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Outpatient hysterectomy results prove positive.

ORLANDO -- Good perioperative outcomes result when women undergo a total vaginal approach to hysterectomy in an outpatient setting, according to a case series of more than 1,000 such surgeries.

"Vaginal hysterectomy can be successfully adapted for outpatient surgery centers," Dr. Mark A. Zakaria said. "In this select patient population, regardless of previous pelvic surgery or nulliparity, and even in cases with larger uteri, good perioperative outcomes have been achieved."

Dr. Zakaria and his associates retrospectively reviewed 1,162 consecutive women who underwent hysterectomy from 2000 to 2010 by a single surgeon. A total of 1,071, or 92%, were total vaginal hysterectomies, and their outcomes were studied further. The current research is an update to a 2005 study of outcomes in the first 412 patients (J. Minim. Invasive Gynecol. 2005; 12:494-501).

Approximately 600,000 hysterectomies are performed annually in the United States, according to the Centers for Disease Control and Prevention. At the time of the 2005 study, approximately two-thirds of hysterectomies were done through an open, abdominal incision, Dr. Zakaria said at the meeting. "Vaginal hysterectomy has been shown to be safely adapted as an outpatient procedure. Both the American College of Obstetrics and Gynecology and the AAGL support vaginal hysterectomy as a preferred, minimally invasive mode of hysterectomy"

The current study supports a vaginal approach, Dr. Zakaria said, with its mean operative time of 40 minutes, mean estimated blood loss of 63 mL, and same-day discharge for 96% of patients.

Although many women in the series had concurrent procedures, researchers focused only on the hysterectomy portion of surgery from incision of the mucosa to the close of the vaginal cuff. Dr. Zakaria said in response to a meeting attendee's question. Dr. Zakaria is a minimally invasive gynecologic surgery fellow at the University of South Florida, Tampa.

All women had hysterectomies for benign indications, including dysfunctional uterine bleeding, pelvic organ prolapse, fibroids, pelvic pain, and carcinoma-in-situ of the cervix.

Preoperative and postoperative care was standardized.

For example, all patients received preoperative counseling, pre-emptive analgesia, and deep vein thrombosis prophylaxis. In addition, they had active pain control during recovery and intensive postoperative surveillance, including daily telephone calls up to 7 days post surgery.

The researchers reviewed potential confounders including age, uterine weight, nulliparity, and prior pelvic surgery. Mean patient age was 47 years. The mean uterine weight was 230 g.

"Of note, 30% of these cases had greater than 250-g uteri, and 17 out of the 1,071 were greater than 1,000 g," Dr. Zakaria said.

A total 193 women were nulliparous and 281 had prior pelvic surgery. Four patients were readmitted after surgery, for a rate of 0.4%.

All surgeries were performed by Dr. Barbara Levy, coauthor of the current research and lead investigator for the 2005 report. Dr. Levy is a gynecologist at St. Francis Hospital in Federal Way, Wash.

Prospective studies in the outpatient setting are needed to further compare minimally invasive hysterectomy approaches, Dr. Zakaria said.


Major Finding: Mean operative time was 40 minutes, mean estimated blood loss was 63 mL, and 96% of women were discharged the same day.

Data Source: Retrospective review of 1,071 outpatient total vaginal hysterectomies.

Disclosures: Dr. Zakaria said he had no relevant financial disclosures


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Title Annotation:OBSTETRICS
Author:McNAMARA, Damian
Publication:OB GYN News
Date:Jan 1, 2012
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