What is the value of preoperative bimanual pelvic examination in women undergoing laparoscopic total hysterectomy?

Condous, G.; Calster, Ben Van; Huffel, Sabine Van; Lam, Alan

doi:10.1016/j.jmig.2006.12.001

Cited by 17 publications

(6 citation statements)

References 21 publications

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“…This is of importance as deep infiltrating endometriosis is correlated with adenomyosis in almost every second case [ 12 ]. Thus, the gynecological examination allows more detailed information about severity and complexity of the disease in the planning of medical or surgical treatment [ 20 ]. As a next step, clinical history and gynecological examination should be combined with transvaginal ultrasound considering the diagnostic sonographic signs of adenomyosis.…”

Section: Resultsmentioning

confidence: 99%

From Clinical Symptoms to MR Imaging: Diagnostic Steps in Adenomyosis

Krentel

Cezar

Becker

et al. 2017

BioMed Research International

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Adenomyosis or endometriosis genitalis interna is a frequent benign disease of women in fertile age. It causes symptoms like bleeding disorders and dysmenorrhea and seems to have a negative effect on fertility. Adenomyosis can be part of a complex genital and extragenital endometriosis but also can be found as a solitary uterine disease. While peritoneal endometriosis can be easily diagnosed by laparoscopy with subsequent biopsy, the determination of adenomyosis is difficult. In the following literature review, the diagnostic methods clinical history and symptoms, gynecological examination, 2D and 3D transvaginal ultrasound, MRI, hysteroscopy, and laparoscopy will be discussed step by step in order to evaluate their predictive value in the diagnosis of adenomyosis.

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Section: Resultsmentioning

confidence: 99%

From Clinical Symptoms to MR Imaging: Diagnostic Steps in Adenomyosis

Krentel

Cezar

Becker

et al. 2017

BioMed Research International

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“…However, in 2020, the FDA recommended performing laparoscopic power morcellation only with tissue containment systems, in appropriately selected patients 9 . Therefore, diligent patient selection and counselling is paramount for surgical planning of morcellation techniques and management of patient’s expectations 5,10 …”

Section: Introductionmentioning

confidence: 99%

Predictive factors of the need to morcellate in total laparoscopic hysterectomy

Asgari

Enzevaei

Hosseini

et al. 2021

Aust NZ J Obst Gynaeco

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Background Specimen extraction is a major challenge in total laparoscopic hysterectomy (TLH) and tissue morcellation may be needed to extract a large uterus. Aims The study aims to determine preoperative factors that could predict the need for uterine morcellation in TLH, and also find the best cut‐off values of each measured parameter leading to optimum sensitivity and specificity. Materials and Methods This was a cross‐sectional study of women from August 2019 to May 2020 who underwent TLH, with or without salpingo‐oophorectomy in our department. We performed bimanual exams preoperatively to estimate the uterine size and recorded the uterine ultrasonographic dimensions and myoma size in myomatous uteri. Receiver operating characteristic (ROC) were used to establish cut‐offs that maximised the sensitivity and specificity of each factor in predicting the need for morcellation. Poisson regression was used to calculate the relative risks (RR) of each cut‐off. Results One hundred and sixty‐two women were recruited in the study. ROC curves demonstrated maximum sensitivities and specificities with a cross‐sectional area of 36.5 cm2, the largest leiomyoma dimension of 40 mm, uterine length of 10 cm, and bimanual uterine size of 13 weeks. Multiple modified Poisson regression revealed that the strongest predictors of morcellation were the largest leiomyoma diameter of >40 mm (RR: 3.58), the uterine cross‐sectional area of >36.5 cm2 (RR: 6.38), and uterine size in the bimanual exam of >13 weeks pregnancy (RR: 3.57). Conclusion The largest leiomyoma diameter, uterine cross‐sectional area, and size on a bimanual exam can all be used to predict needing morcellation preoperatively in TLH.

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“…Because of these concerns, accurately predicting which specimens require morcellation is important for preoperative planning and patient counseling [19]. Unfortunately, current attempts to predict which specimens will require morcellation are based on clinical judgment.…”

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confidence: 99%

“…Unfortunately, current attempts to predict which specimens will require morcellation are based on clinical judgment. Prior studies attempting to address this question have used uterine weight, which is not known preoperatively and so has limited clinical utility [19,20]. Additionally, there may be more discrepancy between clinical and ultrasonographic assessments for intermediate-sized uteri.…”

mentioning

confidence: 99%