Hysterectomy Techniques and Outcomes for Benign Large Uteri: A Systematic Review.

Autor:	Mamik MM; Albert Einstein College of Medicine, Bronx, New York; University of Calgary, Calgary, Alberta, Canada; Northwestern Medicine, Chicago, Illinois; Ochsner Clinical School, Jefferson, Louisiana; Waukesha Memorial Hospital, Waukesha, Wisconsin; University Hospitals, Cleveland, Ohio; Rutgers New Jersey Medical School, Newark, New Jersey; Kaiser Permanente, Roseville, California; Florida State University, Tallahassee, Florida; Brown University School of Public Health, Providence, Rhode Island; and Houston Methodist Hospital, Houston, Texas., Kim-Fine S, Yang L, Sharma V, Gala R, Aschkenazi S, Sheyn D, Howard D, Walter AJ, Kudish B, Balk EM, Antosh DD
Jazyk:	angličtina
Zdroj:	Obstetrics and gynecology [Obstet Gynecol] 2024 Jul 01; Vol. 144 (1), pp. 40-52. Date of Electronic Publication: 2024 May 15.
DOI:	10.1097/AOG.0000000000005607
Abstrakt:	Objective: To identify the optimal hysterectomy approach for large uteri in gynecologic surgery for benign indications from a perioperative morbidity standpoint. Data Sources: PubMed and Embase databases were searched from inception through September 19, 2022. Meta-analyses were conducted as feasible. Methods of Study Selection: This review included studies that compared routes of hysterectomy with or without bilateral salpingo-oophorectomy for large uteri (12 weeks or more or 250 g or more) and excluded studies with any concurrent surgery for pelvic organ prolapse, incontinence, gynecologic malignancy, or any obstetric indication for hysterectomy. Tabulation, Integration, and Results: The review included 25 studies comprising nine randomized trials, two prospective, and 14 retrospective nonrandomized comparative studies. Studies were at high risk of bias. There was lower operative time for total vaginal hysterectomy compared with laparoscopically assisted vaginal hysterectomy (LAVH) (mean difference 39 minutes, 95% CI, 18-60) and total vaginal hysterectomy compared with total laparoscopic hysterectomy (mean difference 50 minutes, 95% CI, 29-70). Total laparoscopic hysterectomy was associated with much greater risk of ureteral injury compared with total vaginal hysterectomy (odds ratio 7.54, 95% CI, 2.52-22.58). There were no significant differences in bowel injury rates between groups. There were no differences in length of stay among the laparoscopic approaches. For LAVH compared with total vaginal hysterectomy, randomized controlled trials favored total vaginal hysterectomy for length of stay. When rates of blood transfusion were compared between these abdominal hysterectomy and robotic-assisted total hysterectomy routes, abdominal hysterectomy was associated with a sixfold greater risk of transfusion than robotic-assisted total hysterectomy (6.31, 95% CI, 1.07-37.32). Similarly, single studies comparing robotic-assisted total hysterectomy with LAVH, total laparoscopic hysterectomy, or total vaginal hysterectomy all favored robotic-assisted total hysterectomy for reduced blood loss. Conclusion: Minimally invasive routes are safe and effective and have few complications. Minimally invasive approach (vaginal, laparoscopic, or robotic) results in lower blood loss and shorter length of stay, whereas the abdominal route has a shorter operative time. Systematic Review Registration: PROSPERO, CRD42021233300. Competing Interests: Financial Disclosure Shunaha Kim-Fine received payments from Duschenay Pharma, Lupin Pharmaceuticals, and Searchlight Pharma. Linda Yang received payment from KLAAS, Inc. David Sheyn received payment from Calder Medical, Medtronic, and Axonics. Danielle Antosh received payment from La Grippe research as a consultant to a surgical robot usability study. The other authors did not report any potential conflicts of interest. (Copyright © 2024 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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