Total Laparoscopic Hysterectomy with Prior Uterine Artery Ligation at Its Origin

Poojari, Vidyashree G.; Bhat, Vidya V; Bhat, Rajani

doi:10.1155/2014/420926

Cited by 14 publications

(16 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The anterior vaginal fornix is delineated using a simple sponge stick, and a colpotomy is created using the Harmonic Scalpel. The uterus is then extracted vaginally, and if needed in cases of large specimen, via extraperitoneal vaginal debulking techniques . The vaginal cuff is closed transvaginally.…”

Section: Methodsmentioning

confidence: 99%

Value‐based assessment of hysterectomy approaches

Danilyants¹,

MacKoul²,

Baxi³

et al. 2018

J of Obstet and Gynaecol

View full text Add to dashboard Cite

Aim By evaluating operative outcomes relative to cost, we compared the value of minimally invasive hysterectomy approaches, including a technique discussed less often in the literature, laparoscopic retroperitoneal hysterectomy (LRH), which incorporates retroperitoneal dissection and ligation of the uterine arteries at their vascular origin. Methods Retrospective chart review of all women (N = 2689) aged greater than or equal to 18 years who underwent hysterectomy for benign conditions from 2011 to 2013 at a high‐volume hospital in Maryland, USA. Procedures included: laparoscopic supracervical hysterectomy, robotic‐assisted laparoscopic hysterectomy (RALH), total laparoscopic hysterectomy, laparoscopic‐assisted vaginal hysterectomy, total vaginal hysterectomy (TVH), and LRH. Results Total vaginal hysterectomy had the highest intraoperative complication rate (9.6%; P < 0.0001) but the lowest postoperative complication rate (1.8%; P < 0.0001). Robotics had the highest postoperative complication rate (11.4%; P < 0.0001). LRH had the shortest operative time (71.2 min; P < 0.0001) and the lowest intraoperative complication rates (2.1%; P < 0.0001). LRH and TVH were the least costly (averaging $4061 and $6416, respectively), while RALH was the most costly ($9354). Taking both operative outcomes and cost into account, LRH, TVH and laparoscopic‐assisted vaginal hysterectomy yielded the highest value scores; total laparoscopic hysterectomy, RALH, and laparoscopic supracervical hysterectomy yielded the lowest. Conclusion Understanding the value of surgical interventions requires an evaluation of both operative outcomes and direct hospital costs. Using a quality‐cost framework, the LRH approach as performed by high‐volume laparoscopic specialists emerged as having the highest calculated value.

show abstract

Section: Methodsmentioning

confidence: 99%

Value‐based assessment of hysterectomy approaches

Danilyants¹,

MacKoul²,

Baxi³

et al. 2018

J of Obstet and Gynaecol

View full text Add to dashboard Cite

show abstract

“…The uterine artery is usually ligated, coagulated, or clipped near the neck of the uterus at the U3 segment or at its origin from the internal iliac artery (U1 segment), but also at the U2 segment within the broad ligament [ 10 , 11 ]. For many surgical procedures, the intervention begins with a retroperitoneal dissection or transection of the broad ligament to identify the uterine artery, its course, and the ureter [ 12 – 14 ]. However, unlike angiography, using laparoscopic approaches to access the uterine vessels cannot necessarily rule out vascular anomalies.…”

Section: Discussionmentioning

confidence: 99%

The extremely rare vascular variant of a segmental duplicated uterine artery and its relevance for the interventionist and gynecologist: a case report

Rott¹,

Boecker²

2016

J Med Case Reports

View full text Add to dashboard Cite

BackgroundAnatomic variants of the uterine artery are rare, with the absence of one of the uterine arteries presumably being the most abundant variant. A duplicated uterine artery is mentioned in the medical literature, but to the best of our knowledge, an angiographic study has never been published. A partially duplicated uterine artery is an extremely rare variant not previously mentioned in the literature, and it could lead to technical difficulties or cause problems in various gynecological interventions.Case presentationWe present the case of a 45-year-old Caucasian woman with a uterine fibroid and typical fibroid-related symptoms who came to our department to get treated with fibroid embolization. During the procedure, angiography revealed a partial or segmental duplicated left uterine artery. This exceptionally rare anatomic variant proved to be beneficial for the safety of the embolization in our case; however, it is far more likely that such a variant would be unfavorable in some types of gynecological operative and minimally invasive techniques.ConclusionsKnowledge of the anatomic variant of a partially duplicated uterine artery is important, especially for gynecologists performing minimally invasive surgical procedures.

show abstract

“…We provide here the most important technical principles of the LRH technique as described in the operative reports. LRH is a variation of a total laparoscopic hysterectomy, with the distinguishing aspect of a standard retroperitoneal dissection (RPD), lateralization of the ureters, and ligation of the uterine artery at its origin from the anterior division of the internal iliac artery [14][15][16]. Abdominal entry is obtained by 5mm direct entry trocar via the umbilicus and a 5mm suprapubic port.…”

Section: Lrh Techniquementioning

confidence: 99%

A value-based evaluation of minimally invasive hysterectomy approaches

Danilyants¹,

MacKoul²,

Does³

et al. 2019

Gynecol Surg

View full text Add to dashboard Cite

Background: With surgical care contributing to the rising healthcare costs around the globe, quantifying the value of surgical modalities is critical to pushing healthcare systems in the direction of greater sustainability. The purpose of this study was to assess and compare the value of minimally invasive hysterectomy approaches, as defined by operative outcomes and patient satisfaction relative to direct hospital costs. Methods: Sequential mixed methods; retrospective chart review of all women (N = 2689) ≥ 18 years old who underwent hysterectomy for benign conditions from 2011 through 2013 at a suburban hospital in Maryland, USA; a mail survey of the same population was administered in June to October 2015. Procedures included laparoscopic supracervical hysterectomy (LSH), robotically assisted laparoscopic hysterectomy (RALH), total laparoscopic hysterectomy (TLH), laparoscopically assisted vaginal hysterectomy (LAVH), total vaginal hysterectomy (TVH), and laparoscopic retroperitoneal hysterectomy (LRH), a procedure that incorporates retroperitoneal dissection and ligation of the uterine arteries at their vascular origin. We estimated the value of each procedure by dividing quality over direct hospital costs, where quality was quantified by creating a summary composite score of the average operating time, estimated blood loss, complication and conversion rates, and patient satisfaction. Results: The majority of LRH and RALH procedures were performed by high-volume surgeons, while the majority of LSH and TVH procedures were performed by low-volume surgeons. RALH had the highest postoperative complication rate (11.4%; p < .0001). TVH had the highest intraoperative complication rate (9.6%; p < .0001) but lowest postoperative complication rate (1.8%; p < .0001). LRH had the shortest operating time (71.2 min; p < .0001) and lowest intraoperative complication rates (2.1%; p < .0001). LRH and TVH were the least costly ($4061 and $6416, respectively), while RALH was the most costly ($9354). LRH had the highest combined patient satisfaction score, followed by RALH, while TLH, LAVH, TVH, and LSH averaged similar scores. Conclusion: LRH, TVH, and LAVH yielded the highest value scores; LSH, TLH, and RALH yielded the lowest. Healthcare costs continue to escalate, in large part due to innovations in medical technology. For healthcare stakeholders seeking to control costs without sacrificing quality, it is critical to operationalize the value of varying surgical techniques, including measures of surgeon experience, operative outcomes, costs, and patient satisfaction.

show abstract

Total Laparoscopic Hysterectomy with Prior Uterine Artery Ligation at Its Origin

Cited by 14 publications

References 9 publications

Value‐based assessment of hysterectomy approaches

Value‐based assessment of hysterectomy approaches

The extremely rare vascular variant of a segmental duplicated uterine artery and its relevance for the interventionist and gynecologist: a case report

A value-based evaluation of minimally invasive hysterectomy approaches

Contact Info

Product

Resources

About