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2912 Quality of Life Following Hysterectomy: A Randomized Clinical Trial of Laparoscopic vs Abdominal Hysterectomy
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
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Setting: Tertiary health care facility. Two consecutive patients underwent TLH for fibroid uterus, abnormal uterine bleeding and pelvic pain. Interventions: Total Laparoscopic Hysterectomy, Bilateral Salpingectomy (BS) and Cystourethroscopy. Two consecutive patients with large uteri who failed medical management and desired definitive surgical management were selected. Both patients diagnosed with multiple uterine leiomyomas and underwent pre-operative endometrial biopsy and magnetic resonance imaging to minimize risk of occult malignancy. Patient one had a uterus measuring 22 £ 15 £ 12 cm and patient two had a uterus measuring 20 £ 16 £ 13 cm. They both had history of multiple prior abdominal surgeries. The mean total operative time was 78 minutes and EBL was 50 ml in both cases. They were discharged on postoperative day one and had no complications. Conclusion: TLH is a feasible option for women with a uterus larger than 500 grams. Despite the uterine size and multiple prior abdominal surgeries, a systematic approach to performing TLH allows safe completion of surgery with relatively short surgical time and minimal blood loss while affording the recognized benefits of minimally invasive surgery.
and sexual functioning improve after hysterectomy regardless of route of surgery; for several outcomes, laparoscopic hysterectomy confers earlier, and more substantial, improvements over abdominal hysterectomy.
Virtual Poster Session 1: Laparoscopy (10:00 AM — 10:10 AM) 10:00 AM: STATION R 2912 Quality of Life Following Hysterectomy: A Randomized Clinical Trial of Laparoscopic vs Abdominal Hysterectomy Kho KA,1,* Walsh TM,2 Schaffer JI,3 Mcintire DJ,4 Leveno KJ5. 1 Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX; 2Division of Minimally Invasive Gynecologic Surgery, UT Southwestern Medical Center, Dallas, TX; 3Ob/Gyn, University of Texas Southwestern Medical Center, Dallas, TX; 4UT Southwestern Medical Center, Dallas; 5UT Southwestern Medical Center, Dallas, TX *Corresponding author. Study Objective: To compare long-term quality of life outcomes of patients undergoing laparoscopic vs. abdominal hysterectomy for noncancerous gynecologic conditions. Design: Randomized controlled trial. Setting: Academic teaching hospital. Patients or Participants: All patients undergoing hysterectomy from the benign gynecology service with clinical uterine size < 15 weeks, but not candidates for TVH, were offered enrollment. Interventions: Women were randomized to laparoscopic (TLH or LAVH) or abdominal (TAH) hysterectomy with evaluation of clinical and patient reported outcomes (PROs) using validated questionnaires including quality of life (SF12), body image (BIS), sexual functioning (SAQ), and physical activity (AAS) measured at baseline, hospital discharge, 2 weeks, 6 weeks, 6 months and 12 months postoperatively. Measurements and Main Results: 94 patients underwent abdominal (48) or laparoscopic (46) hysterectomy. There were no differences in demographics including median age, BMI, race, comorbidities or surgical indication. There were no significant differences in operative time, estimated blood loss, uterine weight, surgical complications, nor Clavien-Dindo grade. PROs were systematically collected with 95% completing follow up to 12 months. Conclusion: Comparisons of clinical outcomes after laparoscopic vs. abdominal hysterectomy are well-documented and our study affirms these findings of diminished pain, shorter hospital stay and earlier return to activities after laparoscopic hysterectomy. This study demonstrates overall quality of life improves up to 1 year after hysterectomy, regardless of route, but is significantly better in patients undergoing laparoscopic hysterectomy as early as 2 weeks postoperatively. Body image improves after either type of hysterectomy and is more dramatically improved after laparoscopic hysterectomy as early as 6 weeks postoperatively. Compared to abdominal hysterectomy, sexual functioning is significantly better after laparoscopic hysterectomy and continues to be better up to 12 months postoperatively. PROs of quality of life, pain, body image, physical activity,
Virtual Poster Session 1: Laparoscopy (10:00 AM — 10:10 AM) 10:00 AM: STATION S 2298 Immediate Laparoscopic Nontransvesical Repair with Omental Interposition for Vesicovaginal Fistula Developing after Total Laparoscopic Hysterectomy Eom JM,* Choi JS, Bae J, Lee WM, Jung US. Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Korea, Republic of (South) *Corresponding author. Video Objective: To investigate the safety and feasibility of laparoscopic management for vesicovaginal fistula developing after TLH. Setting: Case study, University hospital in Korea. Interventions: A 51-year-old Korean woman underwent of immediate laparoscopic management for vesicovaginal fistula developing after total laparoscopic hysterectomy. A 51-year-old Korean woman was referred to my department for having urinary leakage two weeks before. She underwent total laparoscopic hysterectomy due to heavy vaginal bleeding and leiomyoma four weeks ago. We performed a laparoscopic vesicovaginal fistula repair with omental interposition on November 8th, 2016. We encountered a large adhesion from prior surgery in the pelvic cavity, so performed adhesiolysis using a harmonic sheers. After adhesiolysis, I performed bilateral ureterolysis that continued to the posterior bladder until it reaches the vesicovaginal space, which is then sharply dissected laterally and distally until the fistula is encountered. A bulb syringe were used to mobilize the vaginal cuff so that the dissection of the vesico-vaginal space and mobilization of the vagina could be performed easily. After adequate dissection and resection of the fistula tract from both the vagina and the bladder, a double-layer closure using 3-0 Vicryl was placed in a interrupted suture to secure the bladder. After the first layer of closure, the bladder was retrograde filled with 300cc of sterile water. Then second layer was closed in the same manner. And a single-layer closure of the vagina using a 1-0 Vicryl was placed transvaginally. After omental interposiotion to the fistula site, the procedure was over. There were no serious intraoperative or postoperative complications. Conclusion: Laparoscopic approach for vesicovaginal fistula is safe and feasible. Virtual Poster Session 1: Laparoscopy (10:00 AM — 10:10 AM) 10:00 AM: STATION T 2048 Colo -Anal Anastomosis: A Novel Idea for Treatment of Re-Re-Recurrent Rectovaginal Fistula Puntambekar S,* Chandak S, Goel A, Puntambekar A. Galaxy CARE Laparoscopy Institute Pvt. Ltd, PUNE, India *Corresponding author. Video Objective: Treatment of rectovaginal fistulas was always difficult; treating post radiation recurrent rectovaginal fistulas was challenging; Colo-Anal Anastomosis is a novel way of treating such fistulas. Setting: 49yr/Female/P1L1 had undergone Total Abdominal Hysterectomy for AUB-E; was diagnosed with adenocarcinoma of endometrium stage II. Patient underwent BPLND + BSO 3 weeks later and then took 25# radiation for same. Patient developed radiation proctitis and Rectovaginal Fistula following Radiation Therapy. A diversion colostomy was done for same. Patients complaints persisted. Patient then underwent RVF closure with omental flap interposition. Despite the omental flap a distal loopogram was suggestive of leak of dye.
S109
Setting: Tertiary health care facility. Two consecutive patients underwent TLH for fibroid uterus, abnormal uterine bleeding and pelvic pain. Interventions: Total Laparoscopic Hysterectomy, Bilateral Salpingectomy (BS) and Cystourethroscopy. Two consecutive patients with large uteri who failed medical management and desired definitive surgical management were selected. Both patients diagnosed with multiple uterine leiomyomas and underwent pre-operative endometrial biopsy and magnetic resonance imaging to minimize risk of occult malignancy. Patient one had a uterus measuring 22 £ 15 £ 12 cm and patient two had a uterus measuring 20 £ 16 £ 13 cm. They both had history of multiple prior abdominal surgeries. The mean total operative time was 78 minutes and EBL was 50 ml in both cases. They were discharged on postoperative day one and had no complications. Conclusion: TLH is a feasible option for women with a uterus larger than 500 grams. Despite the uterine size and multiple prior abdominal surgeries, a systematic approach to performing TLH allows safe completion of surgery with relatively short surgical time and minimal blood loss while affording the recognized benefits of minimally invasive surgery.
and sexual functioning improve after hysterectomy regardless of route of surgery; for several outcomes, laparoscopic hysterectomy confers earlier, and more substantial, improvements over abdominal hysterectomy.
Virtual Poster Session 1: Laparoscopy (10:00 AM — 10:10 AM) 10:00 AM: STATION R 2912 Quality of Life Following Hysterectomy: A Randomized Clinical Trial of Laparoscopic vs Abdominal Hysterectomy Kho KA,1,* Walsh TM,2 Schaffer JI,3 Mcintire DJ,4 Leveno KJ5. 1 Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX; 2Division of Minimally Invasive Gynecologic Surgery, UT Southwestern Medical Center, Dallas, TX; 3Ob/Gyn, University of Texas Southwestern Medical Center, Dallas, TX; 4UT Southwestern Medical Center, Dallas; 5UT Southwestern Medical Center, Dallas, TX *Corresponding author. Study Objective: To compare long-term quality of life outcomes of patients undergoing laparoscopic vs. abdominal hysterectomy for noncancerous gynecologic conditions. Design: Randomized controlled trial. Setting: Academic teaching hospital. Patients or Participants: All patients undergoing hysterectomy from the benign gynecology service with clinical uterine size < 15 weeks, but not candidates for TVH, were offered enrollment. Interventions: Women were randomized to laparoscopic (TLH or LAVH) or abdominal (TAH) hysterectomy with evaluation of clinical and patient reported outcomes (PROs) using validated questionnaires including quality of life (SF12), body image (BIS), sexual functioning (SAQ), and physical activity (AAS) measured at baseline, hospital discharge, 2 weeks, 6 weeks, 6 months and 12 months postoperatively. Measurements and Main Results: 94 patients underwent abdominal (48) or laparoscopic (46) hysterectomy. There were no differences in demographics including median age, BMI, race, comorbidities or surgical indication. There were no significant differences in operative time, estimated blood loss, uterine weight, surgical complications, nor Clavien-Dindo grade. PROs were systematically collected with 95% completing follow up to 12 months. Conclusion: Comparisons of clinical outcomes after laparoscopic vs. abdominal hysterectomy are well-documented and our study affirms these findings of diminished pain, shorter hospital stay and earlier return to activities after laparoscopic hysterectomy. This study demonstrates overall quality of life improves up to 1 year after hysterectomy, regardless of route, but is significantly better in patients undergoing laparoscopic hysterectomy as early as 2 weeks postoperatively. Body image improves after either type of hysterectomy and is more dramatically improved after laparoscopic hysterectomy as early as 6 weeks postoperatively. Compared to abdominal hysterectomy, sexual functioning is significantly better after laparoscopic hysterectomy and continues to be better up to 12 months postoperatively. PROs of quality of life, pain, body image, physical activity,
Virtual Poster Session 1: Laparoscopy (10:00 AM — 10:10 AM) 10:00 AM: STATION S 2298 Immediate Laparoscopic Nontransvesical Repair with Omental Interposition for Vesicovaginal Fistula Developing after Total Laparoscopic Hysterectomy Eom JM,* Choi JS, Bae J, Lee WM, Jung US. Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Korea, Republic of (South) *Corresponding author. Video Objective: To investigate the safety and feasibility of laparoscopic management for vesicovaginal fistula developing after TLH. Setting: Case study, University hospital in Korea. Interventions: A 51-year-old Korean woman underwent of immediate laparoscopic management for vesicovaginal fistula developing after total laparoscopic hysterectomy. A 51-year-old Korean woman was referred to my department for having urinary leakage two weeks before. She underwent total laparoscopic hysterectomy due to heavy vaginal bleeding and leiomyoma four weeks ago. We performed a laparoscopic vesicovaginal fistula repair with omental interposition on November 8th, 2016. We encountered a large adhesion from prior surgery in the pelvic cavity, so performed adhesiolysis using a harmonic sheers. After adhesiolysis, I performed bilateral ureterolysis that continued to the posterior bladder until it reaches the vesicovaginal space, which is then sharply dissected laterally and distally until the fistula is encountered. A bulb syringe were used to mobilize the vaginal cuff so that the dissection of the vesico-vaginal space and mobilization of the vagina could be performed easily. After adequate dissection and resection of the fistula tract from both the vagina and the bladder, a double-layer closure using 3-0 Vicryl was placed in a interrupted suture to secure the bladder. After the first layer of closure, the bladder was retrograde filled with 300cc of sterile water. Then second layer was closed in the same manner. And a single-layer closure of the vagina using a 1-0 Vicryl was placed transvaginally. After omental interposiotion to the fistula site, the procedure was over. There were no serious intraoperative or postoperative complications. Conclusion: Laparoscopic approach for vesicovaginal fistula is safe and feasible. Virtual Poster Session 1: Laparoscopy (10:00 AM — 10:10 AM) 10:00 AM: STATION T 2048 Colo -Anal Anastomosis: A Novel Idea for Treatment of Re-Re-Recurrent Rectovaginal Fistula Puntambekar S,* Chandak S, Goel A, Puntambekar A. Galaxy CARE Laparoscopy Institute Pvt. Ltd, PUNE, India *Corresponding author. Video Objective: Treatment of rectovaginal fistulas was always difficult; treating post radiation recurrent rectovaginal fistulas was challenging; Colo-Anal Anastomosis is a novel way of treating such fistulas. Setting: 49yr/Female/P1L1 had undergone Total Abdominal Hysterectomy for AUB-E; was diagnosed with adenocarcinoma of endometrium stage II. Patient underwent BPLND + BSO 3 weeks later and then took 25# radiation for same. Patient developed radiation proctitis and Rectovaginal Fistula following Radiation Therapy. A diversion colostomy was done for same. Patients complaints persisted. Patient then underwent RVF closure with omental flap interposition. Despite the omental flap a distal loopogram was suggestive of leak of dye.