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Robotic Hysterectomy in Fibroid Uterus
Published in Rooma Sinha, Arnold P. Advincula, Kurian Joseph, FIBROID UTERUS Surgical Challenges in Minimal Access Surgery, 2020
In another Cochrane review (2015), Aarts et al. compared different modalities of hysterectomy [23]. It was reported by patients that average days for return to normal activities was observed to be much shorter in vaginal and laparoscopic hysterectomy than in abdominal hysterectomy. However, there was no statistically significant difference between the mean days to return to normal activities between the two modalities. Urinary complications like injury to urinary tract, involving ureters and bladder, were found to be more in the laparoscopic than in the abdominal approach and the difference was statistically significant. There were no statistically significant differences on comparing laparoscopic with vaginal or vaginal with abdominal approach. On comparing laparoscopic with abdominal and vaginal hysterectomy, risk of bowel injury, vascular injury, and bleeding was not found to be statistically significant. No difference was noted in intraoperative vascular and visceral injuries, postoperative infection rates, need for transfusion, and return to normal activities between robotic versus laparoscopic hysterectomy. This was assessed by comparing two small randomized controlled trials in this study; however, the operative time was significantly greater in robotic hysterectomy by 32 min [23].
Knowledge Area 3: Surgical Procedures
Published in Rekha Wuntakal, Ziena Abdullah, Tony Hollingworth, Get Through MRCOG Part 1, 2020
Rekha Wuntakal, Ziena Abdullah, Tony Hollingworth
The risks at hysterectomy are broadly classified as frequent and serious risksOne should always discuss not only procedure (abdominal hysterectomy) but also additional procedures, which may be required during this procedure (blood transfusion, repair of injured organs and oophorectomy for unexpected cause).Further readingRoyal College of Obstetricians and Gynaecologists (RCOG). Consent Advice No. 4. Abdominal hysterectomy for benign conditions. May 2009.
Endometrial stromal tumors — are they hormonally sensitive?
Published in A. R. Genazzani, Hormone Replacement Therapy and Cancer, 2020
P. E. Schwartz, M. C. Chu, W. Zheng, G. Mor
In 1972, Baggish and Woodruff reported on 12 patients at the Johns Hopkins Hospital7. Six of seven patients who underwent a total abdominal hysterectomy experienced recurrence. Only one of four who underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy experienced recurrence. One patient with very extensive disease underwent only a bilateral salpingooophorectomy. The clinical courses of three patients suggested that the tumors might be sensitive to progestin therapy. The first patient developed a pulmonary metastasis 2 years after undergoing hysterectomy for a low-grade endometrial stromal sarcoma. She was started on hydroxyprogesterone acetate (Delalutin®) and then changed to depot medroxyprogesterone acetate (Depo Provera®) therapy. The pulmonary lesion regressed over a 15-month period. The patient was alive and disease-free 3 years after the diagnosis of recurrence, and was still taking the progestin therapy. A second patient with widespread intra-abdominal Sarcomatosis had only the ovaries removed and a large mass was left in the right upper quadrant of the abdomen. It was noted at the time of publication 11 months later that this large mass had regressed to half of its original size with no additional therapy, suggesting that withdrawal of the gonadal hormones may have influenced the regression. Finally, the authors noted that a patient who was operated on during her menstrual period had stromal cells invading into the myometrium that had the characteristics of a decidual reaction, suggesting that these cells respond to progestins.
Vaginal length and sexual function after vertical versus horizontal closure of the vaginal cuff after abdominal hysterectomy: a randomised clinical trial
Published in Journal of Obstetrics and Gynaecology, 2022
Omima Tharwat Taha, Noha Al-Okda, Mostafa Ahmed Hamdy
There is a steady decline in the rates of hysterectomies with reported annual rates of 450,000 in the US (Wright et al. 2013). Such rates have been declining lately with the introduction of effective medical treatments and non- invasive procedures as endometrial resection and ablation (Kalampokas et al. 2017). Also, rates of abdominal hysterectomy have been declining in favour of the vaginal and laparoscopic routes (Donnez et al. 2009). The impact of these different routes on sexual function is not properly evaluated. However, sexual function was found to be improved in patients with pelvic organ prolapse after hysterectomy, regardless of the route (Lonnée-Hoffmann and Pinas 2014). While, there was no change in the sexual function after laparoscopic hysterectomy with different routes of vaginal cuff closure (Uccella et al. 2020). Additionally, there was no difference in the sexual function after laparoscopic versus abdominal hysterectomy in an earlier study (Wang and Ying 2020).
The Comparison of Surgical Outcomes following Laparoscopic Hysterectomy and vNOTES Hysterectomy in Obese Patients
Published in Journal of Investigative Surgery, 2022
Cihan Kaya, Şükrü Yıldız, İsmail Alay, Özgür Aslan, İlke Esin Aydıner, Levent Yaşar
The increasing rate of obesity among women has been associated with an increased risk of infertility, abnormal uterine bleeding, endometrial hyperplasia, and endometrial cancer [3]. Since obesity is related to increased comorbidities, intra- and postoperative complications such as risk of venous thromboembolism, and wound infection are also increased after surgical procedures [4–7]. In the studies evaluating the surgical outcomes of different hysterectomy procedures in obese patients, inconsistent results have been reported so far. Camanni et al. [8] concluded that BMI has no evident impact on surgical outcomes of laparoscopic gynecological operations. On the contrary, McMahon et al. [9] indicated that obese women have a higher risk of complication than non-obese women. Compared to abdominal hysterectomy (AH), both the laparoscopic and vaginal approaches were associated with significantly fewer postoperative complications in a systematic review. However, the VH rates were about 20%. Although the vaginal approach is the recommended method when a hysterectomy is required, the lack of experience and large uterine size were considered as the primary restrictions.
Complete response of recurrent malignant struma ovarii followed by 131I therapy
Published in Journal of Obstetrics and Gynaecology, 2021
Junhua Tang, Pan Hao, Wei Zhu, Jun Hu, Hongwu Wen
A 27-year-old female who complained of acute abdominal swelling and pain was admitted on the March 5, 1985. A pelvic ultrasound revealed a 20 cm diameter, right solid, cystic ovarian mass. Four days post-admission, the patient received scheduled fertility preservation surgery involving a right adnexectomy, a left ovarian wedge resection, and a peritoneal biopsy as intraoperative frozen sections revealed benign SO. Upon exploration, the right ovary was enlarged (21 × 11 × 3 cm), an irregular solid cyst with multiple raised growths was observed, a 3 mm-diameter breach was noted, and a yellow liquid discharge occurred. The left ovary contained multiple follicles protuberant and a 5 mm-diameter pink nodule. Diffuse, pink, firm nodules of 1 mm diameter were visible at the fundus uteri and the peritoneum. Postoperative histologic sections showed right ovarian struma-derived follicular thyroid carcinoma with contralateral ovaries and peritoneal focal metastasis (Figure 1(A)). Three weeks later, total abdominal hysterectomy, left adnexectomy, omentectomy, and appendectomy were performed. The patient was finally diagnosed as MSO (FIGO Stage IIIA). A dose of 10 mCi P-32 was administered intraperitoneally during the first post-surgical week.