Gaining prowess in the art of hysterectomy, reflections and complications; a teaching hospital experience

Abstract

Objective: The purpose of this audit is to analyze the indications, complications, and the final histopathology reports of all hysterectomies done under our care during the study period at Jordan University Hospital. The ultimate goal of the study is to clarify the importance of acquiring brain surgical skills during practice and follow-up. It should be a target present in teaching hospitals that adopt educational residency programs. Methods: This is a retrospective study involving all patients who underwent hysterectomy from January 2017 till January 2020. Results: a total of 245 patients underwent hysterectomy (regardless of the type) during the study period. The most common indication was abnormal vaginal bleeding followed by malignancy. The most common intraoperative complication was bladder injury followed by bleeding. The most common postoperative complication was wound infection followed by hematoma. The most common histopathology was benignly followed by malignancy. Conclusion: hysterectomy is a surgical procedure commonly performed to alleviate health welfare; nevertheless, in some situ, actions it is portrayed as a lifesaving procedure. Unsurprisingly, the significance and consequences of related complications mandate for patients planned for the procedure to be appraised thoroughly and adequately before surgery. The aim and art of refining and improving acquired surgical skills and experience portrayed intraoperatively errors a decline in complications rate. Time and practice aid to the ascending linear curve of gained surgical skills, which mirrors a gradual drop in the complications rate.

Maternal request for cesarean delivery; a solid indication or a window for complications; a teaching hospital experience

“…30 Perhaps employing rationality, wisdom, and advice in surgical decisions, away from emotion, will give a positive outcome, but that also requires distinguished surgical skills to deal with complications that may arise. 31,32 We must remember the three key contributors to maternal morbidity and mortality related to CS include impediments of hemorrhage, surgical site infection, and venous thromboembolism. All women should be screened for risk factors associated with these major complications during the antepartum, intrapartum, and postpartum periods to assure the availability of immediate resources based on the assessment.…”

Subtotal hysterectomy reviewed: a stable or aperture for stump cervical malignancy. A referral hospital experience

“…The hymen carries personal and social dimensions, and it is taboo to be approached or discussed if the patient is single. Bearing in mind the increased incidence of cervical cancer, the absence of any health benefits that are reflected in the future life of women, and the increased opportunity for them to undergo another major and more complex surgery to remove the cervix through the vagina or abdominally, it is necessary to inform women when deciding on the surgical approach for hysterectomy, accompanied by a thorough explanation of all the expected possibilities, because it needs complete preparation before surgery, with marked improvement of the gained surgical skills upon this practice [ 27 , 28 ]. Subtotal hysterectomy is easier, does not need distinct skills that lead to experience and follow-up, and must be limited to the narrowest limits of practice, provided that the woman knows the phrase stating there are no health benefits for keeping the cervix in place, and there is a clear red flashlight related to future medical hazards, including the development of a cancerous tumour of the cervix.…”