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 |