Retroperitoneal and retrograde total laparoscopic hysterectomy as a standard treatment in a community hospital

Volpi, Eugenio; Bernardini, Luca; Angeloni, Moira; Cosma, Stefano; Mannella, Paolo

doi:10.1016/j.ejogrb.2013.10.013

Cited by 8 publications

(8 citation statements)

References 19 publications

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“…as a technique to control blood loss and protect the ureter, even in cases with large uteri. The RPD required for this technique may also help prevent other visceral injuries by allowing full visualization and lateralization of the ureters . A randomized study of 400 patients showed shorter operative time (OT) and significantly less blood loss in patients who underwent uterine artery ligation at the origin versus the isthmo‐cervical region …”

Section: Methodsmentioning

confidence: 99%

Value‐based assessment of hysterectomy approaches

Danilyants¹,

MacKoul²,

Baxi³

et al. 2018

J of Obstet and Gynaecol

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Aim By evaluating operative outcomes relative to cost, we compared the value of minimally invasive hysterectomy approaches, including a technique discussed less often in the literature, laparoscopic retroperitoneal hysterectomy (LRH), which incorporates retroperitoneal dissection and ligation of the uterine arteries at their vascular origin. Methods Retrospective chart review of all women (N = 2689) aged greater than or equal to 18 years who underwent hysterectomy for benign conditions from 2011 to 2013 at a high‐volume hospital in Maryland, USA. Procedures included: laparoscopic supracervical hysterectomy, robotic‐assisted laparoscopic hysterectomy (RALH), total laparoscopic hysterectomy, laparoscopic‐assisted vaginal hysterectomy, total vaginal hysterectomy (TVH), and LRH. Results Total vaginal hysterectomy had the highest intraoperative complication rate (9.6%; P < 0.0001) but the lowest postoperative complication rate (1.8%; P < 0.0001). Robotics had the highest postoperative complication rate (11.4%; P < 0.0001). LRH had the shortest operative time (71.2 min; P < 0.0001) and the lowest intraoperative complication rates (2.1%; P < 0.0001). LRH and TVH were the least costly (averaging $4061 and $6416, respectively), while RALH was the most costly ($9354). Taking both operative outcomes and cost into account, LRH, TVH and laparoscopic‐assisted vaginal hysterectomy yielded the highest value scores; total laparoscopic hysterectomy, RALH, and laparoscopic supracervical hysterectomy yielded the lowest. Conclusion Understanding the value of surgical interventions requires an evaluation of both operative outcomes and direct hospital costs. Using a quality‐cost framework, the LRH approach as performed by high‐volume laparoscopic specialists emerged as having the highest calculated value.

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Section: Methodsmentioning

confidence: 99%

Value‐based assessment of hysterectomy approaches

Danilyants¹,

MacKoul²,

Baxi³

et al. 2018

J of Obstet and Gynaecol

View full text Add to dashboard Cite

show abstract

“…The retroperitoneal dissection required for this technique may also help prevent other visceral injuries by allowing full visualization and lateralization of the ureters. 15–17 A randomized study of 400 patients showed shorter operative time and significantly less blood loss in patients who underwent uterine artery ligation at the origin versus the isthmo-cervical region. 18…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Hysterectomy Outcomes: Hospital vs Ambulatory Surgery Center

MacKoul¹,

Danilyants²,

Baxi³

et al. 2019

JSLS

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Background and Objective:Compare operative outcomes of laparoscopic hysterectomy in an outpatient hospital setting versus freestanding ambulatory surgery center.Methods:Retrospective cohort study of two groups in an outpatient hospital surgery department and freestanding ambulatory surgical center, both serving the Washington, DC area. Women, 18 years or older, who underwent laparoscopic hysterectomy for benign conditions in an outpatient hospital setting between 2011 and 2014 (n = 821), and at an ambulatory surgery center between 2013 and 2017 (n = 1210). Laparoscopic hysterectomy with retroperitoneal dissection and early ligation of the uterine arteries at the origin, performed by gynecologic surgical specialists from a single practice. Patient characteristics, medical history, uterine weight, pathology, operating times, estimated blood loss, and complications were analyzed.Results:The mean uterine size between settings was not significantly different (Ambulatory Surgery Center, 349.4 g; Hospital, 329.7 g). The largest uteri removed at the surgery center was 3500 g; at the hospital it was 2489 g. The surgery center had a shorter average operating time than the hospital (53.7 and 61.3 minutes, respectively; P < .001). Intraoperative and postoperative complication rates were not significantly different between settings (2.7% and 3.7%, surgery center; 2.1% and 4.8%, hospital). There were two hospital transfers from the surgery center: 1 for blood transfusion, and 1 for low oxygen saturation. Same-day discharge occurred in 99.8% of surgery center patients versus 88% hospital patients.Conclusions:Laparoscopic hysterectomy can be performed safely and effectively by skilled surgeons at a freestanding ambulatory surgery center, even in complex cases with large uteri.

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“… 6 Several studies of TLH have demonstrated that ligation of the uterine artery where it originates from the internal iliac artery is effective for reducing blood loss. 7 – 11 …”

Section: Introductionmentioning

confidence: 99%

Retroperitoneal Approach in Single-Port Laparoscopic Hysterectomy

Kim

et al. 2016

JSLS

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Background and Objectives:In single-port laparoscopic hysterectomy(SP-LH), ligation of the uterine artery is a fundamental step. We analyzed the effectiveness and safety of 2 different surgical approaches to ligate the uterine artery in SP-LH for women with uterine myomas or adenomyosis.Methods:A single surgeon (TJ Kim) performed 36 retroperitoneal single-port laparoscopic hysterectomies (SP-rH) from September 1st 2012 to April 30th 2013. We compared these cases with 36 cases of conventional single-port laparoscopic abdominal hysterectomy (SP-aH) performed by the same surgeon from November 1st 2011 to July 31th 2012 (historic control). In the SP-rH cases, the retroperitoneal space was developed to identify the uterine artery; then, it was ligated where it originates from the internal iliac artery.Results:Estimated blood loss (EBL) was decreased in the SP-rH group compared with the SP-aH group (100 mL vs 200 mL; P = .023). The median total operative time was shorter in the SP-rH group (75 minutes vs 93 minutes; P < .05). The operative time of the Scope I phase, including ligation of the utero-ovarian (or infundibulopelvic) ligament, round ligament, uterine artery, and detachment of the bladder, was longer in the SP-rH group compared with that in the SP-aH group (26.0 minutes vs 24 minutes; P = .043). However, the operative time of the Scope II phase, including detachment of the uterosacral-cardinal ligament, vaginal cutting, and uterus removal, was shorter in the SP-rH group (19.5 minutes vs 30 minutes; P < .05). Operative complications were not significantly different between the groups (P = .374).Conclusion:Although SP-rH may be considered technically difficult, it can be performed safely and efficiently with surgical outcomes comparable to those of SP-aH.

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Retroperitoneal and retrograde total laparoscopic hysterectomy as a standard treatment in a community hospital

Cited by 8 publications

References 19 publications

Value‐based assessment of hysterectomy approaches

Value‐based assessment of hysterectomy approaches

Laparoscopic Hysterectomy Outcomes: Hospital vs Ambulatory Surgery Center

Retroperitoneal Approach in Single-Port Laparoscopic Hysterectomy

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