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PubMed1998

Comparison of classic intrafascial supracervical hysterectomy with total laparoscopic and laparoscopic-assisted vaginal hysterectomy.

STUDY OBJECTIVE: To evaluate the efficacy of laparoscopic hysterectomy and compare classic intrafascial supracervical hysterectomy (CISH) with total laparoscopic hysterectomy (TLH) and laparoscopic-assisted vaginal hysterectomy (LAVH). DESIGN: Retrospective review (Canadian Task Force classification II-2). SETTING: University-affiliated hospital. PATIENTS: Six hundred fifty women who underwent laparoscopic hysterectomy from August 1993 to August 1996. INTERVENTIONS: Charts of 231 women undergoing CISH, 102 TLH, and 317 LAVH were reviewed regarding patient characteristics, indications, uterine weight, associated procedures, estimated blood loss, operating time, and complications. MEASUREMENTS AND MAIN RESULTS: Among the three groups, despite having the largest specimen weight and highest number of associated procedures, women undergoing CISH had the lowest complication rate and smallest amount of estimated blood loss (p <0.05). The next lowest was the TLH group (p <0.05). Although LAVH was associated with shortest operating time, there were no statistically significant differences among groups (p >0.05). The CISH group had relatively shorter operating times when compared with similar average specimen weights. Patients who underwent total hysterectomy by either TLH or LAVH had more postoperative visits than those having CISH (p <0.05, Fisher's exact test); the LAVH group had the highest number of postoperative visits. The overall complication rate appeared to be highest in the LAVH group (p <0.05, Fisher's exact test). CONCLUSION: Among the three groups, CISH resulted in lowest blood loss and fewest complications; these values were also lower for TLH than for LAVH. If the cervix is removed along with the uterus, TLH is recommended. In our opinion, CISH is preferred in cases of benign uterine diseases because it lowers major operative complications, especially in women who have large masses with no pathologic lesions of the cervix.

Adult↗
PubMed1993

Laparoscopic supracervical hysterectomy. A comparison of morbidity and mortality results with laparoscopically assisted vaginal hysterectomy.

Laparoscopic applications in hysterectomy promise to be a factor in decreasing both economic and medical morbidity. However, with the need for both advanced laparoscopic skills and good vaginal surgical techniques, the meaningful conversion rate (total abdominal hysterectomy to laparoscopically assisted vaginal hysterectomy) appears to be low. A less morbid approach may be subtotal hysterectomy, in appropriate candidates, particularly if this procedure is readily accomplished by an increased number of physicians. A comparison of outcomes in 50 laparoscopically assisted vaginal hysterectomy patients versus 50 laparoscopic supracervical hysterectomy patients was made, demonstrating that the subtotal procedure was significantly less morbid.

Adult↗
PubMed1996

Laparoscopically assisted vaginal hysterectomy (LAVH)--an alternative to total abdominal hysterectomy.

OBJECTIVE: To assess the feasibility of performing laparoscopically assisted vaginal hysterectomy (LAVH) on women referred for total abdominal hysterectomy (TAH). DESIGN: Prospective intervention study on women referred for TAH from a gynaecological outpatient clinic. SETTING: Groote Schuur Hospital, Cape Town. This institution accepts patient referrals from community hospitals and family physicians for hospitalised care. PATIENTS: Forty-one consecutive women referred for TAH were suitable for LAVH. Women able to undergo conventional vaginal hysterectomy, women with uterine fibroids exceeding 14 weeks in size and subjects with malignant disease were excluded. The most common indication for hysterectomy was persistent abnormal bleeding. INTERVENTION: Of the 41 women assessed pre-operatively as suitable for LAVH, the procedure was successfully performed in 40 by means of a bipolar desiccation and scissors transection technique with re-usable equipment. MAIN OUTCOME MEASURES: Assessment of intra-operative and postoperative morbidity, surgical complications, operating time, length of hospitalisation and assessment at postoperative visit 6 weeks after surgery. RESULTS: Only 1 woman was unable to undergo successful LAVH because she had pelvic adhesions and densely adherent loops of bowel; a TAH was performed. No operative complication occurred. One woman had postoperative vaginal bleeding controlled with a vaginal pack, and a diagnosis of von Willebrand's disease was subsequently established. No patient had febrile morbidity and when reviewed at clinic 6 weeks later all women were well. CONCLUSIONS: LAVH is possible in many women in whom hysterectomy is indicated but conventional vaginal hysterectomy is not feasible. In this study LAVH was found to be a safe procedure with minimal complications.

Adolescent↗
PubMed2004

Total laparoscopic hysterectomy and laparoscopic supracervical hysterectomy.

Laparoscopic hysterectomy was first performed in 1989 and has become one of the procedures that may be offered to women with significant gynecologic symptoms. This article describes alternatives to hysterectomy, indications for laparoscopic hysterectomy, and outcomes and complications of laparoscopic hysterectomy as compared with vaginal and abdominal hysterectomy. Surgical technique for both total and supracervical hysterectomy are described as well as the learning curve, training, and credentialing for these procedures.

Abdomen↗
PubMed1994

A new approach to hysterectomy without colpotomy: pelviscopic intrafascial hysterectomy.

OBJECTIVE: Total abdominal and vaginal hysterectomies have been performed by extrafascial enucleation of the uterus with amputation of the upper vagina. Our new method, which is limited to an intrafascial cylindriform enucleation of the cervix, leaves intact the highly vascularized extrafascial cervical tissue, the corresponding nerves, and the topography of the ureters. STUDY DESIGN: From December 1991 to December 1992, 60 patients underwent an intrafascial hysterectomy by pelviscopy and two patients by laparotomy for leiomyomas, endometriosis, and other intractable bleeding disorders and for a variety of additional benign gynecologic diseases. Uterine extirpation was performed in the classic manner with grasping forceps, scissors, ligatures, and sutures. No electrosurgical equipment, stapling devices, or lasers were used. RESULTS: We analyzed our cases according to intraoperative, immediate postoperative, and late postoperative complications. We had no major complications. Average operating time is compatible with that of conventional total abdominal or vaginal and laparoscopy-assisted vaginal hysterectomy. Blood loss was minimal (average drop of hemoglobin 1.8 gm). Average hospitalization was 50.6 hours. CONCLUSION: There has never been an indication for the removal of the normal cervix at hysterectomy, other than for cancer prophylaxis. The synthesis of supracervical extirpation of the uterus, conization of the cervix, and operative laparoscopy (pelviscopy) enables us to perform a truly laparoscopic hysterectomy without colpotomy. Pelvic floor support is maintained and transvaginal sexual sensation is less likely to be impaired because of the preservation of the cardinal and uterosacral ligaments. With the serrated-edge macromorcellator, morcellated cylinders of cervical and uterine body tissue guarantee a thorough histologic examination and interpretation. Physical stress to the patient is minimized. There are no abdominal or vaginal incisions. The abdominal space remains practically unopened. Pelviscopic intrafascial hysterectomy equates with minimally invasive and organ-preserving surgery. It may be sufficient for cervical and endometrial cancer prophylaxis.

Adult↗
PubMed2003

Alteration of sexual function after classic intrafascial supracervical hysterectomy and total hysterectomy.

STUDY OBJECTIVE: To investigate possible advantages of classic intrafascial supracervical hysterectomy (CISH) over total hysterectomy with respect to sexual function. DESIGN: Retrospective study (Canadian Task Force classification II-2). SETTING: Department of obstetrics and gynecology at a university teaching hospital. PATIENTS: One hundred eight women who had undergone CISH and 125 who had total hysterectomy. INTERVENTION: A standard questionnaire sent to all 233 patients a minimum of 12 and maximum of 24 months after hysterectomy. MEASUREMENTS AND MAIN RESULTS: Data obtained on sexual function were classified by changes (improved, no change, deteriorated) before and after hysterectomy. No significant difference was found between groups in mean time interval between surgery and first intercourse. Overall, over two-thirds of women experienced either no change or improvement in sexual function regardless of which procedure was performed, with no statistically significant differences in changes in libido, frequency of coitus, frequency of orgasm, and degree of orgasm. CONCLUSIONS: Women who underwent CISH and total hysterectomy had no statistically significant differences with regard to postoperative sexual function.

Adult↗
PubMed2000

Decrease in the number of abdominal hysterectomies after introduction of laparoscopic hysterectomy.

STUDY OBJECTIVE: To compare two 3-year periods before and after laparoscopic hysterectomy was introduced into our resident training program. DESIGN: Retrospective analysis (Canadian Task Force classification II-2). SETTING: Teaching hospital in the Netherlands. PATIENTS: Women undergoing hysterectomy from 1992 to 1994 and 1995 to 1997. INTERVENTION: Abdominal, vaginal, and laparoscopic hysterectomies. MEASUREMENTS AND MAIN RESULTS: Laparoscopic hysterectomy significantly (p<0.002) reduced the number of abdominal hysterectomies. CONCLUSION: To reduce the number of abdominal hysterectomies, it is essential that the laparoscopic procedure be taught to residents.

Adult↗
PubMed2003

Gasless laparoscopic hysterectomy: a comparative study with total abdominal hysterectomy.

AIM: To evaluate the short-term results of gasless laparoscopic hysterectomy (GLH) compared to total abdominal hysterectomy. METHODS: A comparative study of GLH using an abdominal wall-lifting device (n = 31) and total abdominal hysterectomy (TAH) (n = 31) was carried out between July 1999 and July 2001. RESULTS: One patient (3.2%) in the GLH group required conversion to TAH. The operative time was 168 +/- 38 min and 112 +/- 29 min (P < 0.001) for the GLH and TAH groups, respectively. Gasless laparoscopic hysterectomy cases had a shorter hospital stay and convalescent period (2.6 +/- 0.9 days vs 5.0 +/- 1.3 days, P < 0.001 and 8.0 +/- 3.0 days vs 15.8 +/- 2.4 days, P < 0.001, respectively). Postoperative meperidine use and estimated blood loss were lower for GLH (P < 0.001). Complications were comparable in the two groups. Hospital charges were 8.5% higher for GLH (P = 0.02). CONCLUSIONS: Gasless laparoscopic hysterectomy may be an alternative technique for hysterectomy which provides laparoscopic benefit with minimal increase in hospital charges.

Adult↗
PubMed1995

[Laparoscopy-assisted vaginal hysterectomy (LAVH)--a comparison between vaginal and abdominal hysterectomy with reference to intra- and postoperative quality parameters].

First experiences after the introduction of LAVH with regard to intra- and postoperative parameters of quality in comparison with the classical abdominal and vaginal hysterectomies are shown. The main indications for LAVH were large myomas, previous pelvic surgery and adnexal mass. Intra- and postoperative complications, time of operation, uterine weight, estimated blood loss, the period of use of analgetics and discharge wishes of 40 patients after abdominal and 25 after vaginal hysterectomies were compared with the results of 30 patients after LAVH. Patients after abdominal hysterectomy need more and longer analgetics. The lowest perioperative morbidity we found in the LAVH group. In cases with enlarged uteri the high blood loss during the vaginal hysterectomy can be significantly reduced with LAVH. LAVH offers a new technique to convert a lot of abdominal hysterectomies with benign indications (large myomas, adhesions, adnexal mass) into vaginal hysterectomies.

Adult↗
PubMed2000

A comparison of laparoscopic supracervical hysterectomy vs laparoscopically assisted vaginal hysterectomy.

BACKGROUND: We set out to compare the length of stay, costs, and morbidity associated with laparoscopic supracervical hysterectomy (LSH) with laparoscopically assisted vaginal hysterectomy (LAVH). METHODS: We performed a cohort analysis of consecutive patients at a university-based medical center from April 1997 through October 1999. RESULTS: A total of 145 patients were identified initially; however, 13 cases were excluded because of concomitant procedures (retropubic urethropexy, lymphadenectomy, paravaginal repair). Of the 132 patients included in the study, 27 underwent LSH and 105 underwent LAVH. The two groups were similar with respect to gravidity, parity, uterine weight, and preoperative diagnosis. Patients undergoing LSH had significantly shorter operating times (median, 181 vs 220 min, p = 0.007), briefer hospital stays (median, 1.0 vs 2.0 days, p = 0.0001), and less blood loss (median, 125 vs 400 ml, p = 0.0001). None of the patients submitted to LSH experienced morbidity, as compared with a 13% morbidity rate for LAVH (bladder injury, n = 3; blood loss >1000 ml, n = 7; vaginal cuff hematoma, n = 4; 0% vs 13%; p = 0.04). CONCLUSIONS: Patients undergoing laparoscopic supracervical hysterectomy had shorter operating times, shorter hospital stays, and less morbidity than those who underwent laparoscopically assisted vaginal hysterectomy. The practice of routine cervicectomy at laparoscopic hysterectomy should be reconsidered.

Case-Control Studies↗
PubMed1994

Sexuality after hysterectomy: a model based on quantitative and qualitative analysis of 104 women before and after subtotal hysterectomy.

To study the effect of subtotal hysterectomy on a woman's sexual life 104 women were interviewed 1 month before and 1 year after subtotal hysterectomy. The interview was semi-structured with the addition of unstructured, open questions. Data concerning sexuality before and after the operation were evaluated with statistical methods, and the result was compared to the answers to the open questions. The most important factor for postoperative sexuality was preoperative sexual activity and enjoyment. Most women described the meaning of sexuality in terms of partner relationship. Those who reported improved sexuality in most cases described the improvement in terms of improved personal sexual capacity, whereas most cases of deterioration described the deterioration in terms of absent, poor, or malfunctioning partner relationship. A model for sexuality after hysterectomy is introduced. Sexual functioning before the operation is the most important factor. Partner sexual functioning, socioemotional support from the partner, adaptation to the consequences of the hysterectomy, mental status, physical ability and hormonal status are other factors influencing sexuality after hysterectomy.

Adult↗
PubMed2002

Hysterectomy and ovarian function: levels of follicle stimulating hormone and incidence of menopausal symptoms are not affected by hysterectomy in women under age 45 years.

OBJECTIVE: To investigate levels of follicle stimulating hormone (FSH), as a measure of ovarian function and menopausal symptoms prior to and following hysterectomy in women under the age of 45 years. DESIGN: This was a prospective controlled study. SAMPLE: A total of 56 hysterectomy patients and 34 controls, up to the age of 42 years, were recruited. METHODS: Women undergoing hysterectomy were recruited prior to their operation and were matched, where possible, with controls for age, parity and smoking. Five blood samples were taken over 2 years, two before the operation (or at a 1-month interval in the control group) and then at 6 months, 1 year and 2 years. Questionnaires were completed at each sampling to assess symptoms associated with reduced estrogen secretion. RESULTS: No significant differences in FSH levels between patients and controls were found. Modest differences in FSH levels between different time-points were identified (p = 0.03), but this disappeared if age and smoking were included as covariates. For the questionnaire data, there were no significant differences between the two groups on the somatic and vasomotor scales, but for psychological symptoms the patients scored significantly higher than the controls (p = 0.007), particularly at the pre-operation time-point. CONCLUSION: The study found no evidence of compromise of ovarian function, as reflected in FSH levels, within 2 years of hysterectomy. Psychological symptoms were higher in women undergoing hysterectomy both before and after the operation.

Adult↗
PubMed1994

Cost Comparison Between Laparoscopic Hysterectomy and Abdominal Hysterectomy at the Women and Infants Hospital of Rhode Island

Two cohorts of 10 women, 1 treated by laparoscopic hysterectomy, and 1 treated by abdominal hysterectomy were matched by age, gravity, parity, preoperative indications, and uterine size. The hospital charges for each cohort were then analyzed according to the following categories: operating room time, operating room supplies, laboratory charges, anesthesia services, room and board, and pharmacy charges. The laparoscopic hysterectomy group had lower dollar charges for operating room time (N.S.), anesthesia fee (N.S.), laboratory charges, room and board charges, and total bills were significantly lower. The abdominal hysterectomy group had significantly less in operating room supplies. I conclude that, overall, laparoscopic hysterectomy represents cost-savings in the hospital environment.

Journal Article↗
PubMed2000

Hysterectomy-the patient's view: a survey of outcomes of hysterectomy in a district general hospital.

Debate continues on the preferred method of hysterectomy, usually focusing on economic implications and details such as length of inpatient stay and time to return to work. However, little published data exists on patients' level of satisfaction with hysterectomy. We performed a retrospective survey of patients' views after different methods of hysterectomy. Patients were asked about discharge timing after operation, success or failure in relieving their symptoms, the presence of any new symptoms, and overall satisfaction. Six hundred and fifty-three patients were identified. The questionnaire response rate was 82.5%. As noted by other authors there was a difference in the rate of return to normal activity, depending on the method of hysterectomy. Significantly a proportion of patients felt discharge was too early. There was no difference in overall satisfaction rates or in the incidence of new problems between methods. Overall, patients were highly satisfied with the outcome after hysterectomy with no method being superior.

Journal Article↗
PubMedDate not supplied

A comparison of laparoscopic supracervical hysterectomy and total abdominal hysterectomy outcomes.

STUDY OBJECTIVE: To compare operative and postoperative results of laparoscopic supracervical hysterectomy (LSH) and total abdominal hysterectomy (TAH). DESIGN: Cohort retrospective analysis of consecutive patients (Canadian Task Force classification II-3). SETTING: Department of gynecology at a metropolitan medical center. PATIENTS: Two hundred-twenty women who underwent LSH with or without bilateral salpingo-oophorectomy (BSO). Two hundred-twenty women who underwent TAH with or without BSO. Both groups had similar surgical indications and final pathology. MEASUREMENTS AND MAIN RESULTS: Women who underwent LSH had a shorter operating time than those in the TAH group (47.7 +/- 14.6 min vs 74.9 +/- 25.6 min). Hospital stay was significantly shorter in the LSH group, and those patients returned to work sooner. The operative complication rate was higher in the TAH group (2.7% vs 0.9%). Postoperative complication rate for the TAH group was higher than the LSH group (25% vs zero). CONCLUSION: Laparoscopic supracervical hysterectomy is a safe and effective surgical treatment for patients in need of a hysterectomy with or without BSO. The procedure can be performed in an outpatient setting. Patients experience a much quicker recovery than those who undergo TAH, and the complication rate is significantly lower.

Adult↗
PubMed1994

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 with 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.

Adult↗
PubMed1996

[Comparison of laparoscopically assisted vaginal hysterectomy with abdominal hysterectomy. Technique and results].

Technique and Results: The aim of this prospective randomised study was to compare laparoscopy-assisted vaginal hysterectomy (LAVH, group A) with abdominal hysterectomy (abd. HE, group B). Therefore, 35 hysterectomies due to non-malignant diseases such as uterine fibroma were performed in each group. A rather simple technique of LAVH was developed. In respect of the indication for hysterectomy, mean duration of operation and the size of the excised uteri there were no statistical differences between the two groups. One severe complication of haemorrhage was observed after LAVH in a patient suffering from a coagulopathy. The requirements for analgesics were significantly lower after LAVH compared to abd. HE during the postoperative period. A significantly lower serum concentration of the c-reactive protein on the first and third days after operation was found in group A. The patients of group A were discharged on the average 5 days after operation and 11 days in group B, respectively. Hence LAVH should replace abd. HE in most cases with the advantages of shorter hospitalisation, minimised requirements for analgesics and cost reduction.

Adult↗
PubMed1994

A simpler approach to hysterectomy: one-suture laparoscopic hysterectomy.

This article describes in detail a new approach to laparoscopic hysterectomy. It is based on understanding the vasculature of the uterus, cervix, and cardinal ligament. The result of this appreciation of the anatomy is a clean, logical, rapid, anatomic approach to hysterectomy not previously promoted. There is a dissectible, loose, fibrous plane that lies between the uterus and the portion of the uterine artery that courses up and down the side of the uterus. It is traversed by multiple small branches of the uterine artery, which are coagulated easily with monopolar coagulation current. By the dissection of this plane down the side of the uterus and cervix, the cardinal ligament can be peeled off the cervix. This allows a bloodless dissection well away from any risk of injury to the ureter. The anatomy and surgical technique are described for laparoscopic hysterectomy and laparoscopically assisted vaginal hysterectomy.

Female↗