HYSTERECTOMY Edited by Ayman Al-Hendy and Mohamed Sabry           Hysterectomy Edited by Ayman Al-Hendy and Mohamed Sabry Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Tajana Jevtic Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published April, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechopen.com Hysterectomy, Edited by Ayman Al-Hendy and Mohamed Sabry p. cm. ISBN 978-953-51-0434-6    Contents  Preface IX Part 1 Types of Hysterectomy 1 Chapter 1 Techniques of Hysterectomy 3 Nirmala Duhan Chapter 2 Subtotal Versus Total Abdominal Hysterectomy for Benign Gynecological Conditions 23 Zouhair Amarin Chapter 3 Robotic Surgery Versus Abdominal and Laparoscopic Radical Hysterectomy in Cervical Cancer 31 E. Ancuta, Codrina Ancuta and L. Gutu Chapter 4 The Role of Modified Radical Hysterectomy in Endometrial Carcinoma 51 Masamichi Hiura and Takayoshi Nogawa Chapter 5 New Approaches to Hysterectomy by Minimal Invasive Surgery (MIS) 75 Shanti Raju-Kankipati and Omer Devaja Chapter 6 Emergency Peripartum Hysterectomy 85 Abiodun Omole-Ohonsi Chapter 7 Peripartum Hysterectomy 93 Chisara C. Umezurike and Charles A. Adisa Chapter 8 Peripartum Hysterectomy Versus Non Obstetrical Hysterectomy 103 S. Masheer and N. Najmi VI Contents Part 2 Alternatives to Hysterectomy 113 Chapter 9 Medical Treatment of Fibroid to Decrease Rate of Hysterectomy 115 Mohamed Y. Abdel-Rahman, Mohamed Sabry and Ayman Al-Hendy Chapter 10 Hysteroscopic Surgery as an Alternative for Hysterectomy 129 Chang-Sheng Yin and Fung-Wei Chang Chapter 11 The LNG-IUS: The First Choice Alternative to Hysterectomy? Intrauterine Levonorgestrel-Releasing Systems for Effective Treatment and Contraception 141 D. Wildemeersch Chapter 12 Menorrhagia and the Levonorgestrel Intrauterine System 159 Johnstone Shabaya Miheso Chapter 13 Is Embolization Equal to Hysterectomy in Treating Uterine Fibroids? 169 Tomislav Strinic Chapter 14 Pharmacotherapy of Massive Obstetric Bleedings as Alternative to Hysterectomy 197 Andrey Momot, Irina Molchanova, Vitaly Tskhai and Andrey Mamaev Part 3 Hysterectomy Pre-Operative Considerations 223 Chapter 15 Hysterectomy: Advances in Perioperative Care 225 Kenneth Jensen and Jens Børglum Part 4 Hysterectomy Post-Operative Care 249 Chapter 16 Innovations in the Care of Postoperative Hysterectomy Patients 251 Sepeedeh Saleh and Amitabha Majumdar Chapter 17 Postoperative Pain Management After Hysterectomy – A Simple Approach 269 Mariana Calderon, Guillermo Castorena and Emina Pasic Part 5 Hysterectomy Complications 283 Chapter 18 Ureter: How to Avoid Injuries in Various Hysterectomy Techniques 285 Manoel Afonso Guimarães Gonçalves, Fernando Anschau, Daniela Martins Gonçalves and Chrystiane da Silva Marc Contents VII Chapter 19 Sacrocolpopexy for Post Hysterectomy Vault Prolapse 293 Serge P. Marinkovic, Lisa M. Gillin and Christina M. Marinkovic Chapter 20 Urinary Tract Injuries in Low-Resource Settings 313 Mathias Onsrud Part 6 Hysterectomy: Multiple Aspects 323 Chapter 21 Management of Pregnancy After Conization and Radical Trachelectomy 325 Keun-Young Lee and Ji-Eun Song Chapter 22 Know-How of the Hormonal Therapy and the Effect of the Male Hormone on Uterus in the Female to Male Transsexuals 335 Seok Kwun Kim and Myoungseok Han Chapter 23 The Role of Prophylactic Oophorectomy in the Management of Hereditary Breast & Ovarian Cancer Syndrome 345 A.J. Lowery and K.J. Sweeney Chapter 24 Psychological Aspects of Hysterectomy & Postoperative Care 365 Amitabha Majumdar and Sepeedeh Saleh Chapter 25 What Do We Know About Hysterectomy? 393 Karolina Chmaj-Wierzchowska, Marcin Wierzchowski, Beata Pięta, Joanna Buks and Tomasz Opala Chapter 26 Predictive Value of Cellular Immune Response and Tumor Biomarkers in Patients Surgically Treated for Cervical Cancer in Relation to Clinical Outcomes 409 E. Ancuta, Codrina Ancuta and D. Sofroni    Preface  This book is intended for the general and family practitioners, as well as for gynecologists, specialists in gynecological surgery, general surgeons, urologists and all other surgical specialists that perform procedures in or around the female pelvis, in addition to intensives and all other specialities and health care professionals who care for women before, during or after hysterectomy. While removal of the uterus using newer techniques such as laparoscopic and robotic hysterectomy attract the most attention of both the patients as well as the practitioners, still, for most women, especially in low resources countries, the conventional hysterectomy, abdominal or vaginal, is considered the intervention of choice for removing the uterus. Such techniques have withstood the test of time and can be performed in almost any small or midsized surgical hospital without the need to travel to distant specialty hospitals. It is the aim of this book to review the recent achievements of the research community regarding the field of gynecologic surgery and hysterectomy as well as highlight future directions and where this field is heading. While no single volume can adequately cover the diversity of issues and facets in relation to such a common and important procedure such as hysterectomy, this book will attempt to address the pivotal topics especially in regards to safety, risk management as well as pre- and post-operative care.  Finally, we dedicate this book to our wonderful prior, current and future patients for whom we strive for excellence and beyond, as we care for them with full and most respect and love as they are our daughters, sisters and mothers, all the time.   Ayman Al-Hendy, MD, PhD Professor, Vice Chair and Scientific Director, Department of Obstetrics and Gynecology, Center of Women Health Research, Meharry Medical College, Nashville, Tennessee,  Adjunct professor, Vanderbilt University and Vanderbilt University Medical Center, Nashville, Tennessee, USA Mohamed Sabry, MD Department of Obstetrics and Gynecology, Sohag University Hospitals, Sohag, Egypt Center for Women's Health Research, Department of Obstetrics and Gynecology, Meharry Medical College, Nashville, Tennessee, USA [...]... perform an oophorectomy before a vaginal hysterectomy has been regarded as safe and easy 11 Laparoscopic hysterectomy Laparoscopy has been used to carry out Laparoscopic Assisted Vaginal Hysterectomy (LAVH), laparoscopic subtotal hysterectomy (LSH), total laparoscopic hysterectomy (TLH) and vaginally assisted laparoscopic hysterectomy (VALH) Raoul Palmer of France is credited with introducing operative laparocopy... carry out a myomectomy first (by a vertical central incision on the myoma capsule) and then proceed with hysterectomy This debulking of the mass may also be achieved by sagittal hemisection of the small uterine body and shelling out of the cervical myoma Removal of the myoma allows greater accessibility and eases the subsequent completion of hysterectomy Fig 3 A total hysterectomy specimen removed... and long-term morbidity 24 Hysterectomy In a multi-centre retrospective cohort analysis to evaluate the peri- and postoperative outcomes in women undergoing laparoscopic subtotal hysterectomy versus laparoscopic total hysterectomy, the overall number of short-term and long-term complications was comparable for both procedures Laparoscopic subtotal hysterectomy as compared with laparoscopic total hysterectomy. .. abdominal hysterectomy for benign indications are low at 6 per 10,000 (2) As mortality at abdominal hysterectomy is such an infrequent event, there are no meaningful statistical comparisons comparing mortality of subtotal abdominal hysterectomy versus total abdominal hysterectomy In a study by the author to assess the standard of hysterectomy, so as to improve the quality of patient care and outcome,... surgeon to operate from one side Fig 12 Laparoscopic evaluation of pelvic organs at laparoscopic hysterectomy Fig12 shows the evaluation of uterus, adnexae and other pelvic structures at initiation of a laparoscopic hysterectomy The uterine ligaments and vascular pedicles can be coagulated 20 Hysterectomy and cut by using bipolar electro coagulation (e.g Valley lab Ligasure), ultrasonic energy (Ethicon Harmonic... actually resumed by the end of 10-14 days post operatively Coital abstinence is advised for 6 weeks 11.6 Complications of hysterectomy 1 2 3 4 5 6 Intraoperative: Anaesthetic (cardiorespiratory) and surgical problems like hemorrhage, injuries to surrounding viscera are avoided by appropriate preoperative evaluation and ensuring senior and multidisciplinary help Rarely, postoperative ileus and destruction... access by the vaginal route is associated with fewer complications, a shorter hospital stay, faster recovery and lower costs Most patients with gynecologic malignancies are operated by open abdominal route, though laparoscopic and robotic surgical techniques are increasingly being used for endometrial and cervical cancer surgery Significant uterine enlargement and/ or fixity, adnexal fixation and obliteration... be counseled prior to subtotal abdominal hysterectomy regarding hormone replacement therapy, which should include progesterone The main objectively measurable parameters in the comparison between subtotal and total abdominal hysterectomy are morbidity and mortality The main short-term and long-term comparative events and complications of subtotal versus total hysterectomy for benign uterine diseases... Bowel function Quality of life (SF-36)/Psychological outcome Overall Mortality Table 1 Short-term and long-term comparative events and complications of subtotal versus total abdominal hysterectomy for benign uterine diseases 26 Hysterectomy Generally, the mortality rates for hysterectomy, standardized for age and race, are higher for procedures associated with pregnancy or cancer than for procedures not... differences between total and subtotal hysterectomy Techniques of Hysterectomy 7 Fig 2 A total hysterectomy specimen along with both tubes and ovaries for a left sided malignant ovarian tumor which later turned out to be a clear cell carcinoma Subtotal / supracervical hysterectomy 1 Presence of cervix retains the uterine supports attached to it Hence, vault prolapse is less common 2 Easier and less morbid to . HYSTERECTOMY Edited by Ayman Al-Hendy and Mohamed Sabry           Hysterectomy Edited by Ayman Al-Hendy and Mohamed Sabry . Hysterectomy, Edited by Ayman Al-Hendy and Mohamed Sabry p. cm. ISBN 978-953-51-0434-6    Contents  Preface IX Part 1 Types of Hysterectomy