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PubMed1999

Early feeding compared with nasogastric decompression after major oncologic gynecologic surgery: a randomized study.

OBJECTIVE: To evaluate the feasibility, safety, and tolerance of early feeding in patients undergoing surgery for gynecologic malignancies. METHODS: Patients were stratified according to operative time and type of tumor and were randomized into two arms: A) early oral feeding and B) nasogastric decompression followed by feeding at the first passage of flatus. Variables assessed included nausea, vomiting, time to first passage of flatus and stool, time elapsed before adequate tolerance of a regular diet, postoperative stay, and complications. RESULTS: Sixty-one patients were randomized into each arm. The types of tumor, the surgical procedures performed, and the operative times were similar in both groups. Early oral feeding in patients in arm A was associated with a significantly faster resolution of postoperative ileus (P < .01), with a more rapid return to a regular diet (P < .01), with an earlier first passage of stool (P < .01), and with a shorter postoperative stay (P < .05) than patients in arm B. Rates of nausea and vomiting were similar in both arms. Hindered deglutition and nasal soreness caused by the nasogastric tube were observed in 88% of patients in arm B. Insertion of a nasogastric tube was necessary in six patients in arm A (10%), and three of these had postoperative complications. Thus, early feeding was feasible in 95% of patients and did not seem to be related to preoperative chemotherapy, tumor type, or lymphadenectomy. CONCLUSION: Early feeding is feasible and well tolerated and is associated with reduced postoperative discomfort and a more rapid recovery in patients undergoing major surgery for gynecologic malignancies.

Adult↗
PubMed1997

[Experiences with external quality assurance in gynecologic surgery].

A project, 'Quality Management in Gynecological Surgery', was developed as an external means of quality management in gynecological surgery and tested in 44 clinics in 1994. The external comparison of clinics generally demonstrated the high quality of the services, but certain aspects of these services exhibited an extremely high variability, for instance as far as thrombosis prevention and the choice of the routes of access for defined interventions are concerned. The positive effects of the project were that the clinics used the comparative data provided by the project as a basis to modify the management processes and thus improved the quality of their services. On the other hand, the external comparisons uncovered the need for guidelines for the management of patients. It will now be the responsibility of the gynecological societies to establish such guidelines and communicate them to their members via the appropriate channels.

Female↗
PubMed1999

Lower urinary tract injury during gynecologic surgery and its detection by intraoperative cystoscopy.

OBJECTIVE: To review the frequency of lower urinary tract injuries after major gynecologic surgery and the role of routine intraoperative cystoscopy during major gynecologic surgery in the detection of lower urinary tract injuries. DATA SOURCES: We combined a MEDLINE search for reports from 1966 to October 1998, using the terms "urinary tract injury," "ureter/ureteric/ureteral obstruction/fistula/injury," "bladder fistula/injury," and "vesico-vaginal fistula," with a second search for all reports of gynecologic surgical procedures. Additional references were obtained from relevant articles and review articles. METHODS OF STUDY SELECTION: Included were all English language articles on the frequency of unintentional urinary tract injuries identified during or after benign gynecologic surgery. There were 22 reports on the frequency of lower urinary tract injuries after gynecologic surgery and eight on the use of routine cystoscopy during gynecologic surgery to diagnose unsuspected injuries. TABULATION, INTEGRATION, AND RESULTS: In the reports of studies not involving routine cystoscopy, the frequency of ureteral injury varied from 0 to 14.6 injuries per 1000 operations, with an overall frequency of 1.6 per 1000. The frequency of bladder injury varied from 0.2 to 19.5 per 1000, with an overall frequency of 2.6 per 1000. Only 11.5% of ureteral injuries and 51.6% of bladder injuries were identified and managed intraoperatively. In the reports of studies involving routine cystoscopy, the frequency of ureteral injury varied from 0 to 26.8 per 1000, with an overall frequency of 6.2 per 1000. The frequency of bladder injury varied from 0 to 29.2 per 1000, with an overall frequency of 10.4 per 1000. Up to 90% of unsuspected ureteral injuries and 85% of unsuspected bladder injuries were identified with the use of cystoscopy and were managed successfully intraoperatively. In 69% of the unsuspected ureteral and bladder injuries, the intraoperative management consisted of removing and replacing sutures or repairing unintentional cystotomies. CONCLUSION: Use of routine intraoperative cystoscopy during major gynecologic and urogynecologic surgery might prevent sequelae from lower urinary tract injuries.

Cystoscopy↗
PubMed1976

Ureteral injuries associated with gynecologic surgery: prevention and management.

Gynecologic surgery is responsible for most of the ureteral injuries that occur. The "easy" operation--the "simple" abdominal hysterectomy--and not the technically difficult pelvic one, is responsible for most ureteral injuries. Total abdominal hysterectomy accounts for almost 50% of the genitourinary fistulas and perhaps 80-99% of all surgical ureteral injuries. This problem will persist until a most important surgical axiom is applied routinely during the accomplishment of all pelvic operations: With all dissections, the contiguous structures subject to injury must be exposed. This step not only will avoid injuries to the ureter but also will facilitate an equally important aspect, that is, urinary tract injuries must be recognized at the time of operation. With recognition and adequate repair, problems such as fistula formation and serious morbidity (and litigation) can be avoided almost entirely. Because the gnecologic surgeon frequently will find that urologic consultation is not available at the time of urinary tract injury, he or she must be aware of and familiar with the various ureteral reconstructive procedures that may be required. The gynecologic surgeon must devote time and study to the management of urinary tract injuries before their occurrence. All pelvic surgeons eventually will encounter ureteral problems. The methods of bladder mobilization and ureteroneocystostomy should be within the ability of all who operate within the pelvis. When extensive damage has occurred and a urologist is not available, the gynecologist who is unfamiliar with the more demanding techniques (that is, ureteroureterostomy, bladder flaps, ileal conduits) should avoid additonal damage to the urinary tract and accomplish a simple catheter ureterostomy, deffering the definitive repair for a urologist.

Female↗
PubMed2006

[Postpartum and early postoperative anemia after gynecological surgery: treatment with intravenous iron].

OBJECTIVE: To assess the efficacy and safety of treatment with intravenous iron for postpartum anemia or postoperative anemia after gynecological surgery. PATIENTS AND METHODS: A prospective study enrolling patients entering our recovery care unit from June through December 2004 with hemoglobin levels less than 10 g x dL(-1) after vaginal childbirth or cesarean section or after another form of gynecological surgery. Three 200 mg doses of intravenous iron sucrose (Venofer) were administered on consecutive days. Fifteen days after the last dose, the patient came for follow-up tests and was asked about side effects. The results were analyzed with a Student t test for matched samples. RESULTS: A total of 250 obstetric and 52 gynecological surgery patients were enrolled; 156 and 33 completed the study in each group, respectively. Hemoglobin increased after treatment by 3.2 g x dL(-1) in the obstetric patients and by 2.7 g x dL(-1) in patients who underwent gynecological surgery. The increase was significant in both groups (P<0.001); the 95% confidence interval was 2.918-3.519 for the obstetric patients and 2.220-3.071 for the gynecological surgery patients. The incidence of side effects was low (13 obstetric patients and 1 gynecological surgery patient). Most side effects were related to pain at the injection site (in 12 of the 14 women). CONCLUSIONS: Intravenous iron sucrose is safe and effective for treating puerperal anemia and following gynecological surgery. The low incidence of serious side effects and the rapid recovery of hemoglobin levels make this a safe, effective drug for treating anemia.

Adolescent↗
PubMedDate not supplied

Robotic-assisted laparoscopy in gynecological surgery.

BACKGROUND: Laparoscopic surgery has revolutionized the concept of minimally invasive surgery for the last 3 decades. Robotic-assisted surgery is one of the latest innovations in the field of minimally invasive surgery. Already, many procedures have been performed in urology, cardiac surgery, and general surgery. In this article, we attempt to report our preliminary experience with robotic-assisted laparoscopy in a variety of gynecological surgeries. We sought to evaluate the role of robotic-assisted laparoscopy in gynecological surgeries. METHODS: The study was a case series of 15 patients who underwent various gynecologic surgeries for combined laparoscopic and robotic-assisted laparoscopic surgery. The da Vinci robot was used in each case at a tertiary referral center for laparoscopic gynecologic surgery. An umbilicus, suprapubic, and 2 lateral ports were inserted. These surgeries were performed both using laparoscopic and robotic-assisted laparoscopic techniques. The assembly and disassembly time to switch from laparoscopy to robotic-assisted surgery was measured. Subjective advantages and disadvantages of using robotic-assisted laparoscopy in gynecological surgeries were evaluated. RESULTS: Fifteen patients underwent a variety of gynecologic surgeries, such as myomectomies, treatment of endometriosis, total and supracervical hysterectomy, ovarian cystectomy, sacral colpopexy, and Moskowitz procedure. The assembly time to switch from laparoscopy to robotic-assisted surgery was 18.9 minutes (range, 14 to 27), and the disassembly time was 2.1 minutes (range, 1 to 3). Robotic-assisted laparoscopy acts as a bridge between laparoscopy and laparotomy but has the disadvantage of being costly and bulky. CONCLUSION: Robotic-assisted laparoscopic surgeries have advantages in providing a 3-dimensional visualization of the operative field, decreasing fatigue and tension tremor of the surgeon, and added wrist motion for improved dexterity and greater surgical precision. The disadvantages include enormous cost and added operating time for assembly and disassembly and the bulkiness of the equipment.

Colposcopy↗
PubMed2005

Factors associated with complications in gynecological surgeries.

OBJECTIVE: To evaluate the factors associated with complications in major gynecological surgeries. METHODS: A retrospective study on major gynecological surgeries performed at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia, from the year 1997-2001. A total of 555 cases were included. Risk factors associated with complications were evaluated by a unique regression analysis. RESULTS: High blood loss was associated with salpingectomy/salpingotomy, myomectomy, and total abdominal hysterectomy (TAH). Old age was associated with TAH, oophorectomy and vaginal hysterectomy. Prolonged hospitalization was associated with TAH and oophorectomy. Urinary tract infection, wound infection, nausea and vomiting were not significant postoperative complications in major gynecological surgeries. CONCLUSION: The recognition of the specific complications associated with each type of surgery are important for counseling the patients and preoperative preparation to reduce the risk of long term morbidity.

Adult↗
PubMed2003

Facial and body blood contamination in major gynecologic surgeries.

AIM: To determine the incidence of facial and body blood contamination in various major gynecologic surgeries. METHODS: A prospective study was conducted over a 6-month period on 122 major gynecologic surgeries (abdominal and vaginal) to determine the incidence of blood splashes on masks, goggles (or spectacles), body and feet of surgeons and assistants. RESULTS: The overall incidence of blood splashes was 49.18%, 59.5%, 28.68% and 22.95% on surgeons masks, goggles, body and feet, respectively. This incidence was significantly higher (P < 0.05) than for first assistants, who showed an incidence of blood splashes of 35.24% (mask), 38.13% (goggles), 20.49% (body) and 9.83% (feet). The lowest incidence of splashes was seen on second assistants, with 22.1% (mask), 24.73% (goggles), 10.52% (body) and 7.36% (feet). There was no significant difference in the facial splash rate between major abdominal and vaginal surgeries, but body and feet contamination was significantly higher in major vaginal surgeries (P < 0.05). CONCLUSION: There is a very high risk of facial and body blood contamination in major gynecologic surgeries, putting the surgeon and assistants at risk of acquiring viral disease. Routine use of universal precautions in all gynecologic surgeries is strongly recommended.

Blood↗
PubMed2006

Rates of urinary tract injury from gynecologic surgery and the role of intraoperative cystoscopy.

OBJECTIVE: To estimate the rates of urinary tract injury after benign gynecologic surgery. To explore the role of routine intraoperative cystoscopy at benign gynecologic surgery. DATA SOURCES: We conducted a systematic MEDLINE search for urinary tract injuries at gynecologic surgery for the period from November 1998 to May 2004 and combined this with a previous systematic review performed in the same fashion for the period from January 1966 to October 1998. METHODS OF STUDY SELECTION: There were 47 studies that fit our inclusion criteria: 29 that did not use routine intraoperative cystoscopy, 17 that used routine intraoperative cystoscopy, and 1 that reported the frequency of urinary tract injury separately, with and without routine intraoperative cystoscopy. We determined the crude and fitted ureteric and bladder injury rates for each surgery type from the studies where routine intraoperative cystoscopy was not performed and then from the studies where routine intraoperative cystoscopy was performed. TABULATION, INTEGRATION, AND RESULTS: From studies without routine cystoscopy, combined ureter and bladder injury rates varied according to the complexity of the surgery, ranging from less than 1 injury per 1000 for subtotal hysterectomy with or without bilateral salpingo-oophorectomy to as many as 13 injuries per 1000 surgeries for laparoscopic hysterectomy with or without bilateral salpingo-oophorectomy and for other gynecologic and urogynecologic surgeries. Injury rates were higher when routine intraoperative cystoscopy was used, but the confidence intervals were wider. CONCLUSION: The reasons for higher injury detection rates when routine cystoscopy was performed are unclear. Further study is needed to identify the scenarios where routine cystoscopy is warranted after major gynecologic surgery.

Cystoscopy↗
PubMed2000

Routine hematocrit after elective gynecologic surgery.

OBJECTIVE: To determine the clinical use and associated costs of routine postoperative hematocrit after elective gynecologic surgery. METHODS: We reviewed the charts of all women who had elective gynecologic surgery over 12 months at a community hospital. Demographic data, estimated blood loss at surgery, pre- and postoperative hematocrits, postoperative symptoms suggesting anemia, and incidence of transfusion were tabulated. Laboratory charges for hematocrit at the hospital were used to develop an economic assessment. Statistical analysis was done with Student t test, Mann-Whitney U test, and Fisher exact test. RESULTS: Among 1105 women who had elective surgery, a single postoperative hematocrit was done in 761 (69%) and two or more postoperative hematocrits (mean 2.4, range 2-6) were done in 201 (18%). The overall incidence of blood transfusion related to elective gynecologic surgery was 1.9% (21 of 1105). Five of those women needed preoperative transfusions, eight needed intraoperative transfusions, and the remaining eight had postoperative transfusions. All women who needed postoperative transfusion showed some sign or symptom of anemia. None received transfusions based solely on hematocrit. Risk factors for postoperative transfusion included low preoperative hematocrit and increased intraoperative blood loss. CONCLUSION: Routine postoperative hematocrit in asymptomatic women after uncomplicated elective gynecologic surgery did not improve outcome.

Adult↗
PubMed2006

Saline irrigation and wound infection in abdominal gynecologic surgery.

OBJECTIVE: To evaluate whether saline wound irrigation decreases the incidence of wound infection following abdominal gynecologic surgery. METHOD: In this prospective randomized study, 104 patients underwent wound irrigation before wound closure following abdominal gynecologic surgery and 102 patients did not. RESULTS: There were no significant differences between the 2 groups in patient characteristics or in factors influencing the incidence of wound infection after abdominal gynecologic surgery. The incidence of wound infection was 10.6% among women who underwent wound irrigation and 9.8% among those who did not, and the difference was not statistically significant. CONCLUSION: Saline wound irrigation before abdominal wall closure is not helpful in decreasing the incidence of wound infection after abdominal gynecologic surgery.

Adult↗
PubMed2006

Appropriateness of antibiotic prophylaxis in gynecologic surgery at Srinagarind Hospital.

OBJECTIVE: To evaluate the rate of appropriate prophylactic antibiotic use in gynecologic surgery at Srinagarind Hospital. DESIGN STUDY: Prospective descriptive study. SETTING: Srinagarind Hospital, Khon Kaen University, Thailand. MATERIAL AND METHOD: Medical records of 250 women who had undergone gynecologic surgery at Srinagarind Hospital during August 2004 and February 2005 were evaluated. The criteria of appropriate prophylactic antibiotics were based on ACOG recommendation 2001. Data on demographic information, surgery procedure and antibiotic use during surgery were extracted from these medical records and analyzed. MAIN OUTCOMES: Rate of appropriate prophylactic antibiotic use and type of inappropriate use. RESULTS: Two hundred and fifty women had undergone gynecologic surgery during the study period. There were 168 total abdominal hysterectomy (TAH), 12 vaginal hysterectomy (VH), 30 salpingooophorectomy (SO), 3 myomectomy, 30 diagnostic laparoscopy and 7 laparoscopic ovarian cystectomy (LOC). Twenty private staff and twenty residents conducted these operations. The overall rate of appropriate prophylactic antibiotic use was 75.2% (95% CI 69.28-80.33). Main type of inappropriate use were multiple doses and indication not fulfilled. The overall rate of appropriate antibiotic prophylaxis among surgeries conducted by private staff was 53.19% (95% CI 42.66-63.46) and the overall rate of appropriate antibiotic prophylaxis among surgeries conducted by residents was 88.46% (95% CI 82.13-93.83). The rate of early post operative infection between both groups was not different (p = 0.529). There was no drug complication in all subjects. CONCLUSION: The overall rate of appropriate antibiotic prophylaxis in gynecologic surgery at Srinagarind Hospital was 75.2% (95% CI 69.28-80.33). Residents used prophylactic antibiotics more appropriately than private staff.

Adult↗
PubMed2001

[Analysis of urinary tract injury during gynecological surgery performed with preoperative ureter catheterization or intraoperative ureter control].

DESIGN: To analyze urinary tract injuries during gynecological surgery performed with preoperative ureter catheterization or intraoperative ureter control. MATERIAL AND METHODS: Retrospective analysis of 1986 chosen gynecological operations performed between 1990-1998 in Dept. of Gynecological Surgery Polish Mother's Health Center Institute. RESULTS: The overall frequency of urinary injuries was 2.15%. It was less during gynecological surgery performed with ureter catheterization compared to intraoperative ureter control only (ureter: 0.30% vs. 0.55%, p = 0.22; urinary bladder: 0.40% vs. 0.90%, p < 0.05). CONCLUSION: 1/ urinary injury was twice as frequent during ureter control than during ureter catheterization, 2/ urinary injury was the most frequent complication during hysterectomy with adnexa, 3/ the results of our analysis should be treated as a vote "for" ureter catheterization before gynecological surgery.

Female↗
PubMed1976

Perineovulvovaginal preoperative preparation in minor gynecological surgery.

Fifty consecutive patients underwent minor elective gynecologic surgery. Most of them were from the low socioeconomic class. Twenty-five patients had their pubic, vulval and perineal hair shaved as part of the preoperative preparation. All patients underwent the same routine perineal, vulval and vaginal swabbing in the operating room. All patients were then examined for postoperative complications. Only two women (who were shaved) complained of mild lower abdominal pain 48 hours after operation, but neither had any clinical evidence of genital or urinary infection. Their symptoms disappeared with the use of analgesics. Even in developing countries where patients with poor personal hygiene are common, preoperative vulval, pubic and perineal hair shaving prior to minor gynecologic surgery is unnecessary. We suggest that this procedure should be discontinued.

Adult↗