Considerations to Improve the Evidence-Based Use of Vaginal Hysterectomy in Benign Gynecology

Moen, Michael D.; Walter, Andrew J.; Harmanli, Oz; Cornella, Jeffrey L.; Nihira, Mikio A.; Gala, Rajiv B.; Zimmerman, Carl W.; Richter, Holly E.

doi:10.1097/aog.0000000000000398

Cited by 37 publications

(27 citation statements)

References 15 publications

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“…Collaboration or referral to those who can safely perform vaginal hysterectomies has been suggested to increase vaginal surgery and provide effective care (25). Support of this includes data that high-volume surgeons have shorter operative times, lower morbidity and mortality rates, including operative injury, transfusion rates, and intensive care unit admissions (26,27).…”

Section: Discussionmentioning

confidence: 99%

10: Determining the optimal route of hysterectomy for benign indications: A clinical decision tree algorithm

Schmitt

Carranza

Weaver

et al. 2016

American Journal of Obstetrics and Gynecology

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Objective-To evaluate practice change after initiation of a robotic surgery program using a clinical algorithm to determine the optimal surgical approach to benign hysterectomy.Methods-A retrospective post-robot cohort of benign hysterectomies (2009)(2010)(2011)(2012)(2013) was identified and the expected surgical route was determined from an algorithm using vaginal access and uterine size as decision tree branches. We excluded laparoscopic hysterectomy route. A prerobot cohort (2004)(2005) was used to evaluate a practice change after the addition of robotic technology (2007). Costs were estimated.Results-Cohorts were similar in regard to uterine size, vaginal parity, and prior laparotomy history. In the pre-robot cohort (n=473), 320 hysterectomies (67.7%) were performed vaginally and 153 (32.3%) through laparotomy, with 15.1% (46/305) performed abdominally when the algorithm specified vaginal hysterectomy. In the post-robot cohort (n=1,198), 672 hysterectomies (56.1%) were vaginal; 390 (32.6%), robot-assisted; and 136 (11.4%), abdominal. Of 743 procedures, 38 (5.1%) involved laparotomy and 154 (20.7%) involved robotic technique when vaginal approach was expected. Robotic hysterectomies had longer operations (141 vs 59 minutes, P<.001) and higher rates of surgical site infection (4.7% vs 0.2%, P<.001) and urinary tract infection (8.1% vs 4.1%, P=.05) but no difference in major complications (P=.27) or readmissions (P=.27) compared with vaginal hysterectomy. Algorithm conformance would have saved an estimated $800,000 in hospital costs over 5 years.Conclusion-When a decision tree algorithm indicated vaginal hysterectomy as the route of choice, vaginal hysterectomy was associated with shorter operative times, lower infection rate, and lower cost. Vaginal hysterectomy should be the route of choice when feasible. Financial Disclosure: Dr. Gebhart has served on the advisory board for Astora and received royalties from UpToDate, Inc, and Elsevier BV. The other authors did not report any potential conflicts of interest. Graphical Abstract HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptAn algorithm can be used for decision-making in determining the most appropriate route of hysterectomy to optimize patient outcomes and lower health care delivery costs.

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Section: Discussionmentioning

confidence: 99%

10: Determining the optimal route of hysterectomy for benign indications: A clinical decision tree algorithm

Schmitt

Carranza

Weaver

et al. 2016

American Journal of Obstetrics and Gynecology

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“…Increasing the surgical volume of these cases during residency and in the initial years of practice, along with increased laparoscopic simulation exercises, would help achieve this goal. [27][28][29][30] Surgeons performing less than 10 hysterectomies a year have the highest rates of AH. [27][28][29] Additionally, VH should continue to be reinforced in resident training as the preferred minimally invasive route.…”

Section: -26mentioning

confidence: 99%

“…[27][28][29][30] Surgeons performing less than 10 hysterectomies a year have the highest rates of AH. [27][28][29] Additionally, VH should continue to be reinforced in resident training as the preferred minimally invasive route. 31 As robotic surgery becomes more integrated into residency programs and adapted by the general gynecologist, it will be interesting to examine whether its use decreases AH rates or if it just replaces one of the minimal invasive approaches.…”

Section: -26mentioning

confidence: 99%

Introduction of Laparoscopic Hysterectomy Approach: Decreasing the Abdominal Hysterectomy Approach or Replacing Vaginal Hysterectomy

McLeod¹,

Cao²,

Spiryda³

2015

Surg Res Open J

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CitationMcLeod JB, Cao J, Spiryda LB. Introduction of laparoscopic hysterectomy approach: decreasing the ab- It has been noted in the medical literature that abdominal hysterectomy rates continue to be over 66%, with less than one-third of hysterectomies performed via minimally invasive approaches despite the rapidity of recovery. We compared trends in hysterectomy routes for the years 2000 and 2010 at our institution. Methods: Expedited IRB approval was obtained for a retrospective chart review of all hysterectomies performed during 2000 and 2010. Medical records were abstracted for basic demographics, including age, Body Mass Index (BMI), uterine size (grams), and route of hysterectomy (laparoscopic, vaginal, laparotomy). Laparoscopic approaches included Total Laparoscopic Hysterectomy (TLH), Laparoscopic Supracervical Hysterectomy (LSH), Laparoscopy Assisted Vaginal Hysterectomy (LAVH), and Da Vinci robotic hysterectomy. Standard statistical analysis was performed using JMP statistical programming. Results: No differences were found between mean age and racial distribution in the years analyzed. In 2000 and 2010, 50% of hysterectomies were performed using minimally invasive techniques. In 2000, 47% were performed via the vaginal route whereas in 2010, 47.7% were performed via laparoscopy. When patients were stratified by weight class, obese women (BMI>30) had a statistically significant greater number of hysterectomies performed via the abdominal route when compared to normal weight women; this was independent of uterine weight. African-American women were also found more likely to have an abdominal hysterectomy, but once controlled for uterine weight, this difference dissipated. Conclusions: At our institution, 50% of hysterectomies were performed using minimally invasive techniques in both 2000 and 2010, with laparoscopic approaches essentially replacing vaginal hysterectomies by 2010 without affecting abdominal hysterectomy rates. Minimally invasive approaches continue to lag in obese women.

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“…La vía vaginal es el abordaje menos invasivo y la que se asocia con menor tiempo hasta la recuperación, menores complicaciones, menores costos y mejor resultado estético, motivo por el cual la Asociación Americana de Ginecólogos Laparoscopistas, en concordancia con el Colegio Americano de Obstetras y Ginecólogos, la recomienda como la ruta preferida para las condiciones benignas (2). A pesar de esto, la frecuencia de su realización es inferior a la que se lleva a cabo por vía abdominal o mediante laparoscopia, aun en países que han incrementado la proporción de histerectomías vaginales en los últimos años (3).…”

Section: Introductionunclassified

Impacto de la histerectomía abdominal total y de la histerectomía vaginal sin prolapso en la calidad de vida y la satisfacción sexual. Estudio de cohortes, Medellín, 2015

Correa-Ochoa

Pandales-Pérez

Román-Vásquez

et al. 2017

Rev. Colomb. Obstet. Ginecol.

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Objetivo: identificar diferencias en calidad de vida y sexualidad en mujeres sin prolapso genital intervenidas con histerectomía vaginal o abdominal.Materiales y métodos: estudio de cohortes prospectivo. Se incluyeron mujeres sin prolapso vaginal con condiciones benignas, sin adherencias, con útero menor de 1000 cc, que fueran susceptibles de ser intervenidas tanto por vía abdominal como vaginal en una clínica privada de Medellín, Colombia. Evaluación de calidad de vida con la escala SF-12 antes, a los 2 y 4 meses posquirúrgico y de la sexualidad con la escala Índice de Función Sexual Femenina, antes y a los 4 meses posoperatorio. Comparaciones con ANCOVA ajustadas por los valores basales y por otras características. Se contó con aprobación de comité de ética y se tomó consentimiento informado.Resultados: se incluyeron 24 mujeres en el grupo de histerectomía vaginal y 22 en el grupo de histerectomía abdominal, con características similares antes de la cirugía. Ambos grupos mejoraron en calidad de vida y en satisfacción sexual después del procedimiento. Los puntajes para histerectomía vaginal e histerectomía abdominal fueron, respectivamente: salud física posoperatoria: puntaje ajustado en histerectomía vaginal 49,5 (DS 1,6) e histerectomía abdominal 43,8 (DS 1,7), diferencia 5,6 puntos (IC 95%: 0,87-10,4). Salud mental: 51,0 (DS 1,7) y 59,3 (DS 1,6) puntos, respectivamente, diferencia ajustada 8,4 (IC 95%: 3,6-13,3). Sexualidad: 22,7 (DS 1,8) y 26,5 (DS 1,7), respectivamente, diferencia 3,8 puntos (IC 95%: -1,2-8,7).Conclusión:aunque se encontraron diferencias estadísticamente significativas en la calidad de vida, el puntaje alcanzado no es clínicamente significativo.

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Considerations to Improve the Evidence-Based Use of Vaginal Hysterectomy in Benign Gynecology

Cited by 37 publications

References 15 publications

10: Determining the optimal route of hysterectomy for benign indications: A clinical decision tree algorithm

10: Determining the optimal route of hysterectomy for benign indications: A clinical decision tree algorithm

Introduction of Laparoscopic Hysterectomy Approach: Decreasing the Abdominal Hysterectomy Approach or Replacing Vaginal Hysterectomy

Impacto de la histerectomía abdominal total y de la histerectomía vaginal sin prolapso en la calidad de vida y la satisfacción sexual. Estudio de cohortes, Medellín, 2015

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