Preoperative evaluation for gynecologic surgery: a guide to judicious, evidence-based testing

Shields, Jessica; Lupo, Andrew; Walsh, Teresa M.; Kho, Kimberly A.

doi:10.1097/gco.0000000000000472

Cited by 5 publications

(5 citation statements)

References 33 publications

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“…Although this decision did include the most common "routine preoperative" tests (i.e., CBC, BMP, ECG, coagulation studies, and so on), it did not permit us to make recommendations regarding tests such as hemoglobin A1c and thyroid-stimulating hormone, measures of disease control for 2 common comorbidities encountered by gynecologic surgeons. Applying the general principle dictating that preoperative testing is meant to reduce perioperative morbidity with optimization of medical conditions and not to diagnose unknown medical problems [47], hemoglobin A1c and thyroid-stimulating hormone would not be necessary in routine preoperative testing [48,49] and should only be ordered for patients with these relevant medical conditions that are not up-to-date on their surveillance laboratory work [15,49,50].…”

Section: Discussionmentioning

confidence: 99%

Preoperative Evaluation for Minimally Invasive Gynecologic Surgery: What Is the Best Evidence and Recommendations for Clinical Practice

Shields

Kho

2019

Journal of Minimally Invasive Gynecology

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Preoperative evaluation for elective benign gynecologic procedures is a necessary step in reducing perioperative complications. Although a thorough history and physical examination are the foundation of this assessment, much evidence exists that physicians rely on unnecessary laboratory and diagnostic testing. Our goal was to perform a systematic review of the available literature regarding preoperative evaluation to better inform preoperative test selection and to identify deficiencies in the current literature. There is very limited data specific to preoperative testing for patients undergoing gynecologic surgeries. Abnormal test results are common when routine, unselected testing is applied. Using a protocol to guide preoperative testing improves patient care by eliminating unnecessary tests without compromising the efficacy of predicting adverse perioperative events or case cancellation and modifications.

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Section: Discussionmentioning

confidence: 99%

Preoperative Evaluation for Minimally Invasive Gynecologic Surgery: What Is the Best Evidence and Recommendations for Clinical Practice

Shields

Kho

2019

Journal of Minimally Invasive Gynecology

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“…The proven benefits of MIGS training include decreased complications, postoperative pain, and hospital LOS to name a few. Consultation with a MIGS subspecialist would be advantageous for patients with multiple comorbid conditions, high fibroid burden, and extensive endometriosis [55]. This highlights the impact of MIGS both for preoperative planning and intraoperative consultation when higher and/or collaborative care is needed.…”

Section: The Rationale For Minimally Invasive Gynecologic Surgerymentioning

confidence: 99%

The role of minimally invasive gynecologic surgeons in the era of subspecialties: when to refer and consult

Shu

Sosa

Pineda

et al. 2022

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of reviewMinimally invasive gynecologic surgery (MIGS) is a subspecialty focus of obstetrics and gynecology with focused expertise on complex benign gynecologic disorders. To date, no formal recommendations have been made in defining a referral system for MIGS. This article reviews the evidence regarding common disorders and procedures and their outcomes, and posits a basis for MIGS referral. Recent findingsIn instances where intraoperative and perioperative features may pose clinical challenges to the surgeon and ultimately the patient, the literature suggests the following scenarios may have adverse outcomes, and therefore, benefit from the skills of MIGS subspecialists: fibroids --at least five myomas, myoma size at least 9 cm, and suspected myoma weight at least 500 g; endometriosis --presence of endometrioma(s), suspected stage III/IV endometriosis, and requirement for advanced adjunct procedures; hysterectomy -uteri at least 250 g or 12 weeks estimated size, at least three prior laparotomies, obesity, and complex surgical history with suspected adhesive disease. SummaryA referral system for MIGS subspecialists has proven benefits for both the gynecologic surgical community as well as the patients and their outcomes. This article provides evidence for collaboration with MIGS especially as it relates to leiomyomatous uteri, endometriosis, and complex hysterectomies.

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“…Prophylactic antibiotic therapy after these procedures is not recommended. Perioperative antibiotic prophylaxis is also not required [54].…”

Section: Possible Complicationsmentioning

confidence: 99%

An Overview of Outpatient Hysteroscopy

Ignaszak-Kaus¹,

Chmaj-Wierzchowska²,

Nowak³

et al. 2022

Clin. Exp. Obstet. Gynecol.

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Objective: Hysteroscopic procedures are minimally invasive procedures that enable to assess the uterine cavity (diagnostic hysteroscopy) and to treat intrauterine lesions (operative hysteroscopy). In recent years have witnessed a steady increase in the number of procedures performed via minimally invasive surgery (MIS) including hysteroscopies. Most outpatient hysteroscopies are painless, without complications, and not only allow to diagnose but also treat several intrauterine pathologies. Vaginoscopy hysteroscopy without using speculum, tenaculum and other potentially painful instrumentation should become the default method for outpatient hysteroscopy. This 'no-touch' technique is faster in contrary to standard hysteroscopy and is associated with less pain. Mechanism: A wide range of feasible procedures, constantly improved endoscopic equipment and tools, improving the technical conditions of the procedure, as well as short hospitalization time and a quick recovery period, are just some of the benefits of hysteroscopic surgeries. Findings in Brief: Performing hysteroscopy in an outpatient setting without general anesthesia addictionally reduces treatment cost and avoid of possible complications of general anesthesia. Conclusions: Performing hysteroscopy in an outpatient setting without general anesthesia (with the patient's consciousness preserved during the surgery) reduces treatment cost and shortens the duration of hospitalization and convalescence, thus increasing patient satisfaction with care.

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Preoperative evaluation for gynecologic surgery: a guide to judicious, evidence-based testing

Cited by 5 publications

References 33 publications

Preoperative Evaluation for Minimally Invasive Gynecologic Surgery: What Is the Best Evidence and Recommendations for Clinical Practice

Preoperative Evaluation for Minimally Invasive Gynecologic Surgery: What Is the Best Evidence and Recommendations for Clinical Practice

The role of minimally invasive gynecologic surgeons in the era of subspecialties: when to refer and consult

An Overview of Outpatient Hysteroscopy

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