Hysterectomy

CONCLUSIONS: Perioperative and postoperative outcomes after benign hysterectomy differ significantly according to surgical approach. These findings suggest that surgical approach may be associated with differences in perioperative outcomes and support individualized route selection.

CONCLUSIONS: Age-related indication shifts accompanied major route changes, with greater vaginal and minimally invasive use among older patients.

CONCLUSION: Both surgical methods ensure comparable sexual function. While TLH shows stable results over the years, LASH shows a significant decrease in some areas of sexual function, particularly with regard to lubrication. However, these differences do not result in a significantly worse overall outcome compared to TLH.

CONCLUSIONS: We identified several sociodemographic and reproductive correlates of hysterectomy in LMICs. Prospective and mixed-methods studies, as well as studies examining health system factors, including provider incentives and facility-level variation, are needed to inform targeted interventions in LMIC settings.

CONCLUSION: Placenta previa and placenta accreta spectrum (PAS) disorders represent serious obstetric challenges with significant maternal and neonatal morbidity. This study highlights key risk factors and complications, underscoring the importance of early identification and multidisciplinary management strategies to improve outcomes.

A high-reaching longitudinal vaginal septum presents specific technical challenges during total laparoscopic hysterectomy, particularly in achieving controlled colpotomy and tension-free vaginal cuff closure. In asymptomatic patients, the optimal timing and extent of septal resection remain undefined, and routine complete excision may represent overtreatment. We report a case of total laparoscopic hysterectomy performed using a stepwise colpotomy guided by independent vaginal landmarks in a...

Hysterectomy is medically necessary for transgender and gender diverse patients experiencing dysphoria. During the surgical evaluation, patients should be asked about their desires for childbearing and counseled about gamete preservation. There should also be coordination with a multidisciplinary team of surgeons if patients desire other gender-affirming procedures at the time of hysterectomy. Many perioperative considerations should be given, including the continuation of testosterone...

Robotic-assisted hysterectomy is widely performed, yet device-related malfunctions and their impact on patient safety remain incompletely characterized. This study evaluates device-specific malfunctions and associated patient harm across Da Vinci system generations using the FDA MAUDE database. A retrospective descriptive analysis of adverse event reports submitted to the MAUDE database from system approval dates through March 19, 2026, was conducted. Reports involving robotic-assisted...

CONCLUSION: Opportunistic salpingectomy during hysterectomy does not adversely affect ovarian reserve, ovarian stromal blood flow, or sexual function, regardless of surgical route, supporting its safety in premenopausal women.

CONCLUSIONS: Oxycodone and sufentanil provide comparable postoperative recovery after total laparoscopic hysterectomy.

CONCLUSION: The higher cancer stage resulted in a lower fiveyear survival rate. In this limited sample study, LRH demonstrated an inferior five-year survival rate compared to ARH.

ABSTRACT: Cesarean delivery (CD) is one of the most common surgical procedures worldwide, with rising rates leading to an increasing impact of complications, such as uterine rupture during a trial of labor in a subsequent pregnancy. To date, only little information on uterine wound healing is available. The current challenge is to establish a suitable model and to define quantifiable outcome parameters of uterine scar tissue with the aim of comparing the effect of different surgical techniques...

Synchronous tumours of the female genital tract need to be distinguished from metastatic s such as primary ovarian or endometrial cancer with metastasis to the other site. This is because the treatment approach differs in both the cases and the prognosis of synchronous tumours is better. We present three cases with common symptom of lower abdominal pain in the presentation. These three patients had undergone total abdominal hysterectomy with bilateral salpingo-oophorectomy and were diagnosed...

CONCLUSION: The use of a 50-microgram dexmedetomidine nasal spray on the evening prior to surgery reduces anxiety scores on the day of surgery in patients undergoing gynaecological procedures, improves perioperative sleep quality, and maintains haemodynamic stability during the operation.

CONCLUSION: In patients undergoing TLH, tegileridine was associated with a similar postoperative analgesic success rate and a lower risk of PONV compared with oxycodone.

The da Vinci 5 (DV5) system is the latest evolution in robotic surgery, featuring force feedback technology, improved ergonomics, and integrated workflow solutions. Comparative data on surgical efficiency compared with the established da Vinci Xi system are limited. We evaluated the perioperative outcomes and efficiency of the DV5 system for total laparoscopic hysterectomy (TLH). We retrospectively analyzed 124 patients who underwent robotic TLH for benign indications between January 2024 and...

Clear cell carcinoma (CCC) of the cervix is a rare cancer, particularly in the absence of exposure to diethylstilbestrol (DES). This case is unique because it involves a 40-year-old patient with no history of DES exposure, illustrating the diagnostic and therapeutic challenges in a resource-limited setting such as Mauritania. The patient presented with persistent vaginal bleeding, and a mass was detected during a gynaecological examination. The final diagnosis of CCC was confirmed by...

CONCLUSIONS: Cardiovascular events occurred more frequently following hysterectomy, particularly among women before menopause. Cardiovascular risk assessment may be warranted in this population.

CONCLUSION: Preliminary clinical observations suggest that RRT with the sleeve technique may help reduce postoperative cervical adhesion without the use of anti-adhesion devices, which implies that individualised cervical adhesion prevention strategies should be considered.

CONCLUSION: Although the operative time and VAS scores were lower in the vNOTES group, both vNOTES and laparoscopic HUSLS provide effective and safe for apical prolapse repair following hysterectomy, with comparable anatomic success and low complication rates.

CONCLUSION: Prophylactic balloon occlusion reduces blood loss overall in both TAH and MR for PASD, but its efficacy is highly variable. Collateral circulation and scar defect morphology likely underpin this variability, and further research should focus on refining preoperative risk stratification to guide individualised surgical planning with the aid of available imaging techniques.

CONCLUSIONS: These nationwide, real-world findings show that RAH is increasingly being integrated into minimally invasive hysterectomy pathways within France, with LoS comparable to laparoscopy and shorter than open surgery. Our results support the role of RAS expertise and multidisciplinary organization in optimizing early clinical and operational outcomes during the adoption of gynecologic RAS.

CONCLUSION: OFA combined with ERAS enhances postoperative recovery in laparoscopic total hysterectomy by reducing pain, opioid-related complications, and hospital stay while improving cognitive and functional outcomes.

CONCLUSIONS: Platelet indices show statistically significant but moderate associations with adverse outcomes in PAS. First-trimester MPV may serve as an early adjunctive marker in high-risk pregnancies; however, these parameters should not replace imaging modalities and require validation in prospective multicenter studies.

CONCLUSION: Robotic-assisted vaginal hysterectomy using the da Vinci® Single-Port system is feasible and safe, with favorable short-term outcomes, including in cases with large uterine volume. Direct intravaginal insertion of the SP access port provides effective robotic assistance in a confined anatomical space. Larger prospective studies are needed to confirm these findings and further define the role of single-port robotic technology in vaginal gynecologic surgery.

CONCLUSION: The study underscores the need for personalised patient care in managing HMB, emphasising the importance of educating patients about treatment outcomes to support informed decision-making.

RATIONALE: Differentiation between uterine leiomyoma and leiomyosarcoma of uterus(LMS) is often challenging, especially in the context of pregnancy, which may delay subsequent diagnosis and treatment.

CONCLUSION: Our study demonstrates that the most significant advantage of vNOTES surgery in obese patients undergoing benign hysterectomy is the reduction in the conversion rate to laparotomy, particularly within the class III obesity group. vNOTES statistically eliminated the risk of conversion to laparotomy compared to laparoscopy in patients with class III obesity (OR 0.08; 95% CI 0.00-0.91; P = 0.035). These findings underscore the importance of risk stratification based on patient BMI when...

CONCLUSION: For carefully selected low-risk patients with early-stage cervical cancer, the available retrospective evidence suggests that less radical FSS may offer comparable oncologic safety with potentially superior reproductive outcomes compared with radical trachelectomy. These findings support the consideration of surgical de-escalation within a framework of individualized patient counselling and shared decision-making, although prospective randomized data are needed to definitively...

CONCLUSION: Low-dose intrathecal morphine provides effective, opioid-sparing, and motor-preserving analgesia in robotic-assisted laparoscopic hysterectomy. In this cohort, the 0.15 mg regimen was associated with improved analgesic balance without an increase in clinically significant adverse events. Within ERAS-based robotic pathways, optimized intrathecal morphine dosing may support predictable recovery and perioperative stability. Observational design precludes causal inference. Prospective...

Aims to clarify the role of robotic-assisted system in hysterectomies for benign and malignant conditions and offer strong evidence for choosing the best surgical approach. A retrospective study enrolled 4821 hysterectomy and radical hysterectomy cases post-robotic surgery introduction. Cases were categorized by disease status (benign or malignant) and surgical approach. Time-series analysis assessed annual trends in surgical approaches, and propensity score matching compared surgical outcomes...

CONCLUSION: HRT use after cervical cancer treatment remains suboptimal and is influenced by both patient age and the follow-up system. Structured education and dissemination of clinical guidelines may be important to improve appropriate HRT implementation in survivorship care.

CONCLUSIONS: A standardized damage-control protocol for AFE-uterine artery ligation with tamponade-is feasible and effective. It preserves maternal survival, significantly increases uterine preservation, and does not increase hemorrhage or resource use. Balloon tamponade appears preferable, supporting fertility preservation in AFE management.

We present our experience of managing two patients in their mid-40s at a tertiary care centre who developed ureterovaginal fistulas post-hysterectomy. Management included bilateral double-J stenting, percutaneous nephrostomy (PCN) and conservative treatment for one patient, whereas the other patient developed recurrent symptoms following PCN, necessitating definitive surgical intervention. Early recognition, timely intervention and individualised management strategies are critical in mitigating...

CONCLUSIONS: PET use before radical surgery for early-stage cervical cancer was associated with decreased odds of adjuvant treatment but no significant difference in oncologic outcomes. Future studies may refine our understanding of the predictive performance of multi-modal imaging for adjuvant treatment and prognosis.

CONCLUSIONS: This study found no statistically significant association between hysterectomy and ovarian cancer risk, but the wide confidence intervals and limited number of events indicate that the findings remain inconclusive.

CONCLUSION: While significant differences were not reached, the conversion rate and perioperative complication rate were higher in patients with a history of caesarean delivery, suggesting that a history of caesarean delivery may be associated with increased perioperative morbidity. Although operative time may be prolonged in patients with a history of multiple caesarean deliveries, major morbidity and re-admission rates remain comparable. Overall, a history of caesarean delivery may not...

Hysterectomy is the most common non-obstetric surgical procedure performed in women of all ages, representing a point of intersection between surgery and gynecology, with multiple possible approaches. The lack of a clear consensus on standardized selection criteria for benign pathology results in variability and decisions that may not accurately reflect the specific characteristics of each case. This is a narrative systematic review aimed at identifying and organizing the criteria reported in...

Intravenous leiomyomatosis (IVL) is a rare and special type variant of leiomyoma characterized by intravascular proliferation of benign smooth muscle cells extending beyond the uterus into the heart and even to the pulmonary arteries through a variety of ways. Owing to its rare occurrence and lacking of obvious symptoms, early diagnosis is very difficult. Complete excision of tumors is vital for a favorable prognosis. There is no consensus about the operative drug-assisted treatment to reduce...

CONCLUSION: The posterior colpotomy first technique is associated with less shortening of the total vaginal length, less occurrence of dyspareunia, and higher female sexual function index score compared to the classic approach for TAH.

Intravenous leiomyomatosis (IVL) is a rare benign smooth muscle tumor that can extend into the heart, posing major anesthetic challenges. We report a 57-year-old woman with IVL extending from the uterus through the inferior vena cava into the right atrium. A multidisciplinary team performed single-stage intracardiac tumor resection under cardiopulmonary bypass with hysterectomy and bilateral salpingo-oophorectomy. Continuous transesophageal echocardiography (TEE) enabled real-time assessment of...

CONCLUSION: Endometriosis was found in 73.6% of patients with suspected adenomyosis, which is higher than previously reported. This suggests a role for careful laparoscopic examination of the pelvis at time of hysterectomy in this population in order to account for all pathology. Further confirmation with a larger sample size and pain outcomes would assist with clinical decision-making and counseling.

CONCLUSION: Between 2005 and 2021, hysterectomy rates in Israel declined steadily with a shift from abdominal to minimally invasive approaches, reflecting global trends within a universal healthcare system providing equitable access to gynecologic care.

CONCLUSION: These findings suggest that the presence of TB and PDCs may be valuable in stratifying prognostic risk in EEC and support the inclusion of these parameters in routine pathology reporting.

CONCLUSION: Among laparoscopic hysterectomy patients, esketamine-based opioid-free anesthesia was linked to higher POD1 QoR-40 scores and fewer PONV events than opioid-based anesthesia. However, given the modest sample size, these preliminary findings warrant confirmation in larger multicenter trials.

Background: Endometrial cancer is the most common gynecologic malignancy in developed countries. Sentinel lymph node (SLN) mapping has emerged as a less invasive alternative to systematic lymphadenectomy and is increasingly incorporated into surgical staging algorithms. Vaginal natural orifice transluminal endoscopic surgery (vNOTES) provides transvaginal access to the retroperitoneum and may facilitate SLN mapping while potentially reducing postoperative morbidity, including lower extremity...

The purpose of this study was to assess the efficacy of grapiprant combined with metamizole for postoperative analgesia of healthy queens undergoing elective ovariohysterectomy, as well as the effects of both drugs on laboratory variables of blood and urine samples. Twenty-six mixed-breed adult queens deemed healthy based on clinical examination and scheduled for elective ovariohysterectomy were randomly allocated in three groups comprising three analgesia protocols: MET, metamizole at 25 mg/kg...

CONCLUSION: The incidence of peripartum hysterectomy in Taiwan remained low and stable over the last decade, with rates comparable to other developed countries. This protective effect was significantly associated with medical centers, regional hospitals, and institutions with higher delivery volume, suggesting that institutional practice and resource availability may play a crucial role in mitigating the risk of peripartum hysterectomy.

CONCLUSION: Preoperative CTA can provide critical information when managing retained placenta following conservative treatment, aiding clinicians in determining whether hysterectomy is necessary.

CONCLUSION: Preoperative diagnosis of ovarian SLCT is challenging, particularly when clinical manifestations are atypical, and the ovarian tumor is too small to be detected by imaging studies. Clinicians should maintain a high index of suspicion for this occult lesion in postmenopausal women presenting with hyperestrogenism in the absence of virilization symptoms.