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Objectives: This study aimed to evaluate the training and self‐assessed proficiency of surgeons in the surgical management of pelvic organ prolapse (POP). We focused on the factors that influence decision‐making, the surgical techniques employed, the training received, and the management of complications. Design: A cross‐sectional survey. Setting: An electronic questionnaire. Population: European Urogynaecological Association (EUGA) and International Urogynecological Association (IUGA) members. Methods: A total of 33 questions evaluating surgeon preference regarding vaginal surgeries. Main Outcome Measures: Demographics, surgical selection, proficiency and technique, and training methods. Results: There were 471 respondents, of which 273 (58%) dedicated more than 50% of their week to urogynaecology. 250 (53%) had completed a fellowship, with 215 (86%) of those fellowships being in urogynaecology and pelvic floor reconstruction. A preference for hysterectomy in cases of uterine descent was noted by 297 (63%) respondents, influenced mainly by patient preference, age, and prolapse anatomical score. A total of 443 (94%) were proficient in vaginal hysterectomy, with two‐thirds performing 30 or fewer procedures annually; 212 (45%) reporting a decrease in the number of procedures over the last decade. Additionally, 373 (79%) respondents believed that 10–30 cases were needed to achieve and maintain proficiency. Conclusion: Vaginal hysterectomy remains a key component in uterine prolapse repair. However, with the rise of uterine‐sparing prolapse repairs, the decision‐making process may be influenced by multiple factors, including surgical training. Emphasis should be placed on training and maintaining proficiency in both traditional and novel techniques. [ABSTRACT FROM AUTHOR]

Background/Objectives: This systematic review aimed to evaluate the outcomes of minimally invasive techniques in gynecological cancer surgery, specifically laparoscopic hysterectomies (LHs), robotic-assisted hysterectomies (RHs), and laparoscopic-assisted vaginal hysterectomies (LAVHs). Methods: We conducted a comprehensive search of electronic databases including PubMed and MedLine from January 2010 to August 2024. The search included randomized controlled trials (RCTs) and observational studies. Studies were selected based on inclusion criteria such as a focus on LHs, RHs, or LAVHs, and reporting on key outcomes like recovery rates, overall survival (OS) rates, disease-free survival (DFS), postoperative complications, and surgery time. Exclusion criteria were applied to omit non-randomized studies, non-English publications, and those lacking relevant data. Results: The analysis included 35 studies on gynecological cancers and surgical procedures, conducted across multiple countries. Among them, 8 were RCTs from countries like the Netherlands and Italy, while 20 were retrospective cohort studies from China and the USA. The studies varied in design, cancer type, and participant age, highlighting diverse surgical approaches and the adaptation of minimally invasive techniques in gynecological cancer treatment. LH and RH demonstrated similar oncological safety with comparable OS and DFS rates. RH was associated with reduced blood loss, but longer operative times compared to LH. LAVH showed favorable perioperative outcomes, including shorter hospital stays and faster recovery, but was less frequently studied in advanced-stage cancers. Complication rates were generally lower in minimally invasive surgeries compared to open procedures. The findings support the efficacy of LH and RH as viable alternatives to open surgery, with specific advantages depending on patient and disease characteristics. Conclusions: Minimally invasive techniques in gynecological cancer surgery offer significant advantages in terms of recovery and complication rates. Despite these benefits, further research is needed to confirm their oncological safety and overall effectiveness compared to traditional open surgeries. [ABSTRACT FROM AUTHOR]

The article discusses the potential benefits of enhanced recovery after surgery (ERAS) pathways for day case hysterectomies, drawing parallels with the principles of marginal gains used by elite athletes. It highlights the importance of preoperative patient education, minimal access approaches, and early mobilization for improved outcomes. The authors emphasize the need for multidisciplinary collaboration, patient selection, and ERAS principles to facilitate rapid recovery and discharge. The text also addresses challenges in implementing day case hysterectomies and suggests strategies for successful adoption of ERAS programs. [Extracted from the article]

Background: Hysterectomy for endometrial hyperplasia and endometrial cancer in morbidly obese patients is challenging. Here, we reported data regarding three minimally invasive approaches. Method: This is a multicenter retrospective study evaluating 30-day and 90-day surgery-related outcomes of morbidly obese patients (those with BMI > 40kg/m2) undergoing robotic-assisted, laparoscopic, and vaginal hysterectomy. Results: Charts of 95 morbidly obese patients who underwent surgery for endometrial cancer were retrieved. Overall, robotic-assisted, laparoscopic, and vaginal surgeries were performed in 35 (36.8%), 38 (40%), and 22 (23.2%) patients, respectively. Patients having robotic-assisted surgery experienced longer operative time than patients having vaginal and laparoscopic approaches (p < 0.001). Surgical approaches did not influence the risk of having intraoperative and severe (Clavien-Dindo grade 3 or more) postoperative complications. No 90-day mortality occurred. Conclusions: Robotic-assisted, laparoscopic, and vaginal surgery represent three safe and feasible minimally invasive approaches to manage morbidly obese patients with endometrial hyperplasia and endometrial cancer. [ABSTRACT FROM AUTHOR]

• vNOTES high uterosacral ligament suspension showed shorter surgical time than vaginal suspension. • vNOTES high uterosacral ligament suspension showed less complications than vaginal suspension. • vNOTES high uterosacral ligament suspension showed equivalent patient reported outcomes as vaginal suspension. Vaginal hysterectomy combined with uterosacral suspension (USLS) is a technique for treating pelvic organ prolapse. Vaginal natural orifice transluminal endoscopic surgery (vNOTES) has been described as an alternative minimal invasive approachfor treating various gynecological and non-gynecological pathologies. The aim was to compare the surgical time between conventional vaginal hysterectomy combined with USLS and vNOTES hysterectomy combined with USLS. Multi-center randomized controlled trial performed 2019–2021 at Rambam Health Care Campus (Israel) and Imelda Hospital (Belgium). Thirty women underwent vNOTES procedures and 30 women underwent conventional vaginal procedures. The primary outcome was total surgical time. Secondary outcomes included hysterectomy time, USLS time, intraoperative bleeding, length of hospitalization, pain during the first 24 h postoperative, the need of analgesia, intraoperative and postoperative adverse events, and patient-reported outcomes questionnaires. Parametric statistical methods were used to analyze the data. Compared to conventional vaginal procedures, vNOTES procedures were shorter in total surgical time (77 vs. 93 min, p = 0.004), hysterectomy time (26 vs 33 min, p < 0.001), and USLS time (20 vs 26 min. p = 0.02). Blood loss was higher in conventional vaginal compared to vNOTES surgery, as reflected by the mean blood loss estimate (143 vs 60 ml. p < 0.001) and the delta-hemoglobin (pre-operation minus the post-operation hemoglobin level (1.8 vs 1.2 ml/dL, p = 0.01). There was no difference between the groups regarding analgesics used, postoperative pain, surgical objective outcomes, and scores on patient-reported outcomes questionnaires. Adverse events were significantly more frequent in the conventional vaginal group than in the vNOTES group (p < 0.001 for intraoperative events and p = 0.05 for events that occurred in the follow-up time interval). vNOTES hysterectomy with USLS has lower surgical times than conventional vaginal hysterectomy with USLS, lower blood loss and less adverse events. Other surgical objective and subjective outcomes were similar between the approaches. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the effects of suturing the cuff to the uterosacral ligaments (USL) during vaginal hysterectomy on healing with regards to anatomy and lower urinary tract symptoms (LUTS). Materials and Methods: This study was carried out on patients, who applied to the Urogynecology Outpatient Clinics of Muğla Research and Training Hospital between the dates of March 2021 and March 2022 and were diagnosed as having uterine prolapse. All of the patients were operated on by the same experienced surgeon (Prof. AAS) and the newly created vaginal cuff was sutured to the USL. In the preoperative period, all patients underwent pelvic organ prolapse quantification (POP-Q) system measurement, and were questioned about LUTS, including stress urinary incontinence, urgency, urge incontinence, frequency, hesitancy, abnormal micturition, nocturia, dysuria, pelvic pain, fecal incontinence, incomplete evacuation of stool, constipation, and vaginal wind. The patients, who were operated on, were reevaluated with respect to POP-Q and LUTS in the follow-up period at the 3rd, 6th and 12th months. Results: A total of 80 patients were included in this study. POP-Q points; Aa, Ba, C, Ap and Bp measurements were significantly deeper and genital hiatus measurements were significantly narrower after surgery than during the preoperative period. No statistically significant difference was observed in the perineal body and with respect to total vaginal length measurements. Moreover, statistically significant improvements were found in the symptoms of urgency, urge incontinence, stress urinary incontinence, frequency, abnormal micturition, nocturia, pelvic pain, fecal incontinence, incomplete evacuation of stool and constipation. In the POP-Q scoring performed in the postoperative follow-up of the cases, the C value was taken as a reference for de novo vaginal vault prolapse. There were 8 cases of recurrence. The mean C value was +3.6 in these cases. Recurrent cases were treated with LeFort colpocleisis, iliococcygeal fixation and posterior intravaginal sling (PIVS) operations. No recurrence was observed in the follow-ups. Conclusion: The suturing of the newly created vaginal cuff during vaginal hysterectomy to the USLs is a very simple, easily applicable, highly effective surgical technique with low morbidity and low risk of vaginal vault prolapse. This technique should be included in the armamentarium of all surgeons dealing with urogynecology due to the positive effect it provides in LUTS as well as anatomical healing. [ABSTRACT FROM AUTHOR]

Objective: Rare disease Background: Hysterectomy is a gynecological procedure that can lead to complications arising from structural changes incurred during the surgical process. Vaginal nodules may appear at the vaginal cuff after hysterectomy, which could be indicative of recurring cancer, endometriosis, or formation of fistulae or granulation tissue. In rare instances, abdominal organ prolapse occurs after vaginal cuff dehiscence. Prolapse of the terminal ileum is the most common type of prolapse from vaginal cuff dehiscence, but prolapsed epiploica of colon after hysterectomy occurs in rare instances. Epiploic appendages are a type of fatty tissue attached to the colonic surface that can become inflamed or necrotic and detach from the colon. The purpose of this report is to describe a rare case of prolapsed epiploica of colon at the vaginal cuff. Case Report: A 55-year-old woman who had robot-assisted laparoscopic hysterectomy for endometrioid carcinoma presented with a vaginal polyp 2 months after surgery. Histological analysis of the excised polyp revealed adipose tissue with fat necrosis and calcification, indicative of prolapsed epiploica of colon. This is the first report of posthysterectomy epiploica of colon at the vaginal cuff not associated with obvious dehiscence. Conclusions: This case highlights the importance of thorough histological analysis of excised vaginal nodules and consideration of prolapsed epiploica of colon in the differential diagnoses in addition to benign and malignant vaginal neoplasms. [ABSTRACT FROM AUTHOR]

This is a single Institute, prospective cohort study. We enrolled twenty-two postmenopausal women with pelvic organ prolapse planning to undergo vaginal hysterectomy with transvaginal pelvic reconstructive surgery, with or without a concomitant anti-incontinence procedure. Vaginal swabs and urine samples were longitudinally collected at five time points: preoperative consult visit (T1), day of surgery prior to surgical scrub (T2), immediately postoperative (T3), day of hospital discharge (T4), and at the postoperative exam visit (T5). Women experiencing urinary tract infection symptoms provided a sample set prior to antibiotic administration (T6). Microbiome analysis was performed on vaginal and urinary specimens at each time point. Region V3-V5 of the 16S ribosomal RNA gene was amplified and sequenced. DNA samples were analyzed for visit T1, T2, T5 and T6. Six (27.3%) participants developed postoperative urinary tract infection whose vaginal sample at first clinical visit (T1) revealed beta-diversity analysis with significant differences in microbiome structure and composition. Women diagnosed with a postoperative urinary tract infection had a vaginal microbiome characterized by low abundance of Lactobacillus and high prevalence of Prevotella and Gardnerella species. In our cohort, preoperative vaginal swabs can predict who will develop a urinary tract infection following transvaginal surgery for pelvic organ prolapse. ClinicalTrials.gov Identifier: NCT02751073. [ABSTRACT FROM AUTHOR]

Vaginal cuff rupture is a rare but serious postoperative complication predominantly occurring after hysterectomy. Given that it can lead to partial or total evisceration, bowel strangulation, sepsis, and acute mesenteric ischemia. Any instance of this complication should be treated as a surgical emergency. In this context, we report a case of a vaginal stump following regular use of pessaries. Case Report: A 50-year-old woman was admitted to the hospital with sudden onset of bowel-like prolapse from the vagina. She had a 7-year history of vaginal prolapse and had previously undergone repair surgery and laparoscopic hysterectomy for uterine fibroids. Following her hysterectomy, she began using a pessary due to recurrent prolapse. Clinical assessment revealed vaginal evisceration of the intestines, necessitating emergency surgery. She was discharged smoothly on the eighth day post-operation. Three months later, she underwent a laparoscopic sacrocolpopexy. Conclusion: The utilization of pessaries may heighten the risk of stump rupture in patients following hysterectomy, thereby demanding more vigilant attention from gynecologists. [ABSTRACT FROM AUTHOR]

Background: Bilateral oophorectomy has been linked to numerous health outcomes, some of which can have a long latency period. Limited data are available on bilateral oophorectomy prevalence among U.S. women. Methods: The National Health Interview Survey fielded measures of bilateral oophorectomy most recently in 2010 and 2015. We pooled these 2 data years to present bilateral oophorectomy prevalence estimates by age-group, race, ethnicity, geographic region, and hysterectomy status. Results: Our study found bilateral oophorectomy was common among older women. Among women aged 70–79 years, 29% reported a bilateral oophorectomy, compared with <1% for women aged 20–29 years. By geographic region, bilateral oophorectomy prevalence among women 20–84 years was 12.3% in the South, 10.8% in the Midwest, 9.4% in the West, and 8.0% in the Northeast. Small numbers limited our ability to generate age-specific estimates for American Indian and Alaska Native women and subgroups of Asian and Hispanic women. Nearly half of women who had a bilateral oophorectomy reported their procedure occurred more than 20 years ago. Among women aged 20–84 years who reported a hysterectomy, 57% reported they also had both of their ovaries removed. Conclusion: Standard measures of incidence rates for ovarian cancer are not adjusted for oophorectomy status. These findings suggest that ovarian cancer incidence rates may be underestimated among older women. Continued monitoring of bilateral oophorectomy prevalence will be needed to track its potential impact on ovarian cancer incidence and numerous other chronic health outcomes. [ABSTRACT FROM AUTHOR]

Objective: To determine the preferable route of hysterectomy by comparing the intra-operative and postoperative complications of non-descent vaginal hysterectomy with abdominal hysterectomy. Study Design: Randomized Control Trial. Setting: Madina Teaching Hospital, Faisalabad, Pakistan. Period: January 2022 to December 2022. Methods: Forty cases of each vaginal and abdominal hysterectomy were enrolled for study. Outcomes were measured by recording intra-operative and post-operative complications in both groups. Results: Time of surgery, postoperative pain, postoperative blood transfusion, wound infection, febrile morbidity and duration of hospital stay were significantly less (p value 0.0001) in the non-descent vaginal hysterectomy compared to abdominal hysterectomy. Conclusion: Non-descent vaginal hysterectomy is a safe and cost effective approach when compared to abdominal rout due to less intra and post operative morbidity particularly in settings where facilities and expertise for laparoscopic surgery are lacking. [ABSTRACT FROM AUTHOR]

We present two cases of patients with body mass index (BMI) >50 undergoing transvaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy for gynecological indications. Case 1 involves a 52‐year‐old woman with post‐menopausal bleeding and suspicion of ovarian torsion, while case 2 describes a patient with newly diagnosed endometrial adenocarcinoma. Both cases highlight the feasibility and challenges of vNOTES in this patient population. To date, this is the first paper to describe the use of vNOTES in patients of Asian ethnicity, with BMI >50. [ABSTRACT FROM AUTHOR]

Objective: To determine the maximum uterine diameter threshold associated with an elevated risk of complications following laparoscopic supracervical hysterectomy (LSH). Methods: This was a retrospective cohort study from a single tertiary referral center. We enrolled patients who underwent LSH for benign indications at our hospital between January 2013 and June 2023. The primary outcome was the occurrence of surgical complications within the 30‐day timeframe of hysterectomy. The covariate included the year of the procedure, patient age, body mass index, parity, American Society of Anesthesiologists classification, comorbidities, history of previous abdominal and pelvic surgery, and preoperative anemia, blood loss, surgical time, hospital stay and pathology. The exclusion criteria comprised those who underwent hysterectomy for malignancy, individuals who underwent total vaginal hysterectomy or laparoscopically assisted vaginal hysterectomy, and those with missing data on uterine maximum diameter, study outcomes, or covariates. Results: We included a final sample of 120 patients, revealing a median uterine diameter of 9.12 cm, with 9.2% experiencing complications. The median uterine weight among 40 patients was 275 g. Receiver operating characteristic (ROC) curve analysis suggested a potential cutoff of 11.55 cm for predicting complications, with an area under the ROC curve of 0.67. Multivariate logistic regression confirmed a significant association between uterine diameter exceeding the cutoff and increased complication risk (OR 33.925, 95% CI: 2.294–501.690, P = 0.0103). A correlation (r = 0.762, P < 0.001) between uterine weight and diameter indicated the latter's suitability for preoperative assessment of uterine weight. Conclusion: The maximum uterine diameter with an optimal cutoff of 11.55 cm was associated with increased complication risk. Synopsis: The maximum uterine diameter is a key predictor of complications within 30 days post‐laparoscopic supracervical hysterectomy, with a cutoff of 11.55 cm significantly linked to heightened risk. [ABSTRACT FROM AUTHOR]

The average lifespan has increased over time due to improvements in quality of life, leading to an aging population that stays healthy for longer. Pelvic organ prolapse (POP), whether uterine or vaginal, is a problem that severely impairs quality of life and imposes significant restrictions. The present study provides the reader with a summary of the many surgical techniques used in POP surgery, comparing international guidelines, offering an algorithm that is simple to understand, and allows the reader to quickly choose the table that includes the best surgical therapy for each individual. Using relevant keywords, the writers searched the PubMed and Scopus databases for relevant publications from 2000 to April 2023. Studies with cases of oncologic disorders or prior hysterectomy performed for another reason were not included in the analysis. Ten distinct international guidelines are highlighted and examined in the present study. We used the Appraisal of Guidelines for Research and Evaluation II‐S (AGREE II‐S) method to assess their quality, and incorporated the results into the conclusion. Worldwide, anterior colporrhaphy is the preferred method of treating anterior compartment abnormalities, and mesh is virtually always used when recurrence occurs (which happens in about half of the cases). Worldwide, posterior colporrhaphy is commonly used to repair posterior compartment abnormalities. Only a few national guidelines (the Iranian guideline, Acta Obstetricia et Gynecologica Scandinavica [AOGS], and the German‐speaking countries) permit the use of mesh or xenograft in cases of recurrence. There is agreement on the abdominal approach (sacrocolpopexy) with mesh for treating apical deformities. Sacrospinous‐hysteropexy is the standard method used to guide the vaginal approach; mesh is typically used to aid in this process. There are just three recommendations that do not include vaginal operations: HSE, AOGS, and Iran. Of obliteration techniques, colpocleisis is unquestionably the best. In conclusion, our analysis highlights the significance of customized methods in POP surgery, taking into account the requirements and preferences of each patient. To choose the best surgical therapy, criteria and patient features must be carefully considered. Synopsis: Tailored surgical approach for pelvic organ prolapse respects patient preferences, aligning with diverse international guidelines. [ABSTRACT FROM AUTHOR]

Background and Aims: This network meta‐analysis aimed to compare the perioperative efficacy of various minimally invasive hysterectomy procedures for treating benign gynecological diseases and to assess whether vaginal natural orifice transluminal endoscopic hysterectomy (VNOTEH), a recently emerging procedure, is inferior to traditional laparoscopy. Methods: We searched PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), Wanfang Data, and China VIP Database from inception to August 2022 and updated in June 2023. We included randomized controlled trials (RCTs) comparing different minimally invasive hysterectomy techniques in patients with benign gynecological conditions. The intervention measures included nine minimally invasive hysterectomies. The two researchers used the Cochrane risk‐of‐bias assessment tool for study appraisal. All statistical analyses and drawings were performed using STATA 17.0 and R 4.4.1. A network meta‐analysis (NMA) was conducted to compare the effectiveness of minimally invasive hysterectomy and rank its relative impact probabilistically. Results: A total of 78 RCTs involving 7640 patients and nine minimally invasive hysterectomy methods with 16 intervention combinations were included in this study. Among these, 2, 63, and 13 studies were deemed to have a low, medium, and high risk of bias, respectively. Based on the Surface Under the Cumulative Ranking (SUCRA) probability ranking results of NMA, laparoendoscopic single‐site surgery‐laparoscopic‐assisted vaginal hysterectomy (LESS‐LAVH) demonstrated superior outcomes in terms of complications, infections, and 24‐h postoperative pain scores. LAVH exhibited better performance in injuries and hospital stays, total laparoscopic hysterectomy showed the least blood loss, and vaginal hysterectomy had the shortest operation time. Conclusion: LESS‐LAVH and LAVH are recommended options, if feasible. Meanwhile, VNOTEH can achieve comparable results to traditional laparoscopy but requires careful attention to the risk of injury and infection. Future research should aim to broaden the search scope by including high‐quality, large‐scale, multicenter RCTs. [ABSTRACT FROM AUTHOR]

Ureaplasma parvum is one of the most common endemic mycoplasmas in the genitourinary tract and can cause amniotic fluid infection leading to preterm labor. We report a rare case of Ureaplasma parvum infection ascending from the vagina to the abdominal cavity after hysterectomy, causing vaginal cuff infection, postoperative peritonitis, and small bowel obstruction. A 29‐year‐old nulliparous woman presented with infected uterine cervical cancer. After radical hysterectomy for uterine cervical cancer, the patient had paralytic ileus with ascites and fever. Peritonitis was suspected; however, all cultures were negative, making it difficult to identify the causative organism. Polymerase chain reaction (PCR) of the ascites revealed Ureaplasma parvum, which could be treated with levofloxacin (LVFX). Open drainage to control the infection revealed a necrotic tissue around vaginal cuff and the small intestine encased in cocoon‐like fibers like sclerosing encapsulating peritonitis. After the infection was improved, the bowel obstruction was also improved. Ureaplasma spp. can be difficult to culture. PCR testing for Ureaplasma infection should be considered when urogenital infection is suspected in patients prone to opportunistic infections, such as those with malignant tumors. [ABSTRACT FROM AUTHOR]

Background/Objectives: Hysterectomy (HE) is the most common surgical procedure in gynecology worldwide. The guidelines of most countries unanimously recommend vaginal hysterectomy (VH) as the access of first choice. However, there are significant international differences in the implementation of this recommendation. Methods: In the consistent implementation of the national guidelines, the aim of this prospective observational cohort study was to evaluate how many hysterectomies can be performed vaginally under real-world conditions for benign indications excluding genital prolapse and extensive endometriosis. For this purpose, the requirements of the guidelines were implemented for all HE cases. All HEs were performed by a single, experienced surgeon. The aim was not to go to the limits of the method, but to develop a reproducible benchmark with the lowest possible complication rate. Results: From 2011 to 2020, 230 hysterectomies were performed for benign indications. A VH was performed in 146 cases (63.5%), and a laparoscopic hysterectomy (LH) in 75 cases (32.6%). An abdominal hysterectomy (AH) was only required in nine cases (3.9%). The decision for LH was made in half of the cases due to the assumed presence of endometriosis or a significantly enlarged uterus. The median duration of VH was 32 min (range 16–118 min), and the uterine weights were 15–540 g. The rate of postoperative complications of VH was 3.4%. Conclusions: In line with international guidelines, VH is possible in over 60% of cases with a short surgical time and a low complication rate. LH procedures are useful in the presence of assumed additional pathology in 35%. AH is reserved for huge uteri. A reduction in AH below 10% is possible. The global target could be a rate of 60–30–10% for VH, LH, and AH. [ABSTRACT FROM AUTHOR]

Background: Hysterectomy is one of the most common surgical procedures performed by the gynaecologist. It can be performed by vaginal, abdominal and laparoscopic route. Vaginal hysterectomy ranks as one of the least and minimally invasive types of hysterectomies, and it has better outcomes and fewer complications when compared to other types. This study assesses the intraoperative and postoperative complications of vaginal hysterectomy. Material & Methods: This hospital based retrospective observational study was carried out from March 2023 to March 2024. A total of 105 patients who underwent vaginal hysterectomy were included in this study. Age, parity, associated medical conditions like anaemia, diabetes, hypertension, thyroid disorders, indications for vaginal hysterectomy, intraoperative complications like excessive blood loss, bladder, bowel or ureteric injuries, conversion to TAH, postoperative complications like vault infection, subacute intestinal obstruction, VVF, RVF, stress urinary incontinence and vault prolapse were analysed. Results: Our study included 105 patients. Majority were in the age between 40 - 49 years (69%). AUB (L)was the commonest indication for vaginal hysterectomy (60%). There was no excessive blood loss for any patient and none needed blood transfusion. Bladder injury occurred in 1 case (0.9%), Subacute intestinal obstruction occurred in 1 case (0.9%), conversion to TAH in 2 cases (1.8%). 2 cases (1.8%) developed vault cellulitis, whereas 3 cases (2.7%) developed stress urinary incontinence. Conclusions: In majority of the cases, no intraoperative complications were found suggesting low morbidity associated with the procedure. The postoperative hospital stay was restricted to 4 days in 85.7% of cases which indicates early discharge of the patient. Post-operative complications such as vault cellulitis(1.8%) and stress urinary incontinence(2.7%) were seen only in few cases. So, Vaginal hysterectomy is associated with quicker recovery, early mobilization, shorter hospitalization, less operative and postoperative morbidity. Therefore, vaginal hysterectomy should be considered as the primary route for all hysterectomies unless contraindicated. [ABSTRACT FROM AUTHOR]

Objective: This study examined postoperative urinary retention (POUR) rates in patients who had transvaginal or transabdominal morcellation for large fibroids or adenomyotic uteri. Materials and Methods: This retrospective, observational cohort study was conducted, from January 2015 to April 2021, in a multicenter health care system, in Calgary and Southern Alberta, Canada. The patients were women, ≥18 years, who had total laparoscopic hysterectomy with morcellation. Women with preexisting urinary retention were excluded. POUR was urinary retention needing an indwelling or in-and-out catheter postoperatively before discharge. Results: There were no differences in POUR for transvaginal (29/139; 20.9%) and transabdominal (12/56; 21.4%) morcellation. There were also no differences in time to first postoperative void (5.5 hours [range: 3.5–8] versus 5.75 hours [range: 4–7.125]); length of stay (23 hours [range: 20.875–25.625] versus 22 hours [range:18.5–24.5]); postoperative urinary tract infections (5.1% versus 3.6%); or visits to the emergency department for POUR postdischarge (1.4% versus 1.8%) for transvaginal and transabdominal morcellation, respectively. The vaginal-morcellation group trended toward increased complication rates during morcellation (7% versus 0%) and urinary complaints at postoperative follow-ups (9.4% versus 0%). Conclusions: Either morcellation type produces similar rates of POUR. Surgeon and patient preferences guide decisions on preferred morcellation routes. Larger prospective trials are needed to further assess POUR, potential for increased complications, and postoperative urinary complaints induced by transvaginal morcellation. (J GYNECOL SURG 20XX:000) [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: The objective was to assess trends in hysterectomy routes by patients who are likely and unlikely candidates for a vaginal approach. Methods: We performed a retrospective cohort study of patients who underwent vaginal, abdominal, or laparoscopic/robotics-assisted laparoscopic hysterectomy between 2017 and 2020 using the National Surgical Quality Improvement Program database. Patients undergoing hysterectomy for a primary diagnosis of benign uterine pathology, dysplasia, abnormal uterine bleeding, or pelvic floor disorders were eligible for inclusion. Patients who were parous, had no history of pelvic or abdominal surgery, and had a uterine weight ≤ 280 g on pathology were considered likely candidates for vaginal hysterectomy based on an algorithm developed to guide the surgical approach. Average annual changes in the proportion of likely vaginal hysterectomy candidates and route of hysterectomy were assessed using logistic regression. Results: Of the 77,829 patients meeting the inclusion criteria, 13,738 (17.6%) were likely vaginal hysterectomy candidates. Among likely vaginal hysterectomy candidates, the rate of vaginal hysterectomy was 34.5%, whereas among unlikely vaginal hysterectomy candidates, it was 14.1%. The overall vaginal hysterectomy rate decreased −1.2%/year (p < 0.01). This decreasing trend was nearly twice as rapid among likely vaginal hysterectomy candidates (−1.9%/year, p <.01) compared with unlikely vaginal hysterectomy candidates (−1.1%/year, P < 0.01); the difference in trends was statistically significant (p < 0.01). Conclusions: The rate of vaginal hysterectomy performed for eligible indications decreased between 2017 and 2020 in a national surgical registry. This negative trend was more pronounced among patients who were likely candidates for vaginal hysterectomy based on favorable parity, surgical history, and uterine weight. [ABSTRACT FROM AUTHOR]

Objective: Uterine-sparing surgery for pelvic organ prolapse (POP) repair has shown good results, but the potential negative implications of leaving the uterus in place are yet to be fully defined. We aimed to assess the risk of unanticipated abnormal gynecological pathology at the time of reconstructive pelvic surgery. Methods: A retrospective consecutive case series including women who underwent vaginal hysterectomy for POP repair at a tertiary medical center in 2006–2020. All patients were offered a free Pap smear test at the age of 65 years as part of a national screening program. Transvaginal ultrasound was routinely performed preoperatively. Standard 3 pedicle hysterectomy was performed with/without bilateral salpingo-oophorectomy (BSO). Results: The study comprised 462 women of mean age 63 ± 9.3 years without previous known malignant or premalignant pathology. Benign pathology was observed in 286 patients (61.9%). Endometrial malignancy was found in three patients (0.7%) and significant premalignant pathology in 15 patients (3.2%), including cervical intraepithelial neoplasia stage 2–3 in seven patients (1.5%) and complex hyperplasia with atypia in eight patients (1.7%). All these pathologies were found in postmenopausal women. None had preoperative clinical symptoms or endometrial thickness of ≥5 mm on preoperative ultrasound. In the 35 patients after BSO, adnexal findings were normal (77.2%) or benign (22.8%). Conclusions: Premenopausal women with uterovaginal prolapse and normal preoperative evaluation have a minimal risk of significant abnormal uterine pathology. In postmenopausal women, the risk of unanticipated malignant uterine pathology is 0.7% and 3.2% for significant premalignancy. [ABSTRACT FROM AUTHOR]

Introduction: Hysterectomy has been suggested to increase the risk of urinary incontinence (UI), although evidence is controversial. In our population‐based cohort study, we aimed to assess the independent effect of hysterectomy on the risk of de novo UI. Material and Methods: This is a population‐based cohort study on the women of the Northern Finland Birth Cohort 1966 (n = 5889). We identified all hysterectomies among the cohort (n = 461) using the national Care Register for Health Care and classified them according to surgical approach into laparoscopic (n = 247), vaginal (n = 107), and abdominal hysterectomies (n = 107). Women without hysterectomy formed the reference group (n = 3495). All women with UI diagnoses and operations were identified in the register, and women with preoperative UI diagnosis (n = 36) were excluded from the analysis to assess de novo UI. Data on potential confounding factors were collected from registers and the cohort questionnaire. Incidences of different UI subtypes and UI operations were compared between the hysterectomy and the reference groups, and further disaggregated by different hysterectomy approaches. Logistic regression models were used to analyze the association between hysterectomy and UI, with adjustments for several UI‐related covariates. Results: We found no significant difference in the incidence of UI diagnoses or the rate of subsequent UI operations between the hysterectomy and the reference groups (24 [5.6%] vs. 166 [4.7%], p = 0.416 and 14 [3.3%] vs. 87 [2.5%], p = 0.323). Hysterectomy was not significantly associated with the risk of any subtype of UI (overall UI: OR 1.20, 95% CI 0.77–1.86; stress UI (SUI): OR 1.51, 95% CI 0.89–2.55; other UI: OR 0.80, 95% CI 0.36–1.74). After adjusting for preoperative pelvic organ prolapse (POP) diagnoses, the risk was decreased (overall UI: OR 0.54, 95% CI 0.32–0.90; other than SUI: OR 0.40, 95% CI 0.17–0.95). Regarding different hysterectomy approaches, the risks of overall UI and SUI were significantly increased in vaginal, but not in laparoscopic or abdominal hysterectomy. However, adjusting for preoperative POP diagnosis abolished these risks. Conclusions: Hysterectomy is not an independent risk factor for de novo UI. Instead, underlying POP appears to be a significant risk factor for the incidence of UI after hysterectomy. [ABSTRACT FROM AUTHOR]

• Largest study about transvaginal USL suspension for primary prolapse repair. • Recurrence rate of 12.4% with reoperation rate for recurrence below 1%. • Functional outcomes statistically improved after surgery. • Total complication rate of 3.4% with ureteral injuries being the most frequent (2.3%). Surgical repair is the mainstay of genital prolapse management. Among native-tissue apical procedures, high uterosacral ligaments suspension is considered a valid and effective option for central compartment repair. In this study, we aimed to evaluate the effectiveness, complications rate, and functional results of high USL suspension as a primary prolapse repair technique in a large cohort of patients. Patients who underwent vaginal hysterectomy followed by high uterosacral ligaments suspension for POP between January 2008 and December 2020 were retrospectively analyzed. Questionnaires and clinical interviews were preoperatively performed to assess symptoms and severity of urinary, bowel, and sexual dysfunctions. After surgical procedure, diagnostic cystoscopy was performed to evaluate ureteral patency. Postoperative data, objective, and subjective cure rate were then noted at the follow-up evaluation. A total of 1099 patients underwent high uterosacral ligaments suspension. The total complication rate was 3.4 % and recurrence in any of the vaginal compartments was 12.4 %. Reoperation for symptomatic prolapse recurrence or pessary treatment was required in 9 women (0.9 %). In the evaluation of postoperative questionnaires, functional outcomes analysis revealed a significant improvement (p < 0.05) in terms of stress urinary incontinence, urge urinary incontinence, voiding symptoms, constipation, and dyspareunia after prolapse repair. Uterosacral ligament suspension is a safe and effective procedure for primary surgical treatment of pelvic organ prolapse. Anatomical, functional, and subjective outcomes were very satisfactory, and the reoperation rate for recurrence was below 1%. [ABSTRACT FROM AUTHOR]

• The increasing use of robot-assisted hysterectomy in benign indications lowers the need for open surgery. • Implementation of robot-assisted hysterectomy reduces length of stay, complications and hospitalisation costs. • Robot-assisted hysterectomy remains the most expensive technique due to high material and depreciation costs. As a minimally invasive technique, robot-assisted hysterectomy (RAH) offers surgical advantages and significant reduction in morbidity compared to open surgery. Despite the increasing use of RAH in benign gynaecology, there is limited data on its cost-effectiveness, especially in a European context. Our goal is to assess the costs of the different hysterectomy approaches, to describe their clinical outcomes, and to evaluate the impact of introduction of RAH on the rates of different types of hysterectomy. A retrospective single-centre cost-analysis was performed for patients undergoing a hysterectomy for benign indications. Abdominal hysterectomy (AH), vaginal hysterectomy (VH), laparoscopic hysterectomy (LH), laparoscopically assisted vaginal hysterectomy (LAVH) and RAH were included. We considered the costs of operating room and hospital stay for the different hysterectomy techniques using the "Activity Centre–Care program model". We report on intra- and postoperative complications for the different approaches as well as their cost relationship. Between January 2014 and December 2021, 830 patients were operated; 67 underwent VH (8%), 108 LAVH (13%), 351 LH (42%), 148 RAH (18%) and 156 AH (19%). After the implementation and learning curve of a dedicated program for RAH in 2018, AH declined from 27.3% in 2014–2017, to 22.1% in 2018 and 6.9 % in 2019–2021. The reintervention rate was 3–4% for all surgical techniques. Pharmacological interventions and blood transfusions were performed after AH in 28%, and in 17–22% of the other approaches. AH had the highest hospital stay cost with an average of €2236.40. Mean cost of the hospital stay ranged from €1136.77-€1560.66 for minimally invasive techniques. The average total costs for RAH were €6528.10 compared to €4400.95 for AH. Implementation of RAH resulted in a substantial decrease of open surgery rate. However, RAH remains the most expensive technique in our cohort, mainly due to high material and depreciation costs. Therefore, RAH should not be considered for every patient, but for those who would otherwise need more invasive surgery, with higher risk of complications. Future prospective studies should focus on the societal costs and patient reported outcomes, in order to do cost-benefit analysis and further evaluate the exact value of RAH in the current healthcare setting. [ABSTRACT FROM AUTHOR]

Objective: Enhanced recovery after surgery (ERAS) protocols have been introduced in gynecology. Postoperative pain management after vaginal procedures remains a relevant issue. In the present study we aimed to evaluate the effectiveness of pre‐emptive uterosacral/cervical block (PUCB) for postoperative pain control in patients with uterovaginal prolapse undergoing vaginal hysterectomy and pelvic floor repair. We also evaluated the impact on the length of recovery. Methods: This was a pilot study analyzing 40 women who underwent pelvic organ prolapse repair through uterosacral ligament suspension. Patients who chose to undergo PUCB were considered as cases, otherwise as controls. After general or spinal anesthesia induction, the treatment group received the PUCB with ropivacaine plus clonidine injections at 2, 4, 8, and 10 o'clock of the cervix. The control group did not receive additional treatment. Pain intensity was measured at rest and after forceful cough at 1, 4, 8, 12, 24, and 48 h postoperatively. Results: We found a significant reduction in pain values at 1 h (rest and forceful cough) and 24 h (forceful cough) in the PUCB group. The incidence of moderate/severe pain was inferior in the PUCB group at 1 h (rest) and 24 h (rest and forceful cough). There were no differences in terms of the use of rescue opioids (0% vs. 5%; P = 0.311) and length of hospital stay (2.5 ± 0.6 vs. 2.3 ± 0.6; P = 0.180). Conclusions: For the first time, we demonstrated the impact of pre‐emptive uterosacral/cervical block on pain control up to 24 h after surgery. Clonidine as a sensory blockade extender appears promising in enhancing the efficacy of local anesthetics. Synopsis: Pre‐emptive uterosacral/cervical block showed efficacy on pain control up to 24 h after vaginal surgery for pelvic organ prolapse. [ABSTRACT FROM AUTHOR]

• Cervical elongation in pelvic organ prolapse lacks standardized diagnostic criteria. • POP-Q system is effective for assessing cervical elongation, especially in stage 2 and 3 cases. • Manchester-Fothergill procedure offers fewer complications than vaginal hysterectomy. • Preoperative cervical evaluation is crucial for selecting appropriate surgical interventions. • Study emphasizes need for standardized approaches in managing cervical elongation. This review aims to consolidate current research on cervical elongation, a common but often overlooked complication in pelvic organ prolapse and hysteropexy procedures. It seeks to define, diagnose, and manage cervical elongation, aiming to establish standardized criteria and strategies to enhance clinical outcomes for this condition. A comprehensive search of the PubMed/MEDLINE, Cochrane Library, and Web of Science databases was executed utilizing the keywords: "cervical elongation," "long cervix uteri," "Manchester," and "cervical amputation". Data were gathered and organized in an Excel spreadsheet, with the analysis conducted according to each category, methodology, or reference range. All types of study designs with full-text availability, including randomized controlled trials, cohort studies, case-control studies, case reports, and systematic reviews, were considered for inclusion. Included studies were fully accessible in English and focused on the topic of interest. Exclusions were made for studies addressing cervical elongation not pertinent to pelvic organ prolapse, and publications such as secondary analyses, case reports, literature reviews, and opinion papers. Out of 108 relevant studies, only 63 defined their inclusion criteria; of these, 57 were utilized for the narrative review and 8 were used in a meta -analysis comparing the Manchester operation with vaginal hysterectomy. Magnetic Resonance Imaging offers the highest sensitivity in measuring cervical elongation, its practical limitations and high cost necessitate the use of the more feasible Pelvic Organ Prolapse Quantification System (POP-Q), particularly effective for stage 2 and 3 prolapse cases. The POP-Q point C emerges as a pivotal marker for identifying cervical elongation, with specific measurements indicating the condition's presence. The Manchester-Fothergill procedure presents a viable management option for isolated cervical elongation, showing fewer complications and comparable recurrence rates to vaginal hysterectomy. This review highlights the diagnostic and definitional diversity of cervical elongation within populations experiencing pelvic organ prolapse. It emphasizes the critical role of preoperative cervical evaluation, particularly in patients with uterine descensus for selecting the most appropriate surgical intervention. [ABSTRACT FROM AUTHOR]

Background/Aim: Hysterectomy is the most frequent gynecological surgery. Vaginal hysterectomy (VH) seems to be related to favorable perioperative outcomes compared to abdominal or laparoscopic approaches. As the population ages, anesthesia that is safer for the elderly, such as local anesthesia (LA) with conscious sedation, is gaining popularity and is related to favorable outcomes in patients’ recovery compared to general or regional anesthesia. We aimed to evaluate the efficacy of dexmedetomidine versus propofol for women undergoing VH for uterine prolapse under LA and conscious sedation. Patients and Methods: A prospective study on 40 women with uterine prolapse stage ≥3 who had VH under LA with conscious sedation under either dexmedetomidine (n=20) or propofol (n=20) was performed. A standardized surgical approach with continuous hemodynamic monitoring and sedation assessment using the Ramsay Sedation Scale (RSS) was conducted. The primary endpoint of the study was to determine the percentage of patients receiving intraoperative fentanyl. Results: Analysis of outcomes demonstrated a significant reduction in the proportion of patients requiring intraoperative rescue fentanyl (35% vs. 5%, respectively, p=0.04) and in postoperative pain scores, with more patients achieving an optimal RSS score of 3 in the dexmedetomidine group. Conclusion: Based on the findings of the present study, dexmedetomidine offered superior analgesia and patient comfort compared to propofol, suggesting a favorable anesthetic profile for VH under LA. [ABSTRACT FROM AUTHOR]

Vaginal evisceration is an exceedingly rare and poorly documented complication following vaginal hysterectomy. Prompt detection and surgical intervention are critical to prevent severe complications such as bowel ischemia, perforation, and secondary sepsis. We present the case of an 84-year-old woman with a history of vaginal hysterectomy two years prior, who presented with acute abdominal pain and a significant portion of her small bowel protruding through a defect in the vaginal vault. The patient was urgently transferred to the operating room, where the loops of the small bowel were manually reduced through the vaginal defect. As the bowel appeared viable, no resection was required. The etiology of this condition is unclear and likely multifactorial. Various surgical approaches, including laparoscopic, abdominal, transvaginal, and combined techniques, have been described, all offering comparable outcomes. Therefore, the choice of surgical procedure should be tailored to the patient's clinical presentation. [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: Colpocleisis is a surgical procedure intended to treat pelvic organ prolapse. Compared with other modes of pelvic reconstructive surgery, colpocleisis is associated with lower morbidity and higher satisfaction, and has a success rate of 91–100% and a reoperation rate of less than 2%. However, there is limited information on how to treat recurrent prolapse after colpocleisis. Methods: We performed a review of the existing literature regarding colpocleisis failure and retreatment. A total of 118 articles were reviewed, with 16 articles suitable for inclusion. We also describe a case from our own institution of a "repeat colpocleisis" for recurrent prolapse after previous colpocleisis. Results: "Repeat colpocleisis" was the most common surgical technique used (18 out of 24 patients, 75.0%). The median follow-up time after the repeat surgery was 12 months, with only 1 patient with recurrence reported owing to recurrent rectocele 2 years after surgery, treated successfully with perineorrhaphy. Other less common techniques included perineorrhaphy, reversal of colpocleisis with native tissue repair, and vaginal hysterectomy with vaginal repair. Our case report describes the surgical management of a patient who had previously undergone LeFort colpocleisis with recurrence of prolapse, subsequently undergoing repeat colpocleisis. Conclusions: The colpocleisis failure, though rare, presents a surgical challenge owing to both its rarity and the paucity of information in the literature regarding the optimal mode of management. In this review, the most common technique for surgical management of colpocleisis failure was repeat colpocleisis, with good short-term success rates noted. Additional studies with longer-term follow-up are needed. [ABSTRACT FROM AUTHOR]

Background: Despite the rising rates of opportunistic salpingectomy at the time of surgery for non‐malignant conditions, salpingectomy is not widely adopted during vaginal hysterectomy (VH) and has not been extensively investigated. Objectives: The aim of the primary study was to determine the feasibility of bilateral opportunistic salpingectomy at the time of VH. Secondary aims included surgical outcomes, factors associated with patient selection, and the prevalence of incidental tubal malignancies. Search Strategy: In this systematic review and meta‐analysis we searched Pubmed, Embase and ClinicalTrials.gov databases from inception to September 1, 2023, using relevant keywords. Selection Criteria: Original articles with no language restriction reporting outcomes of women undergoing planned VH with opportunistic salpingectomy, were considered eligible. Studies including patients undergoing VH with and without opportunistic salpingectomy were also included. Data Collection and Analysis: The Newcastle‐Ottawa scale was used to assess quality of observational studies. DerSimonian–Laird random effects meta‐analysis was performed and pooled effect estimates and proportions with corresponding 95% confidence intervals were computed. Heterogeneity was assessed using the I2 statistic. Results: Seven observational cohort studies including 4808 women undergoing opportunistic salpingectomy at the time of VH and 10 295 patients undergoing VH alone were selected. The pooled proportion of success was 81.83 per 100 observations (95% CI: 75.35–87.54). Opportunistic salpingectomy at the time of VH, when feasible, was associated with a significant reduction in intraoperative complications (OR 0.06, 95% CI: 0.01, −0.37, P = 0.03) and total operative time (95% CI: −17.80, −1.07, P = 0.03) compared to those where it failed. Successful salpingectomy was significantly hindered by nulliparity (OR 0.12, 95% CI: −17.69, −1.21, P < 0.001) and favored by pelvic organ prolapse (OR 3.20, 95% CI: 1.35, 7.55, P = 0.008). Immunohistochemical tubal abnormalities were found in 13/579 (2.1%) patients. The overall quality of the evidence, according to the GRADE assessment, was low. Conclusion: Opportunistic salpingectomy is safe, effective, and feasible at the time of VH. Nulliparity and pelvic organ prolapse are factors potentially influencing surgical outcomes. Synopsis: Opportunistic salpingectomy is safe, effective, and feasible at the time of VH. Nulliparity and pelvic organ prolapse are factors potentially influencing surgical outcomes. [ABSTRACT FROM AUTHOR]

• Vaginal hysterectomy in local anaesthesia and sedation in feasible. • In our study it was associated with lower pain scores the first two days after the procedure. • It can be especially beneficial for older patients with serious medical comorbidities. Vaginal hysterectomy (VH) is usually performed under general (GA) or regional anaesthesia. In recent years, the possibility of performing vaginal hysterectomy under local anaesthesia (LA) has also been explored. Our aim was to compare intraoperative and early postoperative outcomes in women who underwent VH under LA with intravenous sedation or GA. In this retrospective study, we collected data of patients who underwent VH at our department from June 2021 to December 2022. For every patient, the following data was obtained: hospitalisation duration, type of anaesthesia (LA or GA), accompanying procedures, the dosage of used local anaesthetic in the LA group, maximal pain score for each day of hospitalisation after the procedure, procedure duration, intraoperative blood loss, and postoperative complication rate. Data was analysed using the SPSS Statistics programme. Statistical significance was set at p < 0.05. Seventy patients were included in the study. The mean age was significantly higher in the LA group compared to GA group (73.8 ± 8.0 years vs. 67.1 ± 9.3 respectively, p-value = 0.003). LA was associated with statistically lower pain scores in the first two days after the procedure (p = 0.003), and shorter procedure duration (p-value <0.001) as well as hospitalisation duration (p < 0.001). Furthermore, the cumulative dosage of different analgesics used during hospitalisation was higher in the GA group. Our results show that LA is a feasible option for patients undergoing VH. Vaginal surgical procedures under LA could be especially beneficial for older patients with medical comorbidities in whom GA would be particularly hazardous. [ABSTRACT FROM AUTHOR]

Chronic post-surgical pain (CPSP) significantly impacts patients' recovery and quality of life. Although environmental risk factors are well-established, genetic risk remains less understood. A meta-analysis of genome-wide association studies followed by partitioned heritability was performed on 1350 individuals across five surgery types: hysterectomy, mastectomy, abdominal, hernia, and knee. In subsequent animal studies, withdrawal thresholds to evoked mechanical stimulation were measured in Rag1 null mutant and wild-type mice after plantar incision and laparotomy. Cell sorting by flow cytometry tracked recruitment of immune cell types. We discovered 77 genome-wide significant single-nucleotide polymorphism (SNP) hits, distributed among 24 loci and 244 genes. Meta-analysis of all cohorts estimated a SNP-based narrow-sense heritability for CPSP at ∼39%, indicating a substantial genetic contribution. Partitioned heritability analysis across a wide variety of tissues revealed enrichment of heritability in immune system-related genes, particularly those associated with B and T cells. Rag1 null mutant mice lacking both T and B cells exhibited exacerbated and prolonged allodynia up to 42 days after surgery, which was rescued by B-cell transfer. Recruitment patterns of B cells but not T cells differed significantly during the first 7 days after injury in the footpad, lymph nodes, and dorsal root ganglia. These findings suggest a key protective role for the adaptive immune system in the development of chronic post-surgical pain. [ABSTRACT FROM AUTHOR]

Objectives: To assess the impact of preoperative anxiety on pain and analgesic consumption in patients undergoing vaginal hysterectomy (VH) with general and spinal anesthesia. Material and methods: A total of 200 participants, including 100 undergoing vaginal hysterectomy with general anesthesia (group 1) and 100 with spinal anesthesia (group 2), were enrolled. A visual analog scale (VAS) was used for the postoperative pain intensity. Results: The 1st hour, 6th hour, 12th hour, and 18th hour VAS scores were higher in vaginal hysterectomy with general anesthesia than in vaginal hysterectomy with spinal anesthesia. Conclusions: Although participants undergoing VH with spinal anesthesia (preoperative state anxiety inventory score > 45) had lower pain intensity scores in the first 18 hours compared to those undergoing VH with general anesthesia, their postoperative analgesic requirements were similar. [ABSTRACT FROM AUTHOR]

Surgery remains the gold standard treatment for endometrial cancer. Vaginal approach is suitable for candidates with low risk for lymph node metastasis or in elderly females with extensive comorbidities, especially when surgery is done for palliative purpose only. We herein describe a case of cancer endometrium in huge procidentia, managed by vaginal hysterectomy followed by hormonal therapy.

Background: Sheehan's syndrome is a rare condition, which is classically characterized by anterior pituitary hypofunction following postpartum shock or hemorrhage. While diabetes insipidus (DI) is not commonly associated with Sheehan's syndrome, we present a rare case of a multiparous female developing rapid-onset panhypopituitarism and DI following severe postpartum hemorrhage. Case presentation: A previously healthy 39-year-old woman, gravida 5, para 4, presented with hypovolemic shock after vaginal delivery, attributed to severe postpartum hemorrhage, necessitating emergent hysterectomy. Although her shock episodes resolved during hospitalization, she developed intermittent fever, later diagnosed as adrenal insufficiency. Administration of hydrocortisone effectively resolved the fever. However, she subsequently developed diabetes insipidus. Diagnosis of Sheehan's syndrome with central diabetes insipidus was confirmed through functional hormonal tests and MRI findings. Treatment consisted of hormone replacement therapy, with persistent panhypopituitarism noted during a ten-year follow-up period. Conclusions: Sheehan's syndrome is a rare complication of postpartum hemorrhage. Central diabetes insipidus should be suspected, although not commonly, while the patient presented polyuria and polydipsia. Besides, the potential necessity for long-term hormonal replacement therapy should be considered. [ABSTRACT FROM AUTHOR]

This case report details the surgical treatment of a rare enlarged cervical leiomyoma with uterine prolapse in a 48-year-old woman. She presented to Konyang University Hospital with a palpable vaginal mass, lower abdominal pain, and urinary incontinence. Despite being nulliparous, she had severe chronic constipation due to schizophrenia medication and lived in a health care facility separated from her family. Pelvic examination revealed stage 3 uterine prolapse with a large necrotic cervical leiomyoma. A robot-assisted vaginal hysterectomy followed by sacrocolpopexy was performed using the Da Vinci Xi Surgical System. Histopathology confirmed cervical leiomyoma with squamous metaplasia. At a three-month follow-up, there were no complications, pelvic anatomy was restored, and urinary incontinence improved. Although the patient had a systemic infection due to the necrotic cervical leiomyoma, raising concerns about the increased risk of infection associated with mesh use, she was high-risk for pelvic organ prolapse (POP) recurrence due to her medical history and living situation. Therefore, she underwent concurrent surgeries with pre- and postoperative antibiotic treatment, and recovered without complications. Given that the risk of developing POP increases after a hysterectomy, in high-risk patients, as demonstrated in this case, the concurrent surgical correction of POP may be an effective strategy. [ABSTRACT FROM AUTHOR]

Background Aims Materials and Methods Results Conclusions Vaginal hysterectomy (VH) rate is declining despite being considered as the optimal minimally invasive option for hysterectomy with reduced operative time and length of stay compared with laparoscopic hysterectomy (LH). Vaginal assisted natural orifice transluminal endoscopic surgery hysterectomy (VANH) combines the advantages of both vaginal and endoscopic approach to surgery.To report feasibility and early experience of a single surgeon adopting VANH at a tertiary Australian hospital.Prospective review of the first 20 VANH cases with complete data set collected retrospectively including patient demographics, indication for surgery and perioperative outcomes.The median age of the first 20 participants was 51.5 years (47–57 years of age) and the median body mass index was 33.5 kg/m2 (27.8–38.3 kg/m2). The predominant indication was complex hyperplasia with atypia (12/20, 60%). The median parity was two (1–3) where four patients were nulliparous. The median blood loss was 125 mL (100–200 mL) with an operative time of 149 min (138–198 min) and median weight of the specimen of 181.5 g (66.5–219 g). The mean length of stay was 1.4 days (1–2 days). Five cases had conversion to laparoscopy and the majority (80%) occurred within the first ten cases.VANH is feasible but there is a learning curve to achieve competence in this technique, which requires adequate training in the early stages of adoption with careful case selection. Until further robust data is available to determine the clinical benefit and safety profile of VANH, patients should be carefully counselled and the decision on mode of hysterectomy be individualised. [ABSTRACT FROM AUTHOR]

Background: Delayed spinal epidural hematoma (SEH) following central neuraxial block (CNB) is a rare but serious complication. The underlying causes of SEH associated with neuraxial anesthesia are still unclear. Furthermore, the decision between surgical intervention and conservative management for SEH remains a complex and unresolved issue. Case Presentation: We report a case of delayed SEH in a 73-year-old woman who underwent vaginal hysterectomy under combined spinal-epidural anesthesia, with the administration of postoperative anticoagulants to prevent deep vein thrombosis on the 1st postoperative day (POD). She experienced symptoms 56 h after CNB. Magnetic resonance imaging (MRI) revealed a dorsal SEH at the L1-L4 level with compression of the thecal sac. On conservative treatment, full recovery was achieved after six months. Conclusions: This case reminds anesthesiologists should be alert to the possible occurrence of a delayed SEH following CNB, particularly with the administration of anticoagulants. Immediate neurological evaluation of neurological deficit and MRI are advised. Conservative treatment combined with close and dynamic neurological function monitoring may be feasible for patients with mild or nonprogressive symptoms even spontaneous recovery. [ABSTRACT FROM AUTHOR]

Background: Even though the vaginal route is said to be the gynaecologist route of surgery, abdominal hysterectomy remains the predominant method of uterine removal in most parts of the world, despite the evidence of the safety of vaginal hysterectomy. The study aims to determine the prevalence, sociodemographic variables, indications as well as outcome of vaginal hysterectomy at Federal Teaching Hospital (FTH) Katsina, during the 5-year study period. Methodology: A five-year retrospective study on vaginal hysterectomy was conducted in Federal Teaching Hospital, Katsina from 1st January 2015 to 31st December 2019. Results: The rate of hysterectomies (Abdominal & Vaginal) was 21.6% of the total major gynaecological surgeries performed during the study period. Vaginal hysterectomy accounted for 6.7%. The mean age and parity of the patients were 56.06+/- 9.55 years and 10.17+/- 4.57 respectively. The commonest indication was Utero-vaginal Prolapse (88.9%) and 80.5% (29) of the patients had no complications. Most of the patients (94.4%) were discharged within 7 days of surgery and there was no fatality. Conclusion: The rate of vaginal hysterectomy in our centre is low. Most of the patients were grand multiparous with the main indication being Uterovaginal prolapse. It is associated with favourable outcomes and very low complication rates. [ABSTRACT FROM AUTHOR]

ABSTRACT: Introduction and Hypothesis: The aims of this study were to define long-term anatomic outcome, satisfaction rate, and reasons for disappointment and regret in a group of patients with advanced pelvic organ prolapse who underwent LeFort colpocleisis (LFC). Materials and Methods: This was a retrospective, single-center, cohort study including consecutive patients who underwent LFC from 2007 to 2021. All patients had surgery involving vaginal hysterectomy and anti-incontinence procedure where clinically indicated. All patients were examined 3 months after surgery. A cross-sectional telephone survey was performed in 2022 using the Patient Global Impression of Severity (PGI-S), Patient Global Impression of Improvement (PGI-I), and Patient Global Impression of Change (PGI-C) questionnaires, as well as the Decision Regret Scale. Student's t -test, Fisher's Chi-square test, and univariable logistic regression analysis were carried out. Results: One hundred and forty-one patients (mean age 74.95 ± 6.25 years) were included. The mean preoperative POP Quantification C/D point was +6 (±2.7). In 86 (60.99%) patients, a hysterectomy and in 56 (39.71%), a mid-urethral synthetic sling was performed. At 3-month follow-up, there was one prolapse recurrence (0.71%) and no case of regret of sexual function loss. In the long term, 28 patients died, and 69 patients were interviewed through telephone (follow-up 61.65 months). The mean PGI-S, PGI-I, and PGI-C scores were 1.42 (±0.81), 1.93 (±1.45), and 5.91 (±1.69) respectively, and no patient declared regret about vaginal intercourse loss. Preoperative and postoperative persistent or de novo mixed UI appeared to be related to decreased satisfaction and regret post-LFC (P = 0.0021). Conclusion: LFC is a valuable, easy-to-perform technique with long-lasting results and decreased postoperative anti-incontinence rates. However, de novo or persistent urinary incontinence appears to be related to decreased satisfaction rates. [ABSTRACT FROM AUTHOR]

Various routes of surgery, especially minimally invasive routes, are feasible, safe, and effective for hysterectomy of large uteri in benign cases with few complications. OBJECTIVE: To identify the optimal hysterectomy approach for large uteri in gynecologic surgery for benign indications from a perioperative morbidity standpoint. DATA SOURCES: PubMed and Embase databases were searched from inception through September 19, 2022. Meta-analyses were conducted as feasible. METHODS OF STUDY SELECTION: This review included studies that compared routes of hysterectomy with or without bilateral salpingo-oophorectomy for large uteri (12 weeks or more or 250 g or more) and excluded studies with any concurrent surgery for pelvic organ prolapse, incontinence, gynecologic malignancy, or any obstetric indication for hysterectomy. TABULATION, INTEGRATION, AND RESULTS: The review included 25 studies comprising nine randomized trials, two prospective, and 14 retrospective nonrandomized comparative studies. Studies were at high risk of bias. There was lower operative time for total vaginal hysterectomy compared with laparoscopically assisted vaginal hysterectomy (LAVH) (mean difference 39 minutes, 95% CI, 18–60) and total vaginal hysterectomy compared with total laparoscopic hysterectomy (mean difference 50 minutes, 95% CI, 29–70). Total laparoscopic hysterectomy was associated with much greater risk of ureteral injury compared with total vaginal hysterectomy (odds ratio 7.54, 95% CI, 2.52–22.58). There were no significant differences in bowel injury rates between groups. There were no differences in length of stay among the laparoscopic approaches. For LAVH compared with total vaginal hysterectomy, randomized controlled trials favored total vaginal hysterectomy for length of stay. When rates of blood transfusion were compared between these abdominal hysterectomy and robotic-assisted total hysterectomy routes, abdominal hysterectomy was associated with a sixfold greater risk of transfusion than robotic-assisted total hysterectomy (6.31, 95% CI, 1.07–37.32). Similarly, single studies comparing robotic-assisted total hysterectomy with LAVH, total laparoscopic hysterectomy, or total vaginal hysterectomy all favored robotic-assisted total hysterectomy for reduced blood loss. CONCLUSION: Minimally invasive routes are safe and effective and have few complications. Minimally invasive approach (vaginal, laparoscopic, or robotic) results in lower blood loss and shorter length of stay, whereas the abdominal route has a shorter operative time. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42021233300. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the short-term safety and efficacy of vaginal hysterectomy with cervical preservation in patients with genital prolapse stages II to IV. Materials and methods: This is a descriptive case series study. It included women with genital prolapse stages II to IV, indicated for vaginal hysterectomy, with negative cervicovaginal cytology for malignancy, who underwent subtotal vaginal hysterectomy with suspension of the cervical stump to the sacrospinous ligament between June 1 and December 31, 2023, at a high-complexity general clinic. Sociodemographic variables and complications six months postoperatively were analyzed. The surgical technique is presented, and descriptive analysis, along with a detailed surgical technique exposition of cervical stump suspension to the sacrospinous ligament, was conducted. Results: During the described period, 10 patients consulted, of whom eight met the inclusion criteria. The mean duration of the surgical procedure was 133 minutes. Average blood loss was 200 cc. One patient required analgesic use of pregabalin for peripheral neuropathic pain, achieving adequate postoperative pain control. No other intraoperative or postoperative complications were reported. No prolapse recurrence was observed six months postevaluation. Conclusions: Subtotal vaginal hysterectomy with cervical stump suspension to the sacrospinous ligament is a surgical repair technique that could be considered for the management of uterine prolapse. Randomized studies comparing this technique with other management alternatives are needed to evaluate its long-term efficacy and safety. [ABSTRACT FROM AUTHOR]

Introduction: The study aimed to compare the short‐term outcomes of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for uterosacral ligament suspension (USLS) versus nonendoscopic USLS in patients with subtotal uterine prolapse who had a concomitant vaginal hysterectomy. Methods: There were 51 patients who underwent vNOTES USLS, whereas the nonendoscopic conventional USLS group had 49 patients. The information about patient demographics, and perioperative data including the operative duration, blood loss, intraoperative and postoperative complications, and length of postoperative hospital stay were determined from the patients' files. Postoperative follow‐up visits were scheduled at the first week and 1 month after surgery. Results: The demographic variables including age, body mass index, menopausal status, and parity were comparable, and no significant differences were found. A total of 90.2% of the patients in the vNOTES group and 69.4% of the patients in the shull group were at menopause (p =.09). Operation time was significantly shorter in the shull group (p <.001), and the hospitalization period (p =.029) was significantly shorter in the vNOTES group. Ba, Bp, and D points and total vaginal length (TVL) were significantly behind the hymenal ring in patients who had vNOTES USLS procedure (p <.001). None of the patients who had intraoperative significant blood loss required transfusion. One patient in the vNOTES and two patients in the shull group had a postoperative cuff hematoma. Conclusion: vNOTES USLS has a good safety profile, higher percentage of adnexal surgeries with better improvement on POP‐Q points Ba, Bp, D, and TVL compared with classic USLS in patients with subtotal uterine prolapse. Studies evaluating short‐ and long‐term results of vNOTES versus conventional USLS are needed. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Vaginal hysterectomy (VH) was described as far back as 120 CE. However, it was not till the mid-1900s when reconstructive procedures were introduced to mitigate the risk of, or treat, pelvic organ prolapse in relation to VH. Furthermore, routine hysterectomy, particularly VH, has long been advocated in prolapse surgery. However, this indication is now questionable. Methods: Literature review to provide an overview of current evidence and experts' opinion regarding the relationship between VH and pelvic organ prolapse. The review presents a historical perspective on the role of VH in the management of pelvic organ prolapse, the current debate on the usefulness of the procedure in this context, a practical guide on operative techniques used during VH and the impact of recent surgical developments on its use. Results: Vaginal hysterectomy is a well-established technique that is still superior to laparoscopic hysterectomy for benign gynecological disease, although more surgically challenging. However, it is possible that some contemporary techniques, such as vaginal natural orifice transluminal endoscopic surgery, may overcome some of these challenges, and hence increase the number of hysterectomies performed via the vaginal route. Although patients should be counselled about uterine-sparing reconstructive surgery, vaginal hysterectomy continues to be a major surgical procedure in reconstructive pelvic floor surgery. Conclusions: Therefore, it is prudent to continue to train residents in vaginal surgical skills to ensure that they continue to provide safe, cost-effective, and comprehensive patient care. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The safety and feasibility of same-day discharge (SDD) has been consistently reported across the benign and gynecologic oncology literature. However, outcomes of SDD in the urogynecology population are sparse. The objectives of this study were to describe the success of SDD following vaginal hysterectomy and native-tissue colpopexy, and to compare the incidence of postoperative adverse events in patients discharged same-day versus postoperative day 1 (POD1). Further objectives were to compare pain, quality of recovery (QoR), and satisfaction between the groups. Methods: This was a single-center, prospective cohort study of patients with planned SDD. A standardized ERAS protocol was utilized. The QoR-40 questionnaire was administered at baseline, POD2, and the 6-week postoperative visit. Pain scores were captured similarly, and a satisfaction survey was administered at 6 weeks. The primary outcome was composite adverse events defined as any postoperative adverse event and/or health care utilization, excluding telephone calls, and urinary tract infection. Results: A total of 101 patients were enrolled in the study; the primary outcome was available for 99. SDD was achieved for 76 patients (77.0%); 23 patients stayed overnight (23.2%). The overall incidence of composite adverse events was 20.2% (95% CI, 13.5–29.2), and was not different between the groups (26.1% vs 18.4%, p = 0.42). Additionally, there were no differences in the QoR-40 or pain scores on POD2 and at 6 weeks. Patient satisfaction was high and similar between the groups. Conclusions: Successful SDD was achieved in 77.0% of the patients. SDD following vaginal hysterectomy and native-tissue colpopexy appears to be safe, feasible, and associated with good QoR and a high degree of patient satisfaction. [ABSTRACT FROM AUTHOR]

Background: Previous reviews on hysterectomy versus uterine‐sparing surgery in pelvic organ prolapse (POP) repair did not consider that the open abdominal approach or transvaginal mesh use have been largely abandoned. Objectives: To provide up‐to‐date evidence by examining only studies investigating techniques currently in use for POP repair. Search Strategy: MEDLINE and Embase databases were searched from inception to January 2023. Selection Criteria: We included randomized and non‐randomized studies comparing surgical procedures for POP with or without concomitant hysterectomy. Studies describing open abdominal approaches or transvaginal mesh implantation were excluded. Data Collection and Analysis: A random effect meta‐analysis was conducted on extracted data reporting pooled mean differences and odds ratios (OR) between groups with 95% confidence intervals (CI). Main Results: Thirty‐eight studies were included. Hysterectomy and uterine‐sparing procedures did not differ in reoperation rate (OR 0.93; 95% CI 0.74–1.17), intraoperative major (OR 1.34; 95% CI 0.79–2.26) and minor (OR 1.38; 95% CI 0.79–2.4) complications, postoperative major (OR 1.42; 95% CI 0.85–2.37) and minor (OR 1.18; 95% CI 0.9–1.53) complications, and objective (OR 1.38; 95% CI 0.92–2.07) or subjective (OR 1.23; 95% CI 0.8–1.88) success. Uterine preservation was associated with a shorter operative time (−22.7 min; 95% CI –16.92 to −28.51 min), shorter hospital stay (−0.35 days, 95% CI –0.04 to −0.65 days), and less blood loss (−61.7 mL; 95% CI –31.3 to −92.1 mL). When only studies using a laparoscopic approach for both arms were considered, no differences were observed in investigated outcomes between the two groups. Conclusions: No major differences were observed in POP outcomes between procedures with and without concomitant hysterectomy. The decision to preserve or remove the uterus should be tailored on individual factors. Synopsis: In women with indication for surgical management of pelvic organ prolapse, the decision to preserve or remove the uterus should be tailored on individual factors. [ABSTRACT FROM AUTHOR]