Comparative study of vaginal, laparoscopically assisted vaginal and abdominal hysterectomies for uterine myoma larger than 6 cm in diameter or uterus weighing at least 450 g: a prospective randomized study

Hwang, Jiann-Loung; Seow, Kok-Min; Tsai, Yieh-Loong; Huang, Lee-Wen; Hsieh, Bih-Chwen; Lee, Cagge

doi:10.1034/j.1600-0412.2002.811206.x

Cited by 118 publications

(74 citation statements)

References 26 publications

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“…Our results are similar to those of other studies in the literature, which have reported a patient age range of 41–50 years,9,10,20–25 myoma as the main indication, spinal anesthesia as the most commonly used anesthetic procedure,22–24 volume uterine reduction often being performed, a surgery time of about 75 minutes, and oophorectomy being a frequently associated procedure 10,20,22,26…”

Section: Discussionsupporting

confidence: 91%

“…Despite the introduction of minimally invasive approaches to treat various benign uterine problems, and the long time period for which the vaginal route has been used to perform hysterectomy for benign uterine disease, hysterectomy is still performed abdominally in most cases, and the vaginal approach is used in only 20%–25% of women who undergo the procedure in the US regardless of the indication 4,8,10,17,18…”

Section: Discussionmentioning

confidence: 99%

“…It has been shown that the vaginal route is more advantageous than any other approach to hysterectomy for a number of reasons, including a shorter recovery time, less pain in the postoperative period, a rapid return to former activity levels, and absence of visible scarring 9,10,19…”

Section: Discussionmentioning

confidence: 99%

“…Newer evidence indicates that the vaginal route is indeed safe for hysterectomy, even for larger uterine volumes,8–10 and the literature has demonstrated that, when feasible, vaginal hysterectomy is more cost-effective for uterine removal 1. Even when the uterine volume is large, vaginal hysterectomy can be carried using uterine volume reduction techniques such as myomectomy, uterine morcellation, uterine hemisection, intramyometrial reduction (Lash’s technique), uterine wall wedge resection, and amputation of the uterine cervix, with the aim of obtaining access to the base of the uterus 11.…”

Section: Introductionmentioning

confidence: 99%

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Observational evaluation of preoperative, intraoperative, and postoperative characteristics in 117 Brazilian women without uterine prolapse undergoing vaginal hysterectomy

Batista¹,

Osako²,

Clemente³

et al. 2012

IJWH

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BackgroundDespite 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.MethodsA 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.ResultsThe 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).ConclusionThis study suggests that vaginal hysterectomy is a safe surgical procedure in view of its good performance and low complication rate.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Observational evaluation of preoperative, intraoperative, and postoperative characteristics in 117 Brazilian women without uterine prolapse undergoing vaginal hysterectomy

Batista¹,

Osako²,

Clemente³

et al. 2012

IJWH

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show abstract

“…Of the 27 included trials (with a total of 3643 participants), two compared vaginal with abdominal hysterectomy,5 18 16 compared laparoscopic with abdominal hysterectomy,7 – 9 11 13 14 16 17 19 22 24 – 26 29 – 31 four compared laparoscopic with vaginal hysterectomy,6 23 27 28 one compared LAVH with LH(a),15 one compared laparoscopic with abdominal and vaginal hysterectomy,10 and three compared laparoscopic, vaginal, and abdominal hysterectomy 12 20 21…”

Section: Resultsmentioning

confidence: 99%

Methods of hysterectomy: systematic review and meta-analysis of randomised controlled trials

Johnson

Barlow

Lethaby

et al. 2005

BMJ

386

219

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Objective To evaluate the most appropriate surgical method of hysterectomy (abdominal, vaginal, or laparoscopic) for women with benign disease. Design Systematic review and meta-analysis. Data sources Cochrane Menstrual Disorders and Subfertility Group Trials Register, Cochrane Central Register of Controlled Trials, Medline, Embase, and Biological Abstracts. Selection of studies Only randomised controlled trials were selected; participants had to have benign gynaecological disease; interventions had to comprise at least one hysterectomy method compared with another; and trials had to report primary outcomes (time taken to return to normal activities, intraoperative visceral injury, and major long term complications) or secondary outcomes (operating time, other immediate complications of surgery, short term complications, and duration of hospital stay). Results 27 trials (total of 3643 participants) were included. Return to normal activities was quicker after vaginal than after abdominal hysterectomy (weighted mean difference 9.5 (95% confidence interval 6.4 to 12.6) days) and after laparoscopic than after abdominal hysterectomy (difference 13.6 (11.8 to 15.4) days), but was not significantly different for laparoscopic versus vaginal hysterectomy (difference − 1.1 ( − 4.2 to 2.1) days). There were more urinary tract injuries with laparoscopic than with abdominal hysterectomy (odds ratio 2.61 (95% confidence interval 1.22 to 5.60)), but no other intraoperative visceral injuries showed a significant difference between surgical approaches. Data were notably absent for many important long term patient outcome measures, where the analyses were underpowered to detect important differences, or they were simply not reported in trials. Conclusions Significantly speedier return to normal activities and other improved secondary outcomes (shorter duration of hospital stay and fewer unspecified infections or febrile episodes) suggest that vaginal hysterectomy is preferable to abdominal hysterectomy where possible. Where vaginal hysterectomy is not possible, laparoscopic hysterectomy is preferable to abdominal hysterectomy, although it brings a higher chance of bladder or ureter injury.

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Surgical approach to hysterectomy for benign gynaecological disease

Nieboer

Johnson

Barlow

et al. 2006

Cochrane Database of Systematic Reviews

191

225

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Significantly improved outcomes suggest VH should be performed in preference to AH where possible. Where VH is not possible, LH may avoid the need for AH, however the length of the surgery increases as the extent of the surgery performed laparoscopically increases, particularly when the uterine arteries are divided laparoscopically and laparoscopic approaches require greater surgical expertise. The surgical approach to hysterectomy should be decided by a woman in discussion with her surgeon in light of the relative benefits and hazards. Further research is required with full reporting of all relevant outcomes, particularly important long-term outcomes, in large RCTs, to minimise the possibility of reporting bias. Further research is also required to define the role of the newer approaches to hysterectomy such as TLH.

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Comparative study of vaginal, laparoscopically assisted vaginal and abdominal hysterectomies for uterine myoma larger than 6 cm in diameter or uterus weighing at least 450 g: a prospective randomized study

Cited by 118 publications

References 26 publications

Observational evaluation of preoperative, intraoperative, and postoperative characteristics in 117 Brazilian women without uterine prolapse undergoing vaginal hysterectomy

Observational evaluation of preoperative, intraoperative, and postoperative characteristics in 117 Brazilian women without uterine prolapse undergoing vaginal hysterectomy

Methods of hysterectomy: systematic review and meta-analysis of randomised controlled trials

Surgical approach to hysterectomy for benign gynaecological disease

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