Surgical volume: what can patients access?
Multiple studies and systematic reviews have associated high volume hospitals and high volume surgeons with lower morbidity and mortality rates. In 2013, Doll et al. concluded that lower volume surgeons had higher postoperative morbidity rates after hysterectomy for benign indications compared with high volume surgeons. Despite this well-recognized correlation, publicly available information regarding surgeon and hospital volume is limited. (Source: American Journal of Obstetrics and Gynecology)
Source: American Journal of Obstetrics and Gynecology - March 21, 2024 Category: OBGYN Authors: N Patel, J Lee, S Karkal, C Iglesia, A Dieter Source Type: research
The effect of prior myomectomy on incidence of perioperative complications at time of minimally invasive hysterectomy
Uterine fibroids are common benign tumors that affect 50-60% of women of reproductive age and are a common cause of abnormal uterine bleeding, infertility, and bulk symptom. Many women desire treatment with expectant, medical, or surgical management. Surgical management includes endometrial ablation, uterine artery embolization, radiofrequency ablation or definitive hysterectomy as non-fertility-sparing options. However, for women who desire fertility-sparing treatment, myomectomy, or surgical removal of fibroids, is the standard of care. (Source: American Journal of Obstetrics and Gynecology)
Source: American Journal of Obstetrics and Gynecology - March 21, 2024 Category: OBGYN Authors: L Cheng, N Chawla, D O'sullivan, J Mullins Source Type: research
Preoperative pelvic pain syndromes are a risk factor for failure in patients undergoing radiofrequency endometrial ablation
Endometrial ablation is a widely used procedure for treatment of heavy menstrual bleeding in premenopausal patients. It is less invasive than hysterectomy, has high patient satisfaction rates (92%), and an excellent safety profile. Published rates of treatment failure range from 23-36%, with increased failure noted in age less than 40, history of cesarean section, abnormal imaging prior to procedure (fibroid, polyp, thickened endometrial stripe), history of tubal ligation, and irregular bleeding profile. (Source: American Journal of Obstetrics and Gynecology)
Source: American Journal of Obstetrics and Gynecology - March 21, 2024 Category: OBGYN Authors: K Rakes, J Sosa-Stanley Source Type: research
The impact of transversus abdominus plane (TAP) blocks for total laparoscopic hysterectomy on postoperative pain and recovery time: a retrospective analysis
The multimodal approach to pain control as outlined by the Enhanced Recovery after Surgery program (ERAS) includes consideration of transversus abdominis plane (TAP) blocks, a form of opioid-sparing regional analgesia. Recent studies have shown mixed results; one systematic review demonstrated significant improvement in postoperative early and delayed pain control compared with placebo (Bacal et al., 2019), while other meta-analyses showed no clinically significant difference in pain scores or opioid consumption with or without TAP block for laparoscopic hysterectomy (Shin et al., 2020; Lopez-Ruiz et al., 2022). (Source: A...
Source: American Journal of Obstetrics and Gynecology - March 21, 2024 Category: OBGYN Authors: J Wong, S Lim, D Rasugu, A Broach, A Song, C Sobolewski Source Type: research
Assessing perioperative risk with hysterectomy in very large uteri by surgical route
Uterine size plays an important role in the surgical route offered to patients undergoing hysterectomy for benign indications. Some studies have proposed a uterine size greater than 15 weeks gestation or uterine weight greater than 500 g as the safe upper limit for offering a minimally invasive approach. (Source: American Journal of Obstetrics and Gynecology)
Source: American Journal of Obstetrics and Gynecology - March 21, 2024 Category: OBGYN Authors: S Gupta, P Maghsoudlou, L Perkins King, J Einarsson, M Ajao Source Type: research
Vaginal antiseptic preparation at the time of hysterectomy: a systematic review and meta-analysis
Antiseptic vaginal preparation is recommended before all gynecologic surgery, and povidone iodine (PI) is the only FDA-approved vaginal antiseptic. Chlorhexidine gluconate (CHG), however, has shown to be superior to PI as an antiseptic skin preparation for the prevention of surgical site infections (SSIs). The American Academy of Gynecologic Laparoscopy supports the vaginal use of CHG, and a meta-analysis revealed a reduction in SSI with vaginal CHG prep at the time of cesarean delivery. There has been no meta-analysis, however, comparing CHG with PI vaginal prep at the time of hysterectomy. (Source: American Journal of Ob...
Source: American Journal of Obstetrics and Gynecology - March 21, 2024 Category: OBGYN Authors: S Rozycki, V Nguyen, N Miroballi, E Rutledge, E Balk, D Antosh Source Type: research
It is feasible to offer laparoscopically approach hysterectomy with contained morcelation even with huge uteri
Multiple studies show improved outcomes of laparoscopic hysterectomy compared to laparotomy, including decreased blood loss, shorter hospitalization and faster recovery. These outcomes are preserved even with longer operative time. Huge uteri make minimally invasive surgery technically challenging. Due to the risk of leiomyosarcoma in a presumed benign uterus, we offer patients contained morcellation as part of the minimally invasive approach. Very few publications describe the technical challenges of laparoscopic surgery for very large uteri, particularly if contained morcellation is planned. (Source: American Journal of ...
Source: American Journal of Obstetrics and Gynecology - March 21, 2024 Category: OBGYN Authors: D Pino, A Romo Source Type: research
Opioid use and postoperative pain after hysterectomy
This study sought to examine the association of intra-operative opioid use and postoperative pain and opioid usage, focusing on usage in the PACU. (Source: American Journal of Obstetrics and Gynecology)
Source: American Journal of Obstetrics and Gynecology - March 21, 2024 Category: OBGYN Authors: NB Luna Ramirez, NB Barba, E Flores, P Gracia-Filion, N Mahnert Source Type: research
Developmental uterine anomalies in transgender patients receiving gender-affirming hysterectomies
Most developmental uterine anomalies occur due to Mullerian duct maldevelopment and are often incidentally discovered through pelvic imaging or intraoperatively. The incidence and prevalence of uterine anomalies are well known in the cisgender female general population. A few studies on gender-affirming hysterectomies have reported on the histological endometrial findings of patients using testosterone therapy, with findings of endometrial atrophy ranging from 18 to 50%. 1-3. However, there are no known studies which report developmental uterine anomalies in transgender male or nonbinary (TGNB) patients. (Source: American ...
Source: American Journal of Obstetrics and Gynecology - March 21, 2024 Category: OBGYN Authors: N Nguyen, H Kim, M Sumida, R Galzote Source Type: research
A comparative life cycle cost analysis of uterine manipulators for hysterectomy
The U.S. health care system contributes approximately 10% to total greenhouse gas emissions nationally and makes up approximately 18.3% of the U.S. gross domestic product. Single-use disposable supplies contribute significantly to these emissions, though they are often preferred because of their lower initial purchase cost compared to reusable options. Uterine manipulators can be manufactured from reusable stainless steel, disposable materials, or both - all of which have distinct carbon footprints and associated costs. (Source: American Journal of Obstetrics and Gynecology)
Source: American Journal of Obstetrics and Gynecology - March 21, 2024 Category: OBGYN Authors: A Melnyk, S Glass Clark, N Silva De Souza Lima Cano, M Bilec, A Artsen Source Type: research
The feasibility and benefits of minimally invasive hysterectomy for large uterus
A uterus with a size of 18 to 20 weeks or more is generally considered a large uterus by most gynecological surgeons. Therefore, laparotomy, rather than minimally invasive surgery, is commonly performed to remove the uterus. However, it is well established that minimally invasive surgery offers numerous benefits to patients compared to laparotomy. Uterine size should not be an excluding factor for minimally invasive surgery. (Source: American Journal of Obstetrics and Gynecology)
Source: American Journal of Obstetrics and Gynecology - March 21, 2024 Category: OBGYN Authors: L Uzianbaeva, P Wang Source Type: research
Assessing the presence and impact of care centralization on travel distance for hysterectomies in michigan
Centralization of care to high-volume centers is associated with increased patient travel burden. (Source: American Journal of Obstetrics and Gynecology)
Source: American Journal of Obstetrics and Gynecology - March 21, 2024 Category: OBGYN Authors: J Wang, CX Hong, KR Latack, N Kamdar, B Madden, CA Pizzo, K Ashbaugh, B Cheng, DM Morgan Source Type: research
vNOTES hysterectomy of the large fibroid uterus - tips and tricks
vNOTES hysterectomy represents a unique fusion of vaginal, laparoscopic, and laparo-endoscopic single-site surgery (LESS) techniques, offering an essential tool in the repertoire of gynecologic surgeons. It holds the potential to reverse the decline in vaginal hysterectomies and empowers gynecologic surgeons to continue providing "scarless ” surgeries with reduced post-operative complications, improved pain management, and quicker recovery times. vNOTES proves to be a feasible approach for a wide range of gynecological procedures, including adnexal surgery, myomectomy, pelvic floor prolapse suspension procedures, and hys...
Source: American Journal of Obstetrics and Gynecology - March 21, 2024 Category: OBGYN Authors: L Liron, V Lerner Source Type: research
Resection of non-congenital premenopausal vaginal stenosis
We present a case of a 40-year-old nulliparous premenopausal woman with persistent non-congenital vaginal stenosis. (Source: American Journal of Obstetrics and Gynecology)
Source: American Journal of Obstetrics and Gynecology - March 21, 2024 Category: OBGYN Authors: A Bruscke, D Carr, P Rosenblatt Source Type: research
Approach to the obliterated anterior Cul-De-Sac during a total laparoscopic hysterectomy
An obliterated anterior cul-de-sac occurs when the vesico-uterine avascular space is absent leading to distortion of normal anatomy. Risk factors include cesarean deliveries, prior pelvic surgeries, infection, and endometriosis. Knowledge of anatomy and good surgical technique is critical to safe completion of a hysterectomy. The laparoscopic approach provides advantages of improved visualization posteriorly, global survey, assistance of the pneumo-peritoneum in plane dissection, and decreased blood loss. (Source: American Journal of Obstetrics and Gynecology)
Source: American Journal of Obstetrics and Gynecology - March 21, 2024 Category: OBGYN Authors: A Nutaitis, M Billow Source Type: research
