Comparison of Laparoscopic Hysterectomy in Patients with Endometriosis with and without an Obliterated Cul-de-sac

Melnyk, Alexandra I.; Rindos, N.; Khoudary, Samar R. El; Lee, Ted Teh Min

doi:10.1016/j.jmig.2019.07.001

Cited by 15 publications

(8 citation statements)

References 13 publications

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“…More recently, Melnyk et al examined 333 patients to determine if there was a difference in intraoperative outcomes in endometriosis patients with and without obliterated cul-de-sacs undergoing laparoscopic hysterectomies between 2012 and 2016 [23]. They found that patients with stage IV endometriosis who also had an obliterated cul-de-sac required laparoscopic modified radical hysterectomy in addition to other intraoperative procedures compared to those who had stage IV endometriosis without an obliterated cul-de-sac.…”

Section: Discussionmentioning

confidence: 99%

Nerve-Sparing Modified Radical Hysterectomy for Severe Endometriosis and Complex Pelvic Pathology

Nezhat

Nguyen

Ackroyd

et al. 2020

Cureus

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Background Laparoscopic nerve-sparing modified radical hysterectomy with or without robotic assistance is known for its benefits as a definitive treatment for severe endometriosis. Undiagnosed endometriosis is common in patients with symptomatic fibroids or chronic pelvic pain. There are minimal studies that outline the safety and feasibility of nerve-sparing modified radical hysterectomy for other complex pelvic pathology in addition to endometriosis.

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Section: Discussionmentioning

confidence: 99%

Nerve-Sparing Modified Radical Hysterectomy for Severe Endometriosis and Complex Pelvic Pathology

Nezhat

Nguyen

Ackroyd

et al. 2020

Cureus

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“…According to previous reports, 6 , 8 , 9 the laparoscopic surgeons, in total laparoscopic hysterectomy (TLH), are still facing surgical challenges and the risk of extensive retroperitoneal dissection below the level of the uterine artery up to the vaginal vault in cases of severe pelvic endometriosis with a risk of increasing morbidities. The VLH reported here, performed in a reverse direction to that of the conventional laparo-vaginal approach (TLH or LAVH), demonstrated no injury to autonomic pelvic nerves, the rectum or the ureter, and conserved the vaginal length following hysterectomy for severe pelvic endometriosis ( Table 3 ).…”

Section: Discussionmentioning

confidence: 99%

Vagino-Laparoscopic Conservative Strategy of Hysterectomy in Indicated Cases of Severe Pelvic Endometriosis Followed by 24 Months of Depot-Medroxyprogesterone Acetate Therapy— A Symptom-Solving Treatment Model to Ease Surgical Challenges

Purohit,

Sharma,

Meher

et al. 2023

IJWH

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Purpose To demonstrate the long-term outcome of a symptom-solving treatment model (SSTM). Patients and Methods An observational study was carried out between June 2016 and December 2022 in our private setup on consecutive candidates of hysterectomy for severe pelvic endometriosis. Candidates were treated by the SSTM, which constitutes a systematic vagino-laparoscopic conservative strategy of hysterectomy with preservation of the ovary or ovaries followed by 24 months of postoperative depot-medroxyprogesterone acetate (DMPA) therapy. Cases were followed up to December 2022, 2.5 years beyond the last hysterectomy in May 2020. Main Outcome Measures Relief of endometriosis-associated symptoms and prevention of recurrence in the long term. Results Symptomatic relief of endometriosis-related pain, such as cyclical dysmenorrhoea, pelvic pain, dyschezia, and vaginal pain, occurred in all 68 (100%) cases from the next expected date of menstruation. None of the cases showed a recurrence of endometriosis-related pelvic pain; overall, 37 (54.41%) cases crossed 4–6 years, and 31 (45.58%) cases crossed 2.5–4.0 years following the hysterectomy operation. Four (5.88%) cases had non-endometriotic pelvic pain. None of the cases required repeat surgery or had any major side effects or complications due to DMPA. No major perioperative complications were observed. The results were achieved without the requirement of challenging extensive retroperitoneal laparoscopic dissection, ureterolysis, and rectum surgeries. Conclusion This SSTM can be an option in indicated cases of severe pelvic endometriosis to provide symptom relief and prevent the recurrence of endometriosis-associated pelvic pain in the long term.

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“…Thus, even in the presence of extensive adhesion formation, which was not the case in our patient, the placement of the double-J stents allowed the ureters to be well demarcated, even where they were hidden among adhesions. Ureteral double-J stenting is also described in the literature, with studies reporting the placement of double-J stents prior to laparoscopic Wertheim surgery for cervical cancer [ 37 ] or complex gynecological surgery for endometriosis [ 38 ] and, more recently, hysterectomy after UTx [ 5 ]. Although a recent study found that laparoscopic hysterectomy may be associated with a higher risk of ureteral injury than abdominal hysterectomy, studies by Chang et al [ 39 ] and Han et al [ 40 ] comparing the clinical efficacy of a temporary ureteral catheter in cervical cancer patients undergoing laparoscopic radical hysterectomy showed that a ureteral catheter that is placed preoperatively can help to identify the ureter but does not reduce the incidence of ureteral injury.…”

Section: Discussionmentioning

confidence: 99%

Uterine allograft removal by total laparoscopic hysterectomy after successful cesarean delivery in a living-donor uterus recipient with uterovaginal agenesis (MRKHS)

Brucker

Krämer

Abele

et al. 2022

Arch Gynecol Obstet

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Purpose To limit the burden of long-term immunosuppression (IS) after uterus transplantation (UTx), removal of the uterine allograft is indicated after maximum two pregnancies. Hitherto this has required graft hysterectomy by laparotomy. Our objective was to demonstrate, as a proof of concept, the feasibility of less traumatic transplantectomy by total laparoscopic hysterectomy (TLH). Patient A 37-year-old woman with uterovaginal agenesis due to Mayer–Rokitansky–Küster–Hauser syndrome (MRKHS) who had undergone neovaginoplasty at age 19 years prior to living-donor (LD) UTx in 10/2019 at age 35 years gave birth to a healthy boy by primary cesarean section in 06/2021. During pregnancy, she developed impaired renal function, with bilateral hydronephrosis, necessitating early allograft removal in 09/2021 to prevent chronic kidney disease, particularly during a potential second pregnancy. Methods Transplantectomy by TLH essentially followed standard TLH procedures. We paid meticulous attention to removing as much donor tissue as possible to prevent postoperative complications from residual donor tissue after stopping IS, as well as long-term vascular damage. Results TLH was performed successfully without the need to convert to open surgery. Surgical time was 90 min with minimal blood loss. No major complications occurred intra- or postoperatively and during the subsequent 9-month follow-up period. Kidney function normalized. Conclusions To our knowledge, we report the first successful TLH-based removal of a uterine allograft in a primipara after LD UTx, thus demonstrating the feasibility of TLH in uterus recipients with MRKHS.

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Comparison of Laparoscopic Hysterectomy in Patients with Endometriosis with and without an Obliterated Cul-de-sac

Cited by 15 publications

References 13 publications

Nerve-Sparing Modified Radical Hysterectomy for Severe Endometriosis and Complex Pelvic Pathology

Nerve-Sparing Modified Radical Hysterectomy for Severe Endometriosis and Complex Pelvic Pathology

Vagino-Laparoscopic Conservative Strategy of Hysterectomy in Indicated Cases of Severe Pelvic Endometriosis Followed by 24 Months of Depot-Medroxyprogesterone Acetate Therapy— A Symptom-Solving Treatment Model to Ease Surgical Challenges

Uterine allograft removal by total laparoscopic hysterectomy after successful cesarean delivery in a living-donor uterus recipient with uterovaginal agenesis (MRKHS)

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