Histerektomi
Özet
Histerektomi, uterin leiomyomlar, anormal kanamalar, pelvik organ prolapsusu ve malign hastalıklar gibi endikasyonlarla uygulanan ve gelişen teknolojiyle birlikte abdominal, vajinal veya laparoskopik yollarla gerçekleştirilen bir cerrahi prosedürdür. Vajinal histerektomi, düşük komplikasyon oranları ve hızlı iyileşme süresi nedeniyle teknik olarak mümkün olduğunda ilk tercih edilmesi gereken yöntemdir; ancak eğitim yetersizliği gibi nedenlerle son yıllarda cerrahi eğilim laparoskopik yaklaşıma doğru kaymıştır. Vajinal yolun uygun olmadığı durumlarda, düşük morbidite oranı sunan laparoskopik veya robot asiste yöntemler, geleneksel açık abdominal cerrahiye (laparotomi) tercih edilmektedir. Cerrahi öncesinde tromboprofilaksi ve antibiyotik profilaksisi gibi önlemler standart olarak uygulanırken, operasyon sırasında üreter, mesane ve bağırsak yaralanmalarını önlemek adına anatomik boşlukların doğru diseksiyonu ve iskeletizasyon büyük önem taşır. Vajinal kafın kapatılmasında farklı cerrahi teknikler ve dikenli sütürler kullanılabilmekte, apikal sarkmayı önlemek için vajinal apeks süspansiyonu önerilmektedir. Ameliyat sonrası dönemde hastalar genellikle ikinci ve altıncı haftalarda kontrole çağrılır; ağır kaldırmaktan kaçınma ve belirli bir süre cinsel ilişki yasağı gibi talimatlarla vajinal kaf dehisensi gibi nadir ama ciddi komplikasyonların önüne geçilmesi hedeflenir.
Hysterectomy is a surgical procedure performed for indications such as uterine leiomyomas, abnormal bleeding, pelvic organ prolapse, and malignant diseases, and it has evolved to be executed via abdominal, vaginal, or laparoscopic routes due to advancing technology. Vaginal hysterectomy is the preferred primary approach whenever technically feasible owing to its lower complication rates and faster recovery time; however, due to factors like limited training, the surgical trend has shifted toward laparoscopic approaches in recent years. When the vaginal route is not viable, laparoscopic or robot-assisted methods, which offer lower morbidity rates, are preferred over traditional open abdominal surgery (laparotomy). While measures such as thromboprophylaxis and antibiotic prophylaxis are standardly implemented preoperatively, precise dissection of anatomical spaces and skeletonization are of paramount importance during the operation to prevent ureteral, bladder, and bowel injuries. Various surgical techniques and barbed sutures can be utilized for vaginal cuff closure, and vaginal apex suspension is recommended to minimize the loss of apical support. In the postoperative period, patients are typically scheduled for follow-up exams at two and six weeks, aiming to prevent rare but serious complications such as vaginal cuff dehiscence through instructions like avoiding heavy lifting and adhering to a temporary coital restriction.
Referanslar
Falcone T, Parker WH. Surgical management of leiomyomas for fertility or uterine preservation. Obstet Gynecol. 2013;121(4):856-68.
Committee Opinion No 701: Choosing the Route of Hysterectomy for Benign Disease. Obstet Gynecol. 2017;129(6):e155-e9.
AAGL position statement: route of hysterectomy to treat benign uterine disease. Journal of minimally invasive gynecology. 2011;18(1):1-3.
Aarts JW, Nieboer TE, Johnson N, Tavender E, Garry R, Mol BW, et al. Surgical approach to hysterectomy for benign gynaecological disease. The Cochrane database of systematic reviews. 2015;2015(8):Cd003677.
Sandberg EM, Twijnstra ARH, Driessen SRC, Jansen FW. Total Laparoscopic Hysterectomy Versus Vaginal Hysterectomy: A Systematic Review and Meta-Analysis. Journal of minimally invasive gynecology. 2017;24(2):206-17.e22.
Agrawal S, Chen L, Tergas AI, Hou JY, St Clair CM, Ananth CV, et al. Characteristics associated with prolonged length of stay after hysterectomy for benign gynecologic conditions. Am J Obstet Gynecol. 2018;219(1):89.e1-.e15.
ACOG Practice Bulletin No. 89. Elective and risk-reducing salpingo-oophorectomy. Obstet Gynecol. 2008;111(1):231-41.
ACOG Practice Bulletin No. 84: Prevention of deep vein thrombosis and pulmonary embolism. Obstet Gynecol. 2007;110(2 Pt 1):429-40.
Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e227S-e77S.
Larsson PG, Carlsson B. Does pre- and postoperative metronidazole treatment lower vaginal cuff infection rate after abdominal hysterectomy among women with bacterial vaginosis? Infectious diseases in obstetrics and gynecology. 2002;10(3):133-40.
Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recommendations and reports : Morbidity and mortality weekly report Recommendations and reports. 2015;64(Rr-03):1-137.
ACOG Practice Bulletin No. 195: Prevention of Infection After Gynecologic Procedures. Obstet Gynecol. 2018;131(6):e172-e89.
Hernandez CR, Howard FM. Management of tubal prolapse after hysterectomy. J Am Assoc Gynecol Laparosc. 1998;5(1):59-62.
Petrakis IE, Lasithiotakis KG, Chalkiadakis GE. Use of the LigaSure vessel sealer in total abdominal hysterectomy. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2005;89(3):303-4.
Lakeman M, Kruitwagen RF, Vos MC, Roovers JP. Electrosurgical bipolar vessel sealing versus conventional clamping and suturing for total abdominal hysterectomy: a randomized trial. Journal of minimally invasive gynecology. 2008;15(5):547-53.
Hagen B, Eriksson N, Sundset M. Randomised controlled trial of LigaSure versus conventional suture ligature for abdominal hysterectomy. BJOG : an international journal of obstetrics and gynaecology. 2005;112(7):968-70.
Kaya H, Sezik M, Ozbasar D, Ozkaya O, Sahiner H. Intrafascial versus extrafascial abdominal hysterectomy: effects on urinary urge incontinence. International urogynecology journal and pelvic floor dysfunction. 2004;15(3):171-4.
Colombo M, Maggioni A, Zanini A, Rangoni G, Scalambrino S, Mangioni C. A randomized trial of open versus closed vaginal vault in the prevention of postoperative morbidity after abdominal hysterectomy. Am J Obstet Gynecol. 1995;173(6):1807-11.
Berman ML, Grosen EA. A new method of continuous vaginal cuff closure at abdominal hysterectomy. Obstet Gynecol. 1994;84(3):478-80.
Neuman M, Beller U, Ben Chetrit A, Lavie O, Boldes R, Diamant Y. Prophylactic effect of the open vaginal vault method in reducing febrile morbidity in abdominal hysterectomy. Surgery, gynecology & obstetrics. 1993;176(6):591-3.
Jaszczak SE, Evans TN. Intrafascial abdominal and vaginal hysterectomy: a reappraisal. Obstet Gynecol. 1982;59(4):435-44.
Wall LL. A technique for modified McCall culdeplasty at the time of abdominal hysterectomy. Journal of the American College of Surgeons. 1994;178(5):507-9.
Jenkins TR. It's time to challenge surgical dogma with evidence-based data. Am J Obstet Gynecol. 2003;189(2):423-7.
Maresh MJ, Metcalfe MA, McPherson K, Overton C, Hall V, Hargreaves J, et al. The VALUE national hysterectomy study: description of the patients and their surgery. BJOG : an international journal of obstetrics and gynaecology. 2002;109(3):302-12.
Garry R, Fountain J, Mason S, Hawe J, Napp V, Abbott J, et al. The eVALuate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy. Bmj. 2004;328(7432):129.
Morgan DM, Kamdar NS, Swenson CW, Kobernik EK, Sammarco AG, Nallamothu B. Nationwide trends in the utilization of and payments for hysterectomy in the United States among commercially insured women. Am J Obstet Gynecol. 2018;218(4):425.e1-.e18.
Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB, Mannel RS, et al. Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2009;27(32):5331-6.
Olive DL, Parker WH, Cooper JM, Levine RL. The AAGL classification system for laparoscopic hysterectomy. Classification committee of the American Association of Gynecologic Laparoscopists. J Am Assoc Gynecol Laparosc. 2000;7(1):9-15.
Nezhat C, Nezhat F, Admon D, Nezhat AA. Proposed classification of hysterectomies involving laparoscopy. J Am Assoc Gynecol Laparosc. 1995;2(4):427-9.
Crum CP, Drapkin R, Kindelberger D, Medeiros F, Miron A, Lee Y. Lessons from BRCA: the tubal fimbria emerges as an origin for pelvic serous cancer. Clinical medicine & research. 2007;5(1):35-44.
Kindelberger DW, Lee Y, Miron A, Hirsch MS, Feltmate C, Medeiros F, et al. Intraepithelial carcinoma of the fimbria and pelvic serous carcinoma: Evidence for a causal relationship. The American journal of surgical pathology. 2007;31(2):161-9.
Siedhoff MT, Clark LH, Hobbs KA, Findley AD, Moulder JK, Garrett JM. Mechanical bowel preparation before laparoscopic hysterectomy: a randomized controlled trial. Obstet Gynecol. 2014;123(3):562-7.
Ghomi A, Hantes J, Lotze EC. Incidence of cyclical bleeding after laparoscopic supracervical hysterectomy. Journal of minimally invasive gynecology. 2005;12(3):201-5.
Tulandi T, Einarsson JI. The use of barbed suture for laparoscopic hysterectomy and myomectomy: a systematic review and meta-analysis. Journal of minimally invasive gynecology. 2014;21(2):210-6.
López CC, Ríos JFL, González Y, Vásquez-Trespalacios EM, Serna D, Arango A, et al. Barbed Suture versus Conventional Suture for Vaginal Cuff Closure in Total Laparoscopic Hysterectomy: Randomized Controlled Clinical Trial. Journal of minimally invasive gynecology. 2019;26(6):1104-9.
Einarsson JI, Cohen SL, Gobern JM, Sandberg EM, Hill-Lydecker CI, Wang K, et al. Barbed versus standard suture: a randomized trial for laparoscopic vaginal cuff closure. Journal of minimally invasive gynecology. 2013;20(4):492-8.
Blikkendaal MD, Twijnstra AR, Pacquee SC, Rhemrev JP, Smeets MJ, de Kroon CD, et al. Vaginal cuff dehiscence in laparoscopic hysterectomy: influence of various suturing methods of the vaginal vault. Gynecological surgery. 2012;9(4):393-400.
Uccella S, Ceccaroni M, Cromi A, Malzoni M, Berretta R, De Iaco P, et al. Vaginal cuff dehiscence in a series of 12,398 hysterectomies: effect of different types of colpotomy and vaginal closure. Obstet Gynecol. 2012;120(3):516-23.
Uccella S, Malzoni M, Cromi A, Seracchioli R, Ciravolo G, Fanfani F, et al. Laparoscopic vs transvaginal cuff closure after total laparoscopic hysterectomy: a randomized trial by the Italian Society of Gynecologic Endoscopy. Am J Obstet Gynecol. 2018;218(5):500.e1-.e13.
Chiong E, Hegarty PK, Davis JW, Kamat AM, Pisters LL, Matin SF. Port-site hernias occurring after the use of bladeless radially expanding trocars. Urology. 2010;75(3):574-80.
Phelps P, Cakmakkaya OS, Apfel CC, Radke OC. A simple clinical maneuver to reduce laparoscopy-induced shoulder pain: a randomized controlled trial. Obstet Gynecol. 2008;111(5):1155-60.
Lim CS, Mowers EL, Mahnert N, Skinner BD, Kamdar N, Morgan DM, et al. Risk Factors and Outcomes for Conversion to Laparotomy of Laparoscopic Hysterectomy in Benign Gynecology. Obstet Gynecol. 2016;128(6):1295-305.
Wong JMK, Bortoletto P, Tolentino J, Jung MJ, Milad MP. Urinary Tract Injury in Gynecologic Laparoscopy for Benign Indication: A Systematic Review. Obstet Gynecol. 2018;131(1):100-8.
Llarena NC, Shah AB, Milad MP. Bowel injury in gynecologic laparoscopy: a systematic review. Obstet Gynecol. 2015;125(6):1407-17.
Nezhat C, Kennedy Burns M, Wood M, Nezhat C, Nezhat A, Nezhat F. Vaginal Cuff Dehiscence and Evisceration: A Review. Obstet Gynecol. 2018;132(4):972-85.
Hur HC, Donnellan N, Mansuria S, Barber RE, Guido R, Lee T. Vaginal cuff dehiscence after different modes of hysterectomy. Obstet Gynecol. 2011;118(4):794-801.
Yim GW, Jung YW, Paek J, Lee SH, Kwon HY, Nam EJ, et al. Transumbilical single-port access versus conventional total laparoscopic hysterectomy: surgical outcomes. Am J Obstet Gynecol. 2010;203(1):26.e1-6.
Bush AJ, Morris SN, Millham FH, Isaacson KB. Women's preferences for minimally invasive incisions. Journal of minimally invasive gynecology. 2011;18(5):640-3.
Jung YW, Lee M, Yim GW, Lee SH, Paek JH, Kwon HY, et al. A randomized prospective study of single-port and four-port approaches for hysterectomy in terms of postoperative pain. Surgical endoscopy. 2011;25(8):2462-9.
Escobar PF, Starks D, Fader AN, Catenacci M, Falcone T. Laparoendoscopic single-site and natural orifice surgery in gynecology. Fertility and sterility. 2010;94(7):2497-502.
Doucette RC, Sharp HT, Alder SC. Challenging generally accepted contraindications to vaginal hysterectomy. Am J Obstet Gynecol. 2001;184(7):1386-9; discussion 90-1.
Stone DE, Malik SA, Doerhman P, Videla FL. Döderlein-Krönig vaginal hysterectomy: an alternative to the traditional Heaney hysterectomy. Int Urogynecol J. 2015;26(5):769-71.
Balgobin S, Hamid CA, Carrick KS, Montoya TI, Schaffer JI, Corton MM. Distance From Cervicovaginal Junction to Anterior Peritoneal Reflection Measured During Vaginal Hysterectomy. Obstet Gynecol. 2016;128(4):863-7.
Favero G, Miglino G, Köhler C, Pfiffer T, Silva e Silva A, Ribeiro A, et al. Vaginal Morcellation Inside Protective Pouch: A Safe Strategy for Uterine Extration in Cases of Bulky Endometrial Cancers: Operative and Oncological Safety of the Method. Journal of minimally invasive gynecology. 2015;22(6):938-43.
Cavkaytar S, Kokanali MK, Topcu HO, Aksakal OS, Doganay M. Effects of horizontal vs vertical vaginal cuff closure techniques on vagina length after vaginal hysterectomy: a prospective randomized study. Journal of minimally invasive gynecology. 2014;21(5):884-7.
Harris WJ. Early complications of abdominal and vaginal hysterectomy. Obstet Gynecol Surv. 1995;50(11):795-805.
Daly JW, Higgins KA. Injury to the ureter during gynecologic surgical procedures. Surgery, gynecology & obstetrics. 1988;167(1):19-22.
