Trends in Minimally Invasive Hysterectomy Techniques for Nonmalignant Conditions in a Defined Population

Hansdóttir, Kristín; Gudmundsson, Johannes

doi:10.1159/000479026

Cited by 3 publications

(3 citation statements)

References 17 publications

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“…Hysterectomy is one of the most common gynaecologic surgeries performed worldwide for both benign and malignant conditions [4][5][6]. Notably, uterine leiomyoma is a common female pelvic tumour and is the most common indication for hysterectomy.…”

Section: Introductionmentioning

confidence: 99%

Effect of hysterectomy on ovarian function: a systematic review and meta-analysis

Huang

et al. 2023

J Ovarian Res

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Background Hysterectomy is one of the most frequently gynecologic surgeries performed in premenopausal women. Many premenopausal patients are unwilling to undergo hysterectomy due to the probable decreased ovarian function. The aim of this study is to determine the effect of hysterectomy on ovarian function. Methods A meta-analysis has been reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 and the A Measurement Tool to Assess Systematic Reviews (AMSTAR) guidelines. We mainly searched the Embase, PubMed and Web of Science databases for eligible studies. The outcomes were the levels of common indicators of ovarian function, such as anti-müllerian hormone (AMH), follicle stimulating hormone (FSH), inhibin B, estradiol (E2) and luteinizing hormone (LH). The evidence was synthesized using meta-analysis via fixed or random effect model according to heterogeneity. Subgroup analyses were performed to examine the potential sources of heterogeneity. Results The 14 included studies were conducted between 1989 and 2021, involving a total of 1,457 premenopausal women with 760 and 697 in the hysterectomy and control group, respectively. We found that hysterectomy damage ovarian function compared to the control group, with lower AMH level [Weighted mean difference (WMD) = -0.56, 95% confidence interval (95% CI): -0.72 to -0.39, P = 0.000], higher FSH levels (WMD = 2.96, 95% CI: 1.47 to 4.44, P = 0.000), lower inhibin B levels (WMD = -14.34, 95% CI: -24.69 to -3.99, P = 0.000) and higher LH levels (WMD = 4.07, 95% CI: 1.78 to 6.37, P = 0.000). In addition, E2 levels have a decreasing trend (WMD = -17.13, 95% CI: -35.10 to 0.85, P = 0.631) in the hysterectomy group but were not statistically significant. Conclusion Hysterectomy has a negative impact on ovarian function, especially in female patients over 40 years old. So, the older patients should closely monitor their ovarian function for early diagnosis and treatment of menopausal symptoms.

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Section: Introductionmentioning

confidence: 99%

Effect of hysterectomy on ovarian function: a systematic review and meta-analysis

Huang

et al. 2023

J Ovarian Res

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“…Although surgical approaches have been regulated in numerous reports and published guidelines, there is still substantial variation within and between countries about the choice of surgical route ( 8 – 10 ). This study aims to examine changes in surgical approach and adnexal surgeries during hysterectomies for benign diseases from 2015 to 2021.…”

Section: Introductionmentioning

confidence: 99%

Trends in surgical approaches and adnexal surgeries during hysterectomies for benign diseases between 2015–2021

Zhu

Xi²,

Li³

et al. 2023

Front. Surg.

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BackgroundHysterectomy is a widely used surgical approach for benign gynecological conditions, although recently there have been differences in the surgical route selected in different regions.AimsTo estimate recent temporal trends, this study collected data on surgical approaches and adnexal surgeries during hysterectomies for benign diseases at a single institute from 2015 to 2021.Materials and methodsWe retrospectively analyzed data from Xiangyang No.1 People's Hospital, Hubei University of Medicine in Xiangyang, China, and identified 1828 women who underwent hysterectomies for benign gynecologic conditions performed with or without bilateral salpingectomy (BS) or bilateral salpingo-oophorectomy (BSO) between January 2015 and December 2021.ResultsThere was an upward trend in the performance of hysterectomy and hysterectomy with BS, and there was a difference in the trends of concomitant adnexal surgery between AH, TLH, and VH, especially in TLH with BS. Patient characteristics data demonstrated that the most frequent indication for hysterectomy was leiomyoma, especially in women aged 45 to 65. Compared to AH, TLH, and VH, the operative bleeding, duration of surgery, and length of hospital stays of patients undergoing TLH with BS and BSO was the lowest. The surgical approach to benign diseases has changed dramatically due to a growing proportion of patients choosing minimally invasive procedures. The laparoscopic approach is becoming popular due to its capacity to decrease intraoperative blood loss and reduce hospitalization.ConclusionsWe should put more emphasis on surgical training for the TLH approach and help gynecologic surgeons provide the proposed added benefit of BS to their patients.

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“…The surgical approach for benign gynaecologic indications has changed markedly in the last decades with an increase in minimally invasive techniques and a concurrent decrease in associated morbidity [1, 2]. Laparoscopy has become a standard technique to perform a hysterectomy, with recent attempts to further minimalize invasiveness [3].…”

Section: Introductionmentioning

confidence: 99%

Repeat Vaginal Natural Orifice Transluminal Endoscopic Surgery: A First Feasibility Study

Nulens

Genechten

Baekelandt³

2021

Gynecol Obstet Invest

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Objectives: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is an emerging minimally invasive technique in benign gynaecologic surgery whereby surgical access to the peritoneal cavity is achieved through natural orifices, namely through a vaginal colpotomy. Experience in repeat vNOTES cases is limited and so far, repeat vNOTES cases have not been described in the literature. The purpose of this study was to demonstrate the feasibility of vNOTES hysterectomy in women with a history of previous vNOTES adnexal surgery. Design: We performed a retrospective cohort study of the first 11 repeat vNOTES cases in our centre. All vNOTES procedures, primary adnexal surgery as well as repeat vNOTES hysterectomy, were performed by one surgeon (J.B.). Materials, Setting, Methods: Between March 2016 and May 2020, 11 patients underwent a vNOTES hysterectomy after prior vNOTES adnexectomy or cystectomy in Imelda Hospital, Bonheiden, Belgium. Relevant patient characteristics and outcome data were collected after written informed consent. Results: Median age was 49 years (range 44–65) at the moment of the first vNOTES procedure. Two patients had one or more caesarean sections in history, and 2 women were nulliparous. Median interval between primary and repeat vNOTES procedure was 15 months (range 0.8–37 months). All patients underwent a vaginally assisted NOTES hysterectomy (VANH) as repeat vNOTES procedure. Performing a colpotomy and entering the peritoneal cavity after prior vNOTES was technically feasible in all cases. All VANHs were successfully performed. There were 3 minor complications after repeat vNOTES, of which one was anaesthesia-related. The 2 complications associated with the surgical procedure were both cystitis. In one of these 2 patients, there were high post-void residues, which were easily managed by bladder training. There were no conversions to laparoscopy or laparotomy, neither serious nor life-threatening complications. No ureteric, bladder, or intestinal injuries have occurred. Limitations: The retrospective design and small sample size are the main limitations of this study. Moreover, the follow-up period of the most recently operated patients was too short to draw conclusions on long-term outcomes, including sexual function. Conclusions: In all patients in this case series, vNOTES hysterectomy after prior vNOTES adnexal surgery was successfully performed. Large-scale prospective trials with long-term follow-up are needed to evaluate the safety and feasibility of multiple consecutive vNOTES procedures in 1 patient.

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Trends in Minimally Invasive Hysterectomy Techniques for Nonmalignant Conditions in a Defined Population

Cited by 3 publications

References 17 publications

Effect of hysterectomy on ovarian function: a systematic review and meta-analysis

Effect of hysterectomy on ovarian function: a systematic review and meta-analysis

Trends in surgical approaches and adnexal surgeries during hysterectomies for benign diseases between 2015–2021

Repeat Vaginal Natural Orifice Transluminal Endoscopic Surgery: A First Feasibility Study

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