BOOK
Hysterectomy and the Alternatives, An Issue of Obstetrics and Gynecology Clinics of North America, E-Book
John A. Occhino | Emanuel C. Trabuco
(2016)
Additional Information
Book Details
Abstract
The Guest Editors have created a comprehensive issue devoted to the most current and clinically relevant approach to hysterectomies and their alternatives. Top experts have written articles on the following topics: Alternatives to Hysterectomy: Management of Uterine Fibroids; Alternatives to Hysterectomy: Management of Menorrhagia; Hysterectomy for benign conditions of the uterus: Total Abdominal Hysterectomy; Hysterectomy for benign conditions of the uterus: Total Vaginal Hysterectomy; Hysterectomy for benign conditions of the uterus: Total Laparoscopic Hysterectomy/Laparoscopically Assisted Vaginal Hysterectomy; Hysterectomy for benign conditions of the uterus: Radical Hysterectomy Evidence basis for hysterectomy; Cesarean Hysterectomy; Management of ovaries at the time of benign Hysterectomy; Management of the peri- and postoperative patient undergoing hysterectomy; and Simulation and surgical competency: Current issues.
Table of Contents
Section Title | Page | Action | Price |
---|---|---|---|
Front Cover | Cover | ||
Hysterectomy and the Alternatives\r | i | ||
Copyright\r | ii | ||
Contributors | iii | ||
CONSULTING EDITOR | iii | ||
EDITORS | iii | ||
AUTHORS | iii | ||
Contents | v | ||
Foreword: Fewer Hysterectomies and So Many Alternatives\r | v | ||
Preface: Hysterectomy and the Alternatives\r | v | ||
Alternatives to Hysterectomy: Management of Uterine Fibroids\r | v | ||
Management of Abnormal Uterine Bleeding with Emphasis on Alternatives to Hysterectomy\r | v | ||
Hysterectomy for Benign Conditions of the Uterus: Total Abdominal Hysterectomy\r | v | ||
Hysterectomy for Benign Conditions of the Uterus: Total Vaginal Hysterectomy\r | vi | ||
Total Laparoscopic Hysterectomy and Laparoscopic-Assisted Vaginal Hysterectomy\r | vi | ||
The Essential Elements of a Robotic-Assisted Laparoscopic Hysterectomy\r | vi | ||
Evidence Basis for Hysterectomy\r | vi | ||
Cesarean Hysterectomy and Uterine-Preserving Alternatives\r | vii | ||
Management Strategies for the Ovaries at the Time of Hysterectomy for Benign Disease\r | vii | ||
Enhanced Recovery Pathway in Gynecologic Surgery: Improving Outcomes Through Evidence-Based Medicine\r | vii | ||
Surgical Simulation and Competency\r | viii | ||
Current Issues with Hysterectomy\r | viii | ||
OBSTETRICS AND GYNECOLOGY CLINICS\r | ix | ||
FORTHCOMING ISSUES | ix | ||
December 2016 | ix | ||
March 2017 | ix | ||
June 2017 | ix | ||
RECENT ISSUES | ix | ||
June 2016 | ix | ||
March 2016 | ix | ||
December 2015 | ix | ||
Foreword:\rFewer Hysterectomies and So Many Alternatives | xi | ||
Preface:\rHysterectomy and the Alternatives | xiii | ||
Alternatives to Hysterectomy | 397 | ||
Key points | 397 | ||
INTRODUCTION | 397 | ||
EVALUATION | 398 | ||
MANAGEMENT GOALS | 400 | ||
Asymptomatic Fibroids | 400 | ||
Heavy Menstrual Bleeding | 400 | ||
Hysteroscopic myomectomy | 402 | ||
Bulk Symptoms with or Without Heavy Menstrual Bleeding | 402 | ||
GnRH agonists and antagonists | 402 | ||
Ulipristal acetate | 403 | ||
Nonpharmacologic Strategies | 404 | ||
Magnetic resonance-guided focused ultrasound ablation | 404 | ||
Uterine artery embolization (or uterine fibroid embolization) | 405 | ||
Laparoscopic radiofrequency volumetric thermal ablation | 406 | ||
Abdominal myomectomy | 406 | ||
Special consideration: morcellation | 406 | ||
REPRODUCTION AND FIBROIDS | 407 | ||
SUMMARY/DISCUSSION | 409 | ||
REFERENCES | 409 | ||
Management of Abnormal Uterine Bleeding with Emphasis on Alternatives to Hysterectomy | 415 | ||
Key points | 415 | ||
INTRODUCTION | 415 | ||
INITIAL EVALUATION | 416 | ||
INITIAL MEDICAL MANAGEMENT | 419 | ||
Chronic Abnormal Uterine Bleeding | 419 | ||
Systemic estrogen and progestin | 419 | ||
Systemic progestin | 420 | ||
Nonhormonal medications | 420 | ||
Acute Abnormal Uterine Bleeding | 420 | ||
FOLLOW-UP | 421 | ||
MANAGEMENT OF PERSISTENT ABNORMAL UTERINE BLEEDING | 421 | ||
LEVONORGESTREL INTRAUTERINE SYSTEM | 421 | ||
Levonorgestrel Intrauterine System and Abnormal Uterine Bleeding–PALM | 421 | ||
Levonorgestrel Intrauterine System and Abnormal Uterine Bleeding–COEIN | 422 | ||
How to Optimize Levonorgestrel Intrauterine System Outcomes | 422 | ||
ENDOMETRIAL ABLATION | 422 | ||
Endometrial Ablation and Abnormal Uterine Bleeding–Polyp | 423 | ||
Endometrial Ablation and Abnormal Uterine Bleeding–Adenomyosis | 423 | ||
Endometrial Ablation and Abnormal Uterine Bleeding–Leiomyoma | 424 | ||
Endometrial Ablation and Abnormal Uterine Bleeding–Coagulopathy | 424 | ||
Endometrial Ablation and Abnormal Uterine Bleeding–Ovulatory Dysfunction | 424 | ||
Endometrial Ablation and Abnormal Uterine Bleeding–Endometrial | 425 | ||
How to Optimize Outcomes After Endometrial Ablation | 426 | ||
SUMMARY | 427 | ||
REFERENCES | 427 | ||
Hysterectomy for Benign Conditions of the Uterus | 431 | ||
Key points | 431 | ||
HISTORICAL PERSPECTIVE | 431 | ||
CURRENT TRENDS | 432 | ||
PREOPERATIVE PREPARATION | 432 | ||
SURGICAL TECHNIQUE | 432 | ||
POSTOPERATIVE CARE | 438 | ||
COMPLICATIONS | 438 | ||
CONTROVERSIAL ISSUES | 439 | ||
Total Hysterectomy Versus Subtotal (Supracervical) Hysterectomy | 439 | ||
Adnexal Removal | 439 | ||
SUMMARY | 439 | ||
REFERENCES | 439 | ||
Hysterectomy for Benign Conditions of the Uterus | 441 | ||
Key points | 441 | ||
HISTORICAL PERSPECTIVE | 441 | ||
TRENDS | 442 | ||
BEST SURGICAL APPLICATIONS | 442 | ||
TECHNIQUES | 442 | ||
Preoperative Considerations | 442 | ||
Screen for pregnancy | 442 | ||
Bowel preparation | 443 | ||
Povidone-iodine douche | 443 | ||
Perineal hair removal | 443 | ||
Bladder volume | 443 | ||
Prophylactic antibiotics | 443 | ||
Patient Positioning | 443 | ||
Examination Under Anesthesia | 445 | ||
Procedure Technique: Simple Vaginal Hysterectomy | 445 | ||
Vaginal Incision | 445 | ||
Development of the Vesicovaginal Space | 445 | ||
Anterior Entry | 446 | ||
Peritoneal Entry | 446 | ||
Uterosacral Ligament | 446 | ||
Ureteral Identification or Palpation | 449 | ||
Cardinal Ligament | 450 | ||
Utero-Ovarian Pedicle | 451 | ||
Evaluate for Hemostasis | 451 | ||
Addressing the Adnexa | 451 | ||
Modified McCall Apical Suspension | 454 | ||
Reperitonealization | 454 | ||
Vaginal Cuff Closure | 454 | ||
Summary and Key Points | 455 | ||
CHALLENGING SITUATIONS | 455 | ||
Previous Pelvic Surgery or Cesarean Delivery | 455 | ||
Cervical Elongation | 456 | ||
Enlarged Uterus | 456 | ||
Obese Body Habitus | 457 | ||
COMPLICATIONS | 458 | ||
Bladder Injury | 458 | ||
Ureteral Injury | 459 | ||
SUMMARY | 460 | ||
REFERENCES | 461 | ||
Total Laparoscopic Hysterectomy and Laparoscopic-Assisted Vaginal Hysterectomy | 463 | ||
Key points | 463 | ||
HISTORICAL PERSPECTIVE | 463 | ||
INDICATIONS/CONTRAINDICATIONS | 465 | ||
TRENDS | 465 | ||
TECHNIQUE/PROCEDURE | 465 | ||
Preparation | 465 | ||
Patient Positioning | 466 | ||
Energy Sources | 467 | ||
Approach | 468 | ||
Technique/procedure (detailed steps) | 468 | ||
Uterine manipulation | 468 | ||
Laparoscopic entry | 468 | ||
Round ligament transection | 469 | ||
Bladder flap development | 469 | ||
Ligating the cornual pedicles | 469 | ||
Uterine vessel skeletonization | 470 | ||
Securing the uterine artery | 470 | ||
Colpotomy | 471 | ||
Vaginal cuff closure | 472 | ||
VAGINAL ASSISTANCE TO LAPAROSCOPIC HYSTERECTOMY | 472 | ||
Colpotomy | 473 | ||
Secure the Uterine Artery | 473 | ||
Vaginal Cuff Closure | 474 | ||
COMPLICATIONS AND MANAGEMENT | 474 | ||
Bleeding | 474 | ||
Urinary Tract Injury | 474 | ||
POSTOPERATIVE CARE | 475 | ||
REPORTING, FOLLOW-UP, AND CLINICAL IMPLICATIONS | 476 | ||
OUTCOMES | 476 | ||
CURRENT CONTROVERSIES/FUTURE CONSIDERATIONS | 476 | ||
SUMMARY | 476 | ||
REFERENCES | 477 | ||
The Essential Elements of a Robotic-Assisted Laparoscopic Hysterectomy | 479 | ||
Key points | 479 | ||
INTRODUCTION | 479 | ||
PREOPERATIVE EVALUATION | 481 | ||
INTRAOPERATIVE SETUP | 482 | ||
Patient Positioning | 482 | ||
Port Placement | 483 | ||
Robotic Docking/Instrumentation | 485 | ||
STEPS OF THE PROCEDURE | 485 | ||
Anatomic Survey | 486 | ||
Ovarian Conservation | 486 | ||
Transection of the Round Ligament | 486 | ||
Broad Ligament Dissection | 486 | ||
Bladder Flap Development | 487 | ||
Skeletonization and Transection of Uterine Vessels | 487 | ||
Colpotomy/Specimen Removal/Vaginal Cuff Closure | 487 | ||
POSTOPERATIVE CARE | 488 | ||
OUTCOMES | 489 | ||
COMPLICATIONS | 489 | ||
FUTURE CONSIDERATIONS/CONTROVERSY | 489 | ||
SUMMARY | 490 | ||
SUPPLEMENTARY DATA | 490 | ||
REFERENCES | 490 | ||
Evidence Basis for Hysterectomy | 495 | ||
Key points | 495 | ||
INTRODUCTION | 495 | ||
USING THE EVIDENCE TO CHOOSE THE BEST APPROACH | 496 | ||
Vaginal Hysterectomy Versus Total Abdominal Hysterectomy | 496 | ||
Vaginal Hysterectomy Versus Laparoscopic Hysterectomy | 497 | ||
Vaginal Hysterectomy Versus Robotic Hysterectomy | 497 | ||
COST DIFFERENCES | 497 | ||
VAGINAL CUFF DEHISCENCE | 509 | ||
ADDITIONAL FACTORS TO CONSIDER | 510 | ||
Increasing Vaginal Hysterectomy Utilization | 510 | ||
Increased Risk of Prolapse | 511 | ||
Impact on Trainees | 512 | ||
SUMMARY | 512 | ||
REFERENCES | 513 | ||
Cesarean Hysterectomy and Uterine-Preserving Alternatives | 517 | ||
Key points | 517 | ||
BACKGROUND | 517 | ||
POSTPARTUM HEMORRHAGE | 519 | ||
UTERINE ATONY | 519 | ||
SURGICAL SITE BLEEDING AND ARTERIAL LIGATION | 519 | ||
COMPRESSION SUTURES | 521 | ||
UTERINE TAMPONADE | 521 | ||
INTERVENTIONAL RADIOLOGY | 522 | ||
MASSIVE TRANSFUSION | 522 | ||
ANTIFIBRINOLYTICS | 523 | ||
TOPICAL HEMOSTATIC AGENTS | 523 | ||
ACTIVATED FACTORS | 526 | ||
INVASIVE PLACENTATION, MORBIDLY ADHERENT PLACENTATION, PLACENTA ACCRETA, PLACENTA INCRETA, AND PLACENTA PERCRETA | 526 | ||
UNEXPECTED PLACENTA ACCRETA | 528 | ||
CONSERVATIVE MANAGEMENT | 531 | ||
CESAREAN HYSTERECTOMY PROCEDURE | 531 | ||
TECHNIQUE | 532 | ||
SUMMARY | 535 | ||
REFERENCES | 535 | ||
Management Strategies for the Ovaries at the Time of Hysterectomy for Benign Disease | 539 | ||
Key points | 539 | ||
INTRODUCTION | 539 | ||
ELECTIVE VERSUS RISK-REDUCING BILATERAL SALPINGO-OOPHORECTOMY AND OVARIAN CANCER | 540 | ||
OPPORTUNISTIC SALPINGECTOMY | 541 | ||
HYSTERECTOMY WITH AND WITHOUT BILATERAL SALPINGO-OOPHORECTOMY AND INCIDENT CANCER RISK | 542 | ||
BILATERAL SALPINGO-OOPHORECTOMY AND OVERALL MORTALITY | 543 | ||
CORONARY HEART DISEASE | 543 | ||
SEXUAL FUNCTION | 545 | ||
OSTEOPOROTIC HIP FRACTURES | 545 | ||
SUBSEQUENT ADNEXAL SURGERY | 546 | ||
BILATERAL SALPINGO-OOPHORECTOMY AND ROUTE OF HYSTERECTOMY | 546 | ||
SUMMARY | 546 | ||
REFERENCES | 547 | ||
Enhanced Recovery Pathway in Gynecologic Surgery | 551 | ||
Key points | 551 | ||
INTRODUCTION | 551 | ||
BASIC CONCEPTS OF ENHANCED RECOVERY AFTER SURGERY PATHWAYS | 552 | ||
Preoperative | 552 | ||
Patient counseling and education | 552 | ||
Preoperative diet | 553 | ||
Avoiding mechanical bowel preparation | 553 | ||
Preemptive analgesia | 554 | ||
Intraoperative | 554 | ||
Anesthesia | 554 | ||
Maintaining normothermia | 554 | ||
Avoiding intraoperative fluid overload | 554 | ||
Prevention of postoperative nausea and vomiting | 555 | ||
Avoiding nasogastric tubes | 555 | ||
Limiting prophylactic peritoneal drains | 556 | ||
Postoperative | 556 | ||
Early postoperative feeding | 556 | ||
Early mobilization | 556 | ||
Early urinary catheter removal | 557 | ||
Perioperative pain management | 557 | ||
Multimodal pharmacologic analgesia | 557 | ||
Regional analgesia | 558 | ||
Thoracic epidural analgesia | 558 | ||
Transversus abdominis plane block | 558 | ||
Wound infiltration | 559 | ||
Intraperitoneal local anesthetic | 559 | ||
Considerations specific to vaginal hysterectomy | 559 | ||
Considerations specific to minimally invasive gynecologic surgery | 559 | ||
Postoperative fluid management | 560 | ||
Laxative use and prevention of postoperative ileus | 560 | ||
HASTENING POSTOPERATIVE RECOVERY | 560 | ||
Enhanced Recovery After Surgery and Benign Abdominal Hysterectomy | 560 | ||
Enhanced Recovery After Surgery and Vaginal Hysterectomy | 561 | ||
Enhanced Recovery After Surgery and Laparoscopic Hysterectomy | 562 | ||
HEALTH ECONOMICS | 562 | ||
HEALTH-RELATED QUALITY OF LIFE AND PATIENT SATISFACTION | 563 | ||
SUMMARY | 563 | ||
REFERENCES | 564 | ||
Surgical Simulation and Competency | 575 | ||
Key points | 575 | ||
INTRODUCTION | 575 | ||
OPTIONS FOR SURGICAL SIMULATION | 576 | ||
Animal and Human Cadaver Simulation | 576 | ||
Low-Fidelity Trainers | 577 | ||
Virtual Reality Simulation | 577 | ||
CURRENT ROLE OF SIMULATION IN SURGICAL TRAINING | 578 | ||
SIMULATION’S ROLE IN COMPETENCY-BASED MEDICAL EDUCATION | 579 | ||
Meaning of Competency and Competency-based Medical Education | 579 | ||
Assessment in Competency-based Medical Education | 580 | ||
Adoption of Competency-based Training in North America | 580 | ||
Simulation’s Role in Achieving Competency | 581 | ||
TRANSLATION OF SIMULATION COMPETENCY TO SURGICAL COMPETENCY | 583 | ||
EXISTING SIMULATORS SPECIFIC TO HYSTERECTOMY | 586 | ||
SUMMARY | 586 | ||
Areas of Future Study/Development | 586 | ||
REFERENCES | 588 | ||
Current Issues with Hysterectomy | 591 | ||
Key points | 591 | ||
INTRODUCTION | 591 | ||
MORCELLATION | 592 | ||
REIMBURSEMENT AND HEALTH CARE REFORM | 595 | ||
Merit-based Incentive Payment System | 595 | ||
Quality (30 points) | 595 | ||
Meaningful use of technology (25 points) | 596 | ||
Resource use (30 points) | 596 | ||
Clinical practice improvement (15 points) | 596 | ||
Alternate Payment Model | 596 | ||
DISCUSSION | 598 | ||
REFERENCES | 599 | ||
Index | 603 |