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Incidence of cyclical bleeding after laparoscopic supracervical hysterectomy
Orol Presentotions
5 cm at US (OR = 5.79; 95% CI = 1.31-25.55); previous history of adhesiogenous abdominopelvic surgery (OR = 3.25; 95% CI = 1.33-7.89). Conclusion. Transvaginal ultrasonography evaluation is essential before performing TLH. It is essential to know what the factors for risk of conversion to laparotomy after TLH are, both for information reasons and for better patient selection.
26. Incidence of Cyclical Bleeding after Laparoscopic Supracervical Hysterectomy A Ghomi, EC Lotze, J Hantes. The Women's Hospital of Texas, Houston, Texas.
Study Objective. The purpose of the study was to investigate the incidence of cyclical spotting after laparoscopic supracervical hysterectomy (LSH) when the uterus is amputated at or below the level of internal cervical os. Design. Prospective series of consecutive patients (Canadian task Force II-3). Setting. Single surgery team, independent surgery center. Patients. Women with symptomatic uterine leiomyomata and/or dysfunctional uterine bleeding. Intervention. LSH (with/without bilateral salpingooophorectomy), along with laparoscopic cervical stump biopsy after uterine amputation. Measurements and Main Results. From 2002 to 2004, we performed 67 consecutive cases of LSH. At the completion of uterine amputation, two biopsies were taken from the cervical stump at 12 and 6 o'clock positions and submitted for permanent histology to assess the presence or absence of cervical tissue. We assume the presence of cervical tissue on biopsy would indicate uterine amputation at or below the level of internal os. All 67 patients were contacted 3-15 (7) months post operatively to inquire about cyclical spotting. Sixty-three of 67 (94%) responded. Twelve of 63 (19.0%) reported cyclical spotting. Among the subgroup with cervical tissue on biopsy (52/63), 9 reported cyclical spotting (17.3%, p =.29). There was no statistical significant difference between the patients with cyclical spotting and those without with regards to age, body mass index, parity, uterine weight, diagnosis of endometriosis or adenomyosis on histology, and history of cesarean section. Conclusion. Our data suggest the overall incidence of post LSH cyclical spotting is 19%. When the uterus is amputated at or below the level of internal os, the incidence of cyclical spotting does not seem to decrease significantly (17.3 %, p =.29). To our knowledge, this is the first study in the medical literature to report on cyclical spotting after LSH when the uterine amputation is shown to have occurred at or below the level of internal os.
27. Comparison of Traditional Hysterectomy Techniques with Laparoscopic-AssistedRoutes 1H Wilson, 2A Abelmonem, 13Rp Pasic. 1University of Louisville School of Medicine, Louisville, Kentucky; 2Sohad Faculty of Medicine, Sohag, Egypt; 3Obstetrics, Gynecology & Women's Health, Louisville, Kentucky.
Study Objective. To compare short-term outcomes of total abdominal hysterectomy (TAH) with total vaginal hyster-
ectomy (TVH) and laparoscopic hysterectomy (LH) regarding operative time, estimated blood loss, postoperative pain, recovery milestones, complication rates, hospital stay, hospital costs, and patient satisfaction. Design. Prospective observational study for patients admitted for elective hysterectomy for benign conditions. Setting. University of Louisville Hospital, Louisville, KY. Patients. The study included 177 women with the following distribution for hysterectomy type: TAH (n = 50; 28 %), TVH (n = 76; 43%), LH (n = 51; 29%). Measurements andMain Results. Operative time was shortest for TVH (103 minutes), followed by TAH (127 minutes), and longest for LH (157 minutes) (p =.000). Blood loss was significantly higher in the TAH group compared with TVH and LH. Pain estimates and analgesia requirements were significantly lower for the LH and TVH group compared with the TAH group. Recovery milestones were met significantly earlier in the TVH and LH groups. Complication rates did not differ significantly between the groups. Hospital stay was significantly longer for the TAH group (3.7 days) than for the TVH (1.9 days) and LH (1.5 days) groups. Hospital costs were significantly less for the TVH group. No significant cost differences were seen between TAH and LH. Conclusion. Laparoscopic hysterectomy, while expensive, does have significant benefits with regard to shorter hospital stay, decreased EBL, lower postoperative pain and analgesia requirements, and more rapid convalescence. Vaginal hysterectomy remains the most cost-effective approach.
28. Resultsof Total Laparoscopic Hysterectomy: Review of 1528 Cases Vl Kulakov, LV Adamyan, SI Kieslev, ER Tkachenko. Scientific Centre for Obstetrics, Gynecology and Perinatology, Moscow, Russian Federation.
Study Objective. To evaluate the results of simplified total laparoscopic hysterectomy (TLH).
Design. Retrospective analysis of 1528 cases of intrafascial TLH for benign uterine conditions. Setting. Department of Operative Gynecology of the Research Centre for Obstetrics, Gynecology and Perinatology, Moscow, Russia. Patients. Age of the patients was 43.7 + 3.1 yrs. Average uterine size was 13.4 weeks, uterine weight, 620 g. Large myomas (20-24 weeks of gestation) were present in 267 cases, localization of myomas in the lower uterine segment or intraligamentous was documented in 40.1% of cases. In 432 cases uterine pathology was accompanied by associated disease (endometriosis, ovarian mass, stress urinary incontinence) indicating concomitant procedures. Intervention. Simplified technique intrafascial TLH implied no ureter dissection, ligation of the uterine vessels before adnexal pedicles, dissection of the posterior leaf of broad ligament and uterosacrals, cutting of vessels and circular transection of pelvic fascia and vaginal walls together with uterosacral-cardinal complex. McCall culdoplasty was performed for prevention of the vaginal stump prolapse in 22.6% of cases; Burch colposuspension for stress
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5 cm at US (OR = 5.79; 95% CI = 1.31-25.55); previous history of adhesiogenous abdominopelvic surgery (OR = 3.25; 95% CI = 1.33-7.89). Conclusion. Transvaginal ultrasonography evaluation is essential before performing TLH. It is essential to know what the factors for risk of conversion to laparotomy after TLH are, both for information reasons and for better patient selection.
26. Incidence of Cyclical Bleeding after Laparoscopic Supracervical Hysterectomy A Ghomi, EC Lotze, J Hantes. The Women's Hospital of Texas, Houston, Texas.
Study Objective. The purpose of the study was to investigate the incidence of cyclical spotting after laparoscopic supracervical hysterectomy (LSH) when the uterus is amputated at or below the level of internal cervical os. Design. Prospective series of consecutive patients (Canadian task Force II-3). Setting. Single surgery team, independent surgery center. Patients. Women with symptomatic uterine leiomyomata and/or dysfunctional uterine bleeding. Intervention. LSH (with/without bilateral salpingooophorectomy), along with laparoscopic cervical stump biopsy after uterine amputation. Measurements and Main Results. From 2002 to 2004, we performed 67 consecutive cases of LSH. At the completion of uterine amputation, two biopsies were taken from the cervical stump at 12 and 6 o'clock positions and submitted for permanent histology to assess the presence or absence of cervical tissue. We assume the presence of cervical tissue on biopsy would indicate uterine amputation at or below the level of internal os. All 67 patients were contacted 3-15 (7) months post operatively to inquire about cyclical spotting. Sixty-three of 67 (94%) responded. Twelve of 63 (19.0%) reported cyclical spotting. Among the subgroup with cervical tissue on biopsy (52/63), 9 reported cyclical spotting (17.3%, p =.29). There was no statistical significant difference between the patients with cyclical spotting and those without with regards to age, body mass index, parity, uterine weight, diagnosis of endometriosis or adenomyosis on histology, and history of cesarean section. Conclusion. Our data suggest the overall incidence of post LSH cyclical spotting is 19%. When the uterus is amputated at or below the level of internal os, the incidence of cyclical spotting does not seem to decrease significantly (17.3 %, p =.29). To our knowledge, this is the first study in the medical literature to report on cyclical spotting after LSH when the uterine amputation is shown to have occurred at or below the level of internal os.
27. Comparison of Traditional Hysterectomy Techniques with Laparoscopic-AssistedRoutes 1H Wilson, 2A Abelmonem, 13Rp Pasic. 1University of Louisville School of Medicine, Louisville, Kentucky; 2Sohad Faculty of Medicine, Sohag, Egypt; 3Obstetrics, Gynecology & Women's Health, Louisville, Kentucky.
Study Objective. To compare short-term outcomes of total abdominal hysterectomy (TAH) with total vaginal hyster-
ectomy (TVH) and laparoscopic hysterectomy (LH) regarding operative time, estimated blood loss, postoperative pain, recovery milestones, complication rates, hospital stay, hospital costs, and patient satisfaction. Design. Prospective observational study for patients admitted for elective hysterectomy for benign conditions. Setting. University of Louisville Hospital, Louisville, KY. Patients. The study included 177 women with the following distribution for hysterectomy type: TAH (n = 50; 28 %), TVH (n = 76; 43%), LH (n = 51; 29%). Measurements andMain Results. Operative time was shortest for TVH (103 minutes), followed by TAH (127 minutes), and longest for LH (157 minutes) (p =.000). Blood loss was significantly higher in the TAH group compared with TVH and LH. Pain estimates and analgesia requirements were significantly lower for the LH and TVH group compared with the TAH group. Recovery milestones were met significantly earlier in the TVH and LH groups. Complication rates did not differ significantly between the groups. Hospital stay was significantly longer for the TAH group (3.7 days) than for the TVH (1.9 days) and LH (1.5 days) groups. Hospital costs were significantly less for the TVH group. No significant cost differences were seen between TAH and LH. Conclusion. Laparoscopic hysterectomy, while expensive, does have significant benefits with regard to shorter hospital stay, decreased EBL, lower postoperative pain and analgesia requirements, and more rapid convalescence. Vaginal hysterectomy remains the most cost-effective approach.
28. Resultsof Total Laparoscopic Hysterectomy: Review of 1528 Cases Vl Kulakov, LV Adamyan, SI Kieslev, ER Tkachenko. Scientific Centre for Obstetrics, Gynecology and Perinatology, Moscow, Russian Federation.
Study Objective. To evaluate the results of simplified total laparoscopic hysterectomy (TLH).
Design. Retrospective analysis of 1528 cases of intrafascial TLH for benign uterine conditions. Setting. Department of Operative Gynecology of the Research Centre for Obstetrics, Gynecology and Perinatology, Moscow, Russia. Patients. Age of the patients was 43.7 + 3.1 yrs. Average uterine size was 13.4 weeks, uterine weight, 620 g. Large myomas (20-24 weeks of gestation) were present in 267 cases, localization of myomas in the lower uterine segment or intraligamentous was documented in 40.1% of cases. In 432 cases uterine pathology was accompanied by associated disease (endometriosis, ovarian mass, stress urinary incontinence) indicating concomitant procedures. Intervention. Simplified technique intrafascial TLH implied no ureter dissection, ligation of the uterine vessels before adnexal pedicles, dissection of the posterior leaf of broad ligament and uterosacrals, cutting of vessels and circular transection of pelvic fascia and vaginal walls together with uterosacral-cardinal complex. McCall culdoplasty was performed for prevention of the vaginal stump prolapse in 22.6% of cases; Burch colposuspension for stress
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