Daily Exam Question - Feb. 25, 2014 - Gynecology

By drwall
February 25, 2014

In comparing LAVH to TAH, all of the following are likely EXCEPT:

A. Longer operating time

B. Lower drop in post-operative hemoglobin/hematocrit

C. Fewer wound infections

D. Lower rate of urinary tract injuries

E. Lower blood loss

Answer: D

Source: ACOG COMMITTEE OPINION Number 444, November 2009, (Reaffirmed 2011). Choosing Route of hysterectomy for benign disease

Hysterectomies are performed vaginally, abdominally, or with laparoscopic or robotic assistance. When choosing the route and method of hysterectomy, the physician should take into consideration how the procedure may be performed most safely and cost effectively to fulfill the medical needs of the patient. Most literature supports the opinion that, when feasible, vaginal hysterectomy is the safest and most cost-effective route by which to remove the uterus. However, analysis of U.S. surgical data shows that abdominal hysterectomy is performed in 66% of cases, vaginal hysterectomy in 22% of cases, and laparoscopic hysterectomy in 12% of cases.

A Cochrane review of 34 randomized trials of abdominal hysterectomy, laparoscopic hysterectomy, and vaginal hysterectomy, including 4,495 patients, concluded that vaginal hysterectomy has the best outcomes of these three routes. The review also found that when a vaginal hysterectomy is not possible, laparoscopic hysterectomy has advantages (including faster return to normal activity, shorter duration of hospital stays, lower intraoperative blood loss, and fewer wound infections) over abdominal hysterectomy; however, laparoscopic surgery also is associated with longer operating time and higher rates of urinary tract injury.

Summary of Comparison of Different Approaches to Hysterectomy:

Vaginal Hysterectomy Compared With Abdominal Hysterectomy

•Shorter duration of hospital stay

•Faster return to normal activity

•Fewer febrile episodes or unspecified infections

Vaginal Hysterectomy Compared With Laparoscopic Hysterectomy

•Shorter operating time

Laparoscopic Hysterectomy Compared With Abdominal Hysterectomy

•Faster return to normal activity

•Shorter duration of hospital stay

•Smaller drop in hemoglobin

•Lower intraoperative blood loss

•Fewer wound or abdominal wall infections

•Longer operating time

Higher rate of lower urinary tract (bladder and ureter) injuries

Data from Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD003677. DOI: 10.1002/14651858. CD003677.pub4.

Source: ACOG COMMITTEE OPINION Number 444, November 2009, (Reaffirmed 2011). Choosing Route of hysterectomy for benign disease

Daily Exam Question - Written/MOC

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