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Hysterectomy

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141. Vaginal Hysterectomy Suturing Skills Training Model and Curriculum. (PubMed)

Vaginal Hysterectomy Suturing Skills Training Model and Curriculum. Declining vaginal hysterectomy numbers in obstetrics and gynecology training programs highlights the need for innovative methods to teach vaginal surgical skills. We describe our experience with a vaginal hysterectomy skills simulation curriculum.A low-fidelity bench model was constructed to simulate four vaginal hysterectomy suturing tasks. A polyvinyl chloride downspout adapter and low-cost materials simulate the Heaney (...) the technical skills required for vaginal hysterectomy and agreed that vaginal skills laboratory training would improve their ability to perform procedures in the operating room. Ninety-two percent of residents felt that a vaginal surgery skills curriculum would be a useful addition to their simulation education.A proficiency-based vaginal hysterectomy skills simulation curriculum using a low-fidelity model may be an important training and evaluation tool for vaginal surgical skills training.

2019 Obstetrics and Gynecology

142. Barriers to Evidence-Based Transgender Care: Knowledge Gaps in Gender-Affirming Hysterectomy and Oophorectomy. (PubMed)

Barriers to Evidence-Based Transgender Care: Knowledge Gaps in Gender-Affirming Hysterectomy and Oophorectomy. Reversal of gender-discriminatory insurance coverage policies has led to a substantial increase in access to gender-affirming surgical care in the United States over the past 20 years. Although the evidence supports the safety, feasibility, and medical necessity of gender-affirming hysterectomy and oophorectomy, there are currently no evidence-based guidelines to define optimal care (...) surrounding many aspects of these surgeries. This commentary reviews the evidence supporting the safety, feasibility, and route of hysterectomy and oophorectomy for transgender men, the benefits and risks of oophorectomy in cisgender women and their extrapolation to transgender men, and the effects of testosterone supplementation in transgender men with and without ovaries. In addition, this article highlights the data gaps surrounding whether oophorectomy should be performed at the time of hysterectomy

2019 Obstetrics and Gynecology

143. Short-Term Health-Related Quality of Life After Hysterectomy Compared With Myomectomy for Symptomatic Leiomyomas. (PubMed)

Short-Term Health-Related Quality of Life After Hysterectomy Compared With Myomectomy for Symptomatic Leiomyomas. To compare short-term health-related quality of life (HRQOL) 6-12 weeks after hysterectomy or myomectomy for the treatment of symptomatic leiomyomas.We conducted a prospective comparative effectiveness analysis of data. In an existing multisite registry, we compared 6-12-week postsurgical HRQOL using the disease-specific Uterine Fibroid Symptom Quality of Life and the generic (...) EuroQoL 5-Dimension Health Questionnaire, in women from the ages of 18-54 years with documented leiomyomas undergoing hysterectomy or myomectomy. Propensity score weighting was used to adjust for confounding, and analyses were also stratified by route of surgery.A total of 1,295 patients (727 with hysterectomy and 568 with myomectomy) enrolled from registry initiation in November 2015 until June 2018 met inclusion criteria. At baseline, leiomyoma-specific HRQOL (44.0±25.4 and 50.2±25.3, P<.01

2019 Obstetrics and Gynecology

144. Urologic Injury and Fistula After Hysterectomy for Benign Indications. (PubMed)

Urologic Injury and Fistula After Hysterectomy for Benign Indications. To explore the rates and risk factors for sustaining a genitourinary injury during hysterectomy for benign indications.In this population-based cohort study, all women who underwent hysterectomy for benign indications were identified from the Office of Statewide Health Planning and Development databases in California (2005-2011). Genitourinary injuries were further classified as identified at the time of hysterectomy (...) , identified after the date of hysterectomy; or unidentified until a fistula developed.Of the 296,130 women undergoing hysterectomy for benign indications, there were 2,817 (1.0%) ureteral injuries, 2,058 (0.7%) bladder injuries and 834 (0.3%) genitourinary fistulas (80/834 of which developed after an injury repair). Diagnosis was delayed in 18.6% and 5.5% of ureteral and bladder injuries, respectively. Subsequent genitourinary fistula development was lower if the injury was identified immediately

2019 Obstetrics and Gynecology

145. Effects of Shared Decision Making on Opioid Prescribing After Hysterectomy. (PubMed)

Effects of Shared Decision Making on Opioid Prescribing After Hysterectomy. To evaluate the effects of shared decision making using a simple decision aid for opioid prescribing after hysterectomy.We conducted a prospective quality initiative study including all patients undergoing hysterectomy for benign, nonobstetric indications between March 1, 2018, and July 31, 2018, at our academic institution. Using a visual decision aid, patients received uniform education regarding postoperative pain (...) implementation of the decision aid. Secondary outcomes included opioid consumption, patient satisfaction, and refill requests after intervention implementation.Of 170 eligible patients, 159 (93.5%) used the decision aid (one patient who used the decision aid was subsequently excluded from the analysis owing to significant perioperative complications), including 110 (69.6%) laparoscopic, 40 (25.3%) vaginal, and eight (5.3%) abdominal hysterectomies. Telephone surveys were completed for 89.2% (n=141

2019 Obstetrics and Gynecology

146. Patterns of hysterectomy in India: a national and state-level analysis of the Fourth National Family Health Survey (2015-2016). (PubMed)

Patterns of hysterectomy in India: a national and state-level analysis of the Fourth National Family Health Survey (2015-2016). The National Family Health Survey-4 in India provided the first nationally representative estimates of hysterectomy among women aged 15-49. This paper aims to examine the national and state-level age-specific prevalence of hysterectomy, individual and household level factors associated with the procedure, and state-level indicators that may explain variation across (...) states.Cross-sectional, nationally representative household survey.National Family Health Survey was conducted across all Indian states and union territories between 2015 and 2016.The survey covered 699 686 women between the ages of 15 and 49 years.Descriptive analyses and multivariate logistic regression.Women who reported ever having a hysterectomy and age at hysterectomy.Age-specific prevalence of hysterectomy was 0.36% (0.33,0.39) among women aged 15-29; 3.59% (3.45,3.74) among women aged 30-39

2019 BJOG

147. The effect of anemia severity on postoperative morbidity among patients undergoing laparoscopic hysterectomy for benign indications. (PubMed)

The effect of anemia severity on postoperative morbidity among patients undergoing laparoscopic hysterectomy for benign indications. One-third of non-pregnant women worldwide are anemic.1 Anemia is a known independent risk factor for postoperative morbidity.2 Given that the vast majority of hysterectomies are not performed in the emergency setting, we designed this study to evaluate the effect of preoperative anemia on postoperative morbidity following laparoscopic hysterectomy performed (...) for benign indications. Our main goal is to encourage surgeons to use anemia-corrective measures before surgery when feasible.Retrospective cohort study of 98 813 patients who underwent a laparoscopic hysterectomy between 2005 and 2016 for benign indications identified through the American College of Surgeons National Surgical Quality Improvement Program. Anemia was examined as a function of hematocrit and was analyzed as an ordinal variable stratified by anemia severity as mild, moderate or severe

2019 Acta Obstetricia et Gynecologica Scandinavica

148. Women undergoing peripartum hysterectomy due to obstetric hemorrhage: A prospective population-based study. (PubMed)

Women undergoing peripartum hysterectomy due to obstetric hemorrhage: A prospective population-based study. Peripartum hysterectomy is usually undertaken in cases of life-threatening obstetric hemorrhage to prevent the death of the mother. Near-miss events are still under-researched and inappropriate care continues to be a critical issue, even in countries with advanced obstetric surveillance systems. The aim of the present study was to estimate the prevalence, associated factors, management (...) and intraoperative and postoperative complications of peripartum hysterectomy due to obstetric hemorrhage.A prospective population-based study has been conducted in six Italian regions covering 49% of births in Italy. The study population comprised all women aged 11-59 years undergoing peripartum hysterectomy, from September 2014 to August 2016, due to obstetric hemorrhage within 7 days of delivery. In each maternity unit a trained reference person reported incident cases using electronic data collection forms

2019 Acta Obstetricia et Gynecologica Scandinavica

149. Preoperative predictors of endometrial cancer at time of hysterectomy for endometrial intraepithelial neoplasia or complex atypical hyperplasia. (PubMed)

Preoperative predictors of endometrial cancer at time of hysterectomy for endometrial intraepithelial neoplasia or complex atypical hyperplasia. Endometrial intraepithelial neoplasia (EIN), also known as complex atypical hyperplasia (CAH), is a precancerous lesion of the endometrium associated with a 40% risk concurrent endometrial cancer at the time of hysterectomy. While a majority of endometrial cancers (EC) diagnosed at the time of hysterectomy for endometrial intraepithelial neoplasia (...) of these factors may assist in the preoperative triaging of patients to general gynecology or gynecologic oncology.(s): 1) To determine if preoperative factors can predict the presence of concurrent endometrial cancer at time of hysterectomy in patients with endometrial intraepithelial neoplasia; 2) To describe the ability of preoperative characteristics to predict which patients may be at a higher risk of lymph node involvement requiring lymph node assessment at the time of hysterectomy.We conducted

2019 American Journal of Obstetrics and Gynecology

150. Outcomes following a clinical algorithm allowing for delayed hysterectomy in the management of severe placenta accreta spectrum. (PubMed)

Outcomes following a clinical algorithm allowing for delayed hysterectomy in the management of severe placenta accreta spectrum. The incidence of placenta accreta spectrum is rising. Management is most commonly with cesarean hysterectomy. These deliveries are often complicated by massive hemorrhage, urinary tract injury, and admission to the intensive care unit. Up to 60% of patients require transfusion of ≥ 4 units of packed red blood cells. There is also a significant risk of death of up to 7 (...) %.To assess the outcomes of patients with antenatal diagnosis of placenta percreta managed with delayed hysterectomy as compared to those who underwent immediate cesarean hysterectomy.We performed a retrospective study of all patients with an antepartum diagnosis of placenta percreta at our large academic institution from January 1, 2012 to May 30, 2018. Patients were managed according to standard clinical practice including scheduled cesarean delivery at 34 to 35 weeks gestational age and intra-operative

2019 American Journal of Obstetrics and Gynecology

151. Incidence of adverse events in minimally invasive versus open radical hysterectomy in early cervical cancer: Results of a randomized controlled trial. (PubMed)

Incidence of adverse events in minimally invasive versus open radical hysterectomy in early cervical cancer: Results of a randomized controlled trial. Standard treatment of early cervical cancer involves a radical hysterectomy and retroperitoneal lymph node dissection. The existing evidence on the incidence of adverse events following minimally invasive versus open radical hysterectomy for early cervical cancer is either non-randomized or retrospective.To compare the incidence of adverse events (...) following minimally invasive versus open radical hysterectomy for early cervical cancer.The Laparoscopic Approach to Carcinoma of the Cervix (LACC) trial was a multinational, randomized non-inferiority trial conducted between 2008 and 2017, in which surgeons from 33 tertiary gynecological cancer centers in 24 countries randomized 631 women International Federation of Gynecology and Obstetrics 2009 stage IA1 with lymph-vascular invasion to IB1 cervical cancer to either minimally invasive versus open

2019 American Journal of Obstetrics and Gynecology

152. Risks of pre-operative anemia in women undergoing elective hysterectomy and myomectomy. (PubMed)

Risks of pre-operative anemia in women undergoing elective hysterectomy and myomectomy. Hysterectomy is one of the most common surgeries performed worldwide. Identification of modifiable risk factors for complications or re-admissions could lead to targeted interventions to improve patient care and reduce healthcare costs. Pre-operative anemia has been identified as a risk factor for adverse post-operative outcomes following non-cardiac surgery. However, studies have not focused on young (...) and healthy surgical populations, such as women undergoing gynecologic surgery for benign indications.The purpose of this study was to evaluate if pre-operative anemia in women undergoing elective hysterectomy or myomectomy for benign indications was associated with increased 30-day post-operative morbidity and mortality.In this retrospective population-based cohort study, we followed adult women (≥18 years of age) who underwent elective hysterectomy or myomectomy (laparoscopic/laparotomy) between

2019 American Journal of Obstetrics and Gynecology

153. Impact of surgical approach on oncologic outcomes in women undergoing radical hysterectomy for cervical cancer. (PubMed)

Impact of surgical approach on oncologic outcomes in women undergoing radical hysterectomy for cervical cancer. Recent studies demonstrating shorter survival among cervical cancer patients undergoing minimally invasive versus open radical hysterectomy could not account for surgeon volume and require confirmation in other jurisdictions with larger sample sizes, longer follow-up, and data on disease recurrence.To determine if surgical approach is associated with oncologic outcomes in cervical (...) cancer patients undergoing minimally invasive or open radical hysterectomy, while accounting for mechanistic factors including surgeon volume.We performed a population-based retrospective cohort study of cervical cancer patients undergoing primary radical hysterectomy by a gynecologic oncologist from 2006 to 2017 in Ontario, Canada. A multivariable marginal Cox proportional hazards model and cause-specific hazards model were used to evaluate the association of surgical approach with all-cause death

2019 American Journal of Obstetrics and Gynecology

154. Comparison of LigaSureâ„¢ tissue fusion system and a conventional bipolar device in hysterectomy via natural orifice transluminal endoscopic surgery (NOTES): A randomized controlled trial. (PubMed)

Comparison of LigaSureâ„¢ tissue fusion system and a conventional bipolar device in hysterectomy via natural orifice transluminal endoscopic surgery (NOTES): A randomized controlled trial. To evaluate the efficacy and effectiveness of applying LigaSure™ Tissue Fusion System in hysterectomy via transvaginal natural orifice transluminal endoscopic surgery (NOTES) in comparison with using the conventional bipolar device.Eighty women scheduled for hysterectomy by transvaginal NOTES were (...) in the LigaSure group (n = 38) found such conversions. Patients who completed full analysis in the LigaSure (n = 36) and control (n = 35) groups did not differ significantly in operative time, estimated blood loss, and the length of hospital stay. In the subgroup of women who underwent hysterectomy only, the LigaSure group (n = 22) showed significantly reduced operative time than the control group (76.50 ± 24.74 min versus 93.96 ± 27.10 min, p = 0.029). Postoperative pain scores were statistically higher

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2019 Taiwanese journal of obstetrics & gynecology Controlled trial quality: uncertain

155. A Triple-Blind Randomized Trial of Preemptive Use of Gabapentin Before Laparoscopic Hysterectomy for Benign Gynaecologic Conditions. (PubMed)

A Triple-Blind Randomized Trial of Preemptive Use of Gabapentin Before Laparoscopic Hysterectomy for Benign Gynaecologic Conditions. This study sought to examine the efficacy of preemptive use of gabapentin in laparoscopic hysterectomy for benign gynaecologic conditions.In a triple-blind trial, the study investigators randomized women undergoing laparoscopic hysterectomy to receive 600 mg gabapentin (n = 43) or placebo (n = 45) orally 1 hour before the procedure. Patient-controlled opioid (...) and not found to differ.Preemptive administration of gabapentin before laparoscopic hysterectomy does not decrease postoperative pain scores and narcotic consumption.Copyright © 2018 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.

2019 Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC Controlled trial quality: predicted high

156. Intraoperative methadone for postoperative pain after laparoscopic hysterectomy: Protocol for a randomised, double-blind trial. (PubMed)

Intraoperative methadone for postoperative pain after laparoscopic hysterectomy: Protocol for a randomised, double-blind trial. Hysterectomy is often carried out as same-day surgery. Treatment of postoperative pain is, therefore, of utmost importance to ensure timely discharge from hospital. Methadone has several desirable pharmacological features, including a long elimination half-life. Theoretically, a single intraoperative dose could provide long-lasting pain relief.This is a single-centre (...) , investigator-initiated, randomised, double-blind study. Two-hundred and fifty women, scheduled to undergo hysterectomy at Horsens Region Hospital, Denmark, are randomized to receive methadone (0.2 mg/kg) or morphine (0.2 mg/kg) intraoperatively, 60 minutes before extubation. Primary outcomes are opioid consumption at 6 and 24 hours. Secondary outcomes include pain intensity at rest and during coughing at 1, 3, 6, 24 and 48 hours; patient satisfaction at 3 and 24 hours, postoperative nausea and vomiting

2019 Acta Anaesthesiologica Scandinavica Controlled trial quality: predicted high

157. Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery versus laparoscopy as a day-care procedure: a randomised controlled trial. (PubMed)

Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery versus laparoscopy as a day-care procedure: a randomised controlled trial. To compare hysterectomy by transvaginal natural orifice transluminal endoscopic surgery (vNOTES) versus total laparoscopic hysterectomy (TLH) as a day-care procedure.Parallel group, 1:1 randomised single-centre single-blinded trial, designed as a non-inferiority study with a margin of 15%.Belgian teaching hospital.Women aged 18-70 years (...) scheduled to undergo hysterectomy for benign indications.Randomisation to TLH (control group) or vNOTES (experimental group). Stratification according to uterine volume. Blinding of participants and outcome assessors.The primary outcome was hysterectomy by the allocated technique. We measured the proportion of women leaving within 12 hours after hysterectomy and the length of hospital stay as secondary outcomes.We randomly assigned 70 women to vNOTES (n = 35) or TLH (n = 35). The primary endpoint

2019 BJOG : an international journal of obstetrics and gynaecology Controlled trial quality: predicted high

158. Postoperative Bladder Filling After Outpatient Laparoscopic Hysterectomy and Time to Discharge: A Randomized Controlled Trial. (PubMed)

Postoperative Bladder Filling After Outpatient Laparoscopic Hysterectomy and Time to Discharge: A Randomized Controlled Trial. To determine whether backfilling the bladder postoperatively will reduce time to discharge in patients undergoing outpatient laparoscopic hysterectomy.In a single-blind, randomized, controlled trial among women undergoing outpatient laparoscopic hysterectomy, patients were randomly assigned to a backfill-assisted void trial or a trial of spontaneous voiding. The primary

2019 Obstetrics and Gynecology Controlled trial quality: predicted high

159. Analgesic Efficacy and Safety of Intravenous Meloxicam in Subjects With Moderate-to-Severe Pain After Open Abdominal Hysterectomy: A Phase 2 Randomized Clinical Trial. (PubMed)

Analgesic Efficacy and Safety of Intravenous Meloxicam in Subjects With Moderate-to-Severe Pain After Open Abdominal Hysterectomy: A Phase 2 Randomized Clinical Trial. An intravenous (IV) formulation of meloxicam was developed for moderate-to-severe pain management. This study evaluated the safety and efficacy of meloxicam IV after open abdominal hysterectomy. Meloxicam IV is an investigational product not yet approved by the US Food and Drug Administration.Women (N = 486) with moderate (...) -to-severe pain after open abdominal hysterectomy were enrolled in this multicenter, randomized, double-blind, placebo- and active-controlled trial. Subjects were randomized to receive a single dose of meloxicam IV (5-60 mg), placebo, or morphine (0.15 mg/kg) in ≤6 hours after morphine dosing on postoperative day 1 and were evaluated for 24 hours. Rescue morphine (≈0.15 mg/kg IV) was available if needed for pain not relieved by the study medication. In an open-label extension (N = 295), meloxicam IV

2019 Anesthesia and Analgesia Controlled trial quality: predicted high

160. Vaginal cuff dehiscence following total laparoscopic hysterectomy by monopolar cut vs coagulation mode during colpotomy: A randomized controlled trial. (PubMed)

Vaginal cuff dehiscence following total laparoscopic hysterectomy by monopolar cut vs coagulation mode during colpotomy: A randomized controlled trial. To assess the effect of monopolar coagulation vs cut mode during colpotomy at total laparoscopic hysterectomy on vaginal cuff dehiscence.We conducted this randomized controlled trial at a university hospital's department of obstetrics and gynecology from September 2016 through January 2018. Enrolled women were randomized 1:1 to monopolar (...) analyzed by chi-square test and the comparisons of continuous variables between groups were analyzed by Student's t-test RESULTS: The study groups were comparable regarding demographics and perioperative parameters. The rate of vaginal cuff dehiscence in coagulation group (1%) was similar to that of cut group (0%) (p = 0.995). The other vaginal cuff related complication rates were also similar.Monopolar coagulation and cut modes during colpotomy at total laparoscopic hysterectomy have similar vaginal

2019 European journal of obstetrics, gynecology, and reproductive biology Controlled trial quality: uncertain

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