OBJECTIVE: To report our clinical outcome on 160 cases of laparoscopically assisted vaginal hysterectomy (LAVH) and to evaluate the efficacy and safety of LAVH. METHODS: From May, 1998 to April 2004, 160 patients were performed LAVH at the Department of Obstetrics and Gynecology, Dankook University Hospital. We retrospectively analyzed the results with regard to age, parity, height, weight, previous operation history, preoperative indication, combined operation, operation time, uterine weight, change of hemoglobin, hospitalization, convert to total abdominal hysterectomy (TAH), and complication. RESULTS: The mean age was 44.63 +/- 6.79 years, The mean parity was 2.34 +/- 1.18. The common previous operations were tubal ligation (54%) and appendectomy (17%). The common preoperative indications were myoma (75%) and adenomyosis (10%). The most common combined operation was unilateral salpingoophorectomy (39%). The mean operation time was 97.81 +/- 29.90 minutes, and the mean uterine weight was 215.59 +/- 89.97 g. The mean hemoglobin change was 2.08 +/- 1.34 g/dL, and the mean hospitalization was 4.45 +/- 0.71 days. The complications were bladder injury (1 case), rectum injury (1 case), subcutaneous hematoma (2 cases), hemoperitoneum (1 case). CONCLUSION: LAVH is effective and safe alternative to TAH in many cases of gynecologic surgery. LAVH has been possible to replace TAH with improvement of surgical skill and laparoscopic instruments.
Adenomyosis ; Appendectomy ; Female ; Gynecologic Surgical Procedures ; Gynecology ; Hematoma ; Hemoperitoneum ; Hospitalization ; Humans ; Hysterectomy ; Hysterectomy, Vaginal* ; Myoma ; Obstetrics ; Parity ; Rectum ; Retrospective Studies ; Sterilization, Tubal ; Urinary Bladder

Vaginal evisceration is a rare but life threatening complication of gynecologic surgery. Most of them occur after abdominal or vaginal hysterectomy. The incidence after laparoscopic hysterectomy is unknown. The incidence of evisceration in the patients undergoing laparoscopic hysterectomy in our hospital was 0.1 %. The rapid recovery after laparoscopic hysterectomy, compared with abdominal hysterectomy, is widely acknowledged. Swift return to everyday activities and early resumption of intercourse could predispose to rupture of vaginal vault. Upon discharge, patients undergoing laparoscopic hysterectomy should be given careful instructions to avoid coitus until complete healing of vaginal vault. We described three cases of vaginal evisceration after laparoscopic hysterectomy including a review of the literature.
Coitus ; Female ; Gynecologic Surgical Procedures ; Humans ; Hysterectomy* ; Hysterectomy, Vaginal ; Incidence ; Rupture

OBJECTIVE: To evaluate the incidence, characteristics, and convalescence times of urinary tract injury after gynecological surgery, total abdominal hysterectomy (TAH), laparoscopic-assisted vaginal hysterectomy (LAVH), total vaginal hysterectomy (VH), radical hysterectomy (RH), and laparoscopic-assisted radical hysterectomy (LRH). METHODS: We retrospectively analyzed 109 patients with urinary tract injuries after total hysterectomy from May 1989 to April 2004. During the study period, 18,721 hysterectomies were carried out. RESULTS: The total incidence of urinary tract injury after total hysterectomy was 0.59%, as follows: TAH, 0.55%; LAVH, 0.64%; VH, 0.62%; RH, 0.69%; and LRH, 1.56%. The total incidence of bladder and ureteric injury was, respectively, 0.51 and 0.09%, as follows: TAH, 0.51 and 0.04%; LAVH, 0.57 and 0.07%; VH, 0.62 and 0%; RH, 0.21 and 0.49%; and LRH, 1.79 and 0.89%. There was no significant difference of the incidence of urinary tract injury type of operation with benign findings (P>0.05), but there was significant difference of the incidence of injury between type of operation with benign and malignant findings (P<0.05). The convalescence times were 10.3+/-8.7 days after bladder injury and 44.4+/-16.27 days after ureteric injury diagnosed intraoperatively, but 33.3+/-46.6 days after bladder injury and 69.0+/-16.4 days after ureteric injury diagnosed postoperatively. There was significant difference between both groups (P<0.05). CONCLUSION: In this study, total hysterectomy resulted in 0.59% incidence of urinary tract injury and repair of these injuries was successful in all cases. There was no significant difference for incidence of urinary tract injury between types of operation with benign findings, but there was significant difference between types of operation for benign and malignant findings. The convalescence times for intraoperatively recognized injuries were significantly shorter than those for injuries recognized postoperatively. 109, but significant difference between benign and malignant gynecological operations (P<0.05). Tintraoperatively recognized.
Convalescence ; Female ; Gynecologic Surgical Procedures ; Humans ; Hysterectomy* ; Hysterectomy, Vaginal ; Incidence ; Retrospective Studies ; Ureter ; Urinary Bladder ; Urinary Tract*

Vesicovaginal fistula (VVF) is one of the most serious surgical complication in gynecologic surgery. Surgical approach to repair this condition can be performed by transvaginal or transabdominal. However, laparoscopic repair of VVF may be an alternative surgical method. We present four cases of VVF treated with transperitoneal laparoscopic technique. Laparoscopic repair is a feasible, safe and efficacious minimally invasive approach for the management of VVF. We believe that this method provides excellent results and may result in lower morbidity, shorter hospital stay, and quicker recovery than the abdominal or transvaginal approaches.
Female ; Gynecologic Surgical Procedures ; Hysterectomy ; Laparoscopy ; Length of Stay ; Vesicovaginal Fistula

The development of robotic technology has facilitated the application of minimally invasive techniques for complex gynecologic surgery. Robot-assisted gynecologic surgery has grown exponentially since receiving Food and Drug Administration approval for use in gynecologic surgery in 2005. Robotic surgery has several major advantages, including three-dimensional visual magnification, articulation beyond normal manipulation, and the filtering of the operator's hand tremors. Therefore, robotic surgery is suitable for microsurgery, and it could be an alternative option for laparotomy. Robotic surgery has advantages, especially for suture-intensive operations such as myomectomy. Patients who underwent robot-assisted laparoscopic myomectomy had significantly decreased estimated blood loss, complication rates, and length of hospital stay. The advantages of robotic surgery help to overcome the limitations of laparoscopy, especially for complicated procedures in deep infiltrating endometriosis. Although extensive radical operations for deep infiltrating endometriosis of the bowel and urinary tract, such as segmental resections of the bladder, ureters, and bowel, were performed by laparotomy in the past, they are now performed more easily and more effectively using robotic techniques. In a recent systematic review and meta-analysis, robotic and laparoscopic sacrocolpopexy resulted in similar clinical outcomes, but robotic surgery was associated with a longer operation time and higher costs. Robotic and conventional laparoscopic hysterectomy show equivalent surgical and clinical outcomes. Compared to laparotomy, robotic gynecologic cancer surgery results in improved clinical outcomes and comparable oncologic outcomes. If robotic surgery is tailored in terms of patient selection, surgeon ability, and equipment availability, it could be a feasible option for highly advanced minimally invasive surgery.
Endometriosis ; Female ; Gynecologic Surgical Procedures ; Gynecology ; Hand ; Humans ; Hysterectomy ; Laparoscopy ; Laparotomy ; Length of Stay ; Microsurgery ; Minimally Invasive Surgical Procedures ; Patient Selection ; Robotic Surgical Procedures ; Trachelectomy ; Tremor ; United States Food and Drug Administration ; Ureter ; Urinary Bladder ; Urinary Tract ; Uterine Myomectomy

PURPOSE: Urologic injuries occur frequently during surgery in the pelvic cavity. Inadequate diagnosis and treatment may lead to severe complications and side effects. This investigation examined the clinical features of urologic complications following obstetric and gynecologic surgery. MATERIALS AND METHODS: We accumulated 47,318 obstetric and gynecologic surgery cases from 2007 to 2011. Ninety-seven patients with urological complications were enrolled. This study assessed the causative disease and surgical approach, type, and treatment method of the urologic injury. RESULTS: Of these 97 patients, 69 had bladder injury, 23 had ureteral injury, 2 had vesicovaginal fistula, 2 had ureterovaginal fistula, and 1 had renal injury. With respect to injury rate by specific surgery, laparoscopic-assisted radical vaginal hysterectomy was the highest with 3 of 98 cases, followed by radical abdominal hysterectomy with 15 of 539 cases. All 69 cases of bladder injury underwent primary suturing during surgery without complications. Of 14 cases with an early diagnosis of ureteral injury, 7 had a ureteral catheter inserted, 5 underwent ureteroureterostomy, and 2 underwent ureteroneocystostomy. Of nine cases with a delayed diagnosis of ureteral injury, ureteral catheter insertion was carried out in three cases, four cases underwent ureteroureterostomy, and two cases underwent ureteroneocystostomy. CONCLUSIONS: Bladder injury was the most common urological injury during obstetric and gynecologic surgery, followed by ureteral injury. The variety of injured states, difficulty of diagnosis, and time to complete cure were much greater among patients with ureteral injuries. Early diagnosis and urologic intervention is important for better outcomes.
Delayed Diagnosis ; Early Diagnosis ; Female ; Fistula ; Gynecologic Surgical Procedures ; Humans ; Hysterectomy ; Hysterectomy, Vaginal ; Iatrogenic Disease ; Ureter ; Urinary Bladder ; Urinary Catheters ; Urinary Tract ; Vesicovaginal Fistula

From January 1998 to December 2002, 3,259 cases of uterine myoma were treated at the department of Obstetrics and Gynecology, Chunbuk National University Hospital. A clinico-stastical study of uterine myoma was perfomed to analyse the clinical characteristics. The results were as follows. 1. The incidence of uterine myoma was 9.8%. 2. The most frequent age group was 40 to 49 years, and the mean age was 44.6 years. 3. The average parity was 2.29, the infertility was 163 cases (5.0%), while the primary infertility, 2.4%, the secondary, 2.6% respectively. 4. The most frequent chief complaint was pain which was observed in 2,648 cases (81.2%), abnormal bleeding in 1,775 cases (53.8%). dizziness in 270 cases (8.3%). 5. The corporeal myomas were observed in 2,879 cases (95.9%). Intramural type was observed in 1,687 cases (58.2%), subserous in 529 cases (18.2%), submucous in 191 cases (6.5%), mixed type in 483 cases (17.0%). 6. The mean value of preoperative hemoglobin was 11.1 gm/dL, and the anemia (Hb<10.0 gm/dL) was observed in 481 cases (11.7%). Transfusion was necessary in 215 cases (6.5%). 7. The mean weight of the uterine myoma operated was 335.0 gm. 8. The secondary change of myoma was found in 54 cases (1.7%) and hyaline degeneration was the most common (0.7%). 9. The most common associated condition was chronic cervicitis, which was observed in 784 cases (24.1%). 10. The gynecologic surgery were performed in 1,456 cases (44.7%), medical therapy in 25 cases (0.8%), observation in 1,792 cases (55.0%). 11. Total abdominal hysterectomy was performed in 607 cases (41.7%), total abdominal hysterectomy with unilateral adnexectomy in 115 cases (7.9%), total abdominal hysterectomy with both adnexectomy in 164 cases (11.3%), subtotal hysterectomy in 304 cases (20.9%), myomectomy in 153 cases (10.5%), total laparoscopic hysterectomy in 103 cases (7.0%), laparoscopy assisted vaginal hysterectomy in 8 cases (0.5%), diagnostic laparoscopy in 2 cases (0.1%) respectively. 12. The postoperative complication were found in 113 cases (3.5%) and the wound infection was the most common (1.6%). 13. The mean period of hospitalization was 8 days, and the period less than 10 days in 1,177 cases (80.9%).
Anemia ; Dizziness ; Female ; Gynecologic Surgical Procedures ; Gynecology ; Hemorrhage ; Hospitalization ; Humans ; Hyalin ; Hysterectomy ; Hysterectomy, Vaginal ; Incidence ; Infertility ; Laparoscopy ; Leiomyoma* ; Myoma ; Obstetrics ; Parity ; Postoperative Complications ; Uterine Cervicitis ; Wound Infection

OBJECTIVETo examine the operative approaches, major indications, and medical economic parameters of the hysterectomy.

METHODSData on hysterectomy performed due to benign gynecological disorders in Peking Union Medical College Hospital (PUMCH) from 1996 to 2001 were reviewed. The cases were classified into three groups according to the operative approaches: total abdominal hysterectomy (TAH), vaginal hysterectomy (VH), and laparoscopic assisted vaginal hysterectomy (LAVH). The major indications, length of hospital stay, operative cost, and total medical cost were analyzed.

RESULTSRecords of 4,180 women who had hysterectomies in PUMCH were examined. Operations included TAH (78.4%), LAVH (13.0%), and VH (8.6%). The use of LAVH increased from 2.4% in 1996 to 17.3% in 2001. The common indications for surgery included uterine leiomyoma (56.2%), adenomyosis (12.2%), benign ovarian tumor (9.2%), genital prolapse (7.7%), endometriosis (6.9%), atypical endometrial hyperplasia (3.0%), and cervical intraepithelial neoplasm (2.0%). The most common indications for TAH and LAVH were uterine leiomyomas and adenomyosis, whereas the most common indication for VH was genital prolapse, followed by uterine leiomyoma. The lengths of hospital stay in TAH, VH, and LAVH were (11.0 +/- 4.9) d, (10.9 +/- 3.9) d, and (8.9 +/- 3.7) d respectively. The total medical cost was (5,666.6 +/- 1,709.4) RMB Yuan for TAH, (5,027.6 +/- 1,067.0) RMB Yuan for VH, and (7,473.8 +/- 1,464.8) RMB Yuan for LAVH.

CONCLUSIONSThe use of LAVH has been increasing. Although the direct medical cost for LAVH is higher than that for TAH, its indirect benefit appeares superior to TAH. The major indications for LAVH and TAH are similar, whereas the indications for VH are different from those for TAH and LAVH.

Costs and Cost Analysis ; Evaluation Studies as Topic ; Female ; Gynecologic Surgical Procedures ; economics ; Humans ; Hysterectomy ; economics ; methods ; Hysterectomy, Vaginal ; Laparoscopy ; Leiomyoma ; surgery ; Uterine Neoplasms ; surgery

Hinh-Minh’s incision is a modified technique based on Pfannestiel’s incision (1900) and Cohen’s incision (1977), and could be applied in obstetric and gynecological surgeries (including Cesarean section). It has the advantages of two old techniques for gynecological operations. Hinh-Minh’s incision had taken full advantages and limited shortcomings of both techniques of Pfannenstiel’s incision and Joel Cohen’s incision. It secured aesthetics as Pfannestiel technique but reduced operation time and limited harmfully blood-vessels and nerves as well as Joel Cohen technique. At the same time, this technique was applied firstly in the situation of Vietnam on 49 patients underwent gynecological operations from June 2000 to December 2001. Operative time and recovery time were reduced, the rate of fever, wound infection and incision dehiscence were low.
Gynecologic Surgical Procedures ; Surgery

Background: Robotic surgery is a form of minimally invasive surgery wherein the surgeon controls the camera and instruments in a console, remote from the operating room table. Currently, the system in place is the da Vinci Surgical System which was approved by the United States Food and Drug Administration in 2000 for laparoscopic surgery. Since its approval in 2005 for Gynecologic procedures, the da Vinci Surgical System has been used for hysterectomies, lymph node dissections, sacrocolpopexies, myomectomies, and cerclage. Objective: This paper presents the initial seven cases of benign gynecologic diseases operated on utilizing the da Vinci Surgical System in our institution – six hysterectomies and one myomectomy. Methodology: Seven gynecologic surgeries that utilized the da Vinci Surgical System in 2019 until the first quarter of the year 2020 were done. Medical records of the seven patients were reviewed. Results: The average docking time was 38 minutes (range: 25 – 65 minutes) and the average console time was 227 minutes (range: 175 – 345 minutes). The average blood loss was 576 cc (range: 80 – 1200 cc). No cases converted to an abdominal laparotomy and no morbidities were reported. While two cases underwent blood transfusion intraoperatively, all cases were stable post-operatively and were for discharge after two days. On follow-up, all patients were stable with an unremarkable clinical course. Conclusion Our initial experience demonstrates that robotic surgery appears as a viable alternative to traditional approaches. As more cases are to be done in the future, fine-tuning of the logistical set-up and surgical skills are expected, as well as venturing into other gynecologic diseases such as malignancies. Further research must be conducted on various aspects of robotic surgery, such as but not limited to outcome comparison with traditional and other laparoscopic approaches, long term outcomes, patient safety, and patient experience and preference, among others.
Female ; Gynecologic Surgical Procedures