Changing hysterectomy technique from open abdominal to laparoscopic: New trend in Oslo, Norway

Department of Obstetrics and Gynaecology (OBSTGYN), University of Oslo, Kristiania (historical), Oslo, Norway
Journal of Minimally Invasive Gynecology (Impact Factor: 1.83). 01/2007; 14(1):74-7. DOI: 10.1016/j.jmig.2006.08.011
Source: PubMed


To evaluate the change in hysterectomy technique.
Retrospective study (Canadian Task Force classification XXX).
University tertiary referring center in Norway.
A total of 1963 women treated with hysterectomy over a 5-year period in Oslo.
The operative records and techniques were investigated in all treated patients.
A total of 1963 hysterectomies were performed from 2001 through 2005. The operative patient records were investigated with the main focus on indication for surgery and the technique used in the operative procedure. In 2001, 62 (17.7%) laparoscopic hysterectomies were performed, while 256 (73.1%) of the hysterectomies were done with laparotomy. The operative technique has gradually changed during the last 5 years. In 2005, 220 (53.5%) of the surgical procedures were laparoscopic, 177 (43.1%) were done by laparotomy, while the vaginal approach in all these years was less than 10%.
From 2001 to 2005, a trend shift of the operative technique has been observed in Oslo, increasing the endoscopic hysterectomy rate from approximately 18% to 54%. During the same time, enlarged uteri with myomas equivalent to 10 to 12 weeks' gestation and endometrial cancer were more often treated by laparoscopic hysterectomy instead of open abdominal hysterectomy. With modern equipment and trained staff, more routine hysterectomies can be managed with laparoscopy.

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    • "In a recent review by Hauspy et al., comparing laparoscopic approach with open surgery in endometrial cancer patients, the same benefits of laparoscopy were observed as for women with benign indication, and, based on currently available data, they recommend that women with endometrial cancer should be offered minimally invasive surgery as part of their treatment whenever possible [14]. We have previously reported on changing hysterectomy technique, mainly for benign indications [15]. We strongly believe that minimally invasive surgery is beneficial also for endometrial cancer patients, as was briefly mentioned in our previous report. "
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    ABSTRACT: Background. Laparoscopic hysterectomy has proved to be a safe alternative to open surgery in women with benign indications. Few studies compare laparotomy and laparoscopy in gynecologic oncology, and the objective of this study was to analyze the feasibility and development of laparoscopic surgery in endometrial cancer patients. Material and Methods. Records from all women having a hysterectomy due to premalignant or malignant endometrial changes during the years 2002-2009 were examined retrospectively. Results. A total of 521 hysterectomies were performed during the study period. Laparoscopy was performed in about 20% of the cases in the first two years, increasing to 83% in the last year of the period. Moreover, the laparoscopic technique was increasingly applied in older women, more obese women and in women with high-risk preoperative diagnosis, without increasing the complication rate. Conclusions. As for benign indications, laparoscopic hysterectomy in endometrial cancer patients should be preferred whenever possible.
    Full-text · Article · Jul 2011 · Obstetrics and Gynecology International
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    • "At our department in Oslo, Norway, supracervical hysterectomy is the recommended procedure for women with benign conditions requiring hysterectomy and with no previous history of cervical dysplasia. Although laparoscopic supracervical hysterectomy (LSH) has gradually replaced abdominal hysterectomy, SAH is still performed in women where laparoscopic or vaginal approach is not feasible, mainly due to significant enlarged uterus [7]. Opponents of supracervical hysterectomy, either it is performed open or by a laparoscopic approach, often seem to be concerned with the risk of cervical stump symptoms such as vaginal bleeding and pelvic pain following the hysterectomy, causing patient distress and eventually repeated surgery. "
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    ABSTRACT: Long-term outcomes, in terms of cervical stump symptoms and overall patient satisfaction, were studied in women both after abdominal (SAH) and laparosocopic (LSH) supracervical hysterectomies. Altogether, 134 women had SAH and 315 women LSH during 2004 and 2005 at our department. The response rate of this retrospective study was 79%. Persistent vaginal bleeding after the surgery was reported by 17% in the SAH group and 24% in the LSH group. Regular bleeding was reported by only 8% in both study groups, and the women rarely found the bleeding bothersome. The women reported a significant pain reduction after the surgery, but women having a hysterectomy because of pain and/or endometriosis should be informed about the possibility of persistent symptoms. The overall patient satisfaction after both procedures was high, but the patients should have proper preoperative information about the possibility of cervical stump symptoms after any supracervical hysterectomy.
    Full-text · Article · Mar 2010 · Obstetrics and Gynecology International
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    • "Laparoscopic hysterectomy is indicated as an alternative to laparotomy when the vaginal route is potentially difficult because of an immobile uterus or a poor vaginal accessibility (Chapron et al., 1995). Most hysterectomies are done by laparotomy but the rate of hysterectomies performed by laparoscopy is increasing regularly these last years (Chapron et al., 1999; Farquhar and Steiner, 2002; David-Montefiore et al., 2007; Istre et al., 2007). The benefit of laparoscopy compared with laparotomy is actually well known (Kovac, 2000; Garry et al., 2004; Johnson et al., 2005; Falcone et al., 1999). "
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    ABSTRACT: Laparoscopic hysterectomy is indicated as an alternative to laparotomy when the vaginal route is potentially difficult because of an immobile uterus and a poor vaginal accessibility. The aim of this study was to evaluate the rate, the risk factors for bladder injuries in a series of 1501 laparoscopic hysterectomies indicated for benign uterine pathologies. This study was conducted retrospectively from January 1993 to 2000 and prospectively from 2001 to July 2007.The indications, patients' characteristics and complications were recorded. The overall rate of bladder injuries, the comparison of means (t test) and percentages (exact chi(2) test) between the cases and the population with no injury, the odd ratios (OR) and multivariate analysis were performed using the statistical package for the social sciences software. The rate of bladder injuries was 1% (15 patients). Risks factors were previous Caesarian section [OR: 4.33, 95% confidence interval (CI): 1.53-12.30] and previous laparotomy (OR: 4.69, 95% CI: 1.59-13.8). The rate of injury decreases with the surgeons' experience and reaches a plateau of 0.4% after 100 hysterectomies performed. The rate of bladder injury during total laparoscopic hysterectomy is low and decreases with the surgeon's experience. Bladder injury is not linked to an increase of post-operative morbidity when recognized and repaired during the same laparoscopic procedure. The comparison with other routes of hysterectomies should take into account these risk factors.
    Preview · Article · Feb 2009 · Human Reproduction
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