scholarly journals Clinical Outcomes of Total Laparoscopic Hysterectomy (TLH): Seven Years’ Experience in a Public Hospital

2019 ◽  
Vol 34 (1) ◽  
pp. 28-35
Author(s):  
Jobaida Sultana ◽  
Md Manir Hossain Khan ◽  
Professor Fatema Ashraf ◽  
Mahmuda Sultana ◽  
Mariha Alam Chowdhury
Keyword(s):  
Demographic Data ◽  
Operating Time ◽  
Laparoscopic Hysterectomy ◽  
Outcome Data ◽  
Total Laparoscopic Hysterectomy ◽  
Pelvic Surgery ◽  
Bladder Injury ◽  
Ureterovaginal Fistula ◽  
Urological Complications ◽  
The Mean

Objective: The aim of the study was to explore the surgical outcomes of total laparoscopic hysterectomy. Materials and methods: This was a prospective analysis of total Laparoscopic Hysterectomy (TLH) done between January, 2012 to December, 2018 in Shaheed Suhrawardy Medical College and Hospital. Demographic data, clinical criteria, intra operative and postoperative outcome data were recorded. Data were collected in a predesigned Data collection sheet. Follow up records done during discharge from the hospital, one week and four weeks postoperatively. Results: Total 298, laparoscopic hysterectomy were performed during the period. Among them 96 % (n=286) for benign and 4 %( n=12) for malignant condition were included in the study population. Mean age of the patients was 45.4 ± 5.6 years, mean parity was 1.9 ± 0.64 and the mean body mass index was 27.48 ± 0.57. The most common benign disease was leiomyoma, 51.7 %. Among the study cases 21.8% (n=65) had history of at least one previous abdomino-pelvic surgery. Maximum size of uterus removed was 28 weeks and maximum patients, 48% (n=143) had uterine size of 10-14 weeks. The operating time was variable between 50 min to 180 min and in the course of time, the mean operating time dropped from 130 min to 60 min. The mean length of hospital stay was 2 days and the return to normal activities was within 2 weeks. Major complications observed among 3.7 % of cases among them 2(0.67%) bladder injury, 2(0.67%) vesico-vaginal fistula (VVF), 3(1.0%) ureterovaginal fistula (UVF) and 4(1.3%) peroperative hemorrhage requiring blood transfusion. Among the 7 cases of urological complications, one patient with VVF and one patient with UVF needed relaparotomy. Ultimately all cases were managed without any residual problem. Conversion to laparotomy was 0.3 % (n=1) of case. Conclusion: TLH offers the benefit of minimally invasive surgery to the patient and is a safe and acceptable alternative to standard hysterectomy for various gynaecological indications. Bangladesh J Obstet Gynaecol, 2019; Vol. 34(1): 28-35

scholarly journals Trends and patterns in total laparoscopic hysterectomy in tertiary care hospital

2018 ◽  
Vol 7 (6) ◽  
pp. 2170
Author(s):  
Sonali Ingole ◽  
Sameer Darawade
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Laparoscopic Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Bladder Injury ◽  
Care Hospital ◽  
Estimated Blood Loss ◽  
The Mean

Background: Due to technical advances in the field of laparoscopy, there has been an increase in total laparoscopic hysterectomies all over the world in last decade. This study was conducted to analyse the technique and surgical outcome of total laparoscopic hysterectomy in tertiary care hospitalMethods: This is a retrospective cohort (observational) study, which included all patients who underwent Total Laparoscopic Hysterectomy (TLH) for benign conditions from January 2012 to December 2017 at the tertiary Care Hospital. The data so obtained was analysed for various parameters like indication for surgery, mean operating time, length of hospital stay, complications and conversion to abdominal route.Results: Total number of 2307 hysterectomies were performed over a period of 5 years. Of these, TLH were 270 (11.70%). Amongst those undergoing TLH, the mean age was 45±7.84 years. The most common indication for the surgery was fibroid uterus (38.14%), followed by dysfunctional uterine bleeding (28.88%), and adenomyosis (15.1%). The mean estimated blood loss was 106±4.34 ml. Hemorrhage (n = 2) and bladder injury (n = 4) were most common surgical complications.Conclusions: TLH is safe and effective procedure for most of the benign pelvic conditions. With adequate training TLH can be used more widely in tertiary care hospital and teaching institute.

scholarly journals Total Laparoscopic Hysterectomy: A Two-Year Experience in Apollo Hospitals Dhaka

Pulse ◽  
2016 ◽  
Vol 8 (1) ◽  
pp. 21-29
Author(s):  
Monowara Begum ◽  
Nasrin Zulfiqar ◽  
Fatema Yasmin
Keyword(s):  
Hospital Stay ◽  
Demographic Data ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Laparoscopic Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Bladder Injury ◽  
Published Data ◽  
Complication Rates ◽  
Morbidity Data

Objective: Aim of our study is to analyze the surgical outcome of total laparoscopic hysterectomy (TLH) in our patient perspective of Apollo Hospitals Dhaka.Methods: This is a retrospective, observational study where we have reviewed demographic data, intraoperative and postoperative outcomes, and morbidity data on 100 women who underwent TLH between January 2011 and December 2012.Results: Total 100 patients were studied. Among them five patient required conversion to laparotomy due to presence of severe adhesion. The major and minor complication rates were 2% (bladder injury-2 cases) and 0% respectively. The average operating time was 148 ± 40 minutes and the mean length of hospital stay was 3±1 day. The average uterine size was 10 ± 4 weeks. In our cases operating time and duration of hospital stay were very similar with lower procedural complications to other published data elsewhere.Conclusion: We have observed that TLH is a safe and acceptable alternative procedure to standard hysterectomy from the patients perspective at Apollo Hospital Dhaka.Pulse Vol.8 January-December 2015 p.21-29

scholarly journals Total laparoscopic hysterectomy: a retrospective study of 5 years

2019 ◽  
Vol 8 (12) ◽  
pp. 5008
Author(s):  
Suma S. Moni ◽  
Suchith Hoblidar ◽  
Rathnamala M. Desai ◽  
Sunil Kumar K. S.
Keyword(s):  
Retrospective Study ◽  
Demographic Data ◽  
Operating Time ◽  
Laparoscopic Hysterectomy ◽  
Bladder Injury ◽  
Medical Sciences ◽  
Operative Specimen ◽  
Duration Of Surgery ◽  
Operative Complications ◽  
Operative Findings

Background: Hysterectomy is one of the most common gynecological surgeries performed around the world. This study was done to review the data of all patients who underwent TLH. With this study a uniform method of performing TLH by a single surgeon was assessed.Methods: A 5 years retrospective study was performed at Sri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital Dharwad, Karnataka India. Demographic data, pre-operative findings, indication for surgery, intra-operative and post-operative complications, duration of surgery were recorded and analyzed.Results: A total of 118 women were included in the study. Mean age of the patients wasMost common indication for the surgery was leiomyoma. Mean operating time was 162.18 minutes. Mean weight of the post-operative specimen was 208.45 grams. Intra-operative urinary bladder injury was seen in 1 patient. Conversion to laparotomy was needed in 2 patients.Conclusions: With improving experience TLH can be performed safely without complications. As number of surgeries done increases duration of TLH reduces. TLH can be effectively used to avoid laparotomy.

scholarly journals Assessment of the learning curve: total laparoscopic hysterectomy versus total abdominal hysterectomy

2019 ◽  
Vol 8 (10) ◽  
pp. 4045
Author(s):  
Nutan Yadav ◽  
Priyanka Tiwari ◽  
Abhishek Mangeshikar ◽  
Sushil Kumar
Keyword(s):  
Blood Loss ◽  
Learning Curve ◽  
Operating Time ◽  
Laparoscopic Hysterectomy ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Success Rates ◽  
Estimated Blood Loss ◽  
The Mean

Background: Abdominal hysterectomy is the most frequented way of hysterectomy in the world; today we have a lot of techniques for hysterectomy. Total Laparoscopic Hysterectomy (TLH) versus Total Abdominal Hysterectomy (TAH) needs experience an assessment of the learning curve. Objective of the study was to determine the feasibility and safety of TLH and TAH.Methods: Total 100 women were taken for study. Operating time, estimated blood loss, operating complication and length of stay in hospital were noted for each patient. The success rates of TLH were more compared to TAH. The operating time estimated blood loss, conversion to laparotomy was directly proportional to size of uterus.Results: There were no statistically significant differences between the two groups regarding age, body mass index (BMI), specimen weight, pre-operative hemoglobin (Hb) value and rates of the complications. The mean post-operative Hb value was significantly higher in group TLH than group TAH (11.3±0.7 gr/dl versus 10.6±1.6, p = 0.03). The mean time of operation was significantly longer in TLH than group TAH (105.4±22.9 minutes versus 74±18, p<0.001). The mean duration of hospital stay was statistically shorter in TLH compared to the TAH (2.47±0.5 days versus 4.86±1.1, p<0.001).Conclusions: Advantage of TLH over TAH are less blood loss, fewer wound infection and fever, smaller incisions, with less pain, shorter hospitalization time, speedier recovery.

scholarly journals Histerectomia Totalmente Laparoscópica: Análise Retrospetiva de 262 Casos

2014 ◽  
Vol 27 (1) ◽  
pp. 73 ◽  
Author(s):  
Cristina Nogueira-Silva ◽  
Samuel Santos-Ribeiro ◽  
Sónia Barata ◽  
Conceição Alho ◽  
Filipa Osório ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Major Complication ◽  
Laparoscopic Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Complication Rates ◽  
Uterine Weight ◽  
Average Hospital ◽  
The Mean

<strong>Introduction:</strong> Hysterectomy is one of the most common gynecological procedures and may be performed either by vaginal approach, laparotomy or laparoscopy. Although total laparoscopic hysterectomy has multiple advantages, conflicting major complication rates have been previously reported.<br /><strong>Objectives:</strong> To describe our experience performing TLH and to evaluate complication rates.<br /><strong>Material and Methods:</strong> A retrospective observational study of all total laparoscopic hysterectomy performed in our department, by the same surgical team, between April 2009 and March 2013 (n = 262), was conducted. Medical records were reviewed for patient characteristics, operating time, uterine weight, post-operative hemoglobin variation, length of hospital stay, and intra and postoperative complications.<br /><strong>Results:</strong> Patient average age was 48.9 ± 9.0 years and 49.2% had previous abdominopelvic surgery. The average body mass index was 26.5 ± 4.5 kg/m2 and 42% of women were either overweight or obese. The mean operating time during the total study period was 77.7 ± 27.5 minutes, but it decreased significantly as the surgical team’s training increased. Average uterine weight was 241.0 ± 168.4g and average hospital stay was 1.49 ± 0.9 days. The mean postoperative hemoglobin variation was -1.5 ± 0.8g/dL. The major and minor complication rates were 1.5% (n = 4) and 11.5% (n = 30), respectively. One procedure was converted to laparotomy and two women<br />had a vaginal vault dehiscence. No important urinary tract or bowel injuries occurred.<br /><strong>Conclusions:</strong> This study demonstrates that, in experienced hands, total laparoscopic hysterectomy is safe and with low complications rates.

Earthquake Related Injuries: Assessment of 854 Victims of the 2003 Bam Disaster Transported to Tertiary Referral Hospitals

2008 ◽  
Vol 23 (6) ◽  
pp. 510-515 ◽  
Author(s):  
Hassan Ali Mohebbi ◽  
Shaban Mehrvarz ◽  
Masoud Saghafinia ◽  
Yadollah Rezaei ◽  
Seyed Mohsen Towliat Kashani ◽  
...  
Keyword(s):  
Medical Care ◽  
Injury Severity ◽  
Demographic Data ◽  
Mean Value ◽  
Outcome Data ◽  
Tertiary Referral ◽  
Disaster Victims ◽  
Richter Scale ◽  
Referral Hospitals ◽  
The Mean

AbstractBackground:In December 2003, the residents of Bam, Iran experienced an earthquake that measured 6.6 on the Richter scale and destroyed >90% of the city. After the assessment and initial treatment of injuries at national and international field hospitals, a considerable number of victims (approximately 12,000) were transferred to tertiary referral hospitals around the country. Objective: This report evaluated the injuries of 854 victims transferred to 12 referral hospitals in Tehran.Methods:The demographic data, injury patterns, injury severity score (ISS), diagnosis, treatment, and outcome data of 854 Bam earthquake victims were assessed.Results:There were 467 (54.7%) males and 387 (45.3%) females. The mean age of the patients was 29.0 years. Transportation by aircraft was the most common method used for evacuation, which was used to evacuate 555 patients (65%). Fifty-four percent of the victims required initial medical aid at field hospitals before transportation to Tehran. There were 1,322 patients with injuries, of which, fractures of the lower extremities were the most common (331; 25%). Limb fixation was the most commonly performed primary procedure in emergency wards (389 cases, 39.9%). The mean value ±SD for ISS was 6.7 ±5.2. Orthopedic operations were the most frequent surgical procedures performed (195/260 operations, 75%) and the overall mortality rate was 1.6% (n = 14).Conclusions:Along with the crucial importance of aid provided by national and international field hospitals in disasters, suitable triage of casualties and preparedness of tertiary referral centers in unaffected regions also play an important role in providing medical care to disaster victims. During these situations, the number of victims cannot be predicted accurately, and sufficient medical care, particularly for orthopedic problems, can be provided by referral centers.

scholarly journals URINARY TRACT INJURIES FOLLOWING OBSTETRIC AND GYNECOLOGIC SURGERIES -A PROSPECTIVE STUDY IN A TERTIARY CARE HOSPITAL.

2020 ◽  
pp. 67-68
Author(s):  
Khumallambam Ibomcha Singh ◽  
Konsam Jina Devi ◽  
Kangjam Sholay Meitei
Keyword(s):  
Urinary Tract ◽  
Vesicovaginal Fistula ◽  
Tertiary Care ◽  
Ureteral Injury ◽  
Gynecologic Surgery ◽  
Bladder Injury ◽  
Care Hospital ◽  
Ureterovaginal Fistula ◽  
Ureteral Injuries ◽  
Urological Complications

Purpose: Urinary tract injuries occur frequently during surgery in the pelvic cavity. Inadequate diagnosis and treatment may lead to severe complications and morbidities. This study examined the clinical features of urologic complications following obstetric and gynecologic surgery and their management. Materials and Methods: We prospectively analysed 14,678 obstetric and gynecologic surgery cases from May 2015 to May 2019. Twenty-one patients with urological complications were enrolled. This study assessed the etiology and surgical approach, type, and treatment method of the urologic injury. Results: Of these 21 patients, 11 had bladder injury, 1 had ureteral injury, 1 had combined bladder and ureteral injury, 8 had vesicovaginal fistula and 5 had ureterovaginal fistula. With respect to injury rate by specific surgery, radical hysterectomy was the highest with 5 of 21 cases. Out of 11 cases of bladder injury, only one underwent laparoscopic bladder repair and the rest had transabdominal primary repair during surgery with a 100% success rate. Two of 7 ureteral injuries were identified intraoperatively. One underwent ureteroureterostomy and another had ureteroneocystostomy with no major complications. All 8 cases of vesicovaginal fistula had open transabdominal O’ connor repair and all 5 cases of ureterovaginal fistula were cured after ureteroneocystostomy following percutaneous nephrostomy. Conclusions: Urinary bladder injury was the most common urological injury during obstetric and gynecologic surgery, followed by ureteral injury. The types of injured states, diagnostic difficulty, and time to complete cure were much greater among patients with ureteral injuries. Early diagnosis and necessary urologic intervention are important for better outcome.

scholarly journals Ureterovaginal Fistula after Use of Harmonic Scalpel in Total Laparoscopic Hysterectomy: Possible Causes and Successful Management

2014 ◽  
Vol 2 (2) ◽  
pp. 111-112
Author(s):  
De Arpita ◽  
Archana Sharma
Keyword(s):  
South Asian ◽  
Clinical Examination ◽  
Harmonic Scalpel ◽  
Laparoscopic Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Successful Management ◽  
Ureterovaginal Fistula ◽  
Bladder Control ◽  
Full Bladder

ABSTRACT We report a case of a woman presenting with continuous dribbling of urine since her total laparoscopic hysterectomy with harmonic scalpel three months back. A clinical examination, three swab test and IVP confirmed a left sided uretrovaginal fistula. A ureteroneocystostomy was done and she recovered full bladder control. In this case we try to find the reasons and the finer points of harmonic use to prevent such an injury. How to cite this article Arpita D, Sharma A. Ureterovaginal Fistula after use of Harmonic Scalpel in Total Laparoscopic Hysterectomy: Possible Causes and Successful Management. J South Asian Feder Menopause Soc 2014;2(2):111-112.

scholarly journals Non-Descent Vaginal Hysterectomy - Analysis of 100 Cases

2013 ◽  
Vol 3 (1) ◽  
pp. 1-5
Author(s):  
Soma Bandyopadhyay ◽  
Manidip Pal
Keyword(s):  
Vaginal Hysterectomy ◽  
Operating Time ◽  
Pelvic Surgery ◽  
Bladder Injury ◽  
Medical Sciences ◽  
Wide Range ◽  
Abdominal Route ◽  
History Of ◽  
Large Uterus ◽  
And Training

OBJECTIVE: To evaluate the feasibility of performing vaginal hysterectomy for non-prolapsed uteri as primary route METHODS: 100 patients planned for hysterectomy for a wide range of  indications like large uterus, cervix flushed with vagina, previous pelvic surgery were chosen for vaginal hysterectomy. Prerequisite were uterine size not more than 16 weeks, adequate vaginal access and good uterine mobility. Patients with utero-vaginal prolapse, complex adnexal mass and suspected malignancy were excluded. RESULTS: Majority were aged 35 – 45 years (77%) with 8 nullipara and 21 primipara. Commonest indication was fibroid (54%) and largest uterine size was 16 weeks. There were 79 patients with history of different pelvic surgeries. Different morcellation techniques were used in more than 10 weeks sized uteri. Adnexal surgeries were performed in 12 cases without difficulty. In uncomplicated cases average blood loss was 200 ml and operating time was 50 minutes. Most of the patients were discharged by 5th post operative day. Two patients were converted to abdominal route due to bladder injury and slippage of upper pedicle respectively. CONCLUSION: Experience and training can lead gynecologist to consider the vaginal approach as the standard route for hysterectomy.DOI: http://dx.doi.org/10.3126/ajms.v3i1.4471Asian Journal of Medical Sciences 3(2012) 1-5

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