Surgical approach to hysterectomy for benign gynaecological disease

Abstract

BackgroundThe four approaches to hysterectomy for benign disease are abdominal hysterectomy (AH), vaginal hysterectomy (VH), laparoscopic hysterectomy (LH) and robotic-assisted hysterectomy (RH). ObjectivesTo assess the effectiveness and safety of different surgical approaches to hysterectomy for women with benign gynaecological conditions. Search methodsWe searched the following databases (from inception to 14 August 2014) using the Ovid platform: Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO. We also searched relevant citation lists. We used both indexed and free-text terms. Selection criteriaWe included randomised controlled trials (RCTs) in which clinical outcomes were compared between one surgical approach to hysterectomy and another. Data collection and analysisAt least two review authors independently selected trials, assessed risk of bias and performed data extraction. Our primary outcomes were return to normal activities, satisfaction, quality of life, intraoperative visceral injury and major long-term complications (i.e. fistula, pelvi-abdominal pain, urinary dysfunction, bowel dysfunction, pelvic floor condition and sexual dysfunction).

Is an enlarged fibroid uterus a contraindication for Non-Descent Vaginal Hysterectomy (NDVH)? Retrospective comparison between cohort whose uterine size ≥ 12 weeks and cohort whose uterine size less than 12 weeks underwent NDVH.

“…As the NDVH is associated with high success rates, faster recovery times, lower morbidity rates , higher patient safety, higher security, efficient economics, excellent cosmesis, fewer perioperative morbidity, least complications, shortened operating time, reduced hospitalization, lesser costs, and quicker convalescence, the most prestigious gynecologic regularity authorities including American College of Obstetricians and Gynecologists (ACOG) in 2009 (5) ,2017 (6) ,2019 (7) , International Society for Gynecologic Endoscopy (ISGE)in 2018,2020 (8,9) , American Association of Gynecologic Laparoscopists (AAGL)in2011 (10) , Danish Health Authority in 2017 (DHA) (11) , National Institute for Health and Care Excellence (NICE) (12) ,Royal College of Obstetricians and Gynecologists (RCOG) (13) , Society Obstetrics and Gynecology of Canada(SOGC) in 2002 (14) ,2011 (15) ,2018 (16) ,2019 (17 ) , DGGG, OEGGG, SGGG collectively in 2015 (18,19) , and Society of Gynecologic Surgeons (SGS) (20), are recommending vaginal route for hysterectomy for treatment of benign gynecologic conditions for mobile uteri up to 280 gram, which corresponding clinically to 12 weeks gestational age uterine size, in at least women who underwent prior vaginal delivery with absent of prior lower abdominal surgical procedures including cesarean section. Also, the same recommendation had been reported in literature (20)(21)(22)(23)(24)(25) and Cochrane library reviews for surgical approach to hysterectomy for benign gynecologic disease of RCTs in 2005 (26) ,2006 (27) ,2009 (28) ,2015 (29) ,2023 (30) compared to traditional abdominal hysterectomy and other MIH including TLH and RALH. Moreover, AAGL has stated "surgeonswithout the requisite training and skills required for the safe performance of vaginal hysterectomy or laparoscopic hysterectomy-should enlist the aid of colleagues who do or should refer patients requiring hysterectomy to such individuals for their surgical care."…”

“…In the latest hysterectomy route trend, VH has increased from 15/100,000 to 75/100,000 (66) . Despite that, VH is recommended by evidence for benign conditions to hysterectomy due to extensively documented health issues involving fewer morbidities, infections febrile episodes, shorter hospital stays, recuperation time and economic benefits versus TAH, TLH, RALH (21)(22)(23)(24)(25)(26)(27)(28)(29)(30) . The NDVH is underutilized and continues after introduction of industry based TLH, RALH even in high scientific communities (5)(6)(7) .…”

Infectious Complications in Laparoscopic Gynecologic Oncology Surgery within an ERAS-Compliant Setting

“…In the last few years, there has been an increasing trend in MIS utilization for gynecologic malignancies, with reassuring evidence on oncological outcomes and low rate of postoperative complications [1,4,6,17,18]. Independently from the surgical approach, the most common postoperative infections after pelvic surgery include vaginal cuff cellulitis (about 8%), infected hematoma or abscess (about 14%), SSI (about 22%), UTIs (about 13%), and pneumonia (about 2%) [27,32]. In line with these observations, the majority of infections in our population were UTIs, followed by abdominal abscesses and SSI.…”

Basic knowledge for counseling patients undergoing risk-reducing salpingo-oophorectomy

“…Gordhandas et al [ 44 ] noted that patients receiving tamoxifen may benefit from a hysterectomy to avoid the risk of endometrial cancer. Concurrent hysterectomy and RRSO may simplify HRT or tamoxifen administration; however, hysterectomy is also associated with an increased hospital stay, morbidity, and cost [ 93 ]. There is no conclusive answer regarding hysterectomy as a risk-reducing surgery for EOC.…”