacional de Perinatología].

In gynecologic surgery the most frequent procedure is hysterectomy. Some factors are determinant for the election of the kind of surgery to be done, it could be by abdominal or vaginal approach. These factors include the experience and ability of the surgeon as well as the indication for the operation. Two hundred and sixty six patients operated of vaginal hysterectomy at Instituto Nacional de Perinatología, from August 1986 to July 31 1992 were reviewed. Indications, complications and associated surgery to this procedures, were analyzed. The findings were compared with other authors.

Adult↗
PubMed1981

Removal of a presacral tumor via a Schuchardt incision.

Presacral tumors have been traditionally approached either abdominally or via a transsacral incision. We describe a perineal approach to these tumors. A patient with a presacral benign cystic teratoma is described. The tumor was removed through a Schuchardt incision with no difficulties or complications. The vaginal approach should be considered for the removal of selected presacral tumors.

Adult↗
PubMed1995

Laparoscopic hysterectomy--a step forward?

Laparoscopic gynaecological surgery has made tremendous progress since the last decade and the introduction of laparoscopic hysterectomy has gained immense popularity amongst both gynaecologists and consumers alike in its short history of 5 years. This review surveys the literature available on this technique and critically evaluates the indications, limitations as well as the benefits and risks of this approach to hysterectomy. There is some evidence presently that laparoscopic hysterectomy may offer benefits to selected patients who otherwise have indications for an abdominal hysterectomy. Overall, the incidence of laparotomy for hysterectomy may be decreased by converting a portion of these patients to the laparoscopically-assisted vaginal approach.

Female↗
PubMed1996

Assessing the role of laparoscopically assisted vaginal hysterectomy in the everyday practice of gynecology.

OBJECTIVE: To assess how often a gynecologist may have to apply a laparoscopic technique over a traditional vaginal approach to avert total abdominal hysterectomy. STUDY DESIGN: This retrospective study involved 349 consecutive hysterectomies performed by the author in his private practice from January 1990 to December 1993. A vaginal route was selected for every patient except those who had universally accepted indications for laparotomy or who posed predictable technical difficulties. RESULTS: A total of 306 patients (87.7%) underwent vaginal hysterectomies without a single conversion to total abdominal hysterectomy. Excluding those with malignant disease, 304 women (91.3%) underwent vaginal hysterectomies. Five patients (1.4%) who had total abdominal hysterectomies could have been converted to a vaginal route with the visual assistance of a laparoscope. Mean operation time was 64 minutes without oophorectomy and 71 minutes with it. Mean length of stay was 1.9 days after vaginal hysterectomy, 1.8 without oophorectomy and 2.1 with it. CONCLUSION: The proportion of vaginal hysterectomies in the total number of hysterectomies should be > 80%, perhaps closer to 90%, instead of the current 25-30%. Laparoscopy may assist in converting a potential total abdominal hysterectomy case to a vaginal route in very limited cases, probably in the range of 2-3%.

Adult↗
PubMed2005

Hysterectomy.

Hysterectomy is one of the most commonly performed major surgical procedures; approximately 100,000 are performed in the UK each year. Hysterectomy can be total or subtotal. The postulated benefits of subtotal hysterectomy--better pelvic floor and sexual function--have not been confirmed in randomised trials. Traditionally, hysterectomy was performed using either an abdominal or vaginal approach. More recently, laparoscopic techniques have been used. The decision about the technique used is often related to the surgeon's training and expertise, as the indications for each technique overlap. Vaginal hysterectomy is probably the preferred route because it is quicker and cheaper than laparoscopic hysterectomy, with no other clear differences in outcome measures. Laparoscopic hysterectomy has a number of advantages over abdominal hysterectomy: specifically, shorter hospital stay and quicker return to normal activities; complication rates, however, appear to be greater. This also seems to be the case with radical hysterectomy performed for cervical cancer.

Adnexa Uteri↗
PubMed2006

Hysterectomy in the 21st century: different approaches, different challenges.

The final decision to perform a certain method of hysterectomy customarily mirrors experience and level of comfort with a particular surgical approach in the context of the patient's condition and indication for surgery. Given the morbidity and recovery associated with a laparotomic incision, every effort should be made to avoid abdominal hysterectomy. The best available evidence points to the advantage of the vaginal approach over other methods of hysterectomy for benign conditions. Regrettably, the state of education in residency programs is not providing a level of surgical competency to meet this charge. Whenever vaginal surgery is not an option, laparoscopically assisted hysterectomy offers the best alternative. Although the promises of supracervical hysterectomy have yet to be demonstrated, laparoscopic supracervical hysterectomy may offer the least morbid alternative to vaginal hysterectomy.

Female↗
PubMed1990

Laparoscopy-assisted vaginal hysterectomy.

Intraoperative laparoscopy was used to evaluate pelvic pathology in 46 patients who had been anesthetized for abdominal hysterectomy. Because traditional indicators--clinical history, pelvic examination, and ultrasound studies--suggested the presence of more serious pelvic pathology, these patients were considered poor candidates for vaginal hysterectomy. Laparoscopic findings, however, revealed that 42 of the 46 (91%) could undergo uncomplicated vaginal surgery (which they did). Laparoscopy-assisted hysterectomy is recommended as an additional method of investigation in order to improve diagnostic accuracy and minimize surgical risk while allowing more frequent selection of the vaginal approach to hysterectomy.

Adnexal Diseases↗
PubMed2000

Recurrent posttraumatic urethrovaginal fistula: a new application for ASTRA.

The authors describe the results of an application of the surgical technique called ASTRA (anterior sagittal transrectal approach) in the case of a 16-year-old girl with a posttraumatic urethrovaginal fistula. The young girl with a posttraumatic urethrovaginal fistula had recurrence after 4 surgical attempts at closure performed by the vaginal approach before it was definitively corrected with the ASTRA. Two years after the ASTRA operation the patient is well with a complete restitution of function confirmed by a voiding cystourethrogram and urodynamic and rectal manometric tests. The successful recovery confirmed that ASTRA may be an excellent method of treating the developmental or acquired anomalies of the perineal region.

Adolescent↗
PubMed2005

Removal of the retained cervical stump.

OBJECTIVE: The purpose of this study was to identify indications for and complications of abdominal or vaginal surgical removal of the cervical stump after previous supracervical hysterectomy. STUDY DESIGN: This was a retrospective chart review of trachelectomy patients at Mayo Clinic, Rochester, Minnesota, or Mayo Clinic, Scottsdale, Arizona, between January 1974 and December 2003. RESULTS: Of 335 patients with a history of supracervical hysterectomy who subsequently required trachelectomy, 25 were excluded from study. Half of the remaining 310 patients had trachelectomy between 1974 and 1983, an average of 26 years after hysterectomy. The indication in three quarters of trachelectomies performed vaginally was prolapse. The vaginal approach had significantly fewer complications than the abdominal approach. CONCLUSION: Removal of the cervical stump is infrequent and has declined over a 30-year period. The decline in trachelectomy may be because of a decreasing number of supracervical hysterectomies performed. When trachelectomy is performed vaginally, prolapse is the most common indication, and there are few complications.

Aged↗
PubMed1995

Laparoscopically assisted vaginal hysterectomy at a health maintenance organization. Cost-effectiveness and comparison with total abdominal hysterectomy.

Fifty laparoscopically assisted vaginal hysterectomies (LAVHs) were compared with 46 total abdominal hysterectomies (TAHs) at a health maintenance organization for operating time, preoperative and postoperative hematocrit, estimated blood loss, major and minor complications, length of hospital stay and disability until return to normal work duties. Indications for surgery, parity and weight were similar for both groups. Although operating time and blood loss were greater for LAVH, hospital stay was statistically significantly shorter, disability time was shorter, and return to normal activity was sooner. The cost of nonreusable instruments was $1,250 per case, far lower than in other settings. The potential for a shorter recovery time and real cost savings would be considerable if LAVH could convert an abdominal to a vaginal approach.

Absenteeism↗
PubMed1988

Comparison of transabdominal and transvaginal pelvic ultrasonography for ovarian follicle assessment in in vitro fertilisation.

The emergence of transvaginal ultrasound-guided oocyte retrieval provided an opportunity to review and improve the traditional transabdominal ultrasonic approach for follicular tracking in in vitro fertilisation (IVF). This technique requires a full bladder, which may cause extreme discomfort. Hence, to provide both effective and comfortable monitoring, we instituted a study comparing transabdominal and transvaginal ultrasonography, with regard to patient preference and follicular number, size and dominance, in patients undergoing IVF and gamete intrafallopian transfer (GIFT). Commencing usually on day 9 of the treatment cycle, 45 patients were scanned on 55 occasions, initially abdominally (with a full bladder) and subsequently vaginally, using a transvaginal 7.5 MHz sector transducer. Follicular number was identical in 78% of cases, with the majority of the remaining patients showing an extra follicle on vaginal assessment. There were no significant differences in overall or dominant follicular diameters with either technique. Overall, 85% unashamedly preferred the vaginal approach. We believe that tracking follicular development in IVF treatment cycles is efficient and popular using the vaginal sector transducer and accordingly have ceased all assessments using the abdominal probe. Subsequently, 450 follicle scans have been performed with virtually the unanimous approval of our patients.

Abdomen↗
PubMed2003

Laparoscopic radical trachelectomy for stage Ib1 cervical cancer.

Radical trachelectomy by vaginal approach is an alternative for young women with early-stage cervical cancer. We modified this procedure to treat two patients with stage Ib1 cervical cancer. With 100% laparoscopic pelvic lymphadenectomy and 80% laparoscopic approach, the technique is laparoscopic radical trachelectomy (LRT). Under direct enhanced vision of the laparoscope, it is easy to identify and preserve ascending branches of the uterine arteries and to divide ligaments surrounding the cervix and vagina. Vaginal procedures require only colpotomy, amputation of cervix, dividing caudal paracolpium, and corpus-vagina anastomosis. Short-term follow-up results of our first patients are satisfactory. Thus, LRT could be a useful alternative for women with early cervical cancer who want to preserve fertility.

Adult↗
PubMed1996

Transvaginal colposuspension for the treatment of genuine stress incontinence combined with vaginal hysterectomy: a preliminary report.

The authors used a new, simple, modified transvaginal needle colposuspension technique in combination with vaginal hysterectomy for uterine prolapse and cystocele repair. The technique was used in 20 women with genuine stress incontinence which was urodynamically proven. One year after operation, 90% of patients were clinically normal and 85% were urodynamically cured. The advantages of this new technique are that the cost of the needle is low, it can be applied in all cases where a vaginal approach is necessary, and the method of needle insertion avoids perforation of the bladder.

Female↗
PubMed1995

Guidelines to determine the route of hysterectomy.

OBJECTIVE: To 1) test the validity of a method of assigning patients prospectively to a vaginal, abdominal, or laparoscopy-assisted vaginal approach to hysterectomy for benign disease; 2) compare the outcomes of these options from the day of surgery to the first day of returning to normal activities; and 3) estimate the proportion of hysterectomies by each route when patients were assigned according to this system, and the impact on hospital charges. METHODS: Six hundred seventeen women were assigned to a route of hysterectomy on the basis of uterine size (greater or less than 280 g), presumptive risk factors, and uterine or adnexal immobility or inaccessibility. Data regarding the success of the procedure, complications, length of hospital stay and convalescence, and hospital charges were compiled. RESULTS: Vaginal hysterectomy alone (n = 548) or in conjunction with laparoscopy (n = 63) was successful in 99.5% of women assigned to these groups. Patients in whom the vaginal route was successful included 94% of those with uterine weights exceeding 280 g and 97% of those having risk factors often cited as reasons for selecting abdominal hysterectomy. Laparoscopic surgery was necessary to permit a transvaginal operation in only 12 of 63 patients (19%). Use of the guidelines produced a potential savings of 615 hospital days, $1,317,434 in hospital charges, and 7250 convalescent days relative to the 3:1 ratio of abdominal to vaginal hysterectomies prevalent in the United States. CONCLUSIONS: Specific guidelines for uterine size, risk factors, and uterine and adnexal mobility and accessibility are useful in selecting the operative approach to hysterectomy and will significantly reduce the number of abdominal operations performed. Laparoscopy is valuable in properly selected patients to determine the route of hysterectomy, but the need for laparoscopic techniques to permit a vaginal operation may be considerably less than some investigators have proposed.

Adult↗
PubMed1985

[Operative measures in recurrence of urinary incontinence and advanced displacement of pelvic organs in the female].

The individual approach in the stress incontinence of the woman requires the consideration of general pathological and social factors, the locoregional topical anatomy of the pelvic organs, results of functional investigations and aimed metaphylactic measures. The possibility of selecting incontinent women for the abdomino-vaginal approach is demonstrated with the help of a model of diagnostics and the tactics of operation as well as metaphylactic measures are described. In 92% of the women with highly pathological topical anatomy of the pelvic organs or recidivations of incontinence of urine a continence could be proved on an average three years after operation. 25% of the female patients showed a component of urgent desire to pass water. The combined approach with application of chorium material contains three operative suspensory steps and the correction of further factors evoking incontinence. The technique tested on account of the results obtained is an alternative method if indication is given.

Female↗
PubMed1996

Posthysterectomy fallopian tube herniation. A report of two cases.

BACKGROUND: Tubal herniation as a complication of hysterectomy is a rare phenomenon, markedly more frequent after vaginal hysterectomy. With the increasing use of the vaginal route, the ratio between tubal herniation after vaginal versus abdominal hysterectomy may exceed 3:1. CASE: We report two cases of tubal herniation into the vagina, one after vaginal hysterectomy and the other after total abdominal hysterectomy, in two patients, aged 36 and 37 years. CONCLUSION: A tubal prolapse in the vagina may be considered a hernia and occurs only if a communication exists between the peritoneal cavity and vaginal canal. It can be an early or late prolapse. Symptoms consist almost exclusively of persistent blood loss and/or leukorrhea, dyspareunia and chronic pelvic pain. Whether the abdominal or vaginal approach should be used in surgical correction of prolapsed tubes must be decided in each case according to the patient's individual characteristics. Both histologic pictures described merit careful attention, distinguishing between the terminal tubal segment and the more cranial tract (above the vaginal strangulation).

Adult↗
PubMed1988

Sacrospinous ligament fixation for eversion of the vagina.

During the period from January 1, 1974, through June 30, 1987, 100 patients were treated with a sacrospinous ligament suspension of the vaginal apex at the University of Michigan Medical Center. Fifty-seven patients had a posthysterectomy complete vaginal prolapse; 38 patients, an incomplete vaginal prolapse; and five, a posthysterectomy enterocele. Fifty-one patients had had an abdominal hysterectomy and 49 a vaginal hysterectomy previously. Almost half of the patients had had at least one attempt at surgical correction of the prolapse and three patients had had four previous procedures. The immediate postoperative complications were not unexpected. Febrile morbidity responding to appropriate therapy was the most common complication. There was no surgical mortality. Seventy-one of the 78 patients were operated on greater than or equal to 1 year ago and were the subjects of the review. Sixty-four of the patients (90%) had complete symptomatic relief after operation. Ten of these patients had some asymptomatic laxity of the vaginal walls and nine others had satisfactory support but vaginal stenosis or symptoms of stress urinary incontinence after operation. Four patients developed cystoceles and three others had recurrent vaginal prolapse. The vaginal approach to the treatment of eversion of the vagina has many advantages, as reported. The surgical goals described were attained; therefore, use of the sacrospinous ligament fixation procedure as a therapeutic procedure only is defended. The surgical technique is described. Finally, the sacrospinous ligament fixation of vaginal vault prolapse should assume high priority in our therapeutic regimen.

Adult↗
PubMed1999

Laparoscopic total abdominal hysterectomy in morbidly obese women. A pilot-phase report.

OBJECTIVE: To establish the consecutive steps in and evaluate the safety and effectiveness of laparoscopic total abdominal hysterectomy (L-TAH) (hysterectomy completed via laparoscopy, with no transvaginal approach by the suturing technique) in a group of morbidly obese women and to compare the results to a group of nonobese women with clinically similar characteristics and indications for hysterectomy. STUDY DESIGN: Eleven morbidly obese women were subjected to a L-TAH with no vaginal approach. The operation was executed by suturing and tying an extracorporeal sliding knot and by using intracorporeal two-turn flat square knot methods. The consecutive steps of the operation were changed from the original to facilitate this procedure. The group of morbidly obese women was compared to a group of nonobese women. RESULTS: All the subjects exceeded their ideal body weight by 100%. Their actual weight ranged from 118.9 to 139.8 kg, and their height ranged from 58 to 69 in. All the planned surgery was completed, and no intraoperative or postoperative complications were observed. There was no conversion from the laparoscopic approach to a laparotomy or transvaginal path. When compared to that in the control group, the mean operating time was significantly longer in morbidly obese subjects. CONCLUSION: L-TAH is safe and effective for morbidly obese women.

Adult↗