Laparoscopic hysterectomy for benign indications: clinical practice guideline

Sandberg, Evelien M.; Hehenkamp, Wouter J.K.; Geomini, Peggy M.A.J.; Janssen, Petra F.; Jansen, Frank Willem; Twijnstra, Andries R. H.

doi:10.1007/s00404-017-4467-9

Cited by 14 publications

(17 citation statements)

References 29 publications

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“…3 , 4 , 7 , 19 , 21 Vaginal hysterectomy is the most recommended and preferred route whenever feasible, with the least morbidity and better outcomes. 11 , 13 VH is mostly performed for pelvic organ prolapse and was true in our study as well where we performed VH exclusively for pelvic organ prolapse only (99.6%). 3 , 4 With the proper patient selection, Kovac et al performed VH in 98.9% (10,975 out of 11,094) patients with benign pathology, suggesting that abdominal and laparoscopic route might have been overused or misused.…”

Section: Discussionsupporting

confidence: 62%

Prevalence of Hysterectomy among Gynecological Surgeries in a Tertiary Care Hospital

et al. 2020

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Introduction: Hysterectomy is the most common gynecological procedure. Over the last decade, the minimally invasive approach has been practiced more frequently. Fibroid uterus being the most common indication for hysterectomy justifies this minimal approach, however, whenever feasible, vaginal hysterectomy can be the preferred route. The objective of this study was to find out the prevalence and indication of hysterectomy among major gynecological surgeries in a tertiary care hospital. Methods: A descriptive cross-sectional study was done at a tertiary care hospital among 1912 patients who had major gynecological surgeries from January 2017 to December 2019. Ethical clearance was obtained from the institutional review committee (ref. no. ACD 935/076/077). Convenient sampling was used. Statistical analysis was done using Statistical Package for Social Sciences version 21.0. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: During the study period, there were 1,912 major gynecological surgeries and the prevalence of hysterectomy was 1,131 (59.15%) (56.94-61.35 at 95% Confidence Interval). Fibroid uterus was the most common clinical indication for hysterectomy which was done in 397 (35.10%) patients, followed by uterovaginal prolapse in 254 (22.46) patients, adnexal mass in 210 (18.56%), and abnormal uterine bleeding in 117 (10.34%) patients. Conclusions: Hysterectomy, being the most common gynecological surgery, selection of the most appropriate route is of paramount importance. As for any other surgery, it is not without complication and hysterectomy should always be justified. With the advancement in the conservative approaches, these organ-preserving options should be explored rigorously before opting for hysterectomy.

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Section: Discussionsupporting

confidence: 62%

Prevalence of Hysterectomy among Gynecological Surgeries in a Tertiary Care Hospital

et al. 2020

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“…Depending on the choice of genital masculinizing procedure, this may involve the removal of the internal female reproductive organs. Vaginal hysterectomy (VH) with or without a bilateral salpingo-oophorectomy (BSO) is thought to have advantages over total laparoscopic hysterectomy (TLH) (Sandberg et al., 2017 ). Available data suggest that a VH or TLH and BSO for trans men is safe, not associated with any additional risks compared to TLH and BSO in cisgender women, and is correlated with improved quality of life (Kaiser et al., 2011 ; Louie & Moulder, 2017 ; Obedin-Maliver et al., 2017 ).…”

Section: Introductionmentioning

confidence: 99%

Combining total laparoscopic hysterectomy and bilateral salpingo-oophorectomy with subcutaneous mastectomy in trans men: The effect on safety outcomes

Elfering

Grift

Bouman

et al. 2020

International Journal of Transgender Health

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Background: Masculinizing mastectomy is the most requested gender affirming surgery (GAS) in trans men, followed by genital GAS. Mastectomy and total laparoscopic hysterectomy, with or without bilateral salpingo-oophorectomy (TLH ± BSO), can both be performed in one single operation session. However, data on complication rates of the combined procedure is scarce and no consensus exists on the preferred order of procedures. Aims: To compare safety outcomes between mastectomy performed in a single procedure with those when performed in a combined procedure and assess whether the order of procedures matters when they are combined. Methods: A retrospective chart review was performed of trans men who underwent masculinizing mastectomy with or without TLH ± BSO in a combined session. The effects of the surgical procedure on complication and reoperation rate of the chest were assessed using logistic regression. Results: In total, 480 trans men were included in the study. Of these, 212 patients underwent the combined procedure. The gynecological procedure was performed first in 152 (71.7%) patients. In the total sample, postoperative hematoma of the chest occurred in 11.3%; 16% in the combined versus 7.5% in the single mastectomy group (p ¼ 0.001). Reoperations due to hematoma of the chest were performed in 7.5% of all patients; 10.8% in the combined versus 4.9% in the single mastectomy group (p ¼ 0.017). The order of procedures in the combined group had no significant effect on postoperative hematoma of the chest (p ¼ 0.856), and reoperations (p ¼ 0.689). Conclusion: Combining masculinizing mastectomy with TLH ± BSO in one session was associated with significantly more hematoma and reoperations compared with separately performing mastectomy. This increased risk of complications after a combined procedure should be considered when deciding on surgical options. The order of procedures in a combined procedure did not have an effect on safety outcomes.

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“…The Clinical Practice Guidelines for Laparoscopic Hysterectomy for Benign Indications developed by the Dutch Society of Obstetrics and Gynecology (NVOG). The recommendations are unclear but they are all implied as strong [17]. The Guidelines for Laparoscopic Treatment of Ventral and Incisional Abdominal Wall Hernias (International Endohernia Society [IEHS])-Part 1 was developed using the Oxford hierarchy of evidence (Oxford Methodology) [18].…”

Section: Resultsmentioning

confidence: 99%

“…This suggested that the GRADE system of recommendation itself was not used as per the guidance document. On the contrary, the guidelines that used Oxford Methodology and the 'Bespoke' system (SAGES Guidelines for the Clinical Application of Laparoscopic Biliary Tract original article Surgery) had more recommendations with matching strength than different strength when re-evaluated using GRADE, which was 62.2% and 50.0% respectively, mainly due to the fact that that the guideline developers complied better with the criteria of the recommendation system, and that the system included a quality of evidence section similar to GRADE: the lowest level in both the systems would always be inadequate evidence and advises the physician to find alternatives [17,18,20]. There are two potential reasons for the differences in agreement between the study authors and us.…”

Section: Discussionmentioning

confidence: 99%

Differences in the recommendation of laparoscopic clinical practice guidelines according to the recommendation system—Re-evaluation using GRADE

Leung

Gurusamy

2020

Eur Surg

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Background Guidelines are essential for safe and effective treatment. They usually have multiple statements. Since the supporting information for the guidelines varies widely, the degree to which these statements are recommended also differ. We rely on recommendation systems for grading the recommendations for different statements. All recommendation systems have different grading criteria and they could potentially cause confusion and affect the quality of recommendations. Therefore, there is a need to determine the extent of variation and explore the potential reasons behind it. Methods A purposive sampling on PubMed was conducted to find four different laparoscopic guidelines using different methods to grade the recommendations. Each statement was then re-evaluated using the GRADE recommendation system. Results The guidelines used GRADE, Oxford Methodology, SIGN, and 'bespoke' systems. The number of statements with similar strength for the different statements as the re-evaluated strengths in the four guidelines were 24.1, 62.2, 35.8 and 50.0% respectively.

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Laparoscopic hysterectomy for benign indications: clinical practice guideline

Cited by 14 publications

References 29 publications

Prevalence of Hysterectomy among Gynecological Surgeries in a Tertiary Care Hospital

Prevalence of Hysterectomy among Gynecological Surgeries in a Tertiary Care Hospital

Combining total laparoscopic hysterectomy and bilateral salpingo-oophorectomy with subcutaneous mastectomy in trans men: The effect on safety outcomes

Differences in the recommendation of laparoscopic clinical practice guidelines according to the recommendation system—Re-evaluation using GRADE

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