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Sample records for wertheim-meigs radical hysterectomy

  1. Radical hysterectomy in surgical treatment of invasive cervical cancer at the Department of gynecology and obstetrics in Novi Sad in the period 1993-2013.

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    Đurđević Srđan

    2015-01-01

    Full Text Available Introduction. During the period from 1993 - 2013, 175 women with invasive cervical cancer underwent radical hysterectomy sec. Wertheim-Meigs at the Department of Gynecology and Obstetrics, Clinical Center of Vojvodina in Novi Sad. Indications for radical hysterectomy comprise histopathologically confirmed invasive cervical cancer in stages I B 1 - II B according to the International Federation of Gynecology and Obstetrics. Material and Methods. Stage of the disease or extent of the disease spread to the adjacent structures was assessed in accordance with the International Federation of Gynecology and Obstetrics staging system from 2009. Exclusion criteria were all other stages of this disease: I A and stages higher than II B, as well as the absence of definite histological confirmation of the cervical cancer (primary endometrial or vaginal cancer which infiltrates the uterine cervix. Prior the operation, the following had to be done: the imaging of pelvis and abdomen, chest X-ray in two directions, electrocardiography, internist and anesthesiological examination. Results. The patients’ age ranged from 24-79 years (x : 46 years, and the operation duration was 120-300 minutes (x : 210 min.. Stage I B 1 was found in 64.6% of operated patients, 14.8% of the patients were in stage I B 2, 9.1% were in stage II A and 11.4 % were in stage II B. Blood loss during the operation ranged from 50-800 ml (on average 300 ml, and the number of removed lymph nodes per operation was 14-75 (x : 32. Intraoperative and postoperative complications developed in 6.8% of and 17.7% of patients, respectively. Recurrence was reported in 22 (12.5% patients, most often in paraaortic lymph nodes (3.4% and parametria (2.8%, while the overall 5-year survival rate was 87% until 2008. Concluision. Wertheim-Meigs radical hysterectomy is a basic surgical technique for the treatment of initial stages of invasive cervical cancer.

  2. Operation results of Wertheim-Meig. Analysis of some variables (1989-2009.

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    Rafael E. Pérez Castro

    2011-06-01

    Full Text Available A retrospective cross-sectional study was made to 63 patients operated with the surgical technique Wertheim-Meig having cervical cancer in stage I (1A2 and 1b1 during the corresponding period to the decade (1989-2009 in the University General Hospital Camilo Cienfuegos, with the objective to determine some factors associated to this pathology , so as the morbidity of this technique. The studied group was conformed by 63 patients who had the inclusion requirements taking into consideration the stages (t1a2, T1b1 from the total of patients having a cervical cancer. The HC was checked in a retrospective way collecting variables in a form such as: age groups, clinical stage, complications and survival, arriving to the following conclusions: the highest incidence of cervical cancer was in third decade of life (31 to 40 years. As a risk factor was: having sex at 17 years old or less than this age. It was very significant. Postoperative complications were minimum. It was found a 92% of survival, 2 recurrence (3.1%, 4 deaths (6.3% and a free interval diseases of 93.6%.

  3. Radicality of surgical treatment for cervical cancer.

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    Mirković, L; Petković, S; Mirković, D; Jeremić, K; Milenković, V; Maksimović, M

    2009-01-01

    Analyses were carried out on 545 Wertheim-Meigs radical hysterectomies performed at the Institute of Gynecology and Obstetrics of the Clinical Center of Serbia during a four-year period from 2002 to 2006. More than ten lymphatic glands in 84.4% of patients were removed. The apical part of the vagina was removed in 77.8% of cases, and 77.6% of patients had the right part of the vagina removed. Distribution of surgical radicality according to FIGO stage of disease has been demonstrated. Comparison of research results in the period from 1996 to 2000 shows a significantly more radical approach concerning the number of lymphatic glands removed during this period.

  4. Resultados de la operación de Wertheim-Meig. análisis de algunas variables y su impacto económico.

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    Rafael E. Pérez Castro

    2006-10-01

    Full Text Available Se realizó un estudio transversal y retrospectivo a 36 pacientes operadas con la técnica quirúrgica de Wertheim-Meig con cáncer cérvico uterino en Etapa I, durante el período correspondiente al quinquenio 1996-2000 en el Hospital Materno Docente Provincial “Isabel María de Valdivia”. La mayor incidencia de cáncer cérvico uterino estuvo en la tercera década de la vida (31-40 años. Dentro de los factores de riesgo, las relaciones sexuales a los 17 años o menos, fueron de gran significación. Las complicaciones post-operatorias fueron mínimas. El tiempo de evolución post-operatoria fue de un 75,6% en pacientes con 4 años o más de operada.

  5. Place of Schauta's radical vaginal hysterectomy.

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    Roy, Michel; Plante, Marie

    2011-04-01

    Women affected by early stage invasive cancer of the cervix are usually treated by surgery. Radical abdominal hysterectomy with pelvic lymphadenectomy is the most widely used technique. Because the morbidity of the abdominal approach can be important, the radical vaginal hysterectomy has gained acceptance in gynaecologic oncology. New instrumentation in laparoscopy also opens the possibility of treating cervical cancer by laparoscopically assisted vaginal radical hysterectomy and also total laparoscopic radical hysterectomy. Before these techniques become widely accepted, it has to be shown that safety and efficacy are comparable with the 'standard' abdominal approach. In this chapter, we review the technique of radical vaginal hysterectomy with pelvic lymphadenectomy and evaluate results of published studies, comparing the abdominal, vaginal and laparoscopic approaches.

  6. Nerve plane-sparing radical hysterectomy: a simplified technique of nerve-sparing radical hysterectomy for invasive cervical cancer

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    LI Bin; LI Wei; SUN Yang-chun; ZHANG Rong; ZHANG Gong-yi; YU Gao-zhi; WU Ling-ying

    2011-01-01

    Background In order to simplify the complicated procedure of nerve-sparing radical hysterectomy, a novel technique characterized by integral preservation of the autonomic nerve plane has been employed for invasive cervical cancer. The objective of this study was to introduce the nerve plane-sparing radical hysterectomy technique and compare its efficacy and safety with that of nerve-sparing radical hysterectomy.Methods From September 2006 to August 2010, 73 consecutive patients with International Federation of Gynecology and Obstetrics stage IB to IIA cervical cancer underwent radical hysterectomy with two different nerve-sparing approaches. Nerve-sparing radical hysterectomy was performed for the first 16 patients (nerve-sparing radical hysterectomy group). The detailed autonomic nerve structures were identified and separated by meticulous dissection during this procedure. After January 2008, the nerve plane-sparing radical hysterectomy procedure was developed and performed for the next 57 patients (nerve plane-sparing radical hysterectomy group). During this modified procedure, the nerve plane (meso-ureter and its extension) containing most of the autonomic nerve structures was integrally preserved. The patients' clinicopathologic characteristics, surgical parameters, and outcomes of postoperative bladder function were compared between the two groups.Conclusion Nerve plane-sparing radical hysterectomy Is a reproducible and simplified modification of nerve-sparing radical hysterectomy, and may be preferable to nerve-sparing radical hysterectomy for treatment of early-stage invasive cervical cancer.

  7. Robotic radical hysterectomy in the management of gynecologic malignancies.

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    Pareja, Rene; Ramirez, Pedro T

    2008-01-01

    Robotic surgery is being used with increasing frequency in gynecologic oncology. To date, 44 cases were reported in the literature of radical hysterectomy performed with robotic surgery. When comparing robotic surgery with laparoscopy or laparotomy in performing a radical hysterectomy, the literature shows that robotic surgery offers an advantage over the other 2 surgical approaches with regard to operative time, blood loss, and length of hospitalization. Future studies are needed to further elucidate the equivalence or superiority of robotic surgery to laparoscopy or laparotomy in performing a radical hysterectomy.

  8. Laparoscopic compared with open radical hysterectomy in obese women with early-stage cervical cancer.

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    Park, Jeong-Yeol; Kim, Dae-Yeon; Kim, Jong-Hyeok; Kim, Yong-Man; Kim, Young-Tak; Nam, Joo-Hyun

    2012-06-01

    To compare the surgical and oncological outcomes of laparoscopic radical hysterectomy and open radical hysterectomy in obese women with early-stage cervical cancer. The medical records of 166 patients with stage IA2-IIA2 cervical cancer and a body mass index of at least 30 who underwent laparoscopic radical hysterectomy (n=54) or open radical hysterectomy (n=112) at the Asan Medical Center between 1998 and 2011 were reviewed. None of the patients in the laparoscopic radical hysterectomy group required conversion to laparotomy. The resection margin was negative in 98.1% of the laparoscopic radical hysterectomy group and 98.2% of the open radical hysterectomy group (P=.976). No difference between the two groups was observed in terms of operating time, perioperative hemoglobin level change, transfusion requirement, or the number of retrieved lymph nodes. Compared with open radical hysterectomy, laparoscopic radical hysterectomy was associated with a significant reduction in the following: interval to return of bowel movements (2 days compared with 2.7 days, Plaparoscopic radical hysterectomy group and 85% for the open radical hysterectomy group (P=.682). The 5-year overall survival rate was 97% for the laparoscopic radical hysterectomy group and 90% for the open radical hysterectomy group (P=.220). Laparoscopic radical hysterectomy was a preferred alternative to open radical hysterectomy in the present cohort of obese women with early-stage cervical cancer because it is associated with a more favorable surgical outcome without compromising survival outcomes. II.

  9. Pilot study of radical hysterectomy versus radical trachelectomy on sexual distress.

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    Brotto, Lori A; Smith, Kelly B; Breckon, Erin; Plante, Marie

    2013-01-01

    Radical trachelectomy, which leaves the uterus intact, has emerged as a desirable surgical option for eligible women with early-stage cervical cancer who wish to preserve fertility. The available data suggest excellent obstetrical outcomes with radical trachelectomy, and no differences in sexual responding between radical trachelectomy and radical hysterectomy. There is a need to examine the effect of radical hysterectomy on sexual distress given that it is distinct from sexual function. Participants were 34 women diagnosed with early-stage cervical cancer. The authors report 1-month postsurgery data for 29 women (radical hysterectomy group: n = 17, M age = 41.8 years; radical trachelectomy group: n = 12, M age = 31.8 years), and 6-month follow-up data on 26 women. Whereas both groups experienced an increase in sex-related distress immediately after surgery, distress continued to increase 6 months after surgery for the radical hysterectomy group but decreased in the radical trachelectomy group. There were no between-group differences in mood, anxiety, or general measures of health. The decrease in sex-related distress in the radical trachelectomy but not in the radical hysterectomy group suggests that the preservation of fertility may have attenuated sex-related distress. Care providers should counsel women exploring surgical options for cervical cancer about potential sex distress-related sequelae.

  10. Comparison of Nerve-Sparing Radical Hysterectomy and Radical Hysterectomy: a Systematic Review and Meta-Analysis

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    Zhuowei Xue

    2016-05-01

    Full Text Available Background/Aims: Radical hysterectomy (RH for the treatment of cervical cancer frequently caused pelvic organ dysfunctions. This study aimed to compare the results of pelvic organ function and recurrence rate after Nerve sparing radical hysterectomy (NSRH and RH treatment through systematic review and meta-analysis. Methods: PubMed, Web of Science and China Knowledge Resource Integrated Database were searched from inception to 25 February 2015. Studies of cervical cancer which reported radical hysterectomy or nerve sparing radical hysterectomy were included. The quality of included studies was evaluated using the guidelines of Cochrane Handbook for Systematic Reviews of Interventions. Statistical analysis was performed using Review Manager 5.3 software (Cochrane Collaboration. Results: A total of 20 studies were finally included. Meta-analysis demonstrated that NSRH was associated with less bladder and anorectal dysfunction than RH. The time to bladder and anorectal function recovery after NSRH was shorter than RH. Patients undergoing NSRH also scored higher than patients undergoing RH at Female Sexual Function Index (FSFI. On the other hand, the local recurrence and overall recurrence rate were similar between NSRH and RH. Conclusion: NSRH may be an effective technique for lowering pelvic organ dysfunction and improving the function recovery without increasing the recurrence rate of cervical cancer.

  11. Safety of total laparoscopic modified radical hysterectomy with or without lymphadenectomy for endometrial cancer

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    Masakazu Kitagawa

    2017-02-01

    Conclusion: Total laparoscopic modified radical hysterectomy is safe and feasible for the treatment of early stage endometrial cancer. This procedure can be an alternative to total laparoscopic hysterectomy, especially when the uterus must be removed completely.

  12. Urological complications after radical hysterectomy: Incidence rates and predisposing factors

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    Likić-Lađević Ivana

    2007-01-01

    Full Text Available Bacground/Aim. Radical hysterectomy is a surgical approach for stage Ib and IIa of cervical cancer. The incidence of intraoperative injuries of the bladder during radical hysterectomy ranges from 0.4-3.7%. The ureter can be crushed, caught in sutures, transsected, obstructed by angulation, or ischemic by the stippling or periureteric fascia. Vesicovaginal and ureterovaginal fistuls are reported to develop in 0.9-2% of patients after radical abdominal hysterectomy. Fistulas usually become manifested or visible at speculum examination within 14 days following the surgery. The aim of this study was to establish the incidence and predisposing factor of urological complications after radical hysterectomy. Methods. The study included a total of 536 patients with invasive stage Ib to IIb cancer of the cervix uteri who had underwent radical hysterectomy. The special elements considered were: the patient’s age; the International Federation of Ginecology and Obstetrics (FIGO stage after pathohistology; duration of operation; the result of preoperative laboratory tests for diabetes, anemia, hypoproteinemia, or disorders of liver or kidney function; ASA status; postoperative surgical infection. Results. The average age of the patients with complications was 48.68 years. All patients with intraoperative ureteric and bladder injuries had statisticaly significant higher stage of disease and operation lasted more than in others without injury. We noticed 1.3% ureteral injuries and 1.49% bladder injuries, more than 50% of the patients with a previously mentioned injuries were operated on more than 3 hours. We found 2.61% vesicovaginal and 2.43% ureterovaginal fistuls. A total of 50% of the patients with bladder injury and vesicovaginal fistuls and 70% of the patients with ureterovaginal fistuls had diabetes mellitus. Postoperative infection of surgical site is a very important factor for the development of fistule. Half of the patients with vesicovaginal

  13. Can radical parametrectomy be omitted inoccult cervical cancer afterextrafascial hysterectomy?

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    Huai-WuLu,; JingLi,; Yun-YunLiu,; Chang-HaoLiu,; Guo-CaiXu,; Ling-LingXie,; Miao-FangWu; Zhong-QiuLin

    2015-01-01

    Background:Occult invasive cervical cancer discovered after simple hysterectomy is not common, radical parame‑trectomy (RP) is a preferred option for young women. However, the morbidity of RP was high. The aim of our study is to assess the incidence of parametrial involvement in patients who underwent radical parametrectomy for occult cervical cancer or radical hysterectomy for early‑stage cervical cancer and to suggest an algorithm for the triage of patients with occult cervical cancer to avoid RP. Methods:A total of 13 patients with occult cervical cancer who had undergone RP with an upper vaginectomy and pelvic lymphadenectomy were included in this retrospective study. Data on the clinicopathologic characteristics of the cases were collected. The published literature was also reviewed, and low risk factors for parametrial involvement in early‑stage cervical cancer were analyzed. Results:Of the 13 patients, 9 had a stage IB1 lesion, and 4 had a stage IA2 lesion. There were four patients with grade 1 disease, seven with grade 2 disease, and two with grade 3 disease. The median age of the entire patients was 41years. The most common indication for extrafascial hysterectomy was cervical intraepithelial neoplasia 3. Three patients had visible lesions measuring 10–30mm, in diameter and ten patients had cervical stromal invasions with depths ranging from 4 to 9mm; only one patient had more than 50% stromal invasion, and four patients had lymph‑vascular space invasion (LVSI). Perioperative complications included intraoperative bowel injury, blood transfusion, vesico‑vaginal ifstula, and ileus (1 case for each). Postoperative pathologic examination results did not show residual disease or parametrial involvement. One patient with positive lymph nodes received concurrent radiation therapy. Only one patient experienced recurrence. Conclusions:Perioperative complications following RP were common, whereas the incidence of parametrial involve‑ment was very low

  14. Evaluation of radical hysterectomu for treatment of stage IB cancer of the cervix, at Hospital San Vicente, Medellín, Colombia, 1980-1990 Evaluación de la histerectomía radical en el tratamiento del cáncer de cérvix estadio IB, en el Hospital San Vicente de Paúl de Medellín, 1980-1990

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    Felipe Carlos Petro Prieto

    1998-01-01

    Full Text Available A review was made of clinical charts of 139 patients with cancer of the cervix stage IB, treated by Wertheim-Meigs radical hysterectomy, at Hospital San Vicente, Medellín, Colombia, between 1980 and 1990, in order to evaluate results concerning complications derived from surgery, recurrences and residual cervicallesions. Average age was 39.3 ::!: 9.4 years. Follow-up period fluctuated between 0 and 181 months. One hundred and twenty two tumors (87.8% were epidermoid and 17 (12.2% adenocarcinomas. The degree of differentiation was determined in 101 cases: 43 (42.6% were well differentiated, 29 (28.7% moderately differentiated and 29 (28.7% poorly differentiated. Metastatic pelvic Iymphnodes involvement was present in 13 patients (9.4%: In 11 of them involvement was unilateral. Residual cervicallesion was left in 6 patients (4.3% of which 4 received additional treatment with radiotherapy. Recurrences appeared in 12 of the 100 patients followed for 2 or more years; in seven of these the recurrence ocurred in the first two years; there was a recurrence 13 years after surgery. Recurrences happened more often when tumors were poorly or moderately differentiated. Complications, mostly infectious, occurred in 43 patients (30.9%: Urinary tract infections (17 cases, wound infection (15 cases and infection of the vaginal dome (14 cases were the most frequently found. Se revisaron las historias clínicas de 139 pacientes con cáncer de cérvix estadio 18 sometidas a histerectomía radical tipo Wertheim-Meigs, en el Hospital San Vicente de Paúl de Medellín entre 1980 y 1990, con el fin de evaluar los resultados en lo referente a complicaciones derivadas de la cirugía, presencia de lesión cervical residual y recurrencias. La edad promedio de las pacientes fue 39.3 :!: 9.4 años. El tiempo de seguimiento varió entre 0 y 181 meses. El 87.8% de los tumores fueron epidermoides y el 12.2% adenocarcinomas. En 101 casos se logró determinar el grado de

  15. Laparoscopic, robotic and open method of radical hysterectomy for cervical cancer: A systematic review

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    Puliyath Geetha

    2012-01-01

    Full Text Available Background : Over the last two decades, numerous studies have indicated the feasibility of minimally invasive surgery for early cervical cancer without compromising the oncological outcome. Objective : Systematic literature review and meta analysis aimed at evaluating the outcome of laparoscopic and robotic radical hysterectomy (LRH and RRH and comparing the results with abdominal radical hysterectomy (ARH. Search Strategy : Medline, PubMed, Embase, Cochrane library and Reference lists were searched for articles published until January 31 st 2011, using the terms radical hysterectomy, laparoscopic radical hysterectomy, robotic radical hysterectomy, surgical treatment of cervical cancer and complications of radical hysterectomy. Selection Criteria : Studies that reported outcome measures of radical hysterectomy by open method, laparoscopic and robotic methods were selected. Data collection and analysis: Two independent reviewers selected studies, abstracted and tabulated the data and pooled estimates were obtained on the surgical and oncological outcomes. Results : Mean sample size, age and body mass index across the three types of RH studies were similar. Mean operation time across the three types of RH studies was comparable. Mean blood loss and transfusion rate are significantly higher in ARH compared to both LRH and RRH. Duration of stay in hospital for RRH was significantly less than the other two methods. The mean number of lymph nodes obtained, nodal metastasis and positive margins across the three types of RH studies were similar. Post operative infectious morbidity was significantly higher among patients who underwent ARH compared to the other two methods and a higher rate of cystotomy in LRH. Conclusions : Minimally invasive surgery especially robotic radical hysterectomy may be a better and safe option for surgical treatment of cervical cancer. The laparoscopic method is not free from complications. However, experience of surgeon may

  16. Application of da Vinci(®) Robot in simple or radical hysterectomy: Tips and tricks.

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    Iavazzo, Christos; Gkegkes, Ioannis D

    2016-01-01

    The first robotic simple hysterectomy was performed more than 10 years ago. These days, robotic-assisted hysterectomy is accepted as an alternative surgical approach and is applied both in benign and malignant surgical entities. The two important points that should be taken into account to optimize postoperative outcomes in the early period of a surgeon's training are how to achieve optimal oncological and functional results. Overcoming any technical challenge, as with any innovative surgical method, leads to an improved surgical operation timewise as well as for patients' safety. The standardization of the technique and recognition of critical anatomical landmarks are essential for optimal oncological and clinical outcomes on both simple and radical robotic-assisted hysterectomy. Based on our experience, our intention is to present user-friendly tips and tricks to optimize the application of a da Vinci® robot in simple or radical hysterectomies.

  17. Hysterectomy

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    ... however, problems can occur: • Fever and infection • Heavy bleeding during or after surgery • Injury to the urinary tract or nearby organs • ... given medication to relieve pain. You will have bleeding and discharge ... surgery. Constipation is common after most hysterectomies. Some women ...

  18. Robotic versus total laparoscopic radical hysterectomy with pelvic lymphadenectomy for the treatment of early cervical cancer

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    Jagdishwar G Goud

    2014-02-01

    Conclusions: According to our experience, robotic radical hysterectomy appears to be safe and effective therapeutic procedure for managing early-stage cervical cancer without significant differences when compared to TLRH, with respect to operative time, blood loss, hospital stay. Regarding the oncological outcome, Robotic radical hysterectomy is superior in terms of number of lymph nodes and parametrial bulk; although multicenter randomized clinical trials with longer follow-up are necessary to evaluate the overall oncologic outcome. [Int J Reprod Contracept Obstet Gynecol 2014; 3(1.000: 34-39

  19. Urologic complication in laparoscopic radical hysterectomy: meta-analysis of 20 studies.

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    Hwang, Jong Ha

    2012-11-01

    A meta-analysis was done to assess the risk of intraoperative and postoperative urologic complications, and laparoscopic radical hysterectomy (LRH) and lymph node dissection. Pubmed, EMBASE and Cochrane library were searched for studies published to December, 2011, supplemented by manual searches of relevant bibliographies from the retrieved articles. Two researchers independently extracted the data. Eligible studies had reported perioperative complications and a sample size of at least 10 patients. The search yielded 19 retrospective studies and one prospective cohort study (intraoperative urologic complication, 18 studies; postoperative urologic complication, 16 studies). When all studies were pooled, the odds ratio (OR) of LRH for the risk of intraoperative urologic complications compared to abdominal radical hysterectomy (ARH) was 1.97 [95% confidence interval (CI) 1.23-3.13] and the OR of LRH for postoperative complication risk compared to ARH was 1.35 [95% CI 0.84-2.16]. In subgroup analysis, obesity and laparoscopic type (laparoscopic assisted vaginal radical hysterectomy) were associated with intraoperative urologic complications. Laparoscopic radical hysterectomy is associated with a significant increased risk of intraoperative urologic complications. Copyright © 2012. Published by Elsevier Ltd.

  20. Surrogate pregnancy in a patient who underwent radical hysterectomy and bilateral transposition of ovaries.

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    Azem, Foad; Yovel, Israel; Wagman, Israel; Kapostiansky, Rita; Lessing, Joseph B; Amit, Ami

    2003-05-01

    To evaluate IVF-surrogate pregnancy in a patient with ovarian transposition after radical hysterectomy for carcinoma of the cervix. Case report. A maternity hospital in Tel Aviv that is a major tertiary care and referral center. A 29-year-old woman who underwent Wertheim's hysterectomy for carcinoma of the uterine cervix and ovarian transposition before total pelvic irradiation. Standard IVF treatment, transabdominal oocyte retrieval, and transfer to surrogate mother. Outcome of IVF cycle. A twin pregnancy in the first cycle. This is the second reported case of controlled ovarian stimulation and oocyte retrieval performed on a transposed ovary.

  1. Minilaparoscopic radical hysterectomy (mLPS-RH) vs laparoendoscopic single-site radical hysterectomy (LESS-RH) in early stage cervical cancer: a multicenter retrospective study.

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    Fagotti, Anna; Ghezzi, Fabio; Boruta, David M; Scambia, Giovanni; Escobar, Pedro; Fader, Amanda N; Malzoni, Mario; Fanfani, Francesco

    2014-01-01

    To compare the perioperative outcomes of laparoendoscopic single-site radical hysterectomy (LESS-RH) and minilaparoscopic radical hysterectomy (mLPS-RH). Retrospective study (Canadian Task Force classification II-2). Seven institutions in Italy. Forty-six patents with early cervical cancer (FIGO stage IA2-IB1/IIA1) were included in the study. Nineteen patients (41.3%) underwent LESS-RH, and 27 (58.7%) underwent mLPS-RH. Pelvic lymph node dissection was performed in all patients. In the LESS-RH group, all surgical procedures were performed through a single umbilical multichannel port. In the mLPS-RH group, the procedure was completed using a 5-mm umbilical optical trocar and 3 additional 3-mm ancillary trocars, placed suprapubically and in the left and right lower abdominal regions. There was no difference in clinicopathologic characteristics at the time of diagnosis between the LESS-RH and mLPS-RH groups. Median operative time was 270 minutes (range, 149-380 minutes) for LESS-RH, and was 180 minutes (range, 90-240 minutes) for mLPS-RH (p = .001). No further differences were detected between the 2 groups insofar as type of radical hysterectomy, number of lymph nodes removed, or perioperative outcomes. In the LESS-RH group, conversion to laparotomy was necessary in 1 patient (5.3%) because of external iliac vein injury, and in another patient, conversion to standard laparoscopy was required because of truncal obesity. In the mLPS-RH group, no conversions were observed; however, a repeat operation was performed to repair a ureteral injury. The percentage of patients discharged 1 day after surgery was significantly higher in the LESS-RH group (57.9%) compared with the mLPS-RH group (25.0%) (p = .03). After a median follow-up of 27 months (range, 9-73 months), only 1 patient, who had undergone mLPS-RH, experienced pelvic recurrence and died of the disease. Both LESS-RH and mLPS-RH are feasible ultra-minimally invasive approaches for performance of radical hysterectomy

  2. Acupuncture for Preventing Complications after Radical Hysterectomy: A Randomized Controlled Clinical Trial

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    Wei-min Yi

    2014-01-01

    Full Text Available We aimed to investigate the preventive effects of acupuncture for complications after radical hysterectomy. A single-center randomized controlled single-blinded trial was performed in a western-style hospital in China. One hundred and twenty patients after radical hysterectomy were randomly allocated to two groups and started acupuncture from sixth postoperative day for five consecutive days. Sanyinjiao (SP6, Shuidao (ST28, and Epangxian III (MS4 were selected with electrical stimulation and Zusanli (ST36 without electrical stimulation for thirty minutes in treatment group. Binao (LI14 was selected as sham acupuncture point without any stimulation in control group. The main outcome measures were bladder function and prevalence of postoperative complications. Compared with control group, treatment group reported significantly improved bladder function in terms of maximal cystometric capacity, first voiding desire, maximal flow rate, residual urine, and bladder compliance, and decreased bladder sensory loss, incontinence, and urinary retention on fifteenth and thirtieth postoperative days. Treatment group showed significant advantage in reduction of urinary tract infection on thirtieth postoperative day. But no significant difference between groups was observed for lymphocyst formation. By improving postoperative bladder function, early intervention of acupuncture may provide a valuable alternative method to prevent bladder dysfunctional disorders and urinary tract infection after radical hysterectomy.

  3. Modified uterine manipulator and vaginal rings for total laparoscopic radical hysterectomy.

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    Ramirez, P T; Frumovitz, M; Dos Reis, R; Milam, M R; Bevers, M W; Levenback, C F; Coleman, R L

    2008-01-01

    At present, there is no standard technique that allows surgeons performing total laparoscopic radical hysterectomy to complete the colpotomy and remove an adequate (2-cm) margin of upper vaginal tissue while maintaining adequate pneumoperitoneum. We evaluated the feasibility and safety of using a modified uterine manipulator for total laparoscopic radical hysterectomy in patients with cervical or endometrial cancer. A retrospective review was performed in all patients who underwent total laparoscopic radical hysterectomy using a modified uterine manipulator at our institution during the period April 2004 to December 2006. This analysis included 30 patients who underwent surgery with the modified uterine manipulator. There were no reports of difficulty with placement of the instrument, multiple attempts at placement, difficulty with uterine manipulation, or uterine perforation. In no patient was a vaginal incision or episiotomy required to fit the instrument through the introitus. In no case was there loss of pneumoperitoneum during colpotomy. Additional upper vaginal tissue had to be removed after intraoperative assessment of the adequacy of the surgical specimen in five (16.7%) of 30 patients. Use of the modified uterine manipulator according to our technique is safe and feasible, allowing for adequate vaginal resection and maintenance of pneumoperitoneum.

  4. Early catheter removal following laparoscopic radical hysterectomy for cervical cancer: assessment of a new bladder care protocol.

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    Campbell, Patrick; Casement, Maire; Addley, Susan; Dobbs, Stephen; Harley, Ian; Nagar, Hans

    2017-10-01

    Evidence to support prolonged catheterisation after radical hysterectomy is lacking. We sought to assess feasibility of a new protocol of early post-operative catheter removal following laparoscopic radical hysterectomy for cervical cancer. A retrospective review of post-operative bladder care in patients who underwent laparoscopic radical hysterectomy for cervical cancer was carried out. The post-operative bladder care protocol recommended catheter removal after 24-72 hours. Three consecutive post-void residual scans of less than 150 millilitres (ml) were considered evidence of normal voiding function. First line management of voiding dysfunction was clean intermittent self-catheterisation (CISC). Ninety-eight patients underwent laparoscopic radical hysterectomy for cervical cancer of whom 78 patients had catheter removal 24-72 hours post-operatively. The incidence of post-operative voiding dysfunction in this group was 44%, of whom 88% were managed with CISC and 82% regained normal voiding function. Average hospital stay was 4.2 days. The overall rate of long-term voiding dysfunction was 6%. Early catheter removal after laparoscopic radical hysterectomy appears to be both feasible and effective and compliments the ethos of enhanced patient recovery.

  5. Outpatient laparoscopic nerve-sparing radical hysterectomy: A feasibility study and analysis of perioperative outcomes.

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    Rendón, Gabriel J; Echeverri, Lina; Echeverri, Francisco; Sanz-Lomana, Carlos Millán; Ramirez, Pedro T; Pareja, Rene

    2016-11-01

    The goal of our study was to report on the feasibility of outpatient laparoscopic radical hysterectomy in patients with early-stage cervical cancer. We included all patients who underwent a laparoscopic radical hysterectomy at the Instituto de Cancerología - Las Americas in Medellin, Colombia, between January 2013 and July 2015. The control group was a similar cohort of patients who were admitted after their surgery. Seventy-six patients were included [outpatient (31) and admitted (45)]. There were no statistically significant differences between groups regarding age, clinical stage, histology, nodal count, need of adjuvant treatment, visual pain scores at discharge or follow up time. All patients underwent a transversus abdominis plane block. The median operative time was 150min (range, 105-240) in the outpatient group vs. 170min (range, 97-300) in the admitted group (p=0.023). The median estimated blood loss was 50ml (range, 20-150) in the outpatient group vs. 120ml (range, 20-1000) in the admitted group (p=0.001). All patients were able to void spontaneously and tolerate a diet before discharge. In patients who were admitted, the median hospital stay was 1day, (range; 1-6), and 39 (87%) were discharged at postoperative day 1. There were 6 postoperative complications, 3 in each group. There were no recurrences in the follow-up period in the outpatient group, and there were 3 (6.6%) recurrences in the admitted group. Outpatient laparoscopic radical hysterectomy is feasible and can be performed safely in a developing country in well-selected patients. Copyright © 2016. Published by Elsevier Inc.

  6. Early-stage cervical carcinoma, radical hysterectomy, and sexual function. A longitudinal study

    DEFF Research Database (Denmark)

    Jensen, Pernille T; Groenvold, Mogens; Klee, Marianne C

    2004-01-01

    BACKGROUND: Limited knowledge exists concerning the impact of radical hysterectomy (RH) alone on the sexual function of patients with early-stage cervical carcinoma. The authors investigated the longitudinal course of self-reported sexual function after RH. METHODS: The current study was comprised...... with an age-matched control group from the general population. RESULTS: Compared with control women, patients experienced severe orgasmic problems and uncomfortable sexual intercourse due to a reduced vaginal size during the first 6 months after RH, severe dyspareunia during the first 3 months, and sexual...

  7. Complications after radiotherapy and radical hysterectomy in early-stage cervical carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Gerdin, E. [Univ. Hospital, Dept. of Obstetrics and Gynecology, and Gynecologic Oncology, Uppsala (Sweden); Cnattingius, S. [Univ. Hospital, Dept. of Social Medicine, Uppsala (Sweden); Johnson, P. [Univ. Hospital, Dept. of Obstetrics and Gynecology, Uppsala (Sweden)

    1995-08-01

    Objective: To evaluate the overall complications, major as well as minor, in patients treated for early-stage cervical carcinoma as related to treatment parameters. Methods: In this retrospective study, 167 consecutive patients with early-stage cervical carcinoma treated with preoperative radiotherapy and radical hysterectomy were investigated. Clinical data were collected from the medical files. Results: Transient or permanent complications appeared in up to half of all patients. Seven percent exhibited intraoperative complications and 35% suffered from early postoperative urinary tract problems; most frequently urinary tract infection. After one year, the urinary tract complications dominated; voidance difficulties and incontinence being most common. Gastrointestinal complications occurred in 15% of patients. Lymphedema appeared during the first year in 21% of the patients but several of the mild or moderate cases improved after the first year. The relative risk of lymphedema was increased with shorter duration of surgery, extensive preoperative irradiation to the bladder and after external postoperative irradiation. Some form of late sequelae remained in every fifth patient, and every fourth patient, aged 23-44 years, periodically suffered from vasomotor symptoms despite estrogen replacement therapy. Conclusion: The complications after radiotherapy and radical hysterectomy in early stage cervical carcinoma suggest that attempts should be made to evaluate effective treatments designed to minimize risk to the patients. (au) 29 refs.

  8. Radical Hysterectomy

    Science.gov (United States)

    ... with your cancer care team about surgery that's right for you. This surgery tends to affect a woman's sex life, but sometimes things can be done ... Life Chemo and Hormone Therapy Can Affect a Woman’s Sex Life Treating Sexual Problems for Women With Cancer Cancer, Sex, and Single Women Questions Women Have ... Site Comments © 2017 American Cancer Society, Inc. All rights reserved. The American Cancer Society is a qualified ...

  9. Radical Hysterectomy

    Science.gov (United States)

    ... than 1 in 10 women noticed problems with lubrication and pain during sex. Almost 8 in 10 ... News and Stories Glossary For Health Care Professionals Programs & Services Breast Cancer Support TLC Hair Loss & Mastectomy ...

  10. INFECTION AFTER RADICAL ABDOMINAL HYSTERECTOMY AND PELVIC LYMPHADENECTOMY - PREVENTION OF INFECTION WITH A 2-DOSE PERIOPERATIVE ANTIBIOTIC-PROPHYLAXIS

    NARCIS (Netherlands)

    BOUMA, J

    1993-01-01

    Surgical site-related infections occurred in 21% of 87 consecutive patients undergoing radical hysterectomy with pelvic lymphadenectomy (RHPL) without planned peri-operative prophylaxis. A prospective, randomized double-blind, placebo-controlled study was conducted in 68 consecutive RHPL patients.

  11. Vaginal and pelvic recurrence rates based on vaginal cuff length in patients with cervical cancer who underwent radical hysterectomies.

    Science.gov (United States)

    Kim, K; Cho, S Y; Park, S I; Kim, B J; Kim, M H; Choi, S C; Ryu, S Y; Lee, E D

    2011-09-01

    The objective of this study was to determine the association of vaginal cuff length (VCL) with vaginal and pelvic recurrence rates in patients with cervical cancer who underwent radical hysterectomies. The clinicopathologic characteristics were collected from the medical records of 280 patients with cervical cancer who underwent radical hysterectomies. The association of VCL with 3-year vaginal and pelvic recurrence rates was determined using a Z-test. The association of VCL with other clinicopathologic characteristics was also determined. The VCL was not associated with 3-year vaginal and pelvic recurrence rates. The 3-year vaginal recurrence rate was 0%-2% and the 3-year pelvic recurrence rate was 7%-8%, independent of VCL. The VCL and the age of patients had an inverse relationship. However, the VCL was not associated with histologic type, FIGO stage, clinical tumor size, tumor size in the surgical specimen, depth of invasion, lymphovascular space invasion, parametrial involvement, lymph node involvement, and adjuvant therapy. One-hundred ninety of 280 patients (68%) underwent adjuvant therapies following radical hysterectomies. Although it is limited by the high rate of adjuvant therapy, the current study suggested that the VCL following radical hysterectomy in patients with cervical cancer was not associated with vaginal and pelvic recurrence rates. Copyright © 2011 Elsevier Ltd. All rights reserved.

  12. Early stage cervical cancer, radical hysterectomy and sexual function: a longitudinal study

    DEFF Research Database (Denmark)

    Jensen, Pernille Tine

    Background: Limited knowledge exists regarding the impact of treatment on the sexual function of early stage cervical cancer patients. We investigated the longitudinal course of self-reported sexual function after radical hysterectomy (RH) alone. Methods: 173 patients with lymph node-negative early......-surgery, the patients completed an extended version of the questionnaire with additional items assessing the patient’s perception of changes in sexual function compared with before the cancer diagnosis. Results: Compared with control women, patients experienced severe orgasmic problems and uncomfortable sexual...... intercourse due to a reduced vaginal size during the first 6 months after RH, severe dyspareunia during the first 3 months, and sexual dissatisfaction during the first 5 weeks after RH. A persistent lack of sexual interest and insufficient vaginal lubrication were reported throughout the first 2 years after...

  13. Radical abdominal hysterectomy using the ENDO-GIA stapler: report of 150 cases and literature review.

    Science.gov (United States)

    Patsner, B

    1998-01-01

    Over a seven-year period from 1990-1997 150 consecutive patients underwent Type III radical abdominal hysterectomy using the ENDO-GIA stapler on the cardinal and uterosacral ligaments. Compared to prior patients operated on with standard suturing methods, the stapler patients had shorter operating times, lower blood loss and infection rates, and shorter hospital stays without any increase in recurrence rate. The equipment failure rate was 3%. Although not all improvements in surgical and post-operative morbidity are likely due to use of the ENDO-GIA stapler, the use of the stapler clearly lowered operating times, blood loss, surgical morbidity, hospital stay with no adverse effect on patient survival.

  14. Prevalence of prognostic factors for cancer of the uterine cervix after radical hysterectomy

    Directory of Open Access Journals (Sweden)

    Marília Buenos Aires Cabral Tavares

    Full Text Available CONTEXT AND OBJECTIVE: Cancer of the uterine cervix is still very common in Brazil. It is important to evaluate factors that influence its prognosis. The aim here was to analyze the prevalence of prognostic anatomoclinical factors among patients with carcinoma of the uterine cervix undergoing radical hysterectomy. DESIGN AND SETTING: Cross-sectional study on 301 patients with invasive carcinoma of the uterine cervix who underwent Level III Piver-Rutledge hysterectomy surgery at São Marcos Hospital. METHODS: The following variables were analyzed: age, histological type, degree of differentiation, invasion of lymphatic, vascular and perineural space, lymph node metastasis, distance to nearest margin, tumor invasion depth, vaginal cuff size, largest diameter of the tumor, presence of necrosis and surgical margin involvement. Descriptive statistics, multiple regression analysis, Kaplan-Meier survival curves and the log-rank test were performed. A significance level of 5% was used. RESULTS: The mean age was 48.27 years. The following were not important for the prognosis, in relation to survival analysis: degree of differentiation and tumor invasion depth; presence of lymphatic, blood and perineural invasions; distance to nearest margin; and vaginal cuff size. Tumor size (P < 0.036, presence of lymph node metastasis (P < 0.0004, necrosis (P < 0.05 and surgical margin involvement (P < 0.0015 presented impacts on survival. The overall survival with 98 months of follow-up was 88.35%. CONCLUSION: The most prevalent prognostic factors were the presence of lymph node metastasis, tumor size and surgical margin involvement.

  15. A retrospective study of neoadjuvant chemotherapy plus radical hysterectomy versus radical hysterectomy alone in patients with stage II cervical squamous cell carcinoma presenting as a bulky mass

    Directory of Open Access Journals (Sweden)

    Takatori E

    2016-09-01

    Full Text Available Eriko Takatori, Tadahiro Shoji, Anna Takada, Takayuki Nagasawa, Hideo Omi, Masahiro Kagabu, Tatsuya Honda, Fumiharu Miura, Satoshi Takeuchi, Toru Sugiyama Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, Iwate, Japan Objective: In order to evaluate the usefulness of neoadjuvant chemotherapy (NAC for stage II cervical squamous cell carcinoma with a bulky mass, we retrospectively compared patients receiving NAC followed by radical hysterectomy (RH; NAC group with patients who underwent RH without NAC (Ope group. Patients and methods: The study period was from June 2002 to March 2014. The subjects were 28 patients with a stage II bulky mass in the NAC group and 17 such patients in the Ope group. The chi-square test was used to compare operative time, volume of intraoperative blood loss, use of blood transfusion, and time from surgery to discharge between the two groups. Moreover, the log-rank test using the Kaplan–Meier method was performed to compare disease-free survival (DFS and overall survival (OS between the groups. Results: There were no statistically significant differences between the two groups in operative time, volume of intraoperative blood loss, or use of blood transfusion. However, the time from surgery to discharge was 18 days (14–25 days in the NAC group and 25 days (21–34 days in the Ope group; the patients in the NAC group were discharged earlier (P=0.032. The hazard ratio for DFS in the NAC group as compared with that in the Ope group was 0.36 (95% CI 0.08–0.91, and the 3-year DFS rates were 81.2% and 41.0%, respectively (P=0.028. Moreover, the hazard ratio for OS was 0.39 (95% CI 0.11–1.24, and the 3-year OS rates were 82.3% and 66.4%, respectively (P=0.101. Conclusion: NAC with cisplatin and irinotecan was confirmed to prolong DFS as compared with RH alone. The results of this study suggest that NAC might be a useful adjunct to surgery in the treatment of stage II squamous

  16. Adjuvant radiotherapy after radical hysterectomy of the cervical cancer. Prognostic factors and complications

    Energy Technology Data Exchange (ETDEWEB)

    Chatani, Masashi; Nose, Takayuki; Masaki, Norie [Osaka Univ. Medical School (Japan). Dept. of Radiation Therapy; Inoue, Toshihiko [Osaka Univ. Medical School (Japan). Dept. of Radiation Oncology

    1998-10-01

    Aim: To investigate prognostic factors and complications after radical hysterectomy followed by postoperative radiotherapy for carcinoma of the uterine cervix. Patients and Methods: One hundred twenty-eight patients with T1b-2b carcinoma of the uterine cervix following radical hysterectomy with bilateral pelvic lymphadenectomy and postoperative radiation therapy were reviewed. Pathologic and treatment variables were assessed by multivariate analysis for local recurrence, distant metastases and cause specific survival. Results: The number of positive nodes (PN) in the pelvis was the strongest predictor of pelvic recurrence and distant metastases. These 2 failure patterns independently affect the cause specific survival. The 5-year cumulative local and distant failure were PN(0): 2% and 12%, PN(1-2): 23% and 25%, PN(2<): 32% and 57%, respectively (p=0.0029 and p=0.0051). The 5-year cause specific survival rates were PN(0): 90%, PN(1-2): 59% and PN(2<): 42% (p=0.0001). The most common complication was lymphedema of the foot experienced by one-half of the patients (5-year: 42%, 10-year: 49%). Conclusion: These results suggest that patients with pathologic T1b-T2b cervix cancer with pelvic lymph node metastases are at high risk of recurrence or metastases after radical hysterectomy with pelvic lymphadenectomy and postoperative irradiation. (orig.) [Deutsch] Ziel: Untersuchung der prognostischen Faktoren und Komplikationen der adjuvanten Radiotherapie nach radikaler Hysterektomie bei Patienten mit Zervixkarzinom. Patienten und Methoden: In dieser Studie wurden 128 Patientinnen mit Zervixkarzinom untersucht, bei denen die pathologische Untersuchung nach radikaler Hysterektomie mit gleichzeitiger bilateraler pelvischer Lymphadenektomie und postoperativer Radiotherapie die Klassifikation als T1b-T2b-Karzinome ergab. Dabei wurden pathologische und therapeutische Parameter auf der behandelten Seite mit Hilfe der Multivarianzanalyse auf lokale Rezidive und Fernmetastasen

  17. Total Laparoscopic Radical Hysterectomy for Treatment of Uterine Malignant Tumors:Analysis of Short-term Therapeutic Efficacy

    Institute of Scientific and Technical Information of China (English)

    沈怡; 王泽华

    2010-01-01

    To investigate the efficacy and the clinical value of total laparoscopic radical hysterectomy(TLRH) for the treatment of uterine malignancies,we performed a retrospective review of 87 patients with cervical cancer and 23 patients with endometrial carcinoma who underwent TLRH at Union hospital between June 2008 and September 2009.Data collected included operative time,estimated blood loss,lymph node count,time for the recovery of normal temperature and time to resumption of normal bladder function,intraopera...

  18. Surgical and oncological outcome of total laparoscopic radical hysterectomy in obese women with early-stage cervical cancer.

    Science.gov (United States)

    Moss, Esther Louise; Balega, Janos; Chan, Kiong K; Singh, Kavita

    2012-01-01

    To evaluate the clinical experience of the total laparoscopic radical hysterectomy (TLRH) for the surgical management of cervical cancer in obese (body mass index [BMI] >30 kg/m) and nonobese (BMI obese, BMI >30 kg/m, or nonobese, BMI hysterectomy cases performed before the introduction of the TLRH. A total of 58 women underwent a TLRH; 15 (25.9%) were obese and 43 (74.1%) were in the nonobese group. There was no significant difference in intraoperative blood loss or median duration of surgery between the obese and nonobese groups. The median hospital stay in both groups was 3 days (range, 2-13 days). Four cases were converted to laparotomy (7%); all were in the nonobese group. Postoperatively, 3 patients developed ischemic ureterovaginal fistulae (5%) between days 5 and 7 after surgery; all were in the nonobese group. There was no significant difference in the parametrial length, maximum vaginal cuff length, and number of lymph nodes excised between the 2 groups. To date, there has been one recurrence during the median follow-up period of 19 months (range, 3-42 months). She belonged to the nonobese group. The TLRH is a surgically safe procedure for early-stage cervical cancer. Obesity did not adversely affect the performance of TLRH or the radicality of the excision. In obese women, TLRH should be the favored route of surgery for all women who require a radical hysterectomy owing to its favorable perioperative outcome and short hospital stay.

  19. Morbidity and survival patterns in patients after radical hysterectomy and postoperative adjuvant pelvic radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Fiorica, J.V.; Roberts, W.S.; Greenberg, H.; Hoffman, M.S.; LaPolla, J.P.; Cavanagh, D. (Univ.ersity of South Florida College of Medicine, Tampa (USA))

    1990-03-01

    Morbidity and survival patterns were reviewed in 50 patients who underwent radical hysterectomy, pelvic lymphadenectomy, and adjuvant postoperative pelvic radiotherapy for invasive cervical cancer. Ninety percent of the patients were FIGO stage IB, and 10% were clinical stage IIA or IIB. Indications for adjuvant radiotherapy included pelvic lymph node metastasis, large volume, deep stromal penetration, lower uterine segment involvement, or capillary space involvement. Seventy-two percent of the patients had multiple high-risk factors. An average of 4700 cGy of whole-pelvis radiotherapy was administered. Ten percent of the patients suffered major gastrointestinal complications, 14% minor gastrointestinal morbidity, 12% minor genitourinary complications, one patient a lymphocyst, and one patient lymphedema. Of the five patients with major gastrointestinal morbidity, all occurred within 12 months of treatment. Three patients required intestinal bypass surgery for distal ileal obstructions and all are currently doing well and free of disease. All of the patients who developed recurrent disease had multiple, high-risk factors. The median time of recurrence was 12 months. All patients recurred within the radiated field. Actuarial survival was 90% and disease-free survival 87% at 70 months. It is our opinion that the morbidity of postoperative pelvic radiotherapy is acceptable, and benefit may be gained in such a high-risk patient population.

  20. Adjuvant radiotherapy following radical hysterectomy for patients with stage IB and IIA cervical cancer

    Energy Technology Data Exchange (ETDEWEB)

    Soisson, A.P.; Soper, J.T.; Clarke-Pearson, D.L.; Berchuck, A.; Montana, G.; Creasman, W.T. (Duke Univ. Medical Center, Durham, NC (USA))

    1990-06-01

    From 1971 through 1984, 320 women underwent radical hysterectomy as primary therapy of stage IB and IIA cervical cancer. Two hundred forty-eight patients (78%) were treated with surgery alone and 72 patients (22%) received adjuvant postoperative external-beam radiotherapy. Presence of lymph node metastasis, large lesion (greater than 4 cm in diameter), histologic grade, race (noncaucasian), and age (greater than 40 years) were significant poor prognostic factors for the entire group of patients. Patients treated with surgery alone had a better disease-free survival than those who received combination therapy (P less than 0.001). However, patients receiving adjuvant radiation therapy had a higher incidence of lymphatic metastases, tumor involvement of the surgical margin, and large cervical lesions. Adjuvant pelvic radiation therapy did not improve the survival of patients with unilateral nodal metastases or those who had a large cervical lesion with free surgical margins and the absence of nodal involvement. Radiation therapy appears to reduce the incidence of pelvic recurrences. Unfortunately, 84% of patients who developed recurrent tumor after combination therapy had a component of distant failure. The incidence of severe gastrointestinal or genitourinary tract complications was not different in the two treatment groups. However, the incidence of lymphedema was increased in patients who received adjuvant radiation therapy. Although adjuvant radiation therapy appears to be tolerated without a significant increase in serious complications, the extent to which it may improve local control rates and survival in high-risk patients appears to be limited. In view of the high incidence of distant metastases in high-risk patients, consideration should be given to adjuvant systemic chemotherapy in addition to radiation therapy.

  1. Role of pelvic and para-aortic lymphadenectomy in abandoned radical hysterectomy in cervical cancer.

    Science.gov (United States)

    Barquet-Muñoz, Salim Abraham; Rendón-Pereira, Gabriel Jaime; Acuña-González, Denise; Peñate, Monica Vanessa Heymann; Herrera-Montalvo, Luis Alonso; Gallardo-Alvarado, Lenny Nadia; Cantú-de León, David Francisco; Pareja, René

    2017-01-14

    Cervical cancer (CC) occupies fourth place in cancer incidence and mortality worldwide in women, with 560,505 new cases and 284,923 deaths per year. Approximately, nine of every ten (87%) take place in developing countries. When a macroscopic nodal involvement is discovered during a radical hysterectomy (RH), there is controversy in the literature between resect macroscopic lymph node compromise or abandonment of the surgery and sending the patient for standard chemo-radiotherapy treatment. The objective of this study is to compare the prognosis of patients with CC whom RH was abandoned and bilateral pelvic lymphadenectomy and para-aortic lymphadenectomy was performed with that of patients who were only biopsied or with removal of a suspicious lymph node, treated with concomitant radiotherapy/chemotherapy in the standard manner. A descriptive and retrospective study was conducted in two institutions from Mexico and Colombia. Clinical records of patients with early-stage CC programmed for RH with an intraoperative finding of pelvic lymph, para-aortic nodes, or any extracervical involvement that contraindicates the continuation of surgery were obtained. Between January 2007 and December 2012, 42 clinical patients complied with study inclusion criteria and were selected for analysis. In patients with CC whom RH was abandoned due to lymph node affectation, there is no difference in overall survival or in disease-free period between systematic lymphadenectomy and tumor removal or lymph node biopsy, in pelvic lymph nodes as well as in para-aortic lymph nodes, when these patients receive adjuvant treatment with concomitant radiotherapy/chemotherapy. This is a hypothesis-generator study; thus, the recommendation is made to conduct randomized prospective studies to procure better knowledge on the impact of bilateral pelvic and para-aortic lymphadenectomy on this group of patients.

  2. Comparison of remifentanil and fentanyl in patients undergoing modified radical mastectomy or total hysterectomy

    Institute of Scientific and Technical Information of China (English)

    郭向阳; 易杰; 叶铁虎; 罗爱伦; 黄宇光; 任洪智

    2003-01-01

    Objective To compare the efficacy and safety of remifentanil and fentanyl in patients undergoing a modified radical mastectomy or total hysterectomy.Methods Fifty-four patients were evenly randomised into remifentanil group and fentanyl group. Anesthesia was induced by propofol (1-2 mg/kg) and either remifentanil (2 μg/kg) or fentanyl (2.5 μg/kg), and was maintained with inhalation of nitrous oxide in oxygen (2∶1) and continuous infusion of either remifentanil (0.2 μg*kg-1*min-1) or fentanyl(0.03 μg*kg-1*min-1). Results The number of patients exhibiting light anesthesia responses in the remifentanil group during intubation and the maintenance of anesthesia was significantly less than that in the fentanyl group. Both systolic and diastolic blood pressures in the fentanyl group were significantly higher than those in the remifentanil group during intubation, skin incision, maintenance of anesthesia and extubation. The time to opening eyes on command and the time for extubation after surgery was comparable between the two groups. More patients in the remifentanil group (25 patients) required bolus injection of morphine for postoperative pain relief than those in the fentanyl group (5 patients, P<0.05). There was no significant difference between the two groups in terms of side effects.Conclusions Under the condition of this study protocol, the anesthetic and analgesic effects of remifentanil are more potent than those of fentanyl. Remifentanil can offer superior intraoperative hemodynamic stability in comparison with fentanyl, and has no compromising recovery from anesthesia.

  3. [Quality of life and sexual function of cervical cancer patients following radical hysterectomy and vaginal extension].

    Science.gov (United States)

    Ye, Shuang; Yang, Jiaxin; Cao, Dongyan; Zhu, Lan; Lang, Jinghe; Shen, Keng

    2014-08-01

    To investigate the quality of life and sexual function of cervical cancer patients following radical hysterectomy (RH) and vaginal extension. Case-control and questionnaire- based method was employed in this study. Thirty-one patients of early-stage (I b1-I b2) cervical cancer who had undergone vaginal extension following classic RH in Peking Union Medical College Hospital from December 2008 to September 2012 were included in study group, while 28 patients with matching factors and RH only during the same period were allocated to control group. There was no significant difference between two groups in terms of clinical and demographic variables including age at diagnosis, tumor stage and follow-up time (P > 0.05). Patients were assessed retrospectively by validated self-reported questionnaires the European Organization for Research and Treatment of Cancer Cervix Cancer Module Questionnaire (EORTC QLQ-CX24) mainly for quality of life and sexual function for cervical cancer patients; the Sexual Function and Vaginal Changes Questionnaire (SVQ) further investigates sexual function and vaginal changes of patients with gynecologic malignancy at least 6 months after treatment. Vaginal length acquired by pelvic examination by gynecologic oncologists during follow-up visits was (10.0 ± 1.3) cm and (5.9 ± 1.0)cm in study group and control group respectively (P = 0.000). Sixty-eight percent (21/31) of cases in study group and 64% (18/28) of cases in control group had resumed sexual activity at the time of interview, and the time interval between treatment and regular sexual activity was mean 6 months (range 3-20 months) and mean 5 months (range 1-12 months) in study and control group respectively, in which there was not statistical significance (P > 0.05). No difference was observed regarding pelvic floor symptoms (P > 0.05) while difficulty emptying bladder, incomplete emptying and constipation were most commonly reported. Both group presented with hypoactive sexual desire

  4. Risk model in stage IB1-IIB cervical cancer with positive node after radical hysterectomy

    Directory of Open Access Journals (Sweden)

    Chen Z

    2016-05-01

    Full Text Available Zhilan Chen,1,2,* Kecheng Huang,1,* Zhiyong Lu,1,3 Song Deng,1,4 Jiaqiang Xiong,1 Jia Huang,1 Xiong Li,5 Fangxu Tang,1 Zhihao Wang,6 Haiying Sun,1 Lin Wang,1 Shasha Zhou,1 Xiaoli Wang,1 Yao Jia,1 Ting Hu,1 Juan Gui,7 Dongyi Wan,1 Ding Ma,1 Shuang Li,1 Shixuan Wang11Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Techonology, Wuhan, 2Department of Obstetrics and Gynecology, Wuhan General Hospital of Guangzhou Military Command, Wuhan, 3Hubei Key Laboratory of Embryonic Stem Cell Research, Tai-He Hospital, Hubei University of Medicine, Shiyan, Hubei, 4Department of Obstetrics and Gynecology, University Hospital of Hubei University for Nationalities, Enshi, Hubei, 5Department of Obstetrics and Gynecology, Wuhan Central Hospital, Wuhan, 6Department of Pathology and Pathophysiology, Key Laboratory of Ministry of Education of China for Neurological Disorders, Huazhong University of Science and Techonology, Wuhan, 7Department of Obstetrics and Gynecology, Renmin Hospital, Wuhan University, Wuhan, People’s Republic of China*These authors contributed equally to this workAbstract: The purpose of this study was to identify risk factors in patients with surgically treated node-positive IB1-IIB cervical cancer and to establish a risk model for disease-free survival (DFS and overall survival (OS. A total of 170 patients who underwent radical hysterectomy and bilateral pelvic lymphadenectomy as primary treatment for node-positive International Federation of Gynaecology and Obstetrics (FIGO stage IB1-IIB cervical cancer from January 2002 to December 2008 were retrospectively analyzed. Five published risk models were evaluated in this population. The variables, including common iliac lymph node metastasis and parametrial invasion, were independent predictors of outcome in a multivariate analysis using a Cox regression model. Three distinct prognostic groups (low, intermediate, and high risk

  5. Application of gene expression programming and neural networks to predict adverse events of radical hysterectomy in cervical cancer patients.

    Science.gov (United States)

    Kusy, Maciej; Obrzut, Bogdan; Kluska, Jacek

    2013-12-01

    The aim of this article was to compare gene expression programming (GEP) method with three types of neural networks in the prediction of adverse events of radical hysterectomy in cervical cancer patients. One-hundred and seven patients treated by radical hysterectomy were analyzed. Each record representing a single patient consisted of 10 parameters. The occurrence and lack of perioperative complications imposed a two-class classification problem. In the simulations, GEP algorithm was compared to a multilayer perceptron (MLP), a radial basis function network neural, and a probabilistic neural network. The generalization ability of the models was assessed on the basis of their accuracy, the sensitivity, the specificity, and the area under the receiver operating characteristic curve (AUROC). The GEP classifier provided best results in the prediction of the adverse events with the accuracy of 71.96 %. Comparable but slightly worse outcomes were obtained using MLP, i.e., 71.87 %. For each of measured indices: accuracy, sensitivity, specificity, and the AUROC, the standard deviation was the smallest for the models generated by GEP classifier.

  6. Laparoscopic radical hysterectomy with the use of a modified uterine manipulator for the management of stage IB1 cervix cancer.

    Science.gov (United States)

    Canton-Romero, J C; Anaya-Prado, R; Rodriguez-Garcia, H A; Mejia-Romo, F; De-Los-Rios, P E; Cortez-Martinez, G; Delgado-Ramirez, R; Quijano, F

    2010-01-01

    We prospectively collected data on all patients with stage IB1 cervical cancer, who underwent total laparoscopic radical hysterectomy with the use of a modified uterine manipulator. From January 2000 to December 2005, 54 patients met the study criteria. The mean age was 41.8 +/- 7.47 years. Average BMI (kg/m(2)) was 27.38 +/- 3.13. Squamous carcinoma and adenocarcinoma were found in 88.88% and 11.11% of the cases, respectively. The average surgical time was 265 +/- 70.8 min. The mean estimated blood loss was 276.11 +/- 123.03 ml. The average patient lymph node count was 19.64 +/- 5.08. Positive malignant lymph nodes were identified in 11.11% of the cases. Surgical margins were free of disease in all patients. The mean hospital stay was 1.5 +/- 1 days. There was no mortality. Total laparoscopic radical hysterectomy can be considered a safe alternative to laparotomy. The use of a uterine manipulator does not pose an increased surgical risk and allows for a simpler and more feasible procedure.

  7. Laparotomy conversion rate of laparoscopic radical hysterectomy for early-stage cervical cancer in a consecutive series without case selection.

    Science.gov (United States)

    Park, Jeong-Yeol; Nam, Joo-Hyun

    2014-09-01

    To estimate the feasibility and conversion rate of laparoscopic radical hysterectomy (LRH) in early-stage cervical cancer. Data were collected from the medical records of 260 consecutive patients with stage IA2 to IIA2 cervical cancer who had undergone LRH, regardless of age, body mass index, prior abdominal surgery, uterus size, or tumor size. The median patient age was 48 years (range, 26-78 years), 11.9 % of whom were elderly (≥65 years), 11.2 % were obese (≥30 kg/m(2)), 15.4 % had undergone previous abdominal surgery, and 13.1 % had a tumor larger than 4 cm. Negative-margin resection was feasible in all patients except one. The median operative time and estimated blood loss were 253 min (range, 111-438 min) and 300 mL (range, 80-2000 mL), respectively. Intraoperative and postoperative complications occurred in seven (2.7 %) and 10 patients (3.8 %), respectively. Four patients (1.5 %) required intraoperative conversion to laparotomy, three of which were due to conglomerated metastatic lymph nodes surrounding the aorta (n = 2), the left external iliac vein (n = 1) or the left ureter (n = 1). LRH was still completed in the four conversion patients, and a laparotomy was required for the removal of the conglomerated metastatic lymph nodes and the repair of the injured vessels. The conversion rate to laparotomy among patients undergoing LRH for early-stage cervical cancer was 1.5 % when performed exclusively in consecutive patients. LRH showed comparable feasibility and effectiveness to open radical hysterectomy in the treatment of early-stage cervical cancer.

  8. Sentinel lymph node identification in patients with early stage cervical cancer undergoing radical hysterectomy and pelvic lymphadenectomy

    Institute of Scientific and Technical Information of China (English)

    李斌; 章文华; 刘琳; 吴令英; 张蓉; 李宁

    2004-01-01

    Background In general, sentinel lymph node (SLN) can reflect the whole state of the entire drainage area. The present study evaluated the clinical significance of sentinel lymph node identification in the treatment of early stage cervical cancer.Methods Twenty-eight patients with early stage (Ia-Iia) cervical cancer undergoing radical hysterectomy and pelvic lymphadenectomy were included in this study. At two locations 8 hours before operation, 0.4 ml 37 Mbq technicium-99 labeled dextran was injected intracervically. After that, preoperative lymphoscintigraphy was performed to detect SLNs. During the operation, lymph nodes were detected ex vivo by a γ-counter to identify SLNs. The samples of SLNs and non-SLNs were used for pathological examination separately and compared with the final results. Results SLNs were identified in 27 of 28 (96.4%) patients. A total of 123 SLNs were identified from 814 nodes. Six patients had altogether 11 positive lymph nodes, which were all SLNs. No patient had false-negative sentinel node. Conclusion SLNs can successfully predict the lymphatic metastasis in patients with cervical cancer. The clinical validity of this technique should be evaluated prospectively.

  9. Adjuvant chemoradiation after laparoscopically assisted radical vaginal hysterectomy (LARVH) in patients with cervical cancer. Oncologic outcome and morbidity

    Energy Technology Data Exchange (ETDEWEB)

    Gruen, Arne; Musik, Thabea; Stromberger, Carmen; Budach, Volker; Marnitz, Simone [Charite Univ. Medicine Berlin, Campus Virchow-Klinikum, Berlin (Germany). Dept. of Radiooncology; Koehler, Christhardt; Schneider, Achim [Charite Univ. Medicine Berlin, Campus Mitte- und Benjamim Franklin, Berlin (Germany). Dept. of Gynaecology; Fueller, Juergen; Wendt, Thomas [Jena Univ. Hospital (Germany). Dept. of Radiooncology

    2011-06-15

    Compared to laparotomic surgery, laparoscopically assisted radical vaginal hysterectomy (LARVH) offers decreased blood loss during surgery and faster convalescence of the patient postoperatively, while at the same time delivering similar oncologic results. However, there is no data on outcome and toxicity of LARVH followed by (chemo)radiation. A total of 55 patients (range 28-78 years) with cervical cancer on FIGO stages IB1-IIIA (Tables 1 and 2) with risk factors were submitted to either external beam radiotherapy alone [EBRT, n = 8 (14%), including paraaortic irradiation, n = 4 (2.2%); EBRT and brachytherapy (BT), n = 33 (60%); BT alone, n = 14 (25.5%)] or chemoradiation after LARVH. At a median follow-up of 4.4 years, the 5-year disease-free survival (DFS) was 81.8% with 84.5% overall survival (OS). Acute grade 3 side effects were seen in 4 patients. These were mainly gastrointestinal (GI) and genitourinary (GU) symptoms. Grade 4 side effects were not observed. With similar oncologic outcome data and mostly mild side effects, LARVH followed by (chemo)radiation is a valid alternative in the treatment of cervical cancer patients. (orig.)

  10. Preoperative radium therapy and radical hysterectomy in the treatment of cervical cancer stage IB, IIA, and initial IIB.; Radiumterapia pre-operatoria e histerectomia radical no tratamento do cancer do colo uterino IB, IIA e IIB inicial

    Energy Technology Data Exchange (ETDEWEB)

    Salum, Resalla; Lopes, Edison R.; Souza, Maria A.H. de [Faculdade de Medicina do Triangulo Mineiro, Uberaba, MG (Brazil). Hospital Escola

    1995-07-01

    Patients with IB, IIa and in initial IIb cervical cancer were randomized for combined therapy, consisting of one or two radium insertion followed by Wertheim Meigs operation performed 40 days later. We look for the early and late complications of the treatment, residual cancer after radiotherapy and survival without recurrence. The project begin in 1965 and ended in 1986. All the operations were done by one of the investigators and 116 patients were analysed. The age ranged from 21 to 75 years with an average of 4.18 years. During the operations 31 (26.72%) patients needed 1.500 cc or greater amount of blood transfusion and we have 3 iliac veins lesions. Managing the ureters, we do our best to leave the posterior fascia as intact as possible. Post operative complications ranged from minor (fever, localised pelvic infections, temporary popliteal nerve paralysis) to evisceration (3 patients) deep venous thrombosis (3 patients) and two early urinary fistulas. Late complications were seen in patients submitted to sequential teletherapy irradiation. One uretrovaginal fistula occurred 10 month after treatment, another one, 7 years later and the third one 24 years later. One patient develop hydronefrosis and enterocolite after 7.000 rads of teletherapy and another one rectovaginal fistula 13 years after initial therapy. The shortening of the vagina making impossible the intercourse was seen in 7 patients. By the histological examination, the cervix was sterilized in 73.3 % of the patients. Residual cancer was found according the original size of the tumour and the stage of the disease. Studying different combinations between the existence of residual cervical cancer with positive or negative limphnodes and making a correlation with survival, we found the critical points is to have positive cervix and positive lymphonodes. The five years survival (life table methodology) for stage 1 lesion was 96%; stage II, 67%. At ten years survival was slighted different. With positive

  11. Feasibility and morbidity of total laparoscopic radical hysterectomy with or without pelvic limphadenectomy in obese women with stage I endometrial cancer.

    Science.gov (United States)

    Pellegrino, Antonio; Signorelli, Mauro; Fruscio, Robert; Villa, Annalisa; Buda, Alessandro; Beretta, Pietro; Garbi, Annalisa; Vitobello, Domenico

    2009-05-01

    The aim of this study was to describe the feasibility and morbidity rates associated with total laparoscopic radical hysterectomy (TLRH) with or without pelvic lymphadenectomy for stage I endometrial cancer in obese women. Obese patients with stage I endometrial cancer who underwent total laparoscopic radical surgery at the Department of Obstetrics and Gynecology of San Gerardo Hospital were compared to nonobese patients. The same group of obese patients was compared with patients who underwent radical laparotomic surgery. Obesity was defined as a body mass index more than 30 kg/m(2). Between September 2003 and September 2007, 75 women underwent TLRH. Median age was 54 years and median body mass index was 28 kg/m(2). Thirty-seven women were obese. There were no differences between nonobese and obese women in operative, time length of parametria and pelvic nodes removed and operative or late complications. Blood loss was significantly higher in obese patients. Comparing retrospectively laparoscopy and laparotomy in obese women treated in our center, laparotomy was associated with decreased operative time, but also with increased blood loss, transfusion rate, duration of hospitalization and frequency of post surgical complications. Total laparoscopic radical hysterectomy (with pelvic lymphadenectomy) is a safe option in patients with endometrial cancer. Obesity is not a contraindication to perform a TRLH with no differences in surgical parameters between obese and nonobese population. TLRH show a significant decrease of complications compared to laparotomic radical surgery in obese women.

  12. Management of low-risk early-stage cervical cancer: Should conization, simple trachelectomy, or simple hysterectomy replace radical surgery as the new standard of care?

    Science.gov (United States)

    Ramirez, Pedro T.; Pareja, Rene; Rendón, Gabriel J.; Millan, Carlos; Frumovitz, Michael; Schmeler, Kathleen M.

    2014-01-01

    The standard treatment for women with early-stage cervical cancer (IA2-IB1) remains radical hysterectomy with pelvic lymphadenectomy. In select patients interested in future fertility, the option of radical trachelectomy with pelvic lymphadenectomy is also considered a viable option. The possibility of less radical surgery may be appropriate not only for patients desiring to preserve fertility but also for all patients with low-risk early-stage cervical cancer. Recently, a number of studies have explored less radical surgical options for early-stage cervical cancer, including simple hysterectomy, simple trachelectomy, and cervical conization with or without sentinel lymph node biopsy and pelvic lymph node dissection. Such options may be available for patients with low-risk early-stage cervical cancer. Criteria that define this low-risk group include: squamous carcinoma, adenocarcinoma, or adenosquamous carcinoma, tumor size <2 cm, stromal invasion <10mm, and no lymph-vascular space invasion. In this report, we provide a review of the existing literature on the conservative management of cervical cancer and describe ongoing multi-institutional trials evaluating the role of conservative surgery in selected patients with early-stage cervical cancer. PMID:24041877

  13. Brachytherapy versus radical hysterectomy after external beam chemoradiation: a non-randomized matched comparison in IB2-IIB cervical cancer patients

    Directory of Open Access Journals (Sweden)

    Flores Vladimir

    2009-02-01

    Full Text Available Abstract Background A current paradigm in the treatment of cervical cancer with radiation therapy is that intracavitary brachytherapy is an essential component of radical treatment. This is a matched retrospective comparison of the results of treatment in patients treated with external beam chemoradiation (EBRT-CT and radical hysterectomy versus those treated with identical chemoradiation followed by brachytherapy. Methods In this non-randomized comparison EBRT-CT protocol was the same in both groups of 40 patients. In the standard treated patients, EBRT-CT was followed by one or two intracavitary Cesium (low-dose rate applications within 2 weeks of finishing external radiation to reach a point A dose of at least 85 Gy. In the surgically treated patients, radical hysterectomy with bilateral pelvic lymph node dissection and para-aortic lymph node sampling were performed within 7 weeks after EBRT-CT. Response, toxicity and survival were evaluated. Results A total of 80 patients were analyzed. The patients receiving EBRT-CT and surgery were matched with the standard treated cases. There were no differences in the clinicopathological characteristics between groups or in the delivery of EBRT-CT. The pattern of acute and late toxicity differed. Standard treated patients had more chronic proctitis while the surgically treated had acute complications of surgery and hydronephrosis. At a maximum follow-up of 60 months, median follow-up 26 (2–31 and 22 (3–27 months for the surgery and standard therapy respectively, eight patients per group have recurred and died. The progression free and overall survival are the same in both groups. Conclusion The results of this study suggest that radical hysterectomy can be used after EBRT-CT without compromising survival in FIGO stage IB2-IIB cervical cancer patients in settings were brachytherapy is not available. A randomized study is needed to uncover the value of surgery after EBRT-CT.

  14. Clinical Behaviors and Outcomes for Adenocarcinoma or Adenosquamous Carcinoma of Cervix Treated by Radical Hysterectomy and Adjuvant Radiotherapy or Chemoradiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Huang, Yi-Ting; Wang, Chun-Chieh; Tsai, Chien-Sheng [Department of Radiation Oncology, Chang Gung Memorial Hospital, Lin-Kou, Chang Gung University, Taoyuan, Taiwan (China); Department of Medical Imaging and Radiological Science, Chang Gung University, Taoyuan, Taiwan (China); Lai, Chyong-Huey; Chang, Ting-Chang; Chou, Hung-Hsueh [Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Lin-Kou, Chang Gung University, Taoyuan, Taiwan (China); Lee, Steve P. [Department of Radiation Oncology, University of California, Los Angeles School of Medicine, Los Angeles, CA (United States); Hong, Ji-Hong, E-mail: jihong@adm.cgmh.org.tw [Department of Radiation Oncology, Chang Gung Memorial Hospital, Lin-Kou, Chang Gung University, Taoyuan, Taiwan (China); Department of Medical Imaging and Radiological Science, Chang Gung University, Taoyuan, Taiwan (China)

    2012-10-01

    Purpose: To compare clinical behaviors and treatment outcomes between patients with squamous cell carcinoma (SCC) and adenocarcinoma/adenosquamous carcinoma (AC/ASC) of the cervix treated with radical hysterectomy (RH) and adjuvant radiotherapy (RT) or concurrent chemoradiotherapy (CCRT). Methods and Materials: A total of 318 Stage IB-IIB cervical cancer patients, 202 (63.5%) with SCC and 116 (36.5%) with AC/ASC, treated by RH and adjuvant RT/CCRT, were included. The indications for RT/CCRT were deep stromal invasion, positive resection margin, parametrial invasion, or lymph node (LN) metastasis. Postoperative CCRT was administered in 65 SCC patients (32%) and 80 AC/ASC patients (69%). Patients with presence of parametrial invasion or LN metastasis were stratified into a high-risk group, and the rest into an intermediate-risk group. The patterns of failure and factors influencing survival were evaluated. Results: The treatment failed in 39 SCC patients (19.3%) and 39 AC/ASC patients (33.6%). The 5-year relapse-free survival rates for SCC and AC/ASC patients were 83.4% and 66.5%, respectively (p = 0.000). Distant metastasis was the major failure pattern in both groups. After multivariate analysis, prognostic factors for local recurrence included younger age, parametrial invasion, AC/ASC histology, and positive resection margin; for distant recurrence they included parametrial invasion, LN metastasis, and AC/ASC histology. Compared with SCC patients, those with AC/ASC had higher local relapse rates for the intermediate-risk group but a higher distant metastasis rate for the high-risk group. Postoperative CCRT tended to improve survival for intermediate-risk but not for high-risk AC/ASC patients. Conclusions: Adenocarcinoma/adenosquamous carcinoma is an independent prognostic factor for cervical cancer patients treated by RH and postoperative RT. Concurrent chemoradiotherapy could improve survival for intermediate-risk, but not necessarily high-risk, AC/ASC patients.

  15. Laparoendoscopic single-site radical hysterectomy with pelvic lymphadenectomy: initial multi-institutional experience for treatment of invasive cervical cancer.

    Science.gov (United States)

    Boruta, David M; Fagotti, Anna; Bradford, Leslie S; Escobar, Pedro F; Scambia, Giovanni; Kushnir, Christina L; Michener, Chad M; Fader, Amanda Nickles

    2014-01-01

    To describe the feasibility, safety, and outcomes of women with stage I cervical cancer treated with laparoendoscopic single-site surgery radical hysterectomy (LESS-RH). A retrospective descriptive study (Canadian Task Force classification III). Multiple academic teaching hospitals. Women with Fédération Internationale de Gynécologie et d'Obstétrique FIGO stage IA1 to IB1 cervical cancer. LESS-RH as the primary therapy for cervical cancer performed by a gynecologic oncologist with expertise in LESS. A multichannel, single-port access device; a flexible-tipped 5-mm laparoscope; and a multifunctional instrument were used in all cases. Clinicopathologic, surgical, and perioperative outcomes were analyzed. Twenty-two women were identified in whom a LESS-RH was attempted; 20 (91%) successfully underwent the procedure, including 19 in whom pelvic lymphadenectomy (PLND) was completed. Of the 2 converted procedures, 1 patient underwent 2-port laparoscopy secondary to truncal obesity, and 1 patient underwent conversion to laparotomy secondary to external iliac vein laceration during PLND. The median age and body mass index were 46 years and 23.3 kg/m(2), respectively. The median number of pelvic lymph nodes removed was 22. One patient experienced an intraoperative complication, and no patient required reoperation. The margins of excision were negative. One patient with 2 positive pelvic nodes and 1 patient with microscopic parametrial disease received adjuvant chemosensitized radiation; 3 additional patients received adjuvant radiation therapy secondary to an intermediate risk for recurrence. After a median follow up of 11 months, no recurrences were detected. LESS-RH/PLND is feasible and safe for select patients with stage I cervical cancer. Larger studies are needed to confirm whether the increased technical difficulty of this procedure justifies its use in routine gynecologic oncology practice. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

  16. Lower limb compartment syndrome by reperfusion injury after treatment of arterial thrombosis post-laparoscopic radical hysterectomy and pelvic lymph node dissection for cervical cancer.

    Science.gov (United States)

    Yeon, Jihee; Jung, Ye Won; Yang, Shin Seok; Kang, Byung Hun; Lee, Mina; Ko, Young Bok; Yang, Jung Bo; Lee, Ki Hwan; Yoo, Heon Jong

    2017-03-01

    Compartment syndrome is a clinical condition associated with decreased blood circulation that can lead to swelling of tissue in limited space. Several factors including lithotomy position, prolonged surgery, intermittent pneumatic compressor, and reperfusion after treatment of arterial thrombosis may contribute to compartment syndrome. However, compartment syndrome rarely occurs after gynecologic surgery. In this case, the patient was diagnosed as compartment syndrome due to reperfusion injury after treatment of arterial thrombosis, which occurred after laparoscopic radical hysterectomy and pelvic lymph node dissection for cervical cancer. Despite its rarity, prevention and identifying the risk factors of complication should be performed perioperatively; furthermore, gynecologist should be aware of the possibility of complications.

  17. Lower limb compartment syndrome by reperfusion injury after treatment of arterial thrombosis post-laparoscopic radical hysterectomy and pelvic lymph node dissection for cervical cancer

    Science.gov (United States)

    Yeon, Jihee; Jung, Ye Won; Yang, Shin Seok; Kang, Byung Hun; Lee, Mina; Ko, Young Bok; Yang, Jung Bo; Lee, Ki Hwan

    2017-01-01

    Compartment syndrome is a clinical condition associated with decreased blood circulation that can lead to swelling of tissue in limited space. Several factors including lithotomy position, prolonged surgery, intermittent pneumatic compressor, and reperfusion after treatment of arterial thrombosis may contribute to compartment syndrome. However, compartment syndrome rarely occurs after gynecologic surgery. In this case, the patient was diagnosed as compartment syndrome due to reperfusion injury after treatment of arterial thrombosis, which occurred after laparoscopic radical hysterectomy and pelvic lymph node dissection for cervical cancer. Despite its rarity, prevention and identifying the risk factors of complication should be performed perioperatively; furthermore, gynecologist should be aware of the possibility of complications. PMID:28344966

  18. The influence of number of high risk factors on clinical outcomes in patients with early-stage cervical cancer after radical hysterectomy and adjuvant chemoradiation

    Science.gov (United States)

    Lim, Soyi; Lee, Seok-Ho; Park, Chan-Yong

    2016-01-01

    Objective The purpose of this study was to evaluate the prognosis according to the number of high risk factors in patients with high risk factors after radical hysterectomy and adjuvant chemoradiation therapy for early stage cervical cancer. Methods Clinicopathological variables and clinical outcomes of patients with FIGO (International Federation of Gynecology and Obstetrics) stage IB1 to IIA cervical cancer who had one or more high risk factors after radical hysterectomy and adjuvant chemoradiation therapy were retrospectively analyzed. Patients were divided into two groups according to the number of high risk factors (group 1, single high risk factor; group 2, two or more high risk factors). Results A total of 93 patients were enrolled in the present study. Forty nine out of 93 (52.7%) patients had a single high risk factor, and 44 (47.3%) had two or more high risk factors. Statistically significant differences in stage and stromal invasion were observed between group 1 and group 2. However, age, histology, tumor size, and lymphovascular space invasion did not differ significantly between the groups. Distant recurrence occurred more frequently in group 2, and the probability of recurrence and death was higher in group 2. Conclusion Patients with two or more high risk factors had worse prognosis in early stage cervical cancer. For these patients, consideration of new strategies to improve survival may be worthwhile. Conduct of further clinical trials is warranted for development of adjuvant treatment strategies individualized to each risk group. PMID:27200308

  19. Treatment of cervical cancer in the Republic of Srpska

    Directory of Open Access Journals (Sweden)

    Draganović Dragica

    2011-01-01

    Full Text Available Introduction. Since 1897, when the first radical hysterectomy with lymphadenectomy was done by Wertheim in Vienna, this operation has had the central role in the surgical treatment of invasive cervical tumors. Material and methods. In the period from 1997 to 2010, 177 patients diagnosed with invasive cervical cancer according to the International Federation of Gynecology and Obstetrics (FIGO stage IB1 - II were operated at the Department of Obstetrics and Gynecology in Banja Luka. All patients underwent radical hysterectomy by Wertheim - Meigs. The aim of this study is to present the technique of this operation, as well as its effectiveness in the treatment of cervical cancer. Results. The distribution of the patients having invasive cervical cancer according to the International Federation of Gynecology and Obstetrics classification was as follows: I B1 - 35.67%, I B2 - 23.17%, II A - 15.48%, II B - 25.68% on average is 21.3 removed lymph glands. The rate of intraoperative and postoperative complications was 8 (4.51% and 17 (9.60%, respectively. Of the 26 patients who were operated in the period from 2005 - 2010, 13 had stage II B according to the International Federation of Gynecology and Obstetrics; there were 6 lethal outcomes (23.08 and the five-year survival rate was 76.92%. Discussion and conclusion. By applying the proper surgical technique and early prevention of immediate complications, we achieved satisfactory results in operative morbity and mortality, intraoperative and postoperative complications of the lesion for radical surgery by the Wertheim- Meigs-in the treatment of cancer of the uterus in the I B - II B stage according to the International Federation of Gynecology and Obstetrics classification.

  20. Hysterectomy (image)

    Science.gov (United States)

    Hysterectomy is surgical removal of the uterus, resulting in inability to become pregnant. This surgery may be done for a variety of reasons including, but not restricted to, chronic pelvic inflammatory disease, uterine fibroids and ...

  1. Incidence of pelvic organ prolapse repair subsequent to hysterectomy

    DEFF Research Database (Denmark)

    Lykke, Rune; Blaakær, Jan; Ottesen, Bent

    2017-01-01

    INTRODUCTION AND HYPOTHESIS: The aim of this study was to compare the incidence of subsequent pelvic organ prolapse (POP) repair in women following radical hysterectomy versus total abdominal hysterectomy. METHODS: From the Danish National Patient Registry, we collected data on all radical...

  2. Quality of laparoscopic radical hysterectomy in developing countries: a comparison of surgical and oncologic outcomes between a comprehensive cancer center in the United States and a cancer center in Colombia.

    Science.gov (United States)

    Pareja, Rene; Nick, Alpa M; Schmeler, Kathleen M; Frumovitz, Michael; Soliman, Pamela T; Buitrago, Carlos A; Borrero, Mauricio; Angel, Gonzalo; Reis, Ricardo Dos; Ramirez, Pedro T

    2012-05-01

    To help determine whether global collaborations for prospective gynecologic surgery trials should include hospitals in developing countries, we compared surgical and oncologic outcomes of patients undergoing laparoscopic radical hysterectomy at a large comprehensive cancer center in the United States and a cancer center in Colombia. Records of the first 50 consecutive patients who underwent laparoscopic radical hysterectomy at The University of Texas MD Anderson Cancer Center in Houston (between April 2004 and July 2007) and the first 50 consecutive patients who underwent the same procedure at the Instituto de Cancerología-Clínica las Américas in Medellín (between December 2008 and October 2010) were retrospectively reviewed. Surgical and oncologic outcomes were compared between the 2 groups. There was no significant difference in median patient age (US 41.9 years [range 23-73] vs. Colombia 44.5 years [range 24-75], P=0.09). Patients in Colombia had a lower median body mass index than patients in the US (24.4 kg/m(2) vs. 28.7 kg/m(2), P=0.002). Compared to patients treated in Colombia, patients who underwent surgery in the US had a greater median estimated blood loss (200 mL vs. 79 mL, P<0.001), longer median operative time (328.5 min vs. 235 min, P<0.001), and longer postoperative hospital stay (2 days vs. 1 day, P<0.001). Surgical and oncologic outcomes of laparoscopic radical hysterectomy were not worse at a cancer center in a developing country than at a large comprehensive cancer center in the United States. These results support consideration of developing countries for inclusion in collaborations for prospective surgical studies. Copyright © 2011 Elsevier B.V. All rights reserved.

  3. Quality of life and sexuality in disease-free survivors of cervical cancer after radical hysterectomy alone: A comparison between total laparoscopy and laparotomy.

    Science.gov (United States)

    Xiao, Meizhu; Gao, Huiqiao; Bai, Huimin; Zhang, Zhenyu

    2016-09-01

    The aim of the present study was to evaluate the possible differences between total laparoscopy and laparotomy regarding their impact on postoperative quality of life and sexuality in disease-free cervical cancer survivors who received radical hysterectomy (RH) and/or lymphadenectomy alone and were followed for >1 year.We reviewed all patients with cervical cancer who had received surgical treatment in our hospital between January 2001 and March 2014. Consecutive sexually active survivors who received RH and/or lymphadenectomy for early stage cervical cancer were enrolled and divided into 2 groups based on surgical approach. Survivors were interviewed and completed validated questionnaires, including the European Organization for Research Treatment of Cancer Quality-of-Life Core Questionnaire including 30 items, the Cervical Cancer-Specific Module of European Organization for Research Treatment of Cancer Quality-of-Life Questionnaire including 24 items (EORTC QLQ-CX24), and the Female Sexual Function Index (FSFI).In total, 273 patients with histologically confirmed cervical cancer were retrospectively reviewed. However, only 64 patients had received RH and/or lymphadenectomy alone; 58 survivors meeting the inclusion criteria were enrolled, including 42 total laparoscopy cases and 16 laparotomy cases, with an average follow-up of 46.1 and 51.2 months, respectively. The survivors in the 2 groups obtained good and similar scores on all items of the European Organization for Research Treatment of Cancer Quality-of-Life Core Questionnaire including 30 items and Cervical Cancer-Specific Module of European Organization for Research Treatment of Cancer Quality-of-Life Questionnaire including 24 items, without significant differences after controlling for covariate background characteristics. To the date of submission, 21.4% (9/42) of cases in the total laparoscopy group and 31.2% (5/16) of cases in the laparotomy group had not resumed sexual behavior after RH. Additionally

  4. Emergency peripartum hysterectomy

    DEFF Research Database (Denmark)

    Jakobsson, Maija; Tapper, Anna Maija; Colmorn, Lotte Berdiin

    2015-01-01

    OBJECTIVE: To assess the prevalence and risk factors of emergency peripartum hysterectomy. DESIGN: Nordic collaborative study. POPULATION: 605 362 deliveries across the five Nordic countries. METHODS: We collected data prospectively from patients undergoing emergency peripartum hysterectomy withi...

  5. Health care cost consequences of using robot technology for hysterectomy

    DEFF Research Database (Denmark)

    Laursen, Karin Rosenkilde; Hyldgård, Vibe Bolvig; Jensen, Pernille Tine

    2017-01-01

    The objective of this study is to examine the costs attributable to robotic-assisted laparoscopic hysterectomy from a broad healthcare sector perspective in a register-based longitudinal study. The population in this study were 7670 consecutive women undergoing hysterectomy between January 2006...... and August 2013 in public hospitals in Denmark. The interventions in the study were total and radical hysterectomy performed robotic-assisted laparoscopic hysterectomy (RALH), total laparoscopic hysterectomy (TLH), or open abdominal hysterectomy (OAH). Service use in the healthcare sector was evaluated 1...... year before to 1 year after the surgery. Tariffs of the activity-based remuneration system and the diagnosis-related grouping case-mix system were used for valuation of primary and secondary care, respectively. Costs attributable to RALH were estimated using a difference-in-difference analytical...

  6. Current Issues with Hysterectomy.

    Science.gov (United States)

    Barker, Matthew A

    2016-09-01

    Hysterectomy is one of the most common gynecologic surgeries. Early adoption of surgical advancements in hysterectomies has raised concerns over safety, quality, and costs. The risk of potential leiomyosarcoma in women undergoing minimally invasive hysterectomy led the US Food and Drug Administration to discourage the use of electronic power morcellator. Minimally invasive hysterectomies have increased substantially despite lack of data supporting its use over other forms of hysterectomy and increased costs. Health care reform is incentivizing providers to improve quality, improve safety, and decrease costs through standardized outcomes and process measures.

  7. Laparoscopic approach to hysterectomy

    Directory of Open Access Journals (Sweden)

    Hakan Nazik

    2013-04-01

    Full Text Available Modern laparoscopic surgery is widely used throughout the world as it offers greater advantages than open procedures. The laparoscopic approach to hysterectomy has evolved over the last 20 years. Hysterectomies are performed abdominally, vaginally, laparoscopically or, more recently, with robotic assistance. Indications for a total laparoscopic hysterectomy are similar to those for total abdominal hysterectomy, and most commonly include uterine leiomyomata, pelvic organ prolapse, and abnormal uterine bleeding. When hysterectomy is going to be performed, the surgeon should decide which method is safer and more cost-effective. This paper aims to make a review of the indications, techniques and advantages of laparoscopic hysterectomy as well as the criteria to be used for appropriate patient selection.

  8. Chronic pain after hysterectomy

    DEFF Research Database (Denmark)

    Brandsborg, B.; Nikolajsen, L.; Kehlet, H.;

    2008-01-01

    BACKGROUND: Chronic pain is a well-known adverse effect of surgery, but the risk of chronic pain after gynaecological surgery is less established. METHOD: This review summarizes studies on chronic pain following hysterectomy. The underlying mechanisms and risk factors for the development of chronic...... post-hysterectomy pain are discussed. RESULTS AND CONCLUSION: Chronic pain is reported by 5-32% of women after hysterectomy. A guideline is proposed for future prospective studies Udgivelsesdato: 2008/3...

  9. Chronic pain after hysterectomy

    DEFF Research Database (Denmark)

    Brandsborg, B; Nikolajsen, L; Kehlet, Henrik;

    2008-01-01

    BACKGROUND: Chronic pain is a well-known adverse effect of surgery, but the risk of chronic pain after gynaecological surgery is less established. METHOD: This review summarizes studies on chronic pain following hysterectomy. The underlying mechanisms and risk factors for the development of chronic...... post-hysterectomy pain are discussed. RESULTS AND CONCLUSION: Chronic pain is reported by 5-32% of women after hysterectomy. A guideline is proposed for future prospective studies. Udgivelsesdato: 2008-Mar...

  10. "STUDY OF CONCURRENT CISPLATIN AND EXTERNAL RADIOTHERAPY PRIOR TO RADICAL HYSTERECTOMY AND LYMPHADENECTOMY IN PATIENTS WITH STAGE IB-IIB CERVICAL CANCER"

    Directory of Open Access Journals (Sweden)

    M. Modares Gilani

    2004-06-01

    Full Text Available The purpose of this study was to describe the feasibility of a combined preoperative chemoradiation program Ib-IIa, bulky and suspicious IIb by radical surgery in patients with stage Ib-IIb cervical cancer. From September 1999 to April 2002, 30 patients with carcinoma of the cervix were treated with preoperative external beam radiotherapy of 45 Gy in 5 weeks. Patients received concurrent continuous infusion of cisplatin 50 mg/m2 for one day in week during 5 weeks of radiation. Radical surgery was performed 4-6 weeks after completion of the preoperative treatment. Toxicity with chemoradiation was usually mild. Two patients developed vesicovaginal fistula, and four developed long-term hydronephrosis that needed ureteral stenting. Clinical response was observed in 100% of the patients (23.7% complete response. The analysis of the surgical specimens revealed complete pathological response in 43.3% of the cases and partial pathological response in 56.7%. The degree of pathological response was not predictable by the degree of clinical response. Thirty months disease-free survival and overall survival were 66.3% and 77.31%, respectively. Patients with complete and partial pathological response were not significantly different in terms of disease-free survival (p= 0.08 and overall survival (p= 0.3. Cisplatin in preoperative chemoradiation is effective and usually welltolerated in bulky cervical cancer and parametrial invasion, inducing a high rate of clinical and pathological complete responses. When this therapy is followed by radical surgery, disease-free and overall survival rates are higher. The latter may be possible only through extensive surgical resection with a parallel increase in complication rates.

  11. EMERGENCY PERIPARTUM HYSTERECTOMY

    African Journals Online (AJOL)

    2001-02-02

    Feb 2, 2001 ... complications that give rise to emergency hysterectomy should decrease maternal and fetal morbidity ... labour and early recourse to Caesarean section, the clinical ... insertion of prostaglandin, the patient was found to be in.

  12. Efficacy of biofeedback combined with electrical stimulation therapy for retention after radical hysterectomy%生物反馈联合电刺激治疗宫颈癌根治术后尿潴留的疗效分析

    Institute of Scientific and Technical Information of China (English)

    傅琦博; 吕坚伟; 蒋晨; 吕婷婷; 李震东; 邱丰; 黄翼然

    2015-01-01

    ABSTRACT:Objective To investigate the efficacy of biofeedback combined with electrical stimulation therapy for reten‐tion after radical hysterectomy .Methods A total of 38 cases with retention after radical hysterectomy treated during June 2012 to May 2014 were randomly divided into two groups .The trial group was treated with pelvic floor biofeedback with elec‐trical stimulation AM800B for 20 to 30 minutes once daily for a week ,while the control group was treated with traditional blad‐der training .Results After one week of trement ,the effective rate for the trial group was 89 .47% (17/19) ,which was higher than 52 .63% (10/19) ,the rate for the control group (P0 .05 ) .Conclusions Pelvic floor biofeedback with electrical stimulation therapy can improve the urinary function effectively within a short period of time .It is worth clinical application .%目的:评估生物反馈联合电刺激治疗宫颈癌根治术后尿潴留的疗效。方法2012年6月至2014年5月共收治38例宫颈癌根治术后尿潴留患者,随机分成2组,治疗组采用生物反馈治疗仪进行生物反馈联合电刺激治疗,治疗时间约为20~30 min ,1次/d ,疗程1周;对照组采用传统膀胱功能训练进行治疗,对比两组间的疗效。结果1周后疗效比较,治疗组有效率89.47%(17/19),对照组52.63%(10/19),治疗组疗效明显优于对照组( P<0.05);2周后疗效比较,治疗组有效率达到94.74%(18/19),对照组89.47%(17/19),两组间统计学无明显差异( P>0.05)。结论采用生物反馈联合电刺激治疗宫颈癌根治术后尿潴留能明显缩短恢复患者排尿功能的时间,且创伤小,无明显不良反应,容易被患者接受,值得临床推广。

  13. Salvage interstitial brachytherapy based on computed tomography for recurrent cervical cancer after radical hysterectomy and adjuvant radiation therapy: case presentations and introduction of the technique.

    Science.gov (United States)

    Liu, Zhong-Shan; Guo, Jie; Zhao, Yang-Zhi; Lin, Xia; Chen, Bin; Zhang, Ming; Li, Jiang-Ming; Ren, Xiao-Jun; Zhang, Bing-Ya; Wang, Tie-Jun

    2016-10-01

    Locally recurring cervical cancer after surgery and adjuvant radiotherapy remains a major therapeutic challenge. This paper presents a new therapeutic technique for such patients: interstitial brachytherapy (BT) guided by real-time three-dimensional (3D) computed tomography (CT). Sixteen patients with recurrent cervical cancer after radical surgery and adjuvant external-beam radiotherapy (EBRT) were included in this study. These patients underwent high-dose-rate (HDR) interstitial BT with free-hand placement of metal needles guided by real-time 3D-CT. Six Gy in 6 fractions were prescribed for the high-risk clinical target volume (HR-CTV). D90 and D100 for HR-CTV of BT, and the cumulative D2cc for the bladder, rectum, and sigmoid, including previous EBRT and present BT were analyzed. Treatment-related complications and 3-month tumor-response rates were investigated. The mean D90 value for HR-CTV was 52.5 ± 3.3 Gy. The cumulative D2cc for the bladder, rectum, and sigmoid were 85.6 ± 5.8, 71.6 ± 6.4, and 69.6 ± 5.9 Gy, respectively. The mean number of needles was 6.1 ± 1.5, with an average depth of 3.5 ± 0.9 cm for each application. Interstitial BT was associated with minor complications and passable tumor-response rate. Interstitial BT guided by real-time 3D-CT for recurrent cervical cancer results in good dose-volume histogram (DVH) parameters. The current technique may be clinically feasible. However, long-term clinical outcomes should be further investigated.

  14. Surgical approach to hysterectomy for benign gynaecological disease

    NARCIS (Netherlands)

    Aarts, J.W.M.; Nieboer, T.E.; Johnson, N.; Tavender, E.; Garry, R.; Mol, B.W.; Kluivers, K.B.

    2015-01-01

    BACKGROUND: The four approaches to hysterectomy for benign disease are abdominal hysterectomy (AH), vaginal hysterectomy (VH), laparoscopic hysterectomy (LH) and robotic-assisted hysterectomy (RH). OBJECTIVES: To assess the effectiveness and safety of different surgical approaches to hysterectomy

  15. Multivariate analysis of the prognostic factors of squamous cell cervical cancer treated by radical hysterectomy or combined radiation therapy; Carcinoma espinocelular do colo uterino submetido a cirurgia radical isolada ou em combinacao com radioterapia

    Energy Technology Data Exchange (ETDEWEB)

    Coelho, Francisco Ricardo Gualda; Kowalski, Luiz Paulo; Abrao, Fauzer Simao [Fundacao Antonio Prudente, Sao Paulo, SP (Brazil). Hospital A.C. Camargo; Franco, Eduardo Luiz [McGill Univ., Montreal, PQ (Canada). Dept. of Oncology; Zeferino, Luiz Carlos [Universidade Estadual de Campinas, SP (Brazil). Faculdade de Medicina; Brentani, Maria Mitzi [Sao Paulo Univ., SP (Brazil). Faculdade de Medicina

    1996-04-01

    Six hundred and nine cases of invasive squamous cell carcinoma of the cervix uteri in a retrospective analysis (1953-1982) at the A.C. Camargo Hospital, Antonio Prudente Foundation, Sao Paulo, Brazil. The patients were submitted to radical surgery and radiation therapy, individually or in combination. A multivariate analysis of the different variables were performed according to the Cox`s regression method. The variables of prognosis value, in decreasing order of importance, were: the decade of patient`s admission, the modality of therapy employed, the presence of residual tumor in the surgical specimens and the clinical stage of the disease. Other variables like ethnic group, age of first menstrual flux, menopause, number of pregnancy, kind of delivery, number and kind of abortion, were found to be of no prognostic importance. The decade of admission was of independent prognostic significance. The presence of residual tumor in the surgical specimens was more important than lymph nodes spreading, but the overall survival was affected by the increase in the number of positive lymph nodes. Patient`s age was a weak prognostic factor accounting for a reduction in the survival time among cases with age upper to 45 years old. Radiation therapy sterilizes a considerable number of lymph nodes but not all of them in every patient. There are a specific group of patients where the radical surgery is necessary in order to carry a complete debulking of the disease. (author) 82 refs., 10 figs.

  16. Total versus subtotal hysterectomy

    DEFF Research Database (Denmark)

    Gimbel, Helga; Zobbe, Vibeke; Andersen, Anna Birthe;

    2005-01-01

    The aim of this study was to compare total and subtotal abdominal hysterectomy for benign indications, with regard to urinary incontinence, postoperative complications, quality of life (SF-36), constipation, prolapse, satisfaction with sexual life, and pelvic pain at 1-year postoperative. Eighty...

  17. Depression, anxiety, hostility and hysterectomy.

    Science.gov (United States)

    Ewalds-Kvist, S Béatrice M; Hirvonen, Toivo; Kvist, Mårten; Lertola, Kaarlo; Niemelä, Pirkko

    2005-09-01

    Sixty-five women (aged 32 - 54 yrs) were assessed at 2 months before to 8 months after total abdominal hysterectomy on four separate occasions. Beck's Depression Inventory (BDI), Taylor's Manifest Anxiety Scale (TMAS), the Buss-Durkee Hostility Inventory (BDHI), Measurement of Masculinity-Femininity (MF), Likert scales and semantic differentials for psychological, somatic and sexual factors varied as assessment tools. High-dysphoric and low-dysphoric women were compared with regard to hysterectomy outcomes. Married nulliparae suffered from enhanced depression post-surgery. Pre-surgery anxiety, back pain and lack of dyspareunia contributed to post-surgery anxiety. Pre-surgery anxiety was related to life crises. Pre- and post-surgery hostility occurred in conjunction with poor sexual gratification. Post-hysterectomy health improved, but quality of sexual relationship was impaired. Partner support and knowledge counteracted hysterectomy aftermath. Post-hysterectomy symptoms constituted a continuum to pre-surgery signs of depression, anxiety or hostility.

  18. Sexuality after total vs. subtotal hysterectomy

    DEFF Research Database (Denmark)

    Zobbe, Vibeke Bahn; Gimbel, Helga Margrethe Elisabeth; Andersen, Birthe Margrethe;

    2004-01-01

    The effect of hysterectomy on sexuality is not fully elucidated and until recently total and subtotal hysterectomies have only been compared in observational studies.......The effect of hysterectomy on sexuality is not fully elucidated and until recently total and subtotal hysterectomies have only been compared in observational studies....

  19. Sexuality after total vs. subtotal hysterectomy

    DEFF Research Database (Denmark)

    Zobbe, Vibeke Bahn; Gimbel, Helga Margrethe Elisabeth; Andersen, Birthe Margrethe

    2004-01-01

    The effect of hysterectomy on sexuality is not fully elucidated and until recently total and subtotal hysterectomies have only been compared in observational studies.......The effect of hysterectomy on sexuality is not fully elucidated and until recently total and subtotal hysterectomies have only been compared in observational studies....

  20. Preoperative teaching and hysterectomy outcomes.

    Science.gov (United States)

    Oetker-Black, Sharon L; Jones, Susan; Estok, Patricia; Ryan, Marian; Gale, Nancy; Parker, Carla

    2003-06-01

    This study used a theoretical model to determine whether an efficacy-enhancing teaching protocol was effective in improving immediate postoperative behaviors and selected short- and long-term health outcomes in women who underwent abdominal hysterectomies. The model used was the self-efficacy theory of Albert Bandura, PhD. One hundred eight patients in a 486-bed teaching hospital in the Midwest who underwent hysterectomies participated. The participation rate was 85%, and the attrition rate was 17% during the six-month study. The major finding was that participants in the efficacy-enhancing teaching group ambulated significantly longer than participants in the usual care group. This is an important finding because the most prevalent postoperative complications after hysterectomy are atelectasis, pneumonia, paralytic ileus, and deep vein thrombosis, and postoperative ambulation has been shown to decrease or prevent all of these complications. This finding could affect the overall health status of women undergoing hysterectomies.

  1. 子宫切除联合阴道延长手术对Ⅰb1~Ⅰb2期宫颈癌患者婚姻质量的影响%Quality of marriage and sexual function of cervical cancer patients following radical hysterectomy and vaginal extension

    Institute of Scientific and Technical Information of China (English)

    陈红; 张友忠

    2015-01-01

    Objective To investigate the quality of marriage and sexual function of cervical cancer patients following radical hysterectomy and vaginal extension.Methods Case-control and questionnairebased methods were used in this study.Forty patients of early-stage (Ⅰ b 1 ~ Ⅰ b2) cervical cancer who had undergone vaginal extension following classic radical hysterectomy were included in the observation group,while 40 patients with matching factors and radical hysterectomy only during the same period were included in the control group.The quality of marriage and sexual function were compared with OLSON marriage prolapse and incontinence sexual function questionnaire Shon Fonn (PISQ-12).Results The operation time and postoperative vaginal length in the observation group were higher than those in the control group (P < 0.05 or P < 0.01).The emotional,physical,and total scores during postoperation were lower than those during preoperation (P < 0.01).The emotional,physical,and total scores in the control group were lower than those in the observation group (P < 0.01).The marital satisfaction,husband and wife communication,conflict resolution methods,extracurricular activities and sex scores in the observation group were higher than those in the control group (P < 0.05 or P < 0.01).Conclusions Patients with peritoneovaginoplasty following radical hysterectomy had much longer vagina and less self-perceived short vagina.Vaginal extension following radical hysterectomy does not worsen the pelvic floor symptoms.%目的 探讨子宫切除联合阴道延长手术对Ⅰb1~Ⅰb2期宫颈癌患者婚姻质量、生活质量及性生活的影响.方法 选择本院住院经宫腔细胞学及宫颈活组织病理学确诊的Ⅰb1~Ⅰb2期宫颈癌患者80例为研究对象,采用随机数字表法分为观察组和对照组,每组40例,两组分别给予腹腔镜子宫切除联合阴道延长手术与单独腹腔镜子宫切除手术治疗.观察患者术

  2. Effect of epidural anesthesia combined with remifentanil-propofol in radical hysterectomy for cervical cancer%硬膜外阻滞复合雷米芬太尼-丙泊酚应用于宫颈癌根治术的效果观察

    Institute of Scientific and Technical Information of China (English)

    李秀满; 王立祥

    2011-01-01

    目的 探讨硬膜外麻醉复合雷米芬太尼-丙泊酚应用于宫颈癌根治术的麻醉效果.方法 56例ASAⅠ~Ⅱ行宫颈癌根治术患者随机分成雷米芬太尼组(R组,n=28)和杜氟合剂组(D组,n=28),R组在硬膜外麻醉后缓慢静注丙泊酚1 mg/kg后用丙泊酚2.0 mg/kg.h+雷米芬太尼0.1ug/kg.min靶控输注,D组用杜冷丁50 mg+氟哌啶2.5 mg后,靶控输注丙泊酚2.0 mg/kg.h.记录5个时间点的血压和心率;记录术中体动反应及术毕呼之睁眼时间,恶心呕吐等评级及患者满意度.结果 ①两组在给药后SBP、DBP、HR较给药前降低(P<0.05〉,切皮时有增高,但D组升高较R组明显(P<0.05〉;②术后D组眩晕、头痛、躁动及患者满意度与R组相比,差异有统计学意义(P<0.05〉.结论 硬膜外复合雷米芬太尼适合在宫颈癌根治术中使用,与复合杜氟合剂相比较,在苏醒程度上更为优良,患者更为舒适.%Objective To explore clinical effect of cpidural anesthesia combined with remifentanil-propofol undergoing radical hysterectomy in patients with cervical cancer. Methods 56 ASA Ⅰ~Ⅱ cases with radical hysterectomy were randomly divided into two groups, Remifentanil group (group R, n= 28), target controlled infusion (TCI) propofol 2.0 mg/kg.h concentration + Remifentanil 0.1 ug/kg. Min after lmg/kg propofol injected slowly by the intraverous route, and Dolantin- droperidol mixture group (group D, n= 28), VCI propofol 2.0 mg/kg.h concentration after Dolantin50mg + droperidol 2.5mg injected slowly by the intravenous route. All patients were oxygenated by nasal cannula. The HR and BP were recorded at five time points respectively. Body reaetion of interoperation, the time of opening eyes, nausea and vomiting rating and patient satisfaction of post operation were observed respectively. Results ① In both groups, patients' HR dropped after drug intravenous injection and inereased when operation was started (P< 0.05 ), in which HR in group

  3. Peripartum hysterectomy in Denmark 1995-2004

    DEFF Research Database (Denmark)

    Sakse, Abelone Elisabeth; Weber, Tom; Nickelsen, Carsten Nahne Amtof

    2007-01-01

    BACKGROUND: Severe postpartum hemorrhage (PPH) is a potentially life-threatening situation that sometimes requires a hysterectomy. We examined the national incidence, risk factors, indications, outcomes and complications of peripartum hysterectomy following vaginal and caesarean delivery. METHODS...

  4. 子宫颈癌患者广泛子宫切除术后下泌尿道尿动力学特点%The low urethra urethral dynamics characteristics after cervical cancer radical hysterectomy postoperative

    Institute of Scientific and Technical Information of China (English)

    戴森戈; 雷鸣; 詹丽飞

    2013-01-01

    Objective To investigate a wide range of uterine cervical cancer after hysterectomy for lower urinary tract urinary dynamics characteristics.Methods Cervical cancer Ib Ⅱ a via ablominal extensive hysterectomy in 25 cases were analyzed retrospectively,which had the type of operation in 7 cases,type Ⅲ Procedures for 18 cases,respectively,at 1 month after operation and 1 urethral urodynamic studies.Results The patients showed varying degrees of voiding dysfunction and urine storage dysfunction,maximum urinary flow rate decreased significantly (10.01 ml/min),the average decrease in urinary flow rate(6.44ml/min),voiding time 77.63s,residual urine volume 103.16ml,maximum bladder capacity 288.68ml,postoperative beard had the aid of abdominal pressure urination.Conclusion Extensive hysterectomy can occur after different degree of voiding dysfunction and urine storage dysfunction,and duration is longer,the main manifestation of impaired detrusor function,bladder sensory dysfunction,urethral dynamics can contribute to early diagnosis,early treatment,to prevent serious complications of the urinary system.%目的 探讨子宫颈癌广泛子宫切除术后下泌尿道尿动力学的特点.方法 回顾性分性因子宫颈癌Ib~Ⅱa期行经腹广泛子宫切除术的患者25例,其中Ⅱ型术式7例、Ⅲ型术式18例,分别于术后1个月至1年间行尿道动力学检查.结果 患者术后均显示不同程度的排尿功能障碍及储尿功能障碍,最大尿流率明显下降(10.01 ml/min),平均尿流率下降(6.44 ml/min),排尿时间77.63 s,残余尿量103.16 ml,最大膀胱容量288.68ml,术后须借助腹压排尿.结论 广泛子宫切除术后可发生不同程度的排尿功能障碍及储尿功能障碍,且持续时间较久,其主要表现为逼尿肌功能受损、膀胱感觉功能减退,尿道动力学可有助于早期诊断、早期治疗,以预防严重的泌尿系统并发症.

  5. Peripartum hysterectomy: an evolving picture.

    LENUS (Irish Health Repository)

    Turner, Michael J

    2012-02-01

    Peripartum hysterectomy (PH) is one of the obstetric catastrophes. Evidence is emerging that the role of PH in modern obstetrics is evolving. Improving management of postpartum hemorrhage and newer surgical techniques should decrease PH for uterine atony. Rising levels of repeat elective cesarean deliveries should decrease PH following uterine scar rupture in labor. Increasing cesarean rates, however, have led to an increase in the number of PHs for morbidly adherent placenta. In the case of uterine atony or rupture where PH is required, a subtotal PH is often sufficient. In the case of pathological placental localization involving the cervix, however, a total hysterectomy is required. Furthermore, the involvement of other pelvic structures may prospectively make the diagnosis difficult and the surgery challenging. If resources permit, PH for pathological placental localization merits a multidisciplinary approach. Despite advances in clinical practice, it is likely that peripartum hysterectomy will be more challenging for obstetricians in the future.

  6. The decline of hysterectomy for benign disease.

    LENUS (Irish Health Repository)

    Horgan, R P

    2012-01-31

    Hysterectomy is one of the most common gynaecological surgical procedures performed but there appears to be a decline in the performance of this procedure in Ireland in recent times. We set out to establish the extent of the decline of hysterectomy and to explore possible explanations. Data for hysterectomy for benign disease from Ireland was obtained from the Hospital In-Patient Enquiry Scheme (HIPE) section of the Economic and Social Research Institute for the years 1999 to 2006. The total number of hysterectomies performed for benign disease showed a consistent decline during this time. There was a 36% reduction in the number of abdominal hysterectomy procedures performed.

  7. Peripartum hysterectomy in Denmark 1995-2004

    DEFF Research Database (Denmark)

    Sakse, Abelone Elisabeth; Weber, Tom; Nickelsen, Carsten Nahne Amtoft;

    2007-01-01

    BACKGROUND: Severe postpartum hemorrhage (PPH) is a potentially life-threatening situation that sometimes requires a hysterectomy. We examined the national incidence, risk factors, indications, outcomes and complications of peripartum hysterectomy following vaginal and caesarean delivery. METHODS......: Peripartum hysterectomy was defined as a hysterectomy after birth until 1 month after delivery using the codes for hysterectomy from the NOMESCO classification (1995). National data from the period 1995-2004 were extracted from the Danish Medical Birth Register and linked to the Danish National Hospital...... Register followed by registration of relevant data from the medical records of all the patients. RESULTS: We found 152 hysterectomies corresponding to an incidence of 0.24/1,000 deliveries. The risk of peripartum hysterectomy increased 11-fold following caesarean compared to vaginal delivery. Placenta...

  8. Hysterectomy does not cause constipation

    NARCIS (Netherlands)

    Roovers, Jan-Paul; van der Bom, Johanna G.; van der Vaart, C. Huub

    PURPOSE: This study was designed to evaluate the risk on development and persistence of constipation after hysterectomy. METHODS: We conducted a prospective, observational, multicenter study with three-year follow-up in 13 teaching and nonteaching hospitals in the Netherlands. A total of 413 females

  9. Hysterectomy does not cause constipation

    NARCIS (Netherlands)

    Roovers, Jan-Paul; van der Bom, Johanna G.; van der Vaart, C. Huub

    2008-01-01

    PURPOSE: This study was designed to evaluate the risk on development and persistence of constipation after hysterectomy. METHODS: We conducted a prospective, observational, multicenter study with three-year follow-up in 13 teaching and nonteaching hospitals in the Netherlands. A total of 413 females

  10. TOTAL LAPAROSCOPIC HYSTERECTOMY VERSUS TOTAL ABDOMINAL HYSTERECTOMY: A RETROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Virupaksha

    2015-10-01

    Full Text Available BACKGROUND: Hysterectomy is a common gynaecological surgery which can be done by abdominal, vaginal or laparoscopic routes or with robotic assistance. Although there were concerns regarding the safety of laparoscopic surgery, a newer technique when compared with abdominal hysterectomy, it is now being reco gnized as a safe procedure in the hands of an experienced surgeon. AIMS: This study was done to compare the intra - operative and post - operative parameters of abdominal and laparoscopic hysterectomy. SETTINGS AND DESIGN: This study was done at JSS Hospital, Mysore between June 2013 and September 2014. It is a retrospective study . MATERIALS AND METHOD S: Patients admitted in the Department of Obstetrics and Gynaecology at JSS Hospital, JSS University, Mysore, with an indication for total abdominal hysterectomy( TAH or total laparoscopic hysterectomy(TLH for benign pathology from June 2013 to September 2014 were included in the study. Exclusion criteria were suspicion of malignancy, vaginal prolapse higher than first degree and those undergoing laparoscopic assi sted vaginal hysterectomy. Baseline characteristics, intraoperative and postoperative parameters were compared between the two groups. STATISTICAL ANALYSIS : The data were analyzed using independent T test, Chi square test and Mann Whitney test. A p value o f <0 . 05 was accepted as significant. RESULTS: The mean time taken to perform TLH was significantly longer, i.e. 113.46 minutes compared with TAH, i.e. 70.44 minutes, with the p value being <0.0001. But the duration of stay in the hospital was shorter for t he women undergoing TLH, mean duration being 3.74 days as opposed to 7.65 days in women undergoing TAH. This difference was also statistically significant with p value being <0.0001. Also, women undergoing TAH required more analgesic doses (mean 3.29 than those undergoing TLH (mean 1.36 and this difference was also statistically significant. CONCLUSION: Although TLH took a

  11. Changes in incontinence after hysterectomy

    DEFF Research Database (Denmark)

    Kruse, Anne Raabjerg; Jensen, Trine Dalsgaard; Lauszus, Finn Friis

    2017-01-01

    . Sample size calculation indicated that 102 women had to be included. The incontinence status was estimated by a Danish version of the ICIG questionnaire; further, visual analogue scale, dynamometer for hand grip, knee extension strength and balance were applied. Work capacity was measured ergometer cycle...... together with lean body mass by impedance. Quality of life was assessed using the SF-36 questionnaire. Patients were examined preoperatively and twice postoperatively. Results: In total 41 women improved their incontinence after hysterectomy and 10 women reported deterioration. Preoperative stress...... patients undergoing planned hysterectomy were compared pre- and postoperatively. In a sub-study of the prospective follow-up study the changes in incontinence, postoperative fatigue, quality of life, physical function, and body composition were evaluated preoperatively, 13 and 30 days postoperatively...

  12. Antibiotic prophylaxis for abdominal hysterectomy.

    Science.gov (United States)

    Mele, G; Loizzi, P; Greco, P; Gargano, G; Varcaccio Garofalo, G; Belsanti, A

    1988-01-01

    Three different regimens of antibiotic treatment have been employed in order to evaluate their efficacy as a profilaxis for abdominal hysterectomy. Two short term administrations (Cephtriaxone and Cephamandole plus Tobramycine) and a conventional full dose treatment (Cephazoline) have been compared over a group of homogeneous patients. No significant differences, except a reduction in postoperative time spent in hospital, have been found among the groups. A reduction in urinary tract infection has also been reported with a single-dose antibiotic prophylaxis.

  13. Socioeconomic factors may influence the surgical technique for benign hysterectomy

    DEFF Research Database (Denmark)

    Daugbjerg, Signe B; Ottesen, Bent; Diderichsen, Finn

    2012-01-01

    Owing to significantly improved outcomes, vaginal hysterectomy is the recommended standard approach when feasible in preference to abdominal hysterectomy. It is, however, not clear whether the use of vaginal hysterectomy varies with the women's socioeconomic background....

  14. Socioeconomic factors may influence the surgical technique for benign hysterectomy

    DEFF Research Database (Denmark)

    Daugbjerg, Signe B; Ottesen, Bent; Diderichsen, Finn

    2012-01-01

    Owing to significantly improved outcomes, vaginal hysterectomy is the recommended standard approach when feasible in preference to abdominal hysterectomy. It is, however, not clear whether the use of vaginal hysterectomy varies with the women's socioeconomic background....

  15. Potentially Avoidable Peripartum Hysterectomies in Denmark

    DEFF Research Database (Denmark)

    Colmorn, Lotte Berdiin; Krebs, Lone; Langhoff-Roos, Jens

    2016-01-01

    to minimize the number of unnecessary peripartum hysterectomies, obstetricians and anesthesiologists should investigate individual cases by structured clinical audit, and disseminate and discuss the results for educational purposes. An international collaboration is warranted to strengthen our recommendations......OBJECTIVE: To audit the clinical management preceding peripartum hysterectomy and evaluate if peripartum hysterectomies are potentially avoidable and by which means. MATERIAL AND METHODS: We developed a structured audit form based on explicit criteria for the minimal mandatory management...

  16. Potentially avoidable peripartum hysterectomies in Denmark

    DEFF Research Database (Denmark)

    Colmorn, Lotte Berdiin; Krebs, Lone; Langhoff-Roos, Jens

    2016-01-01

    to minimize the number of unnecessary peripartum hysterectomies, obstetricians and anesthesiologists should investigate individual cases by structured clinical audit, and disseminate and discuss the results for educational purposes. An international collaboration is warranted to strengthen our recommendations......Objective: To audit the clinical management preceding peripartum hysterectomy and evaluate if peripartum hysterectomies are potentially avoidable and by which means. Material and Methods: We developed a structured audit form based on explicit criteria for the minimal mandatory management...

  17. The Feasibility of Societal Cost Equivalence between Robotic Hysterectomy and Alternate Hysterectomy Methods for Endometrial Cancer

    Directory of Open Access Journals (Sweden)

    Neel T. Shah

    2011-01-01

    Full Text Available Objectives. We assess whether it is feasible for robotic hysterectomy for endometrial cancer to be less expensive to society than traditional laparoscopic hysterectomy or abdominal hysterectomy. Methods. We performed a retrospective cohort analysis of patient characteristics, operative times, complications, and hospital charges from all (=234 endometrial cancer patients who underwent hysterectomy in 2009 at our hospital. Per patient costs of each hysterectomy method were examined from the societal perspective. Sensitivity analysis and Monte Carlo simulation were performed using a cost-minimization model. Results. 40 (17.1% of hysterectomies for endometrial cancer were robotic, 91 (38.9%, were abdominal, and 103 (44.0% were laparoscopic. 96.3% of the variation in operative cost between patients was predicted by operative time (=0.963, <0.01. Mean operative time for robotic hysterectomy was significantly longer than other methods (<0.01. Abdominal hysterectomy was consistently the most expensive while the traditional laparoscopic approach was consistently least expensive. The threshold in operative time that makes robotic hysterectomy cost equivalent to the abdominal approach is within the range of our experience. Conclusion. It is feasible for robotic hysterectomy to be less expensive than abdominal hysterectomy, but unlikely for robotic hysterectomy to be less expensive than traditional laparoscopy.

  18. Impact of obesity on outcomes of hysterectomy.

    Science.gov (United States)

    McMahon, Megan D; Scott, Dana Marie; Saks, Erin; Tower, Amanda; Raker, Christina A; Matteson, Kristen A

    2014-01-01

    To evaluate the impact of obesity on complications of hysterectomy. Retrospective cohort study (Canadian Task Force II-2). The Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, Providence, RI. Patients who had a hysterectomy at WIH between July 2006 and January 2009. Hysterectomy by any mode. We collected data from medical records of all laparoscopic hysterectomies during the time period and collected data from a random subset of abdominal and vaginal hysterectomies. The independent variable, body mass index, was grouped according to World Health Organization guidelines. A composite of surgical complications was generated. Multivariable logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). We collected data from 907 hysterectomies, and 29.9% (n = 267) of the population was obese. Eighteen percent of patients (n = 154) had at least 1 complication. Compared to non-obese women, obese women were at increased odds of having any complication (OR 1.62, 95% CI 1.12-2-34). Performing subgroup analyses by mode of hysterectomy and controlling for confounding factors, we were unable to detect differences odds of complications between obese and non-obese women who underwent either an abdominal, vaginal, or laparoscopic hysterectomy. In our study, we found that among women who had a hysterectomy, obese women had a higher rate of complications than nonobese women. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

  19. On the measurement of recovery following hysterectomy

    NARCIS (Netherlands)

    Kluivers, K.B.

    2007-01-01

    Hysterectomy is the most frequently performed major gynaecologic surgical procedure, with millions of procedures performed annually throughout the world. Hysterectomy can be performed by a vaginal, abdominal or laparoscopic approach, and there is an overlap in indications for either choice. In gener

  20. Use of vaginal hysterectomy in Denmark

    DEFF Research Database (Denmark)

    Nielsen, Sidsel Lykke; Daugbjerg, Signe B; Gimbel, Helga

    2011-01-01

    To describe the use of vaginal, abdominal and laparoscopic hysterectomy in Denmark from 1999 to 2008, the influence of national guidelines and the patient and procedure-related characteristics associated with the choice of vaginal hysterectomy. Design. Nationwide register-based cohort study....

  1. The Danish Hysterectomy and Hysteroscopy Database

    DEFF Research Database (Denmark)

    Topsøe, Märta Fink; Ibfelt, Else Helene; Settnes, Annette

    2016-01-01

    AIM OF THE DATABASE: The steering committee of the Danish Hysterectomy and Hysteroscopy Database (DHHD) has defined the objective of the database: the aim is firstly to reduce complications, readmissions, reoperations; secondly to specify the need for hospitalization after hysterectomy; thirdly...

  2. Clinical assessment for three routes of hysterectomy

    Institute of Scientific and Technical Information of China (English)

    ZHU Lan; LANG Jing-he; LIU Chun-yan; SHI Hong-hui; SUN Zhi-jing; FAN Rong

    2009-01-01

    Background Hysterectomy is a very common surgery in gynecology. Ideal surgery for hysterectomy is microinvasive with few complications. There are three major routes of hysterectomy that are currently used. The aim of this study was to identify the differences of peri-operative outcome among the patients who underwent the three different approaches.Methods One hundred and one women undergoing hysterectomy for myoma had the procedure performed by laparoscopic assisted vaginal hysterectomy (LAVH), total vaginal hysterectomy (TVH) or total abdominal hysterectomy (TAH) in a randomized study. We compared the course of peri-operative and post-operative outcome for the three different approaches. Results were evaluated by linear regression analysis, Fishers exact test and Student's t test for independent samples.Results The operation time among the three procedures was not significantly different (P >0.05). The amount of blood loss in the TVH group was less than in the LAVH and TAH groups (P<0.05). The pain score 3 hours after operation in the LAVH group was significantly lower than in the TAH and TVH groups (P<0.001). The pain scores in the LAVH and TVH groups were lower than in the TAH group at 24 and 48 hours after operation (P<0.01). The women who underwent LAVH and TVH had a shorter hospitalization stay (P <0.001). The highest body temperature after operation in the TAH group was higher than that in LAVH and TVH groups (P <0.001).Conclusions LAVH and TVH are better procedures for women requiring hysterectomy. The peri-operative and post-operative courses of TVH are better than LAVH, excluding the pain score 3 hours after operation. Vaginal hysterectomy is the most cost-effective approach but the final choice for the route of hysterectomy can depend on many factors such as gynecological disease, patients' health status and experiences of the gynecologist.

  3. Risk profiles and outcomes of total laparoscopic hysterectomy compared with laparoscopically assisted vaginal hysterectomy.

    Science.gov (United States)

    Hanwright, Philip J; Mioton, Lauren M; Thomassee, May S; Bilimoria, Karl Y; Van Arsdale, John; Brill, Elizabeth; Kim, John Y S

    2013-04-01

    With the increasing rates of minimally invasive hysterectomy procedures serving as impetus, the aim of this study was to analyze the 30-day risk profiles associated with total laparoscopic hysterectomy and laparoscopically assisted vaginal hysterectomy (LAVH). The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent a total laparoscopic hysterectomy or LAVH operation between 2006 and 2010. Patient demographics and 30-day complication rates were calculated. Multivariable regression analyses were used to study the effect of hysterectomy approach on outcomes. A total of 6,190 patients underwent laparoscopic hysterectomy, with 66.3% receiving LAVH and 33.7% receiving a total laparoscopic hysterectomy. The patient cohorts were well-matched. Although total laparoscopic hysterectomy procedures were significantly longer than LAVH operations (2.66 hours compared with 2.20 hours; Plaparoscopic hysterectomy populations (7.05% compared with 6.3% for overall morbidity; 1.3% compared with 1.7% for reoperation). Regression analyses revealed that surgical approach was not a significant predictor of overall postoperative morbidity or reoperation in minimally invasive hysterectomy patients. Additionally, obesity did not demonstrate a significant association with morbidity or reoperation rates; however, operative time was found to be a significant predictor of reoperation (odds ratio 1.23, 95% confidence interval 1.07-1.42). Laparoscopic hysterectomy is well-tolerated with total laparoscopic hysterectomy and LAVH, yielding comparable rates of postoperative morbidity and reoperation. On average, LAVH procedures were 28 minutes faster than total laparoscopic hysterectomy. Additionally, increasing body mass index was not associated with higher rates of morbidity. II.

  4. Elective cesarean hysterectomy vs elective cesarean section followed by remote hysterectomy: reassessing the risks.

    Science.gov (United States)

    Bost; Rising; Bost

    1998-07-01

    Objective: The purpose of this study was to compare the risks of elective cesarean hysterectomy with the risks of elective cesarean section followed by remote hysterectomy.Methods: A census of elective cesarean hysterectomies (n = 31) and a random sample of 200 cesarean sections and 200 hysterectomies performed by the authors between 1987 and 1996 were evaluated. Only elective repeat and primary cesarean section patients without labor were selected for study (n = 86). Total abdominal hysterectomies were drawn from the sample (n = 60), excluding cancer cases, patients over 50 years old, and those with ancillary procedures other than adnexectomy and lysis of adhesions. General probability theory was used to calculate a predicted complication rate of cesarean section followed by TAH from the complication rates of the component procedures done independently. This predicted combined complication rate was then compared to the observed rate of complications from cesarean hysterectomy to evaluate the risks of the two alternative treatment regimens.Results: Elective cesarean section and total abdominal hysterectomy had complication rates of 12.8% and 13.4%, respectively. The predicted combined complication rate for elective cesarean section followed by TAH was 24.5%. The observed rate of complications for elective cesarean hysterectomy was much lower (16.1%). Although bleeding complications were similar for the two regimens, the rate of transfusion was higher for cesarean hysterectomy (13.0%) than for cesarean section (0%) and TAH (3.4%) alone. Eighty percent of the cesarean hysterectomy patients would have been candidates for autologous blood donation, had it been available.Conclusions: Elective cesarean hysterectomy has a lower risk of complications than elective cesarean section followed by remote abdominal hysterectomy and should be preferred. Transfusion risks are higher for cesarean hysterectomy but can be decreased by the use of autologous blood.

  5. Total laparoscopic hysterectomy in the obese patient.

    Science.gov (United States)

    Mikhail, Emad; Scott, Lauren; Imudia, Anthony N; Hart, Stuart

    2014-11-01

    Obesity is a challenging health problem that affects surgical decision-making. Obesity has also been associated with an increase in the perioperative complication rate in open abdominal hysterectomy and can increase the level of difficulty in performing a vaginal hysterectomy. Total laparoscopic hysterectomy (TLH) is a route that can offer advantages in obese patients including smaller incisions that are less likely to become infected as well as less post-operative pain and good visualization. With appropriate perioperative planning and techniques, excellent outcomes can be achieved.

  6. Hysterectomy

    Science.gov (United States)

    ... cuts in the belly, in order to perform robotic surgery You and your doctor will decide which type ... through the vagina using a laparoscope or after robotic surgery. When a larger surgical cut (incision) in the ...

  7. Hysterectomy

    Science.gov (United States)

    ... site Find a Health Center Near: Enter a city, ZIP code (such as 20002), address, state, or ... you have symptoms of depression, including feelings of sadness, a loss of interest in food or things ...

  8. The Triple-P procedure as a conservative surgical alternative to peripartum hysterectomy for placenta percreta.

    Science.gov (United States)

    Chandraharan, Edwin; Rao, Sridevi; Belli, Anna-Maria; Arulkumaran, Sabaratnam

    2012-05-01

    The reported maternal mortality for morbidly adherent placenta ranges from 7% to 10% worldwide. Current treatment modalities for this potentially life-threatening condition include radical approaches such as elective peripartum hysterectomy with or without bowel/bladder resection or ureteric re-implantation (for placenta percreta infiltrating these organs), and conservative measures such as compression sutures with balloon tamponade and the placenta remaining in situ. However, both conservative and radical measures are associated with significant maternal morbidity and mortality. The present article describes the Triple-P procedure-which involves perioperative placental localization and delivery of the fetus via transverse uterine incision above the upper border of the placenta; pelvic devascularization; and placental non-separation with myometrial excision and reconstruction of the uterine wall-as a safe and effective alternative to conservative management or peripartum hysterectomy. Copyright © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  9. Uterine cervical neoplasia prevention in Parque Indigena do Xingu.

    Science.gov (United States)

    Speck, N M de Góis; Pereira, E R; Schaper, M; Tso, F K; de Freitas, V G; Ribalta, J C L

    2009-01-01

    Results of preventive health measures, diagnosis and treatment applied to Parque Indigena do Xingu native women were studied. Thirty-seven cases of uterine cervical intraepithelial lesions and invasive neoplasias were treated in the local villages without referral to an advanced medical center. LEEPs were carried out in 32 women, three cold knife conizations, one vaginal hysterectomy and one Wertheim Meigs procedure. Results of 53.1% of LEEP surgical procedures did not have margin involvement by the lesions. Bleeding complications were seen in 15.6%. Regular follow-up with two or three cytologic and colposcopic tests in 32 women was carried out. All cases were negative for lesions. Five women were not followed-up due mainly to logistical reasons. Health endeavors adopted in the period 2005-2007 brought about a significant reduction of precursor lesions in this native aboriginal population without screening resources.

  10. First case of vaginal radical trachelectomy in a pregnant patient.

    NARCIS (Netherlands)

    Nieuwenhof, H.P. van de; Ham, M.A.P.C. van; Lotgering, F.K.; Massuger, L.F.A.G.

    2008-01-01

    Women who present with cervical carcinoma during pregnancy pose for us a clinical problem. In general, three treatment options exist: (i) radical hysterectomy with termination of pregnancy, (ii) a planned delay, or (iii) chemotherapy until lung maturation has occurred, both followed by a radical

  11. Hysterectomy in Adolescents, in Port Harcourt, Nigeria.

    African Journals Online (AJOL)

    Alasia Datonye

    Background. Hysterectomy in adolescents is a very difficult decision to ... reproductive health services to adolescents especially those who are sexually active. ... fifth of the world's population . In Nigeria, over ... consequences. Unsafe abortions ...

  12. Effects of Hysterectomy on Sexual Function

    OpenAIRE

    Lonnée-Hoffmann, Risa; Pinas, Ingrid

    2014-01-01

    Hysterectomy remains the most common major gynecological surgery. Postoperative sexual function is a concern for many women and their partners. In this respect, a beneficial effect of hysterectomy for benign disease independent of surgical techniques or removal of the cervix has been demonstrated in the past decade by the majority of studies. For about 20 % of women, deteriorated sexual function has been reported and current research is attempting to identify mechanisms and predictive factors...

  13. The long-term efficacy of neoadjuvant chemotherapy followed by radical hysterectomy compared with concurrent chemoradiotherapy on locally advanced uterine cervix cancer%新辅助化疗后根治性手术与同步放化疗在局部晚期宫颈癌的远期疗效评价

    Institute of Scientific and Technical Information of China (English)

    印明柱; 娄阁; 陈秀玮; 顾泰华

    2011-01-01

    目的 本研究的目的 是比较ⅠB2~ⅡB期局部晚期宫颈癌新辅助化疗后根治性手术与同步放化疗的远期生存情况. 方法 回顾性分析从2000年1月-2004年12月间ⅠB2~ⅡB期局部晚期宫颈癌共222例,将其分为二组:新辅助化疗+根治性全子宫切除术+盆腔淋巴结切除术共155例;同步放化疗组67例.所有患者最长随访时间为114个月,最短随访时间为54个月,中位随访时间为72.6个月.且对所有可能影响无瘤生存时间和总生存时间的高危因素进行评估. 结果 本研究中位随访时间为72.6个月,新辅助化疗后根治性手术组和同步放化疗组5年无瘤生存率分别是88.39%和70.94%,两组比较有统计学意义(P=0.006);而5年总生存率分别为88.52%和72.91%,两组比较有统计学意义(P=0.0004).在Cox风险回归模型中,调整宫颈癌患者的年龄、病理分型后,结果显示:接受新辅助化疗后根治性手术组和同步放化疗组治疗的宫颈癌患者5年无瘤生存时间有明显差异(HR=2.765,95%CI:1.446~5.288,P=0.0021);在5年总生存时间上也有显著性差异(HR=3.516,95%CI:1.822~6.784,P=0.0002). 结论 本研究ⅠB2~ⅡB期局部晚期宫颈癌新辅助化疗后根治性手术组在无瘤生存时间和总生存时间方面显著优于同步放化疗组.%Objective The purpose of this study is to compare long - term survival of neoadjuvant chemotherapy followed by radical hysterectomy with concurrent chemoradiotherapy in locally advanced cervical cancer.Methods A total of 222 stage Ⅰ B2 - Ⅱ B locally advanced cervical cancer cases from January 2000 to December 2004 were analyzed retrospectivly. All the cases were divided into two groups:155 cases of neoadjuvant chemotherapy followed by radical hysterectomy with pelvic lymph node dissection( NACT + RS group );67 cases of concurrent chemoradiotherapy group( CCRT group ). Patients were followed up from 54 to 114 months. NACT group patients were followed up for

  14. 腹腔镜下保留盆腔自主神经平面根治性子宫切除术的初步临床研究%Preliminary clinical study of laparoscopic pelvic autonomic nerve-plane sparing radical hysterectomy

    Institute of Scientific and Technical Information of China (English)

    卢艳; 姚德生; 莫凌昭; 李菲; 潘忠勉

    2012-01-01

    目的 探讨保留盆腔自主神经平面的腹腔镜下根治性子宫切除术的技术要点、可行性及其对降低术后膀胱功能障碍的作用.方法 将2010年1月至2011年5月30例宫颈癌患者分为两组,一组(15例)根据盆腔自主神经的标志性结构行保留“神经平面”法,于腹腔镜下保留盆腔自主神经的根治性子宫切除术(LNSRH),另一组(15例)行腹腔镜下根治性子宫切除术(LRH)作为对照.结果 LNSRH组15例患者中2例因出血较多保留单侧神经,1例为ⅡA期选择性保留病灶对侧盆腔神经,其余成功保留了双侧神经.全组30例患者均顺利完成手术,LNSRH组的手术时间为(301.8±47.6) min,长于LRH组的(178.3±17.0) min(P <0.05).术中出血量、术后肠道恢复时间、切除盆腔淋巴结的数目、宫旁和阴道切除范围两组比较差异无统计学意义(P>0.05).术后LNSRH组的住院时间为(10.9±2.0)d,明显少于LRH组的(15.1±0.8)d(P<0.05).LNSRH组术后拔除尿管的平均时间为(10.8±3.2)d,明显短于LRH组的(17.4±3.2)d(P <0.05).随访3~19个月,全组无复发和转移病例.结论 LNSRH在技术上安全、可行,可明显减少术后膀胱功能障碍,既不降低根治性标准,又有利于患者术后恢复及生活质量提高.%Objective To study the feasibility of laparoscopic pelvic autonomic nerve-plane sparing radical hysterectomy (LN-SRH) technique and its effect on decreasing postoperative bladder dysfunction. Methods From February 2010 to May 2011, 30 consecutive patients with cervical cancer were divided into LNSRH group and laparoscopic radical hysterectomy (LRH) group. We performed 15 LNSRH with the fascia space dissection technique and according to the basic anatomic landmarks of pelvic autonomic nerves and the operating time, operating bleeding and the postoperative recovery of bladder function were assayed. The other 15 patients were in control group under LRH. Results In LNSRH group, 2 cases reserved

  15. Randomised controlled trial of total compared with subtotal hysterectomy with one-year follow up results

    DEFF Research Database (Denmark)

    Gimbel, Helga; Zobbe, Vibeke; Andersen, Birthe Margrethe

    2003-01-01

    To compare total abdominal hysterectomy and subtotal abdominal hysterectomy performed for benign uterine diseases.......To compare total abdominal hysterectomy and subtotal abdominal hysterectomy performed for benign uterine diseases....

  16. Hysterectomy and Lower Urinary Tract Symptoms : A Nonrandomized Comparison of Vaginal and Abdominal Hysterectomy

    NARCIS (Netherlands)

    Lakeman, M. M. E.; van der Vaart, C. H.; Roovers, J. P. W. R.

    2010-01-01

    Common adverse effects of hysterectomy include lower urinary tract symptoms (LUTS), especially urinary incontinence. A difference in the prevalence of LUTS between patients who have undergone vaginal and abdominal hysterectomy may be an additional factor in the choice between these 2 surgical approa

  17. [Is hysterectomy indicated during prolapsus treatment?].

    Science.gov (United States)

    Fatton, B; Amblard, J; Jacquetin, B

    2007-06-01

    Hysterectomy remains a usual procedure in vaginal reconstructive pelvic surgery. However, it may seem illogical, given our improved knowledge of the pathologic pelvic anatomy, to begin pelvic repair by a removal procedure. The question about uterine preservation during vaginal reconstructive surgery is crucial. Although some authors have proposed some arguments on this topic, we don't have, at present, any rigorous prospective and randomized studies able to prove the superiority of hysterectomy or uterine preservation, on long-term anatomic results. Nevertheless, in reconstructive surgery with synthetic mesh, hysterectomy exposes to an increased risk of mesh exposure. Consequently, it increases blood lost, surgical duration and hospitalisation stay. On the other hand, uterine preservation imposes constant gynaecologic follow-up. Subsequently, if a hysterectomy is needed for benign or malignant diseases, the surgery is often difficult because of prior uterine fixation. Subtotal hysterectomy which prevents endometrial cancer can be a possible alternative but, at the moment, no study was able to demonstrate that uterine cervix has a role in pelvic static. Functional results, influenced by biological individual characteristics and by the number of associated procedures, are even more difficult to analyse. Sexual life after hysterectomy has been the subject of numerous publications of unequal scientific quality. Among correctly evaluated and informed patients, hysterectomy do not seem to produce negative consequences on sexuality; it can even improve, in some circumstances, the sexual life. We can admit that cervical conservation in some women may have a role in terms of pleasure, more from sexual fantasies and ballistic reasons than in relation with organic and physiologic reasons. Since no rigorous and specifically oriented works on that topic have been published until now, it seems justified today to promote prospective and randomized studies, advice against

  18. Vaginal hysterectomy as a primary route for morbidly obese women.

    Science.gov (United States)

    Sheth, Shirish S

    2010-07-01

    Vaginal hysterectomy is a least invasive and the choicest route when hysterectomy is possible by recourse to all the three available techniques. However in obese women, the common method is by the more invasive abdominal or laparoscopic route, with attendant morbidity. Vaginal hysterectomy was reviewed in 102 morbidly obese women (body mass index, BMI > or = 40) and compared with 50 comparable morbidly obese women who underwent abdominal hysterectomy and with vaginal hysterectomy in 200 normal weight women (BMI hysterectomy was slightly but significantly longer in the morbidly obese compared to those of normal weight, while the abdominal approach was significantly longer in the morbidly obese. Hospital stay was significantly longer for the abdominal operations in the obese. Surgical and anesthetic complications did not differ. In the absence of specific contraindications for vaginal hysterectomy it is recommended that the surgeon should perform hysterectomy vaginally and consider obesity as a contraindication for taking the abdominal route.

  19. Laparoscopic radical trachelectomy.

    Science.gov (United States)

    Rendón, Gabriel J; Ramirez, Pedro T; Frumovitz, Michael; Schmeler, Kathleen M; Pareja, Rene

    2012-01-01

    The standard treatment for patients with early-stage cervical cancer has been radical hysterectomy. However, for women interested in future fertility, radical trachelectomy is now considered a safe and feasible option. The use of minimally invasive surgical techniques to perform this procedure has recently been reported. We report the first case of a laparoscopic radical trachelectomy performed in a developing country. The patient is a nulligravid, 30-y-old female with stage IB1 adenocarcinoma of the cervix who desired future fertility. She underwent a laparoscopic radical trachelectomy and bilateral pelvic lymph node dissection. The operative time was 340 min, and the estimated blood loss was 100mL. There were no intraoperative or postoperative complications. The final pathology showed no evidence of residual disease, and all pelvic lymph nodes were negative. At 20 mo of follow-up, the patient is having regular menses but has not yet attempted to become pregnant. There is no evidence of recurrence. Laparoscopic radical trachelectomy with pelvic lymphadenectomy in a young woman who desires future fertility may also be an alternative technique in the treatment of early cervical cancer in developing countries.

  20. Factors influencing women's decision making in hysterectomy.

    Science.gov (United States)

    Janda, Monika; Armfield, Nigel R; Page, Katie; Kerr, Gayle; Kurz, Suzanne; Jackson, Graeme; Currie, Jason; Weaver, Edward; Yazdani, Anusch; Obermair, Andreas

    2017-09-12

    To explore factors influencing how well-informed women felt about hysterectomy, influences on their decision making, and on them receiving a less-invasive alternative to open surgery. Online questionnaire, conducted in 2015-2016, of women who had received a hysterectomy in Australia, in the preceding two years. Questionnaires were completed by 2319/6000 women (39% response). Most women (n=2225; 96%) felt well-informed about hysterectomy. Women were more aware of the open abdominal approach (n=1798; 77%), than of less-invasive vaginal (n=1552; 67%), laparoscopic (n=1540; 66%), laparoscopic-assisted (n=1303; 56%), and robotic approaches (n=289; 12%). Most women (n=1435; 62%) reported their gynaecologist was the most influential information source. Women who received information about hysterectomy from a GP (OR=1.47; 95% CI 1.15-1.90), or from a gynaecologist (OR=1.3; 95% CI 1.06-1.58), were more likely to feel better informed (p<0.01). This study is important because it helps clinicians, researchers and health policy makers to understand why many women still receive an open abdominal approach despite many learned societies recommending to avoid it if possible. Additional information, or education about avoiding open abdominal approach where possible may lead to a greater number of women receiving less-invasive types of hysterectomy in the future. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

  1. Single-port laparoscopic hysterectomy: preliminary results

    Directory of Open Access Journals (Sweden)

    Renata Assef Tormena

    2015-10-01

    Full Text Available Summary Objective: to describe the initial results of a laparoscopic single port access hysterectomy and also to evaluate the feasibility and safety of this access. Methods: a prospective study was performed at a tertiary university medical center (Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo between March 2013 and June 2014. A total of 20 women, referred for hysterectomy due to benign uterine disease, were included in the study after they had signed an informed consent. Outcome measures, including operating time, blood loss, rate of complications, febrile morbidity, visual analogical pain score and length of hospital stay were registered. Results: mean patient age and body mass index (BMI were 47.8 years and 27.15 kg/m2, respectively. Mean operating time was 165.5 min. Blood loss was minimal, with no blood transfusion. All procedures but one were successfully performed via a single incision and no post-operative complications occurred. We experienced one conversion to multiport laparoscopic hysterectomy due to extensive pelvic adhesions. There was no conversion to “open” total abdominal hysterectomy. None of the patients required narcotics or NSAD post-operatively. Conclusion: single-port hysterectomy is a feasible and safe technique, with no major complications.

  2. Impact on survival and quality of life of laparoscopic radical hysterectomy and pelvic lymphadenectomy to patients with early-stage cervical cancer%腹腔镜下广泛性子宫切除术治疗早期子宫颈癌的疗效及对患者预后和生命质量的影响

    Institute of Scientific and Technical Information of China (English)

    阳志军; 陈艳丽; 姚德生; 张洁清; 李菲; 李力

    2011-01-01

    Objective To compare intraoperative,pathologic,postoperative outcomes and quality of life of laparoscopic radical hysterectomy and pelvic lymphadenectomy ( LRH + LPL) with abdominal radical hysterectomy and pelvic lymphadenectomy ( ARH + APL) for patients with early-stage cervical cancer.Methods The consecutive cases with International Federation of Gynecology and Obstetrics (FIGO) stages Ⅰ a2 - Ⅱ a cervical cancer who underwent surgery from Jan.1,2002 to Jan.1,2011 were documented,including 85 patients underwent LRH + LPL,and 85 patients underwent ARH + APL as control group.The clinical data of intraoperative,pathologic,postoperative outcomes and quality of life were compared between two groups.Survival data were estimated using Kaplan-Meier survival curves and compared with the log-rank test.Cox proportional hazards model was used for multivariate analysis.Results All but 2 surgical procedures were completed laparoscopically because of right common ihac vein vessel injuries.Mean operative time,it was longer for LRH + LPL than that for ARH + APL [ (242 ±74) minutes vs.( 190 ±61 ) minutes,P =0.000 ].Mean recovery time of intestines function was less for LRH + LPL than that for ARH + APL [ (45 ± 7 ) hours vs.(63 ± 1 1 ) hours,P =0.000 ].Mean estimated blood loss was less for LRH + LPL than that for ARH + APL[ (367 ±252) ml vs.(460 ±220) ml,P =0.006].Mean recovery time of urinary function was less that for LRH + LPL than that for ARH + APL [ ( 19 ±4) days vs.(21 ±4) days,P =0.000 ].There were no significant difference in numbers of the pelvic lymph nodes resected,the extent of parametrial tissue,vaginal cuff,negative margins obtained and complications.The median follow-up was 32 months (range 4 to 105 months),there was no significant difference in the recurrence rate (7% vs.5%,P=0.540) and mortality rate (7% vs.5%,P=0.540),5 years disease-free survival(90% vs.94%,P =0.812),5 years over survival ( 90% vs.95%,P =0.532 ).There were not

  3. Two-phase laparoendoscopic single-site cervical ligament-sparing hysterectomy: A novel approach in difficult laparoscopic hysterectomy

    Directory of Open Access Journals (Sweden)

    Mun-Kun Hong

    2016-06-01

    Conclusion: This novel minimal invasive method of hysterectomy makes difficulty laparoscopic hysterectomy easy and safe. Preservation of cervical ligaments retains stability in the pelvic floor and may reduce intraoperative complications and subsequent pelvic floor organ prolapse.

  4. Robotic-assisted hysterectomy: patient selection and perspectives

    Directory of Open Access Journals (Sweden)

    Smorgick N

    2017-03-01

    Full Text Available Noam Smorgick Departments of Obstetrics and Gynecology, Assaf Harofe Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Abstract: Minimally invasive hysterectomy via the laparoscopic or vaginal approach is beneficial to patients when compared with laparotomy, but has not been offered in the past to all women because of the technical difficulties and the long learning curve required for laparoscopic hysterectomy. Robotic-assisted hysterectomy for benign indications may allow for a shorter learning curve but does not offer clear advantages over conventional laparoscopic hysterectomy in terms of surgical outcomes. In addition, robotic hysterectomy is invariably associated with increased costs. Nevertheless, this surgical approach has been widely adopted by gynecologic surgeons. The aim of this review is to describe specific indications and patients who may benefit from robotic-assisted hysterectomy. These include hysterectomy for benign conditions in cases with high surgical complexity (such as pelvic adhesive disease and endometriosis, hysterectomy and lymphadenectomy for treatment of endometrial carcinoma, and obese patients. In the future, additional evidence regarding the benefits of single-site robotic hysterectomy may further modify the indications for robotic-assisted hysterectomy. Keywords: robotic-assisted hysterectomy, single-site laparoscopy, minimally invasive hysterectomy

  5. [Reprodcutive results of radical trachelectomy].

    Science.gov (United States)

    Martínez-Chapa, Arnulfo; Alonso-Reyes, Nelly; Luna-Macías, Miguel

    2015-12-01

    Historically, cervical cancer in early stages has been treated with radical hysterectomy and radiotherapy with no option in keeping the uterine-ovarian function. Since two decades ago, evidence shows these cases are candidates for radical trachelectomy, a procedure capable of preserving the fertility without affecting the oncological outcome. To analyze reproductive results among patients treated with radical trachelectomy, in a reference center from the northeast of Mexico. Between March 1999 and December 2013, 27 cases with cervical cancer in early stages were treated with vaginal or abdominal radical trachelectomy in the ISSSTE Regional Hospital in Monterrey, NL (Mexico). We obtained the gynecological, medical and surgical clinical history. Plan of analysis consisted of descriptive statistics. Age range was 27-39 years. Main complications were cervical stenosis (n=1) and erosion of cerclaje (n=2). Eighteen patients tried to get pregnant, 8 of them got a spontaneous pregnancy; 1 more patient required assisted reproduction technics and did not succeed. All pregnancies were delivered by cesarean section and were preterm births; 3 underwent premature rupture of membranes. Two pregnancies ended in abortion, one at 10 weeks with severe hemorrhage that needed hysterectomy; the second one, at 1 7 weeks, received a fine uterine curettage. Only 6 cases (33%) got a live birth. Only one third of the attempted pregnancies got a live birth. Assisted reproduction technics play an important role and should be offer to all cases. Cerclaje is an important factor to carry a pregnancy up to the third trimester.

  6. Cutting inoperable bodies: particularizing rural sociality to normalize hysterectomies in Balochistan, Pakistan.

    Science.gov (United States)

    Towghi, Fouzieyha

    2012-01-01

    Drawing on 15 months of ethnographic research in Balochistan, Pakistan (2005 -2006), I explore Panjguri midwives' (dïnabogs, kawwās, or balloks) narrative links between routine injections of prostaglandins around childbirth and the increasing number of hysterectomies. These techno-medical interventions reflect the postcolonial biomedicalization of women's bodies and reproductive health care, and are reinforced by shifts in Pakistan's public health policy against maternal mortality in a context where about 90 percent of births occur outside of hospitals. Transnational campaigns against maternal mortality further biomedicalize women's lives. Interviews with doctors, midwives, and women, and analysis of women's experiences, illustrate the practical considerations that were used to normalize radical hysterectomies over less invasive procedures.

  7. Tolerance and efficacy of preoperative intracavitary HDR brachytherapy in IB and IIA cervical cancer

    Science.gov (United States)

    Bialas, Brygida; Fijalkowski, Marek; Raczek-Zwierzycka, Katarzyna

    2009-01-01

    Purpose The aim of this work is to analyze the efficacy and tolerance of preoperative intracavitary HDR brachytherapy (HDR-BT) in patients with IB and IIA cervical cancer. Material and methods 139 patients with cervical cancer IB-IIA with preoperative HDR-BT, out of which 60 patients with cervical cancer IB (43.2%) and 79 with IIA (56.8%) were treated since 1996 to 2002. In preoperative BT total dose to point A ranged from 30-45 Gy in 6-9 fractions twice a week. The fraction dose was 4-5 Gy at point A. Six weeks after BT all patients underwent radical Wertheim-Meigs hysterectomy. Patients with disadvantageous risk factors or with positive specimen histology had a complementary therapy: external-beam radiotherapy (EBRT) given to the whole pelvic volume in daily fractions of 2 Gy up to total dose of 36-52 Gy (20 patients) or EBRT with cisplatin-based chemotherapy with the dose of 30-40 mg/m2 in 5-7 fractions given weekly (7 patients) or chemotherapy (6 patients). Acute and late radiation toxicity was evaluated according to EORTC/RTOG. Results In postoperative specimen histopathology the number of 114 women (82%) had tumor-free specimen within brachytherapy target (in cervix and cavity), 96 women (60.1%) had tumor-free specimen both in and outside brachytherapy target (lymph nodes, parametra, adnexis). The 5-year and 10-year DFS were 93.8% and 88% for IB and 89.7% and 64.7% for IIA respectively. 7.9% of patients developed acute toxicity both in rectum and bladder (only in I and II grade of EORTC/RTOG). Late severe complication occurred in rectum in 2.2% of patients and in bladder 1.4%. Conclusions 1. Preoperative HDR-BT in patients with IB and IIA cervical cancer is an effective and well tolerated therapy with acceptable rate of side effects. 2. Preoperative HDR-BT followed by surgery in a group without risk factors is a sufficient treatment option with no additional adjuvant therapy requirement.

  8. Hysterectomy in women with obesity: complications related to surgical site.

    Science.gov (United States)

    Naveiro-Fuentes, Mariña; Rodríguez-Oliver, Antonio; Maroto-Martín, María T; González-Paredes, Aida; Aguilar-Romero, María T; Mozas-Moreno, Juan

    2017-02-01

    The aim of this study was to describe the trends in surgical routes in obese women who underwent hysterectomy for benign disease at our center and compare complications in different groups. Retrospective study done between 2011 and 2015 in women with a Body Mass Index≥30 who underwent hysterectomy for benign disease at Virgen de las Nieves Universitary Hospital in Granada, Spain. We studied three groups based on the surgical route chosen for hysterectomy: vaginal, abdominal or laparoscopic. The rates of intraoperative and postoperative complications, major complications, reintervention and days of hospital stay were compared. Abdominal hysterectomy was associated with the highest risk of postoperative complications and the longest hospital stay. Laparoscopic hysterectomy had a higher risk than vaginal hysterectomy of major complications. There were no significant differences between groups for any of the other variables. In obese women vaginal hysterectomy was associated with the lowest morbidity, and should be the approach of choice whenever feasible.

  9. VAGINAL HYSTERECTOMY - CEFUROXIME, METRONIDAZOLE OR BOTH

    NARCIS (Netherlands)

    KAUER, FM; WIJMA, J; MANSON, WL

    1990-01-01

    A randomized double-blind prospective study on the efficacy of single-dose antibiotic prophylaxis compared cefuroxime versus metronidazole versus the combination of both agents in vaginal hysterectomy. Overall antibiotic prophylaxis was effective in abscess prevention (one abscess in 68 patients). I

  10. VAGINAL HYSTERECTOMY - CEFUROXIME, METRONIDAZOLE OR BOTH

    NARCIS (Netherlands)

    KAUER, FM; WIJMA, J; MANSON, WL

    1990-01-01

    A randomized double-blind prospective study on the efficacy of single-dose antibiotic prophylaxis compared cefuroxime versus metronidazole versus the combination of both agents in vaginal hysterectomy. Overall antibiotic prophylaxis was effective in abscess prevention (one abscess in 68 patients).

  11. Laparoscopic hysterectomy : predictors of quality of surgery

    NARCIS (Netherlands)

    Twijnstra, Andries Roelof Huig

    2013-01-01

    Although hospitals increasingly opt for the laparoscopic over the conventional approach and the decline in diagnostic procedures is well compensated by an increase in numbers of all types of therapeutic procedures, the implementation of laparoscopic hysterectomy in the Netherlands seems to be hamper

  12. Anaesthetic challenges in emergency peripartum hysterectomy in ...

    African Journals Online (AJOL)

    2009-09-17

    Sep 17, 2009 ... The causes of emergency hysterectomies were ruptured uterus (11 patients or. 69%), placenta ... is the leading cause of maternal death worldwide.2–4. Significant .... including fear of being tested for HIV, and their blood being ...

  13. Evaluation of postoperative bladder function and prognosis after modified nerve sparing radical hysterectomy%改良型保留盆腔自主神经的子宫颈癌根治性手术对患者膀胱功能及预后的影响

    Institute of Scientific and Technical Information of China (English)

    王文文; 李斌; 佐晶; 张功逸; 杨页多; 曾红梅; 李晓光; 吴令英

    2014-01-01

    者的复发率分别为10.8%(11/102)、12.2%(25/204),两组比较,差异无统计学意义(P =0.707);3年无复发生存率(RFS)分别为88.5%及91.1%,3年总生存率(OS)分别为93.7%及96.3%,两组分别比较,差异均无统计学意义(P>0.05).(4)预后影响因素分析:单因素分析显示,病理类型、淋巴结转移和淋巴脉管间隙受侵是影响患者3年RFS和3年OS的危险因素(P<0.05),而保留神经平面与否对患者3年RFS和3年OS无明显影响(P>0.05);多因素分析显示,病理类型、淋巴结转移是影响患者3年RFS的独立危险因素(P<0.05),淋巴结转移也是影响患者3年OS的独立危险因素(P=0.001).结论 NPSRH治疗能明显改善了患者术后的膀胱功能,且不影响患者的预后.%Objective To compare the nerve plane sparing radical hysterectomy (NPSRH) with conventional radical hysterectomy (CRH) in terms of postoperative bladder function and prognosis.Methods One hundred and two patients with International Federation of Gynecology and Obstetrics (FIGO) stage Ⅰ b1-Ⅱa2 cervical cancer were treated by open NPSRH (study group) from January 2008 to March 2013.During the same time periods,two hundred and four patients who underwent open CRH were randomly selected as the control group.Age,pathological type and FIGO stage were matched.Results The median operation time in NPSRH group and CRH group were 268.8 and 242.4 minutes,respectively (P < 0.01).The median hospital stay were 14.6 and 17.2 days (P < 0.01).The median volume of blood loss in the two groups were respectively 394 and 450 ml (P > 0.05).The blood transfusion rate was respectively 46.1% (47/102) and 41.7% (85/204; P > 0.05).The rate of postoperative complications were not significantly difference [14.7% (15/102) vs 11.8% (24/204),P > 0.05].The median duration of catheterization was 9.1 and 15.2 days between two groups (P <0.01).Eighty-five patients in NPSRH group and one hundred and sixty-seven patients in CRH group completed

  14. Health care cost consequences of using robot technology for hysterectomy: a register-based study of consecutive patients during 2006-2013.

    Science.gov (United States)

    Laursen, Karin Rosenkilde; Hyldgård, Vibe Bolvig; Jensen, Pernille Tine; Søgaard, Rikke

    2017-07-10

    The objective of this study is to examine the costs attributable to robotic-assisted laparoscopic hysterectomy from a broad healthcare sector perspective in a register-based longitudinal study. The population in this study were 7670 consecutive women undergoing hysterectomy between January 2006 and August 2013 in public hospitals in Denmark. The interventions in the study were total and radical hysterectomy performed robotic-assisted laparoscopic hysterectomy (RALH), total laparoscopic hysterectomy (TLH), or open abdominal hysterectomy (OAH). Service use in the healthcare sector was evaluated 1 year before to 1 year after the surgery. Tariffs of the activity-based remuneration system and the diagnosis-related grouping case-mix system were used for valuation of primary and secondary care, respectively. Costs attributable to RALH were estimated using a difference-in-difference analytical approach and adjusted using multivariate linear regression. The main outcome measure was costs attributable to OAH, TLH, and RALH. For benign conditions RALH generated cost savings of € 2460 (95% CI 845; 4075) per patient compared to OAH and non-significant cost savings of € 1045 (95% CI -200; 2291) when compared with TLH. In cancer patients RALH generated cost savings of 3445 (95% CI 415; 6474) per patient when compared to OAH and increased costs of € 3345 (95% CI 2348; 4342) when compared to TLH. In cancer patients undergoing radical hysterectomy, RALH generated non-significant extra costs compared to OAH. Cost consequences were primarily due to differences in the use of inpatient service. There is a cost argument for using robot technology in patients with benign disease. In patients with malignant disease, the cost argument is dependent on comparator.

  15. Robotic-assisted hysterectomy: patient selection and perspectives

    Science.gov (United States)

    Smorgick, Noam

    2017-01-01

    Minimally invasive hysterectomy via the laparoscopic or vaginal approach is beneficial to patients when compared with laparotomy, but has not been offered in the past to all women because of the technical difficulties and the long learning curve required for laparoscopic hysterectomy. Robotic-assisted hysterectomy for benign indications may allow for a shorter learning curve but does not offer clear advantages over conventional laparoscopic hysterectomy in terms of surgical outcomes. In addition, robotic hysterectomy is invariably associated with increased costs. Nevertheless, this surgical approach has been widely adopted by gynecologic surgeons. The aim of this review is to describe specific indications and patients who may benefit from robotic-assisted hysterectomy. These include hysterectomy for benign conditions in cases with high surgical complexity (such as pelvic adhesive disease and endometriosis), hysterectomy and lymphadenectomy for treatment of endometrial carcinoma, and obese patients. In the future, additional evidence regarding the benefits of single-site robotic hysterectomy may further modify the indications for robotic-assisted hysterectomy. PMID:28356774

  16. A comparison of abdominal and vaginal hysterectomies in Benghazi, Libya.

    Science.gov (United States)

    Agnaeber, K; Bodalal, Z

    2013-08-01

    We performed a comparative study between abdominal and vaginal hysterectomies using clinical data from Al-Jamhouria hospital (one of the largest maternity hospitals in Eastern Libya). Various parameters were taken into consideration: the rates of each type (and their subtypes); average age of patients; indications; causes; postoperative complications; and duration of stay in the hospital afterwards. Conclusions and recommendations were drawn from the results of this study. In light of the aforementioned parameters, it was found that: (1) abdominal hysterectomies were more common than vaginal hysterectomies (p < 0.001); (2) patients admitted for abdominal hysterectomies are younger than those admitted for vaginal hysterectomies (p < 0.001); (3) the most common indication for an abdominal hysterectomy was menstrual disturbances, while for vaginal hysterectomies it was vaginal prolapse; (4) the histopathological cause for abdominal and vaginal hysterectomies were observed and the most common were found to be leiomyomas and atrophic endometrium; (5) there was no significant difference between the two routes in terms of postoperative complications; (6) patients who were admitted for abdominal hysterectomies spent a longer amount of time in the hospital (p < 0.01). It was concluded that efforts should be made to further pursue vaginal and laparoscopic hysterectomies as a viable option to the more conventional abdominal route.

  17. Robot-assisted hysterectomy for endometrial and cervical cancers: a systematic review.

    Science.gov (United States)

    Nevis, Immaculate F; Vali, Bahareh; Higgins, Caroline; Dhalla, Irfan; Urbach, David; Bernardini, Marcus Q

    2017-03-01

    Total and radical hysterectomies are the most common treatment strategies for early-stage endometrial and cervical cancers, respectively. Surgical modalities include open surgery, laparoscopy, and more recently, minimally invasive robot-assisted surgery. We searched several electronic databases for randomized controlled trials and observational studies with a comparison group, published between 2009 and 2014. Our outcomes of interest included both perioperative and morbidity outcomes. We included 35 observational studies in this review. We did not find any randomized controlled trials. The quality of evidence for all reported outcomes was very low. For women with endometrial cancer, we found that there was a reduction in estimated blood loss between the robot-assisted surgery compared to both laparoscopy and open surgery. There was a reduction in length of hospital stay between robot-assisted surgery and open surgery but not laparoscopy. There was no difference in total lymph node removal between the three modalities. There was no difference in the rate of overall complications between the robot-assisted technique and laparoscopy. For women with cervical cancer, there were no differences in estimated blood loss or removal of lymph nodes between robot-assisted and laparoscopic procedure. Compared to laparotomy, robot-assisted hysterectomy for cervical cancer showed an overall reduction in estimated blood loss. Although robot-assisted hysterectomy is clinically effective for the treatment of both endometrial and cervical cancers, methodologically rigorous studies are lacking to draw definitive conclusions.

  18. Low adherence to cervical cancer screening after subtotal hysterectomy

    DEFF Research Database (Denmark)

    Andersen, Lea Laird; Møller, Lars Mikael Alling; Gimbel, Helga Margrethe

    2015-01-01

    have unnecessary tests performed after total hysterectomy. Clarification of the use of cervical/vaginal smears after hysterectomy is needed to identify women at risk of cervical dysplasia or cancer. FUNDING: Research Foundation of Region Zealand, University of Southern Denmark, Nykøbing Falster......INTRODUCTION: A reason for not recommending subtotal hysterectomy is the risk of cervical pathology. We aimed to evaluate cervical cancer screening and to describe cervical pathology after subtotal and total hysterectomy for benign indications. METHODS: Data regarding adherence to screening...... and pathology results from the national Danish registry (Patobank) were obtained on women from a randomised clinical trial and an observational study of subtotal versus total abdominal hysterectomy from the time of surgery until 2014. RESULTS: We included 501 women (259 subtotal hysterectomies and 242 total...

  19. [Laparoscopic hysterectomy--brief history, frequency, indications and contraindications].

    Science.gov (United States)

    Tomov, S; Gorchev, G; Tzvetkov, Ch; Tanchev, L; Iliev, S

    2012-01-01

    Hysterectomy is the most common gynecological operation after Caesarean section and the laparoscopic access to uterus removal is one of the contemporary methods showing slow but steady growth in time. In reference to indications and contraindications for laparoscopic hysterectomy, the following directions emerge as controversial: malignant gynecological tumors, uterus size, and high body mass index. Laparoscopic hysterectomy can be taken into consideration at the first stage of endometrial, cervical and ovarian cancer. If there is doubt about an uterus sarcoma and a laparoscopic access is accomplished, a conversion to abdominal hysterectomy must be done. Obesity and big uteri are not a contrarindication for that minimally-invasive access. Today, laparoscopic hysterectomy is a reasonable alternative to total abdominal and vaginal hysterectomy.

  20. ACOG Committee Opinion No. 444: choosing the route of hysterectomy for benign disease.

    Science.gov (United States)

    2009-11-01

    Hysterectomies are performed vaginally, abdominally, or with laparoscopic or robotic assistance. When choosing the route and method of hysterectomy, the physicians should take into consideration how the procedure may be performed most safely and cost-effectively to fulfill the medical needs of the patient. Evidence demonstrates that, in general, vaginal hysterectomy is associated with better outcomes and fewer complications than laparoscopic or abdominal hysterectomy. When it is not feasible to perform a vaginal hysterectomy, the surgeon must choose between laparoscopic hysterectomy,robot-assisted hysterectomy, or abdominal hysterectomy. Experience with robot-assisted hysterectomy is limited at this time; more data are necessary to determine its role in the performance of hysterectomy. The decision to electively perform a salpingoophorectomy should not be influenced by the chosen route of hysterectomy and is not a contraindication to performing a vaginal hysterectomy.

  1. Temporal trend and nationwide utility for hysterectomies in Taiwan, 1997–2010

    Directory of Open Access Journals (Sweden)

    Wei-Yi Huang

    2016-10-01

    Conclusion: As in most Western countries, hysterectomy rates in Taiwan declined by year. There was a marked shift in the types of hysterectomies from 1997 through to 2010 in Taiwan. Minimally invasive surgeries and supracervical hysterectomies were more commonly adopted.

  2. Lower urinary tract symptoms after subtotal versus total abdominal hysterectomy

    DEFF Research Database (Denmark)

    Andersen, Lea Laird; Møller, Lars Mikael Alling; Gimbel, Helga

    2015-01-01

    INTRODUCTION AND HYPOTHESIS: Lower urinary tract symptoms (LUTS) are common after hysterectomy and increase after menopause. We aimed to compare subtotal with total abdominal hysterectomy regarding LUTS, including urinary incontinence (UI) subtypes, 14 years after hysterectomy. Main results from...... prior to hysterectomy, local estrogen treatment, and body mass index (BMI) > 25 kg/m(2). High BMI was primarily associated with mixed UI (MUI) and urgency symptoms. Predictors of bothersome LUTS were UI and incomplete bladder emptying. CONCLUSIONS: The difference in the frequency of subjectively...

  3. 早期子宫颈癌患者行子宫广泛性切除联合阴道延长术后的生命质量和性生活状态的评估%Quality of life and sexual function of cervical cancer patients following radical hysterectomy and vaginal extension

    Institute of Scientific and Technical Information of China (English)

    叶双; 杨佳欣; 曹冬焱; 朱兰; 郎景和; 沈铿

    2014-01-01

    便相关症状的发生风险.所有患者术后均存在性功能障碍问题,应重视患者术后性功能的改善和恢复.%Objective To investigate the quality of life and sexual function of cervical cancer patients following radical hysterectomy (RH) and vaginal extension.Methods Case-control and questionnaire-based method was employed in this study.Thirty-one patients of early-stage (Ⅰ b1-Ⅰ b2) cervical cancer who had undergone vaginal extension following classic RH in Peking Union Medical College Hospital from December 2008 to September 2012 were included in study group,while 28 patients with matching factors and RH only during the same period were allocated to control group.There was no significant difference between two groups in terms of clinical and demographic variables including age at diagnosis,tumor stage and follow-up time (P>0.05).Patients were assessed retrospectively by validated selfreported questionnaires the European Organization for Research and Treatment of Cancer Cervix Cancer Module Questionnaire (EORTC QLQ-CX24) mainly for quality of life and sexual function for cervical cancer patients; the Sexual Function and Vaginal Changes Questionnaire (SVQ) further investigates sexual function and vaginal changes of patients with gynecologic malignancy at least 6 months after treatment.Results Vaginal length acquired by pelvic examination by gynecologic oncologists during follow-up visits was (10.0±1.3) cm and (5.9± 1.0) cm in study group and control group respectively (P=0.000).Sixty-eight percent (21/31) of cases in study group and 64% (18/28) of cases in control group had resumed sexual activity at the time of interview,and the time interval between treatment and regular sexual activity was mean 6 months (range 3-20 months) and mean 5 months (range 1-12 months) in study and control group respectively,in which there was not statistical significance (P>0.05).No difference was observed regarding pelvic floor symptoms (P>0.05) while

  4. Comparative study of vaginal hysterectomy and abdominal hysterectomy for enlarged uterus

    Directory of Open Access Journals (Sweden)

    Chandrika S.

    2016-09-01

    Conclusions: Bulk reducing techniques were used to remove the moderately enlarged uterus through vaginal route. Vaginal hysterectomy is invasive route, safe and feasible in cases with enlarged uteri up to 14 weeks due to benign causes. [Int J Reprod Contracept Obstet Gynecol 2016; 5(9.000: 3116-3120

  5. 42 CFR 441.255 - Sterilization by hysterectomy.

    Science.gov (United States)

    2010-10-01

    ... available in expenditures for a hysterectomy not covered by paragraph (a) of this section only under the conditions specified in paragraph (c), (d), or (e) of this section. (c) FFP is available if— (1) The person... representative, if any, orally and in writing, that the hysterectomy will make the individual permanently...

  6. The value of random biopsies, omentectomy, and hysterectomy in operations for borderline ovarian tumors

    DEFF Research Database (Denmark)

    Kristensen, Gitte Schultz; Schledermann, Doris; Mogensen, Ole

    2014-01-01

    -appearing tissues leads to the finding of microscopic disease. To evaluate the value of random biopsies, omentectomy, and hysterectomy in operations for BOT, the macroscopic and microscopic findings in a cohort of these patients were reviewed retrospectively. MATERIALS: Women treated for BOT at Odense University.......7%) in International Federation of Gynecology and Obstetrics stage I, 9 (12%) in stage II, and 7 (9.3%) in stage III. The histologic subtypes were serous (68%), mucinous (30.7%), and Brenner type (1.3%). Macroscopically radical surgery was performed in 62 patients (82.7%), and 46 (61.3%) received complete staging...... was not a good predictor of microscopic disease. During follow-up, 4 patients (5.3%) relapsed with no relation to surgical radicality or the extent of staging procedures. CONCLUSIONS: Ovaries and peritoneal surfaces with a macroscopically normal appearance rarely contain a microscopic focus of BOT....

  7. [Hysterectomy for benign pathology: Guidelines for clinical practice].

    Science.gov (United States)

    Deffieux, X; de Rochambeau, B; Chêne, G; Gauthier, T; Huet, S; Lamblin, G; Agostini, A; Marcelli, M; Golfier, F

    2015-12-01

    The objective of the study was to provide guidelines for clinical practice from the French college of obstetrics and gynecology (CNGOF), based on the best evidence available, concerning hysterectomy for benign pathology. Each recommendation for practice was allocated a grade which depends on the level of evidence (guidelines for clinical practice method). Hysterectomy should be performed by a high volume surgeon (>10 procedures of hysterectomy per year) (grade C). Rectal enema stimulant laxatives are not recommended prior to hysterectomy (grade C). It is recommended to carry out vaginal disinfection using povidone iodine solution prior to an hysterectomy (grade B). Antibioprophylaxis is recommended during a hysterectomy, regardless of the surgical route (grade B). The vaginal or the laparoscopic routes are recommended for hysterectomy for benign pathology (grade B), even if the uterus is large and/or the patient is obese (grade C). The choice between these two surgical approaches depends on others parameters, such as the surgeon's experience, the mode of anesthesia and organizational constraints (operative duration and medico economic factors). Hysterectomy by vaginal route is not contraindicated in nulliparous women (grade C) or in women with previous c-section (grade C). No specific technique to achieve hemostasis is recommended with a view to avoid urinary tract injuries (grade C). In the absence of ovarian pathology and personal or family history of breast/ovarian carcinoma, it is recommended to conserve ovaries in pre-menopausal women (grade B). Subtotal hysterectomy is not recommended in order to diminish the risk of per- or postoperative complications (grade B). The application of these recommendations should minimize risks associated with hysterectomy. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  8. Emergency peripartum hysterectomy: Incidence, indications, risk factors and outcome

    Directory of Open Access Journals (Sweden)

    Lovina S.M. Machado

    2011-01-01

    Full Text Available Background: Peripartum hysterectomy is a major operation and is invariably performed in the presence of life threatening hemorrhage during or immediately after abdominal or vaginal deliveries. Material and Methods: A Medline search was conducted to review the recent relevant articles in English literature on emergency peripartum hysterectomy. The incidence, indications, risk factors and outcome of emergency peripartum hysterectomy were reviewed. Results: The incidence of emergency peripartum hysterectomy ranged from 0.24 to 8.7 per 1000 deliveries. Emergency peripartum hysterectomy was found to be more common following cesarean section than vaginal deliveries. The predominant indication for emergency peripartum hysterectomy was abnormal placentation (placenta previa/accreta which was noted in 45 to 73.3%, uterine atony in 20.6 to 43% and uterine rupture in 11.4 to 45.5 %. The risk factors included previous cesarean section, scarred uterus, multiparity, older age group. The maternal morbidity ranged from 26.5 to 31.5% and the mortality from 0 to 12.5% with a mean of 4.8%. The decision of performing total or subtotal hysterectomy was influenced by the patient′s condition. Conclusion: Emergency peripartum hysterectomy is a most demanding obstetric surgery performed in very trying circumstances of life threatening hemorrhage. The indication for emergency peripartum hysterectomy in recent years has changed from traditional uterine atony to abnormal placentation. Antenatal anticipation of the risk factors, involvement of an experienced obstetrician at an early stage of management and a prompt hysterectomy after adequate resuscitation would go a long way in reducing morbidity and mortality.

  9. [The meaning of hysterectomy for a group of Chilean men partners of women who have undergone hysterectomy].

    Science.gov (United States)

    Gutiérrez, Alejandra Araya; Soto, María-Teresa Urrutia; Suazo, Daniel Jara; Solovera, Sergio Silva; Salas, María Jesús Lira; Espinoza, Claudia Flores

    2012-12-01

    The objective of this study was to understand the meaning of hysterectomy according to a group of Chilean men, partners of women who have undergone the procedure (MPWH). This qualitative study was performed with in-depth interviews. A total of 15 men, partners of women who have undergone hysterectomy, were interviewed between May and September of 2010, under the approval of the Ethics Committees. Data analysis was performed using the phenomenological perspective proposed by Giorgi, and content analysis was performed according to Krippendorff. The Crestwell criteria were used to evaluate the trustworthiness of the analysis and guarantee descriptive validity. Five dimensions emerged, which represented unique aspects of hysterectomy according to the men: symptoms, comments, the attributions of the uterus, concerns and changes in sexuality. It is essential to educate MPWH in terms of the support required by women undergoing hysterectomy. Therefore they should be included in the care plan designed for women undergoing hysterectomy.

  10. Reflex anuria affecting both kidneys following hysterectomy

    Directory of Open Access Journals (Sweden)

    Gholyaf Mahmoud

    2009-01-01

    Full Text Available In situations when there is unilateral ureteral obstruction, the contralateral kidney retains its normal function. In rare instances however, it has been reported that unilateral ureteral obstruction can lead to reflex anuria (RA and acute renal failure (ARF. Even more unusually, RA with ARF can occur without organic obstruction due to ureteric manipulation during pelvic surgery. We report a 78- year-old woman, who underwent hysterectomy because of endometrial carcinoma. She developed ARF evidenced by anuria of 120-hours duration, and gradual rise of serum creatinine levels to 11.8 mg/dL on the fifth day after hysterectomy. Ultrasound study of the urinary tract revealed bilateral moderate hydronephrosis. Detailed evaluation did not reveal any organic obstruc-tion. She was managed with hemodialysis, control of hypertension and correction of fluid and elec-trolyte imbalances. By the sixth day, diuresis was established, and the blood urea and serum crea-tinine levels decreased to normal by the sixteenth day. The patient was finally discharged on the eighteenth day. Our case suggests that urologists and nephrologists should consider RA as one of the causes of anuria and ARF.

  11. Laparoscopic subtotal hysterectomy in the era of minimally invasive surgery

    Directory of Open Access Journals (Sweden)

    Chia-Jen Wu

    2015-02-01

    Full Text Available According to a nation-wide population-based study in Taiwan, along with the expanding concepts and surgical techniques of minimally invasive surgery, laparoscopic supracervical/subtotal hysterectomy (LSH has been blooming. Despite this, the role of LSH in the era of minimally invasive surgery remains uncertain. In this review, we tried to evaluate the perioperative and postoperative outcomes of LSH compared to other types of hysterectomy, including total abdominal hysterectomy (TAH, vaginal hysterectomy, laparoscopic-assisted vaginal hysterectomy, and total laparoscopic hysterectomy (TLH. From the literature, LSH has a better perioperative outcome than TAH, and comparable perioperative complications compared with laparoscopic-assisted vaginal hysterectomy. LSH had less bladder injury, vaginal cuff bleeding, hematoma, infection, and dehiscence requiring re-operation compared with TLH. Despite this, LSH has more postoperative cyclic menstrual bleeding and re-operations with extirpations of the cervical stump. LSH does, however, have a shorter recovery time than TAH due to the minimally invasive approach; and there is quicker resumption of coitus than TLH, due to cervical preservation and the avoidance of vaginal cuff dehiscence. LSH is therefore an alternative option when the removal of the cervix is not strictly necessary or desired. Nevertheless, the risk of further cervical malignancy, postoperative cyclic menstrual bleeding, and re-operations with extirpations of the cervical stump is a concern when discussing the advantages and disadvantages of LSH with patients.

  12. Establishment of a national Danish hysterectomy database: preliminary report on the first 13,425 hysterectomies

    DEFF Research Database (Denmark)

    Hansen, Charlotte T; Møller, Charlotte; Daugbjerg, Signe

    2008-01-01

    are registered prospectively by the surgeons involved in the treatment. Data is reported using the Danish National Patient Registry (LPR) and feedback is provided as clinical indicators with well-defined goals. The DHD concept includes annual plenary meetings, elaboration of national clinical guidelines...... and parallel causal studies. MAIN OUTCOME MEASURES: Completeness, data validation and department-identifiable clinical indicators (surgical volume, method of hysterectomy, use of antibiotic and thromboembolic prophylaxis, postoperative hospitalization and bleeding complications, surgical infections......%, the rate of bleeding complications from 8 to 6%, the reoperation rate from 5 to 4%, and the readmission rate from 7 to 5%. CONCLUSIONS: Clinical performance indicators, audit meetings and nationwide collaboration are useful in monitoring and improving outcome after hysterectomy on a national level...

  13. Sequelae of tubal ligation: an analysis of 75 consecutive hysterectomies.

    Science.gov (United States)

    Stock, R J

    1984-10-01

    Seventy-five consecutive patients undergoing hysterectomy subsequent to elective sterilization were studied regarding the occurrence of the post-tubal-ligation syndrome of pelvic pain and/or menorrhagia. Twenty patients were clinically considered to have the syndrome. In none of the patients operated on specifically for menstrual abnormalities could the findings be remotely attributed to the sterilization procedure. Five of the 20 patients had pelvic varicosities and one had pelvic adhesions that may have been a consequence of previous sterilization and conceivably the cause for the pelvic pain for which the patients were undergoing hysterectomy. I question the legitimacy of the post-tubal-ligation syndrome as a reason for hysterectomy.

  14. Complications of vaginal hysterectomy - (Analysis of 1105 cases

    Directory of Open Access Journals (Sweden)

    Bhattacharya Menna

    1978-01-01

    Full Text Available Eleven hundred and five cases of vaginal hysterectomy are analysed and their complications discussed. More than 90% of the patients were between the ages of 31 to 60 years. The common indications for hysterectomy were prolapse (51% and dysfunctional uterine bleeding (34.9%. In four cases abdominal approach was necessary to complete the operation. The overall incidence of major complications was 4% and the corrected mortality rate was 0.18%. The complications of vaginal hysterec-tomy by other authors are discussed.

  15. Single-incision total laparoscopic hysterectomy

    Directory of Open Access Journals (Sweden)

    Sinha Rakesh

    2011-01-01

    Full Text Available Single-incision laparoscopic surgery is an alternative to conventional multiport laparoscopy. Single-access laparoscopy using a transumbilical port affords maximum cosmetic benefits because the surgical incision is hidden in the umbilicus. The advantages of single-access laparoscopic surgery may include less bleeding, infection, and hernia formation and better cosmetic outcome and less pain. The disadvantages and limitations include longer surgery time, difficulty in learning the technique, and the need for specialized instruments. Ongoing refinement of the surgical technique and instrumentation is likely to expand its role in gynecologic surgery in the future. We perform single-incision total laparoscopic hysterectomy using three ports in the single transumbilical incision.

  16. Effect of socioeconomic position on patient outcome after hysterectomy

    DEFF Research Database (Denmark)

    Daugbjerg, Signe B; Cesaroni, Giulia; Ottesen, Bent;

    2014-01-01

    OBJECTIVE: To investigate the association between socioeconomic position (assessed by education, employment and income) and complications following hysterectomy and assess the role of lifestyle, co-morbidity and clinical conditions on the relationship. DESIGN: Register-based cohort study. SETTING...

  17. Obstetric hysterectomy: a retrospective study at a tertiary care centre

    Directory of Open Access Journals (Sweden)

    Anjali Kanhere

    2013-08-01

    Conclusions: Obstetric hysterectomy is a lifesaving procedure. The outcome depends on timely decision, good clinical judgement and professional surgical technique. It reduces maternal morbidity and mortality. [Int J Reprod Contracept Obstet Gynecol 2013; 2(4.000: 562-565

  18. Sepsis: Primary indication for peripartum hysterectomies in a South ...

    African Journals Online (AJOL)

    Twenty-eight delivered vaginally (18.5%) with 1 requiring an assisted .... a hysterectomy after blunt abdominal trauma. ... She developed severe puerperal ... to brain oedema. ... needing a tracheostomy as a result of prolonged ventilation.

  19. Effect of hysterectomy on anorectal and urethrovesical physiology.

    Science.gov (United States)

    Prior, A; Stanley, K; Smith, A R; Read, N W

    1992-02-01

    To investigate whether vaginal or total abdominal hysterectomy is associated with changes in anorectal and urethrovesical physiology, 26 women were studied before operation and six weeks and six months afterwards. The results showed a postoperative increase in both rectal and vesical sensitivity (p less than 0.01). Similar results were observed irrespective of the type of hysterectomy. No significant changes in rectal or bladder compliance were noted, and anal pressure and urethral pressure and length were unchanged after surgery. Whole gut transit was not affected by hysterectomy. Urinary symptoms occurred de novo in 6/26 women and gastrointestinal symptoms in 2/26 women. These results show that significant changes in rectal and vesical sensitivity occur after hysterectomy for benign disease. These persist for at least six months postoperatively but are not always associated with development of urinary or gastrointestinal symptoms.

  20. 精准-间隙解剖技术在腹腔镜广泛性子宫切除术+腹腔镜下盆腔淋巴结切除术中预防并发症的临床价值%Clinical value of precise-fascia space dissection technique in prevention of complications in laparoscopic radical hysterectomy combined with laparoscopic pelvic lymphadenectomy

    Institute of Scientific and Technical Information of China (English)

    李平军; 嵇振岭; 孟惠吉; 朱委巧; 李霞; 崔晓勇; 李丹; 张新梅; 刘嵩颖

    2014-01-01

    Objective To research the clinical value of precise-fascia space dissection technique in laparoscopic radical hysterectomy (LRH) combined with laparoscopic pelvic lymphadenectomy (LPL).Methods A retrospective analysis for 30 cases with early uterine malignancy operated by LRH + LPL were conducted,each patient was used for precise-fascia space dissection technique.Results All cases were successfully performed LRH + LPL under laparoscopy.The operative time was (253.2 ± 30.5) min,the blood loss in operation was (180.3 ± 83.2) ml,the amount of the excised lymph nodes was (13.2 ± 4.0) pieces,the time of gastrointestinal tract functional rehabilitation was (2.5 ± 0.9) d,the time of keeping urinary catheter was (13 ± 5) d.Three cases occurred lymphatic leakage and recovered after fasting and intravenous nutrition.None occurred ureter,bladder and vascular injury.Followed up for 6-72 months,none occurred recurrence or death.Conclusion LRH + LPL using precise-fascia space dissection technique can avoid ureter,bladder and vascular injury.%目的 探讨精准-间隙解剖技术在腹腔镜广泛性子宫切除术(LRH)+腹腔镜下盆腔淋巴结切除术(LPL)中预防并发症的临床价值.方法 回顾性分析采用精准-间隙解剖技术施行LRH+ LPL治疗的30例早期子宫恶性肿瘤患者的临床资料.结果 30例患者全部成功施行LRH+ LPL,手术时间(253.2±30.5) min,术中出血量(180.3±83.2) ml,切除盆腔淋巴结(13.2士4.0)枚,术后肠功能恢复时间(2.5±0.9)d,术后留置尿管时间(13±5)d;术后发生淋巴漏3例,经禁食和静脉营养治疗痊愈;无输尿管、膀胱及大血管损伤.30例术后随访6 ~ 72个月,未发现复发患者.结论 采用精准-间隙解剖技术施行LRH+ LPL,按层次解剖、间隙分离,可避免输尿管、膀胱及大血管损伤等严重并发症.

  1. Pelvic organ prolapse (POP) surgery among Danish women hysterectomized for benign conditions: age at hysterectomy, age at subsequent POP operation, and risk of POP after hysterectomy

    DEFF Research Database (Denmark)

    Lykke, Rune; Blaakær, Jan; Ottesen, Bent

    2015-01-01

    INTRODUCTION AND HYPOTHESIS: The aim of this study was to describe the incidence of pelvic organ prolapse (POP) surgery after hysterectomy from 1977 to 2009, the time interval from hysterectomy to POP surgery, and age characteristics of women undergoing POP surgery after hysterectomy...

  2. Histopathological Analysis of 422 Nononcological Hysterectomies in a University Hospital

    Directory of Open Access Journals (Sweden)

    Seda Ates

    2016-04-01

    Full Text Available Aim: The aim of the study was to evaluate the surgical indications, routes of surgery and the correlation between preoperative diagnosis and histopathological examination of hysterectomy specimens. Material and Method: Medical records and histopathological findings were reviewed and analyzed retrospectively, in 422 consecutive women who underwent hysterectomy over a two-year period from 2011 to 2014. Those with confirmed malignancy before operation were excluded. Cohen kappa statistics were used to measure agreement between preoperative clinical and postoperative histopathological diagnosis which was found to be fair with %u043A value being 0.4. Results: The mean age of our patients was 51.5 ± 8 years. The abdominal route was used in 378 cases (85.5%, the vaginal route in 55 patients (12.4% and the laparoscopic-assisted vaginal hysterectomy in 9 cases (2%. Abnormal uterine bleeding (28.9 % was the most common indication for hysterectomy. The histopathology of the endometrium prior to hysterectomy was reported in 75% of the cases and the most common finding was a secretory or proliferative endometrium. Leiomyomatous uterus was the most frequently encountered pathology (43.7% followed by coexistence of leiomyoma and adenomyosis (17.4% in hysterectomy specimens. Hysterectomy specimens may be unremarkable histopathologically, most of which are vaginal hysterectomies done for uterine prolapsed (kappa=0,407. Discussion: The correlation between the preoperative clinical and the pathological diagnosis were poor in cases with abdominal pain, abnormal uterine bleeding and fibroids. But there was a high correlation in cases with adnexial mass.

  3. The effect of hysterectomy on ano-rectal physiology.

    LENUS (Irish Health Repository)

    Kelly, J L

    2012-02-03

    Hysterectomy is associated with severe constipation in a subgroup of patients, and an adverse effect on colonic motility has been described in the literature. The onset of irritable bowel syndrome and urinary bladder dysfunction has also been reported after hysterectomy. In this prospective study, we investigated the effect of simple hysterectomy on ano-rectal physiology and bowel function. Thirty consecutive patients were assessed before and 16 weeks after operation. An abdominal hysterectomy was performed in 16 patients, and a vaginal procedure was performed in 14. The parameters measured included the mean resting, and maximal forced voluntary contraction anal pressures, the recto-anal inhibitory reflex, and rectal sensation to distension. In 8 patients, the terminal motor latency of the pudendal nerve was assessed bilaterally. Pre-operatively, 8 patients were constipated. This improved following hysterectomy in 4, worsened in 2, and was unchanged in 2. Symptomatology did not correlate with changes in manometry. Although, the mean resting pressure was reduced after hysterectomy (57 mmHg-53 mmHg, P = 0.0541), the maximal forced voluntary contraction pressure was significantly decreased (115 mmHg-105 mmHg, P = 0.029). This effect was more pronounced in those with five or more previous vaginal deliveries (P = 0.0244, n = 9). There was no significant change in the number of patients with an intact ano-rectal inhibitory reflex after hysterectomy. There was no change in rectal sensation to distension, and the right and left pudendal nerve terminal motor latencies were unaltered at follow-up. Our results demonstrate that hysterectomy causes a decrease in the maximal forced voluntary contraction and pressure, and this appears to be due to a large decrease in a small group of patients with previous multiple vaginal deliveries.

  4. The impact of socioeconomic and clinical factors on purchase of prescribed analgesics before and after hysterectomy on benign indication

    DEFF Research Database (Denmark)

    Daugbjerg, Signe Bennedbæk; Brandsborg, Birgitte; Ottesen, Bent Smedegaard;

    2014-01-01

    OBJECTIVE:: Pelvic pain is a primary symptom of women referred for hysterectomy. This study identified risk factors for purchase of prescribed analgesics before and after hysterectomy and examined purchase changes after hysterectomy, specifically focusing on socioeconomic effects. METHODS:: Nearly...

  5. Robot-assisted laparoscopic hysterectomy vs traditional laparoscopic hysterectomy: five metaanalyses.

    Science.gov (United States)

    Scandola, Michele; Grespan, Lorenzo; Vicentini, Marco; Fiorini, Paolo

    2011-01-01

    To assess differences between laparoscopic hysterectomy performed with or without robot-assistance, we performed metaanalyses of 5 key indices strongly associated with societal and hospital costs, patient safety, and intervention quality. The 5 indexes included estimated blood loss (EBL), operative time, number of conversions to laparotomy, hospital length of stay (LOS), and number of postoperative complications. A search of PubMed, Medline, Embase, and Science citation index online databases yielded a total of 605 studies. After a systematic review, we proceeded with meta-analysis of 14 articles for EBL, with a summary effect of -0.61 (95% confidence interval [CI], -42.42 to 46.20); 20 for operative time, with a summary effect of 0.66 (95% CI, -15.72 to 17.04); 17 for LOS, with a summary effect of -0.43 (95% CI, -0.68 to -0.17); 15 for conversion to laparotomy (odds ratio, 0.50; 95% CI, 0.31 to 0.79 with a random model); and 14 for postoperative complications (odds ratio, 0.69; 95% CI, 0.43 to 1.09 with a random model). In conclusion, compared with traditional laparoscopic hysterectomy, robot-assisted laparoscopic hysterectomy was associated with shorter LOS and fewer postoperative complications and conversions to laparotomy; there were no differences in EBL and operative time. These results confirm that robot-assisted laparoscopy has less deletorious effect on hospital, society, and patient stress and leads to better intervention quality. Copyright © 2011 AAGL. Published by Elsevier Inc. All rights reserved.

  6. Laparoscopically assisted vaginal hysterectomy (LAVH) versus total abdominal hysterectomy (TAH) in endometrial carcinoma: prospective cohort study.

    Science.gov (United States)

    Devaja, Omer; Samara, Ioanna; Papadopoulos, Andreas J

    2010-05-01

    To determine the feasibility and safety of laparoscopically assisted vaginal hysterectomy in the treatment of presumed stage I endometrial cancer. This was a prospective cohort study without randomization of 182 consecutive patients who underwent surgery for early endometrial cancer or atypical hyperplasia at the West Kent Gynaecological Oncology Centre, UK. Seventy-four had laparoscopically assisted vaginal hysterectomy and bilateral salpingo-oophorectomy (BSO), and 108 had a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Lymphadenectomy was performed in 153 patients, and lymph node sampling was performed in 2 patients. Twenty-seven patients with serous papillary endometrial cancer in addition had an omentectomy. The groups were compared for epidemiological and clinical characteristics, surgical outcomes, hospital stay, lymph node harvest, and intraoperative and postoperative complications. The patients in the laparoscopy group had less blood loss, similar number of lymph nodes removed, less need for analgesia, and shorter hospital stay but longer operative time than those treated by laparotomy. In our study, we had 4 conversions (5.4%) from laparoscopy to laparotomy. Twenty-eight (41%) patients who had laparoscopic surgery were obese (body mass index [BMI] >30 kg/m2). Postoperative complications were more common in the laparotomy group (34%) than in the laparoscopy group (6%). No major complications occurred in the laparoscopy group. Wound infection was the most common complication in laparotomy patients, and this invariably happened to obese patients (BMI >30 kg/m2). There were 6 readmissions, all from the laparotomy group. Laparoscopic surgery is a safe and reliable alternative to open surgery in the management of early endometrial cancer patients, with significantly reduced hospital stay and complications, especially in those patients with an elevated BMI.

  7. Supracervical versus total hysterectomy in women undergoing hysterectomy for benign gynaecological disease - a new danish recommendation

    DEFF Research Database (Denmark)

    Sloth, Sigurd Beier; Jørgensen, Annemette; Schroll, Jeppe Bennekou

    for systematic literature and 44 hits for primary literature. One systematic review (n = 1553) and one randomized controlled trial (RCT, n = 200) met the inclusion criteria. The quality of evidence for the critical outcomes was rated low to very low and for the important outcomes low to moderate. Evidence showed...... supracervical hysterectomy should be treated with combined HRT. The panel assesses that the small differences in operating time and intraoperative bleeding are without clinical importance. Based on the available evidence, the balance between benefits and harms and patient values and preferences, the guideline...

  8. Total laparoscopic hysterectomy in obese versus nonobese patients.

    Science.gov (United States)

    Heinberg, Eric M; Crawford, Benjamin L; Weitzen, Sherry H; Bonilla, David J

    2004-04-01

    To estimate the risk of operative and postoperative complications for obese patients undergoing total laparoscopic hysterectomy compared with nonobese patients. A retrospective cohort study was performed for patients undergoing total laparoscopic hysterectomy at Ochsner Clinic Foundation in New Orleans, Louisiana, for a period of 4.3 years. Rates of complications, successful laparoscopic completion, readmission, and reoperation were compared for those patients having a body mass index (BMI) of 30 kg/m(2) or greater with those whose BMI was less than 30 kg/m(2). Of 270 patients who met inclusion criteria, 106 (39.3%) women had a BMI of 30 kg/m(2) or greater. Procedures were completed by using endoscopic technique in 253 cases (93.7%), by using a combined vaginal approach (laparoscopically assisted vaginal hysterectomy) in 7 cases (2.6%), and via laparotomy (total abdominal hysterectomy) in 10 cases (3.7%). Neither the 2-fold risk of conversion to laparoscopically assisted vaginal hysterectomy (relative risk [RR] 2.2; 95% confidence interval [CI] 0.5, 10.1) nor the 4-fold risk of conversion to laparotomy (RR 3.9, 95% CI 1.0, 15.4) associated with obesity was statistically significant. Total laparoscopic hysterectomy for obese patients was 60% more likely to require at least 2 hours to complete (RR 1.6, 95% CI 1.2, 2.0) and was associated with a 3-fold risk of blood loss exceeding 500 mL compared with nonobese patients. Risks of major and minor complications, hospital readmission, and reoperation were similar for both groups. Total laparoscopic hysterectomy can be performed successfully in most obese patients, with complication rates similar to those for nonobese patients. II-2

  9. Early Feeding After a Total Abdominal Hysterectomy

    Directory of Open Access Journals (Sweden)

    Mary Flesher

    2009-02-01

    Full Text Available Background: Oral fluids and food are traditionally introduced slowly after total abdominal hysterectomy (TAH. This descriptive study examined the effect and tolerance of early oral intake following this surgery. Methods: A retrospective chart review was conducted on 164 patients who had been on a clinical pathway following TAH. Comparisons in initiation of fluids and foods, and gastrointestinal effects were made between the early fed group (n=82 and the traditionally fed group (n=82. Results: Both groups had the similar gastrointestinal symptoms postoperatively, but the early fed group had an earlier bowel movement. The early fed group had a statistically significant shorter length of stay. Similar usage of anti-nausea medication and pain medication usage was noted between the two groups, except for a lower usage of Tylenol #3 (acetaminophen with codeine in the early fed group. Conclusions: This study found that early feeding could be tolerated well in TAH patients, with statistically significant improvements in usage of some pain medication and length of stay were noted in the early fed group.

  10. Experience with irrigation analgesia after abdominal hysterectomy

    Directory of Open Access Journals (Sweden)

    R. V. Garyaev

    2012-01-01

    Full Text Available A prospective randomized clinical trial was performed in 100 patients who underwent abdominal hysterectomy under endotracheal anesthesia based on sevoflurane and fentanyl. Intraoperatively, ketorolac 30 mg was administered intramuscularly after induction of anesthesia and paracetamol 1 g was injected intravenously 30–40 minutes prior to surgical termination in a control group (n = 25. For postoperative anal- gesia, promedol, tramadol, and ketorolac were used intramuscularly and paracetamol was given intravenously. Three study groups (n = 2 in each differed from the control group in that during wound suturing a multiperforated catheter was placed above the peritoneum over a length of 15 cm, through which a 10-ml bolus of 0.75 % ropivacaine was first administered, followed by continuous infusion of 0.2 % ropivacaine at a rate of 8 ml/hour for 36 hours. In one irrigation group, ketorolac 30 mg was injected intramuscularly t.i.d. for 2 days; in another group, the agent was added to a ropivacaine solution calculated with reference to 180 mg for 2 days; in the third group, ketoprofen 100 mg instead of ketorolac was used b.i.d. for 2 days. Pain level (by digital rating scale, 0–10 and the need for analgesics were measured. There was no sta- tistical significant difference in the level of pain and the need for analgesics between the wound irrigation and control groups.

  11. Vaginal hysterectomy or laparoscopic assisted vaginal hysterectomy for enlarged myomatous uterus: a randomized clinical trial

    Institute of Scientific and Technical Information of China (English)

    Fan Rong; Zhu Lan; Lang Jing-he; Shi Hong-hui; Gong Xiao-ming

    2011-01-01

    Objective:To compare the intraoperative condition and short-term outcomes of vaginal hysterectomy (VH) and laparoscopic assisted vaginal hysterectomy (LAVH) for enlarged myomatous uterus.Methods:Fifty patients from Peking Union Medical College Hospital (PUMCH) were randomly assigned to two treatment groups:VH (n=23) and LAVH (n=27).All procedures were performed by a single senior surgeon to maintain homogeneity.Results:The baseline characteristics of the two groups were comparable.The operative time for LAVH was significantly longer than for VH (76.7±23.2 vs.57.6±23.5 min,P<0.05),and LAVH costs more money than VH (6,923.07±622.96 vs.5,974.46±1,408.08 RMB,P<0.05).Major complications,uterine weight and the length of hospital stay were comparable between VH and LAVH group.One case of VH was converted to LAVH due to adhesion.Conclusions:Compared with LAVH,VH is a time- and cost-saving operative technique for enlarged myomatous uterus.VH should be the primary method for uterine removal,but LAVH may have advantages when adhesion is present.

  12. Total laparoscopic hysterectomy versus total abdominal hysterectomy for obese women with endometrial cancer.

    Science.gov (United States)

    Obermair, A; Manolitsas, T P; Leung, Y; Hammond, I G; McCartney, A J

    2005-01-01

    Obesity is common in endometrial cancer and surgery for these patients is challenging. We compared total laparoscopic hysterectomy (TLH) with total abdominal hysterectomy (TAH) with respect to feasibility (operating time, estimated blood loss, length of hospital stay, and conversion to laparotomy) and safety (perioperative morbidity and mortality) in a retrospective analysis of 78 morbidly obese patients with endometrial cancer. Analysis is based on the intention to treat. The intention to treat was TLH in 47 patients and it could be successfully completed in 42 patients (89.4%). The mean weight for all patients was 118.7 kg, with patients in the TLH group weighing more and having higher ASA scores. Mean operating time and estimated blood loss were similar in both groups. Mean postoperative hospital stay was 4.4 (+/-3.9) days in the TLH group and 7.9 (+/-3.0) days in the TAH group (P < 0.0001). Wound infections occurred in 15 of 31 patients (48.4%) in the TAH group and in 1 of 47 patients (2.1%) in the TLH group. All other morbidity, as well as patterns of recurrence and survival were similar in both groups. These data justify a prospective randomized trial comparing TLH with TAH for the treatment of endometrial cancer.

  13. Short-term Clinical Outcomes of Laparoscopic Fertility-preserving Radical Hysterectomy in the Management of Early-stage Cervical Cancer%腹腔镜下保留生育功能宫颈癌根治术治疗早期子宫颈癌的近期临床疗效

    Institute of Scientific and Technical Information of China (English)

    刘开江; 刘青; 韩娜娜; 王娟; 李培全; 茹明芳

    2011-01-01

    Objective To investigate the feasibility and effectiveness of laparoscopic radical trache-lectomy and lymphadenectomy in the treatment of early-stage cervical cancer. Methods The clinical data of 6 patients ( stage I a2 to I bl) , who underwent laparoscopic fertility-preserving radical operation for cervical cancer in our department from February 2009 to October 2010, were retrospectively analyzed in terms of operation duration, intra-operative blood loss, postoperative pathology, complications, and pregnancy. Results Both radical resection of cervical and pelvic lymph node dissection were completed under laparoscopy, and only the cervical and vaginal cuffs were closed from vagina. The operation duration ranged 155-210 min ( mean; 185 min) and the intra-operative blood loss was approximately 60-120 ml (mean: 105 ml). The average length of hospital stay was 18 days without complications, postoperative infection, and bleeding. Postoperative pathology showed no lymph node metastasis, and no ligament, blood vessels, vaginal cutting margin, or upper part of cervix was invaded by tumor cells. During the 8-20-month follow-up, 1 patient had become pregnant for 4 months and no case experienced tumor recurrence. Conclusion Laparoscopic fertility-preserving lymphadenectomy and radical trachelectomy is feasible for patients with early-stage cervical cancer who have strong wish to have a child.%目的 探讨腹腔镜下根治性子宫颈切除术和盆腔淋巴结切除术治疗早期子宫颈癌的可行性和效果.方法 回顾分析6例Ⅰa2~Ⅰb1期行腹腔镜下保留生育功能子宫颈癌根治术患者的临床资料,分析手术时间、出血量、手术后病理、并发症、妊娠情况等.结果 根治性子官颈切除术和盆腔淋巴结清扫术均在腹腔镜下完成,仅宫颈和阴道断端缝合经阴道完成.手术时间155 ~210 min,平均185 min;术中出血量约60~120ml,平均105 ml.术中及术后均无并发症.术后病理学检查未

  14. A different technique in gasless laparoendoscopic single-site hysterectomy.

    Science.gov (United States)

    Demirayak, Gökhan

    2017-07-01

    The aim of this study was to show a different technique for a gasless laparoendoscopic single-site (LESS) hysterectomy and to present advantages and limitations of this technique. Women undergoing gasless LESS hysterectomy with a different technique were evaluated. A total of 14 LESS hysterectomies were performed using this gasless technique and rigid laparoscopic instruments by one surgeon. The mean age of the patients was 48.6 (±4.6). The average blood loss was 80 ± 35 ml. The average time between an umbilical incision and starting hysterectomy was 5 (±2,1) min. The time between starting hysterectomy and umbilical incision closure was 120 (±24) min in the laparoscopic suture group and 88 (±16) min in the vaginal suture group. The mean uterus weight was 188 (±95) g. In conclusion, this different technique is feasible and low cost, especially in non-obese patients. But further studies with large participants are needed to elucidate the safety. Impact statement Conventional CO2 pneumoperitoneum has many adverse effects on cardiopulmonary function, haemodynamic, metabolic and neurologic systems due to high-intraperitoneal pressure. The usage of gasless technique eliminates these adverse effects and postoperative shoulder pain. The satisfaction of patients is higher in laparoendoscopic single-site (LESS) hysterectomy due to improved cosmesis and reduced postoperative analgesic requirements. In the literature, there are a few studies showing techniques combining LESS and gasless laparoscopy for hysterectomy. In this study, a different approach for creating operational space in gasless laparoscopy is described. Creation of intraabdominal operational space is convenient and takes a short time in this technique. The average time between an umbilical incision and starting a hysterectomy is five minutes. Additional training is not needed for experienced surgeons in LESS. Also, cost-effectiveness is one of important advantages. It is quite safe, no possibility of

  15. Analysis of histopathological examination of the hysterectomy specimens in a north Indian teaching institute

    Directory of Open Access Journals (Sweden)

    Deepti Verma

    2016-11-01

    Conclusions: Justification of hysterectomy is proved when the HPE report is compatible with the preoperative diagnosis; hence HPE of all hysterectomy specimens should be done and analyzed. [Int J Res Med Sci 2016; 4(11.000: 4753-4758

  16. Obstetric hysterectomy: trend and outcome in Ile-Ife, Nigeria.

    Science.gov (United States)

    Badejoko, O O; Awowole, I O; Ijarotimi, A O; Badejoko, B O; Loto, O M; Ogunniyi, S O

    2013-08-01

    Worldwide, the incidence of obstetric hysterectomy is expected to be on the decline due to improvements in obstetric care. This hospital-based 10-year review (2001-10) was performed to determine its incidence and outcome in Ile-Ife, Nigeria. The trend was determined by comparing the current incidence with that from two previous studies from the same centre. There were 58 obstetric hysterectomies and 15,194 deliveries during the review period, giving a rate of 3.8/1,000 deliveries. A rising trend was observed in the obstetric hysterectomy rate in Ile-Ife over two decades (1990-2010). Uterine rupture was the commonest indication (60%). Postoperative complications such as sepsis, vesico-vaginal fistula and renal failure affected 34.5% of the patients. Maternal and fetal case fatality rates were 18.2% and 43.6%, respectively. The obstetric hysterectomy rate in Ile-Ife is high and the trend is rising. Universal access to skilled birth attendance is advocated to reduce uterine rupture and consequently obstetric hysterectomy.

  17. Total laparoscopic hysterectomy: our 5-year experience (1998-2002).

    Science.gov (United States)

    Bonilla, David J; Mains, Lindsay; Rice, Janet; Crawford, Benjamin

    2010-01-01

    To review our experience performing total laparoscopic hysterectomy since we first introduced this procedure in 1998. A retrospective cohort study was performed for patients undergoing total laparoscopic hysterectomy at Ochsner Clinic Foundation from February 1998 through December 2002. Rates of complications, successful completion, length of hospital stay, readmission, and reoperation were determined for this period. Among 511 patients who underwent attempted total laparoscopic hysterectomy, 487 procedures (95.3%) were completed by laparoscopy. The major intraoperative complication rate was 3.9%, and the major postoperative complication rate was 4.7%. No significant differences were seen in the intraoperative and postoperative complication rates of patients who were morbidly obese (body mass index ≥30 kg/m(2)), patients with enlarged uteri (≥300 g), or patients who underwent concomitant procedures (unilateral or bilateral salpingo-oophorectomy and lysis of adhesions). The readmission rate was 4.1%, and the reoperation rate was 2%. None of the variables studied, including age, medical problems, morbid obesity, concomitant procedures, or enlarged uterus, were found to have an association with readmission or reoperation rates. Total laparoscopic hysterectomy can be performed successfully in most patients with benign indications. Morbidity is comparable to that of other types of hysterectomies, and this technique may be a more reasonable approach under some circumstances.

  18. Total Laparoscopic Hysterectomy: Our 5-Year Experience (1998–2002)

    Science.gov (United States)

    Bonilla, David J.; Mains, Lindsay; Rice, Janet; Crawford, Benjamin

    2010-01-01

    Purpose: To review our experience performing total laparoscopic hysterectomy since we first introduced this procedure in 1998. Methods: A retrospective cohort study was performed for patients undergoing total laparoscopic hysterectomy at Ochsner Clinic Foundation from February 1998 through December 2002. Rates of complications, successful completion, length of hospital stay, readmission, and reoperation were determined for this period. Results: Among 511 patients who underwent attempted total laparoscopic hysterectomy, 487 procedures (95.3%) were completed by laparoscopy. The major intraoperative complication rate was 3.9%, and the major postoperative complication rate was 4.7%. No significant differences were seen in the intraoperative and postoperative complication rates of patients who were morbidly obese (body mass index ≥30 kg/m2), patients with enlarged uteri (≥300 g), or patients who underwent concomitant procedures (unilateral or bilateral salpingo-oophorectomy and lysis of adhesions). The readmission rate was 4.1%, and the reoperation rate was 2%. None of the variables studied, including age, medical problems, morbid obesity, concomitant procedures, or enlarged uterus, were found to have an association with readmission or reoperation rates. Conclusions: Total laparoscopic hysterectomy can be performed successfully in most patients with benign indications. Morbidity is comparable to that of other types of hysterectomies, and this technique may be a more reasonable approach under some circumstances. PMID:21603347

  19. Woman experiencing gynecologic surgery: coping with the changes imposed by surgery

    Directory of Open Access Journals (Sweden)

    Carolina de Mendonça Coutinho e Silva

    Full Text Available ABSTRACT Objectives: to describe the feelings and perceptions resulting from gynecologic surgery by women and analyze how they experience the changes caused by the surgery. Method: a qualitative, descriptive and exploratory study, which had Symbolic Interactionism and Grounded Theory as its theoretical framework. Participants of the study: 13 women submitted to surgery: Total Abdominal Hysterectomy, Total Abdominal Hysterectomy with bilateral Adnexectomy, Wertheim-Meigs surgery, Oophorectomy, Salpingectomy, Mastectomy, Quadrantectomy and Tracheloplasty. Individual interviews were conducted, recorded and analyzed according to the comparative analysis technique of the Grounded Theory. Results: from the data two categories emerged - Perceiving a different body and feeling as a different person and; building the meaning of mutilation. The changes experienced make women build new meanings and change the perception of themselves and their social environment. From the interaction with their inner self, occurred a reflection on relationships, the difference in their body and themselves, the functions it performs and the harm caused by the surgery. Conclusions: the participants felt like different women; the mutilation developed in concrete feelings, due the loss of the organ, and in abstract, linked to the impact of social identity and female functionality. The importance of the nurse establishing a multidimensional care, to identify the needs that go beyond the biological body is perceived.

  20. Woman experiencing gynecologic surgery: coping with the changes imposed by surgery 1

    Science.gov (United States)

    Silva, Carolina de Mendonça Coutinho e; Vargens, Octavio Muniz da Costa

    2016-01-01

    ABSTRACT Objectives: to describe the feelings and perceptions resulting from gynecologic surgery by women and analyze how they experience the changes caused by the surgery. Method: a qualitative, descriptive and exploratory study, which had Symbolic Interactionism and Grounded Theory as its theoretical framework. Participants of the study: 13 women submitted to surgery: Total Abdominal Hysterectomy, Total Abdominal Hysterectomy with bilateral Adnexectomy, Wertheim-Meigs surgery, Oophorectomy, Salpingectomy, Mastectomy, Quadrantectomy and Tracheloplasty. Individual interviews were conducted, recorded and analyzed according to the comparative analysis technique of the Grounded Theory. Results: from the data two categories emerged - Perceiving a different body and feeling as a different person and; building the meaning of mutilation. The changes experienced make women build new meanings and change the perception of themselves and their social environment. From the interaction with their inner self, occurred a reflection on relationships, the difference in their body and themselves, the functions it performs and the harm caused by the surgery. Conclusions: the participants felt like different women; the mutilation developed in concrete feelings, due the loss of the organ, and in abstract, linked to the impact of social identity and female functionality. The importance of the nurse establishing a multidimensional care, to identify the needs that go beyond the biological body is perceived. PMID:27579935

  1. Adjuvant chemotherapy for endometrial cancer after hysterectomy

    Science.gov (United States)

    Johnson, Nick; Bryant, Andrew; Miles, Tracie; Hogberg, Thomas; Cornes, Paul

    2014-01-01

    Background Endometrial adenocarcinoma (womb cancer) is a malignant growth of the lining (endometrium) of the womb (uterus). It is distinct from sarcomas (tumours of the uterine muscle). Survival depends the risk of microscopic metastases after surgery. Adjuvant (postoperative) chemotherapy improves survival from some other adenocarcinomas, and there is evidence that endometrial cancer is sensitive to cytotoxic therapy. This systematic review examines the effect of chemotherapy on survival after hysterectomy for endometrial cancer. Objectives To assess efficacy of adjuvant (postoperative) chemotherapy for endometrial cancer. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2010, Issue 3), MEDLINE and EMBASE up to August 2010, registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. Selection criteria Randomised controlled trials (RCTs) comparing adjuvant chemotherapy with any other adjuvant treatment or no other treatment. Data collection and analysis We used a random-effects meta-analysis to assess hazard ratios (HR) for overall and progression-free survival and risk ratios (RR) to compare death rates and site of initial relapse. Main results Five RCTs compared no additional treatment with additional chemotherapy after hysterectomy and radiotherapy. Four trials compared platinum based combination chemotherapy directly with radiotherapy. Indiscriminate pooling of survival data from 2197 women shows a significant overall survival advantage from adjuvant chemotherapy (RR (95% CI) = 0.88 (0.79 to 0.99)). Sensitivity analysis focused on trials of modern platinum based chemotherapy regimens and found the relative risk of death to be 0.85 ((0.76 to 0.96); number needed to treat for an additional beneficial outcome (NNT) = 25; absolute risk reduction = 4% (1% to 8%)). The HR for overall survival is 0.74 (0.64 to 0.89), significantly

  2. The indication for hysterectomy as a risk factor for subsequent pelvic organ prolapse repair

    DEFF Research Database (Denmark)

    Lykke, Rune; Blaakær, Jan; Ottesen, Bent

    2015-01-01

    INTRODUCTION AND HYPOTHESIS: The aim of this study was to investigate whether the indication for hysterectomy was itself a risk factor for subsequent pelvic organ prolapse (POP) in Danish women who underwent hysterectomy from 1977 to 2009. METHODS: Data from 154,882 women who underwent hysterectomy...

  3. Systematic review of the limited evidence for different surgical techniques at benign hysterectomy

    DEFF Research Database (Denmark)

    Sloth, Sigurd Beier; Schroll, Jeppe Bennekou; Settnes, Annette

    2017-01-01

    laparoscopic hysterectomy for non-prolapsed uteri when feasible (⊕ΟΟΟ). ↓ Robot-assisted laparoscopic hysterectomy should only be preferred over conventional laparoscopic hysterectomy after careful consideration because the beneficial effect is uncertain and because of the longer operating time (⊕⊕ΟΟ...

  4. Psychological meaning of a woman with a hysterectomy among Mexican physicians and women.

    Science.gov (United States)

    Marván, Maria Luisa; Catillo-López, Rosa Lilia; Ehrenzweig, Yamilet; Palacios, Pedro

    2012-01-01

    The psychological meaning of women who have had a hysterectomy, and attitudes toward them, were explored in 121 Mexican gynecologists, 155 women who had undergone a hysterectomy, and 115 women who had not had a hysterectomy. The surveys were completed between January and May 2011. Both groups of women defined a woman who had had a hysterectomy using words with positive meanings (healthy, happy, reassured, and complete), as well as words with negative meanings (sad, incomplete, and irritable). However, the participants who had not had a hysterectomy defined a woman who had had a hysterectomy using more negative words and showed more negative attitudes toward such a woman with a hysterectomy than those women who had undergone a hysterectomy. Among participants who had undergone a hysterectomy, those who were premenopausal prior to the surgery and those who had undergone bilateral salpingo-oophorectomy defined a woman who had had a hysterectomy in a more negative manner and showed the most negative attitudes. The gynecologists did not use words with emotional content regarding women who had had a hysterectomy and showed more neutral attitudes toward such a woman than did both groups of women. These findings could be helpful in designing support programs for women facing a hysterectomy.

  5. Decreasing trend of hysterectomy in Taiwan: A population-based study, 1997–2010

    Directory of Open Access Journals (Sweden)

    Jerry Cheng-Yen Lai

    2015-10-01

    Conclusion: The clinical utilization and primary indications of hysterectomy changed substantially in Taiwan from 1997 to 2010. The continued monitoring of changes in hysterectomy rates will be critical for understanding the appropriate indications for hysterectomy and oophorectomy, the emergence of alternative managements for uterine disorders, and future trends in women's reproductive health.

  6. Hysterectomy with ovarian conservation: effect on bone mineral density

    Energy Technology Data Exchange (ETDEWEB)

    Lareon, G.; Baillon, L. [Westmead Hospital, Westmead, NSW, (Australia). Department of Nuclear Medicine and Ultrasound

    1997-09-01

    Full text: There are conflicting data on the long-term effects of hysterectomy with ovarian conservation on bone mineral density (BMD). Accordingly, we performed a cross-sectional study on 58 women with premenopausal hysterectomy and ovarian conservation (group 1) and 59 women with natural menopause (group 2). No subjects had disorders or medications known to interfere with bone metabolism. Patients underwent bone densitometry of the lumbar spine and hip using a Norland XR-36. By chi-squared and one-way ANOVA, there were no differences in age: 55.4{+-} 11.0 y (1)v 57.6{+-} 9.8 y (2); exercise, alcohol or smoking consumption, family history of osteoporosis, height: 1.61 {+-} 0.08m (1) v 1.61 {+-} 0.08m (2); weight 67.7 {+-} 11.3kg (1) v 68.3 kg {+-} 12.5 kg (2); body mass index: 30.95 (1 ) v 26.26 (2). Lumbar spine BMD was also similar for the two groups [0.95 {+-} 0.18g/cm{sup 2} (1) v 0.94{+-} 0.21 g/cm{sup 2} (2)]. However, hysterectomy patients had a significantly lower hip BMD: 0.63 {+-} 0.16 g/cm{sup 2} v 0.76 {+-} 0.18 g/cm{sup 2} (p>0.001). Multivariate logistic regression showed that spine BMD was influenced by age, family history, height and weight (R{sup 2} = 0.37), but not prior hysterectomy. Hip BMD was related to age, hysterectomy, smoking and weight (R{sup 2} = o 45). We conclude that prior hysterectomy with ovarian conservation has an adverse effect on hip but not spine BMD.

  7. Risk factors associated with emergency peripartum hysterectomy

    Institute of Scientific and Technical Information of China (English)

    Jin Rong; Guo Yuna; Chen Yan

    2014-01-01

    Background Use of an emergency peripartum hysterectomy (EPH) as a lifesaving measure to manage intractable postpartum hemorrhage (PPH) appears to be increasing recently around the world,and the indications for EPH have changed.The object of this study is to identify risk factors associated with EPH.Methods We conducted a case-control study of 21 patients who underwent EPH because of intractable PPH between January 1,2005 and June 30,2013,at the International Peace Maternity and Child Health Hospital Shanghai Jiao Tong University,School of Medicine (IPMCH).The parametric t-test,chi-square tests and Logistic regression models were used for analysis to identify the risk factors.The results were considered statistically significant when P<0.05.Results There were 89 178 deliveries during the study period.Twenty-one women had an EPH,with an incidence of 24 per 100 000 deliveries.The loss of blood during postpartum hemorrhage of the EPH group was (5 060.7±3 032.6)ml,and that of the control group was (2 040.8±723.5) ml.There was a significant difference of PHH between the EHP group and the control group (P=0.001).Independent risk factors for EPH from a logistic regression model were:disseminated intravascular coagulation (DIC) (OR:9.9,95% CI 2.8-34,P=0.003),previous cesarean section (OR:5.27;95% CI:1.48-17.9,P=0.009),placenta previa (OR:6.9; 95% CI 1.6-2.9,P=0.008),the loss of PPH (OR:1.001; 95% CI 1.001-1.002,P=0.002),placenta accreta (OR:68; 95% CI 10-456,P=0.004),the use of tocolytic agents prenatally (OR:6.55,95%CI 1.34-32.1,P=0.049),and fetal macrosomia (OR:6.9,95% CI 1.25-38,P=0.049).Conclusion Significant risk factors of EPH are DIC,placenta previa,PPH,previous cesarean delivery,and placenta accrete,the use of tocolytic agents prenatally,and fetal macrosomia.

  8. Does route of hysterectomy affect outcome in obese and nonobese women?

    Science.gov (United States)

    Brezina, Paul R; Beste, Todd M; Nelson, Keith H

    2009-01-01

    Our objective was to compare the surgical outcomes of obese women having hysterectomy according to the route (abdominal, vaginal, or laparoscopic) of the procedure. A chart review of 293 hysterectomy procedures was performed. Data were collected including operative and anesthesia time, estimated blood loss, change in hematocrit, hospital stay, complications, conversion to laparotomy, transfusion, and body mass index. An analysis of variance and a Newman-Keuls Multiple Comparison test were performed. Obese women experienced a significant decrease in hospital days (2.5 versus 4.2) and reported blood loss (204 mL versus 455 mL) in the laparoscopic hysterectomy and vaginal hysterectomy groups compared with the abdominal hysterectomy group. No significant difference was found in obese women between laparoscopic and abdominal hysterectomy for time spent in surgery and under anesthesia. For obese and normal weight women, vaginal hysterectomy offered the shortest surgery, anesthesia times, and hospital stays. For normal and obese women, vaginal hysterectomy offered the shortest hospital stay and surgery time. In obese patients for whom vaginal hysterectomy is not possible, laparoscopic hysterectomy should be considered before abdominal hysterectomy, because the laparoscopic route reduced hospital time and blood loss.

  9. Objective comparison of subtotal vs. total abdominal hysterectomy regarding pelvic organ prolapse and urinary incontinence

    DEFF Research Database (Denmark)

    Andersen, Lea Laird; Møller, Lars Alling; Gimbel, Helga Margrethe Elisabeth

    2015-01-01

    OBJECTIVE: To compare subtotal and total abdominal hysterectomy regarding objective assessment of pelvic organ prolapse, urinary incontinence and voiding function 14 years after hysterectomy for benign diseases. STUDY DESIGN: Long-term follow-up of a randomized clinical trial of subtotal vs. total......, total: 100), the PFDI-20 questionnaire was answered by 140 (46.1%) (subtotal: 68, total: 72). We found no difference between subtotal and total abdominal hysterectomy in the PFDI-20 scores or regarding objectively assessed urinary incontinence or pelvic organ prolapse. In the subtotal hysterectomy group......, 31 (59.6%) women had objective stage 2 pelvic organ prolapse compared with 33 (70.2%) in the total hysterectomy group (P=0.27); however, only 6/31 and 9/33 had symptoms (P=0.45). There were more anterior pelvic organ prolapses in the total hysterectomy group (N=10) than in the subtotal hysterectomy...

  10. Instilling fear makes good business sense: unwarranted hysterectomies in Karnataka.

    Science.gov (United States)

    Xavier, Teena; Vasan, Akhila; S, Vijayakumar

    2017-01-01

    This paper uses data from two fact-finding exercises in two districts of Karnataka to trace how government and private doctors alike pushed women to undergo hysterectomies. The doctors provided grossly unscientific information to poor Dalit women to instil a fear of "cancer" in their minds to wilfully mislead them to undergo hysterectomies, following which many suffered complications and died. The paper examines a review, made by two separate panels of experts, of women's medical records from private hospitals to illustrate that a large proportion of the hysterectomies performed were medically unwarranted; that private doctors were using highly suspect diagnostic criteria, based on a single ultrasound scan, to perform the hysterectomies and had not sent even a single sample for histopathology; and that the medical records were incomplete, erroneous and, in several instances, manipulated. The paper describes how a combination of patriarchal bias, professional unscrupulousness and pro-private healthcare policies posed a serious threat to the survival and well-being of women in Karnataka.

  11. The Evaluation Of Histopathological Diagnosis In Hysterectomy Materials

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    Cigdem Kunt isguder

    2016-06-01

    Results: The mean age of the patients was 50.48+/-7.50 (min:38, max:74. Leiomyoma with 77 case (%45.3 was the most hysterectomy indicated disease. Thereafter, dysfunctional uterine bleeding in 50 (%29.49, and endometrial hyperplasia 22 (%12.9 were detected. The other clinical indications were uterine prolapse in 17 patients (%10, chronic pelvic pain in 2 (%1.2 and adenomyosis in 2 (%1.2. The results of histopathological reports belong to hysterectomy materials indicated that leiomyoma was the most common pathological finding with 87 cases (%51.2, subsequently adenomyosis in 35 cases (% 20.5 and endometrial hyperplasia in 31 (18.3 was detected. Endometrial polyp was found in 10 cases (%5.9 and atrophic endometrium in 7 cases (%4.1. Combined pathology was defined in 44 hysteterctomy materials. Leiomyoma and endometrial hyperplasia were detected as the most common combination with a ratio of %50. In addition, chronic cervicitis was seen in %64.7 of cervical examinations of hysterectomy materials. Conclusion: Adenomyosis should be kept in mind while planning the diagnosis and treatment of patients whose admitted with compliants of menometrorrhagia, seconder dysmenorrhea and chronic pelvic pain in 4th and 5th decade. Endometrial sampling caused by the co-existence of leiomyoma and endometrial hyperplasia must be necessary in hysterectomy planned cases for leiomyoma those already have menometrorrhagia. [J Contemp Med 2016; 6(2.000: 87-91

  12. Vaginal vault suspension during hysterectomy for benign indications

    DEFF Research Database (Denmark)

    Bonde, Lisbeth; Noer, Mette Calundann; Møller, Lars Alling

    2017-01-01

    INTRODUCTION AND HYPOTHESIS: Several suspension methods are used to try to prevent pelvic organ prolapse (POP) after hysterectomy. We aimed to evaluate agreement on terminology and surgical procedure of these methods. METHODS: We randomly chose 532 medical records of women with a history...

  13. Global epidemiology of hysterectomy: possible impact on gynecological cancer rates

    DEFF Research Database (Denmark)

    Hammer, Anne; Rositch, Anne; Kahlert, Johnny Abildgaard

    2015-01-01

    Despite the fact that hysterectomy is the most common surgical procedure worldwide in gynecology, national reporting of the incidence rate of gynecological cancers rarely removes the proportion no longer at risk of the disease from the population-at-risk-denominator (ie. women who have had a hyst...

  14. Histopathological audit of 373 nononcological hysterectomies in a teaching hospital.

    Science.gov (United States)

    Tiwana, Kanwardeep Kaur; Nibhoria, Sarita; Monga, Tanvi; Phutela, Richa

    2014-01-01

    Hysterectomy, the most common gynecological surgery, provides a definitive cure to various diseases like DUB (dysfunctional uterine bleeding), leiomyoma, adenomyosis, chronic pelvic pain, prolapse, and malignancy. However, with advent of effective medical and conservative treatment modalities for nononcological causes it is now posing question mark on justification of hysterectomy. Therefore, an audit is required to assess the correlation between preoperative diagnosis and histopathological examination of specimen for justification of the procedure. In this study over period of one year (April 2013 to March 2014) 373 hysterectomies specimens were received in the department of pathology for nononcological causes. The age of patients ranged from 22 to 85 years with mean 45 ± 9.2 years. All cases were divided into five categories on the basis of age and audit was done. In this study the most common finding was leiomyoma (43.7%) followed by adenomyosis (19.3%). Almost 50% of hysterectomies causes were justified as preoperative diagnosis matched with histopathology. Cohen kappa statistics were used to measure agreement between preoperative and postoperative histopathological diagnosis which was found to be fair with κ value being 0.36. This study highlights that regular audit of surgeries can help improve quality of health care services and provide safe conservative option to patients.

  15. Concurrent puerperal hysterectomy with Ascaris lumbricoides infestation: coincidence or consequence?

    Science.gov (United States)

    Zapardiel, Ignacio; Peiretti, Michele; Godoy-Tundidor, Sonia

    2010-04-01

    The most common etiology of postpartum hemorrhage is uterine atony, although hematologic disorders may be present. A 36-year-old nulliparous woman underwent puerperal hysterectomy caused by uncontrolled postpartum hemorrhage. One day after discharge, she vomited in the emergency room a 24-cm long Ascaris lumbricoides. Infestation during gestation may cause hematologic disorders that could complicate pregnancy outcome.

  16. Robotic hysterectomy strategies in the morbidly obese patient.

    Science.gov (United States)

    Almeida, Oscar D

    2013-01-01

    The purpose of this study was to present strategies for performing computer-enhanced telesurgery in the morbidly obese patient. This was a prospective, institutional review board-approved, descriptive feasibility study (Canadian Task Force classification II-2) conducted at a university-affiliated hospital. Twelve class III morbidly obese women with a body mass index of 40 kg/m(2) or greater were selected to undergo robotic-assisted total laparoscopic hysterectomy. Robotic-assisted total laparoscopic hysterectomy, classified as type IVE, with complete detachment of the cardinal-uterosacral ligament complex, unilateral or bilateral, with entry into the vagina was performed. The median estimated blood loss was 146.3 mL (range, 15-550 mL), the mean length of stay in the hospital was 25.3 hours (range, 23- 48 hours), and the complication rate was 0%. The rate of conversion to laparotomy was 8%. The median surgical time was 109.6 minutes (range, 99 -145 minutes). Robotic-assisted total laparoscopic hysterectomy can be a safe and effective method of performing hysterectomies in select morbidly obese patients, allowing them the opportunity to undergo minimally invasive surgery without increased perioperative complications.

  17. Body Mass Index and Its Role in Total Laparoscopic Hysterectomy.

    Science.gov (United States)

    Bhandari, Shilpa; Agrawal, Pallavi; Singh, Aparna

    2014-01-01

    Objective. To evaluate operative and perioperative outcomes in patients undergoing total laparoscopic hysterectomy according to their body mass index. Method. A retrospective study was performed for patients undergoing total laparoscopic hysterectomy at a tertiary care center for a period of 4 years. Patients were divided into two groups: obese (BMI > 30 Kg/m(2)) and nonobese (BMI laparoscopic completion, and intraoperative complications were compared in two groups. Result. A total of 253 patients underwent total laparoscopic hysterectomy from January 2010 to December 2013. Out of them, 105 women (41.5%) had a BMI of more than 30 kg/m(2). Overall, the mean blood loss was 85.79 ± 54.17 mL; the operative time was 54.17 ± 19.83 min. The surgery was completed laparoscopically in 244 (96.4%) women while laparotomy was done in 4 cases and vaginal suturing and closure of vault were done in 5 cases. Risk of vaginal assistance was higher in obese patients whereas out of the 4 conversions to laparotomy 3 had BMI laparoscopic hysterectomy is a safe and effective procedure for obese patients and can be performed with an efficacy similar to that in nonobese patients.

  18. Comparison between microwave endometrial ablation and total hysterectomy

    Institute of Scientific and Technical Information of China (English)

    LIN Hua

    2006-01-01

    Background Microwave endometrial ablation (MEA) is a new form of minimal invasive surgical procedure for menorrhagia. It has been widely adopted clinically in many countries. In this study, we compare the outcome of MEA and total hysterectomy for menorrhagia.Methods Sixty patients with menorrhagia were divided into MEA group or total hysterectomy (control) group (30 in each). The intra operative blood loss, operating time, either preserving the uterus or not, and length of recovery time in the two groups were compared. The independent samples t test was used to analyse our data in the study.Results In comparing the MEA group and the control group, the effective rates were 96% (29/30) and 100%(30/30,x2 = 0, P = 1.0). The operating time was (4.0± 1.1) minutes and (68.3 ± 1.9) minutes (t =-160.42,P = 0.00). The mean blood loss was 0 ml and 50 ml, respectively.Conclusions The curative effect of MEA is similar to that of total hysterectomy. When considering preservation of the uterus and postoperative recovery, MEA is obviously superior to total hysterectomy.

  19. Histopathological Audit of 373 Nononcological Hysterectomies in a Teaching Hospital

    Directory of Open Access Journals (Sweden)

    Kanwardeep Kaur Tiwana

    2014-01-01

    Full Text Available Hysterectomy, the most common gynecological surgery, provides a definitive cure to various diseases like DUB (dysfunctional uterine bleeding, leiomyoma, adenomyosis, chronic pelvic pain, prolapse, and malignancy. However, with advent of effective medical and conservative treatment modalities for nononcological causes it is now posing question mark on justification of hysterectomy. Therefore, an audit is required to assess the correlation between preoperative diagnosis and histopathological examination of specimen for justification of the procedure. In this study over period of one year (April 2013 to March 2014 373 hysterectomies specimens were received in the department of pathology for nononcological causes. The age of patients ranged from 22 to 85 years with mean 45±9.2 years. All cases were divided into five categories on the basis of age and audit was done. In this study the most common finding was leiomyoma (43.7% followed by adenomyosis (19.3%. Almost 50% of hysterectomies causes were justified as preoperative diagnosis matched with histopathology. Cohen kappa statistics were used to measure agreement between preoperative and postoperative histopathological diagnosis which was found to be fair with κ value being 0.36. This study highlights that regular audit of surgeries can help improve quality of health care services and provide safe conservative option to patients.

  20. 42 CFR 50.207 - Sterilization by hysterectomy.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Sterilization by hysterectomy. 50.207 Section 50.207 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS POLICIES OF GENERAL APPLICABILITY Sterilization of Persons in Federally Assisted Family Planning Projects § 50.207...

  1. The Impact of Individual Surgeon Volume on Hysterectomy Costs

    Science.gov (United States)

    Shepherd, Jonathan P.; Kantartzis, Kelly L.; Lee, Ted; Bonidie, Michael J.

    2017-01-01

    Background and Objective: Hysterectomy is one of the most common surgical procedures women will undergo in their lifetime. Several factors affect surgical outcomes. It has been suggested that high-volume surgeons favorably affect outcomes and hospital cost. The objective is to determine the impact of individual surgeon volume on total hospital costs for hysterectomy. Methods: This is a retrospective cohort of women undergoing hysterectomy for benign indications from 2011 to 2013 at 10 hospitals within the University of Pittsburgh Medical Center System. Cases that included concomitant procedures were excluded. Costs by surgeon volume were analyzed by tertile group and with linear regression. Results: We studied 5,961 hysterectomies performed by 257 surgeons: 41.5% laparoscopic, 27.9% abdominal, 18.3% vaginal, and 12.3% robotic. Surgeons performed 1–542 cases (median = 4, IQR = 1–24). Surgeons were separated into equal tertiles by case volume: low (1–2 cases; median total cost, $4,349.02; 95% confidence interval [CI] [$3,903.54–$4,845.34]), medium (3–15 cases; median total cost, $2,807.90; 95% CI [$2,693.71–$2,926.93]) and high (>15 cases, median total cost $2,935.12, 95% CI [$2,916.31–$2,981.91]). ANOVA analysis showed a significant decrease (P < .001) in cost from low-to-medium– and low-to-high–volume surgeons. Linear regression showed a significant linear relationship (P < .001), with a $1.15 cost reduction per case with each additional hysterectomy. Thus, if a surgeon performed 100 cases, costs were $115 less per case (100 × $1.15), for a total savings of $11,500.00 (100 × $115). Conclusion: Overall, in our models, costs decreased as surgeon volume increased. Low-volume surgeons had significantly higher costs than both medium- and high-volume surgeons.

  2. Robotic assisted hysterectomy in obese patients: a systematic review.

    Science.gov (United States)

    Iavazzo, Christos; Gkegkes, Ioannis D

    2016-06-01

    Robotic hysterectomy is an alternative approach to the management of female genital tract pathology. A systematic literature review was performed to evaluate the till now available literature evidence on robotic assisted hysterectomy in obese and morbidly obese patients. In total, robotic assisted hysterectomy was performed on 2769 patients. The most frequent indication for robotic hysterectomy was endometrial carcinoma (1832 out of 2769 patients, 66.2 %). Hypertension, diabetes mellitus, obstructive sleep apnea, chronic obstructive pulmonary disease and venous thromboembolism were the most common comorbidities reported. The conversion rate to laparotomy was 92 out of 2226 patients (4.1 %). The most frequent intraoperative complications for robotic hysterectomy were gastrointestinal injury (17 out of 2769 patients, 0.6 %), haemorrhage (five out of 2769 patients, 0.2 %) and bladder injury (five out of 2769 patients, 0.2 %). Wound infections/dehiscence (66 out of 2769 patients, 2.4 %), fever (56 out of 2769 patients, 2 %), pulmonary complications (55 out of 2769 patients, 1.9 %), urogenital complications (36 out of 2769 patients, 1.3 %) and postoperative ileus (28 out of 2769 patients, 1 %) were the most common postoperative complications. Death was reported in three out of 2769 patients (0.1 %). The ICU admitted patients were eight of 2226 patients (0.4 %). The robotic technique, especially in obese, can optimize the surgical approach and recovery of such patients with equally if not better outcomes compared to open and/or laparoscopic techniques.

  3. Effect of extreme obesity on outcomes in laparoscopic hysterectomy.

    Science.gov (United States)

    Siedhoff, Matthew T; Carey, Erin T; Findley, Austin D; Riggins, Lauren E; Garrett, Joanne M; Steege, John F

    2012-01-01

    To estimate the effect of body mass index (BMI) on several outcomes in laparoscopic hysterectomy, in particular in the extremes of obesity. Retrospective cohort study (Canadian Task Force classification II-3). Tertiary-care university-based teaching hospital. Eight hundred thirty-four patients who underwent laparoscopic hysterectomy from January 2007 to October 2011. Laparoscopic hysterectomy for benign indications. Demographic, operative, and postoperative data were abstracted from medical records. The primary outcome was a composite index score that took into account operative time, nonsurgical operating room time, estimated blood loss, length of hospital stay, number of complications, and severity of complications according to the Dindo-Clavien classification. We individually examined elements of the composite index as a secondary outcome. Models were developed to assess the association of BMI with the composite index score and the components of the index, controlling for age, presence of diabetes, tobacco use, surgeon, type of hysterectomy (total vs supracervical), use of robotics, uterine weight, number of additional procedures performed, presence of adhesions requiring lysis, and deeply infiltrating endometriosis as potential confounders. Mean (SD) BMI was 31.4 (8.1). Mean (SD) uterine weight was 345 (388) g. Mean operative time was 150 (61) minutes. Increasing BMI was associated with a worse composite score (p laparoscopic hysterectomy, and the effect is most pronounced in the morbidly obese. These patients may stand to gain the greatest differential benefit from a laparoscopic approach to surgery. However, they should be properly counseled about the challenge that obesity poses to the operation. Copyright © 2012 AAGL. Published by Elsevier Inc. All rights reserved.

  4. 化疗前血红蛋白及血小板水平对子宫颈癌新辅助化疗后手术患者化疗疗效及预后的影响%Effects of pre-chemotherapy hemoglobin and platelet levels in patients with stage Ⅰ b2 - Ⅱ b cervical cancer treated with neoadjuvant chemotherapy followed by radical hysterectomy

    Institute of Scientific and Technical Information of China (English)

    王丹; 吴鸣; 任彤; 万希润; 冯凤芝; 黄惠芳; 杨佳欣; 沈铿; 向阳

    2012-01-01

    论 对于接受新辅助化疗后手术治疗的宫颈癌患者,化疗前血红蛋白及血小板水平与化疗疗效无明显相关性,也不能作为独立预后因素.%Objective To investigate the role of pre-chemotherapy hemoglobin and platelet levels in the effect of chemotherapy and prognostic outcome in patients with International Federation of Gynecology and Obstetrics(FIGO) stage Ⅰ b2 - Ⅱb cervical cancer treated with neoadjuvant chemotherapy followed by radical hysterectomy.Methods From January 1999 to December 2010,111 patients with FIGO stage Ⅰ b2 - Ⅱ b who underwent chemosurgical treatment at the department of obstetrics and gynecology in Peking Union Medical College Hospital were reviewed.The median age of patients was 42 years (range:21 -68 years).The median level of prechemotherapy hemoglobin and platelet levels was 127 g/L and 266 ×109/L,respectively.Chemotherapy response was evaluated according to the WHO criteria,including complete response (CR),partial response (PR),arable disease (SD) and progressive disease (PD).Patients who achieved CR or PR were defined as responder.Rates of clinical response were compared with the clinicalpathological variables using chi-square test.Multiple logistic regression was carried out to evaluate the relationship among the probability of achieving an optimal clinical response and the variables.The log-rank test was used to compare the homogeneity of progression-free survival and overall survival functions across strata defined by categories of prognostic variables.The Cox proportional hazard model was used to assess the significance of potential prognostic factors for progression-free survival and overall survival.Results All patients received one to three cycles of chemotherapy.After the neoadjuvant chemotherapy,9 patients achieved CR,77 patients PR,23 patients SD, 2 patients PD.The overall response rate was 77.5%(86/111).By univariate analysis,the clinical response rate was associated with tumor grade( P

  5. Comparison of vaginal hysterectomy and laparoscopically assisted vaginal hysterectomy in women with benign uterine disease: a retrospective study

    Directory of Open Access Journals (Sweden)

    Sathiyakala Rajendran

    2016-11-01

    Conclusions: This study shows lesser operative time in VH group when compared to LAVH group and there is no added advantage in performing LAVH other than shorter hospital stay. Hence it is concluded that whenever feasible VH should be the preferred route of hysterectomy. [Int J Reprod Contracept Obstet Gynecol 2016; 5(11.000: 3915-3918

  6. Pelvic organ prolapse (POP) surgery among Danish women hysterectomized for benign conditions: age at hysterectomy, age at subsequent POP operation, and risk of POP after hysterectomy.

    Science.gov (United States)

    Lykke, Rune; Blaakær, Jan; Ottesen, Bent; Gimbel, Helga

    2015-04-01

    The aim of this study was to describe the incidence of pelvic organ prolapse (POP) surgery after hysterectomy from 1977 to 2009, the time interval from hysterectomy to POP surgery, and age characteristics of women undergoing POP surgery after hysterectomy and to estimate the risk of undergoing POP surgery after hysterectomy. The study was a population-based registry study. Patient data from 154,882 women hysterectomized for benign conditions in the period from 1977 to 2009 were extracted from the Danish National Patient Registry. Patients were followed up from hysterectomy to POP surgery, death/emigration, or end of study period. An estimate of the hazard of undergoing POP surgery following hysterectomy was calculated. Survival analysis was performed using the Kaplan-Meier product limit method. The frequency of POP surgery on hysterectomized women was high the first 2 years of the follow-up period with almost 800 women operated yearly. More than one third (n = 2,872) of all women operated for POP were operated less than 5 years after the hysterectomy with a median of 8.6 years. The cumulated incidence of POP surgery after hysterectomy with follow-up of up to 32 years was 12 %; 50 % (n = 5,451) of all POP surgeries were in the posterior compartment. The mean age of women undergoing a first POP surgery after hysterectomy was 60 years. POP after hysterectomy occurs as a long-term complication of hysterectomy; 12 % of hysterectomized women were operated for POP. They were operated at younger age than non-hysterectomized women and half the POP operations were performed in the posterior compartment.

  7. Radical prostatectomy

    DEFF Research Database (Denmark)

    Fode, Mikkel; Sønksen, Jens; Jakobsen, Henrik

    2014-01-01

    OBJECTIVE: The aim of this study was to compare oncological and functional outcomes between robot-assisted laparoscopic radical prostatectomy (RALP) and retropubic radical prostatectomy (RRP) during the initial phase with RALP at a large university hospital. MATERIAL AND METHODS: Patient and tumour...... surgery and at follow-up and they were asked to report their use of pads/diapers. Potency was defined as an IIEF-5 score of at least 17 with or without phosphodiesterase-5 inhibitors. Patients using up to one pad daily for security reasons only were considered continent. Positive surgical margins, blood...... loss and functional outcomes were compared between groups. RESULTS: Overall, 453 patients were treated with RRP and 585 with RALP. On multivariate logistic regression analyses, the type of surgery did not affect surgical margins (p = 0.96) or potency at 12 months (p = 0.7). Patients who had undergone...

  8. Laparoscopic Repair of Vaginal Evisceration after Abdominal Hysterectomy for Uterine Corpus Cancer: A Case Report and Literature Review.

    Science.gov (United States)

    Matsuhashi, Tomohiko; Nakanishi, Kazuho; Hamano, Eri; Kamoi, Seiryu; Takeshita, Toshiyuki

    2017-01-01

    Vaginal cuff dehiscence is a rare but serious complication that can develop after hysterectomy. Emergent surgical intervention is required for vaginal cuff dehiscence due to the potential subsequent vaginal evisceration, which may lead to necrosis of the small bowel. A 62-year-old nulliparous woman with a 30-year history of smoking, diabetes mellitus, and rheumatoid arthritis (treated with oral steroids) presented with a vaginal cuff dehiscence. Thirty-eight days before the admission, she had undergone a radical operation including total abdominal hysterectomy for uterine corpus cancer at another hospital. We performed emergent laparoscopic surgery to reduce the prolapsed small bowel into the abdominal cavity and repaired the vaginal cuff with a two-layer continuous closure using absorbable barbed sutures. The patient experienced no postoperative complications, and no recurrence of the vaginal cuff dehiscence occurred. Vaginal cuff dehiscence and evisceration can be surgically managed using an abdominal, vaginal, or laparoscopic approach, and the choice of method should be based on patient characteristics and the surgeon's skills. Laparoscopic vaginal cuff repair with a two-layer continuous closure using absorbable barbed sutures is a minimally invasive technique that is safe and effective for medically stable patients with no small bowel injury or vascular compromise and no pelvic abscess.

  9. Lower urinary tract symptoms after total and subtotal hysterectomy

    DEFF Research Database (Denmark)

    Gimbel, Helga; Zobbe, Vibeke; Andersen, Birthe Jakobsen

    2005-01-01

    with stress and urinary incontinence in the TAH group. No other differences were found between the two operation methods. The number of women with urinary incontinence and frequency was reduced from study entry for follow-up, while double/triple voiding was increased. Incontinent women had significantly lower......The aim of this Danish multicenter trial was to compare the proportion of women with lower urinary tract symptoms after total abdominal hysterectomy (TAH) and subtotal abdominal hysterectomy (SAH) for benign uterine disorders. A total of 319 women were randomized to TAH (n = 158) or SAH (n = 161......). Women were followed up for 1 year by strict data collection procedures, including postal questionnaires. Results were analyzed by intention-to-treat analyses. Urinary incontinence was found less often among TAH women than among SAH women. This was due to a larger reduction of the number of women...

  10. Elective cesarean hysterectomy for treatment of cervical neoplasia. An update.

    Science.gov (United States)

    Hoffman, M S; Roberts, W S; Fiorica, J V; Angel, J L; Finan, M A; Cavanagh, D

    1993-03-01

    From January 1, 1979, to March 31, 1991, 37 patients underwent elective cesarean hysterectomy for early cervical neoplasia. Thirty-four patients had cervical intraepithelial neoplasia III, and three patients had stage IA-1 squamous cell carcinoma of the cervix. Twenty-eight were primary cesarean sections; nine had obstetric indications. The mean operative time was 128 minutes; mean estimated blood loss was 1,400 mL. One patient experienced an intraoperative hemorrhage (3,500 mL). There were no other recognized intraoperative complications. Four significant postoperative complications included a vaginal cuff abscess, a wound dehiscence and pelvic abscess, one patient with febrile morbidity and an ileus and ligation with partial transection of a ureter. Patients were discharged on a mean of postoperative day 5.7. Although significant complications occurred, we believe that the noncompliant nature of our patient population justifies elective cesarean hysterectomy for treatment of cervical neoplasia.

  11. Clinical study of emergency peripartum hysterectomy for postpartum hemorrhage

    Directory of Open Access Journals (Sweden)

    Amudha S.

    2016-04-01

    Conclusions: PPH is unpredictable in onset, duration and etiology and it remains a major life threatening complication of any delivery. The most common causes of hemorrhage in these women are placental abnormalities and uterine atony. When conservative treatment is not feasible or has failed, prompt peripartum hysterectomy is performed failing which the delay would contribute to the maternal morbidity and mortality. [Int J Reprod Contracept Obstet Gynecol 2016; 5(4.000: 1171-1173

  12. [En block hysterectomy. Institutional experience of 6 years].

    Science.gov (United States)

    Bonfante Ramírez, E; Bolaños Ancona, R; Ambas Argüelles, M; Juárez García, L; Castelazo Morales, E

    1997-06-01

    On block hysterectomy is defined as the removal of the gravid uterus with its gestational content in situ. The described indications for the realization of this procedure are neoplastic process as the most frequent cause; septic process, persistent trophoblastic diseases, and hemorrhage due to anomalous placentation. This is a retrospective, descriptive study of twelve cases of on block hysterectomy collected from January 1989 to December 1994 at Instituto Nacional de Perinatología. An average age of 33.4 years was found. The number of pregnancies for this patients in average was found to be 4.1. The gestational age was established between 9 to 29 weeks. Four patients with a 4 or more previous miscarriage background. There were two reported cases having a multiple gestation. Among the complications found, there were three cases of hipovolemic shock and one with abcess of vaginal cupula. The average days of hospitalization was 5.3 days. We found no mortality at all in this study, and the histopathologic correlation accorded in 100% of the cases. In this five year review, 12 cases of on block hysterectomy were found, being the most frequent reason for it's realization the persistent trophoblastic diseases; severe hemorrhage in second place, and serious infection process in third. The observed complications were derived from the hemodynamic compromise of each patient. Even though on block hysterectomy is one rarely seen procedure, it most be in mind as an alternative therapeutical instance it most be carried out in third level institutions, with technology and human resources capable of solving any complication derived from this kind of surgery.

  13. Influence of alcohol intake on postoperative morbidity after hysterectomy

    DEFF Research Database (Denmark)

    Felding, C; Jensen, L M; Tønnesen, H

    1992-01-01

    Postoperative morbidity after hysterectomy was prospectively studied in 229 consecutive patients in our departments. The incidence of alcohol abuse (greater than 60 gm of alcohol daily) and social drinking (between 25 and 60 gm of alcohol daily) was 6.5% for each. When compared with the social...... drinkers and the control group, the alcohol abuse group had significantly more complications (80% vs 27% and 80% vs 13%, respectively)....

  14. Danish gynecologists' opinion about hysterectomy on benign indication: results of a survey

    DEFF Research Database (Denmark)

    Gimbel, Helga; Ottesen, Bent; Tabor, Ann

    2002-01-01

    WAS: 73%. For women aged > or = 50 years meno-metrorrhagia and symptomatic fibroids seemed to be important for hysterectomy recommendations, and for those aged pelvic pain seemed important for recommendation of other treatments. Employment, gender...... of postmenopausal metrorrhagia, while disagreement was found in cases of asymptomatic leiomyomas and unexplained pelvic pain. The gynecologists preferred the abdominal route and the subtotal hysterectomy method. Certain attributes of the gynecologists were found to be important to the recommendation of hysterectomy...

  15. Analysis of Risk Factors for Post-Hysterectomy Vaginal Vault Prolapse

    Directory of Open Access Journals (Sweden)

    Mahmut Kuntay kuntay Kokanali

    2015-03-01

    Conclusions: Vault prolapse after hysterectomy is a relatively rare complication. Elderly age, obesity, chronic obstructive lung diseases, prior genital prolapse sugery, vaginal hysterectomy, genital prolapse as indication of hysterectomy and the number of vaginal delivery and #8805;2 increase vault prolapse risk. Identification of these risk factors is important to prevent this complication. [Cukurova Med J 2015; 40(1.000: 63-71

  16. EMERGENCY PERIPARTUM HYSTERECTOMY AT A TERTIARY CARE HOSPITAL IN KASHMIR VALLEY

    Directory of Open Access Journals (Sweden)

    Sameena

    2015-01-01

    Full Text Available OBJECTIVE: To determine the incidence , indications , maternal and perinatal outcome of emergency peripartum hysterectomy. METHOD: A prospective observational study of all patients who underwent peripartum hysterectomy was conducted from June 2011 to November 2012 in the Department of Obstetrics and Gynecology , Lalla Ded Hospital , an associated hospital of Government Medical College , Srinagar , Kashmir. Data , specifically on the incidence of emergency peripartum hysterectomy , the total number of deliveries , the maternal parameters , the indications of peripartum hysterectomy and associated maternal morbidity and mortality were recorded on a proforma. RESULTS: There were 87 cases of peripartum hysterectom y ( 75 caesarean hysterectomies , 86.2% and 12 postpartum hysterectomies , 13.8% , making an incidence of 2.56/1000 deliveries. Most of the patients were para 3 , 32 ( 36.8% , were mostly in age group of 35 - 39 years 38 ( 43.7% and belonged to rural areas . Overa ll , the most common indication for emergency peripartum hysterectomy was morbidly adherent placenta with placenta previa 39( 44.8% followed by uterine rupture 24 ( 27.6 % , uterine atony 13 (14.9% and accidental haemorrhage 6 (6.9%. In 38 (43.7% patients total abdominal hysterectomy was performed while 49 (56.3% patients required subtotal hysterectomy. There were 9 (10.3% maternal and 40 (46% perinatal deaths; all were due to severity of conditions necessitating hysterectomy. CONCLUSION: Emergency perip artum hysterectomy is potentially a lifesaving procedure associated with significant maternal morbidity and mortality. Morbidly adherent placenta with placenta previa was the commonest indication for emergency peripartum hysterectomy. Previous scar , multip arity and abnormal placentation were the significant risk factors.

  17. Hematuria at laparoscopic hysterectomy: a 9-year review at Sydney West Advanced Pelvic Surgery, Australia.

    Science.gov (United States)

    Wilson, Matthew; Merkur, Harry

    2008-01-01

    The aim of this study was to estimate the prevalence and significance of hematuria during laparoscopic hysterectomy for benign uterine disease. The review assessed its incidence, risk factors, site of associated urinary tract injuries, methods of diagnosis, management strategies, and most likely intraoperative point at which hematuria occurred during laparoscopic hysterectomies. A retrospective review of 755 cases of laparoscopic-assisted and total laparoscopic hysterectomies from January 1998 through December 2006 was undertaken at Sydney West Advanced Pelvic Surgery, Sydney, Australia.

  18. Total laparoscopic hysterectomy in obese and morbidly obese women.

    Science.gov (United States)

    Guraslan, Hakan; Senturk, Mehmet Baki; Dogan, Keziban; Guraslan, Birgul; Babaoglu, Bulent; Yasar, Levent

    2015-01-01

    The study aimed at estimating the effect of body mass index (BMI), used to classify non-obese, obese, and morbidly obese patients, on clinical outcomes in total laparoscopic hysterectomy (TLH) cases. This retrospective cohort study included 153 patients who underwent TLH for benign, premalignant, or malignant conditions between August 2010 and June 2013. Patients were divided into 3 groups according to BMI, and the following variables were analyzed: operation time, conversion rate, blood loss, total complications, and length of hospital stay. The mean BMI was 33.5 kg/m(2) (range, 22-61). Forty-four patients were non-obese (BMI obese (30≤ BMI obese (BMI ≥40). In 138 patients (90.2%), hysterectomy was performed using an endoscopic technique. The rate of conversion to laparotomy (9.8%; 95% confidence interval (CI), 5.1-14.5), blood loss (70.5 ml; range, 10-700), total complications (5.9%), and length of hospital stay (2.9 d; range, 1-8) did not vary according to BMI. Operation time was longer in obese (p = 0.003) and morbidly obese (0.002) patients than in non-obese patients. TLH could be considered a safe and feasible alternative to abdominal hysterectomy in obese and morbidly obese patients. © 2015 S. Karger AG, Basel.

  19. Effect of obesity on perioperative outcomes of laparoscopic hysterectomy.

    Science.gov (United States)

    Harmanli, Oz; Esin, Sertac; Knee, Alexander; Jones, Keisha; Ayaz, Reyhan; Tunitsky, Elena

    2013-01-01

    To compare the effect of obesity on perioperative outcomes in women undergoing laparoscopic hysterectomy. In this retrospective cohort study, perioperative outcomes of all women who underwent laparoscopic supracervical hysterectomy (LSH) or total laparoscopic hysterectomy (TLH) for benign conditions were compared between obese (body mass index > or = 30 kg/m2) and nonobese women. Baseline characteristics were similar between 320 (33.0%) obese and 550 (67%) nonobese women except for race and the rates of hypertension and diabetes. The adjusted rates of urinary tract injury, vaginal cuff dehiscence, postoperative fever, and ileus were similar between the groups. For obese women, however, bleeding requiring transfusion was almost 3-fold (3.1 vs. 1.1%, adjusted odds ratio [AOR] 2.93, 95% confidence interval [CI] 1.10-7.80) and laparotomy risk was approximately 2-fold (7.5 vs. 3.5%, AOR 2.35, 95% CI 1.30-4.24) increased. The rate of urinary tract injury was 3.2% when obese women had TLH, but it was 0.3% for LSH performed on nonobese women. Of all 7 cuff dehiscences, 5 (71%) occurred in nonobese women undergoing TLH. Obesity increased the risk of bleeding requiring transfusion and conversion to laparotomy but did not influence the other perioperative complications. On subgroup analysis, LSH in nonobese women seems to result in best outcomes.

  20. Neoadjuvant radiotherapy with or without chemotherapy followed by extrafascial hysterectomy for locally advanced endometrial cancer clinically extending to the cervix or parametria.

    Science.gov (United States)

    Vargo, John A; Boisen, Michelle M; Comerci, John T; Kim, Hayeon; Houser, Christopher J; Sukumvanich, Paniti; Olawaiye, Alexander B; Kelley, Joseph L; Edwards, Robert P; Huang, Marilyn; Courtney-Brooks, Madeleine; Beriwal, Sushil

    2014-11-01

    For locally-advanced uterine cancer clinically extending to the cervix, two treatment paradigms exist: surgical staging radical hysterectomy with tailored adjuvant therapy or neoadjuvant therapy followed by a less extensive simple hysterectomy. Currently, insufficient data exists to guide consensus guidelines and practical application of preoperative radiotherapy. Retrospective IRB approved cohort study from 1999 to 2014 of 36 endometrial cancer patients with clinical involvement of cervix±parametria treated with neoadjuvant external beam radiotherapy (45-50.4Gy in 25-28 fractions) and image-based HDR brachytherapy (5-5.5Gy times 3-4 fractions)±chemotherapy followed by extrafascial hysterectomy performed at a median of 6weeks after radiotherapy. All patients had clinical cervical extension, 50% also had parametria extension, and 31% had nodal involvement. At the time of surgery 91% had no clinical cervical involvement, 58% had no pathologic cervical involvement, and all had margin negative resection. The pathologic complete response rate was 24%. Median follow-up from the time of surgery was 20months (range: 0-153). The 3-year local control, regional control, distant control, disease free survival and overall survival rates were 96%, 89%, 84%, 73%, and 100%. The 3-year rate of grade 3 complications was 11%, with no grade 4+ toxicity. Neoadjuvant radiation therapy±chemotherapy followed by extrafascial hysterectomy appears to be a viable option for patients with endometrial cancer clinically extending to the cervix and parametria. The HDR brachytherapy schema of 5-5.5Gy times 3-4 fractions, for a cumulative EQD2 of 60-70Gy, is well tolerated with high rates of clinical and pathological response. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. HYSTERECTOMY IN THE PERINATAL AND POSTPARTUM PERIOD IN THE 17-YEAR CLINICAL MATERIAL

    Directory of Open Access Journals (Sweden)

    Dobrosława L. Sikora-Szczęśniak

    2013-11-01

    Full Text Available Intruduction: Hysterectomy is one of major surgeries. Pregnancy, delivery and postpartum period make the operation even more difficult as it is forced and complicated by various pathological conditions that develop over that time. Objective: The purpose of study was to analyze the frequency of hysterectomy, indications to undertake it and complications associated with the removal of the uterus in pregnancy and during perinatal and postpartum period. The study analyzed the cases of hysterectomies in perinatal and postpartum period performed over the 17-year clinical material from the Department of Gynaecology and Obstetrics, SZOZ, Lipsko in the years 1985–2001. Material and methods : The material for analysis were medical records of 15 women who developed complications in pregnancy, perinatal and postpartum period, which were absolute indication to perform hysterectomy. The following parameters were analyzed: patient’s age, number of deliveries, the way pregnancies were terminated, the way present pregnancy was terminated, complications, indications to Caesarean section and perinatal and postpartum hysterectomy, type of hysterectomy performed, other associated procedures and complications. Results : In total 15 hysterectomies were performed in the period of study which accounts for 0.10% all deliveries. The material revealed the following causes for hysterectomy: placental pathologies (46.7%, inflammatory conditions of internal sex organs (20.0%, uterine atonia after delivery (13.3%, injuries of sex organs (13.3%. Elective hysterectomy in that period was performed in one patient (6.7%. The risk factors predisposing to complications resulting in hysterectomy were history of Caesarean sections in 10 patients (66.7% and multiple spontaneous deliveries. Complications associated with hysterectomy which enforced additional operations were noted in two cases (13.3%. Total hysterectomy was performed in 8 patients (53.3% including hysterectomy with

  2. Robotic-assisted laparoscopic hysterectomy: outcomes in obese and morbidly obese patients

    National Research Council Canada - National Science Library

    Gallo, Taryn; Kashani, Shabnam; Patel, Divya A; Elsahwi, Karim; Silasi, Dan-Arin; Azodi, Masoud

    2012-01-01

    To describe patient characteristics and perioperative outcomes among women undergoing roboticassisted laparoscopic hysterectomy and to evaluate the characteristics of nonobese, obese, and morbidly obese patients...

  3. Assessment of selected perioperative parameters in patients undergoing laparoscopic and abdominal supracervical hysterectomy.

    Science.gov (United States)

    Sokołowski, Jakub; Skręt-Magierło, Joanna; Kluz, Tomasz; Barnaś, Edyta; Sobolewski, Marek; Raś, Renata; Skręt, Andrzej

    2015-12-01

    Subtotal hysterectomy is a method of treatment of patients with mild changes in the uterine body. Laparoscopic methods are increasingly used in surgical gynaecology. One of the limitations of laparoscopy is the proper level of operating surgeon's training, which may be assessed with the use of the learning curve. The aim of the study was to compare data regarding the perioperative period in patients who underwent subtotal hysterectomy with the two methods, and to establish a learning curve for laparoscopic subtotal hysterectomy. One hundred and twenty-seven patients qualified for subtotal hysterectomy due to mild disturbances in the uterine body participated in the study. The study was conducted at the Clinical Department of Gynaecology and Obstetrics of Fryderyk Chopin Provincial Specialist Hospital in Rzeszów in 2012-2013. The time of laparoscopic subtotal hysterectomy is longer than that of the classical surgical procedure. Uterine myomas are the main indication for subtotal hysterectomy. Laparoscopic operation results in lower blood loss compared to the classical surgical method. The mean age of the patients operated due to mild changes in the uterine body is similar in both groups. Patients who are obese or have undergone Caesarean sections are more frequently qualified for the classical surgery. The study revealed a reduction in time of laparoscopic subtotal hysterectomy by ca. 31 minutes (33%). Laparoscopic subtotal hysterectomy is a method chosen by operating surgeons for patients with a lower perioperative risk. The period of the study made it possible to determine a learning curve for laparoscopic subtotal hysterectomy.

  4. C.I.S.H. Laparoscopic Hysterectomy: The Experience at the "Centro Materno Infantil"

    Science.gov (United States)

    Decunto; Traverso; Gibelli; Harpe

    1994-08-01

    Laparoscopic hysterectomy has been established firmly as a surgical alternative to standard abdominal hysterectomy around the world. In Argentina, we had introduced operative laparoscopy at the Hospital Aleman in May 1993, with a major change from basic diagnostic laparoscopy to advanced operative laparoscopy. A total of 180 major laparoscopic cases have been performed from May 1993 to January 1994, including laparoscopic hysterectomies. Of our first five C.I.S.H. laparoscopic hysterectomies, all had excellent outcomes, with greatly diminished hospital stay and less usage of analgesics postoperatively. The average length of stay was 2.5 days. No major complications occurred.

  5. [Does hysterectomy modifies the anatomical and functional outcomes of prolapse surgery?: Clinical Practice Guidelines].

    Science.gov (United States)

    Cayrac, M; Warembourg, S; Le Normand, L; Fatton, B

    2016-07-01

    Provide guidelines for clinical practice concerning hysterectomy during surgical treatment of pelvic organ prolaps, with or without mesh. Systematically review of the literature concerning anatomical and functionnal results of uterine conservation or hysterectomie during surgical treatment of pelvic organ prolaps. Sacrospinous hysteropexy is as effective as vaginal hysterectomy and repair in retrospective comparative studies and in a meta-analysis with reduced operating time, blood loss and recovery time (NP2). However, in a single RCT there was a higher recurrence rate associated with sacrospinous hysteropexy compared with vaginal hysterectomy. Sacrospinous hysteropexy with mesh augmentation of the anterior compartment was as effective as hysterectomy and mesh augmentation (NP2), with no significant difference in the rate of mesh exposure between the groups (NP3). Sacral hysteropexy is as effective as sacral colpopexy and hysterectomy in anatomical outcomes; however, the sacral colpopexy and hysterectomy were associated with increase operating time and blood loss (NP1). Performing hysterectomy at sacral colpopexy was associated with a higher risk of mesh exposure compared with sacral colpopexy without hysterectomy (NP3). There is no sufficient data in the literature to affirm that the uterine conservation improve sexual function (NP3). While uterine preservation is a viable option for the surgical management of uterine prolapse the evidence on safety and efficacy is currently lacking. © 2016 Published by Elsevier Masson SAS. © 2016 Elsevier Masson SAS. Tous droits réservés.

  6. Longitudinal study of uro-gynecological morbidity and quality of life after radical hysterectomy

    DEFF Research Database (Denmark)

    Jensen, Pernille Tine

    with scores from an age-matched control group from the general population. Results: Compared with the control group, patients reported long-term pain and urological adverse effects: frequent voiding, bladder insensitivity for micturition, and burning sensation or pain during micturition for 6 to 12 months...

  7. [Laparoscopic radical hysterectomy with pelvic lymph node dissection for endometrial cancer in obese patients].

    Science.gov (United States)

    Berlev, I V; Urmancheeva, A F; Saparov, A B; Khadzhimba, A B; Nekrasova, E A

    2014-01-01

    The results of treatment of 61 endometrial cancer patients with various forms of obesity are presented. Two groups of patients were compared: the first group comprised 26 patients who had undergone the laparoscopic surgery; the second group included 35 patients who had open surgery. Te laparoscopic approach improved the results of surgical treatment of endometrial cancer in patients with obesity. This technique allowed to reduce intraoperative blood loss, to diminish the duration of analgesics' administration, to shorten the period of bowel function recovery, 3 times to reduce the incidence of postoperative complications.

  8. [Sexual functions after laparoscopically assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH) in preoperatively asymptomatic women].

    Science.gov (United States)

    Kuzel, D; Weiss, P; Kubínová, K; Masková, L; Sosna, O; Bartosová, L; Horák, P; Tóth, D; Fanta, M; Mára, M

    2009-04-01

    To find the consequences of laparoscopically assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH) for sexual functions in preoperatively asymptomatic women. Prospective study. Department of Obstetrics and Gynecology, 1st Faculty of Medicine, Charles University and General Teaching Hospital in Prague. In 100 women without subjective complaints hysterectomy was performed for benign uterine pathology. In all the women the uterus weighted less than 250 g, there were no salpingooophorectomies and no perioperative complications. Women were alternativelly assigned for LAVH (n = 50) or TLH (n = 50). Clinical documentation and questionnaires about sexual functions were evaluated in 87 women (in 40 women after LAVH and in 47 after TLH) 18 months after surgery or later. According to our findings the type of surgery did not influence the frequency of sexual activity after surgery, there was no change in sexual manners using during coitus as well as no change in preferred way how to reach the sexual arousal (clitoridally, vaginally or combined). The type of surgery did not influence frequency, quality and duration of orgasm. From all the evaluated parameters there were only two significantly different: the presence of postoperative sexual activity (positive answer in all women from LAVH group and only in 85% women from TLH group, F test, p = 0.009) and the frequency of sexual satisfaction (in terms of both increase and also decrease in TLH group chi2 8,376, p = 0.015). The type of laparoscopic hysterectomy (LAVH or TLH) does not significantly affect the sexual functions (frequency of sexual satisfaction, type of sexual arousability, intensity and duration of orgasm) in preoperatively asymptomatic women.

  9. Long-term cancer risk after hysterectomy on benign indications: Population-based cohort study.

    Science.gov (United States)

    Altman, Daniel; Yin, Li; Falconer, Henrik

    2016-06-01

    Hysterectomy on benign indications is associated with an increased risk for adverse health effects. However, little is known about the association between hysterectomy and subsequent cancer occurrence later in life. The purpose of this study was to assess the effect of hysterectomy on the incidence of cancer. In this population-based cohort study, we used data on 111,595 hysterectomized and 537,9843 nonhysterectomized women from nationwide Swedish Health Care registers including the Inpatient Register, the Cancer Register and the Cause of Death Register between 1973 and 2009. Hysterectomy with or without concomitant bilateral salpingo-ophorectomy (BSO) performed on benign indications was considered as exposure and incidence of primary cancers was used as outcome measure. Rare primary cancers (cancer was observed for women with previous hysterectomy and for those with hysterectomy and concurrent BSO (HR 0.93, 95% CI 0.91-0.95 and HR 0.92, 95% CI 0.87-0.96, respectively). Compared to nonhysterectomized women, significant risks were observed for thyroid cancer (HR 1.76, 95% CI 1.45-2.14). For both hysterectomy and hysterectomy with BSO, an association with brain cancer was observed (HR 1.48, 95% CI 1.32-1.65 and HR 1.45, 95% CI 1.15-1.83, respectively). Hysterectomy, with or without BSO, was not associated with breast, lung or gastrointestinal cancer. We conclude that hysterectomy on benign indications is associated with an increased risk for thyroid and brain cancer later in life. Further research efforts are needed to identify patient groups at risk of malignancy following hysterectomy.

  10. Factors Contributing to Massive Blood Loss on Peripartum Hysterectomy for Abnormally Invasive Placenta: Who Bleeds More?

    Directory of Open Access Journals (Sweden)

    Hironori Takahashi

    2016-01-01

    Full Text Available Introduction. To identify factors that determine blood loss during peripartum hysterectomy for abnormally invasive placenta (AIP-hysterectomy. Methods. We reviewed all of the medical charts of 11,919 deliveries in a single tertiary perinatal center. We examined characteristics of AIP-hysterectomy patients, with a single experienced obstetrician attending all AIP-hysterectomies and using the same technique. Results. AIP-hysterectomy was performed in 18 patients (0.15%: 18/11,919. Of the 18, 14 (78% had a prior cesarean section (CS history and the other 4 (22% were primiparous women. Planned AIP-hysterectomy was performed in 12/18 (67%, with the remaining 6 (33% undergoing emergent AIP-hysterectomy. Of the 6, 4 (4/6: 67% patients were primiparous women. An intra-arterial balloon was inserted in 9/18 (50%. Women with the following three factors significantly bled less in AIP-hysterectomy than its counterpart: the employment of an intra-arterial balloon (4,448±1,948 versus 8,861±3,988 mL, planned hysterectomy (5,003±2,057 versus 9,957±4,485 mL, and prior CS (5,706±2,727 versus 9,975±5,532 mL. Patients with prior CS (− bled more: this may be because these patients tended to undergo emergent surgery or attempted placental separation. Conclusion. Patients with intra-arterial balloon catheter insertion bled less on AIP-hysterectomy. Massive bleeding occurred in emergent AIP-hysterectomy without prior CS.

  11. Hysterectomy on benign indication in Denmark 1988-1998. A register based trend analysis

    DEFF Research Database (Denmark)

    Gimbel, H; Settnes, A; Tabor, A

    2001-01-01

    BACKGROUND: The aims of the study were to describe the trends in Danish hysterectomy rates from 1988 to 1998 for operations done on benign indication. METHODS: Data from all women (n=67,096) undergoing hysterectomy from 1988 to 1998 were obtained from the Danish National Patient Register. Data on...

  12. Prognosis of women with apparent stage I endometrial cancer who had supracervical hysterectomy.

    Science.gov (United States)

    Matsuo, Koji; Machida, Hiroko; Takiuchi, Tsuyoshi; Garcia-Sayre, Jocelyn; Yessaian, Annie A; Roman, Lynda D

    2017-04-01

    To examine characteristics and survival outcomes of women with apparent early-stage endometrial cancer who had a supracervical hysterectomy. The Surveillance, Epidemiology, and End Results Program was used to identify women with presumed stage I endometrial cancer who underwent supracervical hysterectomy between 1983 and 2012. Propensity score matching was performed to adjust background difference between supracervical hysterectomy (n=1,339) and total hysterectomy (n=110,523) cases. Endometrial cancer-specific survival (CSS) was examined by multivariable analysis expressed with adjusted-hazard ratio [HR] and 95% confidence interval [CI]. Supracervical hysterectomy was independently associated with younger age, low-grade disease, and small tumor size on multivariable analysis (all, Pradiotherapy, 10-year CSS rates were similar between supracervical and total hysterectomy cases (84.7% versus 80.3%, P=0.40). Contrary, in the absence of postoperative radiotherapy, women undergoing supracervical hysterectomy had a significantly lower 10-year CSS rate compared to those undergoing total hysterectomy (92.1% versus 97.2%, Pendometrial cancer supporting the importance of avoiding this procedure in women with or at risk of endometrial cancer. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Age at hysterectomy as a predictor for subsequent pelvic organ prolapse repair

    DEFF Research Database (Denmark)

    Lykke, Rune; Blaakær, Jan; Ottesen, Bent

    2016-01-01

    INTRODUCTION AND HYPOTHESIS: The aim of this study was to investigate the association between patient age at the time of hysterectomy and subsequent pelvic organ prolapse (POP) surgery. METHODS: We gathered data on all benign hysterectomies and POP surgeries performed in Denmark on Danish women...

  14. Complications after hysterectomy. A Danish population based study 1978-1983

    DEFF Research Database (Denmark)

    Andersen, T F; Loft, A; Brønnum-Hansen, Henrik

    1993-01-01

    We studied complications after hysterectomy among all women in the Danish population who had a simple hysterectomy in the period 1978-81 based on data obtained from the Danish National Hospital Registry. Among patients, with neither diagnosed cancer nor major co-surgery (n = 23,386), we identified...

  15. AGE AND CAUSES OF CANCER AND NON-CANCER HYSTERECTOMY AMONGST HINDU AND MUSLIM PATIENTS

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    V Kashyap

    2013-08-01

    Full Text Available Background: Hysterectomy is the second most common surgical procedure in women other than cesarean delivery but there is relatively little information about its causes in relation to religions. Objective: To find out the causes of hysterectomy in relation to age and parity amongst Hindu and Muslim patients Methods: 1000 records of the patients, who underwent cancer hysterectomy due to cervical cancer or non-cancer hysterectomy for benign conditions of the uterus in past years of their life, were analyzed. All patients were from the same hospital and recently visited the hospital for follow-up checkup through Pap smear. Chi square test was employed to test the association. Results: Amongst 1000 hysterectomies 570 (57% were for carcinoma cervix and 430 (43% for benign conditions of uterus. 485 (85% cancer cases were Hindu and 85(15% were Muslim, however 310 (72% cases of benign uterine conditions were Hindu in comparison to 120 (28% Muslim. Majority of hysterectomy cases of both the religions belonged to age group of 41-50 yrs., however, the association between the age groups and benign uterine conditions (Uterine fibroids Vs. Others was observed highly significant in Hindu patients only. Conclusion: The study revealed that fifth decade (41-50 yrs of life of women was found prevalent for hysterectomy in both the religions, however carcinoma cervix was more common in Hindu patients. Prolapse uterus and Pelvic Inflammatory disease were comparable high for non-cancer hysterectomy in Muslim patients.

  16. [A review of 445 cases of laparoscopic hysterectomy: benefits and outcome].

    Science.gov (United States)

    Malzoni, M; Perniola, G; Hannuna, K; Iuele, T; Fruscella, M L; Basili, R; Ebano, V; Marziani, R

    2004-01-01

    Hysterectomy is a major procedure indicated for women with gynaecologic pathologies. After reporting the first laparoscopic hysterectomy (Reich 1989), this technique has recently been considered as a safe and efficient alternative to traditional abdominal hysterectomy in the management of benign uterine pathologies when vaginal route is contraindicated. The laparoscopic approach should not be held to compete with vaginal hysterectomy. From 1995 to 2001 in our institute, the proportion of laparoscopic hysterectomy has increased and laparotomic hysterectomy has decreased. Between January 1999 and January 2001 we carried out 445 total laparoscopic hysterectomies. There were 5 laparotomy conversions for large uterus. The average haemoglobin drop was 1,36 g/dl. Median operative time was 95 +/- 27 min. The mean in postoperative stay was 2.7 +/- 0.8 gg. The postoperative complications were minimal. Laparoscopic approach is less painful, is associated to less blood loss, shorter hospital stay, more rapid recovery and a better assumption by affected women. Some disadvantages are reported too, such as larger operating time, high rate of complication and experience required for performing laparoscopy including a learning curve. A training period is necessary to standardize the operating procedure, to put in place methods of avoiding complication and to reach a plateau of surgical skill. The purpose of this study was to show the role of total laparoscopic hysterectomy and how it can be performed safely with a minimal morbidity after a period of training in which we worked out shrewdness to get a standardized technique with the most effective outcome.

  17. The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy.

    LENUS (Irish Health Repository)

    Carney, John

    2008-12-01

    Patients undergoing total abdominal hysterectomy suffer significant postoperative pain. The transversus abdominis plane (TAP) block is a recently described approach to providing analgesia to the anterior abdominal wall. We evaluated the analgesic efficacy of the TAP block in patients undergoing total abdominal hysterectomy via a transverse lower abdominal wall incision, in a randomized, controlled, double-blind clinical trial.

  18. Cost-analysis of robotic-assisted laparoscopic hysterectomy versus total abdominal hysterectomy for women with endometrial cancer and atypical complex hyperplasia

    DEFF Research Database (Denmark)

    Herling, Suzanne Forsyth; Palle, Connie; Møller, Ann M

    2016-01-01

    INTRODUCTION: The aim of this study was to analyse the hospital cost of treatment with robotic-assisted laparoscopic hysterectomy and total abdominal hysterectomy for women with endometrial cancer or atypical complex hyperplasia and to identify differences in resource use and cost. MATERIAL...... AND METHODS: This cost analysis was based on two cohorts: women treated with robotic-assisted laparoscopic hysterectomy (n = 202) or with total abdominal hysterectomy (n = 158) at Copenhagen University Hospital, Herlev, Denmark. We conducted an activity-based cost analysis including consumables and healthcare...... professionals' salaries. As cost-drivers we included severe complications, duration of surgery, anesthesia and stay at the post-anesthetic care unit, as well as number of hospital bed-days. Ordinary least-squares regression was used to explore the cost variation. The primary outcome was cost difference...

  19. Optimization of subarachanoid block by oral pregabalin for hysterectomy

    Directory of Open Access Journals (Sweden)

    Monica Kohli

    2011-01-01

    Full Text Available Background: 80% of patients undergoing surgical procedures experience postoperative pain 1 and requires adequate pain relief. Nowadays drugs like COX2 inhibitors and calcium channel modulators (Pregabalin and Gabapentin are been increasingly used for postoperative pain management effectively. We conducted this study to find whether preoperative pregabalin has any effect in postoperative analgesic requirement in patients undergoing hysterectomy under spinal anaesthesia. Patients & Methods: This randomized, double-blind, placebo-controlled trial was conducted in 150 patients undergoing hysterectomy under spinal anaesthesia, divided in three groups - Group I (PO - Control group, Group II (P150 received 150 mg pregabalin and Group III (P300 received 300 mg pregabalin. We used VAS for anxiety, Ramsay sedation scale and VAS for patient satisfaction regarding pain relief. Results: There was significant reduction in anxiety in groups P (150 and P (300 than placebo group P (0 during intraoperative and postoperative period than preoperative period. There was significant sedation seen in groups P (150 and P (300 than placebo group P (0. First rescue analgesia in group P (300 was202.42±6.77 and in group P (150 was176.38±4.80on average, group P (0 was131.38±5.15. Dizziness was 44.44% in group P (300, 36.11% in group P (150, and 19.44% in group P (0. Patient satisfaction was better in P (300 group than other two groups. Conclusions: Pregabalin being an oral drug which would be easy for the patients to take and also its prolongation of the neuraxial block helps in immediate postoperative analgesia and further reduction of other parentral analgesics. Pregabalin 150mg would be the optimal preemptive dose for hysterectomy under spinal anaesthesia.

  20. [Is a hysterectomy justifiable to prevent post-tubal ligation syndrome?].

    Science.gov (United States)

    Maheux, R; Fugère, P

    1980-12-01

    Among 2057 tubal ligations performed between 1971-75 in "Hopital Saint-Luc" in Montreal, 78 patients had to be readmitted for hysterectomy. The main indication for hysterectomy among these patients was for menstrual disorders (65%). These menstrual disorders were present at the moment of the tubal ligation in about half of the patients. Among the patients who had to be reoperated for hysterectomy for menstrual disorders and who were asymptomatic at the momemt of their tubal ligation, 88% were using oral contraceptives for a mean period of 5.8 years. The low incidence of hysterectomy post-tubal ligation (3.8%) does not seem to justify a total hysterectomy to prevent what has been described as the "post tubal ligation syndrome" in the patients who are asymptomatic and desire a permanent sterilization. (Author's modified)

  1. Single port robotic hysterectomy technique improving on multiport procedure

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    John R Lue

    2012-01-01

    Full Text Available The benefits of laparoscopic surgery over conventional abdominal surgery have been well documented. Reducing postoperative pain, decreasing postoperative morbidity, hospital stay duration, and postoperative recovery time have all been demonstrated in recent peer-review literature. Robotic laparoscopy provides the added dimension of increased fine mobility and surgical control. With new single port surgical techniques, we have the added benefit of minimally invasive surgery and greater patient aesthetic satisfaction, as well as all the other benefits laparoscopic surgery offers. In this paper, we report a successful single port robotic hysterectomy and the simple process by which this technique is performed.

  2. Hysterectomy in a Danish cohort. Prevalence, incidence and socio-demographic characteristics.

    Science.gov (United States)

    Settnes, A; Jorgensen, T

    1996-03-01

    The aim has been to assess the frequency of hysterectomy in relation to sociodemographic characteristics. A cross-sectional survey of 2,403 women selected at random from the population in the western part of Copenhagen County. One thousand seven hundred and sixty-five Danish women (77%) filled in the questionnaire and took part in the interview. The cohort was followed for eight years through central registers to assess the incidence of hysterectomy. Logistic and Cox regression were used as main statistics. Life time prevalence of hysterectomy was 10.4%. In the prevalence study, hysterectomy on benign diagnoses (85%) was related to short schooling, lack of vocational education, and low social status personally as well as regards the family. In the multivariate analyses school education, vocational education, and ascending social status by marriage were independent explanatory variables. In the incidence study, the crude rate of hysterectomy on benign diagnoses was 3.4 pr. 1000 years, with the 40-year-old women having the highest rate (7.8 pr. 1000 years). Risk factors as regards hysterectomy due to bleeding disorders and uterine fibroids at ages unemployment and lack of vocational education, only the latter reached significant level in the multivariate analysis. There are social inequalities regarding premenopausal hysterectomy on benign diagnoses, but the social-demographic indicators of interest have changed through the last decades. Short schooling and lack of social mobility by marriage were only associated with the hysterectomies performed before 1982, whereas lack of vocational education was related to hysterectomy independent of the calendar period involved. A woman without education has a relative risk of 2.2 (1.1-4.4) for hysterectomy compared to an educated woman.

  3. Ignorance Radicalized

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    Gergo Somodi

    2009-12-01

    Full Text Available The aim of this paper is twofold. I criticize Michael Devitt's linguistic---as opposed to Chomsky's psychological---conception of linguistics on the one hand, and I modify his related view on linguistic intuitions on the other. I argue that Devitt's argument for the linguistic conception is in conflict with one of the main theses of that very conception, according to which linguistics should be about physical sentence tokens of a given language rather than about the psychologically real competence of native speakers. The basis of this conflict is that Devitt's view on language, as I will show, inherits too much from the criticized Chomskian view. This is also the basis of Devitt's strange claim that it is the linguist, and not the ordinary speaker, whose linguistic intuition should have an evidential role in linguistics. I will argue for the opposite by sketching a view on language that is more appropriate to the linguistic conception. That is, in criticizing Devitt, I am not defending the Chomskian approach. My aim is to radicalize Devitt's claims.

  4. Terrorism, radicalization, and de-radicalization

    NARCIS (Netherlands)

    Doosje, B.; Moghaddam, F.M.; Kruglanski, A.W.; de Wolf, A.; Mann, L.; Feddes, A.R.

    2016-01-01

    In this article, we review the literature and present a model of radicalization and de-radicalization. In this model, we distinguish three phases in radicalization: (1) a sensitivity phase, (2) a group membership phase and (3) an action phase. We describe the micro-level, meso-level and macro-level

  5. [Has ketamine preemptive analgesic effect in patients undergoing abdominal hysterectomy?].

    Science.gov (United States)

    Karaman, Semra; Kocabaş, Seden; Zincircioğlu, Ciler; Firat, Vicdan

    2006-07-01

    The aim of this study was to determine if preemptive use of the NMDA receptor antogonist ketamine decreases postoperative pain in patients undergoing abdominal hystrectomy. A total of 60 patients admitted for total abdominal hysterectomy were included in this study after the approval of the ethic committee, and the patients were randomly classified into three groups. After standart general anaesthesia, before or after incision patients received bolus saline or ketamine. Group S received only saline while Group Kpre received ketamine 0.4 mg/kg before incision and saline after incision, and Group Kpost received saline before incision and 0.4 mg/kg ketamine after incision. Postoperatif analgesia was maintained with i.v. PCA morphine. Pain scores were assessed with Vizüal Analog Scale (VAS), Verbal Rating Scale (VRS) at 1., 2, 3., 4., 8., 12. ve 24. hours postoperatively. First analgesic requirement time, morphine consumption and side effects were recorded. There were no significant differences between groups with respect to VAS / VRS scores, the time for first analgesic dose, and morphine consumption ( p>0.05). Patients in Group S had significantly lower sedation scores than either of the ketamine treated groups ( pketamin had no preemptive analgesic effect in patients undergoing abdominal hysterectomy, but further investigation is needed for different operation types and dose regimens.

  6. Association Between Body Mass Index, Uterine Size, and Operative Morbidity in Women Undergoing Minimally Invasive Hysterectomy.

    Science.gov (United States)

    Shah, Divya K; Van Voorhis, Bradley J; Vitonis, Allison F; Missmer, Stacey A

    Although the selection of an approach to minimally invasive hysterectomy is relatively straightforward in an ideal patient scenario, it is more difficult in patients who pose operative challenges such as high body mass index (BMI) and enlarged uteri. The objective of this study was to explore the association between surgical approach and operative morbidity after minimally invasive hysterectomy and examine whether the association varies based on patient BMI and uterine size. Retrospective cohort (Canadian Task Force classification II-2). Data abstracted from the American College of Surgeons National Safety and Quality Improvement Project registry. Thirty-six thousand seven hundred fifty-seven women undergoing vaginal, laparoscopic-assisted vaginal, or total laparoscopic hysterectomy for benign indications between January 2005 and December 2012. Associations between surgical approach, BMI, and operative morbidity were examined, stratifying by uterine size (250 g) and adjusting for covariates. Adjusted means, rate ratios, or odds ratios with 95% confidence intervals (CI) were calculated using linear, Poisson, or logistic regression. Operative times were shortest in women undergoing vaginal hysterectomy regardless of BMI or uterine size (all p hysterectomy; increasing BMI had a minimal impact on operative time with small uteri 250 g. Compared with vaginal hysterectomy, total laparoscopic hysterectomy had lower odds of blood transfusion (all p obese women with small uteri; women with uteri 40 kg/m(2) had 76% lower odds of blood transfusion (95% CI, 0.10-0.54) and 18% shorter hospitalization (95% CI, 0.75-0.90) after laparoscopic hysterectomy compared with vaginal hysterectomy. Major operative morbidity after minimally invasive hysterectomy is rare regardless of the surgical approach. A vaginal approach to hysterectomy is associated with the shortest operative times, but increasing BMI results in a rapid escalation of operative time in women with large uteri

  7. Cesarean section and the risk of emergency peripartum hysterectomy in high-income countries: a systematic review.

    Science.gov (United States)

    de la Cruz, Cara Z; Thompson, Erika L; O'Rourke, Kathleen; Nembhard, Wendy N

    2015-12-01

    Our objective was to determine the incidence and mortality rates associated with emergency peripartum hysterectomy, factors that lead to uncontrolled hemorrhage and emergency peripartum hysterectomy, and to determine the relationship between cesarean section and risk of emergency peripartum hysterectomy. Studies published between January 1, 2000 and December 31, 2012 were identified using PubMed, OVID and Web of Science databases. Studies were included if they reported incidence rates for emergency peripartum hysterectomy, factors that lead to hemorrhage and emergency peripartum hysterectomy, or the association of emergency peripartum hysterectomy with cesarean section in high-income countries. Four hundred and fifty-one studies were identified, and 52 were included. The incidence of emergency peripartum hysterectomy ranged from 0.20 to 5.09 per 1000 deliveries with a median incidence rate of 0.61 per 1000 deliveries. These rates have increased over time. Rates varied by region/country, specifically with the United States reporting higher rates than North American, Asian, Oceania, and European countries. The most common factor leading to emergency peripartum hysterectomy was placental abnormalities. Both cesarean section and prior cesarean section were strong risk factors for emergency peripartum hysterectomy with higher risks conferred for each additional cesarean section. The mean percentage of maternal deaths for EPH survivors was 3.0 %. Given the association of cesarean section with emergency peripartum hysterectomy, the increased risk of emergency peripartum hysterectomy should be factored into the decision of whether to proceed with cesarean delivery, particularly for women who desire more children.

  8. An audit of indications and complications associated with elective hysterectomy at SVMCH and RC, Ariyur, Pondicherry

    Directory of Open Access Journals (Sweden)

    Nidhi Bansal, Hiremath PB, Meenal C, Vishnu Prasad

    2013-04-01

    Full Text Available Background: Hysterectomy is the most common gynaecological surgery performed worldwide Menorrhagia secondary to uterine fibroids and abnormal menstrual bleeding are the two most common indications for hysterectomy. An important factor impacting on the incidence of complications of hysterectomy, apart from the indication for surgery, is the surgical approach. Most surgeons perform up to 80% of procedures by the abdominal route. The incidence of LAVH performed for benign lesions has progressively increased in recent years. Methods : Surgical indications and details, histological findings, and postoperative course were reviewed and analysed for 340 patients who underwent hysterectomy in 2011 and 2012.Results : In our study, fibroid uterus (27.9 % was the leading indication for performing hysterectomies followed by a DUB (22.9% and uterovaginal prolapse (UVP-21.8%. During the study period (2011-2012, most hysterectomies were performed abdominally (54.4%. Overall post operative complications including major and minor, are significantly higher in the abdominal surgery group as compared to the vaginal and laparoscopic group ( p value= 0.001 . Conclusion: We need to ensure that trainees acquire competency in performing hysterectomies vaginally, which is clearly safer than the abdominal approach.

  9. A RETROSPECTIVE STUDY OF EMERGENCY HYSTERECTOMY PERFORMED IN LAST 5 YEARS AT KRISHNA HOSPITAL, KARAD

    Directory of Open Access Journals (Sweden)

    Nikunj

    2016-05-01

    Full Text Available OBJECTIVE Study is to determine the incidence, indications of obstetric hysterectomy, maternal morbidity and maternal mortality associated with emergency obstetric hysterectomy at a tertiary hospital, Karad. This will help to highlight the lack of availability and inadequate utilisation of antenatal services. This will help to identify avoidable factors and stress factors; those need to organise health care services so as to improve maternal and foetal outcome. MATERIAL AND METHODS A retrospective analysis of 30 cases of emergency hysterectomies done for obstetric indications from JULY 2010 to JUNE 2015 was done. Indications for hysterectomy and causes of maternal morbidity and mortality were studied. RESULTS There were 30 cases of emergency hysterectomies amongst 19,635 deliveries during the period of study giving an incidence 0.15%, i.e. 1 in 654 deliveries. CONCLUSION The presence of risk factors like placenta previa, accreta, previous LSCS should facilitate referral or transfer of patients to a tertiary care hospital. When conservative measures like haemostatic sutures, internal iliac artery ligation, embolization is not feasible or has failed obstetric hysterectomy is performed without delay, in which delay would contribute to the maternal morbidity and in unfortunate cases mortality. Special provisions of blood components, dialysis facility and ventilator support associated with availability of experienced obstetrician, anaesthetist, neonatologist, physician and surgical services are necessary round the clock. Training of obstetrician in obstetric hysterectomy is very much necessary to reduce morbidity and mortality.

  10. Vaginal Migration of Ventriculoperitoneal Shunt Catheter and Cerebrospinal Fluid Leak as a Complication of Hysterectomy.

    Science.gov (United States)

    Houten, John K; Smith, Shiela; Schwartz, Amit Y

    2017-08-01

    Ventriculoperitoneal (VP) shunting is a common neurosurgical procedure to treat hydrocephalus that diverts cerebrospinal fluid from the cerebral ventricles to the peritoneal cavity for reabsorption. The distal catheter may potentially migrate through any potential or iatrogenic opening in the peritoneal cavity. Increasingly successfully management of childhood hydrocephalus and adult-onset conditions leading to hydrocephalus, such as subarachnoid hemorrhage, is leading many adult female patients harboring VP shunts needing to undergo hysterectomy. Hysterectomy creates a potential defect though which a VP shunt catheter may migrate. It is not known whether the hysterectomy cuff closure technique may affect the likelihood of distal catheter migration though the repair site. We report the case of a 38-year-old woman with a VP shunt who underwent laparoscopic hysterectomy via an open vaginal cuff technique who subsequently presented with vaginal cerebrospinal fluid leakage secondary to migration of the distal shunt catheter through the hysterectomy cuff. Vaginal migration of the distal VP shunt catheter is a possible complication of hysterectomy. The authors postulate that an open cuff hysterectomy closure technique may increase the risk of catheter migration, an issue that may be better understood with further investigation. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. THE ROLE OF HYSTERECTOMY IN THE THERAPY OF GESTATIONAL TROPHOBLASTIC TUMOR

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective.To evaluate the role of hysterectomy for patients with gestational trophoblastic tumor.Methods.We retrospectively analyzed 68 cases of gestational trophoblastic neoplasia treated by hysterectomy from 1985~1997 at PUMC hospital. Thirty-eight cases were diagnosed of choriocarcinoma and 30 were invasive mole.Results.Twenty-three elder patients who didn't desire to preserve fertility were selected for hysterectomy after shorter courses of chemotherapy, 22 of them had a complete remission(95.6%), the total aver-age courses of chemotherapy was 4.2. Of twenty-seven chemorefractory cases who were suspected of a refractory isolated lesion in the uterus, delayed hysterectomy as an adjunct to chemotherapy was performed, 20 of them got a complete remission(74.1%), the total average courses of chemotherapy were 9.4. Emergency hysterectomy is indicated in 18 patients with uterine perforation or life-threatening hemorrhage, 17 cases had a complete remission(94.4%), the total average courses of chemotherapy were 7.6.Conclusion.Although the development of effective chemotherapy has resulted in improved survival of patients with gestational trophoblastic tumor, hysterectomy remains an important adjuncts in the treatment of a selected subset of patients; in order to operate more completely and prevent recurrence, it's better to perform extended hysterectomy for the indicated patients.

  12. Obesity and older age as protective factors for vaginal cuff dehiscence following total hysterectomy.

    Science.gov (United States)

    Donnellan, Nicole M; Mansuria, Suketu; Aguwa, Nancy; Lum, Deirdre; Meyn, Leslie; Lee, Ted

    Studies have shown an increased risk of vaginal cuff dehiscence following total laparoscopic hysterectomy (TLH). Patient variables associated with dehiscence have not been well described. This study aims to identify factors associated with dehiscence following varying routes of total hysterectomy. This is a retrospective, matched, case-control study of women who underwent a total hysterectomy at a large, urban, university-based teaching hospital from January 2000 to December 2011. Women who underwent a total hysterectomy and had a dehiscence (n = 31) were matched by surgical mode to the next five total hysterectomies (n = 155). Summary statistics and conditional logistic regression were performed to compare cases to controls. Obese women (BMI ≥ 30) were 70 % less likely than normal weight women (BMI hysterectomy route, obese women were 86 % less likely to have a dehiscence following robotic-assisted total hysterectomy (RAH) and TLH than normal weight women (p = 0.04). Further, increasing age was protective of dehiscence in this subgroup of women (p = 0.02). Older age and obesity were associated with a decreased risk of dehiscence following RAH and TLH but not following other routes. Increased risk of dehiscence following TLH observed in previous studies may be partially due to patient characteristics.

  13. Assessment of selected perioperative parameters in patients undergoing laparoscopic and abdominal supracervical hysterectomy

    Science.gov (United States)

    Skręt-Magierło, Joanna; Kluz, Tomasz; Barnaś, Edyta; Sobolewski, Marek; Raś, Renata; Skręt, Andrzej

    2015-01-01

    Introduction Subtotal hysterectomy is a method of treatment of patients with mild changes in the uterine body. Laparoscopic methods are increasingly used in surgical gynaecology. One of the limitations of laparoscopy is the proper level of operating surgeon's training, which may be assessed with the use of the learning curve. The aim of the study was to compare data regarding the perioperative period in patients who underwent subtotal hysterectomy with the two methods, and to establish a learning curve for laparoscopic subtotal hysterectomy. Material and methods One hundred and twenty-seven patients qualified for subtotal hysterectomy due to mild disturbances in the uterine body participated in the study. The study was conducted at the Clinical Department of Gynaecology and Obstetrics of Fryderyk Chopin Provincial Specialist Hospital in Rzeszów in 2012-2013. Results The time of laparoscopic subtotal hysterectomy is longer than that of the classical surgical procedure. Uterine myomas are the main indication for subtotal hysterectomy. Laparoscopic operation results in lower blood loss compared to the classical surgical method. The mean age of the patients operated due to mild changes in the uterine body is similar in both groups. Patients who are obese or have undergone Caesarean sections are more frequently qualified for the classical surgery. The study revealed a reduction in time of laparoscopic subtotal hysterectomy by ca. 31 minutes (33%). Conclusions Laparoscopic subtotal hysterectomy is a method chosen by operating surgeons for patients with a lower perioperative risk. The period of the study made it possible to determine a learning curve for laparoscopic subtotal hysterectomy. PMID:26848296

  14. Histopathological Distribution of Ovarian Masses Occurring After Hysterectomy: A Five-Year Assay in Iranian Patients

    Directory of Open Access Journals (Sweden)

    Lalooei

    2016-01-01

    Full Text Available Background Ovarian cancer, the third most important genital cancer and fifth cause of cancer-related death in women, is diagnosed at terminal stages in 70% of cases. Therefore, it is imperative to know the possible risk factors associated with ovarian cancer. Only a few studies have discussed the histopathological features of ovarian masses occurring after hysterectomy. Objectives The study aimed to investigate the five-year prevalence and histopathological distribution of ovarian masses after hysterectomy in Iranian patients and to determine the need for prophylactic salpingo-oophorectomy. Patients and Methods This descriptive cross-sectional study enrolled all patients with ovarian masses and a history of hysterectomy for benign conditions who were visiting the gynecology clinic of Baqiyatallah Hospital, Tehran, between May 2009 and May 2014. Demographic information, pathological features of ovarian masses, family history, the time between hysterectomy and ovarian mass surgery, and method of hysterectomy were recorded in a predesigned checklist. The level of tumor markers such as CA125 and alpha-fetoprotein (α-FP were measured. Results Of the 1052 patients with ovarian masses, 45patients (mean age, 53.11 ± 9.56 years who had undergone abdominal hysterectomy underwent analysis. The study participants had a mean age of 47.92 ± 1.58 years at the time of hysterectomy. The mean time interval between hysterectomy and diagnosis of ovarian mass was 5.38 ± 4.15 years. Based on pathological reports, serous cystadenoma was the most frequent (43.2% pathological diagnosis, followed by mucinous cystadenoma (17.5%. Conclusions A majority of ovarian masses, especially those diagnosed within a short duration after hysterectomy, are benign. Iranian patients with such ovarian masses when asymptomatic and associated with negative tumor markers could be followed up, and prophylactic oophorectomy may not be necessary.

  15. Mexican beliefs and attitudes toward hysterectomy and gender-role ideology in marriage.

    Science.gov (United States)

    Marván, Ma Luisa; Quiros, Vanessa; López-Vázquez, Esperanza; Ehrenzweig, Yamilet

    2012-01-01

    One hundred and sixty-one Mexican respondents completed a questionnaire that measured beliefs and attitudes toward hysterectomy and another that measured gender-role ideology in marriage (GRIMQ). The participants were divided into two groups according to the GRIMQ: "high machismo/marianismo" and "low machismo/marianismo" groups. The participants belonging to the first group showed the most negative attitudes toward hysterectomy. In this group, men showed more negative attitudes toward hysterctomy and were less likely than women to believe that hysterectomy has positive aspects. The findings are discussed in light of male dominance and female subordination that prevail in certain cultural groups of Mexico.xs.

  16. Histologic artifacts in abdominal, vaginal, laparoscopic, and robotic hysterectomy specimens: a blinded, retrospective review.

    Science.gov (United States)

    Krizova, Adriana; Clarke, Blaise A; Bernardini, Marcus Q; James, Sarah; Kalloger, Steve E; Boerner, Scott L; Mulligan, Anna Marie

    2011-01-01

    Total laparoscopic hysterectomy (LH) is a minimally invasive technique, which results in comparable morbidity and better cosmesis compared with total abdominal hysterectomy. The literature is discrepant as to whether it is associated with a higher incidence of positive peritoneal cytology compared with total abdominal hysterectomy and recently, associated artifacts, including vascular pseudoinvasion (VPI), have been described. A retrospective histopathologic review of 266 hysterectomy specimens from 2 centers was performed. The observers, blinded to the surgical technique, assessed for the presence of artifactual changes including disruption of the endometrial lining, nuclear crush artifact, VPI, endomyometrial cleft artifact with or without epithelial displacement, inflammatory debris within vessels, serosal carryover, and intratubal contaminants. In addition, the rates of positive peritoneal washings over a 5-year period, and the use of immunohistochemistry (IHC) to aid in cell typing over a 3-year period, were compared between hysterectomies in which a uterine manipulator (UM) device had and had not (nonmanipulated hysterectomies) been used. The hysterectomies were performed for malignant (n=160) and benign (n=102) uterine disease or for ovarian or cervical disease (n=4), and included total abdominal (n=108), vaginal (n=17), laparoscopy-assisted vaginal (n=24), laparoscopy converted to laparotomy (n=10), nonrobotic laparoscopic (n=51), and robot-assisted laparoscopic (n=56) hysterectomies. One hundred and two (38%) of these hysterectomies involved the use of a UM. Artifactual changes of disruption of the endometrial lining, endomyometrial clefts, intratubal contaminants, nuclear crush artifact, intravascular inflammatory debris, and VPI were significantly more common with LH and with the use of a UM, independent of whether the endometrial pathology was benign or malignant. IHC to aid in endometrial cancer subtyping was more likely to be used in manipulated

  17. Placenta previa percreta left in situ - management by delayed hysterectomy: a case report

    Directory of Open Access Journals (Sweden)

    Stefanovic Vedran

    2011-08-01

    Full Text Available Abstract Introduction Placenta percreta is an obstetric emergency often associated with massive hemorrhage and emergency hysterectomy. Case presentation We present the case of a 30-year-old African woman, gravida 7, para 5, with placenta percreta managed by an alternative approach: the placenta was left in situ, methotrexate was administered, and a delayed hysterectomy was successfully performed. Conclusions Further studies are needed to develop the most appropriate management option for the most severe cases of abnormal placentation. Delayed hysterectomy may be a reasonable strategy in the most severe cases.

  18. What's the impact of the obesity on the safety of laparoscopic hysterectomy techniques?

    Science.gov (United States)

    Kondo, William; Bourdel, Nicolas; Marengo, Francesca; Botchorishvili, Revaz; Pouly, Jean Luc; Jardon, Kris; Rabischong, Benoit; Mage, Gérard; Canis, Michel

    2012-12-01

    To evaluate the impact of obesity in the safety of laparoscopic hysterectomy. A retrospective study was conducted using a database of 2271 women undergoing laparoscopic hysterectomy for benign diseases between January 1995 and December 2008 at the Centre Hospitalier Universitaire Estaing (Clermont-Ferrand, France). Patients were divided into two groups according to the body mass index: obese patients (P=.89), respectively. The overall postoperative complication rate was 8.81% (n=184) and 7.65% (n=14), respectively. Obesity does not have an adverse effect on the feasibility and safety of laparoscopic hysterectomy in experienced hands.

  19. Large cell neuroendocrine cervical tumor treated by radical surgery and adjuvant chemotherapy: A case report and literature review.

    Science.gov (United States)

    BacalbaȘa, Nicolae; Stoica, Claudia; Marcu, Madalina; Mihalache, Daniela; Vasilescu, Florina; Popa, Ileana; Mirea, Gratiela; Bălescu, Irina

    2016-01-01

    Neuroendocrine carcinomas of the uterine cervix are rare, but extremely aggressive, gynecological malignancies that are associated with an overall poor prognosis. The present study reports the case of a 41-year-old patient diagnosed with large cell neuroendocrine cervical tumor. A radical total hysterectomy with bilateral adnexectomy, pelvic and lymph node dissection was performed. The post-operative course was uneventful, and the patient was discharged on post-operative day 8.

  20. Electrosurgical bipolar vessel sealing versus conventional clamping and suturing for total abdominal hysterectomy: a randomized trial.

    NARCIS (Netherlands)

    Lakeman, M.; Kruitwagen, R.F.P.M.; Vos, M.C.; Roovers, J.P.

    2008-01-01

    STUDY OBJECTIVE: To compare the effects of bipolar vessel sealing versus conventional clamping and suturing in women undergoing total abdominal hysterectomy. DESIGN: A randomized controlled trial was performed. Patients were randomized to vessel sealing or conventional surgery. Postoperative pain wa

  1. Randomized trial of suturing versus electrosurgical bipolar vessel sealing in abdominal hysterectomy

    Directory of Open Access Journals (Sweden)

    Sameer Darwade

    2016-06-01

    Conclusions: The use of bipolar vessel sealing during abdominal hysterectomy for benign conditions appears to be associated with reduced blood loss, postoperative pain and faster recovery. [Int J Reprod Contracept Obstet Gynecol 2016; 5(6.000: 1778-1783

  2. Inflammatory response in patients undergoing uterine artery embolization as compared to patients undergoing conventional hysterectomy

    DEFF Research Database (Denmark)

    Brøchner, A C; Mygil, B; Elle, B;

    2009-01-01

    : To investigate whether uterine artery embolization generates a reduced inflammatory response as compared with conventional hysterectomy. MATERIAL AND METHODS: 40 women, 20 in each group, entered this prospective, non-randomized study. The two groups were comparable concerning age, comorbidity, and body......-mass index (BMI). RESULTS: We found a significant difference between the inflammatory responses in women undergoing embolization compared with the inflammatory response in women having an abdominal hysterectomy. Women undergoing embolization were subjected to a much smaller inflammatory burden, their total...... morphine consumption was lower, and their return to work was faster than women subjected to conventional hysterectomy. CONCLUSION: Uterine artery embolization generates a reduced inflammatory response compared with conventional hysterectomy....

  3. Diagnostic value of hysteroscopy: correlation with histological findings after dilatation and curettage and hysterectomy.

    Science.gov (United States)

    Piccolboni, G; Arlacchi, E; Cattani, P; Zardini, R; Lavanda, E; Zardini, E

    1991-01-01

    The Authors carried out a comparative assessment of hysteroscopy diagnosis and histological findings obtained by dilatation and curettage and hysterectomy. Analysis of the data shows a good correlation between hysteroscopic diagnosis and histological findings obtained with dilatation and curettage.

  4. Total laparoscopic hysterectomy as a primary surgical treatment for endometrial cancer in morbidly obese women

    National Research Council Canada - National Science Library

    Yu, C.K.H; Cutner, A; Mould, T; Olaitan, A

    2005-01-01

    To evaluate the feasibility of total laparoscopic hysterectomy as the primary treatment for endometrial cancer in morbidly obese women, an audit was carried out during an 18-month period in a tertiary...

  5. Perimenopausal invasive hyadatidiform mole treated by total abdominal hysterectomy followed by chemotherapy

    Science.gov (United States)

    Nakashima, Ayaka; Miyoshi, Ai; Miyatake, Takashi; Kazuhide, Ogita; Takeshi, Yokoi

    2016-01-01

    Gestational trophoblastic neoplasias (GTNs) are rare tumors that constitute mole of the uterus with metastasis to the right ovary and labium minus treated by total abdominal hysterectomy followed by chemotherapy. PMID:27651108

  6. [Uterus preserving surgery versus vaginal hysterectomy in treatment of uterine descent: a systematic review].

    NARCIS (Netherlands)

    Detollenaere, R.J.; Boon, J. den; Vierhout, M.E.; Eijndhoven, H.W. van

    2011-01-01

    OBJECTIVE: To compare the outcomes of uterus preserving procedures and vaginal hysterectomy in treatment of uterine prolapse. DESIGN: Systematic review. METHOD: We searched in Pubmed, Embase, the Cochrane Library and the reference lists of relevant publications for articles comparing uterus

  7. Is Previous Tubal Ligation a Risk Factor for Hysterectomy because of Abnormal Uterine Bleeding?

    Directory of Open Access Journals (Sweden)

    Sanam Moradan

    2012-07-01

    Full Text Available Objectives: Post tubal ligation syndrome (PTLS is a term used to describe a variety of post tubal ligation side effects or symptoms. These include increased menstrual bleeding and hysterectomy. Whether or not post tubal syndrome is a real entity, it has been a subject of controversy in the medical literature for decades. Numerous studies have reported conflicting conclusions about these symptoms. In this study the incidence of hysterectomy for bleeding disorders among sterilized women was compared with the incidence of hysterectomy for bleeding disorders among non-sterilized female population of the same age.Methods: This study was carried out on 160 women, 38-52 years, who underwent hysterectomy in Amir University Hospital, Semnan, Iran, from September 2008 to September 2011. After gathering of data from medical records, in this study, the incidence of hysterectomy for bleeding disorders among sterilized women was compared with the incidence of hysterectomy for bleeding disorders among nonsterilized female population for the same age.Results: The mean age of the study group was 44/4±5/7 and the mean age of the control group was 45/2±5/3, (p=0.424.The mean parity of the study group was 3/8±1/8 and the mean parity of the control group was 3/5±1/4, (p=0.220. So, in regard to age and parity, two groups were matched. Hysterectomies were performed for 160 cases and abnormal uterine bleeding was the cause of hysterectomy in 67 cases. Among 67 cases, 19 cases (37.3% had previous tubal sterilization + hysterectomy (study group and 48 cases (44% were not undergoing tubal sterilization but had hysterectomy for abnormal bleeding causes (control group. Statistical analyses showed that there were not significant differences between two groups, (RR=0.85; 95% CI: 0.56-1.28; p=0.418.Conclusion: The result of this study showed that previous tubal sterilization is not a risk factor for undergoing hysterectomy because of abnormal uterine bleeding.

  8. Hysterectomy for dysfunctional uterine bleeding in women with previous tubal sterilization

    OpenAIRE

    Hethyshi Ranganna; Nirmala Shivlingiaha

    2014-01-01

    Background: Post tubal ligation syndrome has been a topic of debate with various studies concluding contradictory results. Hysterectomy can be considered as a continuum of the post ligation syndrome due to prolonged menstrual complaints. The present study was done to evaluate any association of tubal sterilization with hysterectomy in patients presenting with dysfunctional uterine bleeding. Methods: The study was conducted in a medical college hospital. Analysis of case files of patients...

  9. Is Previous Tubal Ligation a Risk Factor for Hysterectomy because of Abnormal Uterine Bleeding?

    OpenAIRE

    Sanam Moradan; Raheb Gorbani

    2012-01-01

    Objectives: Post tubal ligation syndrome (PTLS) is a term used to describe a variety of post tubal ligation side effects or symptoms. These include increased menstrual bleeding and hysterectomy. Whether or not post tubal syndrome is a real entity, it has been a subject of controversy in the medical literature for decades. Numerous studies have reported conflicting conclusions about these symptoms. In this study the incidence of hysterectomy for bleeding disorders among sterilized women was co...

  10. Abdominal Hysterectomy: Reduced Risk of Surgical Site Infection Associated with Robotic and Laparoscopic Technique.

    Science.gov (United States)

    Colling, Kristin P; Glover, James K; Statz, Catherine A; Geller, Melissa A; Beilman, Greg J

    2015-10-01

    Hysterectomy is one of the most common procedures performed in the United States. New techniques utilizing laparoscopic and robotic technology are becoming increasingly common. It is unknown if these minimally invasive surgical techniques alter the risk of surgical site infections (SSI). We performed a retrospective review of all patients undergoing abdominal hysterectomy at our institution between January 2011 and June 2013. International Classification of Diseases, Ninth edition (ICD-9) codes and chart review were used to identify patients undergoing hysterectomy by open, laparoscopic, or robotic approach and to identify patients who developed SSI subsequently. Chi-square and analysis of variance (ANOVA) tests were used to identify univariate risk factors and logistic regression was used to perform multivariable analysis. During this time period, 986 patients were identified who had undergone abdominal hysterectomy, with 433 receiving open technique (44%), 116 laparoscopic (12%), 407 robotic (41%), and 30 cases that were converted from minimally invasive to open (3%). Patients undergoing laparoscopic-assisted hysterectomy were significantly younger and had lower body mass index (BMI) and American Society of Anesthesiologists (ASA) scores than those undergoing open or robotic hysterectomy. There were no significant differences between patients undergoing open versus robotic hysterectomy. The post-operative hospital stay was significantly longer for open procedures compared with those using laparoscopic or robotic techniques (5.1, 1.7, and 1.6 d, respectively; physterectomy procedures was 4.2%. More SSI occurred in open cases (6.5%) than laparoscopic (0%) or robotic (2.2%) (pobesity were all associated with increased risk of SSI. Laparoscopic and robotic hysterectomies were associated with a significantly lower risk of SSI and shorter hospital stays. Body mass index, advanced age, and wound class were also independent risk factors for SSI.

  11. HYSTERECTOMY IN THE PERINATAL AND POSTPARTUM PERIOD IN THE 17-YEAR CLINICAL MATERIAL

    OpenAIRE

    2013-01-01

    Intruduction: Hysterectomy is one of major surgeries. Pregnancy, delivery and postpartum period make the operation even more difficult as it is forced and complicated by various pathological conditions that develop over that time. Objective: The purpose of study was to analyze the frequency of hysterectomy, indications to undertake it and complications associated with the removal of the uterus in pregnancy and during perinatal and postpartum period. The study analyzed the cases of hyst...

  12. Patient preferences for uterine preservation and hysterectomy in women with pelvic organ prolapse.

    Science.gov (United States)

    Korbly, Nicole B; Kassis, Nadine C; Good, Meadow M; Richardson, Monica L; Book, Nicole M; Yip, Sallis; Saguan, Docile; Gross, Carey; Evans, Janelle; Lopes, Vrishali V; Harvie, Heidi S; Sung, Vivian W

    2013-11-01

    The purpose of this study was to describe patient preferences for uterine preservation and hysterectomy in women with pelvic organ prolapse symptoms and to describe predictors of preference for uterine preservation. This multicenter, cross-sectional study evaluated patient preferences for uterine preservation vs hysterectomy in women with prolapse symptoms who were being examined for initial urogynecologic evaluation. Before meeting the physician, the women completed a questionnaire that asked them to indicate their prolapse treatment preference (uterine preservation vs hysterectomy) for scenarios in which the efficacy of treatment varied. Patient characteristics that were associated with preferences were determined, and predictors for uterine preservation preference were identified with multivariable logistic regression. Two hundred thirteen women participated. Assuming outcomes were equal between hysterectomy and uterine preservation, 36% of the women preferred uterine preservation; 20% of the women preferred hysterectomy, and 44% of the women had no strong preference. If uterine preservation was superior, 46% of the women preferred uterine preservation, and 11% of the women preferred hysterectomy. If hysterectomy was superior, 21% of the women still preferred uterine preservation, despite inferior efficacy. On multivariable logistic regression, women in the South had decreased odds of preferring uterine preservation compared with women in the Northeast (odds ratio [OR], 0.17; 95% CI, 0.05-0.66). Women with at least some college education (OR, 2.87; 95% CI, 1.08-7.62) and those who believed that the uterus is important for their sense of self (OR, 28.2; 95% CI, 5.00-158.7) had increased odds for preferring uterine preservation. A higher proportion of women with prolapse symptoms who were examined for urogynecologic evaluation preferred uterine preservation, compared with hysterectomy. Geographic region, education level, and belief that the uterus is important for

  13. An audit of indications, complications, and justification of hysterectomies at a teaching hospital in India.

    Science.gov (United States)

    Pandey, Deeksha; Sehgal, Kriti; Saxena, Aashish; Hebbar, Shripad; Nambiar, Jayaram; Bhat, Rajeshwari G

    2014-01-01

    Objective. Aim of this audit was to analyze indications, complications, and correlation of preoperative diagnosis with final histopathology report of all hysterectomies, performed in a premier teaching hospital. Methods. Present study involved all patients who underwent hysterectomy at a premier university hospital in Southern India, in one year (from 1 January, 2012, to 31 December, 2012). Results. Most common surgical approach was abdominal (74.7%), followed by vaginal (17.8%), and laparoscopic (6.6%) hysterectomy. Most common indication for hysterectomy was symptomatic fibroid uterus (39.9%), followed by uterovaginal prolapse (16.3%). Overall complication rate was 8.5%. Around 84% had the same pathology as suspected preoperatively. Only 6 (5 with preoperative diagnosis of abnormal uterine bleeding and one with high grade premalignant cervical lesion) had no significant pathology in their hysterectomy specimen. Conclusion. Hysterectomy is used commonly to improve the quality of life; however at times it is a lifesaving procedure. As any surgical procedure is associated with a risk of complications, the indication should be carefully evaluated. With the emergence of many conservative approaches to deal with benign gynecological conditions, it is prudent to discuss available options with the patient before taking a direct decision of surgically removing her uterus.

  14. The effectiveness of a multidisciplinary, team-based approach to cesarean hysterectomy in modern obstetric practice.

    Science.gov (United States)

    Gillespie, Caitlin; Sangi-Haghpeykar, Haleh; Munnur, Uma; Suresh, Maya S; Miller, Harold; Hawkins, Shannon M

    2017-04-01

    To examine the effectiveness of a multidisciplinary, team-based approach to management of cesarean hysterectomy. In a retrospective chart review, data were analyzed from a quality assurance database of hysterectomies performed after cesarean delivery at one institution in the USA. Patients were identified through billing codes for cesarean delivery, cross-referenced to codes for hysterectomy. Demographic, reproductive, and outcome data were compared before (2000-2005) and after (2011-2013) implementation of a multidisciplinary team-based protocol. Across the two study periods, 107 cesarean hysterectomies were identified (69 pre-implementation, 38 post-implementation). In univariate analysis, the post-implementation group had fewer days in surgical intensive care than did the pre-implementation group (0.21 ± 0.41 vs 1.04 ± 2.44 days; P=0.011), and a lower frequency of febrile morbidity (4 [11%] vs 22 [32%]; P=0.033]. In multivariate analysis with adjustment for potential confounders, the likelihood of postoperative febrile morbidity was higher during the pre-implementation than the post-implementation period (adjusted odds ratio 3.5, 95% confidence interval 1.09-13.65; P=0.048). Outcomes were improved after the multidisciplinary team-based approach to cesarean hysterectomy was implemented. Team-based approaches to care of women undergoing cesarean hysterectomy are important to improve outcomes. © 2017 International Federation of Gynecology and Obstetrics.

  15. An Audit of Indications, Complications, and Justification of Hysterectomies at a Teaching Hospital in India

    Directory of Open Access Journals (Sweden)

    Deeksha Pandey

    2014-01-01

    Full Text Available Objective. Aim of this audit was to analyze indications, complications, and correlation of preoperative diagnosis with final histopathology report of all hysterectomies, performed in a premier teaching hospital. Methods. Present study involved all patients who underwent hysterectomy at a premier university hospital in Southern India, in one year (from 1 January, 2012, to 31 December, 2012. Results. Most common surgical approach was abdominal (74.7%, followed by vaginal (17.8%, and laparoscopic (6.6% hysterectomy. Most common indication for hysterectomy was symptomatic fibroid uterus (39.9%, followed by uterovaginal prolapse (16.3%. Overall complication rate was 8.5%. Around 84% had the same pathology as suspected preoperatively. Only 6 (5 with preoperative diagnosis of abnormal uterine bleeding and one with high grade premalignant cervical lesion had no significant pathology in their hysterectomy specimen. Conclusion. Hysterectomy is used commonly to improve the quality of life; however at times it is a lifesaving procedure. As any surgical procedure is associated with a risk of complications, the indication should be carefully evaluated. With the emergence of many conservative approaches to deal with benign gynecological conditions, it is prudent to discuss available options with the patient before taking a direct decision of surgically removing her uterus.

  16. A radical approach to radical innovation

    NARCIS (Netherlands)

    D. Deichmann (Dirk); J.C.M. van den Ende (Jan)

    2014-01-01

    textabstractInnovation pays. Amazon, Apple, Facebook, Google – nearly every one of today’s most successful companies has a talent for developing radical new ideas. But how best to encourage radical initiative taking from employees, and does their previous success or failure at it play a role?

  17. A radical approach to radical innovation

    OpenAIRE

    Deichmann, Dirk; van der Ende, Jan

    2014-01-01

    textabstractInnovation pays. Amazon, Apple, Facebook, Google – nearly every one of today’s most successful companies has a talent for developing radical new ideas. But how best to encourage radical initiative taking from employees, and does their previous success or failure at it play a role?

  18. Postpartal hysterectomy performed the consequence of chronic myometritis

    Directory of Open Access Journals (Sweden)

    Jovanović Božidar

    2008-01-01

    Full Text Available Introduction. As a diffuse chronic inflammation, myometritis is very rere and usually follows after postpartal placenta remains or postabortion infections, but it can be also associated with endometrial or ascendent infection. Chronic myometritis is often followed by profuse bleeding, though in most cases it cannot be recognized as it is asymptomatic. Histologically, that chronic process is characterized by the presence of fibriosis within the muscles and mononuclear cells (lymphoplasmocytic and histiocytic infiltration. Case report. A 24 old woman's second child was delivered per vias naturalis but the next day the profuse bleeding occured which would not stop even after repeated curretages and suspecting a case of placenta accreta and uterus atony, subtotal hysterectomy was performed. Histologically, the disappearance of the regular arrangement of the smooth muscles and stroma could be seen with the devastation of myometrium due to the diffuse reduction of its smooth muscle bundles and cells, as well as their atrophy, necrobiosis and apoptosis with the minimal preservation of the muscle bundles and little cell groups of the myometrium, an abundant presence of the fibrocollagene and myxoid transformed connective tissue, group cells similar to the mesenchymal tissue and adipocytes. Discussion It was not possible to find this variant of the changes on the myometrium in the available literature. The present case is about the clinically unknown asymptomatic myometritis, possibly developed in the postpartal period of the previous pregnancy. It is our opinion that it is most probably an autoagressive process directed towards the smooth muscle cells of the myometrium, as shown by their reduction and inflammatory cells composition, which plays an important role in the immune reactions (lymphocytes, plasma cells, eosinophilis, histocytes. Conclusion. A subtotal hysterectomy was performed on a woman, 24 years old, who gave birth to her second child and

  19. Radical theory of rings

    CERN Document Server

    Gardner, JW

    2003-01-01

    Radical Theory of Rings distills the most noteworthy present-day theoretical topics, gives a unified account of the classical structure theorems for rings, and deepens understanding of key aspects of ring theory via ring and radical constructions. Assimilating radical theory's evolution in the decades since the last major work on rings and radicals was published, the authors deal with some distinctive features of the radical theory of nonassociative rings, associative rings with involution, and near-rings. Written in clear algebraic terms by globally acknowledged authorities, the presentation

  20. Hysterectomy at a Canadian tertiary care facility: results of a one year retrospective review

    Directory of Open Access Journals (Sweden)

    Gorwill R Hugh

    2004-11-01

    Full Text Available Abstract Background The purpose of this study was to investigate the indications for and approach to hysterectomy at Kingston General Hospital (KGH, a teaching hospital affiliated with Queen's University at Kingston, Ontario. In particular, in light of current literature and government standards suggesting the superiority of vaginal versus abdominal approaches and a high number of concurrent oophorectomies, the aim was to examine the circumstances in which concurrent oophorectomies were performed and to compare abdominal and vaginal hysterectomy outcomes. Methods A retrospective chart audit of 372 consecutive hysterectomies performed in 2001 was completed. Data regarding patient characteristics, process of care and outcomes were collected. Data were analyzed using descriptive statistics, t-tests and linear and logistic regression. Results Average age was 48.5 years, mean body mass index (BMI was 28.6, the mean length of stay (LOS was 5.2 days using an abdominal approach and 3.0 days using a vaginal approach without laparoscopy. 14% of hysterectomies were performed vaginally, 5.9% were laparoscopically assisted vaginal hysterectomies and the rest were abdominal hysterectomies. The most common indication was dysfunctional or abnormal uterine bleeding (37%. The average age of those that had an oophorectomy (removal of both ovaries was 50.8 years versus 44.3 years for those that did not (p Conclusions A significant reduction in LOS was found using the vaginal approach. Both the patient and the health care system may benefit from the tendency towards an increased use of vaginal hysterectomies. The audit process demonstrated the usefulness of an on-going review mechanism to examine trends associated with common surgical procedures.

  1. Association between obesity and the trends of routes of hysterectomy performed for benign indications.

    Science.gov (United States)

    Mikhail, Emad; Miladinovic, Branko; Velanovich, Vic; Finan, Michael A; Hart, Stuart; Imudia, Anthony N

    2015-04-01

    To estimate the association between obesity and the recent trends of routes chosen for hysterectomy performed for benign indications in the United States. Using the American College of Surgeons-National Surgical Quality Improvement Project's database, patients who underwent hysterectomy for benign indications from 2005 to 2011 were identified by International Classification of Diseases, 9th Revision codes and were categorized into total abdominal hysterectomy (TAH), total vaginal hysterectomy (TVH), laparoscopically assisted vaginal hysterectomy (LAVH), and total laparoscopic hysterectomy (TLH). The patients were divided into four subgroups according to body mass index (BMI) (less than 25, 25-29.9, 30-39.9, and 40 or greater). The data were analyzed using Student's t test or χ2 and Fisher's exact test. A total of 18,810 patients underwent hysterectomy for benign indications during the study period: 9,852 (52.4%) were TAH, 5,146 (27.4%) TVH, 2,296 (12.2%) LAVH, and 1,516 (8.0%) TLH. The rates of TAH increased from 45.7% in patients with ideal body weight to 62% in morbidly obese patients (Pobese patients, respectively (Physterectomy. The rates of superficial and deep wound infections were higher with increasing BMI in patients undergoing TAH (Physterectomy performed for benign indications, increasing BMI was associated with increased rate of TAH and decreased rate of TVH and LAVH, but not the rate of TLH. Increasing BMI was associated with increased operative time for all subgroups and increased surgical site infection in the TAH group.

  2. NON–DESCENT VAGINAL HYSTERECTOMY FOR BENIGN GYNAECOLOGICAL DISEASE – A PROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Thulasi

    2016-04-01

    Full Text Available OBJECTIVE To assess safety and feasibility of non-descent vaginal hysterectomy for benign gynaecological disease. METHODS A prospective study was conducted at the Department of Obstetrics and Gynaecology of P K Das Institute of Medical Sciences from January 2013 to December 2013. An effort was made to perform hysterectomies vaginally in women with benign or premalignant conditions in the absence of prolapse. A suspected adnexal pathology, endometriosis, immobility of uterus, uterus size more than 16 weeks was excluded from the study. Vaginal hysterectomy was done in usual manner. In bigger size uterus, morcellation techniques like bisection, debulking, coring, myomectomy, or combination of these were used to remove the uterus. Data regarding age, parity, uterine size, estimated blood loss, length of operation, intraoperative and postoperative complications and hospital stay were recorded. RESULTS A total of 100 cases were selected for non-descent vaginal hysterectomy. Among them, 97 cases successfully underwent nondescent vaginal hysterectomy. Majority of the patients (55% were in age group 40-45 yrs. Four patients were nulligravida and eight patients had previous LSCS. Uterine size was ≤ 12 weeks in 84 cases and > 12-16 weeks in 16 cases. Commonest indication was leiomyoma of uterus (43%. Mean duration of surgery was 70±20.5 minutes. Mean blood loss was 150±65 mL. Reasons for failure to perform NDVH was difficulty in opening pouch of Douglas in two cases because of adhesions and in one case there was difficulty in reaching the fundal myoma which prevented the uterine descent. Intra–operatively, one case had bladder injury (1% that had previous 2 LSCS. Postoperatively, complications were minimal which included postoperative fever (11%, UTI (8% and vaginal cuff infection was (4%. Mean hospital stay was 3.5 days. CONCLUSION Vaginal hysterectomy is safe, feasible in most of the women requiring hysterectomy for benign conditions with less

  3. [Lavoisier and radicals].

    Science.gov (United States)

    Lafont, Olivier

    2007-01-01

    Lavoisier and his co-workers (Guyton de Morveau, Bertholet, Fourcroy) considered that acids were constituted of oxygen and of something else that they called radicals. These radicals were known in some cases, i.e. nitrogen for nitrous acid, carbon for carbonic acid, phosphorus for phosphoric acid. In the case of sulfur, the sulfuric radical could be associated with different quantities of oxigen leading to sulfuric or sulfurous acids. In other cases radicals remained unknown at the time i.e. muriatic radical for muriatic acid, or benzoyl radical for benzoic acid. It is interesting to notice that Lavoisier evoked the case of compound radicals constituted of different substances such as carbon and hydrogen.

  4. Laparoscopic hysterectomy in obese women: a clinical prospective study.

    Science.gov (United States)

    Holub, Z; Jabor, A; Kliment, L; Fischlová, D; Wágnerová, M

    2001-09-01

    To compare perioperative and postoperative outcomes of laparoscopic hysterectomy (LH) in surgical management of gynecological conditions in two groups of different weight. A prospective comparative clinical study of 271 LH performed for disease of female pelvic organs in a group of 54 obese patients (over 30 body mass index (BMI)) and in a group of 217 non-obese patients (less than 30 BMI). The following criteria were assessed: patient characteristics, indications for surgery, previous surgery, presence of adhesions, duration of procedure, blood loss, weight of specimen, hospital stay and complications. Statistical analysis was performed using the unpaired t-test and non-parametric Chi-square test when appropriate, with a significance level of P=0.05. Three non-obese patients were converted to laparotomy due to operative complications. Laparoscopy in the remaining 268 patients (98.89%) was completed successfully. There was no significant difference in estimated blood loss, presence and degree of adhesions, weight of specimen, length of hospital stay and postoperative complications between women with high BMI and those with low BMI. The rate of major operative complications (5.55% versus 3.22%) was higher in the obese group. The duration of the operation was longer in obese women. However, the significance of the difference was borderline (P=0.06).

  5. Laparoscopic and vaginal approaches to hysterectomy in the obese.

    Science.gov (United States)

    Bogani, Giorgio; Cromi, Antonella; Serati, Maurizio; Di Naro, Edoardo; Casarin, Jvan; Pinelli, Ciro; Uccella, Stefano; Leone Roberti Maggiore, Umberto; Marconi, Nicola; Ghezzi, Fabio

    2015-06-01

    The aim of the study was to compare surgery-related outcomes between laparoscopic (LH) and vaginal (VH) hysterectomy, performed for benign uterine disease (other than pelvic organs prolapse) in obese women. Data of consecutive obese (BMI≥30) patients undergoing LH and VH, between 2000 and 2013, were compared using a propensity-matched analysis. One hundred propensity-matched patient pairs (200 patients) undergoing LH (n=100) and VH (n=100) represented the study group. Baseline demographic characteristics were similar between groups. Patients undergoing LH experienced similar operative time (87.5 (25-360) vs. 85 (25-240)min; p=0.28), slightly lower blood loss (100 (10-3200) vs. 150 (10-800)ml; p=0.006) and shorter length of hospital stay (1 (1-5) vs. 2 (1-5) days; pobese women affected by benign uterine disease LH and VH should not be denied on the basis of the mere BMI, per se. In this setting, LH upholds effectiveness of VH, improving postoperative outcomes. However, complication rate increases as BMI increase, regardless surgical route. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  6. Changing trends in peripartum hysterectomy over the last 4 decades.

    LENUS (Irish Health Repository)

    Flood, Karen M

    2012-02-01

    OBJECTIVE: The purpose of this study was to identify changing trends in peripartum hysterectomy (PH) in a single large obstetric population over the last 40 years. STUDY DESIGN: A retrospective cohort study was performed from 1966-2005 of patients who had PH in any of the 3 Dublin obstetric hospitals. Cases were identified, and details were obtained from the combined patient databases of each hospital. RESULTS: There were 872,379 deliveries during the study period, among which 358 women underwent PH (0.4\\/1000 deliveries). In a comparison of the study decades 1966-1975 with 1996-2005, PH decreased from 0.9 per 1000 deliveries to 0.2 of 1000 deliveries. Although the overall cesarean delivery rate has increased from 6-19% during these 2 decades, the percentage of PH that occurs in the setting of a previous cesarean delivery has increased from 27-57% (P < .00001). Indications for PH have changed significantly in this time period, with "uterine rupture" as the indication for PH decreasing from 40.5-9.3% (P < .0001) and placenta accreta as the indication increasing significantly from 5.4-46.5% (P < .00001). CONCLUSION: PH has decreased over the last 4 decades. However, alongside the rising cesarean delivery rate, there has been a marked increase in the incidence of placenta accreta.

  7. The Retrograde and Retroperitoneal Totally Laparoscopic Hysterectomy for Endometrial Cancer

    Directory of Open Access Journals (Sweden)

    Eugenio Volpi

    2012-01-01

    Full Text Available Introduction. We retrospectively report our experience with the utilization of an original procedure for total laparoscopic hysterectomy based on completely retrograde and retroperitoneal technique for surgical staging and treatment of the endometrial cancer. The surgical, financial, and oncological advantages are here discussed. Methods. The technique used here has been based on a combination of a retroperitoneal approach with a retrograde and lateral dissection of the bladder and retrograde culdotomy with variable resection of parametrium. No disposable instruments and no uterine manipulator were utilized. Results. Intraoperative and postoperative complications were observed in 10% of the cases overall. Operative time length and mean haemoglobin drop value results were 129 min and 125 mL, respectively. Most patients were dismissed on days 3–5 from the hospital. Seventy-eight percent of the patients were alive with no evidence of disease at mean followup of 49 months. Conclusions. Our original laparoscopic technique is based on a retroperitoneal approach in order to rapidly control main uterine vessels coagulation, constantly check the ureter, and eventually decide type and site of lymph nodes removal. This procedure has important cost saving implications and the avoidance of uterine manipulator is of matter in case such as these of uterine malignancy.

  8. Total abdominal hysterectomy for benign gynaecological conditions at a University Teaching Hospital in Nigeria.

    Science.gov (United States)

    Anzaku, A S; Musa, J

    2012-01-01

    Hysterectomy is one of the most commonly performed major gynaecological procedures in women. Total abdominal hysterectomy (TAH) for benign disorders is commonly performed in Jos University Teaching Hospital and this study aimed at ascertaining its frequency in relation to other major gynaecological operations, demographic features of the patients, indications and safety of the procedure in this institution. A retrospective descriptive study of consecutive patients who had elective total abdominal hysterectomy performed for various benign indications during the study period from January 2001 to December 2008 was conducted. Data extracted from the case files included age, parity, presenting symptoms, indications for the surgery, intraoperative findings and post-operative complications. Data was analysed with 2008 EPI-info version 3.5.1. Total abdominal hysterectomy accounted for 18.2% of all major gynaecological operations. Majority of the women were in their fifth decade of life (65.9%) and parity of five and above (46.4%). The most common indications were uterine fibroid with or without menorrhagia (60.6%) and cervical intraepithelial neoplasia (27.0%). Post-operative morbidity was recorded in 40 (17.7%) of cases. Post-operative wound infection (52.5%) and fever (30.0%) accounted for the majority of the complications. There was no mortality. Total abdominal hysterectomy for benign conditions is relatively common and safe in this centre. The review of the antibiotic regimes for chemoprophylaxis may help in reducing the post-operative infection rate associated with the operation.

  9. Histopathological Study of Hysterectomy Operations in A University Clinic in Tehran From 2005 to 2009

    Directory of Open Access Journals (Sweden)

    Mahmoud Khaniki

    2011-06-01

    Full Text Available Objective: We intended to determine causes and histological pattern of hysterectomies in an Iranianpopulation.Materials and methods: Archived reports of pathology department of a university hospital dated March2005 to March 2009 were retrospectively reviewed. Age, chief complaint, type of operation includingabdominal, vaginal and subtotal hysterectomy, the indication of the operation and the pathology of thespecimen were retrieved from the records.Results: The average rate of hysterectomy was 219 per year. The average age of the patients was49.6±11.3. About 40% of cases aged 45-54 years. The main chief compliant was abnormal uterinebleeding (62.2%. The leading preoperative indication for hysterectomy operations were uterineleiomyoma (24.8% and then abnormal uterine bleeding and abdominal/pelvic mass. The most frequentpathologic findings were leiomyoma (22.0% and adenomyosis (12.1%. In 11.8% of hysterectomyspecimens no pathologic lesion was found.Conclusion: The hysterectomy is rather common in Iran with age dependent pattern of indications andcorresponding pathologies.

  10. Obstetric hysterectomy, still a life saving tool in modern day obstetrics: a five year study

    Directory of Open Access Journals (Sweden)

    Neetu Singh

    2014-06-01

    Results: During the study period, 105 emergency obstetric hysterectomies were performed giving an incidence of 0.54% .The incidence of hysterectomy following vaginal delivery was 0.54% and that of caesarean hysterectomy was 2.08%. It was most common in the age group 26-35 years (66.66% and in women of parity 3-4 (71.42%.Rupture uterus was the most common indication accounting for 59.04% cases followed by Atonic PPH (18.09%. Febrile illness and wound infection were the two most common co-morbidities. Maternal mortality was 5.71%. Conclusions: Emergency obstetric hysterectomy is potentially a life saving procedure which every obstetrician must be familiar with in cases of catastrophic rupture uterus and intractable haemorrhage. With the help of prostaglandins, modern policies of active management of labor, timely performance of caesarean section, internal iliac artery ligation, compression sutures etc. obstetric hysterectomy should be made a more rare procedure. [Int J Reprod Contracept Obstet Gynecol 2014; 3(3.000: 540-543

  11. Optimal timing for performing hysterectomy according to different phase of menstrual cycle: Which is best?

    Science.gov (United States)

    Kim, Jeong Jin; Kang, Jun Hyeok; Lee, Kyo Won; Kim, Kye Hyun; Song, Taejong

    2017-05-01

    The aim of this study was to determine whether the different phases of the menstrual cycle could affect operative bleeding in women undergoing laparoscopic hysterectomy. This was a retrospective comparative study. Based on the adjusted day of menstrual cycle, 212 women who underwent laparoscopic hysterectomy were classified into three groups: the follicular phase (n = 51), luteal phase group (n = 125), and menstruation group (n = 36). The primary outcome measure was the operative bleeding. There was no difference in the baseline characteristics of the patients belonging to the three groups. For the groups, there were no significant differences in operative bleeding (p = .469) and change in haemoglobin (p = .330), including operative time, length of hospital stay and complications. The menstrual cycle did not affect the operative bleeding and other parameters. Therefore, no phase of the menstrual cycle could be considered as an optimal timing for performing laparoscopic hysterectomy with minimal operative bleeding. Impact statement What is already known on this subject: the menstrual cycle results in periodic changes in haemostasis and blood flow in the reproductive organs. What the results of this study add: the menstrual cycle did not affect the operative bleeding and other operative parameters during laparoscopic hysterectomy. What the implications are of these findings for clinical practice and/or further research: no phase of the menstrual cycle could be considered as an optimal timing for performing laparoscopic hysterectomy with minimal operative bleeding.

  12. Influence of total laparoscopic hysterectomy on the blood viscosity and erythrocyte immune state in patients

    Institute of Scientific and Technical Information of China (English)

    Li Lin; Hong-yan Xu

    2015-01-01

    Objective:To investigate and study the influenced state of total laparoscopic hysterectomy for the blood viscosity and erythrocyte immune state of patients.Methods:A total of 58 patients who were treated with total hysterectomy in our hospital from June 2013 to February 2015 were the study subjects, the 29 cases in the control group were treated with routine open hysterectomy operation according to the operation types, the 29 cases in the observation group were treated with laparoscopic hysterectomy operation, then the preoperative and postoperative blood viscosity and erythrocyte immune state indexes of two groups were compared.Results:The blood viscosity indexes of the observation group at different postoperative time were all lower than the indexes of the control group, the erythrocyte immune state indexes were all better than those of the control group, and the detection results of two groups at the third day after the operation were all obviously worse than those at other times, their differences were statistically significant.Conclusions:The bad influence of total laparoscopic hysterectomy for the blood viscosity and erythrocyte immune state of patients are relatively smaller, and those postoperative indexes in recovery of patients are faster.

  13. Contemporary Radical Prostatectomy

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    Qiang Fu

    2011-01-01

    Full Text Available Purpose. Patients diagnosed with clinically localized prostate cancer have more surgical treatment options than in the past. This paper focuses on the procedures' oncological or functional outcomes and perioperative morbidities of radical retropubic prostatectomy, radical perineal prostatectomy, and robotic-assisted laparoscopic radical prostatectomy. Materials and Methods. A MEDLINE/PubMed search of the literature on radical prostatectomy and other new management options was performed. Results. Compared to the open procedures, robotic-assisted radical prostatectomy has no confirmed significant difference in most literatures besides less blood loss and blood transfusion. Nerve sparing is a safe means of preserving potency on well-selected patients undergoing radical prostatectomy. Positive surgical margin rates of radical prostatectomy affect the recurrence and survival of prostate cancer. The urinary and sexual function outcomes have been vastly improved. Neoadjuvant treatment only affects the rate of positive surgical margin. Adjuvant therapy can delay and reduce the risk of recurrence and improve the survival of the high risk prostate cancer. Conclusions. For the majority of patients with organ-confined prostate cancer, radical prostatectomy remains a most effective approach. Radical perineal prostatectomy remains a viable approach for patients with morbid obesity, prior pelvic surgery, or prior pelvic radiation. Robot-assisted laparoscopic prostatectomy (RALP has become popular among surgeons but has not yet become the firmly established standard of care. Long-term data have confirmed the efficacy of radical retropubic prostatectomy with disease control rates and cancer-specific survival rates.

  14. Laparoscopic hysterectomy is preferred over laparotomy in early endometrial cancer patients, however not cost effective in the very obese

    NARCIS (Netherlands)

    Bijen, Claudia B. M.; de Bock, Geertruida H.; Vermeulen, Karin M.; Arts, Henriette J. G.; ter Brugge, Henk G.; van der Sijde, Rob; Kraayenbrink, Arjen. A.; Bongers, Marlies Y.; van der Zee, Ate G. J.; Mourits, Marian I. E.; van der, Sijde R.

    2011-01-01

    Background: Total laparoscopic hysterectomy (TLH) is safe and cost effective in early stage endometrial cancer when compared to total abdominal hysterectomy (TAH). In non-randomised data it is often hypothesised that older and obese patients benefit most from TLH. Aim of this study is to analyse whe

  15. Forgotten Radicals in Biology

    OpenAIRE

    2008-01-01

    Redox reactions play key roles in intra- and inter-cellular signaling, and in adaptative processes of tissues towards stress. Among the major free radicals with essential functions in cells are reactive oxygen species (ROS) including superoxide anion (O2 •-), hydroxyl radical (•OH) and reactive nitrogen species (RNS) such as nitric oxide (•NO). In this article, we review the forgotten and new radicals with potential relevance to cardiovascular pathophysiology. Approximately 0.3% of O2 •- pres...

  16. A Marked Increase in Obstetric Hysterectomy for Placenta Accreta

    Institute of Scientific and Technical Information of China (English)

    Xiao-Yu Pan; Yu-Ping Wang; Zheng Zheng; Yan Tian; Ying-Ying Hu; Su-Hui Han

    2015-01-01

    Background:Obstetric hysterectomy (OH) as a lifesaving measure to manage uncontrolled uterine hemorrhage appears to be increasing recently.The objective of this study was to determine the etiology and changing trends of OH and to identify those at particular risk of OH to enhance the early involvement of multidisciplinary intensive care.Methods:A retrospective study was carried out in patients who had OH in China-Japan Friendship Hospital from 2004 to 2014.Maternal characteristics,preoperative evaluation,operative reports,and prenatal outcomes were studied in detail.Results:There were 19 cases of OH among a total of 18,838 deliveries.Comparing the study periods between 2004-2010 and 2011-2014,OH increased from 0.8/1000 (10/12,890) to 1.5/1000 (9/5948).Indications for OH have changed significantly during this study period with uterine atony decreasing from 50.0% (5/10) to 11.1% (1/9) (P < 0.05),and placenta accreta as the indication for OH has increased significantly from 20.0% (2/10) to 77.8% (7/9) (P < 0.05).Ultrasonography and magnetic resonance imaging (MRI) have been used to make an exact antepartum diagnosis of placenta accreta.A multidisciplinary management led to improved outcomes for patients with placenta accreta.Conclusion:As the multiple cesarean delivery rates have risen,there has been a dramatic increase in OH for placenta accreta.An advance antenatal diagnosis of ultrasonography,and MRI,and a multidisciplinary teamwork can maximize patients' safety and outcome.

  17. The effect of a preoperative single-dose methylprednisolone on postoperative pain after abdominal hysterectomy:

    DEFF Research Database (Denmark)

    Aabakke, Anna J M; Holst, Lars B; Jørgensen, Jørgen C;

    2014-01-01

    OBJECTIVE: Methylprednisolone has been shown to have analgesic effects after orthopedic surgery. The objective of this trial was to compare the effect of 125 mg methylprednisolone with placebo on postoperative pain after abdominal hysterectomy. STUDY DESIGN: In this randomized double......-blinded placebo-controlled trial women scheduled for elective abdominal hysterectomy (n=59) were randomized to preoperatively receive either 125 mg methylprednisolone or saline intravenously. Primary outcome was postoperative pain measured on a 0.0-10.0 visual analog scale and assessed at rest and during...... group (P=0.01). CONCLUSIONS: This trial showed no beneficial effect of methylprednisolone on postoperative pain after abdominal hysterectomy. Methylprednisolone significantly lowered postoperative CRP levels. CLINICAL TRIAL REGISTRATION: ClinicalTrial.gov: www.clinicaltrials.gov: NCT01106547....

  18. Transversus abdominis plane (TAP) block after robot-assisted laparoscopic hysterectomy

    DEFF Research Database (Denmark)

    Torup, H; Bøgeskov, M; Hansen, E G

    2015-01-01

    BACKGROUND: Transversus abdominis plane (TAP) block is widely used as a part of pain management after various abdominal surgeries. We evaluated the effect of TAP block as an add-on to the routine analgesic regimen in patients undergoing robot-assisted laparoscopic hysterectomy. METHODS......: In a prospective blinded study, 70 patients scheduled for elective robot-assisted laparoscopic hysterectomy were randomised to receive either TAP block (ropivacaine 0.5%, 20 ml on each side) or sham block (isotonic saline 0.9%, 20 ml on each side). All patients had patient-controlled analgesia (PCA) with morphine...... and Nonsteroidal anti-inflammatory drugs (NSAID) treatment, had no effect on morphine consumption, VAS pain scores, or frequency of nausea and vomiting after robot-assisted laparoscopic hysterectomy compared with paracetamol and NSAID alone....

  19. Total Robotic Hysterectomy: Thailand’s First Case Report of Gynecologic Robotic Surgery

    Directory of Open Access Journals (Sweden)

    Korakot Sirimai

    2016-01-01

    Full Text Available Objective: This study aimed to report the feasibility, trouble shooting and surgical technique in the total robotic hysterectomy for the patient with adenomyoma uteri. Methods: A 51 year-old patient was diagnosed with adenomyosis. Total robotic hysterectomy was performed. Results: Total operating time was 350 min, estimated blood loss was 50 ml, and length of hospitalization was 6 days. The pathologic section revealed adenomyosis with myoma uteri. The intraoperative and post-operative complications were unremarkable. The patient was in good conditions at 6th week, 3rd, 6th, 12th and 24th month. Conclusion: Total robotic hysterectomy for benign gynecologic condition, such as adenomyosis, is safe and feasible. However, the sustained high consuming cost must be weighted with the patient’s advantages.

  20. Health resource utilization and costs during the first 90 days following robot-assisted hysterectomy.

    Science.gov (United States)

    Dandolu, Vani; Pathak, Prathamesh

    2017-08-07

    To compare health resource utilization, costs and readmission rates between robot-assisted and non-robot-assisted hysterectomy during the 90 days following surgery. The study used 2008-2012 Truven Health MarketScan data. All patients admitted as inpatients with a CPT code for hysterectomy between January 2008 and September 2012 were identified and the first hysterectomy-related admission in each patient was included. Patients were categorized based on the route of their hysterectomy and the use of laparoscopy as: total abdominal hysterectomy, vaginal hysterectomy (VH), laparoscopy-assisted supracervical hysterectomy, laparoscopy-assisted vaginal hysterectomy' and total laparoscopic hysterectomy (TLH). Hospitalization costs, including hospital, physician, pharmacy and facility costs, were calculated for the index admissions and for the 90-day follow-up periods. Health resource utilization was determined in terms of inpatient readmissions, outpatient visits, and emergency room visits, RESULTS: There were 302,923 hysterectomies performed over 5 years for benign indications in the inpatient setting (55% abdominal, 17% vaginal, and 28% laparoscopic). Concurrent use of robot assistance steadily increased and was reported in 50% of TLH procedures in 2012. The rates of readmission overall were 4.9% for robot-assisted procedures and 4.3% for procedures without robot assistance (OR 0.89, CI 0.82-0.97). Readmission rates were lowest for VH (3.2%) and highest for TLH (5.6%). Following robot-assisted hysterectomy and VH, 8.3% and 4.6% of patients, respectively, had more than ten outpatient visits in the 90-day follow-up period. The average total cost for 90 days was $16,820 for robot-assisted hysterectomy and $13,031 for procedures without robot assistance. Of the additional costs for robot-assisted surgery, 25% were incurred in the 90-day follow-up period. The study using private insurance data found that robot-assisted hysterectomy was associated with higher health

  1. Length of Catheter Use After Hysterectomy as a Risk Factor for Urinary Tract Infection.

    Science.gov (United States)

    Karp, Natalie E; Kobernik, Emily K; Kamdar, Neil S; Fore, Amanda M; Morgan, Daniel M

    2017-09-13

    The aims of this study were to determine the effect of length of postoperative catheterization on risk of urinary tract infection (UTI) and to identify risk factors for postoperative UTI. This was a retrospective case-control study. Demographic and perioperative data, including duration of indwelling catheter use and postoperative occurrence of UTI within 30 days of surgery, were analyzed for hysterectomies using the Michigan Surgical Quality Collaborative database. Catheter exposure was categorized as low-no catheter placed/catheter removed the day of surgery, intermediate-catheter removed postoperative day 1, high-catheter removal on postoperative day 2 or later, or highest-patient discharged home with catheter. A multivariable logistic regression model was developed to identify factors associated with UTI. An interaction term was included in the final model. Overall, UTI prevalence was 2.3% and increased with duration of catheter exposure (low: 1.3% vs intermediate: 2.1% vs high: 4.1% vs highest: 6.5%, P < 0.0001). High (odds ratio [OR] = 2.54 [1.51-4.27]) and highest (OR = 3.39 [1.86-6.17]) catheter exposure, operative time (OR = 1.15 [1.03-1.29]), and dependent functional status (OR = 4.62 [1.90-11.20]) were independently associated with UTI. Women who had a vaginal hysterectomy with sling/pelvic organ prolapse repair were more likely to have a UTI than those who had a vaginal hysterectomy alone (OR = 2.58 [1.10-6.07]) and more likely to have a UTI than women having an abdominal or laparoscopic hysterectomy with a sling/pelvic organ prolapse repair (OR = 2.13 [1.12-4.04]). Length of catheterization and operative time are modifiable risk factors for UTI after hysterectomy. An interaction between vaginal hysterectomy and concomitant pelvic reconstruction increases the odds of UTI.

  2. Laparoscopic hysterectomy in the overweight and obese: does 3D imaging make a change?

    Science.gov (United States)

    Berlit, Sebastian; Hornemann, Amadeus; Sütterlin, Marc; Weiss, Christel; Tuschy, Benjamin

    2017-01-01

    To evaluate the influence of three-dimensional (3D) high-definition (HD) visualisation in laparoscopic hysterectomy in normal weight, overweight and obese women. A retrospective analysis of 180 patients undergoing total laparoscopic hysterectomy (TLH: n = 90) or laparoscopic supracervical hysterectomy (LASH: n = 90) was performed. The study collective consisted of 90 women (TLH: n = 45, LASH: n = 45), who underwent laparoscopic hysterectomy with a 3D HD laparoscopic system. Ninety matched (uterine weight, previous surgeries) women with hysterectomy (TLH: n = 45, LASH: n = 45) performed by the same surgeon with conventional two-dimensional laparoscopy formed the control group. Statistical analysis was accomplished stratifying patients according to body mass index (BMI) (≤24.9, 25-29.9, ≥30.0 kg/m(2)). In each BMI, collective subtypes of surgery (TLH, LASH) as well as hysterectomies as a whole were analysed. Demographic data and surgical parameters were evaluated. In all BMI subgroups, there were no significant differences concerning demographic parameters. Number of trocar site incisions needed was significantly less in women undergoing 3D compared to 2D laparoscopy independent of BMI. Furthermore, a significantly lower blood loss was revealed using 3D visualisation in LASH subgroups of the normal and overweight collectives. Three-dimensional laparoscopy was additionally associated with a significantly shorter duration of surgery in the TLH subgroup in overweight patients and a lower haemoglobin drop in the LASH subgroup of the obese. The need of less trocar site incisions concerning all weight groups as well.

  3. [Risk factors of peripartum hysterectomy in placenta previa: a retrospective study of 3 840 cases].

    Science.gov (United States)

    Lyu, B; Chen, M; Liu, X X

    2016-07-25

    To investigate the risk factors of peripartum hysterectomy in placenta previa through retrospective study of 3 840 placenta previa cases. The clinical data of 3 840 patients with placenta previa who delivered in West China Second University Hospital between Jan 2005 and June 2014 were analyzed retrospectively. The relationship of certain factors and peripartum hysterectomy was analyzed, including maternal age, residence place, parity, prior curettage, prior cesarean section, twin or multiple pregnancy, antenatal vaginal bleeding, type of placenta previa, suspected placenta accreta, antenatal level of hemoglobin and gestational age at delivery. The prevalence of placenta previa was 4.84%(3 840/79 304)in West China Second University Hospital during the study period, and the incidence of preipartum hysterectomy in patients with placenta previa was 2.76%(106/3 840). One-factor analysis demonstrated that residence place, parity, times of prior curettage, prior cesarean section, prenatal vaginal bleeding, anterior placenta, type of placenta previa, placenta accreta, antenatal anemia and gestational age at delivery were potential risk factors for peripartum hysterectomy(Pplacenta(OR=4.8, 95%CI:2.1-10.7), complete placenta previa(OR=5.9, 95%CI: 1.8-42.5), placenta accreta(OR=11.2, 95%CI:6.8-18.6), antenatal hemoglobinplacenta previa(Pplacenta, complete placenta previa, placenta accreta, antenatal anemia and delivery before 34 gestational weeks are high risk factors of peripartum hysterectomy in placenta previa patients. Perinatal care and risk evaluation before cesarean section are important to improve perinatal outcomes and reduce peripartum hysterectomy.

  4. Risks and benefits of opportunistic salpingectomy during vaginal hysterectomy: a decision analysis.

    Science.gov (United States)

    Cadish, Lauren A; Shepherd, Jonathan P; Barber, Emma L; Ridgeway, Beri

    2017-06-12

    Fallopian tubes are commonly removed during laparoscopic and open hysterectomy to prevent ovarian and tubal cancer but are not routinely removed during vaginal hysterectomy because of perceptions of increased morbidity, difficulty, or inadequate surgical training. We sought to quantify complications and costs associated with a strategy of planned salpingectomy during vaginal hysterectomy. We created a decision analysis model using TreeAgePro. Effectiveness outcomes included ovarian cancer incidence and mortality as well as major surgical complications. Modeled complications included transfusion, conversion to laparotomy or laparoscopy, abscess/hematoma requiring intervention, ileus, readmission, and reoperation within 30 days. We also modeled subsequent benign adnexal surgery beyond the postoperative window. Those whose procedures were converted from a vaginal route were assumed to undergo bilateral salpingectomy, regardless of treatment group, following American College of Obstetricians and Gynecologists guidelines. Costs were gathered from published literature and Medicare reimbursement data, with internal cost data from 892 hysterectomies at a single institution used to estimate costs when necessary. Complication rates were determined from published literature and from 13,397 vaginal hysterectomies recorded in the National Surgical Quality Improvement Program database from 2008 through 2013. Switching from a policy of vaginal hysterectomy alone to a policy of routine planned salpingectomy prevents a diagnosis of ovarian cancer in 1 of every 225 women having surgery and prevents death from ovarian cancer in 1 of every 450 women having surgery. Overall, salpingectomy was a less expensive strategy than not performing salpingectomy ($7350.62 vs $8113.45). Sensitivity analysis demonstrated the driving force behind increased costs was the increased risk of subsequent benign adnexal surgery among women retaining their tubes. Planned opportunistic salpingectomy had

  5. Invasive mole of the uterus: A description of two cases managed by hysterectomy

    Directory of Open Access Journals (Sweden)

    Ahmed Samy El-agwany

    2015-12-01

    Full Text Available Gestational trophoblastic disease (GTD is a term used for a group of pregnancy-related tumors. Gestational trophoblastic neoplasia (GTN, is recognized as the most curable gynecologic malignancy. However, many cases are resistant to first line chemotherapy. We present cases of invasive mole. They were diagnosed as a vesicular mole on ultrasonography and underwent suction and evacuation but vaginal bleeding recurred with plateau and rising B-hcg with intramyometrial vascular lesion. Hysterectomy was done that indicated invasive mole. Patients were cured of their symptoms. Surgical therapy (hysterectomy with chemotherapy has shown to achieve remission in these cases especially with resistance to chemotherapy and in perimenopause.

  6. Vaginal and Laparoscopic hysterectomy as an outpatient procedure: A systematic review.

    Science.gov (United States)

    Dedden, Suzanne J; Geomini, Peggy M A J; Huirne, Judith A F; Bongers, Marlies Y

    2017-09-01

    Laparoscopic and vaginal hysterectomies are common gynaecological procedures. Same-day discharge is usual care in various gynaecological procedures like laparoscopic sterilisation and laparoscopic oophorectomies. In major procedures like vaginal or laparoscopic hysterectomy patients are usually admitted overnight. We systematically reviewed the literature to identify complications, risk factors for (re)admittance, financial consequences and patient satisfaction of same-day discharge after a vaginal or laparoscopic hysterectomy. We systematically searched PubMed, UptoDate, Embase, Cochrane and CINAHL database from inception until July 16th 2016. We selected randomized controlled trials, prospective and retrospective cohort studies assessing the safety and feasibility of same-day discharge after vaginal or laparoscopic hysterectomy. The outcome parameters that were assessed were admission rate, re-admission rate, minor and major complications, patient satisfaction and financial consequences. 27 articles were included in the systematic review. All studies provided data about the admission rate and therefore failure of same-day discharge. Eleven prospective studies were included which compromised a total of 2391 hysterectomies. The percentage of overnight admissions was median 9.3% [0-25%]. Eight retrospective studies, which screened their patients before undergoing an outpatient hysterectomy, showed in 1500 subjects a mean admission rate of 10% [4,4-64%]. Four retrospective studies, which considered a large total cohort of 142,799 hysterectomies had a mean admission rate of 59,7% [48-79%]. The overall re-admission rate was low, varying from 0.73-4.0%. Minor complications were reported in respectively 4,3% and 7,3% in prospective respectively retrospective trials. Major complications were described in 0.7%-3.6% of all cases. Generally high satisfaction rates were reported in the observational trials. Same-day discharge after laparoscopic and vaginal hysterectomy seems

  7. [Life threatening postpartal haemorrhage after rupture of the vagina, uterine cervix, caesarean section or hysterectomy].

    Science.gov (United States)

    Kozovski, I; Radoinova, D

    2010-01-01

    The authors discuss 10 cases--seven after vaginal and cervical rupture, 2 after Caesarean section and 1 after hysterectomy. Six of them died--5 after rupture of the vagina and cervix and one after Caesarean section. The lethal issue was avoidable in all cases because it was a result of untimely done or not done at all hysterectomy and other interventions, e.g., ligation of the hypogastric arteries, as well as of faulty surgical performance. Basic principles of surgical behavior in such cases are postulated.

  8. Vaginal hysterectomy for benign uterine disease in the laparoscopically confirmed frozen pelvis.

    Science.gov (United States)

    Pelosi, M A; Pelosi, M A

    1997-12-01

    Extensive pelvic adhesions present difficulty with access to the uterus, but they may not account for significant symtomatology, although their dissection may account for a significant deal of morbidity. Results of this study are based on a retrospective analysis of operations by a single surgical team. Eight patients with benign uterine pathology and frozen pelvis diagnosed laparoscopically underwent vaginal hysterectomy. The surgeries were accomplished uneventfully and without significant perioperative morbidity. This approach appears to be an efficient surgical option for hysterectomy, which by-passes the need for and the potential morbidity of an extensive intra-abdominal adhesiolysis by laparotomy or laparoscopy.

  9. Association of Previous Cesarean Delivery With Surgical Complications After a Hysterectomy Later in Life.

    Science.gov (United States)

    Lindquist, Sofie A I; Shah, Neel; Overgaard, Charlotte; Torp-Pedersen, Christian; Glavind, Karin; Larsen, Thomas; Plough, Avery; Galvin, Grace; Knudsen, Aage

    2017-08-09

    In recent decades, the global rates of cesarean delivery have rapidly increased. Nonetheless, the influence of cesarean deliveries on surgical complications later in life has been understudied. To investigate whether previous cesarean delivery increases the risk of reoperation, perioperative and postoperative complications, and blood transfusion when undergoing a hysterectomy later in life. This registry-based cohort study used data from Danish nationwide registers on all women who gave birth for the first time between January 1, 1993, and December 31, 2012, and underwent a benign, nongravid hysterectomy between January 1, 1996, and December 31, 2012. The dates of this analysis were February 1 to June 30, 2016. Cesarean delivery. Reoperation, perioperative and postoperative complications, and blood transfusion within 30 days of a hysterectomy. Of the 7685 women (mean [SD] age, 40.0 [5.3] years) who met the inclusion criteria, 5267 (68.5%) had no previous cesarean delivery, 1694 (22.0%) had 1 cesarean delivery, and 724 (9.4%) had 2 or more cesarean deliveries. Among the 7685 included women, 3714 (48.3%) had an abdominal hysterectomy, 2513 (32.7%) had a vaginal hysterectomy, and 1458 (19.0%) had a laparoscopic hysterectomy. In total, 388 women (5.0%) had a reoperation within 30 days after a hysterectomy. Compared with women having vaginal deliveries, fully adjusted multivariable analysis showed that the adjusted odds ratio of reoperation for women having 1 previous cesarean delivery was 1.31 (95% CI, 1.03-1.68), and the adjusted odds ratio was 1.35 (95% CI, 0.96-1.91) for women having 2 or more cesarean deliveries. Perioperative and postoperative complications were reported in 934 women (12.2%) and were more frequent in women with previous cesarean deliveries, with adjusted odds ratios of 1.16 (95% CI, 0.98-1.37) for 1 cesarean delivery and 1.30 (95% CI, 1.02-1.65) for 2 or more cesarean deliveries. Blood transfusion was administered to 195 women (2.5%). Women having

  10. Prophylactic salpingectomy in women undergoing hysterectomy for benign gynaecological disease - a new Danish recommendation

    DEFF Research Database (Denmark)

    Sloth, Sigurd Beier; Gimbel, Helga; Jørgensen, Annemette

    , 282, 158) met the inclusion criteria. The quality of evidence for all critical and important outcomes was rated very low. For the critical outcomes evidence from one OS showed fewer reoperations (RR 0.33 95% CI 0.1 to 1.06) and operations on salpinx (RR 0.15 95% CI 0.01 to 2.46) after hysterectomy...... with concomitant bilateral salpingectomy compared to women undergoing hysterectomy without bilateral salpingectomy. Based on the available evidence, the balance between benefits and harms and patient values and preferences, the guideline panel gave a weak recommendation for concomitant bilateral salpingectomy...

  11. Incidence of postpartum post-cesarean hysterectomy at the Institute of gynecology and obstetrics, Clinical center of Serbia, Belgrade

    Directory of Open Access Journals (Sweden)

    Sparić Radmila

    2007-01-01

    Full Text Available Introduction. Postpartum hysterectomy means hysterectomy at least 6 weeks after delivery or cesarean section. It is usually performed in life-threatening situations. Incidence of postpartum hysterectomy varies from 0.02% to 0.3% of total number of deliveries. Objective. The aim of this study was to show and compare the incidence of postpartum hysterectomy after the cesarean section at the Institute of Gynecology and Obstetrics, Clinical Center of Serbia. We compared two five-year periods: the first period 1987-1982 and the second 2000-2004. Method. The retrospective study analyzed all patients treated at the Institute of Gynecology and Obstetrics who had had hysterectomy until six weeks after vaginal delivery or cesarean section. We analyzed the number of deliveries and the number of postpartum hysterectomies. Results. There were 50,467 deliveries (3,542 cesarean sections and 91 postpartum hysterectomies (70 or 76.92% after cesarean section in the first period. In the second period, there were 34,035 deliveries (7,105 cesarean sections and 64 hysterectomies (39 or 60.94 % after cesarean section. The overall incidence of postpartum hysterectomy was 1.98/1,000 in the first and 1.88/1,000 deliveries in the second period. The incidence of post-cesarean hysterectomy decreased from 19.76/1,000 in the first period to 5.49/1,000 in the second period. Conclusion. It is crucial for each obstetrician to cautiously distinguish and reach an appropriate decision about the exact indications for cesarean delivery having in mind growing incidence of cesarean sections, which is the main risk factor for puerperal morbidity and mortality. .

  12. The Radicalization Puzzle [video

    OpenAIRE

    Mohammed Hafez; Center for Homeland Defense and Security Naval Postgraduate School

    2015-01-01

    This 20 minute lecture, by Dr. Mohammad Hafez of the Naval Postgraduate School examines the driving factors behind the process of radicalization, turning seemingly ordinary men and women into potential terrorists. The lecture is based on the article "The Radicalization Puzzle: A Theoretical Synthesis of Empirical Approaches to Homegrown Extremism" in Studies in Conflict and Terrorism, by Mohammad Hafez and Creighton Mullins.

  13. Orgasm after radical prostatectomy

    NARCIS (Netherlands)

    Koeman, M; VanDriel, MF; Schultz, WCMW; Mensink, HJA

    1996-01-01

    Objective To evaluate the ability to obtain and the quality of orgasm after radical prostatectomy, Patients and methods The orgasms experienced after undergoing radical prostatectomy were evaluated in 20 men (median age 65 years, range 56-76) using a semi-structured interview and a self-administered

  14. ILIAC-ARTERY URETERAL-FISTULA ASSOCIATED WITH AN INDWELLING URETERAL STENT

    NARCIS (Netherlands)

    ZWEERS, HMM; VANDRIEL, MF; MENSINK, HJA

    1991-01-01

    We report on a patient with an ureteroiliac artery fistula, which developed after double J stenting. The stent was introduced because of unilateral hydronephrosis 2 months after a Wertheim-Meigs operation preceded by cesium application. The presenting symptom of gross hematuria was initially misjudg

  15. ILIAC-ARTERY URETERAL-FISTULA ASSOCIATED WITH AN INDWELLING URETERAL STENT

    NARCIS (Netherlands)

    ZWEERS, HMM; VANDRIEL, MF; MENSINK, HJA

    1991-01-01

    We report on a patient with an ureteroiliac artery fistula, which developed after double J stenting. The stent was introduced because of unilateral hydronephrosis 2 months after a Wertheim-Meigs operation preceded by cesium application. The presenting symptom of gross hematuria was initially misjudg

  16. Hysterectomy in Denmark 1977-2011: Changes in rate, indications, and hospitalization

    DEFF Research Database (Denmark)

    Lykke, Rune; Blaakær, J.; Ottesen, B.

    2013-01-01

    . The indication of pelvic organ prolapse and abnormal uterine bleeding increased while the indication of fibroids decreased. The average age of women at time of hysterectomy increased from 46 years in 1977-1981 to 50 years in 2006-2011. The mean number of hospitalization days was reduced by 75%. Regional...

  17. The tryptophan kynurenine pathway, neopterin and IL-6 during vulvectomy and abdominal hysterectomy.

    Science.gov (United States)

    Hol, Jaap Willem; Stolker, Robert J; Klimek, Markus; Stronks, Dirk L; Fekkes, Durk

    2014-12-20

    Surgery has wide ranging immunomodulatory properties of which the mechanism is poorly understood. In order to investigate how different types of surgery influence inflammation, we designed a longitudinal observational study investigating two inflammatory profiles of two separate patient groups undergoing gynaecological operations of differing severity. In addition to measuring the well known inflammatory markers neopterin and IL-6, we also determined the kynurenine/tryptophan ratio. This study was a prospective, single center, two-armed observational study involving 28 female patients. Plasma levels of tryptophan, kynurenine, neopterin and IL-6 were determined from samples taken at: 24 hrs pre-operative, prior to induction, ten minutes before the operation was expected to end, and at 24 and 96 hours post operative in patients undergoing abdominal hysterectomy and vulvectomy. There were 15 and 13 patients included in the vulvectomy and abdominal hysterectomy groups, respectively. In this study we show that anesthesia and surgery significantly increases the enzyme activity of indoleamine 2, 3 dioxygenase (IDO) as measured by the kynurenine/tryptophan ratio (P=0.003), while maintaining stable neopterin levels. However, abdominal hysterectomy causes a considerable IL-6 increase (P<0.001). Surgery and associated anesthesia cause a significant tryptophan level decrease while significantly increasing IDO activity. Both types of surgery produce nearly identical neopterin time curve relationships, with no significant change occurring in either group. However, even though neopterin is unaffected by the severity of surgery, IL-6 responded to surgical invasiveness by revealing a significant increase during abdominal hysterectomy.

  18. Prediction of peripartum hysterectomy and end organ dysfunction in major obstetric haemorrhage.

    LENUS (Irish Health Repository)

    O'Brien, D

    2010-12-01

    The aims of this study are to determine the incidence and aetiology of major obstetric haemorrhage (MOH) in our population, to examine the success rates of medical and surgical interventions and to identify risk factors for peripartum hysterectomy and end organ dysfunction (EOD).

  19. More Wounding Than Wounds: Hysterectomy, Phenomenology, and the Pain(s of Excorporation

    Directory of Open Access Journals (Sweden)

    Heather Hill-Vásquez

    2016-06-01

    Full Text Available Focusing on the pain experience of hysterectomy, this article applies and interrogates the foundational descriptive process on which phenomenology is based and suggests that feminism and phenomenology are more compatible than previously asserted. Building upon the work of feminist philosophers who have also explored how feminist and phenomenological approaches share similar methods and intentions—especially in connection with the former’s significant attention to lived experience as a source for the theory feminism employs—the article engages with the philosophies of Maurice Merleau-Ponty and Samuel Mallin who maintain a consistent attention to the body in their phenomenological approaches. Arguing that Mallin’s method of “body hermeneutics” is especially valuable for constructing a feminist phenomenological approach, the article applies Mallin’s theories to the hysterectomy experience, thus revealing how other female-coded experiences of pain, intrusion, shame, and vulnerability are intertwined with hysterectomy. Moreover, the article posits the pain experience of hysterectomy as a particularly emphatic form of phenomenological excorporation in which hidden and habituated assumptions—in this case, the previously unnoticed and unexamined association of a woman’s womb with what it means to be a woman—are painfully brought to light. As the womb becomes more present in the notion and reality of its absence, what does this mean for the many women who experience the shared phenomenon of hysterectomy—including feminist women who enter the experience with a more explicit understanding of themselves as gendered subjects?

  20. The impact of the body mass index (BMI) on laparoscopic hysterectomy for benign disease.

    Science.gov (United States)

    Bardens, David; Solomayer, Erich; Baum, Sascha; Radosa, Julia; Gräber, Stefan; Rody, Achim; Juhasz-Böss, Ingolf

    2014-04-01

    To investigate the influence of the body mass index (BMI) on laparoscopic hysterectomy, including all intra- and postoperative findings and complications. We reviewed and analyzed the medical records of 200 patients who underwent laparoscopic hysterectomy for benign disease at the Saarland University Hospital. The patient collective was subdivided into four weight groups on the basis of the current WHO BMI classification. Data analysis was carried out by a professional statistician. Over half of the women screened were overweight or obese. The operating times increased together with the BMI (p = 0.017). Blood losses differed significantly between the weight groups (p = 0.027), but ranged to a maximum of only 300 ml. One laparoconversion had to be performed. No other intraoperative complications occurred. During our follow-up time of 13.2 ± 5.4 months, the overall rate of postoperative complications differed significantly between the weight groups (p = 0.008). The group of overweight women had the highest rate of complications and the group of obese women had the lowest. However, the rate of women who required readmission and reoperation was not elevated in the overweight group. Laparoscopic hysterectomy is a safe and feasible method even in obese and morbidly obese patients. Overweight and obesity increase the time needed to perform laparoscopic hysterectomy but do not seem to relevantly influence the rate of major intra- or postoperative complications.

  1. Prophylactic antibiotics for hysterectomy and cesarean section: amoxicillin-clavulanic acid versus cefazolin

    Directory of Open Access Journals (Sweden)

    Jyoti Malik

    2016-04-01

    Conclusions: Broad spectrum amoxicillin-clavulanic acid was not superior to cefazolin in prevention of post-operative infection when given as prophylaxis in hysterectomy and elective cesarean section. [Int J Reprod Contracept Obstet Gynecol 2016; 5(4.000: 980-983

  2. Metastatic adenocarcinoma after laparoscopic supracervical hysterectomy with morcellation: A case report.

    Science.gov (United States)

    Turner, Taylor; Secord, Angeles Alvarez; Lowery, William J; Sfakianos, Gregory; Lee, Paula S

    2013-01-01

    •Uterine morcellation is common in minimally invasive hysterectomy but should be performed with caution due to risk of unsuspected malignancy.•Intraoperative techniques should be considered to minimize dissemination of endometrial tissue during morcellation.•Strategies to ensure accurate pathologic evaluation of morcellated specimens and to improve preoperative risk stratification before morcellation procedures are necessary.

  3. A six year review of hysterectomy for benign gynaecological conditions at the Federal Medical Centre, Owerri

    Directory of Open Access Journals (Sweden)

    Duke A. Onyeabochukwu

    2014-04-01

    Conclusions: Hysterectomy for benign gynaecological conditions is relatively common and safe in our centre, but there is need for improvement on the high post-operative morbidity rate. [Int J Reprod Contracept Obstet Gynecol 2014; 3(2.000: 352-356

  4. Does prolapse equal hysterectomy? The role of uterine conservation in women with uterovaginal prolapse.

    Science.gov (United States)

    Ridgeway, Beri M

    2015-12-01

    Hysterectomy has historically been a mainstay in the surgical treatment of uterovaginal prolapse, even in cases in which the removal of the uterus is not indicated. However, uterine-sparing procedures have a long history and are now becoming more popular. Whereas research on these operations is underway, hysteropexy for the treatment of prolapse is not as well studied as hysterectomy-based repairs. Compared with hysterectomy and prolapse repair, hysteropexy is associated with a shorter operative time, less blood loss, and a faster return to work. Other advantages include maintenance of fertility, natural timing of menopause, and patient preference. Disadvantages include the lack of long-term prolapse repair outcomes and the need to continue surveillance for gynecological cancers. Although the rate of unanticipated abnormal pathology in this population is low, women who have uterine abnormalities or postmenopausal bleeding are not good candidates for uterine-sparing procedures. The most studied approaches to hysteropexy are the vaginal sacrospinous ligament hysteropexy and the abdominal sacrohysteropexy, which have similar objective and subjective prolapse outcomes compared with hysterectomy and apical suspension. Pregnancy and delivery have been documented after vaginal and abdominal hysteropexy approaches, although very little is known about outcomes following parturition. Uterine-sparing procedures require more research but remain an acceptable option for most patients with uterovaginal prolapse after a balanced and unbiased discussion reviewing the advantages and disadvantages of this approach. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Laparoscopic supracervical hysterectomy with transcervical morcellation and sacrocervicopexy for the treatment of uterine prolapse.

    Science.gov (United States)

    Dessie, Sybil G; Park, Michele; Rosenblatt, Peter L

    2016-01-01

    The objective is to describe our surgical approach for management of uterine prolapse using 5-mm skin incisions and transcervical morcellation. This video presents a novel approach for laparoscopic supracervical hysterectomy, bilateral salpingectomy, and sacrocervicopexy using only 5-mm skin incisions and transcervical morcellation. The procedure begins with a laparoscopic supracervical hysterectomy with bilateral salpingectomy. A classic intrafascial supracervical hysterectomy (CISH) instrument is then used transvaginally to core the endocervical canal. A disposable morcellator is placed through the remaining cervix to morcellate the uterus and fallopian tubes. Following morcellation, the handle of the morcellator is removed, and it is used during the remainder of the surgery as an access cannula for the sacrocervicopexy. The polypropylene mesh is introduced through this cannula. It is secured to the anterior and posterior vaginal fascia with a suture that is also introduced through the transcervical port. At the conclusion of the surgery, a previously placed 0 Vicryl purse-string suture at the ectocervix is tied down as a cerclage around the cervix once the cannula is removed. The transcervical morcellation technique demonstrated in this video allows the surgeon to maintain 5-mm skin incisions and core the endocervical canal during a laparoscopic supracervical hysterectomy with sacrocervicopexy.

  6. Hysterectomy and its impact on the calculated incidence of cervical cancer and screening coverage in Denmark

    DEFF Research Database (Denmark)

    Lam, Janni Uyen Hoa; Lynge, Elsebeth; Njor, Sisse Helle;

    2015-01-01

    BACKGROUND: The incidence rates of cervical cancer and the coverage in cervical cancer screening are usually reported by including in the denominator all women from the general population. However, after hysterectomy women are not at risk anymore of developing cervical cancer. Therefore, it makes...

  7. Danish gynecologists' opinion about hysterectomy on benign indication: results of a survey

    DEFF Research Database (Denmark)

    Gimbel, Helga; Ottesen, Bent; Tabor, Ann

    2002-01-01

    AIMS: To survey Danish gynecologists' recommendations concerning hysterectomy and its method for benign diseases. METHODS: A questionnaire of seven clinical cases was sent to all gynecologists in Denmark (n = 450). The gynecologists were asked to recommend one of 14 possible treatments as the mos...

  8. Peripartum hysterectomy in the first decade of the 21st century.

    LENUS (Irish Health Repository)

    Tadesse, W

    2012-02-01

    We reviewed the role of peripartum hysterectomy (PH) in the first decade of the 21st century. The study was confined to women who delivered a baby weighing 500 g or more between 2000 and 2009, and who required a hysterectomy within 72 h of delivery for obstetric reasons. Individual case records were reviewed. There were 19 cases of PH in 78,961 deliveries giving an incidence of 1 in 4,156 (0.02%). Of the 19 cases, 95% were delivered by caesarean section and 89% had one or more prior sections. The indications were placental bed pathology (79%), uterine atony (16%) and uterine trauma (5%). Of the 19 hysterectomies, 16 (84%) were total and a gynaecological oncologist was involved in nine (56%) of these cases. There were no maternal or fetal deaths, but a mother required an average blood transfusion of 10 units. The overall rate of PH was remarkably low compared with other studies but it is likely to increase in the future because of the strong association between increasing caesarean section rates and placental bed pathology. The potential involvement of the cervix and other pelvic structures by placental pathology means that PH in the future will be more challenging, and the hysterectomy will need to be total rather than subtotal.

  9. Multicenter analysis comparing robotic, open, laparoscopic, and vaginal hysterectomies performed by high-volume surgeons for benign indications.

    Science.gov (United States)

    Lim, Peter C; Crane, John T; English, Eric J; Farnam, Richard W; Garza, Devin M; Winter, Marc L; Rozeboom, Jerry L

    2016-06-01

    To compare perioperative outcomes between robotic-assisted benign hysterectomies and abdominal, vaginal, and laparoscopic hysterectomies when performed by high-volume surgeons. A multicenter data analysis compared 30-day outcomes from consecutive robotic-assisted hysterectomies performed by high-volume surgeons (≥60 prior procedures) at nine centers with records retrieved from the Premier Perspective database for abdominal, vaginal, and laparoscopic hysterectomies performed by high-volume gynecologic surgeons. Data on benign hysterectomy disorders from January 1, 2012 to September 30, 2013 were included. Data from 2300 robotic-assisted, 9745 abdominal, 8121 vaginal, and 11 952 laparoscopic hysterectomies were included. The robotic-assisted patient cohort had a significantly higher rate of adhesive disease compared with the vaginal (Plaparoscopic cohorts (Pobesity than the vaginal (Plaparoscopic cohorts (P250g) than the abdominal (Plaparoscopic cohorts (P=0.017). The robotic-assisted cohort experienced significantly fewer intraoperative complications than the abdominal (Physterectomy provided improved outcomes compared with abdominal, vaginal, and laparoscopic hysterectomy. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  10. Salvage robotic radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Samuel D Kaffenberger

    2014-01-01

    Full Text Available Failure of non-surgical primary treatment for localized prostate cancer is a common occurrence, with rates of disease recurrence ranging from 20% to 60%. In a large proportion of patients, disease recurrence is clinically localized and therefore potentially curable. Unfortunately, due to the complex and potentially morbid nature of salvage treatment, radical salvage surgery is uncommonly performed. In an attempt to decrease the morbidity of salvage therapy without sacrificing oncologic efficacy, a number of experienced centers have utilized robotic assistance to perform minimally invasive salvage radical prostatectomy. Herein, we critically evaluate the existing literature on salvage robotic radical prostatectomy with a focus on patient selection, perioperative complications and functional and early oncologic outcomes. These results are compared with contemporary and historical open salvage radical prostatectomy series and supplemented with insights we have gained from our experience with salvage robotic radical prostatectomy. The body of evidence by which conclusions regarding the efficacy and safety of robotic salvage radical prostatectomy can be drawn comprises fewer than 200 patients with limited follow-up. Preliminary results are promising and some outcomes have been favorable when compared with contemporary open salvage prostatectomy series. Advantages of the robotic platform in the performance of salvage radical prostatectomy include decreased blood loss, short length of stay and improved visualization. Greater experience is required to confirm the long-term oncologic efficacy and functional outcomes as well as the generalizability of results achieved at experienced centers.

  11. 3-dimensional versus conventional laparoscopy for benign hysterectomy: protocol for a randomized clinical trial.

    Science.gov (United States)

    Hoffmann, Elise; Bennich, Gitte; Larsen, Christian Rifbjerg; Lindschou, Jannie; Jakobsen, Janus Christian; Lassen, Pernille Danneskiold

    2017-09-07

    Hysterectomy is one of the most common surgical procedures for women of reproductive age. Laparoscopy was introduced in the 1990es and is today one of the recommended routes of surgery. A recent observational study showed that operative time for hysterectomy was significantly lower for 3-dimensional compared to conventional laparoscopy. Complication rates were similar for the two groups. No other observational studies or randomized clinical trials have compared 3-dimensional to conventional laparoscopy in patients undergoing total hysterectomy for benign disease. The objective of the study is to determine if 3D laparoscopy gives better quality of life, less postoperative pain, less per- and postoperative complications, shorter operative time, or a shorter stay in hospital and a faster return to work or normal life, compared to conventional laparoscopy for benign hysterectomy. The design is a randomised multicentre clinical trial. Participants will be 400 women referred for laparoscopic hysterectomy for benign indications. Patients will be randomized to 3-dimensional or conventional laparoscopic hysterectomy. Operative procedures will follow the same principles and the same standard whether the surgeon's vision is 3-dimensional or conventional laparoscopy. Primary outcomes will be the impact of surgery on quality of life, assessed by the SF 36 questionnaire, and postoperative pain, assessed by a Visual Analogue scale for pain measurement. With a standard deviation of 12 points on SF 36 questionnaire, a risk of type I error of 3.3% and a risk of type II error of 10% a sample size of 190 patients in each arm of the trial is needed. Secondarily, we will investigate operative time, time to return to work, length of hospital stay, and - and postoperative complications. This trial will be the first randomized clinical trial investigating the potential clinical benefits and harms of 3-dimensional compared to conventional laparoscopy. The results may provide more evidence

  12. Outcomes of obese versus non-obese subjects undergoing robotic-assisted hysterectomy: a multi-institutional study.

    Science.gov (United States)

    Davenport, W B; Lowe, M P; Chamberlin, D H; Kamelle, S A; Johnson, P R; Tyndall, M; Tillmanns, T D

    2013-03-01

    The goal of our study was to determine whether there was a difference in operative outcomes in obese versus non-obese subjects undergoing robotic-assisted hysterectomies of varying levels of difficulty. Secondarily, we sought to analyze the published outcomes between robotic-assisted hysterectomy and total laparoscopic hysterectomy in obese women at each of these levels of difficulty. This was a multi-institutional retrospective cohort study of all patients undergoing robotic-assisted hysterectomy by five gynecologic oncologists at four geographically separate locations from April 2003 to March 2008. The cohort was stratified into obese vs. non-obese groups, and defined surgical outcomes compared between groups, then further divided into three subgroups based on case difficulty level. Univariate analysis and regression analysis using SAS 9.1 was performed. We then conducted a literature search of total laparoscopic hysterectomy outcomes in obese women, dividing the resulting studies into three comparative subgroups based on surgical difficulty levels for comparison with our robotic-assisted hysterectomy results. Our cohort had 228 obese and 323 non-obese subjects. Overall, the obese group had higher blood loss and longer operative time. When further stratified by level of difficulty, obese subjects also had a higher average blood loss and longer operative time in the hysterectomy-alone subgroup. No clinically significant differences in operative outcomes exist between obese and non-obese women when utilizing the da Vinci robotic system to perform a hysterectomy, independent of case difficulty level. More prospective, controlled studies which compare the two surgical approaches of robotic-assisted and laparoscopic hysterectomy approaches are needed.

  13. Gnosticism and Radical Feminism

    DEFF Research Database (Denmark)

    Cahana, Jonathan

    2016-01-01

    and radical feminism would easily fall under this definition. There is, however, one major difference: since radical feminism is a relatively recent phenomenon which also benefited from modern modes of text production and preservation, almost all of the sources are still with us. This, in turn, may allow us...... to use radical feminism to make certain aspects of ancient Gnosticism re-emerge from their long submersion, provided that enough similarities can be independently drawn between the two phenomena to merit such a comparison. This paper therefore presents a comparison between concepts and positions...

  14. Radical aminomethylation of imines.

    Science.gov (United States)

    Fujii, Shintaro; Konishi, Takehito; Matsumoto, Yusuke; Yamaoka, Yousuke; Takasu, Kiyosei; Yamada, Ken-Ichi

    2014-09-05

    Taking advantage of the high level of performance of N-alkoxycarbonyl-imines, we achieved the first example of addition of the aminomethyl radical to imine. The reaction efficiency depended on the structure of the radical precursor, whether it is an iodide or a xanthate, and an electron-withdrawing group on the nitrogen atom of the radical. This reaction allows direct introduction of an N-substituted aminomethyl group onto imine to provide 1,2-diamine as well as the short-step synthesis of ICI-199,441.

  15. Radical chemistry of artemisinin

    Energy Technology Data Exchange (ETDEWEB)

    Denisov, Evgenii T; Solodova, S L; Denisova, Taisa G [Institute of Problems of Chemical Physics, Russian Academy of Sciences, Chernogolovka, Moscow Region (Russian Federation)

    2010-12-29

    The review summarizes physicochemical characteristics of the natural sesquiterpene peroxide artemisinin. The kinetic schemes of transformations of artemisinin radicals under anaerobic conditions are presented and analyzed. The sequence of radical reactions of artemisinin in the presence of oxygen is considered in detail. Special emphasis is given to the intramolecular chain oxidation resulting in the transformation of artemisinin into polyatomic hydroperoxide. The kinetic characteristics of elementary reaction steps involving alkyl, alkoxyl, and peroxyl radicals generated from artemisinin are discussed. The results of testing of artemisinin and its derivatives for the antimalarial activity and the scheme of the biochemical synthesis of artemisinin in nature are considered.

  16. Radical chemistry of artemisinin

    Science.gov (United States)

    Denisov, Evgenii T.; Solodova, S. L.; Denisova, Taisa G.

    2010-12-01

    The review summarizes physicochemical characteristics of the natural sesquiterpene peroxide artemisinin. The kinetic schemes of transformations of artemisinin radicals under anaerobic conditions are presented and analyzed. The sequence of radical reactions of artemisinin in the presence of oxygen is considered in detail. Special emphasis is given to the intramolecular chain oxidation resulting in the transformation of artemisinin into polyatomic hydroperoxide. The kinetic characteristics of elementary reaction steps involving alkyl, alkoxyl, and peroxyl radicals generated from artemisinin are discussed. The results of testing of artemisinin and its derivatives for the antimalarial activity and the scheme of the biochemical synthesis of artemisinin in nature are considered.

  17. EFFECTIVENESS OF SCHEDULED AMBULATION ON EARLY POSTOPERATIVE OUTCOME AMONG PATIENTS WHO HAVE UNDERGONE ABDOMINAL HYSTERECTOMY

    Directory of Open Access Journals (Sweden)

    Rinku Girija

    2017-01-01

    Full Text Available BACKGROUND Abdominal hysterectomy is one of the most frequently performed surgical procedures in women. The non-ambulatory postoperative period is a high risk period for the development of various complications like wound infection, venous stasis, lower respiratory infection, secondary haemorrhage, deep vein thrombosis, pulmonary embolism, paralytic ileus etc. Prolonged surgery, delayed ambulation and not feeding the patient within 48 hours of surgery are often associated with post-operative morbidity and mortality. This study aims to assess the effectiveness of Scheduled Ambulation on early post-operative outcome among patients undergone abdominal hysterectomy by introduction of Scheduled Ambulation from second day of surgery. MATERIALS AND METHODS Method used is quantitative and quasi experimental post-test control method. Scheduled ambulation technique and pattern were taught pre operatively to 35 patients consecutively selected from general and post-operative ward who formed the experimental group. They were given scheduled ambulation from second to fifth post-operative days and results analysed. Another 35 patients taken as control were given the routine post-operative care. Data Analysis- was performed using SPSS version 17.0. Between group comparisons, quantitative variables analysed by Chisquare test p value >0, 05 considered significant. RESULTS The indication of hysterectomy was fibroid uterus in 80% of the control group and 88, 6% of the experimental group. 51.4% of the hysterectomies were encountered in the age group 40-49 years. There was a statistically significant reduction in the severity of pain, fatigue, postural hypotension and risk for developing Deep vein thrombosis in the experimental group on practicing Scheduled Ambulation from second to fifth post-operative days. CONCLUSION Scheduled ambulation helped the abdominal hysterectomy patients to recover from fatigue, pain, postural hypotension and risk for Deep vein thrombosis

  18. Pattern of mental ill health morbidities following hysterectomy for benign gynaecological disorders among Nigerian women

    Directory of Open Access Journals (Sweden)

    Morhason-Bello Imran O

    2009-07-01

    Full Text Available Abstract Objective to compare the pre and post hysterectomy mental ill health (MIH status and also, to determine whether there is any association with the surgical indication. Methodology An observational study, conducted among women scheduled for hysterectomy at the University College Hospital, Ibadan from January till June 2005. The MIH morbidities were assessed using a validated general health questionnaire (GHQ before and after the surgery by trained research assistant. The score of 4 and above was used as the cut off. Cross tabulations were performed to detect any association and also to compare pre and post hysterectomy mental health status. The level of statistical significance was set at P Results Of the 50 women recruited, 45 participated in the study. The age range of the participants was 35 to 63 years with a mean of 48.6 (SD = 0.6 years. Anxiety related disorder was present in 20 (44.4%, and depression in 3 (6.7% before hysterectomy. Post surgery, there was significant increase in those with anxiety by 6.8% and a reduction in the proportion of depressive illness by 2.3%. Uterine fibroid as a preoperative diagnosis, had significant association among those with anxiety related disorder (68.4% and depression (10.5%. Conclusion This study suggests that mental ill health may complicates hysterectomy for benign uterine pathology among Nigerian women, and that anxiety related disorders increases after operation with the highest proportion in those with clinical diagnosis of Uterine Fibroid. We recommend adequate preoperative counseling using properly trained psychologists when affordable to minimize these morbidities.

  19. Body mass and risk of complications after hysterectomy on benign indications.

    Science.gov (United States)

    Osler, Merete; Daugbjerg, Signe; Frederiksen, Birgitte Lidegaard; Ottesen, Bent

    2011-06-01

    This study examines BMI in relation to risk of complications after hysterectomy on benign indications, and explores whether any associations vary by route of surgery. In this cohort study, we included data on health and lifestyle collected prospectively for all hysterectomy referrals for benign indications in Denmark from 2004 to 2009. Logistic regression was used to investigate relationship between BMI and complications reported at surgery or during the first 30 days after surgery. RESULTS; Of the 20 353 women with complete data, 6.0% had a BMI obese). The overall rate of complications was 17.6%, with bleeding being the most common specific complication (6.8%). After adjustment for age, ethnicity, education, indication for surgery, uterus weight, use of prophylaxis, American Society of Anaesthesiologists classification, co-morbidity status and route of hysterectomy, obesity was associated with an increased risk of heavy bleeding during surgery [odds ratio (OR) = 3.64 (2.90-4.56)], all bleeding complications [OR = 1.27 (1.08-1.48)] and infection [OR = 1.47 (1.23-1.77)]. The risk of all bleeding complications [OR = 1.48 (1.28-1.82)] and re-operation [OR = 1.66 (1.26-2.17)] were also increased among women with a BMI hysterectomy (AH)]. The risk of infections was elevated among women with BMIlaparoscopic surgery [laparoscopic hysterectomy (LH)]. CONCLUSIONS; Obesity increases the risks of bleeding and infections after AH. A BMI below 20 seems to increase the risks of bleeding and infection after AH and LH, respectively.

  20. Robot-assisted total laparoscopic hysterectomy in obese and morbidly obese women.

    Science.gov (United States)

    Rebeles, Sonia A; Muntz, Howard G; Wieneke-Broghammer, Carrie; Vason, Emily S; McGonigle, Kathryn F

    2009-10-01

    Total laparoscopic hysterectomy (TLH) in obese patients is challenging. We sought to evaluate whether total laparoscopic hysterectomies using the da Vinci robotic system in obese patients, in comparison with non-obese patients, is a reasonable surgical approach. One-hundred consecutive robot-assisted TLHs were performed over a 17-month period. Obesity was not a contraindication to robotic surgery, assuming adequate respiratory function to tolerate Trendelenburg position and, for cancer cases, a small enough uterus to allow vaginal extraction without morcellation. Data were prospectively collected on patient characteristics, total operative time, hysterectomy time, estimated blood loss, length of stay, and complications. Outcomes with non-obese and obese women were compared. The median age, weight, and BMI of the 100 patients who underwent robot-assisted TLH was 57.6 years (30.0-90.6), 82.1 kg (51.9-159.6), and 30.2 kg/m(2) (19.3-60.2), respectively. Fifty (50%) patients were obese (BMI ≥ 30); 22 patients were morbidly obese (BMI ≥ 40). There was no increase in complications (p = 0.56) or blood loss (p = 0.44) with increasing BMI. While increased BMI was associated with longer operative times (p = 0.05), median time increased by only 36 min when comparing non-obese and morbidly obese patients. Median length of stay was one day for all weight categories (p = 0.42). Robot-assisted TLH is feasible and can be safely performed in obese patients. More data are needed to compare robot-assisted TLH with other hysterectomy techniques in obese patients. Nonetheless, our results are encouraging. Robot-assisted total laparoscopic hysterectomy may be the preferred technique for appropriately selected obese patients.

  1. Effect of body mass index on robotic-assisted total laparoscopic hysterectomy.

    Science.gov (United States)

    Nawfal, A Karim; Orady, Mona; Eisenstein, David; Wegienka, Ganesa

    2011-01-01

    To estimate the impact of body mass index (BMI) on the surgical outcomes of patients undergoing robotic-assisted total laparoscopic hysterectomy. Retrospective cohort study. Henry Ford Health System academic medical center (Henry Ford and Henry Ford West Bloomfield Hospitals) A total of 135 patients who underwent scheduled robotic-assisted total laparoscopic hysterectomy for benign indications, without concomitant urogynecologic procedures between January 2008 and June 2010. Patients underwent robotic-assisted total laparoscopic hysterectomy as the intention to treat. Two cases were converted to laparotomy. MEASUREMENTS & MAIN RESULTS: Electronic medical records of all patients that underwent robotic-assisted total laparoscopic hysterectomy at Henry Ford Health System were reviewed. Data on demographics, BMI (kg/m(2)), estimated blood loss, perioperative hemoglobin change, procedure duration, hospital length of stay, specimen weight, pathology, and postoperative complications were obtained. The women's median age was 45 years (range 30-68), 61.5% were black, and BMI ranged from 14.8-56.2 kg/m2; 23.4% of women were normal weight or less (BMI obese (BMI >30, n = 70) and 36 of these patients (27.1%) were morbidly obese (BMI ≥35). BMI did not correlate with procedure duration (Spearman r = .12, p = .16), length of stay (Spearman r = .10, p = .24), or estimated blood loss (Spearman r = .12, p =.18). Our analysis did not identify any meaningful associations between BMI and absolute change in hemoglobin. In addition BMI was not associated with an increase in major or minor complications. BMI is not associated with blood loss, duration of surgery, length of stay, or complication rates in patients undergoing robotic-assisted total laparoscopic hysterectomy. Robotic assistance may help surgeons overcome adverse outcomes sometimes found in obese patients. Copyright © 2011 AAGL. Published by Elsevier Inc. All rights reserved.

  2. Radiation Therapy Results of Invasive Cervical Carcinoma Found After Inappropriate Hysterectomy

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Doo Ho; Kim, Eun Seog; Nam, Kae Hyun; Huh, Seung Jae [Soonchunhyang University College of Medicine, Seoul (Korea, Republic of)

    1996-09-15

    Purpose : Hysterectomy without lymph node dissection was considered an inadequate treatment method for invasive uterine cervix cancer. Usually the procedure was performed inadvertently on patients who were thought to have benign or premalignant conditions preoperatively. We analysed radiotherapy results of such patients to evaluate survival rates, failure patterns and prognostic factors according to various conditions. Methods and Materials : Sixty one patients undergoing hysterectomy in the presence of invasive cervical carcinoma were reviewed retrospectively. Preoperative diagnosis were carcioma in situ (38 cases), severe dysplasia(2), myoma(6), uterine bleeding (4), uterine prolapse (2), and early invasive cervix cancer (10) (One patient had myoma and carcinoma in situ coincidently). Patients received postoperative megavoltage radiotherapy form August 1985 to December 1993, and minimum follow-up period was 24 months. Eight patients reveived ICR only, 6 patients ICR and external radiation, and 47 patients received external radiation therapy only. Results : Overall 5-year survival rate and relapse-free survival rate were 83.8%, 86.9% respectively. For patients with retrospective stage IA, IB, IIB (gross residual after surgery), and vaginal cuff recurrence were 90.9%, 88.8%, 38.4%, and 100% respectively. There were 8 cases of treatment failure, most of them (5/8) were in patients with gross residual disease, other patients were full thickness involvement of cervix wall (2/8) except one. Patients with early vaginal cuff recurrence and microinvasive cervical cncer (stage IA) had no treatment related failure. Prognostic factors affecting survival by univariate analysis were status of residual disease, tumor histology and retrospective stage. Conclusion : Adjuvant radiotherapy appeared to be effective treatment method for patients with presumed stage IA, IB and early local recurrent disease after inadvertent hysterectomy. Survivals for patients with gross disease

  3. Hysteropreservation versus hysterectomy in the surgical treatment of uterine prolapse: systematic review and meta-analysis.

    Science.gov (United States)

    de Oliveira, Sofia Andrade; Fonseca, Marcelo C M; Bortolini, Maria A T; Girão, Manoel J B C; Roque, Matheus T; Castro, Rodrigo A

    2017-08-05

    The efficacy and safety of removing or preserving the uterus during reconstructive pelvic surgery is a matter of debate. We performed a systematic review and meta-analysis of studies that compared hysteropreservation and hysterectomy in the management of uterine prolapse. PubMed, Medline, SciELO and LILACS databases were searched from inception until January 2017. We selected only randomized controlled trials and observational cohort prospective comparative studies. Primary outcomes were recurrence and reoperation rates. Secondary outcomes were: operative time, blood loss, visceral injury, voiding dysfunction, duration of catheterization, length of hospital stay, mesh exposure, dyspareunia, malignant neoplasia and quality of life. Eleven studies (six randomized and five non-randomized) were included involving 910 patients (462 in the hysteropreservation group and 448 in the hysterectomy group). Pooled data including all surgical techniques showed no difference between the groups regarding recurrence of uterine prolapse (RR 1.65, 95% CI 0.88-3.10; p = 0.12), but the risk of recurrence following hysterectomy was lower when the vaginal route was used with native tissue repair (RR 10.61; 95% CI 1.26-88.94; p = 0.03). Hysterectomy was associated with a lower reoperation rate for any prolapse compartment than hysteropreservation (RR 2.05; 95% CI 1.13-3.74; p = 0.02). Hysteropreservation was associated with a shorter operative time (mean difference -12.43 min; 95% CI -14.11 to -10.74 ; p uterine prolapse was not lower but the rate of reoperation for prolapse was lower following hysterectomy, while operative time was shorter and blood loss was less with hysteropreservation. The limitations of this analysis were the inclusion of nonrandomized studies and the variety of surgical techniques. The results should be interpreted with caution due to potential biases.

  4. The Incidence of Concomitant Precancerous Lesions in Cases Who Underwent Hysterectomy for Prolapse

    Directory of Open Access Journals (Sweden)

    Serdar Aydin

    2016-09-01

    Full Text Available Aim: The aim of the study was is to assess the incidence of unexpected gynecological cancers and pre-cancerous lesions following hysterectomy for pelvic organ prolapse to better understand the risks of uterine sparing surgery. Material and Method: This was a retrospective analysis of histopathology findings after hysterectomy for uterine prolapse surgery who underwent preoperative diagnostic work including cervical cytology, transvaginal ultrasonography and endometrial histopathological examination for a high risk group (Postmenopausal women with an endometrial thickness of %u22655 mm and premenopausal women with abnormal bleeding. Patients with a history of endometrial, cervical and/or adnexal precancerous or cancerous pathological conditions and with incomplete medical records were excluded.Results: Results were taken from 106 women who underwent hysterectomy. The abdominal route was used in 22 cases (21.7 %, the vaginal route in 82 patients (77.4 % and laparoscopic-assisted vaginal route in two (1.9 % women. Oophorectomy was performed in 35 (33 % cases. None of the patients had malignant histopathology specimens from hysterectomy. Total premalignant pathology incidence was 7.5 % (8/106. Six (5.7% patients had simple endometrial hyperplasia and 2 patients (1.9 % had cervical intraepithelial neoplasia. Discussion: The incidence of unexpected endometrial, cervical or ovarian malignancy among women who underwent hysterectomy after preoperative diagnostic workup including transvaginal ultrasonograhy, endometrial pathological examination to high risk cases was negligible. The inclusion of low risk endometrial and cervical precancerous lesions increased the incidences. Our results could provide precious data to extrapolate to similar populations with uterine prolapse who desire surgical correction sparing uterus.

  5. Comparison of robotic surgery and laparoscopy to perform total hysterectomy with pelvic adhesions or large uterus

    Directory of Open Access Journals (Sweden)

    Li-Hsuan Chiu

    2015-01-01

    Full Text Available Background: Currently, benefits of robotic surgery in patients with benign gynecological conditions remain unclear. In this study, we compared the surgical outcome of robotic and laparoscopic total hysterectomies and evaluated the feasibility of robotic surgery in cases with pelvic adhesions or large uterus. Materials and Methods: A total of 216 patients receiving total hysterectomy via robotic or laparoscopic approach were included in this study. Of all 216 patients, 88 underwent robotic total hysterectomy and 128 underwent laparoscopic total hysterectomy. All cases were grouped by surgical type, adhesion score, and uterine weight to evaluate the interaction or individual effect to the surgical outcomes. The perioperative parameters, including operation time, blood loss, postoperative pain score, time to full diet resumption, length of hospital stay, conversion rate, and surgery-related complications were compared between the groups. Results: Operation time and blood loss were affected by both surgical type and adhesion score. For cases with severe adhesions (adhesion score greater than 4, robotic surgery was associated with a shortened operation time (113.9 ± 38.4 min versus 164.3 ± 81.4 min, P = 0.007 and reduced blood loss (187.5 ± 148.7 mL versus 385.7 ± 482.6, P=0.044 compared with laparoscopy. Moreover, robotic group showed a lower postoperative pain score than laparoscopic group, as the effect was found to be independent of adhesion score or uterine weight. The grade-II complication rate was also found to be lower in the robotic group. Conclusions: Comparing to laparoscopic approach, robotic surgery is a feasible and potential alternative for performing total hysterectomy with severe adhesions.

  6. Comparison of results of Bakri balloon tamponade and caesarean hysterectomy in management of placenta accreta and increta: a retrospective study.

    Science.gov (United States)

    Pala, Şehmus; Atilgan, Remzi; Başpınar, Melike; Kavak, Ebru Çelik; Yavuzkır, Şeyda; Akyol, Alparslan; Kavak, Burçin

    2017-09-14

    The aim of this study was to compare the postoperative results of the patients who were treated with Bakri balloon tamponade or hysterectomy for placenta accreta and increta. Patients who were diagnosed with placenta accreta or increta preoperatively and intraoperatively and treated with Bakri balloon tamponade (Group 1) or caesarean hysterectomy (Group 2) were compared in regards to the postoperative results. Among the 36 patients diagnosed with placenta accreta or increta, 19 patients were treated with Bakri balloon tamponade while 17 cases were treated with hysterectomy. Intraoperative blood loss amount was 1794 ± 725 ml in G1, which was lower than that in G2 (2694 ± 893 ml). Blood transfusion amount was 2.7 ± 2.6 units in G1, lower than that in G2 (5.7 ± 2.4 units), too. Operation time was 64.5 ± 29 min and 140 ± 51 min in G1 and G2, respectively, showing significant differences between two groups. The success rate of Bakri balloon was determined as 84.21%. In conclusion, cases with placenta accreta/increta, with predicted placental detachment who are willing to preserve fertility, application of uterine balloon tamponade devices before the hysterectomy is encouraging with its advantages compared with the hysterectomy. Impact statement What is already known on this subject: Invasive placental anomalies are the most common indication of postpartum hysterectomy. Recently, uterine balloon tamponade was also included in the treatment modalities of postpartum haemorrhage.This study aimed to compare the postoperative results of UBT or hysterectomy for patients with placenta accreta and increta. What the results of this study add: In this study, the total amount of blood loss was higher in the caesarean hysterectomy group when compared with the Bakri balloon tamponade group. The mean transfusion requirement, mean operation time and hospitalisation period was significantly longer in the caesarean hysterectomy group. The success

  7. Radical prostatectomy - discharge

    Science.gov (United States)

    ... to 6 months. You will learn exercises (called Kegel exercises) that strengthen the muscles in your pelvis. ... Radical prostatectomy Retrograde ejaculation Urinary incontinence Patient Instructions Kegel exercises - self-care Suprapubic catheter care Urinary catheters - ...

  8. Validation of Nomograms for Survival and Metastases after Hysterectomy and Adjuvant Therapy in Uterine Cervical Cancer with Risk Factors

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    Won Sup Yoon

    2017-01-01

    Full Text Available Background. Three nomogram models for early stage uterine cervical cancer have been developed (KROG 13-03 for overall survival [OS], SNUH/AMC for disease-free survival [DFS], and KROG 12-08 for distant metastases-free survival [DMFS] after radical hysterectomy (RH and pelvic lymph node dissection (PLND. This study aimed to validate these models using our cohort with adjuvant radiotherapy. Methods. According to the eligibility criteria of nomogram studies, patients were enrolled in Group A (N=109 for the two KROG models (RH with PLND and whole pelvic irradiation and Group B (N=101 for the SNUH/AMC model (RH with PLND and squamous histology. Using Cox-regression hazard models, the prognostic factors of our cohorts were evaluated. The risk probabilities induced from published nomogram scores were calculated and the concordance indices were evaluated. Results. Group A had 88.1% 5-year OS and 86.0% 5-year DMFS. Group B had 83.0% 5-year DFS. In multivariate analyses, large tumor size for OS (HR 8.62, P<0.001 and DMFS (HR 5.13, P=0.003, young age (≤40 versus 41–64 years for OS (HR 4.63, P=0.097 and DFS (HR 3.44, P=0.051, and multiple lymph node metastases (0 versus ≥3 for DMFS (HR 4.03, P=0.031 and DFS (HR 3.90, P=0.038 were significantly correlated. The concordance indices for OS, DMFS, and DFS were 0.612 (P=0.002, 0.597 (P=0.014, and 0.587 (P=0.020, respectively. Conclusion. The developed nomogram models after RH and PLND are clinically useful in predicting various types of survival with significance.

  9. Free Radical Reactions in Food.

    Science.gov (United States)

    Taub, Irwin A.

    1984-01-01

    Discusses reactions of free radicals that determine the chemistry of many fresh, processed, and stored foods. Focuses on reactions involving ascorbic acid, myoglobin, and palmitate radicals as representative radicals derived from a vitamin, metallo-protein, and saturated lipid. Basic concepts related to free radical structure, formation, and…

  10. Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids : 10-year outcomes from the randomized EMMY trial

    NARCIS (Netherlands)

    de Bruijn, Annefleur M.; Ankum, Willem M.; Reekers, Jim A.; Birnie, Erwin; van der Kooij, Sanne M.; Volkers, Nicole A.; Hehenkamp, Wouter J. K.

    2016-01-01

    BACKGROUND: Since 1995 uterine artery embolization has been described as an alternative for hysterectomy in patients with symptomatic fibroids. Many studies including several randomized controlled trials established uterine artery embolization as a valuable treatment. These randomized controlled

  11. A retrospective study of emergency obstetric hysterectomy in a tertiary care center for a period of 5 years

    Directory of Open Access Journals (Sweden)

    Bhawna Sharma

    2016-11-01

    Conclusions: Emergency obstetric hysterectomy is a potentially lifesaving procedure which often puts obstetrician in dilemma at the time of decision making. [Int J Reprod Contracept Obstet Gynecol 2016; 5(11.000: 3778-3781

  12. Association of body mass index and morbidity after abdominal, vaginal, and laparoscopic hysterectomy.

    Science.gov (United States)

    Shah, Divya Kelath; Vitonis, Allison F; Missmer, Stacey A

    2015-03-01

    To examine the association of body mass index (BMI) and operative time and perioperative morbidity after hysterectomy and determine whether the association varies among abdominal, laparoscopic, and vaginal approaches. Data abstracted from the American College of Surgeons National Safety and Quality Improvement Project registry included 55,409 women who underwent hysterectomy for benign conditions between January 2005 and December 2012. The relationships among BMI, operative time, and morbidity were examined, adjusting for age, race, ethnicity, year of surgery, smoking, diabetes, and American Society for Anesthesiologists physical classification. Adjusted means, incidence rate ratios, or odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using linear, Poisson, or logistic regression, respectively. Body mass index was positively correlated with risk of wound complications and infection in women undergoing abdominal hysterectomy. Compared with those of normal BMI, women with BMIs 40 or higher had five times the odds of wound dehiscence (2.1% compared with 0.3%, crude OR 7.35, CI 3.78-14.30; adjusted OR 5.33, CI 2.63-10.8), five times the odds of wound infection (8.9% compared with 1.4%, crude OR 6.81, CI 5.00-9.27; adjusted OR 5.34, CI 3.85-7.41), and 89% higher odds of sepsis (1.3% compared with 0.6%, crude OR 2.39, CI 1.35-4.24; adjusted OR 1.89, CI 1.01-3.52). The magnitude of the association between wound infection and BMI was smaller after vaginal hysterectomy, and no increased odds of wound complications or sepsis were noted with a laparoscopic approach despite longer operative times. Operative time increased with BMI regardless of surgical approach. No associations were noted between BMI and hospital stay or thromboembolism. Obesity is associated with increased wound complications and infection in women undergoing abdominal hysterectomy and with longer operative times regardless of surgical approach. Vaginal or laparoscopic hysterectomy

  13. Comparison of robot-assisted total laparoscopic hysterectomy and total abdominal hysterectomy for treatment of endometrial cancer in obese and morbidly obese patients.

    Science.gov (United States)

    Nevadunsky, N; Clark, R; Ghosh, S; Muto, M; Berkowitz, R; Vitonis, A; Feltmate, C

    2010-12-01

    The objective of our study was to compare clinical and pathologic outcomes of robot-assisted and open abdominal techniques for treatment of uterine cancer in obese patients. Institutional review board approval was obtained. Patient demographic data, pathological data, and surgical data were collected by retrospective chart review. Data were analyzed using SAS statistical software. One-hundred and eighty-nine consecutive cases of suspected uterine cancer were identified from October 2003 until January 2009. Of these, 116 patients (61%) had a body mass index (BMI) over 30. There were 66 completed robot-assisted hysterectomies (RAHs), 43 total abdominal hysterectomies (TAHs), and seven patients that were converted from RAH to open abdominal hysterectomy. There were no significant differences in preoperative patient demographics, including body mass index (BMI), medical co-morbidities, or preoperative cytology, except for parity. There were no differences in postoperative grade, stage, lymph vascular space invasion, positive pelvic washings, mean number of pelvic lymph nodes, or proportion of patients undergoing pelvic lymphadenectomy. Length of stay and estimated blood loss were lower for the robotic technique; RAHs had a significantly longer operative time, however. Postoperative blood transfusions and wound infections were more frequent in the TAH group. Of the RAH group there were seven conversions to TAH (10%). Differences in surgical times with and without lymphadenectomy were least in patients in the largest BMI category of >50. Length of time required for RAH was significantly longer then TAH in obese and morbidly obese patients, however benefits to patients of a minimally invasive approach included reduced incidence of wound infections, reduced transfusion rates, reduced blood loss, and shortened length of stay. These data also suggest the greatest advantage of robotic technology over laparotomy in patients with BMI over 50.

  14. Woman experiencing gynecologic surgery: coping with the changes imposed by surgery.

    Science.gov (United States)

    Silva, Carolina de Mendonça Coutinho E; Vargens, Octavio Muniz da Costa

    2016-08-29

    to describe the feelings and perceptions resulting from gynecologic surgery by women and analyze how they experience the changes caused by the surgery. a qualitative, descriptive and exploratory study, which had Symbolic Interactionism and Grounded Theory as its theoretical framework. Participants of the study: 13 women submitted to surgery: Total Abdominal Hysterectomy, Total Abdominal Hysterectomy with bilateral Adnexectomy, Wertheim-Meigs surgery, Oophorectomy, Salpingectomy, Mastectomy, Quadrantectomy and Tracheloplasty. Individual interviews were conducted, recorded and analyzed according to the comparative analysis technique of the Grounded Theory. from the data two categories emerged - Perceiving a different body and feeling as a different person and; building the meaning of mutilation. The changes experienced make women build new meanings and change the perception of themselves and their social environment. From the interaction with their inner self, occurred a reflection on relationships, the difference in their body and themselves, the functions it performs and the harm caused by the surgery. the participants felt like different women; the mutilation developed in concrete feelings, due the loss of the organ, and in abstract, linked to the impact of social identity and female functionality. The importance of the nurse establishing a multidimensional care, to identify the needs that go beyond the biological body is perceived. descrever as sensações e percepções advindas das cirurgias ginecológicas pelas mulheres e analisar como elas vivenciam as mudanças geradas pelas cirurgias. estudo qualitativo, descritivo-exploratório, que teve o Interacionismo Simbólico e Grounded Theory como referencial teórico-metodológico. Participaram 13 mulheres submetidas às cirurgias: Histerectomia Total Abdominal, Histerectomia Total Abdominal com Anexectomia bilateral, cirurgia de Wertheim-Meigs, Ooforectomia, Salpingectomia, Mastectomia, Quadrantectomia e

  15. Comparison of Perioperative Outcomes of Total Laparoscopic and Robotically Assisted Hysterectomy for Benign Pathology during Introduction of a Robotic Program

    Directory of Open Access Journals (Sweden)

    Gokhan Sami Kilic

    2011-01-01

    Full Text Available Study Objective. Prospectively compare outcomes of robotically assisted and laparoscopic hysterectomy in the process of implementing a new robotic program. Design. Prospectively comparative observational nonrandomized study. Design Classification. II-1. Setting. Tertiary caregiver university hospital. Patients. Data collected consecutively 24 months, 34 patients underwent laparoscopic hysterectomy, 25 patients underwent robotic hysterectomy, and 11 patients underwent vaginal hysterectomy at our institution. Interventions. Outcomes of robotically assisted, laparoscopic, and vaginal complex hysterectomies performed by a single surgeon for noncancerous indications. Measurements and Main Results. Operative times were 208.3±59.01 minutes for laparoscopic, 286.2±82.87 minutes for robotic, and 163.5±61.89 minutes for vaginal (<.0001. Estimated blood loss for patients undergoing laparoscopic surgery was 242.7±211.37 cc, 137.4±107.50 cc for robotic surgery, and 243.2±127.52 cc for vaginal surgery (=0.05. The mean length of stay ranged from 1.8 to 2.3 days for the 3 methods. Association was significant for uterine weight (=0.0043 among surgery methods. Conclusion. Robotically assisted hysterectomy is feasible with low morbidity, a shorter hospital stay, and less blood loss. This suggests that robotic assistance facilitates a minimally invasive approach for patients with larger uterine size even during implementing a new robotic program.

  16. The risk of hydrosalpinx formation and adnexectomy following tubal ligation and subsequent hysterectomy: a historical cohort study.

    Science.gov (United States)

    Morse, Abraham N; Schroeder, Clayton B; Magrina, Javier F; Webb, Maurice J; Wollan, Peter C; Yawn, Barbara P

    2006-05-01

    The objective of the study was to further investigate a previous finding that tubal sterilization followed by hysterectomy was associated with hydrosalpinx formation. The Rochester Epidemiology Project (Rochester, MN) was used to identify three cohorts: women who had undergone tubal sterilization and subsequent hysterectomy, women who had undergone tubal sterilization alone, and women who had undergone hysterectomy alone. Four hundred seventy-three charts were reviewed and 337 met inclusion criteria. Patient histories were analyzed prospectively, looking for subsequent adnexal surgery. There was no increased risk of hydrosalpinx formation in patients who had undergone tubal sterilization and hysterectomy, compared with tubal sterilization alone. The proportion of subjects undergoing later adnexectomy for any reason was significantly higher in the hysterectomy groups, compared with the sterilization only group (relative risk 3.5, 95% confidence interval 1.3-9.4). This prospective study does not support the previously reported case-control data suggesting that tubal sterilization followed by hysterectomy resulted in an increased risk of hydrosalpinx formation, compared with tubal sterilization alone.

  17. Medium-term comparison of uterus preservation versus hysterectomy in pelvic organ prolapse treatment with Prolift™ mesh.

    Science.gov (United States)

    Huang, Li-Yi; Chu, Li-Ching; Chiang, Hsin-Ju; Chuang, Fei-Chi; Kung, Fu-Tsai; Huang, Kuan-Hui

    2015-07-01

    We conducted a medium-term assessment of clinical outcomes and complications after surgical repair of pelvic organ prolapse (POP) using Prolift™ mesh, and sought to determine whether concomitant hysterectomy clinically influenced the outcome of pelvic reconstruction in patients without a prior history of urogenital surgery. Patients diagnosed with POP-Q stage 3/4 uterine prolapse at a tertiary referral urogynecology unit in South Taiwan who had undergone POP repair with Prolift mesh from May 2007 to July 2010 were identified by chart review. Concomitant hysterectomy was performed in 24 patients (hysterectomy group), and uterus-sparing surgery in 78 (uterus-sparing group) Preoperative and postoperative subjective assessments of urinary and prolapse symptoms, objective POP-Q score, urodynamic examination, and postoperative adverse events were compared between the groups. The mean follow-up periods were 25.7 months (range 6.2 - 73.1 months) and 31.7 months (range 6.0 - 78.4 months) in the concomitant hysterectomy and uterus-sparing groups, respectively. There were no between-group differences in functional and anatomic outcomes after surgery. No statistically significant differences were found in postoperative adverse events between the groups. Pelvic reconstruction using Prolift with concomitant hysterectomy and uterus-sparing surgery have similar anatomic and functional results at 2.5 years. Therefore, we consider uterus-sparing surgery to be an alternative to hysterectomy in uterine prolapse repair.

  18. Sexuality Following Radical Prostatectomy

    DEFF Research Database (Denmark)

    Fode, Mikkel; Serefoglu, Ege C; Albersen, Maarten;

    2017-01-01

    INTRODUCTION: Radical prostatectomies can result in urinary incontinence and sexual dysfunction. Traditionally, these issues have been studied separately, and the sexual problem that has received the most focus has been erectile dysfunction. AIM: To summarize the literature on sexually related side...... effects and their consequences after radical prostatectomy and focus on the occurrence and management of problems beyond erectile dysfunction. METHODS: The literature on sexuality after radical prostatectomy was reviewed through a Medline search. Original research using quantitative and qualitative...... methodologies was considered. Priority was given to studies exploring aspects of sexuality other than erectile function. MAIN OUTCOME MEASURES: The prevalence, predictive factors, and management of post-prostatectomy sexual problems beyond erectile dysfunction. RESULTS: Most patients will develop urinary...

  19. Laparoscopic radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Lipke Michael

    2005-01-01

    Full Text Available Millions of men are diagnosed annually with prostate cancer worldwide. With the advent of PSA screening, there has been a shift in the detection of early prostate cancer, and there are increased numbers of men with asymptomatic, organ confined disease. Laparoscopic radical prostatectomy is the latest, well accepted treatment that patients can select. We review the surgical technique, and oncologic and functional outcomes of the most current, large series of laparoscopic radical prostatectomy published in English. Positive margin rates range from 2.1-6.9% for pT2a, 9.9-20.6% for pT2b, 24.5-42.3% for pT3a, and 22.6-54.5% for pT3b. Potency rates after bilateral nerve sparing laparoscopic radical prostatectomy range from 47.1 to 67%. Continence rates at 12 months range from 83.6 to 92%.

  20. Gangs, Terrorism, and Radicalization

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    Scott Decker

    2011-01-01

    Full Text Available What can street gangs tell us about radicalization and extremist groups? At first glance, these two groups seem to push the boundaries of comparison. In this article, we examine the important similarities and differences across criminal, deviant, and extremist groups. Drawing from research on street gangs, this article explores issues such as levels of explanation,organizational structure, group process, and the increasingly important role of technology and the Internet in the context of radicalization. There are points of convergence across these groups, but it is important to understand the differences between these groups. This review finds little evidence to support the contention that American street gangs are becoming increasingly radicalized. This conclusion is based largely on organizational differences between gangs and terror groups.

  1. Perioperative use of etoricoxib reduces pain and opioid side-effects after total abdominal hysterectomy

    DEFF Research Database (Denmark)

    Viscusi, Eugene R; Frenkl, Tara L; Hartrick, Craig T;

    2012-01-01

    -blind, placebo-controlled, randomized clinical trial, we evaluated postoperative pain following total abdominal hysterectomy over 5 days in patients receiving placebo or etoricoxib administered 90 min prior to surgery and continuing postoperatively. Patients were randomly assigned to receive either placebo (n...... as primary endpoints. Conclusion: In patients undergoing total abdominal hysterectomy, etoricoxib 90 and 120 mg dosed preoperatively and then continued postoperatively significantly reduces both resting and movement-related pain, as well as reduced opioid (morphine) consumption that led to more rapid bowel......Abstract Objective: To evaluate the effects of two different doses of etoricoxib delivered perioperatively compared with placebo and standard pain management on pain at rest, pain with mobilization, and use of additional morphine/opioids postoperatively. Research design and methods: In this double...

  2. Total laparoscopic hysterectomy: A case report from ILE-IFE, Nigeria.

    Science.gov (United States)

    Badejoko, Olusegun O; Ajenifuja, Kayode O; Oluborode, Babawale O; Adeyemi, Adebanjo B

    2012-10-01

    Total laparoscopic hysterectomy (TLH) is an advanced gynecological laparoscopic procedure that is widely performed in the developed world. However, its feasibility in resource-poor settings is hampered by obvious lack of equipments and/or skilled personnel. Indeed, TLH has never been reported from any Nigerian hospital. We present a 50-year-old multipara scheduled for hysterectomy on account of pre-malignant disease of the cervix, who had TLH with bilateral salpingo-oophorectomy in the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, southwestern Nigeria and was discharged home on the first post-operative day. She was seen in the gynecology clinic a week later in stable condition and she was highly pleased with the outcome of her surgery. This case is presented to highlight the attainability of operative gynecological laparoscopy, including advanced procedures like TLH in a resource-constrained setting, through the employment of adequate local adaptation and clever improvisation.

  3. Association of previous Cesarean delivery with surgical complications after a hysterectomy later in life

    DEFF Research Database (Denmark)

    Lindquist, Sofie A. I.; Shah, Neel; Overgaard, Charlotte

    2017-01-01

    Importance: In recent decades, the global rates of cesarean delivery have rapidly increased. Nonetheless, the influence of cesarean deliveries on surgical complications later in life has been understudied. Objective: To investigate whether previous cesarean delivery increases the risk...... of reoperation, perioperative and postoperative complications, and blood transfusion when undergoing a hysterectomy later in life. Design, Setting, and Participants: This registry-based cohort study used data from Danish nationwide registers on all women who gave birth for the first time between January 1, 1993......, and December 31, 2012, and underwent a benign, nongravid hysterectomy between January 1, 1996, and December 31, 2012. The dates of this analysis were February 1 to June 30, 2016. Exposure: Cesarean delivery. Main Outcomes and Measures: Reoperation, perioperative and postoperative complications, and blood...

  4. Radical dematerialization and degrowth

    Science.gov (United States)

    Kallis, Giorgos

    2017-05-01

    The emission targets agreed in Paris require a radical reduction of material extraction, use and disposal. The core claim of this article is that a radical dematerialization can only be part and parcel of degrowth. Given that capitalist economies are designed to grow, this raises the question of whether, and under what circumstances, the inevitable `degrowth' can become socially sustainable. Three economic policies are discussed in this direction: work-sharing, green taxes and public money. This article is part of the themed issue 'Material demand reduction'.

  5. Development of Transvaginal Uterus Amputation Device for Laparoscopic Hysterectomies in Gynecologic Surgeries

    Directory of Open Access Journals (Sweden)

    Serkan DİKİCİ

    2015-01-01

    Full Text Available Hysterectomy, that is removal of uterus, is one of the most common major operations in gynecologic surgeries. Laparoscopy technique is preferred in hysterectomy because of its advantages such as lower intra-operative blood loss, decreased surrounding tissue/organ damage, less operating time, lower postoperative infection and frequency of fever, shorter duration of hospitalization and post-operative returning time to normal activity. During total laparoscopic hysterectomy, first uterine vessels and ligaments are cauterized respectively, and then cervicovaginal connections are cauterized and coagulated to remove uterus completely. Uterine manipulators are used during laparoscopy to maximize the endoscopic vision of surgeons by moving related organs. However, conventional uterine manipulators have important drawbacks particularly to move uterus in three dimensions and to show cervicovaginal landmark during laparoscopic circular cauterization and amputation of the uterine cervix. A new transvaginal uterine manipulator may overcome these two important drawbacks of these currently available devices. For this reason, a3D scanned technique was used to get uterus sizes and computer aided design software is used in designing of the new manipulator and then 3D printer was used in prototyping. Special light emitting diodes (LEDs were mounted on the cervical cap of the manipulator to guide light beams from inside of cervicovaginal tissue to abdominal cavity to facilitate the visualization of tissue landmarks. Moreover, performances of different caps and LED systems will be evaluated. Furthermore, after integration of self-cutting and self-suturing mechanisms into our system, final prototype will be produced by using titanium which is biologically and mechanically appropriate. Therefore, aim of this study was to design and produce a new uterine manipulator with three dimensional movements, LED illumination, self-cutting and self-suturing systems to facilitate

  6. LigaSure versus Conventional Suture Ligature for Vaginal Hysterectomy: a Randomized Controlled Trial

    OpenAIRE

    Mohamed Abd Elzaher, a, b, Ashraf Moawad, a, c and Hanaa Abu-Ria

    2011-01-01

    Introduction: Vaginal hysterectomy is considered to be the method of choice for removal of the uterus. Of particular concern for the vaginal surgeon is the ability to access, visualize, and legate structures while maintaining adequate hemostasis. Surgical hemostasis can be secured by a variety of methods, including mechanical means (sutures) or vessel coagulation (diathermy). Electro-surgical vessel sealing (LigaSure) is a new hemostatic system based on the combination of pressure and bipolar...

  7. Emergency peripartum hysterectomy, physical and mental consequences: a 6-year study

    Directory of Open Access Journals (Sweden)

    Denisa-Oana Bălălău

    2016-04-01

    Full Text Available Emergency peripartum hysterectomy (EPH is performed for massive postpartum hemorrhage following a cesarean delivery or vaginal delivery, in order to save the patient’s life. The current study was performed on a sample of 13.162 patients, which underwent cesarean or vaginal delivery during a period of 6 years, from 2010 to 2015, in Bucur Maternity Hospital. There were two subsequential groups consisting in: 6593 patients with cesarean operations and 6569 patients with vaginal delivery. In 12 cases occurred one or more of the risk factors that lead to EPH, divided equally across the two groups above. The main two types of surgery are a more frequent subtotal hysterectomy, which is the preferred type of EPH as it takes less time and is associated with fewer complications, and a total hysterectomy. The majority of procedures were performed at patients over 35 years old (9 of 12, with a median age of 31,16 (ranging from 21 to 44 years old. The most important risk factor present across the lot was multiparity (11 from 12, with cicatricial uterus being the second one (4 of 12. ICU median time was 4,5 days (ranging from 3 to 15 days, with a median blood transfusion necessity of around 2,4 I.U per patient. There were no mother or newborn reported deaths, neither PTSD following EPH.EPH is a procedure performed as last-resort, life-saving surgery, leaving no time for mental preparation of the patients. This may predispose to negative psychological outcomes, especially because they are not part of decision-making process due to the emergency character of hysterectomy.

  8. Internal hernia through the pouch of douglas after hysterectomy: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Dong Jin; Cho, Seung Hyun; Shin, Hyun Woong; Kim, Tae Eun; Kim, Byung Young; Kim, Hee Jin [Daegu Fatima Hospital, Daegu (Korea, Republic of)

    2012-05-15

    Internal hernia is a rare cause of small bowel obstruction. Among the different types of internal hernias, the pelvic hernia is extremely rare. We report the radiographic findings of a patient with a Douglas pouch hernia presenting with closed loop obstruction at the anterior aspect of the distal rectum. The patient was a 60 year old female, who had undergone a hysterectomy 20 years prior, for treatment of a uterine myoma.

  9. Novel Port Placement and 5-mm Instrumentation for Robotic-Assisted Hysterectomy

    OpenAIRE

    Nezhat, Ceana H.; Katz, Adi; Dun, Erica C; Kho, Kimberly A.; Wieser, Friedrich A.

    2014-01-01

    Background and Objectives: The value of robotic surgery for gynecologic procedures has been critically evaluated over the past few years. Its drawbacks have been noted as larger port size, location of port placement, limited instrumentation, and cost. In this study, we describe a novel technique for robotic-assisted laparoscopic hysterectomy (RALH) with 3 important improvements: (1) more aesthetic triangular laparoscopic port configuration, (2) use of 5-mm robotic cannulas and instruments, an...

  10. Changes in female sexual function after pelvic organ prolapse repair: role of hysterectomy.

    Science.gov (United States)

    Costantini, Elisabetta; Porena, Massimo; Lazzeri, Massimo; Mearini, Luigi; Bini, Vittorio; Zucchi, Alessandro

    2013-09-01

    Incontinence and pelvic organ prolapse (POP) have an impact on sexuality. Few studies evaluate the impact of hysterectomy on sexual function. We designed the present observational prospective longitudinal cohort study in order to evaluate the impact of uterus preservation after POP repair on sexual function. Between January 2006 and January 2011, 107 patients with POP, mean age 58 ± 8.9 years, underwent colposacropexy with or without hysterectomy. All the women without uterine disease were offered the chance to preserve the uterus. All patients gave written informed consent and completed the Female Sexual Function Index (FSFI) questionnaire, before and after surgery, provided detailed case history, underwent urogynaecological examination and urodynamic assessment and completed the Urogenital Distress Inventory short form (UDI-6) and Incontinence Impact on Quality of Life short form (IIQ-7) questionnaires, and the satisfaction Visual Analogue Scale (VAS). One year after surgery patients repeated the FSFI questionnaire and underwent a clinical check-up. The primary end-point was post-operative sexual function as evaluated by the FSFI, the secondary end-points were objective anatomical and subjective success, defined respectively as no prolapse and no incontinence-related symptoms. Sixty-eight patients were included: 32 underwent uterus-sparing surgery and 36 hysterectomy plus colposacropexy. After surgery both groups had significant improvements in the total FSFI score and in the domains of desire, arousal and orgasm. The median post-operative scores of desire, arousal, and orgasm domains showed significant improvements in the uterus-sparing group compared with the hysterectomy group. None of the women had a uterine or vault prolapse recurrence. Our data demonstrate that POP plays a role in female sexual dysfunction and uterus sparing surgery is associated with a greater improvement in sexual function.

  11. Patient and Staff (doctors and nurses) Experiences of Abdominal Hysterectomy in Accelerated Recovery Programme

    DEFF Research Database (Denmark)

    Wagner, Lis; Carlslund, Anne Mette; Møller, Charlotte

    2004-01-01

    the experiences of the women operated and the staff involved. Material and methods: The study is exploratory and descriptive, using qualitative methods. Seventeen women, with good health status, were consecutively selected from August to September 2001. The women were observed and ten were interviewed twice...... of information relay and dialogue between staff and patients/family members. A nursing care ambulatory unit is recommended to support with information for women prior to and following hysterectomy in the ARP....

  12. A COMPARISON OF KETOROLAC, DICLOFENAC AND PARACETAMOL FOR POSTOPERATIVE ANALGESIA FOLLOWING ABDOMINAL HYSTERECTOMY

    Directory of Open Access Journals (Sweden)

    Gaurav

    2015-11-01

    Full Text Available BACKGROUND Abdominal hysterectomy is associated with moderate-to-severe postoperative pain. Among non-opioid analgesics diclofenac, paracetamol and ketorolac are most commonly used. OBJECTIVES: The aim of this study was to compare the analgesic duration, efficacy and side effect profile of paracetamol, diclofenac and ketorolac administered intravenously in patients who underwent abdominal hysterectomy. METHODS In a prospective double-blinded study, in which 90 women undergoing elective abdominal hysterectomy under spinal anesthesia were randomly selected and divided into 3 groups to receive 1ml (75mg Diclofenac (Group D, 1ml (30mg Ketorolac (Group K and 100ml (1000mg Paracetamol (Group P. Two hours post spinal anesthesia, irrespective of completion of surgery study drug was administered intravenously. In post-operative ward analgesic, efficacy was assessed hourly using a visual analog scale (VAS, duration of motor blockade due to spinal anesthesia (Modified Bromage scale, time for rescue analgesia (VAS>4 were compared and occurrence of adverse effects noted. STATICS Collected data was analyzed using ANOVA. RESULTS The time taken to administer the first dose of rescue analgesic was significantly (P <0.05 delayed in the group K (276mins. Overall, mean postoperative VAS scores were significantly better with (Group K and VAS scores were not significantly different between other (Group P and (Group D. CONCLUSION Ketorolac was a better post-operative analgesic compared to diclofenac and paracetamol.

  13. Learning Curve Analysis of Different Stages of Robotic-Assisted Laparoscopic Hysterectomy

    Science.gov (United States)

    Tang, Feng-Hsiang

    2017-01-01

    Objective. To analyze the learning curves of the different stages of robotic-assisted laparoscopic hysterectomy. Design. Retrospective analysis. Design Classification. Canadian Task Force classification II-2. Setting. Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. Patient Intervention. Women receiving robotic-assisted total and subtotal laparoscopic hysterectomies for benign conditions from May 1, 2013, to August 31, 2015. Measurements and Main Results. The mean age, body mass index (BMI), and uterine weight were 46.44 ± 5.31 years, 23.97 ± 4.75 kg/m2, and 435.48 ± 250.62 g, respectively. The most rapid learning curve was obtained for the main surgery console stage; eight experiences were required to achieve duration stability, and the time spent in this stage did not violate the control rules. The docking stage required 14 experiences to achieve duration stability, and the suture stage was the most difficult to master, requiring 26 experiences. BMI did not considerably affect the duration of the three stages. The uterine weight and the presence of adhesion did not substantially affect the main surgery console time. Conclusion. Different stages of robotic-assisted laparoscopic hysterectomy have different learning curves. The main surgery console stage has the most rapid learning curve, whereas the suture stage has the slowest learning curve. PMID:28373977

  14. Reduction of feral cat (Felis catus Linnaeus 1758) colony size following hysterectomy of adult female cats.

    Science.gov (United States)

    Mendes-de-Almeida, Flavya; Remy, Gabriella L; Gershony, Liza C; Rodrigues, Daniela P; Chame, Marcia; Labarthe, Norma V

    2011-06-01

    The size of urban cat colonies is limited only by the availability of food and shelter; therefore, their population growth challenges all known population control programs. To test a new population control method, a free-roaming feral cat colony at the Zoological Park in the city of Rio de Janeiro was studied, beginning in 2001. The novel method consisted of performing a hysterectomy on all captured female cats over 6 months of age. To estimate the size of the colony and compare population from year to year, a method of capture-mark-release-recapture was used. The aim was to capture as many individuals as possible, including cats of all ages and gender to estimate numbers of cats in all population categories. Results indicated that the feral cat population remained constant from 2001 to 2004. From 2004 to 2008, the hysterectomy program and population estimates were performed every other year (2006 and 2008). The population was estimated to be 40 cats in 2004, 26 in 2006, and 17 cats in 2008. Although pathogens tend to infect more individuals as the population grows older and maintains natural behavior, these results show that free-roaming feral cat colonies could have their population controlled by a biannual program that focuses on hysterectomy of sexually active female cats. Copyright © 2011 ISFM and AAFP. Published by Elsevier Ltd. All rights reserved.

  15. Efficacy of ultrasound-guided transversus abdominis plane block in laparoscopic hysterectomy. Clinical trial.

    Science.gov (United States)

    Guardabassi, D S; Lupi, S; Agejas, R; Allub, J M; García-Fornari, G

    2017-05-01

    Transversus abdominis plane block is a regional anaesthesia technique that has proven to be effective for postoperative pain reduction in different abdominal surgical procedures. This study evaluated its efficacy on post laparoscopic hysterectomy pain intensity and analgesic consumption. Randomized controlled trial which included 40 patients scheduled for laparoscopic hysterectomy, enrolled in 2 groups: transversus abdominis plane block+systemic analgesia (Group 1; n=20), versus systemic analgesia (Group 2; n=20). Opioid consumption within the first 24 postoperative hours, pain intensity scores at 60min, 2, 8 and 24h after surgery, adverse events related to systemic analgesia and time to hospital discharge were evaluated and registered. We found no differences between both groups in opioid consumption (10mg vs. 7mg; P=.2) and pain scores (NVS) within the first 24 postoperative hours, at 60min (3 vs. 5; P=.65), 120min (0 vs. 2; P=.15), 8 and 24h (0 vs. 0; P>.50) for the last 2 points in time analysed. Adverse events related to medication and time to hospital discharge showed similar results. Adding a transversus abdominis plane block technique to opioid PCA does not seem to improve postoperative pain management in laparoscopic hysterectomy. Patient preparation time and costs could be incremented and complications (although rare) related to the technique could appear. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Robotic-assisted laparoscopic hysterectomy: outcomes in obese and morbidly obese patients.

    Science.gov (United States)

    Gallo, Taryn; Kashani, Shabnam; Patel, Divya A; Elsahwi, Karim; Silasi, Dan-Arin; Azodi, Masoud

    2012-01-01

    To describe patient characteristics and perioperative outcomes among women undergoing roboticassisted laparoscopic hysterectomy and to evaluate the characteristics of nonobese, obese, and morbidly obese patients. A retrospective review was conducted of 442 cases of women who underwent robotic-assisted laparoscopic hysterectomy for benign and malignant conditions over a 4-y period at an academic and community teaching hospital. Patient demographics, surgical indications, operative outcomes, and complications were evaluated for patients with a body mass index (BMI) obese or morbidly obese, with a BMI of ≥30 kg/m(2). Overall, the median estimated blood loss was 100 mL (range, 10 to 800), the operative time was 135 min (range, 40 to 436), and the length of stay was 1 d (range, 0 to 22). These did not differ significantly by BMI group. Overall, 11.9% of patients experienced complications (7.9% minor, 4.1% major), and this did not differ significantly across BMI groups. Robotic hysterectomy can be performed safely in obese and morbidly obese patients, with surgical outcomes and complications similar to those in nonobese patients.

  17. Immediate versus delayed hysterectomy for endometrial carcinoma: surgical morbidity and hospital stay

    Energy Technology Data Exchange (ETDEWEB)

    Chambers, J.T.; Kapp, D.S.; Lawrence, R.; Kohorn, E.I.; Schwartz, P.E.

    1985-02-01

    A retrospective review presented is of the intraoperative complications, postoperative morbidity, and length of hospitalization in 138 patients with stage I endometrial carcinoma treated at Yale-New Haven Hospital from January 1, 1977 to December 31, 1981. One group (stage IA, grade 1) was treated with surgery alone; two groups were treated with preoperative intracavitary radium, followed with either an immediate or a delayed hysterectomy. The three groups were comparable in age, weight, and major preoperative medical problems. The mean estimated blood loss during surgery and transfusion requirements during hospitalization were similar for all three groups. The duration of the surgery in the immediate group was longer than the other two groups. The occurrence of febrile morbidity and major postoperative complications in the three groups was similar, except for bacteriuria, which was significantly more common in the immediate group. The length of the postoperative hospitalization was the same for each group; however, the delayed group as compared with the immediate group had a total hospitalization of two days longer. Hence, in the current study, immediate hysterectomy did not significantly increase the surgical or postoperative morbidity rate, compared with delayed hysterectomy. The single hospital stay in the former treatment group represented cost containment.

  18. Perioperative surgical outcome of conventional and robot-assisted total laparoscopic hysterectomy.

    Science.gov (United States)

    van Weelden, W J; Gordon, B B M; Roovers, E A; Kraayenbrink, A A; Aalders, C I M; Hartog, F; Dijkhuizen, F P H L J

    2017-01-01

    To evaluate surgical outcome in a consecutive series of patients with conventional and robot assisted total laparoscopic hysterectomy. A retrospective cohort study was performed among patients with benign and malignant indications for a laparoscopic hysterectomy. Main surgical outcomes were operation room time and skin to skin operating time, complications, conversions, rehospitalisation and reoperation, estimated blood loss and length of hospital stay. A total of 294 patients were evaluated: 123 in the conventional total laparoscopic hysterectomy (TLH) group and 171 in the robot TLH group. After correction for differences in basic demographics with a multivariate linear regression analysis, the skin to skin operating time was a significant 18 minutes shorter in robot assisted TLH compared to conventional TLH (robot assisted TLH 92m, conventional TLH 110m, p0.001). The presence or absence of previous abdominal surgery had a significant influence on the skin to skin operating time as did the body mass index and the weight of the uterus. Complications were not significantly different. The robot TLH group had significantly less blood loss and lower rehospitalisation and reoperation rates. This study compares conventional TLH with robot assisted TLH and shows shorter operating times, less blood loss and lower rehospitalisation and reoperation rates in the robot TLH group.

  19. Incidence of and risk factors for surgical site infections in women undergoing hysterectomy for endometrial carcinoma.

    Science.gov (United States)

    Tuomi, Taru; Pasanen, Annukka; Leminen, Arto; Bützow, Ralf; Loukovaara, Mikko

    2016-04-01

    The purpose of this study was to determine the incidence of, and risk factors for, surgical site infections in a contemporary cohort of women with endometrial carcinoma. We retrospectively studied 1164 women treated for endometrial carcinoma by hysterectomy at a single institution in 2007-2013. In all, 912 women (78.4%) had minimally invasive hysterectomy. Data on surgical site infections were collected from medical records. Univariate and multivariate analyses were used to identify risk factors for incisional and organ/space infections. Ninety-four women (8.1%) were diagnosed with a surgical site infection. Twenty women (1.7%) had an incisional infection and 74 (6.4%) had an organ/space infection. The associations of 17 clinico-pathologic and surgical variables were tested by univariate analyses. Those variables that were identified as potential risk factors in univariate analyses (p infections as dependent variables. Obesity (body mass index ≥ 30 kg/m(2)), diabetes, and long operative time (>80th centile) were independently associated with a higher risk of incisional infection, whereas minimally invasive surgery was associated with a smaller risk. Smoking, conversion to laparotomy, and lymphadenectomy were associated with a higher risk of organ/space infection. Organ/space infections comprised the majority of surgical site infections. Risk factors for incisional and organ/space infections differed. Minimally invasive hysterectomy was associated with a smaller risk of incisional infections but not of organ/space infections. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

  20. Resection of the vaginal vault for vaginal recurrence of cervical cancer after hysterectomy and brachytherapy.

    Science.gov (United States)

    Abe, Akiko; Matoda, Maki; Okamoto, Sanshiro; Kondo, Eiji; Kato, Kazuyoshi; Omatsu, Kohei; Umayahara, Kenji; Utsugi, Kuniko; Takeshima, Nobuhiro

    2015-04-02

    We describe our experiences with vaginal vault resection for vaginal recurrence of cervical cancer after hysterectomy and radiotherapy. After operative treatment, the rate of vaginal vault recurrence of uterine cervical cancer is reported to be about 5%. There is no consensus regarding the treatment for these cases. Between 2004 and 2012, eight patients with vaginal vault recurrence underwent removal of the vaginal wall via laparotomy after hysterectomy and radiotherapy. The median patient age was 45 years (range 35 to 70 years). The median operation time was 244.5 min (range 172 to 590 min), the median estimated blood loss was 362.5 mL (range 49 to 1,890 mL), and the median duration of hospitalization was 24.5 days (range 11 to 50 days). Two patients had intraoperative complications: a grade 1 bowel injury and a grade 1 bladder injury. The following postoperative complications were observed: one patient had vaginal vault bleeding, three patients developed vesicovaginal fistulae, and one patient had repeated ileus. Two patients needed clean intermittent catheterization. Local control was achieved in five of the eight cases. Vaginal vault resection is an effective treatment for vaginal recurrence of cervical cancer after hysterectomy and radiotherapy. However, complications of this procedure can be expected to reduce quality of life. Therefore, this operation should be selected with great care.

  1. Total laparoscopic hysterectomy without uterine manipulator at big uterus weight (>280 g).

    Science.gov (United States)

    Mebes, Imke; Diedrich, Klaus; Banz-Jansen, Constanze

    2012-07-01

    The retrospective study included the total laparoscopic hysterectomy without uterus manipulator at big uterus >280 g (Group A), proceeding the same technique as known to show feasibility and safety of its technique, compared with a randomized patient group of a uterus weight below 280 g (Group B). Statistical measurement was proceeded in typical clinical parameters. No statistical differences in age, body mass index, further abdominal surgery, blood loss, and hospital stay were observed. Operating time was significantly different favouring the uterus below 280 g (111.74 min Group A/90.68 min Group B). No increase in intra- or postoperative complications in both groups was observed. Total hysterectomy at big uterus (>280 g) is safe and feasible. Statistical analysis shows a significant shorter operating time only in one parameter (Group B). The technique of hysterectomy without uterus manipulator offers a surgical advancement also at vaginal stenosis, early staged cervix, or endometrial cancer and exhibits an opportunity for laparoscopic advancement in these cases too.

  2. Influence of the modifiable life-style factors body mass index and smoking on the outcome of hysterectomy.

    Science.gov (United States)

    Bohlin, Katja S; Ankardal, Maud; Stjerndahl, Jan-Henrik; Lindkvist, Håkan; Milsom, Ian

    2016-01-01

    The aim of this study was to study the impact of body mass index (BMI) and smoking on the outcome of hysterectomy and whether effects of these factors vary between abdominal, laparoscopic and vaginal hysterectomy. Pre-, per- and postoperative (8 weeks) data were retrieved from the Swedish National Register for Gynecological Surgery on 28 537 hysterectomies performed because of a benign indication between 2004 and 2013. Multivariable logistic regression analyses were used to identify independent factors affecting the rate of complications, presented as adjusted odds ratios (adjOR) with 95% confidence intervals (CI). Overweight and obesity had the strongest impact on complications in the abdominal hysterectomy group. In women with a BMI ≥ 30 an increased adjOR could be seen for bleeding >1000 mL (2.90; 95% CI 2.23-3.77), peroperative complications (1.54; 95% CI 1.26-1.88), operation time >120 min (2.67; 95% CI 2.33-3.03), postoperative complications (1.21; 95% CI 1.08-1.34) and postoperative infections (1.73; 95% CI 1.50-1.99). With vaginal hysterectomy, the effect of BMI ≥ 30 could be seen in relation to excessive bleeding >500 mL (1.63; 95% CI 1.22-2.17) and operative time >120 min (2.00; 95% CI 1.60-2.50). With laparoscopic hysterectomy (LH), a BMI ≥ 30 had a higher adjOR for prolonged surgery (1.71; 95% CI 1.30-2.26). Smokers had an increased risk of postoperative infection in the abdominal hysterectomy (1.23; 95% CI 1.07-1.40) and vaginal hysterectomy groups (1.21; 95% CI 1.02-1.43) but not in the LH group. Body mass index and smoking had a negative effect with all hysterectomy approaches but to a lesser extent in vaginal and laparoscopic hysterectomies. This should be taken into consideration in advance of surgery to improve outcome. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

  3. Safety and Feasibility of Same-Day Discharge in Obese Patients Undergoing Laparoscopic Hysterectomy for Endometrial Intraepithelial Neoplasia and Malignancy [335

    National Research Council Canada - National Science Library

    Katz Eriksen, Jennifer Leigh; Melamed, Alexander; Berkowitz, Ross Stuart; Horowitz, Neil S; Muto, Michael George; Feltmate, Colleen Marie

    2015-01-01

    .... Same-day discharge is safe, cost-saving, and acceptable to patients undergoing laparoscopic hysterectomy, but concerns about increased perioperative risks in obese patients limit the utilization...

  4. Radical School Reform.

    Science.gov (United States)

    Gross, Beatrice, Ed.; Gross, Ronald, Ed.

    This book provides a comprehensive examination of the nature of the school crisis and the ways in which radical thinkers and educators are dealing with it. Excerpts from the writings of Jonathan Kozol, John Holt, Kenneth Clark, and others are concerned with the realities of education in ghettos and suburbs. Paul Goodman, Marshall McLuhan, Sylvia…

  5. Homegrown religious radicalization

    DEFF Research Database (Denmark)

    Khawaja, Iram

    It has been reported that a growing number of youngsters from Western Europe are engaging in conflicts motivated by religious and political conflicts in the Middle East. This paper explores the reasons behind this seemingly religious radicalization from the point of view of the youngsters and the...

  6. Radically enhanced molecular recognition

    KAUST Repository

    Trabolsi, Ali

    2009-12-17

    The tendency for viologen radical cations to dimerize has been harnessed to establish a recognition motif based on their ability to form extremely strong inclusion complexes with cyclobis(paraquat-p-phenylene) in its diradical dicationic redox state. This previously unreported complex involving three bipyridinium cation radicals increases the versatility of host-guest chemistry, extending its practice beyond the traditional reliance on neutral and charged guests and hosts. In particular, transporting the concept of radical dimerization into the field of mechanically interlocked molecules introduces a higher level of control within molecular switches and machines. Herein, we report that bistable and tristable [2]rotaxanes can be switched by altering electrochemical potentials. In a tristable [2]rotaxane composed of a cyclobis(paraquat-p-phenylene) ring and a dumbbell with tetrathiafulvalene, dioxynaphthalene and bipyridinium recognition sites, the position of the ring can be switched. On oxidation, it moves from the tetrathiafulvalene to the dioxynaphthalene, and on reduction, to the bipyridinium radical cation, provided the ring is also reduced simultaneously to the diradical dication. © 2010 Macmillan Publishers Limited. All rights reserved.

  7. Violent Radicalization in Europe

    DEFF Research Database (Denmark)

    Dalgaard-Nielsen, Anja

    2010-01-01

    When, why, and how do people living in a democracy become radicalized to the point of being willing to use or directly support the use of terrorist violence against fellow citizens? This question has been at the center of academic and public debate over the past years as terrorist attacks...

  8. Beyond Radical Educational Cynicism.

    Science.gov (United States)

    Wood, George H.

    1982-01-01

    An alternative is presented to counter current radical arguments that the schools cannot bring about social change because they are instruments of capitalism. The works of Samuel Bowles, Herbert Gintis, and Louis Althusser are discussed. Henry Giroux's "Ideology, Culture and the Process of Schooling" provides an alternative to cynicism.…

  9. Electromeric rhodium radical complexes

    NARCIS (Netherlands)

    Puschmann, F.F.; Harmer, J.; Stein, D.; Rüegger, H.; de Bruin, B.; Grützmacher, H.

    2010-01-01

    Radical changes: One single P-Rh-P angle determines whether the odd electron in the paramagnetic complex [Rh(trop2PPh)(PPh3)] is delocalized over the whole molecule (see picture, blue) or is localized on the P—Rh unit (red). The two energetically almost degenerate electromers exist in a fast equilib

  10. Homegrown religious radicalization

    DEFF Research Database (Denmark)

    Khawaja, Iram

    and their families. Existing literature and ways of thinking about the social psychological process of radicalization will be reviewed, such as social identity theory and transformative learning theory, and a theoretical framework based on a focus on belonging, recognition and the sense of community will be proposed...

  11. On Radical Feminism

    Institute of Scientific and Technical Information of China (English)

    翟良锴

    2015-01-01

    <正>All men are created equal.For centuries,human have been struggling for their rights.Women,as a special social force,are fighting vigorously for their equal rights with men.According to an introduction to feminism,there are three main types of feminism:socialist,reformist and radical(Feminism 101).In order

  12. Reducing surgical site infections after hysterectomy: metronidazole plus cefazolin compared with cephalosporin alone.

    Science.gov (United States)

    Till, Sara R; Morgan, Daniel M; Bazzi, Ali A; Pearlman, Mark D; Abdelsattar, Zaid; Campbell, Darrell A; Uppal, Shitanshu

    2017-08-01

    Organisms that are isolated from vaginal cuff infections and pelvic abscesses after hysterectomy frequently include anaerobic vaginal flora. Metronidazole has outstanding coverage against nearly all anaerobic species, which is superior to both cefazolin and second-generation cephalosporins. Cefazolin plus metronidazole has been demonstrated to reduce infectious morbidity compared with either cefazolin or second-generation cephalosporins in other clean-contaminated procedures, which include both as colorectal surgery and cesarean delivery. The purpose of this study was to evaluate whether the combination of cefazolin plus metronidazole before hysterectomy was more effective in the prevention of surgical site infection than existing recommendations of cefazolin or second-generation cephalosporin. This was a retrospective cohort study of patients in the Michigan Surgical Quality Collaborative from July 2012 through February 2015. The primary outcome was surgical site infection. Patients who were >18 years old and who underwent abdominal, vaginal, laparoscopic, or robotic hysterectomy for benign or malignant indications were included if they received 1 of the following prophylactic antibiotic regimens: cefazolin, second-generation cephalosporin, or cefazolin plus metronidazole. Multivariate logistic regression modeling was performed to evaluate the independent effect of an antibiotic regimen, and propensity score matching was used to validate the findings. The study included 18,255 hysterectomies. The overall rate of surgical site infection was 1.8% (n=329). The unadjusted rate of surgical site infection was 1.8% (n=267) for cefazolin, 2.1% (n=49) for second-generation cephalosporin, and 1.4% (n=13) for cefazolin plus metronidazole. After adjustment for differences in patient and operative factors among the antibiotic cohorts, compared with cefazolin plus metronidazole, we found the risk of surgical site infection was significantly higher for patients who received

  13. Analysis of first and second trimester maternal serum analytes for the prediction of morbidly adherent placenta requiring hysterectomy

    Directory of Open Access Journals (Sweden)

    Efser Oztas

    2016-11-01

    Full Text Available Morbidly adherent placenta (MAP is a growing concern currently and is still a diagnostic challenge for obstetricians. As emergency hysterectomy due to unscheduled delivery in MAP carries significant risks, we aimed to evaluate whether first and second trimester serum analytes may be used in the prediction of MAP requiring hysterectomy. A retrospective chart review of all identified cases of placenta previa totalis with and without MAP was performed. A total of 316 pregnant women diagnosed as placenta previa totalis were identified and included in the analysis. Cases were examined in three groups (Group 1: 204 nonadherent placenta previa patients; Group 2: 61 MAP patients managed with endouterine hemostatic square sutures and/or Bakri balloon tamponade; and Group 3: 51 patients with MAP requiring hysterectomy. Among all first and second trimester screening analytes only maternal serum alphafetoprotein (MS-AFP levels were significantly higher in patients with MAP requiring hysterectomy (p < 0.001. According to the Receiver Operating Characteristic (ROC analysis performed for the predictive value of MS-AFP levels, the area under the curve (AUC was 0.742 [95% confidence interval (CI: 0.505–0.979]. The best MS-AFP cut-off value was 1.25 multiple of the median (MoM with 85.94% sensitivity and 71.43% specificity (p = 0.036. The best predictors which affect the increased risk of hysterectomy, was further evaluated by multivariate logistic regression analyses. Only elevated maternal serum alphafetoprotein (MS-AFP was found to be an independent predictor of MAP requiring hysterectomy [odds ratio (OR = 25.329, 95% confidence interval (CI:1.487–43.143, p = 0.025]. In conclusion, increased second trimester MS-AFP levels independently predict morbidly adherent placenta requiring hysterectomy among women with placenta previa totalis.

  14. 经阴道与经腹子宫切除术临床效果对比分析%A Retrospective Analyzation on Clinical.Effects of Vaginal Hysterectomy and Transabdominal Hysterectomy

    Institute of Scientific and Technical Information of China (English)

    马亚宁; 李玉杰

    2009-01-01

    [Objective]To evaluate the clinical effects of vaginal hysterectomy and transabdominal hysterectomy in treatment of uterine benign diseases.[Methods]A retrospective study was performed on 121 cases of hysterectomy (58 cases conducted vaginal hysterectomy, 63 cases conducted transabdominal hysterectomy due to the benign pathological changes of uterus during May 2006 - June 2008. Operation time, bleeding volume, postoperative period of hospitalization, postoperative period of exhaust, postoperative analgesic usage, postoperative morbidity, and postoperative complications of the 2 groups were compared.[Results]The differences of operation time and bleeding volume between the 2 groups were not significant (P>0.05); in vaginal hysterectomy group the postoperative periods of exhaust and hospitalization were short, the postoperative usages of analgesics and morbidity were lower than those of patients with transabdominal hysterectomy(P<0.05).[Conclusion] Compared with transabdominal hysterectomy, vaginal hysterectomy has the advantage of short recovery time and less trauma ,which accords with the view of minimally invasive.%目的 评价经阴道与经腹子宫切除术在子宫良性病变中的临床效果.方法 对2006年5月-2008年6月因子宫良性病变需行子宫切除术的121例病例进行回顾性分析,其中经阴道子宫切除术58例(阴式组),经腹子宫切除术63例(开腹组),主要对比2组手术时间、术中出血量、术后住院时间、术后排气时间、术后镇痛药使用率、术后病率、术后并发症等.结果 2组手术时间,术中出血量比较差异无统计学意义(P>0.05);阴式组术后排气早、住院时间短、术后镇痛药使用率及术后病率低与开腹组比较差异有统计学意义(P<0.05).结论 经阴道子宫切除术较经腹子宫切除术具有创伤小,恢复快的优点,符合微创观点.

  15. Women and radicalization

    OpenAIRE

    Badran, Margot

    2006-01-01

    The paper focuses on women and radicalization within the context of Muslim societies (majority, minority, and half Muslim) societies and groups, mainly in Asia and Africa. The basic argument advanced in this paper is that Islamic feminism with its gender-egalitarian discourse and practices has a major role to play in the empowerment of Muslim women—and of men and society as a whole—and should be brought to bear in devising policy, strategy, and tools.

  16. Probability and radical behaviorism

    Science.gov (United States)

    Espinosa, James M.

    1992-01-01

    The concept of probability appears to be very important in the radical behaviorism of Skinner. Yet, it seems that this probability has not been accurately defined and is still ambiguous. I give a strict, relative frequency interpretation of probability and its applicability to the data from the science of behavior as supplied by cumulative records. Two examples of stochastic processes are given that may model the data from cumulative records that result under conditions of continuous reinforcement and extinction, respectively. PMID:22478114

  17. Probability and radical behaviorism

    OpenAIRE

    Espinosa, James M.

    1992-01-01

    The concept of probability appears to be very important in the radical behaviorism of Skinner. Yet, it seems that this probability has not been accurately defined and is still ambiguous. I give a strict, relative frequency interpretation of probability and its applicability to the data from the science of behavior as supplied by cumulative records. Two examples of stochastic processes are given that may model the data from cumulative records that result under conditions of continuous reinforc...

  18. Radical chic, javisst!

    NARCIS (Netherlands)

    Hartle, J.F.

    2012-01-01

    Det är lätt att raljera över engagerade människor, i synnerhet när engagemanget framstår som ytligt och chict snarare än grundläggande och autentiskt. Men vad ligger bakom ett sådant avfärdande? Johan Frederik Hartle läser om Tom Wolfes klassiska essä "Radical Chic" och visar hur Wolfe −− genom att

  19. Radical substitution with azide

    DEFF Research Database (Denmark)

    Pedersen, Christian Marcus; Marinescu, Lavinia Georgeta; Bols, Mikael

    2005-01-01

    and the substrate. A primary deuterium kinetic isotope effect was found for the azidonation of benzyl ethers both with TMSN3-PhI(OAc)2 and with IN3. Also a Hammett free energy relationship study of this reaction showed good correlation with sigma+ constants giving with rho-values of -0.47 for TMSN3-PhI(OAc)2 and -0.......39 for IN3. On this basis a radical mechanism of the reaction was proposed....

  20. Women's sexual behavior, body image and satisfaction with surgical outcomes after hysterectomy: a comparison of vaginal and abdominal surgery.

    Science.gov (United States)

    Gütl, P; Greimel, E R; Roth, R; Winter, R

    2002-03-01

    The aim of this study was to investigate the impact of vaginal and abdominal hysterectomy on women's sexual behavior, sexual dysfunction, body image and satisfaction with surgery. A prospective study was conducted on 90 women to evaluate the outcomes of hysterectomy. Data were collected prior to surgery, three months and two years after surgery, using self-report questionnaires. The results showed significant differences in women's sexual behavior and sexual dysfunction before and after hysterectomy, independent of the surgical procedure performed. Women in both groups reported improvements in sexual desire, sexual activity and sexual intercourse three months and two years after surgery. Sexual dysfunction such as dyspareunia, vaginismus, lack of orgasm and loss of sexual interest diminished significantly after surgery. Regression analyses revealed that postmenopausal status, severity of gynecological complaints and frequency of sexual intercourse were the most important factors for improved sexual outcomes. Women in the abdominal group were dissatisfied with their body image because of the abdominal scar, experienced more pain and had a longer period of recovery from surgery compared to women in the vaginal group. According to the results, sexual behavior alone is not an important factor in choosing vaginal or abdominal hysterectomy. However, sexual behavior was important in both groups when evaluating outcomes after hysterectomy.

  1. The effects of hysterectomy on body image, self-esteem, and marital adjustment in Turkish women with gynecologic cancer.

    Science.gov (United States)

    Pinar, Gul; Okdem, Seyda; Dogan, Nevin; Buyukgonenc, Lale; Ayhan, Ali

    2012-06-01

    The purpose of this research was to investigate the differences in the effect of hysterectomy on body image, self-esteem, and marital adjustment in Turkish women with gynecologic cancer based on specific independent variables, including age, education, employment, having or not having children, and income. This cross-sectional study compared a group of women who underwent a hysterectomy (n = 100) with a healthy control group (n = 100). The study findings indicate that women who had a hysterectomy were found in worse conditions in terms of body image, self-esteem, and dyadic adjustment compared to healthy women. In terms of dyadic adjustment and body image among women who had undergone a hysterectomy, those with lower levels of income and education were found in poorer conditions. The study's findings show that hysterectomies have negative effects on body image, self-esteem, and dyadic adjustment in women affected by gynecologic cancer. Nursing assessment of self-esteem and marital adjustment indicators and implementation of strategies to increase self-confidence and self-esteem are needed for high-risk women.

  2. THERMOCHEMISTRY OF HYDROCARBON RADICALS

    Energy Technology Data Exchange (ETDEWEB)

    Kent M. Ervin, Principal Investigator

    2004-08-17

    Gas phase negative ion chemistry methods are employed to determine enthalpies of formation of hydrocarbon radicals that are important in combustion processes and to investigate the dynamics of ion-molecule reactions. Using guided ion beam tandem mass spectrometry, we measure collisional threshold energies of endoergic proton transfer and hydrogen atom transfer reactions of hydrocarbon molecules with negative reagent ions. The measured reaction threshold energies for proton transfer yield the relative gas phase acidities. In an alternative methodology, competitive collision-induced dissociation of proton-bound ion-molecule complexes provides accurate gas phase acidities relative to a reference acid. Combined with the electron affinity of the R {center_dot} radical, the gas phase acidity yields the RH bond dissociation energy of the corresponding neutral molecule, or equivalently the enthalpy of formation of the R{center_dot} organic radical, using equation: D(R-H) = {Delta}{sub acid}H(RH) + EA(R) - IE(H). The threshold energy for hydrogen abstraction from a hydrocarbon molecule yields its hydrogen atom affinity relative to the reagent anion, providing the RH bond dissociation energy directly. Electronic structure calculations are used to evaluate the possibility of potential energy barriers or dynamical constrictions along the reaction path, and as input for RRKM and phase space theory calculations. In newer experiments, we have measured the product velocity distributions to obtain additional information on the energetics and dynamics of the reactions.

  3. [Radical prostatectomy - pro robotic].

    Science.gov (United States)

    Gillitzer, R

    2012-05-01

    Anatomical radical prostatectomy was introduced in the early 1980s by Walsh and Donker. Elucidation of key anatomical structures led to a significant reduction in the morbidity of this procedure. The strive to achieve similar oncological and functional results to this gold standard open procedure but with further reduction of morbidity through a minimally invasive access led to the establishment of laparoscopic prostatectomy. However, this procedure is complex and difficult and is associated with a long learning curve. The technical advantages of robotically assisted surgery coupled with the intuitive handling of the device led to increased precision and shortening of the learning curve. These main advantages, together with a massive internet presence and aggressive marketing, have resulted in a rapid dissemination of robotic radical prostatectomy and an increasing patient demand. However, superiority of robotic radical prostatectomy in comparison to the other surgical therapeutic options has not yet been proven on a scientific basis. Currently robotic-assisted surgery is an established technique and future technical improvements will certainly further define its role in urological surgery. In the end this technical innovation will have to be balanced against the very high purchase and running costs, which remain the main limitation of this technology.

  4. Associations of Premenopausal Hysterectomy and Oophorectomy With Breast Cancer Among Black and White Women: The Carolina Breast Cancer Study, 1993-2001.

    Science.gov (United States)

    Robinson, Whitney R; Nichols, Hazel B; Tse, Chiu Kit; Olshan, Andrew F; Troester, Melissa A

    2016-09-01

    Black women experience higher rates of hysterectomy than other women in the United States. Although research indicates that premenopausal hysterectomy with bilateral oophorectomy decreases the risk of breast cancer in black women, it remains unclear how hysterectomy without ovary removal affects risk, whether menopausal hormone therapy use attenuates inverse associations, and whether associations vary by cancer subtype. In the population-based, case-control Carolina Breast Cancer Study of invasive breast cancer in 1,391 black (725 cases, 666 controls) and 1,727 white (939 cases, 788 controls) women in North Carolina (1993-2001), we investigated the associations of premenopausal hysterectomy and oophorectomy with breast cancer risk. Compared with no history of premenopausal surgery, bilateral oophorectomy and hysterectomy without oophorectomy were associated with lower odds of breast cancer (for bilateral oophorectomy, multivariable-adjusted odds ratios = 0.60, 95% confidence interval: 0.47, 0.77; for hysterectomy without oophorectomy, multivariable-adjusted odds ratios = 0.68, 95% confidence interval: 0.55, 0.84). Estimates did not vary by race and were similar for hormone receptor-positive and hormone receptor-negative cancers. Use of estrogen-only menopausal hormone therapy did not attenuate the associations. Premenopausal hysterectomy, even without ovary removal, may reduce the long-term risk of hormone receptor-positive and hormone receptor-negative breast cancers. Varying rates of hysterectomy are a potentially important contributor to differences in breast cancer incidence among racial/ethnic groups.

  5. The Experience of Robotic-Assisted Laparoscopic Hysterectomy for Women Treated for Early-Stage Endometrial Cancer

    DEFF Research Database (Denmark)

    Herling, Suzanne Forsyth; Palle, Connie; Moeller, Ann M

    2016-01-01

    BACKGROUND: An increasing number of women are offered robotic-assisted laparoscopic hysterectomy as treatment for early-stage endometrial cancer in the developed world. OBJECTIVE: The aim of this study was to explore how women diagnosed with early-stage endometrial cancer experienced robotic......-assisted laparoscopic hysterectomy. METHODS: Semistructured interviews were carried out with 12 women, and interview data were analyzed by qualitative content analysis. RESULTS: Four overarching themes emerged: "surgery was a piece of cake," "recovering physically after surgery," "going from being off guard to being...... on guard," and "preparing oneself by seeking information." The women had confidence in the robotic technique and experienced fast recovery after robotic-assisted laparoscopic hysterectomy; however, they had uncertainties and unanswered questions concerning the postoperative course. Shortly after discharge...

  6. A randomized controlled trial to compare pregabalin with gabapentin for postoperative pain in abdominal hysterectomy

    Directory of Open Access Journals (Sweden)

    Anju Ghai

    2011-01-01

    Full Text Available Background: Pregabalin is a potent ligand for alpha-2-delta subunit of voltage-gated calcium channels in the central nervous system, which exhibits potent anticonvulsant, analgesic and anxiolytic activity. The pharmacological activity of pregabalin is similar to that of gabapentin and shows possible advantages. Although it shows analgesic efficacy against neuropathic pain, very limited evidence supports its postoperative analgesic efficacy. We investigated its analgesic efficacy in patients experiencing acute pain after abdominal hysterectomy and compared it with gabapentin and placebo. Methods: A randomized, double-blind, placebo-controlled study was conducted in 90 women undergoing abdominal hysterectomy who were anaesthetized in a standardized fashion. Patients received 300 mg pregabalin, 900 mg gabapentin or placebo, 1-2 hours prior to surgery. Postoperative analgesia was administered at visual analogue scale (VAS ≥3. The primary outcome was analgesic consumption over 24 hours and patients were followed for pain scores, time to rescue analgesia and side effects as secondary outcomes. Results: The diclofenac consumption was statistically significant between pregabalin and control groups, and gabapentin and control groups; however, pregabalin and gabapentin groups were comparable. Moreover, the consumption of tramadol was statistically significant among all the groups. Patients in pregabalin and gabapentin groups had lower pain scores in the initial hour of recovery. However, pain scores were subsequently similar in all the groups. Time to first request for analgesia was longer in pregabalin group followed by gabapentin and control groups. Conclusion: A single dose of 300 mg pregabalin given 1-2 hours prior to surgery is superior to 900 mg gabapentin and placebo after abdominal hysterectomy. Both the drugs are better than placebo.

  7. Laparoscopic and robot-assisted hysterectomy for uterine cancer: a comparison of costs and complications.

    Science.gov (United States)

    Zakhari, Andrew; Czuzoj-Shulman, Nicholas; Spence, Andrea R; Gotlieb, Walter H; Abenhaim, Haim A

    2015-11-01

    Increasingly, robotic surgery is being used for total hysterectomy, bilateral salpingo-oophorectomy, and lymph node dissection for uterine cancer. The purpose of this study was to compare the costs and complications among women undergoing robotic and laparoscopic hysterectomy for uterine cancer. We carried out a cohort study using the Nationwide Inpatient Sample (NIS) database between 2008 and 2012 on all women diagnosed with uterine cancer, classifying women as either laparoscopically or robotically treated, excluding laparotomies or vaginal approaches. Logistic regression analyses were used to evaluate the adjusted effect of surgical approach on complication rates. There were 10,347 women who underwent hysterectomies for uterine cancer either laparoscopically (39%) or robotically (61%). The rate of robotic surgery consistently increased over the 5 year period. Women undergoing robotic surgery had more comorbid conditions (diabetes, hypertension, cardiovascular disease, renal disease, obesity or morbid obesity, and pulmonary disease). In adjusted analyses, women undergoing robotic surgery were more likely to have a lymph node dissection (73.01% vs 66.04%; P laparoscopic surgery. The composite endpoint of any complication was similar between both cohorts (20.56% robotic vs 21.00% laparoscopy). In overall and subset analyses, robotic surgery was more costly, with median charges of $38,161.00 compared with $31,476.00 in those undergoing laparoscopic surgery (P < .0001). Despite the considerably greater burden of comorbidities in those undergoing robotic surgery compared with laparoscopy, the former have shorter hospital admissions, a greater rate of lymph node dissection, and similar postoperative morbidity and mortality, albeit at greater total cost. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Adenomyosis:Pathologies associated in a set of patients underwent hysterectomy

    Institute of Scientific and Technical Information of China (English)

    Luis Humberto Sordia-Hernandez; Julio Herrero; Arturo Morales Martinez; Jose Mara Gris; Donato Saldivar Rodriguez; Oscar Vidal Gutierrez; Celina Castro

    2012-01-01

    Objective:To determine if a relationship exists between the histopathological diagnosis of adenomyosis and the clinical conditions and pathologies that are more commonly related to it in patients undergoing hysterectomy. Methods:Retrospective, comparative, case-control study was conducted. With previous approval by ethics committee, we included 794 patients undergoing hysterectomy at a University Hospital. The Medical records and pathology reports of patients undergoing hysterectomy over a two-year period were reviwed. Clinical conditions and associated pathologies, in patients with and without adenomyosis, were reviewed and compared. Statistical analysis was done using the Chi-square test. Results:Adenomyosis was reported in 140 out of 794 patients, 17.6%(95%CI:15.1-20.4). No differences in adenomyosis prevalence were found among patients with or without uterine fibroids, 20.2%(75/371) vs. 15.5%(65/423);endometrial polyps, 9.7%(6/62) vs. 18.3%(134/732);and the presence or lack of endometrial hyperplasia 13.9%(5/36) vs. 17.4%(135/758). The prevalence of adenomyosis among patients with endometriosis was 40.7%(11/27), and among those without this diagnosis, 16.8%(129/767). This difference was significant (P=0.001). A history of two or more curettages was also positively related to adenomyosis. Conclusions:There was a statistically significant difference in the prevalence of adenomyosis in women with endometriosis when compared to women without endometriosis. A higher incidence of adenomyosis was found in patients with a history of two or more curettages. Trauma to the endometrium could explain the higher incidence of adenomyosis in both conditions.

  9. Histopathology findings in patients presenting with menorrhagia: A study of 100 hysterectomy specimen

    Directory of Open Access Journals (Sweden)

    Nilima G Sawke

    2015-01-01

    Full Text Available Background: Menorrhagia, by definition, is heavy cyclical blood loss in excess of 80 ml/month of menstrual period lasting longer than 7 days. There are many possible causes of heavy menstrual bleeding which include hormonal imbalance, fibroids, miscarriage or ectopic pregnancy, nonhormonal intrauterine device, adenomyosis, pelvic inflammatory disease, and rarely uterine, ovarian, or cervical cancer. Treatment depends on the causes of the menorrhagia. Hysterectomy is one of the several surgical procedures as definitive treatment. Objective: To determine the histopathologic spectrum of lesions associated with menorrhagia in different age groups. Study Design: This prospective descriptive study was conducted at the Department of Pathology, People′s College of Medical Sciences and Research Centre, Bhopal. During the study period, 100 hysterectomy specimens were taken which were performed for the treatment of menorrhagia. Patients with menorrhagia in the age group of 30-50 years were selected after detailed history and fulfilling the inclusion criteria. Result: In our study, it was observed that maximum number of cases were in the age group of 41-50 years (n = 35 followed by the age group of 31-40 (n = 30. Out of 100 cases, 31% cases (n = 31 showed adenomyosis followed by leiomyomas 25% (n = 25, endometrial hyperplasia 23% (n = 23, and endometrial polyp 4% (n = 4. 11% cases (n = 11 showed dual pathology consisting of both adenomyosis and endometrial hyperplasia and 6% cases (n = 6 of leiomyoma with adenomyosis. Conclusion: Uterine adenomyosis and leiomyoma are the most common benign conditions found in hysterectomy specimens with peak incidence at 31-50 years. Patients having menorrhagia above 40 years should be screened for any endometrial pathology. Histopathology is mandatory for confirming diagnosis and the key to effective therapy and optimal outcome.

  10. Costs and effects of abdominal versus laparoscopic hysterectomy: systematic review of controlled trials.

    Directory of Open Access Journals (Sweden)

    Claudia B M Bijen

    Full Text Available OBJECTIVE: Comparative evaluation of costs and effects of laparoscopic hysterectomy (LH and abdominal hysterectomy (AH. DATA SOURCES: Controlled trials from Cochrane Central register of controlled trials, Medline, Embase and prospective trial registers. SELECTION OF STUDIES: Twelve (randomized controlled studies including the search terms costs, laparoscopy, laparotomy and hysterectomy were identified. METHODS: The type of cost analysis, perspective of cost analyses and separate cost components were assessed. The direct and indirect costs were extracted from the original studies. For the cost estimation, hospital stay and procedure costs were selected as most important cost drivers. As main outcome the major complication rate was taken. FINDINGS: Analysis was performed on 2226 patients, of which 1013 (45.5% in the LH group and 1213 (54.5% in the AH group. Five studies scored > or =10 points (out of 19 for methodological quality. The reported total direct costs in the LH group ($63,997 were 6.1% higher than the AH group ($60,114. The reported total indirect costs of the LH group ($1,609 were half of the total indirect in the AH group ($3,139. The estimated mean major complication rate in the LH group (14.3% was lower than in the AH group (15.9%. The estimated total costs in the LH group were $3,884 versus $3,312 in the AH group. The incremental costs for reducing one patient with major complication(s in the LH group compared to the AH group was $35,750. CONCLUSIONS: The shorter hospital stay in the LH group compensates for the increased procedure costs, with less morbidity. LH points in the direction of cost effectiveness, however further research is warranted with a broader costs perspective including long term effects as societal benefit, quality of life and survival.

  11. Surgical, oncological, and obstetrical outcomes after abdominal radical trachelectomy - a systematic literature review.

    Science.gov (United States)

    Pareja, René; Rendón, Gabriel J; Sanz-Lomana, Carlos Millán; Monzón, Otto; Ramirez, Pedro T

    2013-10-01

    Radical trachelectomy is a standard treatment for selected patients with early-stage cervical cancer. Outcomes are well established for vaginal radical trachelectomy (VRT), but not for abdominal radical trachelectomy (ART). We searched MEDLINE, EMBASE, and CINAHL (October 1997 through October 2012) using the terms: uterine cervix neoplasms, cervical cancer, abdominal radical trachelectomy, vaginal radical trachelectomy, fertility sparing, and fertility preservation. We included original articles, case series, and case reports. Excluded were review articles, articles with duplicate patient information, and articles not in English. We identified 485 patients. Ages ranged from 6 to 44 years. The most common stage was IB1 (331/464; 71%), and the most common histologic subtype was squamous cell carcinoma (330/470; 70%). Operative times ranged from 110 to 586 min. Blood loss ranged from 50 to 5568 mL. Three intraoperative complications were reported. Forty-seven patients (10%) had conversion to radical hysterectomy. One hundred fifty-five patients (35%) had a postoperative complication. The most frequent postoperative complication was cervical stenosis (n=42; 9.5%). The median follow-up time was 31.6 months (range, 1-124). Sixteen patients (3.8%) had disease recurrence. Two patients (0.4%) died of disease. A total of 413 patients (85%) were able to maintain their fertility. A total of 113 patients (38%) attempted to get pregnant, and 67 of them (59.3%) were able to conceive. ART is a safe treatment option in patients with early-stage cervical cancer interested in preserving fertility. Copyright © 2013 Elsevier Inc. All rights reserved.

  12. Infusion of hypertonic saline before elective hysterectomy: effects on cytokines and stress hormones

    DEFF Research Database (Denmark)

    Kølsen-Petersen, Jens Aage; Bendtzen, Klaus; Tønnesen, Else Kirstine

    2008-01-01

    BACKGROUND: Infusion of hypertonic saline provides early haemodynamic benefits and may affect the immune system. It is unknown if infusion of hypertonic saline affects plasma cytokines and stress hormones after surgery. METHODS: Sixty-two women undergoing abdominal hysterectomy were randomized...... factor-alpha. Serum cortisol and vasopressin were measured at these time points and 48 h after operation. Epinephrine and norepinephrine (n=26) were quantified at baseline, after infusion, 25 min after incision, 1, and 4 h after surgery. Finally, C-reactive protein was measured at baseline, 24, and 48 h...... with the other groups (Pstress...

  13. Total vaginal hysterectomy (TVH: outcome analysis of 108 cases at a tertiary centre

    Directory of Open Access Journals (Sweden)

    Monika Ramola

    2016-11-01

    Conclusions: TVH should be promoted as the route of choice for all benign gynaecological conditions. It is safe to do TVH in patients who are at poor general anaesthesia risk. In a state like Uttarakhand where medical facilities are hard to avail due to difficult geographic terrain, TVH has a special role. In lack of endoscopic facility, trained medical and paramedical staff and lack of postoperative monitoring instead of; there is a need to promote TVH. To top it all, TVH is the most cost effective route of hysterectomy. It is truly the natural orifice scarless surgery. [Int J Reprod Contracept Obstet Gynecol 2016; 5(11.000: 3679-3682

  14. Anaesthetic management of a patient with Liddle's syndrome for emergency caesarean hysterectomy.

    LENUS (Irish Health Repository)

    Hayes, N E

    2011-04-01

    We describe the anaesthetic management of a patient with Liddle\\'s syndrome during caesarean section and emergency hysterectomy for placenta accreta associated with significant intrapartum haemorrhage. Liddle\\'s syndrome is a rare autosomal dominant disorder characterised by early onset arterial hypertension and hypokalaemic metabolic alkalosis. Additional issues were the presence of short stature, limb hypertonicity and preeclampsia. Initial management with a low-dose combined spinal-epidural technique was subsequently converted to general anaesthesia due to patient discomfort. The management of Liddle\\'s syndrome in the setting of neuraxial and general anaesthesia in a patient undergoing caesarean section is discussed.

  15. Anaesthetic management of a patient with Liddle's syndrome for emergency caesarean hysterectomy.

    LENUS (Irish Health Repository)

    Hayes, N E

    2012-02-01

    We describe the anaesthetic management of a patient with Liddle\\'s syndrome during caesarean section and emergency hysterectomy for placenta accreta associated with significant intrapartum haemorrhage. Liddle\\'s syndrome is a rare autosomal dominant disorder characterised by early onset arterial hypertension and hypokalaemic metabolic alkalosis. Additional issues were the presence of short stature, limb hypertonicity and preeclampsia. Initial management with a low-dose combined spinal-epidural technique was subsequently converted to general anaesthesia due to patient discomfort. The management of Liddle\\'s syndrome in the setting of neuraxial and general anaesthesia in a patient undergoing caesarean section is discussed.

  16. INTERNAL ILIAC ARTERY LIGATION AFTER CAESERIAN HYSTERECTOMY IN POST - PARTUM HAEMORRHAGE LIFE SAVING PROCEDURE

    Directory of Open Access Journals (Sweden)

    Vijayalakshmi

    2015-07-01

    Full Text Available Internal iliac artery (Hypogastric supplies the pelvic viscera. Bilateral ligation of the internal iliac arteries is a safe, rapid and very effective method of controlling bleeding from genital tract. It is also helpful in massive broad ligament hematoma, in torn vessels retracted within th e broad ligament, and even in postoperative hemorrhage after abdominal or vaginal hysterectomy where there are no definitive bleeding points detectable. Bilateral ligation of internal iliac arteries is also helpful in life threatening hemorrhagic condition s like postpartum hemorrhage, placenta previa, cervical and vaginal tear, cervical pregnancy and uterine rupture etc.

  17. Combined epidural-spinal opioid-free anaesthesia and analgesia for hysterectomy

    DEFF Research Database (Denmark)

    Callesen, T; Schouenborg, Lars Øland; Nielsen, D;

    1999-01-01

    Postoperative nausea and vomiting (PONV) are major problems after gynaecological surgery. We studied 40 patients undergoing total abdominal hysterectomy, allocated randomly to receive opioid-free epidural-spinal anaesthesia or general anaesthesia with continuous epidural bupivacaine 15 mg h-1...... or continuous bupivacaine 10 mg h-1 with epidural morphine 0.2 mg h-1, respectively, for postoperative analgesia. Nausea, vomiting, pain and bowel function were scored on 4-point scales for 3 days. Patients undergoing general anaesthesia had significantly higher nausea and vomiting scores (P

  18. Five-year follow up of a randomised controlled trial comparing subtotal with total abdominal hysterectomy

    DEFF Research Database (Denmark)

    Andersen, L L; Zobbe, V; Ottesen, B;

    2015-01-01

    years after surgery. Complications of hysterectomy were further examined by scrutinising registered discharge summaries following hospitalisation. Intention-to-treat and per-protocol analyses were conducted. Potential bias caused by missing data was handled using multiple imputation. MAIN OUTCOME...... of respondents had urinary incontinence 5 years after SAH 34/113 (30.1%) than TAH 21/119 (17.6%) (RR 1.71, 95% confidence interval 1.06-2.75, P = 0.026). This difference reduced after multiple imputation to account for missing data (RR 1.37, 95% confidence interval 0.99-1.89, P = 0.052). Eleven of the 101 women...

  19. [Pyelovenous fistula revealed by repeated thromboembolic events after emergency peripartum hysterectomy].

    Science.gov (United States)

    Sauvanaud, C; Boillot, B; Sergent, F; Long, J A; Pernod, G; Rambeaud, J J

    2014-04-01

    We report the case of a 51-year old woman presenting pyelovenous fistula revealed by recurrent and serious thromboembolic events after ureteral ligation during emergency peripartum hysterectomy. Imaging reported a complete left ureteral obstruction, a fistula between the upper calix and the left renal vein and a renal function preserved. Uretero-vesical reimplantation was performed. The patient was well doing after 12 months. The authors wonder if pyelovenous fistula is responsible for prothrombotic state and maintaining renal function. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  20. Total laparoscopic hysterectomy as a primary surgical treatment for endometrial cancer in morbidly obese women.

    Science.gov (United States)

    Yu, C K H; Cutner, A; Mould, T; Olaitan, A

    2005-01-01

    To evaluate the feasibility of total laparoscopic hysterectomy as the primary treatment for endometrial cancer in morbidly obese women, an audit was carried out during an 18-month period in a tertiary referral centre for gynaecological oncology. Four women who had laparoscopic surgery were compared with a similar cohort who had open surgery. The mean operating time was equivalent, without evidence of excess morbidity with the laparoscopic approach. However, inpatient stay was longer with open versus laparoscopic surgery (11.5 vs 4 days). Laparoscopic surgery is safe to use in morbidly obese women with endometrial cancer.

  1. Leiomyoma mimicking an incarcerated inguinal hernia: A rare complication of laparoscopic hysterectomy

    Directory of Open Access Journals (Sweden)

    Carlos Apestegui

    2011-01-01

    Full Text Available A 52-year-old, obese, female patient was referred for a right inguinal mass, which appeared seven months after a laparoscopic hysterectomy, which was performed because of myomatosis. Despite several examinations, including ultrasound, computed tomography (CT-Scan, positron emission tomography (PET-CT, and ultrasound-guided biopsy, the diagnosis remained unclear until surgical exploration, which disclosed a well-encapsulated solid tumour corresponding to a fibrotic leiomyoma. Spilling of leiomyoma cells is a rare and unusual complication of laparoscopic surgery. Tumour development in the inguinal canal after laparoscopic gynaecological surgery should be kept in mind in the differential diagnosis of inguinal hernia and other uncommon pathologies.

  2. Effect of remote cesarean delivery on complications during hysterectomy: a cohort study.

    Science.gov (United States)

    Hesselman, Susanne; Högberg, Ulf; Jonsson, Maria

    2017-07-21

    Cesarean delivery is performed frequently worldwide, and follow-up studies that report complications at subsequent surgery are warranted. The aim of the study was to investigate the association between a previous abdominal delivery and complications during a subsequent hysterectomy and to estimate the fraction of complications that are driven by the presence of adhesions. This was a longitudinal population-based register study of 25354 women who underwent a benign hysterectomy at 46 hospital units in Sweden 2000-2014. Adhesions were found in 45% of the women with a history of cesarean delivery. Organ injury affected 2.2% of the women. The risk of organ injury (adjusted odds ratio, 1.74; 95% confidence interval, 1.41-2.15) and postoperative infection (adjusted odds ratio, 1.26; 95% confidence interval, 1.15-1.39) was increased with previous cesarean delivery, irrespective of whether adhesions were present or not. The direct effect on organ injury by a personal history of cesarean delivery was estimated to 73%, and only 27% was mediated by the presence of adhesions. Previous cesarean delivery was a predictor of bladder injury (adjusted odds ratio, 1.86; 95% confidence interval, 1.40-2.47) and bowel injury (adjusted odds ratio, 1.83; 95% confidence interval, 1.10-3.03), but not ureter injury. A personal history of other abdominal surgeries was associated with bowel injury (adjusted odds ratio, 2.27; 95% confidence interval, 1.37-3.78), and the presence of endometriosis increased the risk of ureter injury (adjusted odds ratio, 2.15; 95% confidence interval, 1.34-3.44). Previous cesarean delivery is associated with an increased risk of complications during a subsequent hysterectomy, but the risk is only partly attributable to the presence of adhesions. Previous cesarean delivery and presence of endometriosis were major predisposing factors of organ injury at the time of the hysterectomy, whereas background and perioperative characteristics were of minor importance

  3. Catalysis of Radical Reactions: A Radical Chemistry Perspective.

    Science.gov (United States)

    Studer, Armido; Curran, Dennis P

    2016-01-04

    The area of catalysis of radical reactions has recently flourished. Various reaction conditions have been discovered and explained in terms of catalytic cycles. These cycles rarely stand alone as unique paths from substrates to products. Instead, most radical reactions have innate chains which form products without any catalyst. How do we know if a species added in "catalytic amounts" is a catalyst, an initiator, or something else? Herein we critically address both catalyst-free and catalytic radical reactions through the lens of radical chemistry. Basic principles of kinetics and thermodynamics are used to address problems of initiation, propagation, and inhibition of radical chains. The catalysis of radical reactions differs from other areas of catalysis. Whereas efficient innate chain reactions are difficult to catalyze because individual steps are fast, both inefficient chain processes and non-chain processes afford diverse opportunities for catalysis, as illustrated with selected examples.

  4. Predictors of surgical site infection in women undergoing hysterectomy for benign gynecologic disease: a multicenter analysis using the national surgical quality improvement program data.

    Science.gov (United States)

    Mahdi, Haider; Goodrich, Sarah; Lockhart, David; DeBernardo, Robert; Moslemi-Kebria, Mehdi

    2014-01-01

    To estimate the rate and predictors of surgical site infection (SSI) after hysterectomy performed for benign indications and to identify any association between SSI and other postoperative complications. Retrospective cohort study (Canadian Task Force classification II-2). National Surgical Quality Improvement Program data. Women who underwent abdominal or laparoscopic hysterectomy performed for benign indications from 2005 to 2011. Univariable and multivariable logistic regression analyses were used to identify predictors of SSI and its association with other postoperative complications. Odds ratios were adjusted for patient demographic data, comorbidities, preoperative laboratory values, and operative factors. Of 28 366 patients, 758 (3%) were diagnosed with SSI. SSI occurred more often after abdominal than laparoscopic hysterectomy (4% vs 2%; p hysterectomy, predictors of SSI included diabetes, smoking, respiratory comorbidities, overweight or obesity, American Society of Anesthesiologists class ≥ 3, perioperative blood transfusion, and operative time >180 minutes. Among those who underwent laparoscopic hysterectomy, predictors of SSI included perioperative blood transfusion, operative time >180 minutes, serum creatinine concentration ≥ 2 mg/dL, and platelet count ≥ 350 000 cells/mL(3). For patients with deep or organ/space SSI, significant predictors included perioperative blood transfusion and American Society of Anesthesiologists class ≥ 3 for abdominal hysterectomy, and non-white race, renal comorbidities, preoperative or perioperative blood transfusion, and operative time >180 minutes for laparoscopic hysterectomy. SSI was associated with longer hospital stay and higher rates of repeat operation, sepsis, renal failure, and wound dehiscence. SSI was not associated with increased 30-day mortality. SSI occurred more often after abdominal hysterectomy than laparoscopic hysterectomy performed to treat benign gynecologic disease. SSI was associated with

  5. Radically innovative steelmaking technologies

    Science.gov (United States)

    Szekely, Julian

    1980-09-01

    The steel industry is faced with serious problems caused by the increasing cost of energy, labor and capital and by tough overseas competition, employing new highly efficient process plants. The very high cost of capital and of capital equipment renders the construction of new green field site plants, exemplifying the best available technology economically unattractive. For this reason, over the long term the development radically innovative steelmaking technologies appears to be the only satisfactory resolution of this dilemma. The purpose of this article is to present a critical review of some of the radically innovative steelmaking technologies that have been proposed during the past few years and to develop the argument that these indeed do deserve serious consideration at the present time. It should be stressed, however, that these innovative technologies can be implemented only as part of a carefully conceived long range plan, which contains as a subset short term solutions, such as trigger prices improved investment credits, and so forth and intermediate term solutions, such as more extensive use of continuous casting, external desulfurization and selective modernization in general.

  6. Bursectomy at radical gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Cuneyt; Kayaalp

    2015-01-01

    Radical gastrectomy with extended lymph node dissec tion and prophylactic resection of the omentum, peri toneum over the posterior lesser sac, pancreas and/o spleen was advocated at the beginning of the 1960 s in Japan. In time, prophylactic routine resections of the pancreas and/or spleen were abandoned because of the high incidence of postoperative complications. However omentectomy and bursectomy continued to be standard parts of traditional radical gastrectomy. The bursaomentalis was thought to be a natural barrier against invasion of cancer cells into the posterior part of the stomach. The theoretical rationale for bursectomy was to reduce the risk of peritoneal recurrences by eliminating the peritoneum over the lesser sac, which might include free cancer cells or micrometastases. Over time, the indication for bursectomy was gradually reduced to only patients with posterior gastric wall tumors penetrating the serosa. Despite its theoretical advantages, its benefit for recurrence or survival has not been proven yet. The possible reasons for this inconsistency are discussed in this review. In conclusion, the value of bursectomy in the treatment of gastric cancer is still under debate and large-scale randomized studies are necessary. Until clear evidence of patient benefit is obtained, its routine use cannot be recommended.

  7. Patient and Staff (doctors and nurses) Experiences of Abdominal Hysterectomy in Accelerated Recovery Programme

    DEFF Research Database (Denmark)

    Wagner, Lis; Carlslund, Anne Mette; Møller, Charlotte

    2004-01-01

    Introduction: The accelerated recovery programme (ARP) is becoming commonplace in surgical specialties and has also been introduced to hysterectomy patients. Diagnostic, prognostic and other clinical indicators are well described. The aim of this article is to relay knowledge about the ARP, throu...... of information relay and dialogue between staff and patients/family members. A nursing care ambulatory unit is recommended to support with information for women prior to and following hysterectomy in the ARP....... the experiences of the women operated and the staff involved. Material and methods: The study is exploratory and descriptive, using qualitative methods. Seventeen women, with good health status, were consecutively selected from August to September 2001. The women were observed and ten were interviewed twice...... themselves as being good girls but expressed that when the hospital's ARP had expired the attention from the staff declined. The staff continued to be concerned about whether the women received the information and psychological care they needed but claimed that the ARP proved better for the women than...

  8. THE BENEFITS OF IVP AND BARIUM ENEMA IN PATIENTS UNDERGOING HYSTERECTOMY FOR BENIGN CONDITIONS

    Directory of Open Access Journals (Sweden)

    Heshmatollah Azhar

    1995-06-01

    Full Text Available A review of500 cases was undertaken in order to identify which patients undergoing hrsterectomy for benign disease weresubjected topreoperative intravenous pyelogram (lVP and/ or barium enema (BE, and what abnormalities couldbe anticipatedbythese procedures as a surgical screen."nOver 80% ofthe cases reviewed underwent trans-ahdominal hysteredomy, and the remainder hadvaginal hysterectomy. Close to one-third of the patients were admitted with the diagnosis offibroid; and one-sixth with uterine prolapse. Miscellaneous benign conditions included adnexal masses, ovarian cysts, and dysfunctional uterine bleeding. Twentytwo patients (4.4% had IVP preoperatively, while eight patienls (1.6% were given both lIP and barium enema prior to hysterectomy. Over three-fourth ofthe 22 patients revealed normal IVP, while one-half who had received both IVP and/or BE had an unremarkable roentgenogram interpretation. None of the subiects who had unusual findings in either group were ofclinical significance on the pathology report Post-operative coursefor the patients was also quite unremarkable. This review indicates that when benign disease is clear-cut and hysteredomy is indicated there is no needfor IVP and barium enema.

  9. Preoperative screening strategies for bacterial vaginosis prior to elective hysterectomy: a cost comparison study.

    Science.gov (United States)

    McElligott, Kara A; Havrilesky, Laura J; Myers, Evan R

    2011-11-01

    The purpose of this study is to compare costs of 3 strategies for women undergoing hysterectomy: (1) test all patients for bacterial vaginosis; treat if positive; (2) treat all patients for bacterial vaginosis; (3) neither test nor treat patients for bacterial vaginosis. For comparison purposes, a fourth strategy is examined: (4) no surgical site infection prophylaxis or bacterial vaginosis treatment. A cost minimization model was created using estimates obtained from the published literature, Medicare reimbursement data, and wholesale drug costs. In the base case, the optimal strategy was to treat all patients for bacterial vaginosis, with a cuff infection rate of 4.0% and mean cost of $593. The "test all patients for bacterial vaginosis; treat if positive" strategy was also inexpensive, with a mean cost of $623 and 4.2% cuff infection rate. "Neither test nor treat patients for bacterial vaginosis" and "no surgical site infection prophylaxis or bacterial vaginosis treatment" were more expensive and less effective than other strategies. This model suggests that consideration should be given to adding metronidazole to standard surgical site infection prophylaxis before hysterectomy. Copyright © 2011 Mosby, Inc. All rights reserved.

  10. Cervical koilocytosis in hysterectomy specimens of Israeli residents and new immigrants.

    Science.gov (United States)

    Abramov, D; Fintsi, Y; Zakut, H; Menczer, J

    1997-01-01

    There is an impression that the prevalence of cervical squamous cell carcinoma (SCC) among new immigrants from the former Soviet Union, is higher than among Israeli residents. Etiologically, SCC is associated with human papilloma virus infection (HPV). The purpose of the present study was to assess the prevalence of cervical HPV infection in new immigrants from the Soviet Union and in Israeli residents as indicated by the presence of koilocytosis in hysterectomy specimens. The study group consisted of 304 women (60 new immigrants and 244 Israeli residents who underwent hysterectomy for benign reasons). The original histological slides of the cervix were reviewed with special attention to the presence of koilocytosis. The two study subgroups differed, as expected, with regard to some characteristics, but koilocytosis was not present in any of the cervical specimens of new immigrants nor of residents. Although the study subgroups may be too small or selective, our findings do not support a possible higher HPV infection rate among new immigrants, yet may indicate a low reservoir of HPV in new immigrants and residents, in line with the low SCC incidence in Israeli women.

  11. Environmental Impacts of Surgical Procedures: Life Cycle Assessment of Hysterectomy in the United States

    Science.gov (United States)

    2015-01-01

    The healthcare sector is a driver of economic growth in the U.S., with spending on healthcare in 2012 reaching $2.8 trillion, or 17% of the U.S. gross domestic product, but it is also a significant source of emissions that adversely impact environmental and public health. The current state of the healthcare industry offers significant opportunities for environmental efficiency improvements, potentially leading to reductions in costs, resource use, and waste without compromising patient care. However, limited research exists that can provide quantitative, sustainable solutions. The operating room is the most resource-intensive area of a hospital, and surgery is therefore an important focal point to understand healthcare-related emissions. Hybrid life cycle assessment (LCA) was used to quantify environmental emissions from four different surgical approaches (abdominal, vaginal, laparoscopic, and robotic) used in the second most common major procedure for women in the U.S., the hysterectomy. Data were collected from 62 cases of hysterectomy. Life cycle assessment results show that major sources of environmental emissions include the production of disposable materials and single-use surgical devices, energy used for heating, ventilation, and air conditioning, and anesthetic gases. By scientifically evaluating emissions, the healthcare industry can strategically optimize its transition to a more sustainable system. PMID:25517602

  12. Total laparoscopic hysterectomy without uterine manipulator: description of a new technique and its outcome.

    Science.gov (United States)

    Kavallaris, Andreas; Chalvatzas, N; Kelling, K; Bohlmann, M K; Diedrich, K; Hornemann, A

    2011-05-01

    Hysterectomy remains the most common major gynecological operation. This is the first study that describes a new technique of TLH without using any kind of uterine manipulator or vaginal tube (TLHwM) and analyzes the intra- and postoperative surgical outcome of the first 67 cases. Between October 2008 and December 2009, 67 patients underwent TLH without uterine manipulator or vaginal tube. We analyzed the differences in the outcome by using three different kinds of surgical instruments: in 21 cases the TLHwM was performed using conventional 5 mm bipolar and scissors, in 22 cases using Sonosurgical, and in 24 cases using PKS cutting forceps. There was no intra- or postoperative complications. The overall mean operating time was by TLHwM with salpingo-oophorectomy 98 min and without salpingo-oophorectomy, 80 min. The mean operating time using cutting forceps was significantly lower. The mean uterine weight was 263 g. Uterine manipulator seems to be a safe and practical surgical method, especially for patients with vaginal stenosis and in cases of enlarged uterus. With its short operation time and no complication rate, we believe that this method is an enrichment of the laparoscopic hysterectomy techniques.

  13. Histerectomias: estudo retrospectivo de 554 casos Hysterectomies: a retrospective study of 554 cases

    Directory of Open Access Journals (Sweden)

    Eddie Fernando Cândido Murta

    2000-10-01

    Full Text Available OBJETIVO: A histerectomia é uma operação muito realizada, entretanto há poucos trabalhos na literatura nacional sobre suas indicações, técnica e complicações. O objetivo deste trabalho é avaliar estes procedimentos realizados na Disciplina de Ginecologia e Obstetrícia da Faculdade de Medicina do Triângulo Mineiro. MÉTODO: Estudo retrospectivo de 470 histerectomias abdominais e 84 vaginais foi conduzido analisando as indicações, tempo de cirurgia e internação, tipo de incisão e morbidez. RESULTADOS: As principais indicações foram o mioma uterino e o prolapso uterino para as histerectomias abdominais e vaginais, respectivamente. As complicações intra-operatórias aconteceram em 3,4% e as pós-operatórias em 2,4% do total de casos. Nenhuma diferença estatística foi encontrada no número de complicações em relação ao tipo de incisão (vertical ou transversal. O tempo de cirurgia e o de hospitalização foram estatisticamente maiores nas incisões verticais. A hemorragia foi a mais freqüente complicação intra-operatória e a infecção da incisão operatória foi a mais freqüente no pós-operatório. CONCLUSÕES: A histerectomia é um procedimento de baixo risco, no entanto, a realização de revisões sobre indicações e complicações, e a pesquisa de melhores técnicas cirúrgicas são necessárias para torná-la cada vez mais segura.OBJECTIVE: Hysterectomy is a frequently performed surgery, but national literature gives limited information regarding indications, technique and complications. The aim of this study is to evaluate our results with this operation performed by the Discipline of Gynecology and Obstetrics of the Faculty of Medicine of "Triângulo Mineiro". METHODS: A retrospective study of 470 abdominal and 84 vaginal hysterectomies was conducted in which the indications, operation time, abdominal approach, hospitalization time, and morbidity were analyzed. RESULTS: Uterine myoma and uterine prolapse

  14. Radicals in Berkeley?

    Science.gov (United States)

    Linn, Stuart

    2015-04-03

    In a previous autobiographical sketch for DNA Repair (Linn, S. (2012) Life in the serendipitous lane: excitement and gratification in studying DNA repair. DNA Repair 11, 595-605), I wrote about my involvement in research on mechanisms of DNA repair. In this Reflections, I look back at how I became interested in free radical chemistry and biology and outline some of our bizarre (at the time) observations. Of course, these studies could never have succeeded without the exceptional aid of my mentors: my teachers; the undergraduate and graduate students, postdoctoral fellows, and senior lab visitors in my laboratory; and my faculty and staff colleagues here at Berkeley. I am so indebted to each and every one of these individuals for their efforts to overcome my ignorance and set me on the straight and narrow path to success in research. I regret that I cannot mention and thank each of these mentors individually.

  15. Timing of heparin prophylaxis and bleeding complications in hysterectomy a nationwide prospective cohort study of 9,949 Danish women

    DEFF Research Database (Denmark)

    Hansen, Charlotte T; Kehlet, Henrik; Møller, Charlotte

    2008-01-01

    's experience, route and type of hysterectomy and additional surgery, and stratification on assistant's experience, peri-operative pain prophylaxis with NSAID and daily use of Acetyl Salicylic Acid (ASA)/NSAID. RESULTS: 9,051 women (92%) received thromboprophylaxis with heparin, initiated pre-operatively in 48...

  16. TO EVALUATE THE ROLE OF GABAPENTIN AS A PREEMPTIVE ANALGESIC IN PATIENTS UNDERGOING TOTAL ABDOMINAL HYSTERECTOMY UNDER SPINAL ANAESTHESIA

    Directory of Open Access Journals (Sweden)

    Gunavathi Kandappan

    2016-06-01

    Full Text Available AIM OF THE STUDY To evaluate whether Gabapentin when given orally preoperatively at a dose of 300 mg has an effect on postoperative pain and analgesic requirement in patients undergoing total abdominal hysterectomy under spinal anaesthesia. The study also evaluates the side effects associated with administration of Gabapentin. METHODOLOGY This is a prospective, randomised, single blinded case controlled study. This study was conducted in total of 60 patients who underwent elective abdominal hysterectomy in our institute over a period of four months. Patients were randomly allocated into two groups: Group G (Gabapentin Group and Group P (Placebo Group. Patients in Group G received Gabapentin 300 mg orally and Group P patients received placebo capsules with sips of water two hours before surgery. Time since spinal anaesthesia to first requirement of analgesic (T, total analgesic requirement in first 24 hours, visual analogue scale (VAS scores at rest and movement, Ramsay sedation score, side effects of the drug like somnolence, dizziness, confusion, nausea, vomiting were recorded in first 24 hours postoperatively. RESULT Single oral dose of Gabapentin 300 mg when given preoperatively reduces the postoperative pain scores and total tramadol consumption in patients undergoing abdominal hysterectomy under spinal anaesthesia. Sedation was the only significant side effect observed with the Gabapentin usage. Thus, Gabapentin can be considered as an adjunct in treating postoperative pain. CONCLUSION Oral Gabapentin 300 mg given preoperatively as preemptive analgesic is effective in total abdominal hysterectomy patients under spinal anaesthesia without any significant complications.

  17. Comparison of Robotic vs. Standard Surgical Procedure on Postoperative Nursing Care of Women Undergoing Total Abdominal Hysterectomy.

    Science.gov (United States)

    Best, Janie; Day, Luanne; Ingram, Lori; Musgrave, Barbara; Rushing, Holli; Schooley, Brenda

    2014-01-01

    This exploratory study was conducted to determine if the postoperative course is different for women undergoing robotic-assisted total abdominal hysterectomy (TAH) compared to women undergoing traditional (open) TAH. This study adds to the evidence regarding potential benefits and complications of robotic-assisted gynecologic surgery, and identifies specific areas for further research.

  18. Statewide collaboration to evaluate the effects of blood loss and transfusion on surgical site infection after hysterectomy.

    Science.gov (United States)

    Young, Heather; Berumen, Crystal; Knepper, Bryan; Miller, Amber; Silverman, Morgan; Gilmartin, Heather; Wodrich, Elizabeth; Alexander, Sandy; Price, Connie S

    2012-01-01

    We used mandatory public reporting as an impetus to perform a statewide study to define risk factors for surgical site infection. Among women who underwent abdominal hysterectomy, blood transfusion was a significant risk factor for surgical site infection in patients who experienced blood loss of less than 500 mL.

  19. Trocar-guided total tension-free vaginal mesh repair of post-hysterectomy vaginal vault prolapse.

    NARCIS (Netherlands)

    Milani, A.L.; Withagen, M.I.J.; Vierhout, M.E.

    2009-01-01

    INTRODUCTION AND HYPOTHESIS: The objective of this study was to report 1 year anatomical and functional outcomes of trocar-guided total tension-free vaginal mesh (Prolift) repair for post-hysterectomy vaginal vault prolapse with one continuous piece of polypropylene mesh. METHODS: We conducted a pro

  20. The Possible Correlation between the Patient's Immune Tolerance Level During Cesaerean Section and the Incidence of Subsequent Emergency Peripartum Hysterectomy

    Directory of Open Access Journals (Sweden)

    Lukasz Wicherek

    2007-01-01

    Full Text Available Introduction. Cesarean section is an independent risk factor for peripartum hysterectomy. As a method of delivery, cesarean section may interfere with a number of molecular changes that occur at the maternal-fetal interface during the course of labor. Methods. The level of CD3, CD56, CD25, and CD69 antigen immunoreactivity was assessed by immunohistochemistry in 26 decidual tissue samples. The tissue samples were obtained from 18 women who underwent cesarean sections at term and from 8 women who underwent cesarean hysterectomies. Results. An increase in the activity and infiltration of immune cells in the decidua sampled during the spontaneous beginning of labor was observed. The further progression of labor was accompanied by a decrease in the number and activity of immune cells. The number of CD56+ and CD3+ cells in the decidua was statistically significantly lower in patients who had undergone cesarean hysterectomies than in those who had had cesarean sections at term. Conclusion. Abnormal immune response during labor may increase the risk for peripartum hysterectomy.

  1. Robot-assisted laparoscopic hysterectomy in obese and morbidly obese women: surgical technique and comparison with open surgery.

    Science.gov (United States)

    Geppert, Barbara; Lönnerfors, Celine; Persson, Jan

    2011-11-01

    Comparison of surgical results on obese patients undergoing hysterectomy by robot-assisted laparoscopy or laparotomy. University hospital. All women (n=114) with a BMI ≥30 kg/m(2) who underwent a simple hysterectomy as the main surgical procedure between November 2005 and November 2009 were identified. Robot-assisted procedures (n=50) were separated into an early (learning phase) and a late (consolidated phase) group; open hysterectomy was considered an established method. Relevant data was retrieved from prospective protocols (robot) or from computerized patient charts (laparotomy) until 12 months after surgery. Complications leading to prolonged hospital stay, readmission/reoperation, intravenous antibiotic treatment or blood transfusion were considered significant. The surgical technique used for morbidly obese patients is described. Women in the late robot group (n=25) had shorter inpatient time (1.6 compared to 3.8 days, plaparoscopic hysterectomy in a consolidated phase in obese women is associated with shorter hospital stay, less bleeding and fewer complications compared to laparotomy but, apart from women with BMI ≥35, a longer operative time. © 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2011 Nordic Federation of Societies of Obstetrics and Gynecology.

  2. Feasibility and safety of total laparoscopic hysterectomy (TLH) using the Hohl instrument in nonobese and obese women.

    Science.gov (United States)

    Mueller, Andreas; Thiel, Falk; Lermann, Johannes; Oppelt, Peter; Beckmann, Matthias W; Renner, Stefan P

    2010-02-01

    The aim of the present study was to evaluate the feasibility, safety, and complication rates of total laparoscopic hysterectomy (TLH) using the Hohl instrument in nonobese and obese women. A prospective controlled trail (Canadian Task Force classification II-1) was conducted at the Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen-Nuremberg, Germany. Two hundred and fifty-seven women underwent total laparoscopic hysterectomy using the Hohl instrument between January 2006 and May 2008. The laparoscopic approach was used when the patient had undergone previous pelvic abdominal operation and/or had a reduced vaginal capacity. Women were classified according to their body mass index (BMI), with a cutoff point of 30 kg/m(2). Total laparoscopic hysterectomy was performed using the Hohl instrument. One ureteral injury, one bladder injury, one vaginal injury, and one injury to the epigastric vessels occurred. Blood transfusion was necessary in one patient. One conversion to abdominal hysterectomy was performed in a woman with a uterus weighing 893 g. In the postoperative phase, suture dehiscence at the vaginal closure occurred in three patients, one patient had bladder infection, one woman developed unexplained fever, and a hematoma without infection at the vaginal vault occurred in one woman. All complications occurred in women with BMI obese patients.

  3. Absent organs—Present selves: Exploring embodiment and gender identity in young Norwegian women's accounts of hysterectomy

    Directory of Open Access Journals (Sweden)

    Kari Nyheim Solbrække

    2015-04-01

    Full Text Available In this paper, we explore how younger women in Norway construct their embodiment and sense of self after hysterectomy. To do this, we conducted in-depth interviews with eight ethnic Norwegian women aged between 25 and 43 who had undergone hysterectomy. In line with a broad phenomenological approach to illness, the study was designed to explore the trajectories of the women's illness with a specific focus on concrete human experience and identity claims from a subjective point of view. In analysing the stories, we encountered feelings of suffering due to the loss of the uterus as well as profound side-effects, such as menopause. However, we also found evidence of relief from being treated for heavy bleeding and serious illness. In order to accentuate the individual voices in these illness stories, we chose a case-oriented analysis in line with Radley and Chamberlain (2001 and Riessman (2008. From this, two main seemingly contradictory storylines stood out: They have removed what made me a woman versus Without a uterus, I feel more like a woman. We also identified heteronormativity as an unstated issue in both these storylines and in the research data as a whole. Acknowledging diversity in the way women experience hysterectomy is important for a better understanding of the ways in which hysterectomy may affect women as humans as well as for developing more cultural competent healthcare services for this group.

  4. Massive Hematometra due to Congenital Cervicovaginal Agenesis in an Adolescent Girl Treated by Hysterectomy: A Case Report

    Directory of Open Access Journals (Sweden)

    Turki Gasim

    2013-01-01

    Full Text Available A case of massive hematometra with a bicornuate uterus in a 14-year-old mentally handicapped girl complicated by vaginal agenesis and absent cervix is presented. She was managed by abdominal hysterectomy and right salpingo-oophorectomy that included the ovarian cystadenoma. The left ovary was conserved. This treatment was considered appropriate for this patient.

  5. Transfusion rate and prevalence of unexpected red blood cell alloantibodies in women undergoing hysterectomy for benign disease

    DEFF Research Database (Denmark)

    Thoestesen, Lisbeth M; Rasmussen, Kjeld L; Lauszus, Finn F;

    2011-01-01

    To determine transfusion rates, risk factors for transfusion and the prevalence of unexpected red blood cell alloantibodies in women undergoing hysterectomy for benign disease. In addition, we aimed to evaluate the necessity of the pretransfusion testing for red blood cell alloantibodies....

  6. Evolution of the complications of laparoscopic hysterectomy after a decade: a follow up of the Monash experience.

    Science.gov (United States)

    Tan, Jason J; Tsaltas, Jim; Hengrasmee, Pattaya; Lawrence, Anthony; Najjar, Haider

    2009-04-01

    A retrospective review of medical records was performed to assess the incidence and types of significant complications encountered during laparoscopic hysterectomy which would affect the use of a laparoscopic approach versus other routes of hysterectomy. A total of 526 consecutive patients' medical data between January 1994 and August 2007 were reviewed. Two hundred and thirty-two laparoscopic-assisted vaginal hysterectomies and 294 total laparoscopic hysterectomies were performed at Monash Medical Centre, a Melbourne tertiary public hospital, and three Melbourne private hospitals, by or under the supervision of three surgeons. Sixteen significant complications occurred. There were two cases of ureteric fistula, two bladder injuries, two bowel obstructions, four postoperative haematomas, one case of a bladder fistula, four conversions to laparotomy and one superficial epigastric artery injury. Inpatient stay ranged from two to six days. Our complication and inpatient stay rates are consistent with the previously reported rates, although there has been a reduction of incidence of visceral injuries with experience and introduction of new equipment.

  7. Muoniated acyl and thioacyl radicals

    Energy Technology Data Exchange (ETDEWEB)

    McKenzie, Iain [TRIUMF and Department of Chemistry, 8888 University Drive, Simon Fraser University, Burnaby B.C., V5A 1S6 (Canada); Brodovitch, Jean-Claude [TRIUMF and Department of Chemistry, 8888 University Drive, Simon Fraser University, Burnaby B.C., V5A 1S6 (Canada); Ghandi, Khashayar [TRIUMF and Department of Chemistry, 8888 University Drive, Simon Fraser University, Burnaby B.C., V5A 1S6 (Canada); Percival, Paul W. [TRIUMF and Department of Chemistry, 8888 University Drive, Simon Fraser University, Burnaby B.C., V5A 1S6 (Canada)]. E-mail: percival@sfu.ca

    2006-03-31

    The product of the reaction of muonium with tert-butylisocyanate was previously assigned as the muoniated tert-butylaminyl radical (I. McKenzie, J.-C. Brodovitch, K. Ghandi, S. Kecman, P. W. Percival, Physica B 326 (2003) 76). This assignment is incorrect since the muon and {sup 14}N hyperfine-coupling constants (hfcc) of this radical would have the opposite sign, which is in conflict with the experimental results. The radical is now reassigned as the muoniated N-tert-butylcarbamoyl radical, based on the similarities between the experimental muon and {sup 14}N hfcc and hfcc calculated at the UB3LYP/6-311G(d,p)//UB3LYP/EPR-III level. The large zero-point energy in the N-Mu bond results in the dissociation barrier of the muoniated N-tert-butylcarbamoyl radical being above the combined energy of the reactants, in contrast to the N-tert-butylcarbamoyl radical where the dissociation barrier lies below the combined energy of the reactants. The reaction of muonium with tert-butylisothiocyanate produced both conformers of the muoniated N-tert-butylthiocarbamoyl radical and their assignment was based on the similarities between the experimental and calculated muon hfcc. These are the first acyl and thioacyl radicals to be directly detected by muon spin spectroscopy.

  8. Radical chic? Yes we are!

    OpenAIRE

    Hartle, J.F.

    2012-01-01

    Ever since Tom Wolfe in a classical 1970 essay coined the term "radical chic", upper-class flirtation with radical causes has been ridiculed. But by separating aesthetics from politics Wolfe was actually more reactionary than the people he criticized, writes Johan Frederik Hartle.

  9. Melatonin scavenges phenylglyoxylic ketyl radicals.

    Science.gov (United States)

    Sersen, F; Vencel, T; Annus, J

    2004-12-01

    The antioxidant properties of melatonin were tested in this work by EPR technique. It was found that melatonin scavenges phenylglyoxylic ketyl radicals. Its effectiveness was 10-times lower than that of vitamin C. A new method of generation of phenylglyoxylic ketyl radicals by spontaneous decomposition of D,L-2,3-diphenyltartaric acid in propan-2-ol was used.

  10. Hysterectomy in very obese and morbidly obese patients: a systematic review with cumulative analysis of comparative studies.

    Science.gov (United States)

    Blikkendaal, Mathijs D; Schepers, Evelyn M; van Zwet, Erik W; Twijnstra, Andries R H; Jansen, Frank Willem

    2015-10-01

    Some studies suggest that also regarding the patient with a body mass index (BMI) ≥35 kg/m(2) the minimally invasive approach to hysterectomy is superior. However, current practice and research on the preference of gynaecologists still show that the rate of abdominal hysterectomy (AH) increases as the BMI increases. A systematic review with cumulative analysis of comparative studies was performed to evaluate the outcomes of AH, laparoscopic hysterectomy (LH) and vaginal hysterectomy (VH) in very obese and morbidly obese patients (BMI ≥35 kg/m(2)). PubMed and EMBASE were searched for records on AH, LH and VH for benign indications or (early stage) malignancy through October 2014. Included studies were graded on level of evidence. Studies with a comparative design were pooled in a cumulative analysis. Two randomized controlled trials, seven prospective studies and 14 retrospective studies were included (2232 patients; 1058 AHs, 959 LHs, and 215 VHs). The cumulative analysis identified that, compared to LH, AH was associated with more wound dehiscence [risk ratio (RR) 2.58, 95 % confidence interval (CI) 1.71-3.90; P = 0.000], more wound infection (RR 4.36, 95 % CI 2.79-6.80; P = 0.000), and longer hospital admission (mean difference 2.9 days, 95 % CI 1.96-3.74; P = 0.000). The pooled conversion rate was 10.6 %. Compared to AH, VH was associated with similar advantages as LH. Compared to AH, both LH and VH are associated with fewer postoperative complications and shorter length of hospital stay. Therefore, the feasibility of LH and VH should be considered prior the abdominal approach to hysterectomy in very obese and morbidly obese patients.

  11. Observational evaluation of preoperative, intraoperative, and postoperative characteristics in 117 Brazilian women without uterine prolapse undergoing vaginal hysterectomy

    Science.gov (United States)

    Batista, Claudio Sergio; Osako, Takasi; Clemente, Eliana Mara; Batista, Fernanda Carvalhido Antonio; Osako, Maurício Takeshi Janiques

    2012-01-01

    Background Despite the introduction of minimally invasive approaches for various benign uterine problems, hysterectomy is often still performed abdominally, but the vaginal route should be used whenever possible. The aim of this study was to identify the preoperative, intraoperative, and postoperative characteristics of women undergoing vaginal hysterectomy in the absence of uterine prolapse. Methods A prospective, descriptive, quantitative, noncomparative study was conducted in 117 women between August 2009 and February 2011 in Petropolis, Rio de Janeiro, Brazil. The women included had a uterine indication for hysterectomy, their surgeries were performed by the same team, and they were followed up for 12 months. An adapted Pelvic Organ Prolapse Quantification system was used to check for uterine prolapse. Results The age range of the women was 33–59 years, uterine volume was 300–900 mL, and 73.50% has undergone prior cesarean section. The main indication for hysterectomy was uterine myoma (64.95%), with a surgery time of 30–60 minutes in 55 (59.82%) and 19 (15.98%) cases, respectively. Uterine volume reduction was performed in 41 (35.05%) cases, salpingectomy was the most common associated surgery (81.19%), and anesthesia was subdural (68.37%). Common intraoperative complications included bladder lesions (8.54%), with conversion to the abdominal route being necessary in one case (1.28%), and the most common postoperative complication being vaginal cupola granuloma (32.47%). There was a statistically significant relationship between surgery time and uterine volume (χ2 = 17.367; P = 0.002). Conclusion This study suggests that vaginal hysterectomy is a safe surgical procedure in view of its good performance and low complication rate. PMID:23071420

  12. Hybrid approach of retractor-based and conventional laparoscopy enabling minimally invasive hysterectomy in a morbidly obese patient: case report and review of the literature.

    Science.gov (United States)

    Hoellen, Friederike; Rody, Achim; Ros, Andrea; Bruns, Angela; Cirkel, Christoph; Bohlmann, Michael K

    2014-06-01

    Minimally invasive hysterectomy in obese patients may be limited by laparoscopic sight on the one hand and by intraoperative complications related to reduced ventilation due to pneumoperitoneum on the other. Retractor-based laparoscopy offers an operative technique reducing anesthesia risks. We report the case of laparoscopic hysterectomy in an obese patient of short stature. Laparoscopic supracervical hysterectomy was performed by a hybrid approach of a retractor system exerting its effects on lifting the abdominal wall through gravity and conventional laparoscopy, thus bypassing the adverse effects of pneumoperitoneum on ventilation.

  13. Combined spinal and general anesthesia is better than general anesthesia alone for laparoscopic hysterectomy

    Directory of Open Access Journals (Sweden)

    Poonam S Ghodki

    2014-01-01

    Full Text Available Context: Spinal anesthesia (SA was combined with general anesthesia (GA for achieving hemodynamic stability in laparoscopic hysterectomy. Aims: The aim of our study was to evaluate the impact of SA combined with GA in maintaining hemodynamic stability in laparoscopic hysterectomy. The secondary outcomes studied were requirement of inhaled anesthetics, vasodilators, and recovery profile. Settings and Design: We conducted a prospective, randomized study in ASAI/II patients posted for laparoscopic hysterectomy, who were willing to participate in the study. Materials and Methods: Patients were randomly assigned to receive SA with GA (group SGA or plain GA (group GA. Group SGA received 10 mg bupivacaine (heavy for SA. GA was administered using conventional balanced technique. Maintenance was carried out with nitrous oxide, oxygen, and isoflurane. Comparison of hemodynamic parameters was carried out during creation of pneumoperitoneum and thereafter. Total isoflurane requirement, need of vasodilators, recovery profile, and regression of SA were studied. Statistical analysis used: Descriptive statistics in the form of mean, standard deviation, frequency, and percentages were calculated for interval and categorical variables, respectively. One-way analysis of variance (ANOVA was applied for noting significant difference between the two groups, with chi-square tests for categorical variables and post-hoc Bonferroni test for interval variables. Comparison of heart rate (HR, mean arterial pressure (MAP, SPO2, and etCO2 was done with Student′s t-test or Mann-Whitney test, wherever applicable. Results: Patients in group SGA maintained stable and acceptable MAP values throughout pneumoperitoneum. The difference as compared to group GA was statistically significant (P < 0.01. Group GA showed additional requirement of metoprolol (53.33% and higher concentration of isoflurane (P < 0.001 to combat the increased MAP. Recovery was early and quick in group SGA as

  14. LigaSure versus Conventional Suture Ligature for Vaginal Hysterectomy: a Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Mohamed Abd Elzaher, a, b, Ashraf Moawad, a, c and Hanaa Abu-Ria

    2011-07-01

    Full Text Available Introduction: Vaginal hysterectomy is considered to be the method of choice for removal of the uterus. Of particular concern for the vaginal surgeon is the ability to access, visualize, and legate structures while maintaining adequate hemostasis. Surgical hemostasis can be secured by a variety of methods, including mechanical means (sutures or vessel coagulation (diathermy. Electro-surgical vessel sealing (LigaSure is a new hemostatic system based on the combination of pressure and bipolar electrical energy and is able to seal vessels up to 7 mm in diameter. Objective: To assess the safety and efficacy of using the LigaSure vessel sealing system for securing the pedicles during vaginal hysterectomy in comparison with the conventional method of securing the pedicles by suture ligation. Design: Prospective randomized controlled trial. Setting: Obstetrics and Gynecology departments (Al-Kharj University Hospital- KSA, Enjab Hospital - UAE and Gulf Medical College and Research Centre- UAE. Methods: 80 patients undergoing vaginal hysterectomy for benign conditions were randomized to either LigaSure group (n=40 or Suture group (n=40. Main outcome measures: The primary outcome measures were the operative time and blood loss while the secondary outcome measures were the hospital stay and intra- and post-operative complications. Results: Patients in the LigaSure group had a significantly reduced operating time (37.1 ± 8.9 min vs. 63.8 ± 10.9 min; P < 0.001, operative blood loss (125.5 ± 33.2 mL vs. 264.6 ± 70.4 mL; P < 0.001, requirement of surgical sutures(1.2 ± 0.4 units vs. 8.2 ± 0.4 units; p < 0.001, pain status (2.0 ± 0.6 vs. 3.7 ± 0.7; P < 0.001, and hospital stay (30.3 ± 2.5 h vs. 45.7 ±10.5 h; P < 0.001 compared to the control group. The overall complication rate in the study was 10 % (8/80, and did not differ between patients of the LigaSure and control group. Conclusion: The use of LigaSure device can reduce operative time. It allows

  15. Free radicals and male reproduction.

    Science.gov (United States)

    Agarwal, Ashok; Allamaneni, Shyam S R

    2011-03-01

    Male factor accounts for almost 50% cases of infertility. The exact mechanism of sperm dysfunction is not known in many cases. Extensive research in the last decade has led to the identification of free radicals (reactive oxygen species) as mediators of sperm dysfunction in both specific diagnoses and idiopathic cases of male infertility. Elevated levels of reactive oxygen species are seen in up to 30-80% of men with male infertility. The role of free radicals has been studied extensively in the process of human reproduction. We know now that a certain level of free radicals is necessary for normal sperm function, whereas an excessive level of free radicals can cause detrimental effect on sperm function and subsequent fertilisation and offspring health. Oxidative stress develops when there is an imbalance between generation of free radicals and scavenging capacity of anti-oxidants in reproductive tract. Oxidative stress has been shown to affect both standard semen parameters and fertilising capacity. In addition, high levels of free radicals have been associated with lack of or poor fertility outcome after natural conception or assisted reproduction. Diagnostic techniques to quantify free radicals in infertile patients can assist physicians treating patients with infertility to plan for proper treatment strategies. In vivo anti-oxidants can be used against oxidative stress in male reproductive tract. Supplementation of in vitro anti-oxidants can help prevent the oxidative stress during sperm preparation techniques in assisted reproduction.

  16. Laparoscopic hysterectomy with bilateral orchidectomy for Persistent Mullerian duct syndrome with seminoma testes: Case report

    Directory of Open Access Journals (Sweden)

    Senthilnathan Palanisamy

    2015-01-01

    Full Text Available Persistent Mullerian duct syndrome (PMDS is one of the three rare intersex disorders caused by defective anti-mullerian hormone or its receptor, characterized by undescended testes with presence of underdeveloped derivatives of mullerian duct in genetically male infant or adult with normal external genitals and virilization. This population will essentially have normal, 46(XY, phenotype. We hereby present a case of PMDS, presented with incarcerated left inguinal hernia associated with cryptorchidism and seminoma of right testes. Patient underwent laparoscopic hernia repair with bilateral orchidectomy and hysterectomy with uneventful postoperative recovery. Here we highlight the importance of minimal access approach for this scenario in terms of better visualization, less blood loss, combining multiple procedures along with early return to work and excellent cosmetic outcome.

  17. Time course of subjective pain ratings, and wound and leg tenderness after hysterectomy

    DEFF Research Database (Denmark)

    Møiniche, S; Dahl, J B; Erichsen, C J;

    1997-01-01

    BACKGROUND: Little information is available on time course of wound tenderness and relationship to subjective pain ratings following surgery. Furthermore, it is not clarified whether surgical procedures may induce hyperalgesia to mechanical stimulation outside the area of the surgical incision. We...... have therefore assessed postoperative pain and pressure pain thresholds (PPT) adjacent to and remote from the surgical incision in 16 patients undergoing hysterectomy. METHODS: Pressure pain threshold was assessed with pressure algometry preoperatively, 4 and 6 and 1, 4 and 8 d after surgery...... on the abdominal wall 0.05, 5, 10 and 15 cm perpendicular to the wound, and on the anterior surface of the left thigh and tuberositas tibia. Furthermore, pain was assessed on a visual analogue scale (VAS) at rest and during cough. RESULTS: PPT decreased significantly 0.5, 5, 10 and 15 cm from skin incision up...

  18. Postoperative recovery profile after elective abdominal hysterectomy: a prospective, observational study of a multimodal anaesthetic regime

    DEFF Research Database (Denmark)

    Jensen, Kenneth; Kehlet, Henrik; Lund, Claus M

    2009-01-01

    BACKGROUND AND OBJECTIVE: To evaluate the applicability, effectiveness, immediate postoperative complaints and requirements for a postanaesthesia care unit stay after elective abdominal hysterectomy under a well defined, multimodal anaesthetic regime. METHODS: Observational study of 145 consecutive...... patients scheduled for the procedure at a major university hospital in Denmark. Perioperative treatments and postoperative complaints were recorded continuously until discharge from the postanaesthesia care unit. Main outcome measures were treatment regimen adherence, pain, nausea and vomiting, respiratory...... epidural analgesia (bupivacaine, morphine) was feasible in more than 90% of all patients. In the postanaesthesia care unit, 64% did not require opioids, but 25% experienced severe pain. Mean length of stay was 2 h with a mean discharge readiness of 80 min. Half the patients required supplemental oxygen...

  19. The Manchester procedure versus vaginal hysterectomy in the treatment of uterine prolapse

    DEFF Research Database (Denmark)

    Tolstrup, Cæcilie Krogsgaard; Lose, Gunnar; Klarskov, Niels

    2017-01-01

    INTRODUCTION AND HYPOTHESIS: Uterine prolapse is a common health problem and the number of surgical procedures is increasing. No consensus regarding the surgical strategy for repair of uterine prolapse exists. Vaginal hysterectomy (VH) is the preferred surgical procedure worldwide, but uterus......-preserving alternatives including the Manchester procedure (MP) are available. The objective was to evaluate if VH and the MP are equally efficient treatments for uterine prolapse with regard to anatomical and symptomatic outcome, quality of life score, functional outcome, re-operation and conservative re......-intervention rate, complications and operative outcomes. METHODS: We systematically searched Embase, PubMed, the Cochrane databases, Clinicaltrials and Clinical trials register using the MeSh terms "uterine prolapse", "uterus prolapse", "vaginal prolapse" "pelvic organ prolapse", "prolapsed uterus", "Manchester...

  20. Iatrogenic Lower Extremity Subcutaneous Emphysema after Prolonged Robotic-Assisted Hysterectomy

    Directory of Open Access Journals (Sweden)

    Monica Hagan Vetter

    2015-01-01

    Full Text Available Subcutaneous emphysema is a known complication of carbon dioxide insufflation, an essential component of laparoscopy. The literature contains reports of hypercarbia, pneumothorax, or pneumomediastinum. However, isolated lower extremity subcutaneous emphysema remains a seldom-reported complication. We report a case of unilateral lower extremity subcutaneous emphysema following robotic-assisted hysterectomy, bilateral salpingooophorectomy, staging, and anterior/posterior colporrhaphy for carcinosarcoma and vaginal prolapse. On postoperative day 1, the patient developed tender crepitus and bruising of her right ankle. Radiography confirmed presence of subcutaneous air. Vital signs and laboratory findings were unremarkable. Her symptoms spontaneously improved over time, and she was discharged in good condition on day 2. In stable patients with postoperative extremity swelling or pain with crepitus on exam, the diagnosis of iatrogenic subcutaneous emphysema must be considered.

  1. Robotic-assisted laparoscopic hysterectomy seems safe in women with early-stage endometrial cancer

    DEFF Research Database (Denmark)

    Herling, Suzanne Forsyth; Havemann, Maria Cecilie; Palle, Connie

    2015-01-01

    INTRODUCTION: Robotic surgery is increasingly used in the management of endometrial cancer; and although it is known that minimally invasive surgery reduces post-operative morbidity, the outcomes of this novel treatment should be monitored carefully. The aim of this study was to examine...... the incidence of complications according to the Clavien-Dindo scale after robotic-assisted laparoscopic hysterectomy (RALH) for early-stage endometrial cancer and atypical complex hyperplasia. The Clavien-Dindo scale grades the severity of complications. METHODS: This was a retrospective, descriptive cohort...... study of 235 women with endometrial cancer or atypical complex hyperplasia who had RALH. Surgeries were stratified into two groups: with or without pelvic lymphadenectomy. RESULTS: A total of 6% developed a grade 3 or higher complication with no significant difference (p = 0.24) between the groups...

  2. Single-field sterile-scrub, preparation, and dwell for laparoscopic hysterectomy.

    Science.gov (United States)

    O'Hanlan, Katherine A; McCutcheon, Stacey Paris; McCutcheon, John G; Charvonia, Beth E

    2012-01-01

    Type VII laparoscopic hysterectomy is classified as a "clean-contaminated" procedure because the surgery involves contact with both the abdominal and vaginal fields. Because the vulva has traditionally been perceived as a separate but contaminated field, operating room guidelines have evolved to require that surgeons gloved and gowned at the abdominal field either avoid contact with the urethral catheter, the uterine manipulator, and the introitus or change their gloves and even re-gown after any contact with those fields. In the belief that the perception of the vaginal field as contaminated stems from inadequate preoperative preparation instructions, we have developed a rigorous abdomino-perineo-vaginal field preparation technique to improve surgical efficiency and prevent surgical site infections. This thorough scrub, preparation, and dwell technique enables the entire abdomino-perineo-vaginal field to be safely treated as a single sterile field while maintaining a low rate of surgical site infection, and should be further investigated in randomized studies.

  3. Effect of body mass index on clinical outcomes of patients undergoing total laparoscopic hysterectomy.

    Science.gov (United States)

    Morgan-Ortiz, Fred; Soto-Pineda, Juan M; López-Zepeda, Marco A; Peraza-Garay, Felipe de Jesús

    2013-01-01

    To evaluate the effect of normal body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) and obesity on clinical results among patients who underwent total laparoscopic hysterectomy (TLH). In a prospective study at the Civil Hospital of Culiacan in Sinaloa State, Mexico, data were compared from 209 patients who underwent TLH between July 6, 2009, and December 30, 2011. The following primary variables were analyzed for 77 normal BMI patients, 82 overweight patients, and 50 obese patients: procedure duration, operative bleeding, major and minor trans-operative complications, length of hospital stay, and postoperative pain. The mean duration of surgical procedure (Pobesity groups, respectively (Pobesity (P=0.010). The duration of surgical procedure and operative morbidity were found to increase, mainly owing to major complications, among patients with obesity (BMI ≥ 30). Copyright © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  4. Total laparoscopic hysterectomy for early stage endometrial cancer in obese and morbidly obese women.

    Science.gov (United States)

    Farthing, A; Chatterjee, J; Joglekar-Pai, P; Dorney, E; Ghaem-Maghami, S

    2012-08-01

    This is a retrospective observational study, where we have evaluated the role of total laparoscopic hysterectomy (TLH) in obese and morbidly obese patients with early stage endometrial cancer. Our study illustrates that low conversion rates are achievable when appropriately trained surgeons undertake this procedure. All the women with high BMI were operated on laparoscopically in preference to laparotomy, unless there was an obvious contraindication such as a very large uterus or disseminated disease. We have also shown low conversation and complication rates for our patients, in particular a low rate of wound infection. This is in contrast to the high rate of wound infection and prolonged hospital stay reported for obese patients in the literature. Our study shows that TLH for endometrial cancer in obese women is feasible, safe and is likely to be cost-effective and adds to the weight of evidence for its use in this condition.

  5. Effect of systematic local infiltration analgesia on postoperative pain in vaginal hysterectomy

    DEFF Research Database (Denmark)

    Hristovska, Ana-Marija; Kristensen, Billy B; Rasmussen, Marianne A;

    2014-01-01

    MEASURES: Pain, nausea, vomiting and opioid requirements were assessed for 32 h as well as time spent in the post-anesthesia care unit and time to first mobilization. RESULTS: Pain at rest was significantly reduced after one, four and eight hours in the ropivacaine group (p ≤ 0.001-0.01). Pain during...... coughing was significantly reduced after one and four hours (p ≤ 0.001 and p ≤ 0.003), and pain during movement was significantly reduced after four hours (p ≤ 0.02). Opioid requirements and time spent in the post-anesthesia care unit were significantly reduced in the ropivacaine group (p ....001, respectively), as well as the time to first mobilization (p operative systematic local infiltration analgesia reduces postoperative pain in patients undergoing vaginal hysterectomy, facilities mobilization and improves early recovery....

  6. Body mass and risk of complications after hysterectomy on benign indications

    DEFF Research Database (Denmark)

    Osler, Merete; Daugbjerg, Signe; Frederiksen, Birgitte Lidegaard;

    2011-01-01

    between 25 and 30 kg/m(2) (classified as overweight) and 17.5% with a BMI = 30 kg/m(2) (categorized as obese). The overall rate of complications was 17.6%, with bleeding being the most common specific complication (6.8%). After adjustment for age, ethnicity, education, indication for surgery, uterus...... referrals for benign indications in Denmark from 2004 to 2009. Logistic regression was used to investigate relationship between BMI and complications reported at surgery or during the first 30 days after surgery. RESULTS; Of the 20 353 women with complete data, 6.0% had a BMI ... weight, use of prophylaxis, American Society of Anaesthesiologists classification, co-morbidity status and route of hysterectomy, obesity was associated with an increased risk of heavy bleeding during surgery [odds ratio (OR) = 3.64 (2.90-4.56)], all bleeding complications [OR = 1.27 (1...

  7. López-Zepeda uterine manipulator: device description and its application in the total laparoscopic hysterectomy.

    Science.gov (United States)

    López-Zepeda, M A; Morgan, F Ortiz; Reich, Harry

    2010-04-01

    During the total laparoscopic hysterectomy (TLH) operation, small changes in the uterine and vaginal cuff position, provided by an adequate manipulator, may optimize the attack angles to the vulnerable structures involved during the procedure and facilitate their dissection. The uterine manipulators are effective because they raise the uterus when moving it from one place to another, leaving the fixing elements on tension. The Lopez-Zepeda uterine manipulator exposes all the anatomic structures involved in TLH, especially those in the vulnerable areas. It avoids dissection and mobilization of the bladder and therefore its innervation. It takes the ureter away from the risky area by 4 cm. to 5 cm. decreasing the injury risk. Finally, thanks to its anteflexion and anteversion movement, it puts the posterior culdotomy area further away from the ureter, the rectum and the sigmoid colon.

  8. Guest Editorial: Processes of Radicalization and De-Radicalization

    Directory of Open Access Journals (Sweden)

    Donatella Della Porta

    2012-05-01

    Full Text Available The study of radicalization and de-radicalization, understood as processes leading towards the increased or decreased use of political violence, is central to the question of how political violence emerges, how it can be prevented, and how it can be contained. The focus section of this issue of the International Journal of Conflict and Violence addresses radicalization and de-radicalization, seeking to develop a more comprehensive understanding of the processes, dynamics, and mechanisms involved and taking an interdisciplinary approach to overcome the fragmentation into separate disciplines and focus areas. Contributions by Pénélope Larzillière, Felix Heiduk, Bill Kissane, Hank Johnston, Christian Davenport and Cyanne Loyle, Veronique Dudouet, and Lasse Lindekilde address repressive settings, legitimacy, institutional aspects, organizational outcomes, and dynamics in Europe, Asia, Africa, and North and South America.

  9. Effect of intraoperative intravenous lidocaine on pain and plasma interleukin-6 in patients undergoing hysterectomy

    Directory of Open Access Journals (Sweden)

    Caio Marcio Barros de Oliveira

    2015-04-01

    Full Text Available BACKGROUND AND OBJECTIVES: Interleukin-6 is a predictor of trauma severity. The purpose of this study was to evaluate the effect of intravenous lidocaine on pain severity and plasma interleukin-6 after hysterectomy. METHOD: A prospective, randomized, comparative, double-blind study with 40 patients, aged 18-60 years. G1 received lidocaine (2 mg kg-1 h-1 or G2 received 0.9% saline solution during the operation. Anesthesia was induced with O2/isoflurane. Pain severity (T0: awake and 6, 12, 18 and 24 h, first analgesic request, and dose of morphine in 24 h were evaluated. Interleukin-6 was measured before starting surgery (T0, 5 h after the start (T5, and 24 h after the end of surgery (T24. RESULTS: There was no difference in pain severity between groups. There was a decrease in pain severity between T0 and other measurement times in G1. Time to first supplementation was greater in G2 (76.0 ± 104.4 min than in G1 (26.7 ± 23.3 min. There was no difference in supplemental dose of morphine between G1 (23.5 ± 12.6 mg and G2 (18.7 ± 11.3 mg. There were increased concentrations of IL-6 in both groups from T0 to T5 and T24. There was no difference in IL-6 dosage between groups. Lidocaine concentration was 856.5 ± 364.1 ng mL-1 in T5 and 30.1 ± 14.2 ng mL-1 in T24. CONCLUSION: Intravenous lidocaine (2 mg kg-1 h-1 did not reduce pain severity and plasma levels of IL-6 in patients undergoing abdominal hysterectomy.

  10. Hysterectomy-corrected cervical cancer mortality rates reveal a larger racial disparity in the United States.

    Science.gov (United States)

    Beavis, Anna L; Gravitt, Patti E; Rositch, Anne F

    2017-05-15

    The objectives of this study were to determine the age-standardized and age-specific annual US cervical cancer mortality rates after correction for the prevalence of hysterectomy and to evaluate disparities by age and race. Estimates for deaths due to cervical cancer stratified by age, state, year, and race were derived from the National Center for Health Statistics county mortality data (2000-2012). Equivalently stratified data on the prevalence of hysterectomy for women 20 years old or older from the Behavioral Risk Factor Surveillance System survey were used to remove women who were not at risk from the denominator. Age-specific and age-standardized mortality rates were computed, and trends in mortality rates were analyzed with Joinpoint regression. Age-standardized rates were higher for both races after correction. For black women, the corrected mortality rate was 10.1 per 100,000 (95% confidence interval [CI], 9.6-10.6), whereas the uncorrected rate was 5.7 per 100,000 (95% CI, 5.5-6.0). The corrected rate for white women was 4.7 per 100,000 (95% CI, 4.6-4.8), whereas the uncorrected rate was 3.2 per 100,000 (95% CI, 3.1-3.2). Without the correction, the disparity in mortality between races was underestimated by 44%. Black women who were 85 years old or older had the highest corrected rate: 37.2 deaths per 100,000. A trend analysis of corrected rates demonstrated that white women's rates decreased at 0.8% per year, whereas the annual decrease for black women was 3.6% (P cervical cancer mortality rates are underestimated, particularly in black women. The highest rates are seen in the oldest black women, and public health efforts should focus on appropriate screening and adequate treatment in this population. Cancer 2017;123:1044-50. © 2016 American Cancer Society. © 2017 American Cancer Society.

  11. Effects of jazz on postoperative pain and stress in patients undergoing elective hysterectomy.

    Science.gov (United States)

    Rafer, Lorenzo; Austin, Flower; Frey, Jessica; Mulvey, Christie; Vaida, Sonia; Prozesky, Jansie

    2015-01-01

    Anesthesiologists use various medications to provide surgical patients with pain relief in the postoperative period. Other modalities, such as music, could be used in conjunction with opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) to decrease pain and lower heart rate and blood pressure. Our hypothesis was that patients listening to jazz in a postanesthesia care unit (PACU) would have lower heart rates and blood pressures and reduced pain and anxiety. The study objective was to determine if listening to jazz music in the PACU, when compared to wearing noise-canceling headphones with no music playing, would decrease heart rate, blood pressure, pain, or anxiety in patients undergoing a hysterectomy. The research design was a prospective, randomized study. The study was conducted in the PACU at the Penn State Hershey Medical Center in Hershey, PA, USA. A total of 56 patients, aged 18-75 y, who were categorized as status 1 or 2 according to the American Society of Anesthesiologists (ASA) Physical Status Classification System, and who were undergoing elective laparoscopic or abdominal hysterectomies, were enrolled in the study. Patients were randomly assigned either to listen to jazz music where the beats per min (BPM) was jazz group, heart rates were significantly lower at 15, 20, 25, and 30 min when compared with baseline. The pain scores were significantly lower (P jazz group at 10 min into the recovery period. Overall, the results showed that patients responded not only to music but also to silence in the PACU. Using music and/or noise reduction could decrease opioid administration, promote relaxation, and improve patient satisfaction.

  12. Total laparoscopic hysterectomy for uterine pathology: impact of body mass index on outcomes.

    Science.gov (United States)

    O'Hanlan, Katherine A; Dibble, Suzanne L; Fisher, Deidre T

    2006-12-01

    We sought to analyze surgical results of women with uterine cancers having TLH+/-staging, stratifying data by body mass index (BMI). This is a retrospective analysis of data from 9 years, using Pearson and Spearman correlations, ANOVA and Fisher's Exact Test with significance at Pobese (30 to 39.9 kg/m2) and morbidly obese (40 kg/m2 or more). Of 702 patients having TLH over 9 years, 90 patients had uterine pathology. Two (2%) procedures were converted to laparotomy due to unsuspected widespread metastasis and excluded from analysis. BMI ranged from 18 to 60 kg/m2, with 31 patients having ideal, 19 having overweight and 38 having obese BMI. Of these, 19 patients had hyperplasia, while 63 had endometrial carcinoma, 1 had both ovarian and endometrial carcinoma and 5 had sarcoma. Of these 88 patients, 61 had TLH while 27 patients had indicated pelvic and aortic node dissection. The mean age was 60 years, and mean parity was 1.5 for all BMI groups. There were no significant differences in mean duration of surgery (150 min), blood loss (129 cm3) and days in hospital (1.7 days) for all BMI groups. There was no significant difference in uterine weight (140 gm) or number of nodes dissected (21 nodes). Complications occurred in 4 patients (4.5%): 1 diverticulitis, 1 ureteral injury, 1 laparotomy for bleeding and 1 incisional hernia. Total laparoscopic hysterectomy is feasible and safe for women with uterine neoplasia for every BMI category and extends the benefits of minimally invasive hysterectomy to more women, regardless of BMI.

  13. Novel Port Placement and 5-mm Instrumentation for Robotic-Assisted Hysterectomy

    Science.gov (United States)

    Katz, Adi; Dun, Erica C.; Kho, Kimberly A.; Wieser, Friedrich A.

    2014-01-01

    Background and Objectives: The value of robotic surgery for gynecologic procedures has been critically evaluated over the past few years. Its drawbacks have been noted as larger port size, location of port placement, limited instrumentation, and cost. In this study, we describe a novel technique for robotic-assisted laparoscopic hysterectomy (RALH) with 3 important improvements: (1) more aesthetic triangular laparoscopic port configuration, (2) use of 5-mm robotic cannulas and instruments, and (3) improved access around the robotic arms for the bedside assistant with the use of pediatric-length laparoscopic instruments. Methods: We reviewed a series of 44 women who underwent a novel RALH technique and concomitant procedures for benign hysterectomy between January 2008 and September 2011. Results: The novel RALH technique and concomitant procedures were completed in all of the cases without conversion to larger ports, laparotomy, or video-assisted laparoscopy. Mean age was 49.9 years (SD 8.8, range 33–70), mean body mass index was 26.1 (SD 5.1, range 18.9–40.3), mean uterine weight was 168.2 g (SD 212.7, range 60–1405), mean estimated blood loss was 69.7 mL (SD 146.9, range 20–1000), and median length of stay was <1 day (SD 0.6, range 0–2.5). There were no major and 3 minor peri- and postoperative complications, including 2 urinary tract infections and 1 case of intravenous site thrombophlebitis. Mean follow-up time was 40.0 months (SD 13.6, range 15–59). Conclusion: Use of the triangular gynecology laparoscopic port placement and 5-mm robotic instruments for RALH is safe and feasible and does not impede the surgeon's ability to perform the procedures or affect patient outcomes. PMID:24960478

  14. Anatomic outcomes after pelvic-organ-prolapse surgery: comparing uterine preservation with hysterectomy.

    Science.gov (United States)

    Marschalek, Julian; Trofaier, Marie-Louise; Yerlikaya, Guelen; Hanzal, Engelbert; Koelbl, Heinz; Ott, Johannes; Umek, Wolfgang

    2014-12-01

    Pelvic organ prolapse (POP) is of growing importance to gynecologists, as the estimated lifetime risk of surgical interventions due to prolapse or incontinence amounts to 11-19%. Conflicting data exist regarding the effectiveness of POP surgery with and without uterine preservation. We aimed to compare anatomic outcomes in patients with and without hysterectomy at the time of POP-surgery and identify independent risk factors for symptomatic recurrent prolapses. In this single-centre retrospective analysis we analyzed 96 patients after primary surgical treatment for POP. These patients were followed up with clinical and vaginal examination six months postoperatively. For comparison of the groups, the chi-squares test were used for categorical data and the u-test for metric data. A logistic regression model was calculated to identify independent risk factors for recurrent prolapse. Of 96 patients, 21 underwent uterus preserving surgery (UP), 75 vaginal hysterectomy (HE). Median operating time was significantly shorter in the UP group (55 vs. 90min; p=0.000). There was no significant difference concerning postoperative urinary incontinence or asymptomatic relapse (p>0.05), whereas symptomatic recurrent prolapses were significantly more common in the UP group (23.8% vs. 6.7%; p=0.023). However, in multivariate analysis, only vaginal parity and sacrospinous ligament fixation were identified as independent risk factors for recurrent prolapse after POP surgery. Uterus-preservation at time of POP-surgery is a safe and effective alternative for women who wish to preserve their uterus but is associated with more recurrent symptomatic prolapses. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  15. Risk of malignancy in women who underwent hysterectomy for uterine prolapse.

    Science.gov (United States)

    Wan, Osanna Y K; Cheung, Rachel Y K; Chan, Symphorosa S C; Chung, Tony K H

    2013-04-01

    To evaluate the risk of missing a malignancy in surgical specimens following hysterectomy for uterine prolapse if routine pathological examination is not performed. Additionally, information on the risk of missing an hitherto unsuspected malignancy if uterine preservation is the preferred management option will be provided. A retrospective study was performed on all cases of surgery performed for uterine prolapse in a tertiary referral institution from 2003 to 2011. Those with confirmed malignancy before operation were excluded. The study subjects had their clinical history, investigations, the type of operations and histopathology report analysed. They were classified into symptomatic or asymptomatic, depending on whether they reported symptoms that were suggestive of uterine malignancy. A total of 640 women were studied. Three cases of hitherto unsuspected uterine malignancy were found, giving an incidence of 0.47%. Among the 456 asymptomatic women, both pre- and postmenopausal, the risk of incidental malignancy was 0.22%. Within the postmenopausal group, risk of incidental malignancy was 0.26%. Another 3 cases of uterine premalignant conditions were identified, giving an overall risk of premalignant and malignant uterine condition of 0.94%. Five cases of cervical intra-epithelial neoplasia were found, contributing to a risk of 0.78%. The risk of missing an uterine malignancy in patients with uterine prolapse is low if appropriate investigations are carried out prior to surgery. If hysterectomy is to be performed, we recommend that all surgical specimens be subjected to histopathological examination. © 2013 The Authors ANZJOG © 2013 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  16. The Manchester procedure versus vaginal hysterectomy in the treatment of uterine prolapse: a review.

    Science.gov (United States)

    Tolstrup, Cæcilie Krogsgaard; Lose, Gunnar; Klarskov, Niels

    2017-01-01

    Uterine prolapse is a common health problem and the number of surgical procedures is increasing. No consensus regarding the surgical strategy for repair of uterine prolapse exists. Vaginal hysterectomy (VH) is the preferred surgical procedure worldwide, but uterus-preserving alternatives including the Manchester procedure (MP) are available. The objective was to evaluate if VH and the MP are equally efficient treatments for uterine prolapse with regard to anatomical and symptomatic outcome, quality of life score, functional outcome, re-operation and conservative re-intervention rate, complications and operative outcomes. We systematically searched Embase, PubMed, the Cochrane databases, Clinicaltrials and Clinical trials register using the MeSh terms "uterine prolapse", "uterus prolapse", "vaginal prolapse" "pelvic organ prolapse", "prolapsed uterus", "Manchester procedure" and "vaginal hysterectomy". No limitations regarding language, study design or methodology were applied. In total, nine studies published from 1966 to 2014 comparing the MP to VH were included. The anatomical recurrence rate for the middle compartment was 4-7 % after VH, whereas recurrence was very rare after the MP. The re-operation rate because of symptomatic recurrence was higher after VH (9-13.1 %) compared with MP (3.3-9.5 %) and more patients needed conservative re-intervention (14-15 %) than after MP (10-11 %). After VH, postoperative bleeding and blood loss tended to be greater, bladder lesions and infections more frequent and the operating time longer. This review is in favour of the MP, which seems to be an efficient and safe treatment for uterine prolapse. We suggest that the MP might be considered a durable alternative to VH in uterine prolapse repair.

  17. Uterus preserving vaginal surgery versus vaginal hysterectomy for correction of female pelvic organ prolapse.

    Science.gov (United States)

    Iliev, Vasil N; Andonova, Irena T

    2014-01-01

    The objective of this study is to evaluate uterus preserving vaginal procedure of cervical amputation with uterosacral ligament plication (modified Manchester operation) and compare it to vaginal hysterectomy regard recurrence rate, duration of surgery, blood loses, intra and post-operative complications, duration of hospital stay. Consecutive women with pelvic organ prolapse who underwent either vaginal hyste-rectomy or a modified Manchester procedure were included. Assessments were made preoperatively and at 1-year follow-up, including physical examination with pelvic organ prolapse quantification standardized questionnaires. 66 patients were included in the study with a one year follow-up. We found no significant difference in: recurrence of POP and reintervention (recurrence with required treatment n (%): 3(10) vs. 5(15), p=0.28) and hospital stay (mean±SD days: 5±2 vs. 7±2, p=0.97). Significant less blood loses (250±210 ml. vs. 360±230 ml.) and shorter operation time (67±20 min. vs 102±22 min.) in modified Manchester group, but significant more urinary retention (cases: 8 vs 6) in modified Manchester group. The overall functional outcome was acceptable for both procedures. We found an excellent performance of both procedures regarding recurrences and intra and post-operative complications. A high degree of acceptance-satisfaction shows the modified Manchester operation and is good option for the treatment of uterine prolapse in younger women who wish to keep their uterus and in all cases of genital prolapse with elongation of uterine cervix (when there is not other uterine pathology). Shorter operation time and lower blood lose are another factors for stronger recommendation of the modified Manchester operation for patients with concomitant diseases and/or older age patients with elevated risk from anesthesia and/or surgery.

  18. Evaluation of the effect of gabapentin on postoperative analgesia with epidural morphine after abdominal hysterectomy

    Directory of Open Access Journals (Sweden)

    Diptesh Aryal

    2017-07-01

    Full Text Available Background & Objectives: Gabapentin has been used successfully as a non-opioid analgesic adjuvant for postoperative pain management. We hypothesized that the preoperative use of gabapentin prolonged the analgesic effect of epidural morphine without an increase in adverse effects of morphine. Materials & Methods: In a randomized, double blind study sixty ASA PS I and II patients undergoing abdominal hysterectomy were assigned to receive either placebo or gabapentin 1200mg 1 hour before surgery. Postoperatively, 0.125% bupivacaine with morphine 50 µg per kg body weight was used for epidural analgesia. Vital parameters, time to the first request for analgesic, visual analogue scale scoring for pain at rest and during movement, 24-hour morphine consumption, and side effects were studied.Results: The patients were comparable with respect to age, weight, ASA PS, baseline hemodynamic parameters and duration of surgery. Gabapentin significantly decreased the duration of analgesia compared to placebo (1078.26 min Vs. 303.5 min; P value <0.0001. The VAS scores at rest and during movement at 1, 2, 4, 8, 12, and 24h were significantly lower in gabapentin group. The total amount of morphine consumption in 24 h postoperatively was significantly lower in gabapentin group (1.93mg Vs. 6.30mg; P value <0.0001. The incidence of nausea and pruritus was significantly lower with gabapentin. Conclusion: Oral gabapentin 1200 mg as a premedication decreases the dose requirement of epidural morphine and postoperative pain after total abdominal hysterectomy. It also decreases the pain scores at rest and during movement significantly. 

  19. Comparison between Preoperative Rectal Diclofenac Plus Paracetamol and Diclofenac Alone for PostoperativePain of Hysterectomy.

    Directory of Open Access Journals (Sweden)

    Saghar Samimi Sede

    2014-09-01

    Full Text Available To detect whether the preoperative combined administration of rectal diclofenac and paracetamol is superior to placebo or rectal diclofenac alone for pain after abdominal hysterectomy.Ninety female patients (American Society of Anesthesiologists (ASA physical status I-II, scheduled for abdominal hysterectomy were recruited to this double blind trial and were randomized to receive one of three modalities before surgery: rectal combination of diclofenac and paracetamol, rectal diclofenac alone or rectal placebo alone which were given as a suppository one hour prior to surgery. The primary outcomes were visual analogue pain scores measured at 0, 0.5, 2, 4, 8, 16 and 24 hours after surgery and the time of first administration and also total amount of morphine used in the first 24 hour after surgery. A 10 cm visual analog scale (VAS was used to assess pain intensity at rest.In patients receiving the combination of diclofenac and paracetamol total dose of morphine used in the first 24 hour after surgery was significantly lower (13.9 ± 2.7 mg compared to diclofenac group (16.8± 2.8 mg and placebo group (20.1 ± 3.6 mg (p<0.05. VAS pain score was significantly lower in combination group compared to other groups all time during first 24 hours (p<0.05. There had been a significant difference between combination group and the two other groups in terms of the first request of morphine (p<0.05.According to our study Patients who receive the rectal diclofenac-paracetamol combination experience significantly a lower pain scale in the first 24 hour after surgery compared with patients receiving diclofenac or placebo alone. Their need to supplementary analgesic is significantly later and lower compared to placebo and diclofenac alone.

  20. Impact of surgical training on the performance of proposed quality measures for hysterectomy for pelvic organ prolapse.

    Science.gov (United States)

    Adams-Piper, Emily R; Guaderrama, Noelani M; Chen, Qiaoling; Whitcomb, Emily L

    2017-06-01

    Recent healthcare reform has led to increased emphasis on standardized provision of quality care. Use of government- and organization-approved quality measures is 1 way to document quality care. Quality measures, to improve care and aid in reimbursement, are being proposed and vetted in many areas of medicine. We aimed to assess performance of proposed quality measures that pertain to hysterectomy for pelvic organ prolapse stratified by surgical training. The 4 quality measures that we assessed were (1) the documentation of offering conservative treatment of pelvic organ prolapse, (2) the quantitative assessment of pelvic organ prolapse (Pelvic Organ Prolapse-Quantification or Baden-Walker), (3) the performance of an apical support procedure, and (4) the performance of cystoscopy at time of hysterectomy. Patients who underwent hysterectomy for pelvic organ prolapse from January 1 to December 31, 2008, within a large healthcare maintenance organization were identified by diagnostic and procedural codes within the electronic medical record. Medical records were reviewed extensively for demographic and clinical data that included the performance of the 4 proposed quality measures and the training background of the primary surgeon (gynecologic generalist, fellowship-trained surgeon in Female Pelvic Medicine and Reconstructive Surgery, and "grandfathered" Female Pelvic Medicine and Reconstructive Surgery). Data were analyzed with the use of descriptive statistics. Inferential statistics with chi-squared tests were used to compare performance rates of quality measures that were stratified by surgical training. Probability values trained surgeons performed 302 hysterectomies for pelvic organ prolapse; grandfathered Female Pelvic Medicine and Reconstructive Surgery surgeons performed 98 hysterectomies, and gynecologic generalist surgeons performed 230 hysterectomies. Fellowship-trained surgeons had the highest performance rates for individual quality measures (91

  1. Sacrospinous hysteropexy versus vaginal hysterectomy with suspension of the uterosacral ligaments in women with uterine prolapse stage 2 or higher: multicentre randomised non-inferiority trial

    NARCIS (Netherlands)

    Detollenaere, R.J.; Boon, J. den; Stekelenburg, J.; IntHout, J.; Vierhout, M.E.; Kluivers, K.B.; Eijndhoven, H.W. van

    2015-01-01

    OBJECTIVE: To investigate whether uterus preserving vaginal sacrospinous hysteropexy is non-inferior to vaginal hysterectomy with suspension of the uterosacral ligaments in the surgical treatment of uterine prolapse. DESIGN: Multicentre randomised controlled non-blinded non-inferiority trial.

  2. The effectiveness of surgical correction of uterine prolapse: cervical amputation with uterosacral ligament plication (modified Manchester) versus vaginal hysterectomy with high uterosacral ligament plication.

    NARCIS (Netherlands)

    Boer, T.A. de; Milani, A.L.; Kluivers, K.B.; Withagen, M.I.J.; Vierhout, M.E.

    2009-01-01

    INTRODUCTION AND HYPOTHESIS: The objective of this study is to evaluate cervical amputation with uterosacral ligament plication (modified Manchester) and compare it to vaginal hysterectomy with high uterosacral ligament plication procedure with special regard to the middle compartment. METHODS:

  3. CONTINENT RADICAL PROSTATECTOMY

    Directory of Open Access Journals (Sweden)

    Yu. P. Sernyak

    2014-07-01

    Full Text Available Objective: to evaluate the impact of dissection of the dorsal venous complex without pre-ligation, suturing, or coagulation during radical prostatectomy (RPE in patients with localized prostate cancer (PC on the quality of surgery and the function of urinary retention.Subjects and methods. The data of 42 patients who had undergone posterior and anterior anatomical repair and vesicourethral anastomosis using a V-lock suture after prostatectomy were analyzed. All the patients were divided into 2 groups. Group 1 consisted of 22 patients in whom the dorsal venous complex was closed using a 3-0 vicryl suture before urethral dissection. Group 2 included 20 patients in whom the urethra was dissected without suturing the venous complex.Results. In group 1, complete urinary retention after catheter removal was noted in 9 (40.9 % and 15 (68 % patients within 24 hours and after 3 months, respectively. Following 12 months, two (9 % patients were observed to have partial mild urinary incontinence (as many as 2 pads per day. Group 2 patients showed complete urinary retention in 17 (85 % cases on the first day after catheter removal; all the patients retained urine 3 months later.Conclusion. In patients with localized PC, dissection of the dorsal venous complex without presuturing during laparoscopic RPE exerts a considerable impact on the preservation of urinary retention, namely 45% more of the patients reported complete urinary retention in early periods and 10 % more did this in later periods. At the same time, there was no statistically significant increase in intraoperative blood loss (p > 0.05, the number of positive edges, or biochemical recurrences.

  4. CONTINENT RADICAL PROSTATECTOMY

    Directory of Open Access Journals (Sweden)

    Yu. P. Sernyak

    2013-01-01

    Full Text Available Objective: to evaluate the impact of dissection of the dorsal venous complex without pre-ligation, suturing, or coagulation during radical prostatectomy (RPE in patients with localized prostate cancer (PC on the quality of surgery and the function of urinary retention.Subjects and methods. The data of 42 patients who had undergone posterior and anterior anatomical repair and vesicourethral anastomosis using a V-lock suture after prostatectomy were analyzed. All the patients were divided into 2 groups. Group 1 consisted of 22 patients in whom the dorsal venous complex was closed using a 3-0 vicryl suture before urethral dissection. Group 2 included 20 patients in whom the urethra was dissected without suturing the venous complex.Results. In group 1, complete urinary retention after catheter removal was noted in 9 (40.9 % and 15 (68 % patients within 24 hours and after 3 months, respectively. Following 12 months, two (9 % patients were observed to have partial mild urinary incontinence (as many as 2 pads per day. Group 2 patients showed complete urinary retention in 17 (85 % cases on the first day after catheter removal; all the patients retained urine 3 months later.Conclusion. In patients with localized PC, dissection of the dorsal venous complex without presuturing during laparoscopic RPE exerts a considerable impact on the preservation of urinary retention, namely 45% more of the patients reported complete urinary retention in early periods and 10 % more did this in later periods. At the same time, there was no statistically significant increase in intraoperative blood loss (p > 0.05, the number of positive edges, or biochemical recurrences.

  5. Observational evaluation of preoperative, intraoperative, and postoperative characteristics in 117 Brazilian women without uterine prolapse undergoing vaginal hysterectomy

    Directory of Open Access Journals (Sweden)

    Osako MT

    2012-09-01

    Full Text Available Claudio Sergio Batista,1 Takasi Osako,2 Eliana Mara Clemente,2 Fernanda Carvalhido Antonio Batista,3 Maurício Takeshi Janiques Osako41Department of Gynecology and Obstetrics of Faculty of Medicine of Petropolis, Petropolis, Rio de Janeiro, Brazil; 2Gynecology and Obstetrics, Casa Providencia Hospital, Petropolis, Rio de Janeiro, Brazil; 3School of Medicine of Technical Educational Foundation Souza Marques, Rio de Janeiro, Brazil; 4School of Medicine of University Gama Filho, Rio de Janeiro, BrazilBackground: Despite the introduction of minimally invasive approaches for various benign uterine problems, hysterectomy is often still performed abdominally, but the vaginal route should be used whenever possible. The aim of this study was to identify the preoperative, intraoperative, and postoperative characteristics of women undergoing vaginal hysterectomy in the absence of uterine prolapse.Methods: A prospective, descriptive, quantitative, noncomparative study was conducted in 117 women between August 2009 and February 2011 in Petropolis, Rio de Janeiro, Brazil. The women included had a uterine indication for hysterectomy, their surgeries were performed by the same team, and they were followed up for 12 months. An adapted Pelvic Organ Prolapse Quantification system was used to check for uterine prolapse.Results: The age range of the women was 33–59 years, uterine volume was 300–900 mL, and 73.50% has undergone prior cesarean section. The main indication for hysterectomy was uterine myoma (64.95%, with a surgery time of 30–60 minutes in 55 (59.82% and 19 (15.98% cases, respectively. Uterine volume reduction was performed in 41 (35.05% cases, salpingectomy was the most common associated surgery (81.19%, and anesthesia was subdural (68.37%. Common intraoperative complications included bladder lesions (8.54%, with conversion to the abdominal route being necessary in one case (1.28%, and the most common postoperative complication being vaginal

  6. Redox Properties of Free Radicals.

    Science.gov (United States)

    Neta, P.

    1981-01-01

    Describes pulse radiolysis as a useful means in studing one-electron redox potentials. This method allows the production of radicals and the determination of their concentration and rates of reaction. (CS)

  7. Reprodcutive results of radical trachelectomy

    National Research Council Canada - National Science Library

    Martínez-Chapa, Arnulfo; Alonso-Reyes, Nelly; Luna-Macías, Miguel

    2015-01-01

    .... Between March 1999 and December 2013, 27 cases with cervical cancer in early stages were treated with vaginal or abdominal radical trachelectomy in the ISSSTE Regional Hospital in Monterrey, NL (Mexico...

  8. Surgery of the cancer of Uterine Neck Past, present and Future; Cirugia del Cancer de cuello Uterino. Pasado, presente y futuro

    Energy Technology Data Exchange (ETDEWEB)

    Escudero Fernandez, M.

    2009-07-01

    The evolution of the surgery of the cancer of cervix has passed for several stages. First the boarding was indisputably vaginal. Thanks to the anestesea, antibioterapia and transfusion was produced a change that has come to our days to the abdominal route with Wertheim Meigs's intervention. From 1987 Dargent he introduced the route laparoscopica, the conservative surgery and the return to the vaginal boarding. Today the robotic surgery is imposed with the Da Vinci. (Author) 16 refs.

  9. HYSTERECTOMY OPERATION FOR THE TREATMENT OF THE EGG BINDING IN THE LOVEBiRD (AGAPORNIS COMPRISE): CASE REPORT

    OpenAIRE

    GÜNDÜZ, Mehmet Can; TOYDEMİR, Seval; APAYDIN ENGİNLER, Sinem Özlem; Turna YILMAZ, Özge; YİGİT, Funda; UÇMAK, Melih

    2012-01-01

    ABSTRACT The case material is a 15 months-old lovebird who performed hysteretomy operation for egg binding three months ago. Calcium gluconate (0.5 mg/100 g) and oxytocin (1 unit/kg) were administered intramuscularly after the lubrication of the cloacal opening. These applications yielded no results and attempts were made to remove the egg manually as a result of which the egg shell was broken. By considering the case's current condition and future life, treatment by hysterectomy was pre...

  10. ANESTHETIC MANAGEMENT OF ATONIC POST - PARTUM HEMORRHAGE WITH HEMORRHAGIC SHOCK AND IMPENDING CARDIAC ARREST FOR EMERGENCY PERIPARTUM HYSTERECTOMY

    Directory of Open Access Journals (Sweden)

    Ravishankar

    2015-07-01

    Full Text Available Post - partum hemorrhagic complication is a critical situation for an anesthesiologist, which requires timely and skillful anesthetic management. A massive post - partum bleeding leading to severe hypovolemic shock may result in life threatening cardio - pulmonary arrest. Here is a case report of 25 year old with atonic post - partum hemorrhage resulting in hypovolemic shock & impending cardiac arrest and successful anesthetic management for emergency peripartum hysterectomy to save the life of the patient.

  11. Age at menopause: imputing age at menopause for women with a hysterectomy with application to risk of postmenopausal breast cancer

    Science.gov (United States)

    Rosner, Bernard; Colditz, Graham A.

    2011-01-01

    Purpose Age at menopause, a major marker in the reproductive life, may bias results for evaluation of breast cancer risk after menopause. Methods We follow 38,948 premenopausal women in 1980 and identify 2,586 who reported hysterectomy without bilateral oophorectomy, and 31,626 who reported natural menopause during 22 years of follow-up. We evaluate risk factors for natural menopause, impute age at natural menopause for women reporting hysterectomy without bilateral oophorectomy and estimate the hazard of reaching natural menopause in the next 2 years. We apply this imputed age at menopause to both increase sample size and to evaluate the relation between postmenopausal exposures and risk of breast cancer. Results Age, cigarette smoking, age at menarche, pregnancy history, body mass index, history of benign breast disease, and history of breast cancer were each significantly related to age at natural menopause; duration of oral contraceptive use and family history of breast cancer were not. The imputation increased sample size substantially and although some risk factors after menopause were weaker in the expanded model (height, and alcohol use), use of hormone therapy is less biased. Conclusions Imputing age at menopause increases sample size, broadens generalizability making it applicable to women with hysterectomy, and reduces bias. PMID:21441037

  12. Total versus subtotal Laparoscopic Hysterectomy: A comparative study in Arash Hospital

    Directory of Open Access Journals (Sweden)

    Samiei H

    2009-09-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 st1":*{behavior:url(#ieooui } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Over the past 50 years, subtotal or supracervical hysterectomy has come to be viewed as a suboptimal procedure reserved for those rare instances in which when concern over blood loss or anatomic distortion dictates limiting the extent of dissection, the aim of this study was to compare total and subtotal laparoscopic hysterectomy. "n"nMethods: The patients who were candidates for hysterectomy with benign disease, with no contraindication for laparoscopic surgery entered the study in Arash Hospital, from March 2007 to April 2009. By simple randomization 45 patients (25 for TLH and 20 for SLH were selected. Demographic Details and intra and post operative complications, were recorded by the staff and were compared between two groups."n"nResults: The average time for TLH operations look significantly longer than SLH operation (148.6±29.7 minutes; 128.5±25.64 minutes, p=0.03. Although, the hemoglobin (gr/dl drop in TLH was significantly higher than SLH (1.54 Versus 0.9, p<0.05 Blood transfusion were common in SLH (1 case Versus 3 Cases. The total length of hospital stay, was significantly shorter after SLH than TLH (3.6±1.47 day and 2.85±0.59, p=0.04. The drug requirements to

  13. Peroxy radical partitioning during the AMMA radical intercomparison exercise

    Directory of Open Access Journals (Sweden)

    M. D. Andrés-Hernández

    2010-04-01

    Full Text Available Peroxy radicals were measured onboard two scientific aircrafts during the AMMA (African Monsoon Multidisciplinary Analysis campaign in summer 2006. This paper reports results from the flight on 16 August 2006 during which measurements of HO2 by laser induced fluorescence spectroscopy at low pressure (LIF-FAGE and total peroxy radicals (RO2*=HO2+ΣRO2, R= organic chain by two similar instruments based on the peroxy radical chemical amplification (PerCA technique were subject of a blind intercomparison. The German DLR-Falcon and the British FAAM-BAe-146 flew wing tip to wing tip for about 30 min making concurrent measurements on 2 horizontal level runs at 697 and 485 hPa over the same geographical area in Burkina Faso. A full set of supporting measurements comprising photolysis frequencies, and relevant trace gases like CO, NO, NO2, NOy, O3 and a wider range of VOCs were collected simultaneously.

    Results are discussed on the basis of the characteristics and limitations of the different instruments used. Generally, no data bias are identified and the RO2* data available agree quite reasonably within the instrumental errors. The [RO2*]/[HO2] ratios, which vary between 1:1 and 3:1, as well as the peroxy radical variability, concur with variations in photolysis rates and in other potential radical precursors. Model results provide additional information about dominant radical formation and loss processes.

  14. Quality of life, urogynecological morbidity, and lymphedema after radical vaginal trachelectomy for early-stage cervical cancer

    DEFF Research Database (Denmark)

    Frøding, Ligita Paskeviciute; Ottosen, Christian; Mosgaard, Berit Jul

    2015-01-01

    assess quality of life after RVT with focus on urogynecological morbidity and lymphedema. Furthermore, the aim of this study was to compare results with those in women treated with radical abdominal hysterectomy (RAH) and with age-matched control women from the general population. METHODS AND MATERIALS...... severe lymphedema of the legs as assessed by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Cervical Cancer Module. The Global Health Status scores of the RVT patients improved over time but were significantly lower than in the healthy controls during...... the entire observation time (P = 0.029). CONCLUSIONS: Patients treated with RVT for early-stage cervical cancer had persistent bladder emptying problems and lymphedema comparable to those experienced by patients treated with RAH and significantly higher than those reported by healthy control women....

  15. Standard Electrode Potentials Involving Radicals in Aqueous Solution: Inorganic Radicals

    Energy Technology Data Exchange (ETDEWEB)

    Armstrong, David A.; Huie, Robert E.; Koppenol, Willem H.; Lymar, Sergei V.; Merenyi, Gabor; Neta, Pedatsur; Ruscic, Branko; Stanbury, David M.; Steenken, Steen; Wardman, Peter

    2015-12-01

    Recommendations are made for standard potentials involving select inorganic radicals in aqueous solution at 25 °C. These recommendations are based on a critical and thorough literature review and also by performing derivations from various literature reports. The recommended data are summarized in tables of standard potentials, Gibbs energies of formation, radical pKa’s, and hemicolligation equilibrium constants. In all cases, current best estimates of the uncertainties are provided. An extensive set of Data Sheets is appended that provide original literature references, summarize the experimental results, and describe the decisions and procedures leading to each of the recommendations

  16. Radical formation by heavy metals

    Energy Technology Data Exchange (ETDEWEB)

    Beuter, W.

    1982-09-01

    Certain reduced heavy metal ions can convert oxygen to a ''reactive oxygen species'' by donation of an electron. The reactive oxygen then attacks structures susceptible to oxidation, in particular unsaturated fatty acids, and peroxidizes them in a radical reaction. This process is inhibited by the presence of vitamin E and by other means. Peroxidized lipids decay forming free radicals in the process which themselves can peroxidise neighbouring lipids in a radical chain reaction. This decay is, moreover, catalysed by reduced heavy metal ions but on the other hand retarded by selenium-containing glutathione peroxidase. Radical formation by heavy metals is considerably involved in (i) the production of parenteral iron poisoning of the piglet (ii) haemolytic crisis occurring in ruminants through chronic copper poisoning (iii) the production of lead poisoning in ruminants and other animals. These types of poisonings are made worse by a deficiency of vitamin E and/or selenium. Factors which increase the bio-availability of the free heavy metal ion or reduce the redox potential thereof can aid radical formation as well as factors which lead to a reduction of the heavy metal ion e.g. cysteine, ascorbic acid or glucose.

  17. No preemptive analgesic effect of preoperative ketorolac administration following total abdominal hysterectomy: A randomized study

    Science.gov (United States)

    Nistal-Nuño, Beatriz

    2017-01-01

    Background: Experimental models using short-duration noxious stimuli have led to the concept of preemptive analgesia. Ketorolac, a nonsteroidal anti-inflammatory drug, has been shown to have a postoperative narcotic-sparing effect when given preoperatively and alternatively to not have this effect. This study was undertaken to determine whether a single intravenous (IV) dose of ketorolac would result in decreased postoperative pain and narcotic requirements. Methods: In a double-blind, randomized controlled trial, 48 women undergoing abdominal hysterectomy were studied. Patients in the ketorolac group received 30 mg of IV ketorolac 30 min before surgical incision, while the control group received normal saline. The postoperative analgesia was performed with a continuous infusion of tramadol at 12 mg/h with the possibility of a 10 mg bolus for every 10 min. Pain was assessed using the visual analog scale (VAS), tramadol consumption, and hemodynamic parameters at 0, 1, 2, 4, 8, 12, 16, and 24 h postoperatively. We quantified times to rescue analgesic (morphine), adverse effects, and patient satisfaction. Results: There were neither significant differences in VAS scores between groups (P > 0.05) nor in the cumulative or incremental consumption of tramadol at any time point (P > 0.05). The time to first requested rescue analgesia was 66.25 ± 38.61 min in the ketorolac group and 65 ± 28.86 min in the control group (P = 0.765). There were no significant differences in systolic blood pressure (BP) between both groups, except at 2 h (P = 0.02) and 4 h (P = 0.045). There were no significant differences in diastolic BP between both groups, except at 4 h (P = 0.013). The respiratory rate showed no differences between groups, except at 8 h (P = 0.017), 16 h (P = 0.011), and 24 h (P = 0.049). These differences were not clinically significant. There were no statistically significant differences between groups in heart rate (P > 0.05). Conclusions: Preoperative ketorolac

  18. Postirradiation fibrosarcoma following radical mastectomy

    Energy Technology Data Exchange (ETDEWEB)

    Iwasaki, K.; Nagamitsu, S.; Tsuneyoshi, M.

    1978-03-01

    A case of fibrosarcoma arising in the scar of the radical mastectomy with postoperative irradiation of breast carcinoma is reported. The tumors arose five times in spite of the extirpations including surrounding tissue since 11 years after radical mastectomy and postoperative irradiation. All of arisen tumors were diagnosed fibrosarcoma histologically and with every recurrence the aggravation of malignancy of tumors was shown. In this case, the primary tumor of the breast was infiltrating carcinoma and no sign of fibrosarcoma was noted histologically. The mastectomy scar was indicated the irradiation therapy postoperatively and fibrosarcoma developed 11 years after postoperative irradiation. Namely, this case agreed to the strict criteria of the postirradiation sarcoma proposed by Cahan et al. In this paper, a case of postirradiation fibrosarcoma arising in the scar of radical mastectomy for carcinoma is presented.

  19. Epistemological barriers to radical behaviorism.

    Science.gov (United States)

    O'Donohue, W T; Callaghan, G M; Ruckstuhl, L E

    1998-01-01

    The historian and philosopher of science Gaston Bachelard proposed the concept of epistemological barriers to describe the intellectual challenges encountered by scientists in their work. In order to embrace novel ways of approaching a problem in science, scientists must overcome barriers or obstacles posed by their prior views. For example, Einsteinian physics presents scientists with claims that space is curved and that time and space are on the same continuum. We utilize Bachelard's concept of epistemological barriers to describe the differences between the intellectual journeys students pursuing advanced studies face when attempting to accept cognitive psychology or radical behaviorism. We contend that the folk psychological beliefs that students typically hold when entering these studies pose less challenge to cognitive psychology than to radical behaviorism. We also suggest that these barriers may also partly be involved in the problematic exegesis that has plagued radical behaviorism. In close, we offer some suggestions for dealing with these epistemological barriers.

  20. Epistemological barriers to radical behaviorism

    Science.gov (United States)

    O'Donohue, William T.; Callaghan, Glenn M.; Ruckstuhl, L. E.

    1998-01-01

    The historian and philosopher of science Gaston Bachelard proposed the concept of epistemological barriers to describe the intellectual challenges encountered by scientists in their work. In order to embrace novel ways of approaching a problem in science, scientists must overcome barriers or obstacles posed by their prior views. For example, Einsteinian physics presents scientists with claims that space is curved and that time and space are on the same continuum. We utilize Bachelard's concept of epistemological barriers to describe the differences between the intellectual journeys students pursuing advanced studies face when attempting to accept cognitive psychology or radical behaviorism. We contend that the folk psychological beliefs that students typically hold when entering these studies pose less challenge to cognitive psychology than to radical behaviorism. We also suggest that these barriers may also partly be involved in the problematic exegesis that has plagued radical behaviorism. In close, we offer some suggestions for dealing with these epistemological barriers. PMID:22478314