RESUMEN

Resumen OBJETIVO: Analizar las tendencias de la histerectomía por tipo de acceso, motivo de solicitud y complicaciones inmediatas. MATERIALES Y MÉTODOS: Estudio observacional, transversal, retrospectivo y retrolectivo efectuado en el Hospital Español de México con base en la revisión de expedientes de pacientes a quienes se practicó la histerectomía entre los meses de octubre de 2018 a julio de 2023. En todos los casos se identificó el tipo de acceso para la histerectomía, motivo de indicación, edad de la paciente y complicaciones inmediatas trans y posoperatorias. RESULTADOS: Se analizaron los expedientes de 1234 pacientes con una media de edad de 48.63 ± 9.22 años. La vía quirúrgica de elección (54.4%) fue la histerectomía total laparoscópica, seguida de la histerectomía total abdominal (35.89%) y la histerectomía vaginal asistida por laparoscopia, la histerectomía vaginal e histerectomía robótica representaron: 3.72, 5.51 y 0.32%, respectivamente. Las complicaciones totales representaron 8% y la histerectomía total laparoscópica 6%, mientras que la histerectomía total abdominal solo 10%. Las complicaciones más frecuentes: hemorragia ( 53%), lesión de vejiga (17%) y desgarro de pared vaginal (10%). CONCLUSIONES: La histerectomía laparoscópica es el procedimiento quirúrgico preferido en nuestra población: representa más de la mitad de los casos. Se observó una tendencia de menores complicaciones en las histerectomías mediante mínima invasión.

Abstract OBJECTIVE: To analyze trends in hysterectomy by type of approach, reason for request, and immediate complications. MATERIALS AND METHODS: Observational, cross-sectional, retrospective and retrolective study conducted at the Hospital Español de México based on the review of records of patients who underwent hysterectomy between the months of October 2018 and July 2023. In all cases, the type of approach for hysterectomy, reason for indication, patient age, and immediate trans- and postoperative complications were identified. RESULTS: The records of 1234 patients with a mean age of 48.63 ± 9.22 years were analyzed. The surgical route of choice (54.4%) was laparoscopic total hysterectomy, followed by total abdominal hysterectomy (35.89%) and laparoscopic-assisted vaginal hysterectomy, vaginal hysterectomy, and robotic hysterectomy: 3.72, 5.51, and 0.32%, respectively. Total complications represented 8% and total laparoscopic hysterectomy 6%, while total abdominal hysterectomy only 10%. The most common complications were hemorrhage (53%), bladder injury (17%), and vaginal wall tear (10%). CONCLUSIONS: Laparoscopic hysterectomy is the preferred surgical procedure in our population: it accounts for more than half of the cases. A trend towards fewer complications was observed in minimally invasive hysterectomies.

RESUMEN

OBJECTIVES: This study aimed to describe an operative technique for vaginal hysterectomy (VH) and assess the costs, perioperative, and oncological outcomes for this procedure when used in the treatment of patients with low-risk endometrial cancer (LREC). METHODS: A retrospective analysis of medical records was conducted on patients who underwent VH to treat precursor and invasive endometrial lesions between April 2019 and November 2021 at a single center in São Paulo, Brazil. RESULTS: Thirty-four patients met the inclusion criteria. The mean patient age was 61.9 years, and the mean body mass index (BMI) was 34. Obese patients (BMI ≥ 30) accounted for 77% of the sample. Preoperative functional capacity measures were Eastern Cooperative Oncology Group (ECOG) 0-1 and ECOG-2 for 91% and 9% of the patients, respectively. The mean operative time and length of hospital stay were 109 min and 1.2 days, respectively. Four patients had a conversion of the surgical route to laparotomy. No major intraoperative complications were observed. Patients who underwent surgical conversion had a greater uterine volume (227 versus 107 mL, p = 0.006) and longer operative time (177 versus 96 min, p = 0.001). The total cost associated with VH was, on average, US$ 2058.77 (R$ 10,925.91), representing 47% of the cost associated with non-vaginal routes. Twenty-eight patients received a definitive diagnosis of endometrial carcinoma; of these, three received adjuvant radiotherapy. The mean follow-up period was 34.6 months for the patients diagnosed with cancer. One case of disease recurrence occurred 16.6 months after surgery, with one death at 28.6 months of follow-up. CONCLUSIONS: These findings suggest that VH could be a feasible and cost-effective alternative for selected patients with LREC in low-resource settings.

Asunto(s)

RESUMEN

OBJECTIVE: The aim of this study was to describe, from a historical perspective, the relevance, resilience and outcomes of vaginal hysterectomy (VH) in gynecology in the age of technological scenario. METHODS: The authors searched records from January 2011 to January 2021 on the following databases: Medline, EMBASE, and CENTRAL (The Cochrane Library) for combinations of the terms "vaginal hysterectomy," "outcomes" AND "history"; and before that period, if the search had historical relevance. INCLUSION CRITERIA: randomized clinical trials; hysterectomy performed for benign gynecological conditions; and VH outcomes compared with Abdominal Hysterectomy (AH), Laparoscopic Hysterectomy (LH) or Robotic Hysterectomy (RH). RESULTS: The VH combines sequences of reproducible techniques which have been developed over the years to safely and effectively overcome the limitations of difficult cases of vaginal extirpation from the uterus. CONCLUSION: The authors support endoscopic surgical approaches in complex surgery for benign indications, urogynecology, and gynecologic oncology when appropriate. However, what makes the gynecological surgeon different from the general surgeon is the vaginal access. It is essential to continue to train residents in vaginal surgical skills and provide safe and cost-effective patient care. The art of technology is the resilience of keeping only the patient at the center of innovation.

Asunto(s)

RESUMEN

La histerectomía es uno de los principales procedimientos quirúrgicos en ginecología. Se calcula que en EE.UU. se realizan unas 500,000 anualmente y que una de cada nueve mujeres a lo largo de su vida se realizará dicha intervención. Los distintos abordajes (abdominal, vaginal, laparoscópico y robótico) presentan diferencias respecto al tiempo quirúrgico, complicaciones, dolor postoperatorio, estancia hospitalaria y gasto sanitario. Factores como el tamaño uterino, la accesibilidad vaginal, la historia de cirugías pélvicas previas, la existencia de patología extrauterina o la experiencia del cirujano influyen a la hora de decidir la vía de abordaje. Revisar la evidencia disponible respecto a la vía de elección de la histerectomía por patología benigna y cómo decidir el abordaje más adecuado para cada paciente. Búsqueda bibliográfica de literatura en las bases de datos PubMed, Medline, Embase, BioMed Central y SciELO. La vía vaginal es el abordaje de elección para realizar una histerectomía dada su menor invasividad, menor tiempo de recuperación y menor tasa de complicaciones. La generalización del uso de algoritmos para la elección de la vía de abordaje incrementaría la tasa de acceso vaginal y asociaría con ello una disminución del gasto sanitario.

Hysterectomy is one of the most common surgical procedures in gynecology. It is calculated that over 500,000 hysterectomies are performed in the USA per year and that 1 out of 9 women will undergo this surgery in their lifetime. Diverse surgical approaches are possible (abdominal, vaginal, laparoscopic and robotic) with differences in operative time, complication rates, postoperative pain, hospital stay, and health care cost. Factors such as uterus size, vaginal access, prior pelvic surgery, extrauterine pathology and surgeon experience may influence the route selection. To collect the current evidence regarding the preferred route in hysterectomy for benign pathology and how to select the adequate approach for every patient. Bibliographic literature search through the PubMed, Medline, Embase, BioMed Central and SciELO databases. Vaginal hysterectomy is the preferred approach in benign indications. It is less invasive, and it shows shorter operative time, shorter recovery time and less complications. The use of decision algorithms to select the hysterectomy route may increase the vaginal approach and decrease health care costs.

Asunto(s)

RESUMEN

BACKGROUND: Prolapse recurrence after transvaginal surgical repair is common; however, its mechanisms are ill-defined. A thorough understanding of how and why prolapse repairs fail is needed to address their high rate of anatomic recurrence and to develop novel therapies to overcome defined deficiencies. OBJECTIVE: This study aimed to identify mechanisms and contributors of anatomic recurrence after vaginal hysterectomy with uterosacral ligament suspension (native tissue repair) vs transvaginal mesh (VM) hysteropexy surgery for uterovaginal prolapse. STUDY DESIGN: This multicenter study was conducted in a subset of participants in a randomized clinical trial by the Eunice Kennedy Shriver National Institute of Child Health and Human Development Pelvic Floor Disorders Network. Overall, 94 women with uterovaginal prolapse treated via native tissue repair (n=48) or VM hysteropexy (n=46) underwent pelvic magnetic resonance imaging at rest, maximal strain, and poststrain rest (recovery) 30 to 42 months after surgery. Participants who desired reoperation before 30 to 42 months were imaged earlier to assess the impact of the index surgery. Using a novel 3-dimensional pelvic coordinate system, coregistered midsagittal images were obtained to assess study outcomes. Magnetic resonance imaging-based anatomic recurrence (failure) was defined as prolapse beyond the hymen. The primary outcome was the mechanism of failure (apical descent vs anterior vaginal wall elongation), including the frequency and site of failure. Secondary outcomes included displacement of the vaginal apex and perineal body and change in the length of the anterior wall, posterior wall, vaginal perimeter, and introitus of the vagina from rest to strain and rest to recovery. Group differences in the mechanism, frequency, and site of failure were assessed using the Fisher exact tests, and secondary outcomes were compared using Wilcoxon rank-sum tests. RESULTS: Of the 88 participants analyzed, 37 (42%) had recurrent prolapse (VM hysteropexy, 13 of 45 [29%]; native tissue repair, 24 of 43 [56%]). The most common site of failure was the anterior compartment (VM hysteropexy, 38%; native tissue repair, 92%). The primary mechanism of recurrence was apical descent (VM hysteropexy, 85%; native tissue repair, 67%). From rest to strain, failures (vs successes) had greater inferior displacement of the vaginal apex (difference, -12 mm; 95% confidence interval, -19 to -6) and perineal body (difference, -7 mm; 95% confidence interval, -11 to -4) and elongation of the anterior vaginal wall (difference, 12 mm; 95% confidence interval, 8-16) and vaginal introitus (difference, 11 mm; 95% confidence interval, 7-15). CONCLUSION: The primary mechanism of prolapse recurrence following vaginal hysterectomy with uterosacral ligament suspension or VM hysteropexy was apical descent. In addition, greater inferior descent of the vaginal apex and perineal body, lengthening of the anterior vaginal wall, and increased size of the vaginal introitus with strain were associated with anatomic failure. Further studies are needed to provide additional insight into the mechanism by which these factors contribute to anatomic failure.

Asunto(s)

RESUMEN

INTRODUCCIÓN: La histerectomía es la extirpación quirúrgica del útero, cuyas técnicas quirúrgicas han evolucionado a través del tiempo; es una de las cirugías ginecológicas más frecuentes en el mundo. El objetivo del estudio fue evaluar la frecuencia de complicaciones postquirúrgicas por vía de abordaje y correlacionarlas con factores de riesgo. MÉTODOS: Se diseñó un estudio retrospectivo. Se seleccionó al total de mujeres sometidas quirúrgicamente a histerectomía durante los años 2014 y 2015, el universo lo conformó 409 mujeres intervenidas, de las cuales se obtuvo una muestra de 384, en el servicio de Ginecología. El análisis estadístico se realizó en la herramienta estadística SPSS 17.0. En el análisis de los resultados se utilizaron el test de U Mann-Whitney, Chi cuadrado y Riesgo Relativo. RESULTADOS: El promedio de edad fue 85 % con una edad menor a 50 años. El tiempo medio de procedimiento quirúrgico fue 104 minutos, y un tiempo de hospitalización promedio de 2.7 días. Los antecedentes patológicos fueron la cirugía gineco-obstétrica previa 62 %. El 88 % de las histerectomías fueron por la vía abdominal. La incidencia total de complicaciones en general fue del 3.38 %; el 100 % de las complicaciones se presentaron en la histerectomía abdominal. No existió correlación estadística significativa con factores de riesgo como la obesidad (P 0.15 y RR: 0.39). CONCLUSIONES: La histerectomía vaginal tiene menos complicaciones postquirúrgicas, menos días de hospitalización y un menor tiempo quirúrgico comparado con el abordaje de la vía abdominal. Es recomendable realizar más estudios en otros establecimientos de salud en el Ecuador y comparar las diferentes vía de abordaje incluido la vía laparoscópica.

BACKGROUND: Hysterectomy is the surgical removal of the uterus, whose surgical techniques have evolved over time; it is one of the most frequent gynecological surgeries in the world. The objective of the study was to evaluate the frequency of postsurgical complications through theapproach and correlate them with risk factors. METHODS: A retrospective study was designed. The total number of women surgically undergoing hysterectomy was selected during the years 2014 and 2015. The universe consisted of 409 women undergoing surgery, of whom a sample of 384 was obtained at the Gynecology Department. The statistical analysis was realized in the statistical tool SPSS 17.0. In the analysis of the results, U Mann-Whitney test, Chi square and Relative Risk were used. RESULTS: It was obtained that the average age was 85 % with an age under 50 years. The average time of surgical procedure was 104 minutes, and an average hospitalization time of 2.7 days. The pathological antecedents were the gynecological-obstetric surgery previous 62 %. 88 % of the hysterectomies. The total incidence of complications due to hysterectomy in general was 3.38 %; 100 % of complications occurred in abdominal hysterectomy. There was no significant statistical correlation with risk factors such as obesity (P 0.15 and RR: 0.39). CONCLUSIONS: Vaginal hysterectomy has fewer postsurgical complications, less days of hospitalization and a shorter surgical time compared to the abdominal approach; however, abdominal hysterectomy is the most frequent of treatment choice. It is recommendable to realize more studies in other health institutions in Ecuador.

Asunto(s)

RESUMEN

ABSTRACT Objective: To identify differences in quality of life and sexuality in women without genital prolapse taken to vaginal or abdominal hysterectomy. Materials and methods: Prospective cohort study including women with no vaginal prolapse and benign conditions, with no adhesions and a uterus of less than 1000cc, amenable to surgery through the abdominal or vaginal approach, coming to a private clinic in Medellín, Colombia. The SF12 score was used for quality of life assessment two and four months after surgery, and sexuality was assessed before and four months after the procedure, using the Female Sexual Function Index. Comparisons were made using ANCOVA, adjusted on the basis of baseline values and other characteristics. Approval by the ethics committee as well as informed consents were obtained. Results: The study included women with similar pre-operative characteristics. Of them, 24 were included in the vaginal hysterectomy group and 22 in the abdominal hysterectomy group. Quality of life and sexual function improved for the women in both groups following the procedure. Postoperative physical health: adjusted score for vaginal hysterectomy, 49.5 (SD ± 1.6) and for abdominal hysterectomy, 43.8 (SD ± 1.7), with a difference of 5.6 points (95% CI 0.87-10.4). Mental health: 51.0 (SD ± 1.7) and 59.3 (SD ± 1.6) points, respectively; adjusted difference 8.4 (95% CI 3.6-13.3). Sexuality: 22.7 (SD ± 1.8) and 26.5 (SD ± 1.7), respectively; difference, 3.8 points (95% CI -1.2-8.7). Conclusion: Although statistically significant differences were found for quality of life, the score obtained is not clinically significant.

RESUMEN Objetivo: Identificar diferencias en calidad de vida y sexualidad en mujeres sin prolapso genital intervenidas con histerectomía vaginal o abdominal. Materiales y métodos: Estudio de cohortes prospectivo. Se incluyeron mujeres sin prolapso vaginal con condiciones benignas, sin adherencias, con útero menor de 1000 cc, que fueran susceptibles de ser intervenidas tanto por vía abdominal como vaginal en una clínica privada de Medellín, Colombia. Evaluación de calidad de vida con la escala SF-12 antes, a los 2 y 4 meses posquirúrgico y de la sexualidad con la escala índice de Función Sexual Femenina, antes y a los 4 meses posoperatorio. Comparaciones con ANCOVA ajustadas porlos valores basales y por otras características. Se contó con aprobación de comité de ética y se tomó consentimiento informado. Resultados: Se incluyeron 24 mujeres en el grupo de histerectomía vaginal y 22 en el grupo de histerectomía abdominal, con características similares antes de la cirugía. Ambos grupos mejoraron en calidad de vida y en satisfacción sexual después del proce- dimiento. Los puntajes para histerectomía vaginal e histerectomía abdominal fueron, respectivamente: salud física posoperatoria: puntaje ajustado en histerectomía vaginal 49,5 (DE ± 1,6) e histerectomía abdominal 43,8 (DE ± 6,7), diferencia 5,6 puntos (IC 95%: 0,87-10,4). Salud mental: 51,0 (DE ± 1,7) y 59,3 (DE ± 1,6) puntos, respectivamente, diferencia ajustada 8,4 (IC 95%: 3,6-13,3). Sexualidad: 22,7 (DE ± 1,8) y 26,5 (DE ± 1,7), respectivamente, diferencia 3,8 puntos (IC 95%: -1,2-8,7). Conclusión: Aunque se encontraron diferencias estadísticamente significativas en la calidad de vida, el puntaje alcanzado no es clínicamente significativo.

Asunto(s)

RESUMEN

Objetivo: Evaluar la utilidad de la histerectomía vaginal como técnica quirúrgica en patología uterina benigna, en pacientes sin prolapso uterino. Sus ventajas y desventajas. Métodos: Entre octubre 2011 y febrero 2013, se realizó un estudio observacional, descriptivo, longitudinal, prospectivo, serie de casos, 100 pacientes con patología uterina benigna, sin prolapso genital, atendidas en el Servicio de Ginecología del Hospital Central, “Dr. José María Vargas” de San Cristóbal; a quienes se les realizó histerectomía vaginal con técnicas de Heany y reductoras de volumen. Resultados: La miomatosis uterina fue la indicación más frecuente. El antecedente quirúrgico más importante fue la cesárea anterior. La media de peso uterino fue de 281,22 g. Las técnicas reductoras de volumen se realizaron en el 41 %. Un caso requirió una cirugía abierta. Las complicaciones intraoperatorias fueron del 2 %, las posoperatorias leves 1 % y moderadas 2 %. El tiempo quirúrgico fue corto y el dolor posoperatorio fue bajo. Conclusiones: En ausencia de prolapso uterino, la histerectomía vaginal presenta escasas complicaciones intra y posoperatorias, con tiempo quirúrgico corto; cuando la cirugía es bien realizada, el tamaño uterino no debe ser una limitante.

Objectives: To evaluate utility of vaginal hysterectomy as surgical technique for benign uterine diseases, in patients without prolapse. Methods: Between October 2011 and February 2013, an observational, descriptive, longitudinal, prospective case series study was made. 100 patients with benign uterine diseases, without prolapse, treated with vaginal hysterectomy with Heany and volumen reduction techniques at San Cristobal Central Hospital Dr. Jose Maria Vargas”, Gynecology Department were included. Results: Uterine miomatosis was the most frequent indication. Previous cesarean section was the most importan surgical history. Mean uterine weight was 281.22 g. Volumen reduction techniques were performed in 41 % of patients. One case needed conversion to open surgery. Introperative complicacions were 2 %. Surgical time was short and postoperative pain was low. Conclusions: Without uterine prolapse, vaginal hysterectomy has few intra and postoperative complications, with short surgical time; when the procedure is correctly done, uterine size should not be a limiting feature.

RESUMEN

Objetivo: reportar el caso de una paciente con hematoma retroperitoneal posterior a cirugía de corrección de prolapso por vía vaginal, y realizar revisión de la literatura médica sobre la anatomía del espacio retroperitoneal, la etiología, el diagnóstico, manejo y pronóstico del hematoma retroperitoneal posoperatorio en ginecología.Materiales y métodos: se presenta el caso de una paciente con prolapso vaginal estadio II, a quien se le practicó histerectomía vaginal con colporrafia anterior y posterior, quien presentó como complicación un hematoma retroperitoneal. La paciente fue intervenida en el Hospital Universitario de La Samaritana, hospital público de tercer nivel de complejidad, centro de referencia de Cundinamarca, ubicado en Bogotá (Colombia). Se realizó una búsqueda de literatura médica en las bases de dados Medline vía PubMed, Jstor y Lilacs, con terminología MeSH "hysterectomy vaginal" y "retroperitoneal hematoma". La búsqueda se limitó a los idiomas inglés y español entre los años 1980 a 2015.Resultados: se encontraron 15 artículos de los cuales 3 describen casos secundarios a procedimientos ginecológicos. La revisión final se conforma de: 4 revisiones de tema, 8 reportes de caso, 2 series de casos, 1 estudio observacional descriptivo.Conclusión: el hematoma retroperitoneal es una rara entidad que requiere de un alto índice de sospecha clínica para su diagnóstico. Existen varias herramientas diagnósticas, siendo la tomografía computarizada la de mayor utilidad. El manejo debe individualizarse a cada caso. En paciente estable se puede realizar manejo conservador con éxito o intervenciones endovasculares. Sin embargo, en pacientes inestables hemodinámicamente, la laparotomía es la conducta más recomendada.

Objective: To report the case of a patient who developed a retroperitoneal haematoma following prolapse correction surgery through the vaginal approach; and to review the medical literature relating to the anatomy of the retroperitoneal space and the aetiology, diagnosis, management and prognosis of postoperative retroperitoneal haematoma in gynaecology.Materials and methods: Case presentation of a patient with Stage II vaginal prolapse, who was undergone for vaginal hysterectomy with anterior and posterior vaginal wall repair. She had a retroperitoneal haematoma complication. The patien underwent surgery at Samaritana University Hospital, a level III public hospital and referral centre for the Cundinamarca region, located in Bogotá (Colombia). A search in the literature was conducted in the Medline database through PubMed, Jstor and Lilacs using the MeSH terms "vaginal hysterectomy" and "retroperitoneal haematoma". The search was limited to publications in English and Spanish between 1980 and 2015.Results: Overall, 15 articles were found, 3 of which describe cases secondary to gynaecological procedures. The final review consisted of 4 topic reviews, 8 case reports 2 case series and 1 observational descriptive study.Conclusion: Retroperitoneal haematoma is a rare clinical finding and diagnosis requires a high level of clinical suspicion. Several diagnostic tools are available, computed tomography being the most useful. Management has to be individualized in each case. If the patient is stable, the treatments of choice include conservative management, which can be successful, or endovascular interventions. However, in haemodynamically unstable patients, laparotomy is the most recommended treatment approach.

Asunto(s)

RESUMEN

Antecedentes: La histerectomía es la cirugía en la mujer más frecuentemente realizada después de la cesárea a nivel mundial. La mayoría de las veces este procedimiento puede efectuarse por vía vaginal. Objetivo: Realizar un análisis retrospectivo de las histerectomías vaginales realizadas en la Unidad de Piso Pélvico del Hospital Clínico de la Universidad de Chile, sus principales indicaciones y las complicaciones intraoperatorias (2006-2012). Resultados: Se analizaron 379 histerectomías por causa benigna, el 17 por ciento (n=64) por vía abdominal y el 83 por ciento (n=315) por vía vaginal. Las principales complicaciones intraoperatorias en las histerectomías vaginales, fueron lesiones vasculares (1,2 por ciento) y vesicales (0,6 por ciento). Hubo complicaciones infecciosas en el 1,2 por ciento de las pacientes (4 abscesos de la cúpula vaginal), las que han disminuido con el uso de los antibióticos profilácticos. Conclusiones: La histerectomía vaginal, es la vía ideal de abordaje quirúrgico para la patología benigna del útero, por menores complicaciones, rápida recuperación, costo efectividad y reintegro de las pacientes a sus actividades. Nuestros resultados de complicaciones son similares a los reportados por la literatura nacional e internacional.

Background: Hysterectomy is the surgery most frequently in women after caesarean section performed worldwide. Most often, this procedure can be carried out vaginally. Objective: To perform a retrospective analysis of vaginal hysterectomies performed in Pelvic Floor Unit, Clinical Hospital of the University of Chile, the main indications and intraoperative complications (2006-2012). Results: We analyzed 379 hysterectomies for benign causes, 17 percent (n = 64) for abdominal and 83 percent (n = 315) vaginally. The major intraoperative complications in vaginal hysterectomies were vascular (1.2 percent) and bladder lesions (0.6 percent). Infectious complications occurred in 1.2 percent of patients (4 vaginal vault abscess), which decreased with the use of prophylactic antibiotics. Conclusions: Vaginal hysterectomy is the ideal way of surgical approach for benign disease of the uterus, fewer complications, faster recovery, cost-effectiveness and reimbursement of patients to their activities. Our results and complications are similar to those reported by national and international literature.

Asunto(s)

RESUMEN

OBJECTIVE: To compare the outcomes of total laparoscopic hysterectomy (TLH), a relatively new procedure, with vaginal hysterectomy (VH), a wellestablished procedure, in a university teaching hospital. SUBJECTS AND METHODS: A retrospective chart review of all patients who underwent TLH at the University Hospital of the West Indies between January 2007 and December 2011 was conducted. Chart review was also conducted of a group of patients who underwent VH during this time period. The groups were compared with respect to demographic data and intraoperative and postoperative outcomes. Statistical analysis was undertaken using the SPSS software, version 12.0 (SPSS, Chicago, IL). The Student unpaired ttest was used to analyse continuous variables, and the Chi-square test and Fisher exact test for categorical variables, when appropriate. A p-value of < 0.05 was considered statistically significant. RESULTS: Ten patients underwent TLH, and were compared with 22 women who underwent VH. There was no statistically significant difference between groups in uterine weight, estimated blood loss, postoperative analgesic requirement, or length of hospitalization. Total laparoscopic hysterectomy took significantly longer to perform (209.9 vs 145.6 minutes, p = 0.004). One patient in the TLH group had to be brought back to the operating theatre after three months because of bowel prolapse secondary to vault dehiscence. With the exception of one case of bladder injury in the VH group, there were no significant differences between the groups in terms of intraoperative and postoperative complications. CONCLUSION: Total laparoscopic hysterectomy, notwithstanding its learning curve, is as safe as VH. However, TLH was associated with a significantly longer operative time.

Asunto(s)

RESUMEN

BACKGROUND: Despite the introduction of minimally invasive approaches for various benign uterine problems, hysterectomy is often still performed abdominally, but the vaginal route should be used whenever possible. The aim of this study was to identify the preoperative, intraoperative, and postoperative characteristics of women undergoing vaginal hysterectomy in the absence of uterine prolapse. METHODS: A prospective, descriptive, quantitative, noncomparative study was conducted in 117 women between August 2009 and February 2011 in Petropolis, Rio de Janeiro, Brazil. The women included had a uterine indication for hysterectomy, their surgeries were performed by the same team, and they were followed up for 12 months. An adapted Pelvic Organ Prolapse Quantification system was used to check for uterine prolapse. RESULTS: The age range of the women was 33-59 years, uterine volume was 300-900 mL, and 73.50% has undergone prior cesarean section. The main indication for hysterectomy was uterine myoma (64.95%), with a surgery time of 30-60 minutes in 55 (59.82%) and 19 (15.98%) cases, respectively. Uterine volume reduction was performed in 41 (35.05%) cases, salpingectomy was the most common associated surgery (81.19%), and anesthesia was subdural (68.37%). Common intraoperative complications included bladder lesions (8.54%), with conversion to the abdominal route being necessary in one case (1.28%), and the most common postoperative complication being vaginal cupola granuloma (32.47%). There was a statistically significant relationship between surgery time and uterine volume (χ(2) = 17.367; P = 0.002). CONCLUSION: This study suggests that vaginal hysterectomy is a safe surgical procedure in view of its good performance and low complication rate.

RESUMEN

Se efectuó una investigación analítica, longitudinal y retrospectiva de una muestra de 110 mujeres de un total de 639 con diferentes afecciones de los órganos genitales, excluidas las sépticas, e intervenidas las primeras por vía vaginal durante el quinquenio 2005-2009, las cuales fueron asignadas a 2 grupos: el A, integrado por 37 pacientes sin prolapso genital (técnica de Peham-Amreich); y el B, conformado por 73 féminas con dicho prolapso (técnica de Heany) en estadios clínicos I y II-III, quienes fueron reagrupadas en subgrupos de 32 y 41 pacientes, respectivamente. En la serie se consideraron las variables: edad, sangrado peroperatorio, tiempo quirúrgico, estadía posoperatoria, complicaciones peroperatorias y posoperatorias, así como control ambulatorio (trigésimo día). Las integrantes del grupo A se ajustaron a requerimientos clínicos y ecográficos preseleccionados: útero móvil y equivalente en volumen al puño de un hombre adulto de biotipo medio, campo operatorio suficiente y normalidad en examen de anejos. Para el análisis estadístico se aplicó el test de Pearson, con valores de significación considerados en 3 categorías, a saber: I, p=0,05 (estándar); II, p=0,01 (alta) y III, p=0,001 (muy alta). Se demostró, con muy alta significación, que el prolapso genital es una afección privativa de mujeres de edad superior a 50 años. El resto de las variables escogidas careció de valor estadístico en este estudio.

An analytic, longitudinal and retrospective investigation was carried out in a sample of 110 women from a total of 639 with different disorders of the genitals, excluding the septic ones. The former group had surgeries through vagina during the five year period 2005-2009, and were assigned to 2 groups: group A, formed by 37 women without genital prolapse (Peham-Amreich technique); and group B, formed by 73 women with this disorder (Heany technique) in clinical stages I and II-III, who were regrouped in subgroups of 32 and 41 patients, respectively. Variables such as: age, peroperative bleeding, surgical time, postoperative stay, peroperative and postoperative complications, as well as ambulatory control (thirtieth day) were considered in the series. The members of group A were adjusted to previously selected clinical and echographic requirements: mobile uterus and equivalent in volume to the fist of an adult man of average biotype, adequate operative field and normality in the adnexa examination. For the statistical analysis the Pearson test was applied, with significance values considered in 3 categories, that is: I, p=0.05 (standard); II, p=0.01 (high) and III, p=0.001 (very high). It was significantively demonstrated, that genital prolapse is an exclusive disorder of women over 50 years old. The rest of the chosen variables lacked statistical value in this study.

RESUMEN

Objetivo: Comunicar una técnica mínimamente invasiva para el manejo quirúrgico del cáncer cérvicouterino en estadio precoz y sus resultados. Método: 40 pacientes con cáncer cérvicouterino en estadios IA2 y IB1 operadas en un período de 2,5 años. Se les efectúa linfadenectomía pelviana sistemática laparoscópica seguidas de histerectomía vaginal radical, excepto aquellas pacientes que tienen compromiso ganglionar detectado en biopsia contemporánea. Resultados: 40 pacientes son sometidas a esta técnica. Cuatro pacientes son abortadas de su cirugía, 3 por presentar ganglios positivos para carcinoma en biopsia contemporánea y 1 por tener un extenso compromiso cervical al momento de efectuar la histerectomía vaginal radical. Los 36 casos restantes tienen una edad promedio de 43,9 años, ninguna nulípara y 8 tienen el antecedente de cesárea. El IMC promedio fue de 30,49 y 14 conizadas previas. El tiempo operatorio promedio fue de 238 minutos. La estadía postoperatoria promedio fue de 2,9 días. El sangrado estimado fue de 139 cc y ninguna paciente requirió transfusión. Se conservan los anexos en 13 pacientes y en todas se suspenden por vía laparoscópica. El promedio de ganglios obtenidos fue de 30. Cuatro pacientes sufren lesión vesical, 1 fístula vesicovaginal y 3 disfunciones vesicales. Conclusión: El cáncer cérvicouterino en estadio precoz es factible de ser tratado con esta técnica y brinda las ventajas de la cirugía laparoscópica y vaginal con mínimas complicaciones.

Objective: To communicate a minimally invasive technique for surgical handling of early stage cervical cancer and its results. Methods: 40 patients with cervical cancer in stages IA2 and IB1, all of them operated in a period of 2.5 years, are presented. Laparoscopic systemic pelvic lymphadenectomy with posterior radical vaginal hysterectomy was performed, with the exception of those patients who had compromised nodes detected in contemporary biopsy. Results: 40 patients were submitted to this technique. 4 patients had their surgery aborted: 3 presented positive nodes for carcinoma in contemporary biopsy and 1 had extensive cervical compromise when performing radical vaginal hysterectomy. Analysis of the remaining 36 cases shows an average age of 43.9 years, all of them had given birth before, 8 of them through Cs-section. BMI averaged 30.49 and 14 had had cone surgery performed previously. Average duration of surgery was of 238 minutes. Postoperative hospitalization averaged 2.9 days. Bleeding volume was estimated at 139 cc and no patient required blood transfusion. 13 uterine annexes were kept and all of them were suspended by means of laparoscopy. On average, 30 nodes were obtained. 4 patients suffered bladder injury, one had vesicovaginal fistula and there were 3 bladder dysfunctions. Conclusion: The early stage cervical cancer is likely to be treated with this technique and provides de benefits of laparoscopic and vaginal surgery with minimal complications.

Asunto(s)

RESUMEN

Objetivo: Evaluar la histerectomía vaginal en la resolución de patología uterina benigna, en casos que habitualmente se resuelven por histerectomía abdominal. Método: Estudio prospectivo en 68 pacientes sometidas a histerectomía vaginal en el Servicio de Ginecología del Hospital Claudio Vicuña, de San Antonio, entre junio de 2003 a junio de 2009. Son pacientes sin partos vaginales, algunas nuligestas, la mayoría con cicatrices de cesárea o historia de cirugía pélvica previa. Se separan en dos grupos, uno de dificultad moderada (DM) (útero móvil, vagina >2 dedos de diámetro, fondos de saco bien conformados) y otro de dificultad severa (DS) (útero fijo, vagina <2 dedos, o fondos de saco planos). Resultados: No hubo diferencias significativas en edad, número de cesáreas previas, número de cirugías pélvicas previas, tamaño uterino al examen físico, porcentajes de lesión vesical iatrogénica, ni conversión abdominal entre ambos grupos de pacientes. Hubo diferencias significativas en mayor tiempo operatorio y necesidad de morcelación para el grupo DS. Se destaca la ausencia de complicaciones mayores y menores en más del 93 por ciento de las pacientes. Conclusión: Nuestros resultados desmitifican las objeciones a la vía vaginal, incluso en pacientes definidas de dificultad extrema.

Objective: To assess vaginal hysterectomy in benign uterine pathology resolution in cases who are usually resolved by abdominal hysterectomy. Method: We studied, prospectively, 68 patients that were operated by vaginal hysterectomy between june 2003 to june 2009 in the Gynecology Service at Claudio Vicuña Hospital, San Antonio. Most of the patients have history of prior cesarean section or pelvic surgery, but no one has had vaginal deliveries, inclusive, some of them, have no history of previous pregnancies. The patients were separated into two groups, moderate difficulty (MD): composed by patients with uterus conserved motility, vagina >2 fingers diameter, well conserved cul de sac, and severe difficulty (SD): composed by patients with none uterine motility, vagina <2 fingers diameter or fat cul de sac. Results: We did not observed statistically signifcant differences in age, number of prior cesarean sections or pelvic surgeries, estimated uterine size, bladder injury, nor abdominal conversion, but there was significant differences in operative time and need of morcelation, being greater in SD patients. It is important to notice the absent of major and minor complications in 93 percent of the patients. Conclusion: Our results are meant to demystify the objections for vaginal route, including the patients with extreme difficulty.

Asunto(s)

RESUMEN

A cirurgia ginecológica teve um avanço muito significativo nos últimos anos, sobretudo com o surgimento de novas técnicas cirúrgicas minimamente invasivas. A histerectomia vaginal sem prolapso com sistema de selamento de vasos de baixo custo baseia-se na técnica descrita por Heaney, modificada com a utilização de um clamp autoclavável (Marclamp) conectado a um sistema gerador de energia bipolar de selamento de vasos (Maxium - KLS Martin). As vantagens da histerectomia vaginal com sistema de selamento de vasos de baixo custo são: menor tempo cirúrgico, pós-operatório menos doloroso, menor tempo de internação e retorno mais rápido às atividades habituais. A histerectomia vaginal pode ser realizada em regime ambulatorial.

The gynecological surgery had a very significant advance in recent years, over all with the new minimally invasive surgical techniques. The vaginal hysterectomy in nonprolapsed uterus using economic vessel sealer system is based on Heaney modified technique using the Marclamp connected to Maxium (Martin's bipolar vessel sealing system). The advantages of the vaginal hysterectomy with economic vessel sealer system are: less operative time, less post-operative pain, lesser time of internment and faster return to the habitual activities. The vaginal hysterectomy can be realized in ambulatorial hospital care.

Asunto(s)

RESUMEN

Objetivo: Describir la morbilidad, pérdida sanguínea y tiempo quirúrgico en la realización de histerectomía vaginal con el uso de la pinza electroquirúrgica de coagulación bipolar plasmacinética. Metodología: Se realizó un estudio retrospectivo en 18 pacientes sometidas a histerectomía vaginal por patología benigna uterina, utilizando energía plasmacinética durante el período de enero de 2007 a febrero de 2009, en el Hospital Central Norte de Petróleos Mexicanos. Resultados: Tiempo quirúrgico de 59,4 +/- 19,3 min (rango: 50-85 min), sangrado posoperatorio de 76,6 +/- 22,3 mi (rango: 30-110 ml), peso del útero 497,3 +/- 88,9 g (rango: 245-635 g) y tiempo de estancia intrahospitalaria de 2,1 +/- 0,6 días (rango: 1-3 días). No se reportaron complicaciones durante el procedimiento ni en su recuperación posterior. Conclusiones: El uso de la pinza electroquirúrgica de coagulación bipolar plasmacinética, es una alternativa efectiva y segura durante la histerectomía vaginal. Es necesaria la realización de un ensayo aleatorizado para compararla con la técnica tradicional para demostrar otros beneficios.

Objective: To describe morbility, blood loss and procedure time of vaginal hysterectomy using an electro-surgical bipolar vessel sealer. Methods: Patients scheduled for vaginal hysterectomy using electrosurgical bipolar vessel sealer as the hemostasis technique during the period January 2007 to February 2009, at the Central Hospital North of Petróleos Mexicanos. Results: A total of 18 patients underwent vaginal hysterectomy for some benign disease of the uterus. Among these patients, mean procedure time in the electrosurgical bipolar vessel sealer was 59.4 +/- 19.3 min (range: 50-85 min). Mean estimated blood loss was 76.6 +/- 22.3 ml (range: 30-110 ml), weight of the uterus was 497.3 +/- 88.9 g (range: 245-635 g), and length of stay 2.1 +/- 0.6 days (range: 1-3 days). There was no perioperative complication. Conclusion: Electrosurgical bipolar vessel sealer is an effective alternative to sutures in vaginal hysterectomy. Larger adequately-powered studies are however still required.

Asunto(s)

RESUMEN

Se realizó un estudio descriptivo transversal con 300 pacientes operadas de histerectomía vaginal en úteros no prolapsados en el servicio de Cirugía general del hospital "Martín Chang Puga" de Nuevitas durante un trienio. El promedio de edad fue de 42 años, con una desviación estándar de 6,11. La paciente de menor edad tenía 32 años y la mayor 75 años. La principal indicación quirúrgica fue el fibroma uterino (79,66 %), seguida del sangramiento uterino anormal (SUA). La mayoría (280) de los casos utilizaron profilaxis antibiótica. Existió un 24 % de complicaciones, predominando las complicaciones infecciosas. La media de estadía hospitalaria postoperatoria fue de 24 horas. El tiempo quirúrgico medio fue de 34,1±7,61.

A descriptive cross-sectional study was conducted among 300 female patients that underwent vaginal hysterectomy in non-prolapsed uteri at the general surgery service of "Martín Chang Puga" Hospital, in Nuevitas, for 3 years. The average age was 42 years old, with a standard deviation of 6.11. The youngest patient was 32 years old and the oldest was 75 years old. The main surgical indication was uterine fibroma (79.66 %), followed by abnormal uterine bleeding (AUB). Most of the cases (280) used antibiotic prophylaxis. Complications accounted for 24 %, with a predominance of infectious complications. The mean hospital postoperative stay was 34.1±7.61.

RESUMEN

Objetivo: A histerectomia é uma operação muito realizada, entretanto há poucos trabalhos na literatura nacional sobre suas indicações, técnica e complicações. O objetivo deste trabalho é avaliar estes procedimentos realizados na Disciplina de Ginecologia e Obstetrícia da Faculdade de Medicina do Triângulo Mineiro. Método: Estudo retrospectivo de 470 histerectomias abdominais e 84 vaginais foi conduzido analisando as indicações, tempo de cirurgia e internação, tipo de incisão e morbidez. Resultados: As principaisindicações foram o mioma uterino e o prolapso uterino para as histerectomias abdominais e vaginais, respectivamente.As complicações intra-operatórias aconteceram em 3,4% e as pós- operatórias em 2,4% do total de casos. Nenhuma diferença estatística foi encontrada no número de complicações em relação ao tipo de incisão (vertical ou transversal). O tempo de cirurgia e o de hospitalização foram estatisticamente maiores nas incisões verticais. A hemorragia foi a mais freqüente complicação intra-operatória e a infecção da incisão operatória foi a mais freqüente no pós-operatório. Conclusões: A histerectomia é um procedimento de baixo risco, no entanto, a realização de revisões sobre indicações e complicações, e a pesquisa de melhores técnicas cirúrgicas são necessárias para torná-la cada vez mais segura.

Objective: Hysterectomy is a frequently performed surgery, but national literature gives limited informationregarding indications, technique and complications. The aim of this study is to evaluate our results with this operation performed by the Discipline of Gynecology and Obstetrics of the Faculty of Medicine of “Triângulo Mineiro”. Methods: A retrospective study of 470 abdominal and 84 vaginal hysterectomies was conducted in which the indications, operation time, abdominal approach, hospitalization time, and morbidity were analyzed. Results: Uterine myoma and uterine prolapse were the most frequent indications for abdominal and vaginal hysterectomies, respectively. Intra-operative (3.4%) and postoperative (2.4%) complications occurred in abdominal hysterectomies, with no significant statistical difference in theincidence of complications related to the type of incision (transverse or vertical). Operative time and hospital stay were significantly increased with the vertical incision. Hemorrhage was the major intraoperative complication and wound infection in postoperative complications. Conclusions: We concluded that hysterectomy is a low risk procedure although improvements in surgical technique and continued research are needed for a even safer procedure.