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HYSTERECTOMY
Edited by Ayman Al-Hendy
and Mohamed Sabry
Hysterectomy
Edited by Ayman Al-Hendy and Mohamed Sabry
Published by InTech
Janeza Trdine 9, 51000 Rijeka, Croatia
Copyright © 2012 InTech
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Technical Editor Teodora Smiljanic
Cover Designer InTech Design Team
First published April, 2012
Printed in Croatia
A free online edition of this book is available at www.intechopen.com
Additional hard copies can be obtained from orders@intechopen.com
Hysterectomy, Edited by Ayman Al-Hendy and Mohamed Sabry
p. cm.
ISBN 978-953-51-0434-6
Contents
Preface IX
Part 1 Types of Hysterectomy 1
Chapter 1 Techniques of Hysterectomy 3
Nirmala Duhan
Chapter 2 Subtotal Versus Total
Abdominal Hysterectomy for
Benign Gynecological Conditions 23
Zouhair Amarin
Chapter 3 Robotic Surgery Versus
Abdominal and Laparoscopic
Radical Hysterectomy in Cervical Cancer 31
E. Ancuta, Codrina Ancuta and L. Gutu
Chapter 4 The Role of Modified Radical
Hysterectomy in Endometrial Carcinoma 51
Masamichi Hiura and Takayoshi Nogawa
Chapter 5 New Approaches to Hysterectomy
by Minimal Invasive Surgery (MIS) 75
Shanti Raju-Kankipati
and Omer Devaja
Chapter 6 Emergency Peripartum Hysterectomy 85
Abiodun Omole-Ohonsi
Chapter 7 Peripartum Hysterectomy 93
Chisara C. Umezurike
and Charles A. Adisa
Chapter 8 Peripartum Hysterectomy
Versus Non Obstetrical Hysterectomy 103
S. Masheer and N. Najmi
VI Contents
Part 2 Alternatives to Hysterectomy 113
Chapter 9 Medical Treatment of Fibroid
to Decrease Rate of Hysterectomy 115
Mohamed Y. Abdel-Rahman, Mohamed Sabry
and Ayman Al-Hendy
Chapter 10 Hysteroscopic Surgery as an
Alternative for Hysterectomy 129
Chang-Sheng Yin and Fung-Wei Chang
Chapter 11 The LNG-IUS: The First Choice Alternative to
Hysterectomy? Intrauterine Levonorgestrel-Releasing
Systems for Effective Treatment and Contraception 141
D. Wildemeersch
Chapter 12 Menorrhagia and the
Levonorgestrel Intrauterine System 159
Johnstone Shabaya Miheso
Chapter 13 Is Embolization Equal to
Hysterectomy in Treating Uterine Fibroids? 169
Tomislav Strinic
Chapter 14 Pharmacotherapy of Massive Obstetric
Bleedings as Alternative to Hysterectomy 197
Andrey Momot, Irina Molchanova,
Vitaly Tskhai and Andrey Mamaev
Part 3 Hysterectomy Pre-Operative Considerations 223
Chapter 15 Hysterectomy: Advances in Perioperative Care 225
Kenneth Jensen and Jens Børglum
Part 4 Hysterectomy Post-Operative Care 249
Chapter 16 Innovations in the Care of
Postoperative Hysterectomy Patients 251
Sepeedeh Saleh and Amitabha Majumdar
Chapter 17 Postoperative Pain Management
After Hysterectomy – A Simple Approach 269
Mariana Calderon, Guillermo Castorena and Emina Pasic
Part 5 Hysterectomy Complications 283
Chapter 18 Ureter: How to Avoid Injuries in
Various Hysterectomy Techniques 285
Manoel Afonso Guimarães Gonçalves, Fernando Anschau,
Daniela Martins Gonçalves and Chrystiane da Silva Marc
Contents VII
Chapter 19 Sacrocolpopexy for Post Hysterectomy Vault Prolapse 293
Serge P. Marinkovic, Lisa M. Gillin and Christina M. Marinkovic
Chapter 20 Urinary Tract Injuries in Low-Resource Settings 313
Mathias Onsrud
Part 6 Hysterectomy: Multiple Aspects 323
Chapter 21 Management of Pregnancy After
Conization and Radical Trachelectomy 325
Keun-Young Lee and Ji-Eun Song
Chapter 22 Know-How of the Hormonal Therapy and
the Effect of the Male Hormone on Uterus
in the Female to Male Transsexuals 335
Seok Kwun Kim and Myoungseok Han
Chapter 23 The Role of Prophylactic Oophorectomy in the Management
of Hereditary Breast & Ovarian Cancer Syndrome 345
A.J. Lowery and K.J. Sweeney
Chapter 24 Psychological Aspects of
Hysterectomy & Postoperative Care 365
Amitabha Majumdar and Sepeedeh Saleh
Chapter 25 What Do We Know About Hysterectomy? 393
Karolina Chmaj-Wierzchowska, Marcin Wierzchowski,
Beata Pięta, Joanna Buks and Tomasz Opala
Chapter 26 Predictive Value of Cellular Immune Response and
Tumor Biomarkers in Patients Surgically Treated for
Cervical Cancer in Relation to Clinical Outcomes 409
E. Ancuta, Codrina Ancuta and D. Sofroni
Preface
This book is intended for the general and family practitioners, as well as for
gynecologists, specialists in gynecological surgery, general surgeons, urologists and all
other surgical specialists that perform procedures in or around the female pelvis, in
addition to intensives and all other specialities and health care professionals who care
for women before, during or after hysterectomy. While removal of the uterus using
newer techniques such as laparoscopic and robotic hysterectomy attract the most
attention of both the patients as well as the practitioners, still, for most women,
especially in low resources countries, the conventional hysterectomy, abdominal or
vaginal, is considered the intervention of choice for removing the uterus. Such
techniques have withstood the test of time and can be performed in almost any small
or midsized surgical hospital without the need to travel to distant specialty hospitals.
It is the aim of this book to review the recent achievements of the research community
regarding the field of gynecologic surgery and hysterectomy as well as highlight future
directions and where this field is heading. While no single volume can adequately cover
the diversity of issues and facets in relation to such a common and important procedure
such as hysterectomy, this book will attempt to address the pivotal topics especially in
regards to safety, risk management as well as pre- and post-operative care.
Finally, we dedicate this book to our wonderful prior, current and future patients for
whom we strive for excellence and beyond, as we care for them with full and most
respect and love as they are our daughters, sisters and mothers, all the time.
Ayman Al-Hendy, MD, PhD
Professor, Vice Chair and Scientific Director, Department of Obstetrics and Gynecology,
Center of Women Health Research, Meharry Medical College, Nashville, Tennessee,
Adjunct professor, Vanderbilt University and Vanderbilt University Medical Center,
Nashville, Tennessee,
USA
Mohamed Sabry, MD
Department of Obstetrics and Gynecology, Sohag University Hospitals, Sohag,
Egypt
Center for Women's Health Research, Department of Obstetrics and Gynecology,
Meharry Medical College, Nashville, Tennessee,
USA
[...]... perform an oophorectomy before a vaginal hysterectomy has been regarded as safe and easy 11 Laparoscopic hysterectomy Laparoscopy has been used to carry out Laparoscopic Assisted Vaginal Hysterectomy (LAVH), laparoscopic subtotal hysterectomy (LSH), total laparoscopic hysterectomy (TLH) and vaginally assisted laparoscopic hysterectomy (VALH) Raoul Palmer of France is credited with introducing operative laparocopy... carry out a myomectomy first (by a vertical central incision on the myoma capsule) and then proceed with hysterectomy This debulking of the mass may also be achieved by sagittal hemisection of the small uterine body and shelling out of the cervical myoma Removal of the myoma allows greater accessibility and eases the subsequent completion of hysterectomy Fig 3 A total hysterectomy specimen removed... and long-term morbidity 24 Hysterectomy In a multi-centre retrospective cohort analysis to evaluate the peri- and postoperative outcomes in women undergoing laparoscopic subtotal hysterectomy versus laparoscopic total hysterectomy, the overall number of short-term and long-term complications was comparable for both procedures Laparoscopic subtotal hysterectomy as compared with laparoscopic total hysterectomy. .. abdominal hysterectomy for benign indications are low at 6 per 10,000 (2) As mortality at abdominal hysterectomy is such an infrequent event, there are no meaningful statistical comparisons comparing mortality of subtotal abdominal hysterectomy versus total abdominal hysterectomy In a study by the author to assess the standard of hysterectomy, so as to improve the quality of patient care and outcome,... surgeon to operate from one side Fig 12 Laparoscopic evaluation of pelvic organs at laparoscopic hysterectomy Fig12 shows the evaluation of uterus, adnexae and other pelvic structures at initiation of a laparoscopic hysterectomy The uterine ligaments and vascular pedicles can be coagulated 20 Hysterectomy and cut by using bipolar electro coagulation (e.g Valley lab Ligasure), ultrasonic energy (Ethicon Harmonic... actually resumed by the end of 10-14 days post operatively Coital abstinence is advised for 6 weeks 11.6 Complications of hysterectomy 1 2 3 4 5 6 Intraoperative: Anaesthetic (cardiorespiratory) and surgical problems like hemorrhage, injuries to surrounding viscera are avoided by appropriate preoperative evaluation and ensuring senior and multidisciplinary help Rarely, postoperative ileus and destruction... access by the vaginal route is associated with fewer complications, a shorter hospital stay, faster recovery and lower costs Most patients with gynecologic malignancies are operated by open abdominal route, though laparoscopic and robotic surgical techniques are increasingly being used for endometrial and cervical cancer surgery Significant uterine enlargement and/ or fixity, adnexal fixation and obliteration... be counseled prior to subtotal abdominal hysterectomy regarding hormone replacement therapy, which should include progesterone The main objectively measurable parameters in the comparison between subtotal and total abdominal hysterectomy are morbidity and mortality The main short-term and long-term comparative events and complications of subtotal versus total hysterectomy for benign uterine diseases... Bowel function Quality of life (SF-36)/Psychological outcome Overall Mortality Table 1 Short-term and long-term comparative events and complications of subtotal versus total abdominal hysterectomy for benign uterine diseases 26 Hysterectomy Generally, the mortality rates for hysterectomy, standardized for age and race, are higher for procedures associated with pregnancy or cancer than for procedures not... differences between total and subtotal hysterectomy Techniques of Hysterectomy 7 Fig 2 A total hysterectomy specimen along with both tubes and ovaries for a left sided malignant ovarian tumor which later turned out to be a clear cell carcinoma Subtotal / supracervical hysterectomy 1 Presence of cervix retains the uterine supports attached to it Hence, vault prolapse is less common 2 Easier and less morbid to . HYSTERECTOMY
Edited by Ayman Al-Hendy
and Mohamed Sabry
Hysterectomy
Edited by Ayman Al-Hendy and Mohamed Sabry
.
Hysterectomy, Edited by Ayman Al-Hendy and Mohamed Sabry
p. cm.
ISBN 978-953-51-0434-6
Contents
Preface IX
Part 1 Types of Hysterectomy
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