A prospective observational study was designed to evaluate the effect of the different techniques of hysterectomy on urinary and sexual function. One hundred and eighty-seven women aged 29-73 years and admitted for hysterectomy for various indications were recruited to the study. Women presenting primarily with major uterine prolapse and those requiring radical hysterectomy were excluded. Patients underwent one of four different techniques of hysterectomy: total abdominal, vaginal, laparoscopic or subtotal. All patients completed a standardised questionnaire addressing urinary and sexual symptoms and underwent urodynamic testing using the Lectromed 6000 System (Lectromed, Letchworth, Herts, UK) before and 6 months after surgery. Out of 187 women, 184 (98.4%) had completed data. Seventy-three patients (39%) had a total abdominal hysterectomy, 62 (34%) had vaginal, 38 (21%) had laparoscopic and 11 (6%) had subtotal hysterectomy. At 6 months after surgery, urinary symptoms occurred less frequently (P<0.01) and urodynamic studies remained unchanged. Moreover, patients reported significantly lower rates of stress incontinence (P=0.005), urgency (P=0.03) and deep dyspareunia (P<0.001) than before the operation, regardless of the hysterectomy technique used. The route of hysterectomy did not influence the outcome of surgery. We conclude that simple hysterectomy, whether performed abdominally, vaginally or laparoscopically, does not adversely affect urinary or sexual function at 6 months after surgery.
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 Randomised controlled trial.Setting Gynaecology Department, Benenden Hospital, Kent.Population One hundred and sixteen women undergoing vaginal hysterectomy were prospectively randomised to either LigaSure (Group I) or suture ligation (Group II) for securing the pedicles. Methods Data of patients were collected prospectively. Statistical analysis was performed using the MannWhitney U test, m 2 and Fisher's exact test as appropriate.Main outcome measures Operating time, operative blood loss and peri-operative complications.Results The operating time was significantly shorter in the LigaSure group compared with the control group (P < 0.04). There was no statistical significant difference between the two groups in operative blood loss (P ¼ 0.433), but peri-operative haemorrhagic complications were less frequent in the LigaSure group (0% vs 6.8%, P ¼ 0.057). Four patients in the control group required either conversion to laparotomy because of bleeding, return to theatre for immediate post-operative haemorrhage or readmission for vault haematoma, whereas none in the LigaSure group had bleeding from unsecured pedicles. Conclusion The LigaSure vessel sealing system is a safe alternative for securing pedicles in vaginal hysterectomy when compared with conventional suture ligation. Larger studies are required to determine its place in gynaecological surgery.
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 Randomised controlled trial. Setting Gynaecology Department, Benenden Hospital, Kent. Population One hundred and sixteen women undergoing vaginal hysterectomy were prospectively ran-domised to either LigaSure (Group I) or suture ligation (Group II) for securing the pedicles. Methods Data of patients were collected prospectively. Statistical analysis was performed using the Mann-Whitney U test, m 2 and Fisher's exact test as appropriate. Main outcome measures Operating time, operative blood loss and peri-operative complications. Results The operating time was significantly shorter in the LigaSure group compared with the control group (P < 0.04). There was no statistical significant difference between the two groups in operative blood loss (P ¼ 0.433), but peri-operative haemorrhagic complications were less frequent in the LigaSure group (0% vs 6.8%, P ¼ 0.057). Four patients in the control group required either conversion to laparotomy because of bleeding, return to theatre for immediate post-operative haemorrhage or readmission for vault haematoma, whereas none in the LigaSure group had bleeding from unsecured pedicles. Conclusion The LigaSure vessel sealing system is a safe alternative for securing pedicles in vaginal hysterectomy when compared with conventional suture ligation. Larger studies are required to determine its place in gynaecological surgery.
Objective To investigate the ef®cacy of laparoscopic mesh colposuspension as an equivalent approach to the`gold standard' open Burch colposuspension. Patients and methods A prospective controlled study of laparoscopic mesh colposuspension was conducted over 2 years; 87 patients with genuine stress incontinence (GSI) were recruited. The preoperative evaluation included a history, examination, midstream urine analysis, urinary voiding diary, a Urilos pad test, and twin-channel subtracted cystometry, including urethral pro®lometry and measurement of the postvoid residual volume. The study included patients who had undergone previous incontinence surgery, but those with detrusor instability or neurogenic bladder were excluded. The patients were assessed at 6 weeks, 6 months and 1 year after surgery and then yearly thereafter. The urodynamic assessment was repeated 3 months after surgery. Results Forty-nine patients underwent laparoscopic colposuspension using Prolene mesh and titanium tacks to elevate the bladder neck, while 38 patients had open Burch colposuspension. There was no difference between the groups in age, parity, body mass index, menopausal status, medical history, previous bladder neck surgery and prolapse. At 6 weeks the cure rate was similarly high in the two groups (91% laparoscopic and 94% open). After a mean follow-up of 32 months, both groups showed a decline in ef®cacy, which was more marked in the laparoscopic group. Cure rates were 62% for laparoscopy and 79% for open surgery, and the improvement rates were 77% and 89%, respectively (P<0.05). Conclusion Laparoscopic colposuspension using a mesh and tacker technique reduces the technical dif®culty and operating time of the endoscopic procedure, but the long-term cure rates are inferior to open Burch colposuspension.
We present a case series of cold knife cone biopsy with emphasis on validation of the technique for ongoing and future use. This involved: analysis of 100 cold knife cone biopsies performed between 1987 and 1997. Data were gathered relating to indications, technique, postoperative morbidity, histological findings and results of long-term follow-up. Mean age was 41.8 years, and mean parity 2. Smear abnormalities of moderate or severe dyskaryosis were present in 74% of cases, and glandular abnormalities in 8%. Colposcopic diagnosis of CIN II-III was made in 55% of cases, and invasion suspected in 12%. The main indications for conisation were inability to visualise the entire squamocolumnar junction (64%), disparity in cytological and colposcopic findings (26%), and colposcopic suspicion of invasion (12%). Mean blood loss was 90 ml. One patient (1%) required hysterectomy and blood transfusion to control secondary haemorrhage. Postoperative infection occurred in 5%, and cervical stenosis in 3%. All specimens were adequate for histopathological evaluation, including the margin, CIN was histologically proven in 67% of specimens, microinvasion in 4%, adenocarcinoma in-situ in 3%, and invasion in 3%. During a mean follow-up of 4.5 years (range 1.5-11 years), cure rate after complete excision was 97% and after incomplete excision was 85% (P > 0.05) Despite the advent of alternative methods of treatment, cold knife cone biopsy remains an acceptable option in the management of CIN and microinvasion of the cervix. There are valid indications for the technique. When properly performed, it gives accurate representation of the disease process, has low risk of complications and is curative in most cases.
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