Comparison of the first 20 procedures with the subsequent 127 demonstrated that there was considerable improvement in time of cuff closure (p = .04); sacral dissection (p = .004); anterior (p = .006), posterior, (p = .003), and sacral (p = .003) mesh attachment; peritoneal closure (p
OBJECTIVE: To determine gynecologists' attitudes to mode of hysterectomy on benign indication. DESIGN: Cross-sectional study. SETTING: Sweden. POPULATION: Members of the Swedish Society of Obstetrics and Gynecology. METHODS: A postal questionnaire. Questions examined attitudes to mode of hysterectomy based on three clinical scenarios with different conditions of the uterus. Gynecologists were also asked to estimate how the distribution of the different modes of benign hysterectomy should be overall. The modes to choose were total abdominal, subtotal abdominal, laparoscopic or vaginal hysterectomy (VH). Analyses were performed with multiple logistic regression and multivariate analysis of covariance. MAIN OUTCOME MEASURES: Preferred mode of hysterectomy in the three scenarios and distribution of modes of hysterectomy. RESULTS: VH was the most preferred method in general as well as when the uterus was of normal size, whereas subtotal and total abdominal hysterectomy were the most favored methods when the uterus was enlarged. VH was more often preferred by male compared to female gynecologists as a personal preference. The choice and distribution of mode varied significantly between place of work, seniority and in the quantity of yearly performed hysterectomies. The minimal invasive methods, vaginal and laparoscopic hysterectomy, were recommended in more than 50% of the overall suggested distribution. CONCLUSION: Personal choice of mode of hysterectomy does not seem to strictly follow evidence-based recommendations, but varies significantly between gynecologist's gender, type of clinical setting in which the gynecologist works, seniority and by how many hysterectomies the gynecologist does annually.
STUDY OBJECTIVE: To evaluate the change in hysterectomy technique. DESIGN: Retrospective study (Canadian Task Force classification XXX). SETTING: University tertiary referring center in Norway. PATIENTS: A total of 1963 women treated with hysterectomy over a 5-year period in Oslo. INTERVENTIONS: The operative records and techniques were investigated in all treated patients. MEASUREMENTS AND MAIN RESULTS: A total of 1963 hysterectomies were performed from 2001 through 2005. The operative patient records were investigated with the main focus on indication for surgery and the technique used in the operative procedure. In 2001, 62 (17.7%) laparoscopic hysterectomies were performed, while 256 (73.1%) of the hysterectomies were done with laparotomy. The operative technique has gradually changed during the last 5 years. In 2005, 220 (53.5%) of the surgical procedures were laparoscopic, 177 (43.1%) were done by laparotomy, while the vaginal approach in all these years was less than 10%. CONCLUSION: From 2001 to 2005, a trend shift of the operative technique has been observed in Oslo, increasing the endoscopic hysterectomy rate from approximately 18% to 54%. During the same time, enlarged uteri with myomas equivalent to 10 to 12 weeks' gestation and endometrial cancer were more often treated by laparoscopic hysterectomy instead of open abdominal hysterectomy. With modern equipment and trained staff, more routine hysterectomies can be managed with laparoscopy.
We compared subcutaneous clamping and cauterization for hemostasis at laparotomy with Pfannenstiel incision with reference to surgical site infection, postoperative fever and time taken for incision. A total of 214 patients with consecutive hysterectomies were alternately assigned to incisional hemostasis by clamping (n= 107) or cauterization (n= 107). The groups were similar in terms of age, gravidity, parity, body mass index, uterine size and mean hemoglobin drop. Rates of surgical site infection, postoperative fever and time from skin incision to peritoneal cavity entry were significantly higher in the group with cauterization (p
The purpose of this study was to evaluate the feasibility, clinical outcome and complications of laparoscopic surgery in women with endometrial cancer and to compare surgical outcome and postoperative early and late complications with results of traditional laparotomy.
Forty women with endometrial cancer underwent laparoscopic hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy. Each patient operated by laparoscopy was matched by age, preoperative clinical stage and histology of the endometrial cancer with a patient treated by the same operation but using traditional laparotomy. Half of these patients underwent total pelvic lymphadenectomy and half had pelvic lymph node sampling. The groups were compared in clinical characteristics, surgical outcomes, recoveries and early and late postoperative complications.
The patients in the laparoscopy group had less blood loss, more lymph nodes removed, shorter hospital stay but longer operation time than those treated by laparotomy. Only one (2.5%) laparoscopy was converted to laparotomy due to pelvic adhesions. There were no intraoperative complications in either group. Postoperative complications were more common (55.0%) in the laparotomy than in the laparoscopy group (37.5%). Only one major complication (2.5%) occurred among patients undergoing laparoscopy as compared with three (7.5%) major complications in the laparotomy group. Superficial wound infection was the most common (20%) infection in laparotomy patients while vaginal cuff cellulitis occurred in 10% of laparoscopy patients. Late (>42 days) postoperative complications were almost equally frequent (20.0 and 22.5%) in both groups. Lower extremity lymph edema or pelvic lymph cyst was found in 12.5% of all cases. As a result of surgical staging the disease of 6 women (15%) in both groups was upgraded.
Laparoscopic surgery is a viable alternative to traditional surgery in the management of endometrial cancer. The surgical outcome is similar in both cases. In laparoscopic procedures the operation time is longer but the postoperative recovery time shorter than in laparotomy. Severe complications were limited in both groups, while wound infections can be avoided using laparoscopy.
To examine the factors associated with depressive symptoms before and after surgery in women who undergo elective hysterectomy.
A secondary analysis of longitudinal data from a prospective cohort study designed to understand chronic postsurgical pain in women.
One acute care hospital in southeastern, Ontario, over a 4-year period (2006-2010).
Three hundred eighty-four (384) English-speaking women, age 18 years or older, who presented for elective hysterectomies.
Data were gathered preoperatively in the same-day admission center and six months postoperatively using validated web-based or mailed questionnaires.
Thirty six percent (36%) of participants reported depressive symptoms before surgery, 22% reported symptoms afterwards, 15% reported symptoms at both time points, and 6% developed new onset depressive symptoms postoperatively. Younger (odds ratio [OR] = 2.5, 95% confidence interval [CI], [1.7, 5.0]) women, those with higher levels of anxiety (state: OR = 8.6, 95% CI [5.2, 14.0]), or who experienced pain that interfered with their daily functioning (OR = 2.8, 95% CI [1.7, 4.7]) were more likely to report depressive symptoms prior to hysterectomy. Preoperative pain (OR = 2.0, 95% CI [1.1, 3.6]), trait anxiety (OR = 2.4, 95% CI [1.2, 4.6]), and depressive symptoms (OR = 3.9, 95% CI [2.1, 7.5]) increased the risk of depressive symptoms 6 months postoperatively.
Young women who exhibit high levels of anxiety and pain and who require a hysterectomy are at risk of experiencing psychological distress prior to and following their surgery.
The number of beds in surgical wards is declining. Whether the reason is more outpatient surgery or quicker recovery, owing to better perioperative care is unknown.
A questionnaire was sent to all gynaecological and anaesthetic departments in Denmark concerning the treatment of women who had had a hysterectomy for non-malignant disease. The following questions were asked: What were the numbers of patients operated on in 1998, the methods of operation, duration of admission, the surgeon in charge, information about admission and postoperative management of patients, choice of anaesthesia and treatment of postoperative pain.
The chief surgical method was abdominal hysterectomy. There were relatively few vaginal or laparoscopically assisted hysterectomies. The duration of admission varied considerably. Patients mostly were given written information about admission and the postoperative course. Postoperative follow-up was relatively uncommon. The duration of admission was not influenced by the anaesthetic method. Seventeen of 31 anaesthetic departments knew the number of patients anaesthetised for hysterectomy in 1998 and the anaesthetic methods.
This study cannot answer the question: How does the method of operation, choice of anaesthesia, postoperative analgesia, and information to the patient affect the duration of admission? Data allowing a discussion of the quality of the treatment were not available. There is a serious lack of registration.
Does self-administered vaginal misoprostol result in cervical ripening in postmenopausal women after 14 days of pre-treatment with estradiol? Trial protocol for a randomised, placebo-controlled sequential trial.
OBJECTIVE: To compare the impact of 1000 micrograms of self-administered vaginal misoprostol versus self-administered vaginal placebo on preoperative cervical ripening after pre-treatment with estradiol vaginal tablets at home in postmenopausal women prior to day-care operative hysteroscopy. DESIGN: Randomised double-blind placebo-controlled sequential trial. The boundaries for the sequential trial were calculated on the primary outcomes of a difference of cervical dilatation > or = 1 millimetre, with the assumption of a type 1 error of 0.05 and a power of 0.95. SETTING: Norwegian university teaching hospital. POPULATION: Postmenopausal women referred for day-care operative hysteroscopy. METHODS: The women were randomised to either 1000 micrograms of self-administered vaginal misoprostol or self-administered vaginal placebo the evening before day-care operative hysteroscopy. All women had administered a 25-microgram vaginal estradiol tablet daily for 14 days prior to the operation. MAIN OUTCOME MEASURES: Preoperative cervical dilatation (difference between misoprostol and placebo group, primary outcome), difference in dilatation before and after administration of misoprostol or placebo, number of women who achieve a preoperative cervical dilatation > or = 5 millimetres, acceptability, complications and side effects (secondary outcomes). RESULTS: Intra-operative findings and distribution of cervical dilatation in the two treatment groups: values are given as median (range) or n (%). Difference in dilatation before and after administration of misoprostol and placebo: values are given as median (range) of intraindividual differences. Percentage of women who achieve a cervical dilatation of > or = 5 mm, percentage of women who were difficult to dilate. Acceptability in the two treatment groups: values are given as completely acceptable n (%), fairly acceptable n (%), fairly unacceptable n (%), completely unacceptable n (%). Pain in the two treatment groups: pain was measured with a visual analogue scale ranging from 0 (no pain) to 10 (unbearable pain): values are given as median (range). Occurrence of side effects in the two treatment groups. Values are given as n (%). Complications given as n (%). FUNDING SOURCES: No pharmaceutical company was involved in this study. A research grant from the regional research board of Northern Norway has been awarded to finance Dr K.S.O.'s leave from Hammerfest hospital as well as travel expenses between Hammerfest and Oslo, and research courses. The research grant from Prof B.I.N. (Helse ?st) funded the purchase of estradiol tablets, the manufacturing costs of misoprostol and placebo capsules from the hospital pharmacy, as well as the costs incurred for preparing the randomisation schedule and distribution of containers containing capsules to hospital. Prof B.I.N.'s research grant also funded insurance for the study participants. CONCLUSIONS: Estimated completion date 31 December 2008.
In 1972 the College of Physicians and Surgeons of Saskatchewan appointed a committee to study hysterectomies because the Saskatchewan Department of Health had data showing that the annual number of hysterectomies carried out in the province had increased by 72.1 per cent between 1964 and 1971, whereas the number of women over 15 years of age had increased by 7.6 per cent. The committee compiled a list of indications for hysterectomy. Any hysterectomy carried out for one of these reasons was classified as justified, and the remainder as unjustified. Five hospitals were reviewed in 1970 and a further two in 1973. In 1974, all seven hospitals were reviewed again. In these hospitals, the average proportion of unjustified hysterectomies had dropped from 23.7 per cent at the time of the first review to 7.8 per cent in 1974. The total number of hysterectomies in the province dropped by 32.8 per cent between 1970 and 1974.
Factors affecting the postincisional use of analgesics for ovariohysterectomy (OVH) in dogs and cats were assessed by using data collected from 280 Canadian veterinarians, as part of a national, randomized mail survey (response rate 57.8%). Predictors of analgesic usage identified by logistic regression included the presence of at least 1 animal health technician (AHT) per 2 veterinarians (OR = 2.3, P = 0.004), and the veterinarians' perception of the pain caused by surgery without analgesia (OR = 1.5, P
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