ABSTRACT
OBJECTIVE: To review the safety and effectiveness of a new vaginal hysterectomy method, Minilaparatomically Assisted Vaginal Hysterectomy (MAVH), tried on benign diseases with indication of abdominal hysterectomy. MATERIALS AND METHODS: The analysis of the safety and the effectiveness of MAVH is based on randomized consecutive 75 patients who received the operation from Feb. 1, 2002 to Jul. 10, 2002 in the department of Obstetrics and Gynecology at Gacheon Medical University Hospital. OPERATION TECHNIQUE: Access to the pelvic cavity was obtained by the traditional suprapubic minilaparotomical incision that is 2-2.5 cm long and parallel to the pubic hair line. Through this incision site, the adnexa and other pelvic organs around the bladder were brought into sight by manipulating the uterine elevator that was already inserted into the uterine cavity. By this method, the round ligament, uteroovarian ligament, and the fallopian tube were exposed at the incision site, then clamped, cut, sutured and divided. The dissection of the bladder peritoneum was performed and then followed by the traditional transvaginal approach. RESULTS: The MAVH was successful in 73 cases (97.3%) out of 75 attempts. The mean age, parity, weight, and body mass index of the subjects of the 73 cases were 42.6 (+/-7.8) years, 2.0 (+/-0.7), 59.5 (+/-7.5) kg, and 23.6 (+/-2.6). Forty subjects (54.8%) had a previous surgical history. The operational indications were 44 cases (60.3%) of uterine myoma, 19 cases (26.0%) of uterine bleeding, 7 cases (9.6%) of dysmenorrhea, and 3 other cases (4.1%). There were 6 cases (8.2%) of cumulative complication. In terms of pathologic diagnosis, 54 cases (74.0%) were uterine myoma with adenomyosis, 12 cases (16.4%) adenomyosis, 2 cases (2.7%) endometrial polyp, 1 case (1.4%) endometrial hyperplasia, 1 case endometrial cancer, and 3 other cases. The weights of uteri ranged from 75 gm to 1150 gm with an average of 286.8 (+/-217.5) gm. The average operation time for MAVH from skin incision to the completion of suture was 75.8 (+/-21.8) minutes. The average bowel function recovery time was 45.9 (+/-12.9) hours. The external bleeding loss was 337.0 (+/-306.8) ml, 11.0% (8/73) required transfusion with an average amount of 1.5 pint. No subject of this study needed reoperation or expired. CONCLUSION: The technique of MAVH is simple and easy to learn. The MAVH involves a relatively small size of incision and less pain and complication with fast recovery and small wound. The method requires a little bit of practice but not an expensive equipment. The MAVH is considered as a safe and effective operational method which could replace the abdominal hysterectomy in most cases.
Subject(s)
Female , Humans , Adenomyosis , Body Mass Index , Diagnosis , Dysmenorrhea , Elevators and Escalators , Endometrial Hyperplasia , Endometrial Neoplasms , Fallopian Tubes , Gynecology , Hair , Hemorrhage , Hysterectomy , Hysterectomy, Vaginal , Leiomyoma , Ligaments , Obstetrics , Parity , Peritoneum , Polyps , Recovery of Function , Reoperation , Round Ligament of Uterus , Skin , Sutures , Urinary Bladder , Uterine Hemorrhage , Uterus , Weights and Measures , Wounds and InjuriesABSTRACT
OBJECTIVE: To evaluate the clinical significance of AGUS including histologic results and diagnostic modalities according to menopausal status. METHODS: One hundred and four patients with AGUS were identified. Corresponding biopsies were available for 87 of these cases. The evaluation for histologic results and diagnostic modalities was made according to menopausal status. RESULTS: Among the 87 patients with AGUS, the number of premenopausal and menopausal patients were 46 (52.9%) and 41 (47.1%), respectively. Over all, 70 (80.5%) of 87 patients were found to have important histologic findings and of them, premenopausal and menopausal patients with invasive diseases were 19 (41.3%) and 31 (75.6%) respectively. There were significant differences in pathologic findings between premenopausal and menopausal patients indicating more invasive lesions in menopausal than premenopausal patients (p=0.002). For the evaluation of diagnostic modality, the second arm was significantly more needed for menopausal than premenopausal patients (p=0.018). CONCLUSION: AGUS on pap smear represents a cytologic diagnosis associated with high incidence of underlying preinvasive and invasive lesions, especially in postmenopausal patients. Thus aggressive work-up is recommended to rule out the potential pathologic conditions in endocervix, endometrium and rarely extrauterine lesions such as gastrointestinal, tubal, ovarian or breast in patients otherwise unexplained AGUS after careful first arm work-up.