Evidence-based guidelines for vaginal hysterectomy of the International Society for Gynecologic Endoscopy (ISGE)

Chrysostomou, Andreas; Djokovic, Dusan; Edridge, William; Herendael, Bruno J. van

doi:10.1016/j.ejogrb.2018.10.058

Cited by 32 publications

(40 citation statements)

References 34 publications

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“…In a second step, we identified patient discharges with specific CHOP codes for vaginal (codes 68. 43…”

Section: Derivation Of Hysterectomy-specific Hospital Service Areasmentioning

confidence: 99%

“…As reimbursement rates for hysterectomy are similar across Swiss regions and do not depend on the type of intervention used, differing financial incentives are unlikely to explain differences in procedure rates and types. Some gynecologists may consider laparoscopic hysterectomy as a more advanced technique because of a better visualization of the operation field, or lack experience leading to reluctance to perform vaginal hysterectomy [41][42][43].…”

Section: Plos Onementioning

confidence: 99%

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Regional variation of hysterectomy for benign uterine diseases in Switzerland

et al. 2020

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Background Hysterectomy is the last treatment option for benign uterine diseases, and vaginal hysterectomy is preferred over more invasive techniques. We assessed the regional variation in hysterectomy rates for benign uterine diseases across Switzerland and explored potential determinants of variation. Methods We conducted a population-based analysis using patient discharge data from all Swiss hospitals between 2013 and 2016. Hospital service areas (HSAs) for hysterectomies were derived by analyzing patient flows. We calculated age-standardized mean procedure rates and measures of regional variation (extremal quotient [EQ], highest divided by lowest rate) and systematic component of variation [SCV]). We estimated the reduction in the variance of crude hysterectomy rates across HSAs in multilevel regression models, with incremental adjustment for procedure year, age, cultural/socioeconomic factors, burden of disease, and density of gynecologists. Results Overall, 40,211 hysterectomies from 54 HSAs were analyzed. The mean age-standardized hysterectomy rate was 298/100,000 women (range 186-456). While the variation in overall procedure rate was moderate (EQ 2.5, SCV 3.7), we found a very high procedure-specific variation (EQ vaginal 5.0, laparoscopic 6.3, abdominal 8.0; SCV vaginal 17.5, laparoscopic 11.2, abdominal 16.9). Adjusted for procedure year, demographic, cultural, and sociodemographic factors, a large share (64%) of the variance remained unexplained (vaginal 63%, laparoscopic 85%, abdominal 70%). The main determinants of variation were socioeconomic/cultural factors. Burden of disease and the density of gynecologists was not associated with procedure rates.

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“…In a second step, we identified patient discharges with specific CHOP codes for vaginal (codes 68. 43…”

Section: Derivation Of Hysterectomy-specific Hospital Service Areasmentioning

confidence: 99%

Section: Plos Onementioning

confidence: 99%

Regional variation of hysterectomy for benign uterine diseases in Switzerland

et al. 2020

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“…Eight of the 70 cases had a uterine weight between 280 g and 499 g, and in only 2 cases the uterus weighed between 500 g and 999 g [2]. Both the American College of Obstetricians and Gynecologists (ACOG) and International Society for Gynecologic Endoscopy (ISGE) recommend performing a vaginal hysterectomy (VH) when technically feasible [3,4]. Technical feasibility, however, depends on both patient characteristics (including uterine volume, uterine descent, size and shape of the vagina, body mass index [BMI], surgical history, previous cesarean sections, and so on) and the surgeons' experience in VH [3,4].…”

mentioning

confidence: 99%

vNOTES Hysterectomy for Large Uteri: A Retrospective Cohort Study of 114 Patients

Nulens

Bosteels

Rop

et al. 2021

Journal of Minimally Invasive Gynecology

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To evaluate the outcome of hysterectomy through vaginal natural orifice transluminal endoscopic surgery (vNOTES) in cases with a large uterus. Design: A retrospective cohort study. Setting: Belgian teaching hospital. Patients: Women who underwent a vNOTES hysterectomy from March 2015 to March 2020 for benign gynecologic disease with a uterine weight of 280 g or more on pathologic examination (N = 114). Interventions: All women underwent vaginally assisted NOTES hysterectomy. We performed a retrospective analysis of baseline patient characteristics and clinical outcomes. Measurements and Main Results: The mean age was 50 § 3.5 years. Twenty-two (19%) patients were obese (body mass index ≥30 kg/m 2), and 4 (3.5%) were morbidly obese (body mass index ≥40 kg/m 2). Thirty-five (31%) patients were nulliparous, and 15 (13%) women had 1 or more cesarean sections in their medical history. Uterine weight varied from 281 g to 3361 g, with a mean weight of 559 § 425 g. Mean surgical time was 63 § 34 minutes. Surgical time was positively associated with uterine size. There were 4 complications: 3 bleeding complications in the first 24 hours after surgery and 1 minor late complication. Conversion to laparotomy for specimen extraction was performed in 1 case (conversion rate 0.9%). There were no conversions to laparoscopy. No ureteric, bladder, or intestinal injuries occurred in this case series, and there were neither life-threatening complications nor intensive care unit admissions. Conclusion: The vNOTES technique can offer a safe and effective alternative to laparoscopy or laparotomy in cases with a large to very large uterus, even if the patient has a history of cesarean section, obesity, or nulliparity. In 99% of all women in this study, hysterectomy was successfully performed through vNOTES without conversion. By making use of the advantages of endoscopic surgery, vNOTES might broaden the indications of vaginal hysterectomy. Randomized controlled trials are needed to evaluate whether vaginally assisted NOTES hysterectomy is superior to laparoscopic or abdominal hysterectomy in large uteri cases.

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“…It is controversial whether a history of pelvic surgery is a risk factor for complications in VH. Some studies have argued that a history of previous pelvic surgery is not an obstacle for VH and does not increase complication rates [19,21]. Conversely, the study of Akyol et al [10] and the review of Jeppson et al [14] reported that a history of previous pelvic surgery was associated with development of complications in VH.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with complications of vaginal hysterectomy in patients with pelvic organ prolapse — a single centre’s experience

et al. 2019

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Objectives: The study aimed to examine the predisposing factors that play a role in the development of complications in patients undergoing vaginal hysterectomy. Material and methods: This retrospective analysis was performed on data provided from 239 patients who underwent vaginal hysterectomy due to uterine prolapse at a single centre between January 2008 and August 2018. Complications were defined according to Clavien-Dindo classification of complications. The patients were divided into two groups: with and without complications. We built a model using multivariable logistic regression to examine the relationships between complications and five candidate predictors. Results: Intra/postoperative complications developed in 30 patients, and the complication rate was found to be 12.5%. 87.2% of the reported complications were classified as Grade ≤ 2 according to Clavien-Dindo system. It was found that complications were associated with factors such as intraoperative concurrent salpingo-oophorectomy [Odds ratio (OR): 1.24 (1.1-1.4)], low preoperative haemoglobin [OR: 0.96 (0.94-0.98)], uterine weight [OR: 2.69 (2.62-2.76)], and long operation time [OR: 1.04 (1.02-1.07)]. History of pelvic surgery was not found to increase complication rate [OR: 1.11 (0.96-1.27), p = 0.13]. Our multiple logistic regression model correctly classified 74% of participants within the Receiver Operating Characteristic (ROC) curve. Conclusions: Preoperative anaemia, large uterus and concomitant adnexectomy were found to be factors associated with complications during and after vaginal hysterectomy for pelvic organ prolapse.

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Evidence-based guidelines for vaginal hysterectomy of the International Society for Gynecologic Endoscopy (ISGE)

Cited by 32 publications

References 34 publications

Regional variation of hysterectomy for benign uterine diseases in Switzerland

Regional variation of hysterectomy for benign uterine diseases in Switzerland

vNOTES Hysterectomy for Large Uteri: A Retrospective Cohort Study of 114 Patients

Factors associated with complications of vaginal hysterectomy in patients with pelvic organ prolapse — a single centre’s experience

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