ABSTRACT
STUDY OBJECTIVE: To investigate the surgical trends among different types of hysterectomy (abdominal, vaginal, laparoscopic, and subtotal) over a 15-year period in Taiwan. DESIGN: A retrospective cohort study. SETTING: A population-based National Health Insurance Research Database. PATIENTS: Women undergoing various types of hysterectomy for noncancerous lesions. INTERVENTIONS: Data for this study were extracted from the inpatient expenditures by admissions files of Taiwan's National Health Insurance Research Database from 1998 through 2012 and divided into three 5-year time frames: first (1998-2002), second (2003-2007), and third (2008-2012). The variables included types of hysterectomy, patient age, gynecologist age and sex, hospital accreditation level, and surgical volume. Chi-square and trend tests were used to examine the association between the variables. MEASUREMENTS AND MAIN RESULTS: A total of 329 438 patients who underwent various types of hysterectomy were identified; 306 257 were included in the study. During the 15-year period, 45% underwent total abdominal hysterectomy, 41% underwent laparoscopic hysterectomy (LH), 9.8% underwent vaginal hysterectomy, and 4.2% underwent subtotal abdominal hysterectomy. The frequency of LHs increased from 35.9% in the first period to 43.9% in the second period and remained at 44.2% in the third period. During the same time period, there was a decrease in the frequency of total abdominal hysterectomies. Typically, younger patients underwent LHs by gynecologists with large volume surgical practices and medical centers. CONCLUSION: This 15-year study describes an increase of LHs and subtotal abdominal hysterectomies over time and provides evidence of surgical trends and a paradigm shift of hysterectomies. Surgical skills and performance extended from high- to low-surgical volume gynecologists and from medical centers to regional and local hospitals. This shift may have a great influence on patient and health care provider choice of treatment.
Subject(s)
Hysterectomy/methods , Hysterectomy/trends , Uterine Diseases/surgery , Adult , Aged , Aged, 80 and over , Cohort Studies , Female , History, 20th Century , History, 21st Century , Humans , Hysterectomy/history , Hysterectomy/statistics & numerical data , Hysterectomy, Vaginal/history , Hysterectomy, Vaginal/methods , Hysterectomy, Vaginal/statistics & numerical data , Hysterectomy, Vaginal/trends , Laparoscopy/history , Laparoscopy/methods , Laparoscopy/statistics & numerical data , Laparoscopy/trends , Laparotomy/history , Laparotomy/methods , Laparotomy/statistics & numerical data , Laparotomy/trends , Middle Aged , Prevalence , Retrospective Studies , Taiwan/epidemiology , Uterine Diseases/epidemiology , Young AdultABSTRACT
La histerectomía, después de la operación cesárea es la cirugía ginecológica que más se realiza; esta se puede hacer por diferentes vías: la abdominal, vaginal y laparoscópica; de todas ellas la vaginal tiene una significación histórica.Objetivo: Analizar las diferentes etapas históricas de la histerectomía vaginal como técnica quirúrgica.Metodología: Se revisaron documentos publicados en diferentes bases de datos (PubMed, Medline, Redalyc, Hinari, Ebsco) en idioma inglés y español. Se escogieron los que aportaron datos históricos. Se utilizó el método histórico-lógico para el análisis de las diferentes etapas del desarrollo de la histerectomía vaginal y el de análisis y síntesis para determinar las relaciones entre las diferentes etapas que caracterizaron a la técnica y su contribución a la técnica actual(AU)
Subject(s)
Humans , Hysterectomy, Vaginal/historyABSTRACT
La histerectomía, después de la operación cesárea es la cirugía ginecológica que más se realiza; esta se puede hacer por diferentes vías: la abdominal, vaginal y laparoscópica; de todas ellas la vaginal tiene una significación histórica.Objetivo: Analizar las diferentes etapas históricas de la histerectomía vaginal como técnica quirúrgica.Metodología: Se revisaron documentos publicados en diferentes bases de datos (PubMed, Medline, Redalyc, Hinari, Ebsco) en idioma inglés y español. Se escogieron los que aportaron datos históricos. Se utilizó el método histórico-lógico para el análisis de las diferentes etapas del desarrollo de la histerectomía vaginal y el de análisis y síntesis para determinar las relaciones entre las diferentes etapas que caracterizaron a la técnica y su contribución a la técnica actual(AU)
Subject(s)
Humans , Hysterectomy, Vaginal/historyABSTRACT
The difficult path to the "extended vaginal total extirpation" is connected with the outstanding personality of Friedrich Schauta. Czerny, Schuchardt und Dührssen had prepared it. Amreich, Staude and Stoeckel, Högler, Ingiulla, Navratil, Reiffenstuhl and Platzer, Dargent and Querleu extended the radicality of this cancer operation, advocated and recommended it.
Subject(s)
Hysterectomy, Vaginal/history , Austria , Female , Gynecologic Surgical Procedures/history , History, 19th Century , History, 20th Century , Humans , Uterine Neoplasms/surgeryABSTRACT
In the 100 year long history of the abdominal radical operation of collum carcinoma, due to the continued clinical surgical and scientific work of several generations of physicians, abdominal radical operation with standardized pelvic lymphonodectomy has become the method of choice for surgical treatment of collum carcinoma since 1970. Vaginal radical operation in its various forms has since played only a very restricted role in surgical treatment of collum carcinoma. According to the opinion of the majority of cancer surgeons vaginal radical operation had to be abandoned in view of discontinuous spreading of carcinoma into the regional pelvic lymph nodes. Because of its simplicity vaginal radical operation would still be useful today for very old high-risk patients and very young women with early invasive collum carcinoma detected in cancer screening. In view of our knowledge of the lymph node problem in collum carcinoma, however, this can no longer be the vaginal radical operation of past generations. In order to prevent critical objections to vaginal radical operation, the early attempts of Stoeckel, Suboth Mitra, Bastiaanse, Navratil, Inguilla, and Akashi were resumed. Since 1989 attempts have been made to combine vaginal radical operation of collum carcinoma with laparoscopic pelvic or para-aortic lymphonodectomy. The development has passed the following stages: the development of laparoscopic pelvic and para-aortic lymphonodectomy based on staging criteria the combination of laparoscopic lymphonodectomy with vaginal radical operation of collum carcinoma the combination of laparoscopic lymphonodectomy with complete laparoscopic radical hysterectomy and only subsequent vaginal removal of organs.
Subject(s)
Hysterectomy, Vaginal/history , Hysterectomy/history , Uterine Cervical Neoplasms/history , Austria , Female , Gynecology/history , Gynecology/trends , History, 19th Century , History, 20th Century , Humans , Hysterectomy/methods , Hysterectomy, Vaginal/methods , Hysterectomy, Vaginal/trends , Laparoscopy/history , Uterine Cervical Neoplasms/surgerySubject(s)
Hysterectomy, Vaginal/history , Female , History, 19th Century , History, 20th Century , HumansABSTRACT
In the relatively long history of man, surgery has been a comparatively recent development; the abdomen was first deliberately opened to remove an ovarian cyst by Ephraim McDowell in Kentucky in 1809. The first abdominal hysterectomy was performed by Charles Clay in Manchester, England in 1843; unfortunately the diagnosis was wrong and the patient died in the immediate post-operative period. The following year, Charles Clay was almost the first to claim a surviving patient, however she died post-operatively and it was not until 1853 that Ellis Burnham from Lowell, Massachusetts achieved the first successful abdominal hysterectomy although again the diagnosis was wrong. Vaginal hysterectomy dates back to ancient times. The procedure was performed by Soranus of Ephesus 120 years after the birth of Christ, and the many reports of its use in the middle ages were nearly always for the extirpation of an inverted uterus and the patients rarely survived. The early hysterectomies were fraught with hazard and the patients usually died of haemorrhage, peritonitis, and exhaustion. Early procedures were performed without anaesthesia with a mortality of about 70%, mainly due to sepsis from leaving a long ligature to encourage the drainage of pus. Thomas Keith from Scotland realized the danger of this practice and merely cauterized the cervical stump and allowed it to fall internally, thereby bringing the mortality down to about 8%. Hysterectomy became safer with the introduction of anaesthesia, antibiotics and antisepsis, blood transfusions and intravenous therapy. During the 1930s, Richardson introduced the total abdominal hysterectomy to avoid serosanguineous discharge from the cervical remnant and the risk of cervical carcinoma developing in the stump. Apart from this innovation, and the transverse incision introduced by Johanns Pfannenstiel in the 1920s, there was little advance in hysterectomy techniques until the advent of endoscopic surgery and the performance of the first laparoscopic hysterectomy by Harry Reich in Kingston, Pennsylvania in 1988. The refinement and increasing safety of laparoscopic hysterectomy suggests that it will be used increasingly in the future, although developments in pharmacology and photodynamic therapy and interventional radiology may reduce the traditional indications for the operation.
Subject(s)
Hysterectomy/history , Anesthesia, General/history , England , Europe , Female , History, 18th Century , History, 19th Century , History, 20th Century , Humans , Hysterectomy, Vaginal/history , Laparoscopy/history , Ovariectomy/historyABSTRACT
Reviewing the historical development of radical vaginal surgery for the treatment of cervical cancer the different variations of this technique are defined. In 1880 the first modified radical hysterectomy for cervical cancer was performed by Pawlik. Radical vaginal hysterectomy is associated with the name of Schauta who further developed and categorized the technique. The most important modifications were done by Stoeckel and Peham/Amreich. Extraperitoneal dissection of pelvic lymph nodes was combined with radical vaginal hysterectomy by Stoeckel in 1928.
Subject(s)
Hysterectomy, Vaginal/history , Lymph Node Excision/history , Uterine Cervical Neoplasms/history , Europe , Female , History, 19th Century , History, 20th Century , Humans , Uterine Cervical Neoplasms/surgeryABSTRACT
The tradition of transvaginal hysterectomy started in 1878 and is still alive. A recent survey showed that two thirds of all hysterectomies performed in Austria are done transvaginally. Although indications for hysterectomy have changed quite fast during the last years, without doubt, hysterectomy remains an important alternative when conservative treatment fails. If hysterectomy is to be performed, the transvaginal route should be taken into consideration. Thus it is our task to pass our knowledge to those unfamiliar with the vaginal technique.
Subject(s)
Hysterectomy, Vaginal/history , Austria , Female , History, 19th Century , History, 20th Century , HumansABSTRACT
After a historical outlook on the development of radical vaginal hysterectomy, our own results and complications in 51 cases of stages I and II during the years 1968-1983 are reported. The 5-year survival rate was 98.04% with no primary mortality.