Menu Expand
Hysterectomy and the Alternatives, An Issue of Obstetrics and Gynecology Clinics of North America, E-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