scholarly journals Venous Air Embolism during Total Laparoscopic Hysterectomy

2009 ◽  
Vol 111 (1) ◽  
pp. 50-54 ◽  
Author(s):  
Chang Seok Kim ◽  
Ji Young Kim ◽  
Ja-Young Kwon ◽  
Seung Ho Choi ◽  
Sungwon Na ◽  
...  
Keyword(s):  
Transesophageal Echocardiography ◽  
Broad Ligament ◽  
Air Embolism ◽  
Laparoscopic Hysterectomy ◽  
Total Abdominal Hysterectomy ◽  
Hemodynamic Instability ◽  
Abdominal Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Round Ligament ◽  
Venous Air Embolism

Background Total laparoscopic hysterectomy (TLH) has become a widely accepted alternative to total abdominal hysterectomy (TAH). The aim of this study was to compare the incidence and grade of venous air embolism (VAE) in TLH to those in TAH using transesophageal echocardiography. Methods Eighty-two American Society of Anesthesiologists physical status I patients scheduled for either TLH or TAH were enrolled. After induction of general anesthesia, a multiplane transesophageal echocardiography probe was inserted. The midesophageal four-chamber or bicaval view was continuously monitored. An independent transesophageal echocardiography-certified anesthesiologist graded VAE. Results All patients undergoing TLH showed VAE, and 37.5% of patients had VAE grade higher than III. Fifteen percent of patients undergoing TAH showed VAE, and all of them were grade I. No patient in this study showed hemodynamic instability or electrocardiogram changes at the time of VAE occurrence. Most instances of VAE during TLH occurred during transection of the round ligament and dissection of the broad ligament. Conclusion The incidence of VAE in patients undergoing TLH was 100%. VAE grade in TLH was higher compared to that in TAH, especially during transection of the round ligament and dissection of the broad ligament. Although the hemodynamic instability associated with VAE during TLH was not observed in this study, anesthesiologists must be vigilant for detection of VAE during TLH.

scholarly journals Venous Air Embolism during Total Laparoscopic Hysterectomy

2010 ◽  
Vol 112 (2) ◽  
pp. 498-499
Author(s):  
Chang Seok Kim ◽  
Ji Young Kim ◽  
Ja-Young Kwon ◽  
Seung Ho Choi ◽  
Sungwon Na ◽  
...  
Keyword(s):  
Air Embolism ◽  
Laparoscopic Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Venous Air Embolism

scholarly journals Laparoscopic approach to hysterectomy

2013 ◽  
Vol 4 (2) ◽  
pp. 117-126
Author(s):  
Hakan Nazik
Keyword(s):  
Laparoscopic Approach ◽  
Abnormal Uterine Bleeding ◽  
Laparoscopic Hysterectomy ◽  
Cost Effective ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Pelvic Organ ◽  
Uterine Bleeding ◽  
Total Laparoscopic Hysterectomy ◽  
Uterine Leiomyomata

Modern laparoscopic surgery is widely used throughout the world as it offers greater advantages than open procedures. The laparoscopic approach to hysterectomy has evolved over the last 20 years. Hysterectomies are performed abdominally, vaginally, laparoscopically or, more recently, with robotic assistance. Indications for a total laparoscopic hysterectomy are similar to those for total abdominal hysterectomy, and most commonly include uterine leiomyomata, pelvic organ prolapse, and abnormal uterine bleeding. When hysterectomy is going to be performed, the surgeon should decide which method is safer and more cost-effective. This paper aims to make a review of the indications, techniques and advantages of laparoscopic hysterectomy as well as the criteria to be used for appropriate patient selection.

scholarly journals Cost-effectiveness of total laparoscopic hysterectomy and non-descent vaginal hysterectomy versus total abdominal hysterectomy: a multi-centre randomized controlled trial

2019 ◽  
Author(s):  
Chanil Deshan Ekanayake ◽  
Arunasalam Pathmeswaran ◽  
Sanjeewa Kularatna ◽  
Rasika Herath ◽  
Prasantha Wijesinghe
Keyword(s):  
Randomized Controlled Trial ◽  
Cost Effectiveness ◽  
Vaginal Hysterectomy ◽  
Controlled Trial ◽  
Laparoscopic Hysterectomy ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Randomized Controlled ◽  
Clinical Trials Registry

Abstract Background: Hysterectomy is the most common major surgical procedure in gynaecology. The methods in mainstream practice are; total abdominal hysterectomy (TAH), non-descent vaginal hysterectomy (NDVH) and total laparoscopic hysterectomy (TLH). Most patients requiring hysterectomy for benign gynaecological conditions can be operated using one of these methods. The aim of this study was to study cost-effectiveness of NDVH, TLH and TAH in a low resource setting. Methods: A pragmatic multi-centre three arm (parallel groups) RCT was done in the professorial gynaecology unit of the North Colombo Teaching Hospital, Ragama and the gynaecology unit of the District General Hospital, Mannar, Sri Lanka. Participants were patients requiring hysterectomy for non-malignant uterine causes. Exclusion criteria were uterus>14 weeks, previous pelvic surgery, medical illnesses which contraindicate laparoscopic surgery, and those requiring incontinence surgery or pelvic floor surgery. The main outcome measures were time to recover and cost. The willingness-to-pay (WTP) threshold was set at USD 1000. Results: There was no significant difference in median time to recover (inter quartile range) among TAH, NDVH and TLH which was 35 (30-45), 32 (24.5-60) and 30 (25.5-45) days respectively (p=0.37). The difference in area under the curve for quality adjusted life years (QALYs) was 1.33 and 5.21 for NDVH and TLH compared to TAH. The direct cost (median, interquartile range) of a TLH [USD 349 (322-378)] was significantly higher compared to TAH [USD 289 (264-307)] and NDVH [USD 279 (255-305)]. The incremental cost-effectiveness ratio (ICER) for TLH was USD 12/day whereas NDVH showed a net benefit as both costs and median effect were superior to TAH. The incremental cost utility ratio (ICUR) for TLH and NDVH were 12 and 38 USD/QALY. The ICUR for TLH compared to NDVH was USD 3/per QALY. The net monetary benefit (NMB) was USD 4897 and USD 1264 for TLH and NDVH respectively. Conclusion: Despite there being only a marginal difference among the three routes when considering time to recover, a cost-effectiveness approach using ICER, ICUR and NMB shows that alternate routes, NDVH and TLH to be superior to the conventional TAH. Trial Registration: Sri Lanka clinical trials registry, SLCTR/2016/020 and the International Clinical Trials Registry Platform, U1111-1194-8422, on 26 July 2016. Available from: http://slctr.lk/trials/515. Keywords: Non-descent vaginal hysterectomy, total laparoscopic hysterectomy, total abdominal hysterectomy, cost-effectiveness, randomized controlled trial.

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