A retrospective study of 323 total laparoscopic hysterectomy cases for various indications and a case report treating caesarean scar pregnancy

Abstract

Background The application of laparoscopic surgeries has been increasing, and various uterine diseases in addition to leiomyoma/adenomyoma have become indications for total laparoscopic hysterectomy (TLH). Therefore, data acquisition and analysis of TLH procedures, including TLH for rare uterine diseases, have become important for improving surgical procedures and patient selection. To determine the prevalence of and risk factors for the occurrence of intraoperative and postoperative complications of TLH, we performed a multivariate analysis of the records in our hospital. Methods We retrospectively reviewed the medical records of 323 patients who underwent TLH for the treatment of leiomyoma/adenomyoma (278 cases), low-grade (pre)malignant uterine tumours (40 cases) and other rare uterine diseases (5 cases) from January 1, 2015, to December 31, 2019. Of the rare uterine diseases, one case of caesarean scar pregnancy for which TLH was performed is introduced as a case report. To assess the effects of 11 representative factors, including patient characteristics, uterus and leiomyoma sizes, indications for TLH and others, we performed a multivariate logistic regression analysis. Results Among the 323 cases, 20 intraoperative complications and 15 postoperative complications were reported. In the multivariate analysis, “ovarian tumour” and “heavy uterus” were positively associated and “nulliparity” was negatively associated with intraoperative complications. There were no significant risk factors for postoperative complications. The only risk factor for operative complications directly related to the resected uterus was “heavy uterus”. Therefore, we could perform TLH relatively safely for patients with other indications besides leiomyoma/adenomyoma. Conclusions Considering the factors detected in this analysis, the indications for TLH may be expanded. Owing to the increase in TLH for indications other than leiomyoma/adenomyoma, a more accurate determination of the treatment approach can be achieved.

An algorithm for the pre-operative differentiation of benign ovarian tumours based on magnetic resonance imaging interpretation in a regional core hospital: A retrospective study

“…Of these, 293 patients aged ≥ 50 years were excluded from this study as almost all of these women had selected salpingo-oophorectomy. This supported previous reports [4] , [10] , probably because women at this age assumed menopause. Twelve of the remaining 935 cases were excluded because MRI was not performed in these cases.…”

Obvious advantage of vaginal natural orifice transluminal endoscopic surgery hysterectomy against total laparoscopic hysterectomy in small uterus patients and the future prospects at a regional core institution: A retrospective study

“…By using this transvaginal access platform provided in the vaginal wall, we could use 3 laparoscopic forceps under laparoscopic view, similar to TLH. This platform, namely, GelPOINT V-Path, is relatively low cost compared with RALH, and additionally, the attaching procedure is similar to our original procedure for removing a resected uterus from a vaginal wound [16] . These conditions have been advantageous for introducing vNOTES-H, and this surgical method may be expected to become more prevalent for younger generations of gynaecologists who are familiar with laparoscopic techniques [10] .…”

“…Since we could only perform vNOTES-H in our hospital for patients with resected uterine weights less than approximately 250 g, we adopted this cut-off value, namely, 210 g, as a heavy uterus in this study by referring to the average and standard deviation of the uterine weight of all 111 patients. The criteria for “Advanced age”, “High BMI” and “Large leiomyoma” were determined based on past reports [16] , [17] , [18] , [19] . A “High BMI” was defined according to the definition of obesity of the Japan Society for the Study of Obesity.…”

Preventive effect of metronidazole vaginal tablets on vaginal bacteria-related postoperative complications with total laparoscopic hysterectomy

“…In this analysis, we assessed the influence of the following 17 factors: (1) advanced age, defined as an age ≥ 50 years; (2) high body mass index (BMI), defined as a BMI ≥ 25 (kg/m 2 ); (3) nulliparity, defined as no previous delivery; (4) gynecological operation history; (5) menstrual disorder, defined as patients with menstruation-related symptoms such as dysmenorrhea, menostaxis, menorrhagia, anemia or abnormal vaginal bleeding; (6) abdominal distension, defined as patients with abdominal symptoms such as abdominal pressure, pelvic pain, dysuria, or dyschezia; (7): GnRH analog, defined as treatment with gonadotropin-releasing hormone analog (GnRHa) before TLH; (8) concomitant LC; (9) concomitant PLA; (10) long-time operation, defined as an operation lasting over 240 minutes according to the average and standard deviation of 520 cases; (11) massive blood loss, defined as loss of over 500 mL of blood; (12) heavy uterus, defined as a resected uterine weight ≥ 500 g; (13) abdominal adhesion, defined as abdominal adhesion detected by laparoscopic inspection immediately after the start of surgery; (14) blood transfusion, defined as the need for blood transfusion, including both autologous and allogeneic blood transfusion, during or after the operation; (15) large leiomyoma, defined as a dominant leiomyoma ≥ 8 cm by magnetic resonance imaging (MRI); ( 16) large uterus, defined as an average uterine length ≥ 10 cm by transvaginal ultrasound (TVUS) before surgery; and (17) MVT use, defined as treatment with vaginal tablets. The criteria for "massive blood loss, " "large leiomyoma, " and "heavy uterus" were determined on the basis of past reports [11][12][13]. Statistical analyses were performed using Microsoft Excel (Microsoft Corporation, Redmond, WA) and JMP version 12 for Windows (SAS Institute, Inc., Tokyo, Japan) to determine the correlations between patient characteristics and VBRPC.…”