Introduction of Laparoscopic Hysterectomy Approach: Decreasing the Abdominal Hysterectomy Approach or Replacing Vaginal Hysterectomy
DOI:
https://doi.org/10.17140/SROJ-2-107Keywords:
Surgery, Laparoscopic Hysterectomy (LH), Cancer, Minimally invasive technique, Obese patientsAbstract
Background: It has been noted in the medical literature that abdominal hysterectomy rates continue to be over 66%, with less than one-third of hysterectomies performed via minimally invasive approaches despite the rapidity of recovery. We compared trends in hysterectomy routes for the years 2000 and 2010 at our institution.
Methods: Expedited IRB approval was obtained for a retrospective chart review of all hysterectomies performed during 2000 and 2010. Medical records were abstracted for basic demographics, including age, Body Mass Index (BMI), uterine size (grams), and route of hysterectomy (laparoscopic, vaginal, laparotomy). Laparoscopic approaches included Total Laparoscopic Hysterectomy (TLH), Laparoscopic Supracervical Hysterectomy (LSH), Laparoscopy Assisted Vaginal Hysterectomy (LAVH), and Da Vinci robotic hysterectomy. Standard statistical analysis was performed using JMP statistical programming.
Results: No differences were found between mean age and racial distribution in the years analyzed. In 2000 and 2010, 50% of hysterectomies were performed using minimally invasive techniques. In 2000, 47% were performed via the vaginal route whereas in 2010, 47.7% were performed via laparoscopy. When patients were stratified by weight class, obese women (BMI>30) had a statistically significant greater number of hysterectomies performed via the abdominal route when compared to normal weight women; this was independent of uterine weight. African-American women were also found more likely to have an abdominal hysterectomy, but once controlled for uterine weight, this difference dissipated.
Conclusions: At our institution, 50% of hysterectomies were performed using minimally in vasive techniques in both 2000 and 2010, with laparoscopic approaches essentially replacing vaginal hysterectomies by 2010 without affecting abdominal hysterectomy rates. Minimally invasive approaches continue to lag in obese women.
References
Wright JD, Herzog TJ, Tsui J, et al. Nationwide trends in the performance of inpatient hysterectomy in the United States. Obstet Gynecol. 2013; 122(2 Pt 1): 233-241. doi: 10.1097/ AOG.0b013e318299a6cf
Merrill RM. Hysterectomy surveillance in the United States, 1997 through 2005. Med Sci Monit. 2008; 14(1): CR24-CR31.
AAGL Advancing Minimally Invasive Gynecology World-wide. AAGL Position Statement: Route of Hysterectomy to Treat Benign Uterine Disease. J Minim Invasive Gynecol. 2011; 18: 1-3. doi: 10.1016/j.jmig.2010.10.001
Jacoby VL, Autry A, Jacobson G, Domush R, Nakagawa S, Ja-coby A. Nationwide use of laparoscopic hysterectomy compared with abdominal and vaginal approaches. Obstet Gynecol. 2009; 114(5): 1041-1048. doi: 10.1097/AOG.0b013e3181b9d222
Nieboer TE, Johnson N, Lethaby A, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2009; 3: CD003677. doi: 10.1002/14651858. CD003677.pub4
Abenhaim HA, Azziz R, Hu J, Bartolucci A, Tulandi T. So-cioeconomic and racial predictors of undergoing laparoscopic hysterectomy for selected benign diseases: analysis of 341487 hysterectomies. J Minim Invasive Gynecol. 2008; 15: 11-15. doi: 10.1016/j.jmig.2007.07.014
Tu FF, Beaumont JL, Senapati S, Gordon TE. Route of hyster-ectomy influence and teaching hospital status. Obstet Gynecol. 2009; 114(1): 73-78. doi: 10.1097/AOG.0b013e3181aa9597
Burkett D, Horwitz J, Kennedy V, Murphy D, Graziano S, Kenton K. Assessing current trends in resident hysterectomy training. Female Pelvic Med Reconstr Surg. 2011; 17: 210-214. doi: 10.1097/SPV.0b013e3182309a22
Cohen SL, Vitonis AF, Einarsson JI. Updated Hysterec-tomy Surveillance and Factors Associated With Minimally Invasive Hysterectomy. JSLS. 2014; 18(3). doi: 10.4293/ JSLS.2014.00096
Wu JM, Wechter ME, Geller EJ, Nguyen TV, Visco AG. Hysterectomy rates in the United States, 2003. Ob-stet Gynecol. 2007; 110(5): 1091-1095. doi: 10.1097/01. AOG.0000285997.38553.4b
Dorsey JH, Steinberg EP, Holtz PM. Clinical indications for hysterectomy route: patient characteristics or physician pref-erence? Am J Obstet Gynecol. 1995; 173(5): 1452-1460. doi: 10.1016/0002-9378(95)90632-0
Loring M, Morris SN, Isaacson KB. Minimally invasive specialists and rates of laparoscopic hysterectomy. JSLS. 2015; 19(1): e2014.00221. doi: 10.4293/JSLS.2014.00221
Chen I, Lisonkova S, Allaire C, Williams C, Yong P, Joseph KS. Routes of hysterectomy in women with benign uterine dis-ease in the Vancouver Coastal Health and Providence Health Care regions: a retrospective cohort analysis. CMAJ Open. 2014; 2(4): E273-E280. doi: 10.9778/cmajo.20130080
Turner LC, Shepherd JP, Wang L, Bunker CH, Lowder JL. Hysterectomy surgical trends: a more accurate depiction of the last decade? Am J Obstet Gynecol. 2013; 208(4): 277.e1-e7. doi: 10.1016/j.ajog.2013.01.022
Jacoby VL, Autry A, Jacobson G, Domush R, Nakagawa S, Jacoby A. Nationwide use of laparoscopic hysterectomy com-pared with abdominal and vaginal approaches. Obstet Gynecol. 2009; 114(5): 1041-1048.
Antosh DD, Gutman RE, Iglesia CB, Sokol AI, Park AJ. Resident opinions on vaginal hysterectomy training. Female Pelvic Med Reconstr Surg. 2011; 17(6): 314-317. doi: 10.1097/ SPV.0b013e31823a08bf
Jacoby VL, Fujimoto VY, Giudice LC, Kuppermann M, Washington AE. Racial and ethnic disparities in benign gyneco-logic conditions and associated surgeries. Am J Obstet Gynecol. 2010; 202(6): 514-521. doi: 10.1016/j.ajog.2010.02.039
Bogani G, Cromi A, Serati M, et al. Laparoscopic and vaginal approaches to hysterectomy in the obese. Eur J Ob-stet Gynecol Reprod Biol. 2015; 189: 85-90. doi: 10.1016/j. ejogrb.2015.02.035
Mikhail E, Scott L, Imudia AN, Hart S. Total laparoscopic hysterectomy in the obese patient. Surg Technol Int. 2014; 25: 167-174.
Brezina PR, Beste TM, Nelson KH. Does route of hyster-ectomy affect outcome in obese and nonobese women? JSLS. 2009; 13(3): 358-363.
Shah DK, Vitonis AF, Missmer SA. Association of body mass index and morbidity after abdominal, vaginal, and laparo-scopic hysterectomy. Obstet Gynecol. 2015; 125(3): 589-598. doi: 10.1097/AOG.0000000000000698
Tinelli R, Litta P, Meir Y, et al. Advantages of laparoscopy versus laparotomy in extremely obese women (BMI> 35) with early-stage endometrial cancer: a multicenter study. Anti-cancer Res. 2014; 34(5): 2497-2502.
Bardens D, Solomayer E, Baum S, et al. The impact of the body mass index (BMI) on laparoscopic hysterectomy for be-nign disease. Arch Gynecol Obstet. 2014; 289(4): 803-807. doi: 10.1007/s00404-013-3050-2
Morgan-Ortiz F, Soto-Pineda JM, López-Zepeda MA, Peraza-Garay Fde J. Effect of body mass index on clinical out-comes of patients undergoing total laparoscopic hysterectomy. Int J Gynaecol Obstet. 2013; 120(1): 61-64. doi: 10.1016/j. ijgo.2012.08.012
Siedhoff MT, Carey ET, Findley AD, Riggins LE, Garrett JM, Steege JF. Effect of extreme obesity on outcomes in laparo-scopic hysterectomy. J Minim Invasive Gynecol. 2012; 19(6): 701-707. doi: 10.1016/j.jmig.2012.07.005
Kondo W, Bourdel N, Marengo F, et al. What’s the impact of the obesity on the safety of laparoscopic hysterectomy tech-niques? J Laparoendosc Adv Surg Tech A. 2012; 22(10): 949- 953. doi: 10.1089/lap.2012.0213
Boyd LR, NovetskyAP, Curtin JP. Effect of surgical volume on route of hysterectomy and short-term morbidity. Obstet Gynecol. 2010; 116(4): 909-915. doi: 10.1097/AOG.0b013e3181f395d9
Hoyer-Sorensen C, Hortemo S, Lieng M. Changing the route of hysterectomy into a minimal invasive approach. ISRN Obstet Gynecol. 2013; 2013: 249357. doi: 10.1155/2013/249357
Moen M, Walter A, Harmanli O, et al. Considerations to improve the evidence-based use of vaginal hysterectomy in be-nign gynecology. Obstet Gynecol. 2014; 124(3): 585-588. doi: 10.1097/AOG.0000000000000398
Kovac SR. Route of hysterectomy: an evidence-based ap-proach. Clin Obstet Gynecol. 2014; 57(1): 58-71. doi: 10.1097/ GRF.0000000000000009
Moen MD, Richter HE. Vaginal hysterectomy: past, pres-ent, and future. Int Urogynecol J. 2014; 25(9): 1161-1165. doi: 10.1007/s00192-014-2459-x
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
All content published in Surgical Research (SR) is licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0). This license allows anyone to copy, distribute, transmit, and adapt the work — including for commercial purposes — provided appropriate credit is given to the original author(s) and source.