Effects of Using Uterine Manipulator on Vaginal Length After Abdominal Hysterectomy: A Prospective Randomized Study
DOI:
https://doi.org/10.33719/sexscij.2508.14Keywords:
vaginal length, hysterectomy, uterine manipulatorAbstract
Objective: This study aims to research the effects of the uterine manipulator on operation time, complications, and postoperative vaginal length in abdominal hysterectomies.
Materials and Methods: Eighty-five women underwent abdominal hysterectomy and were randomized into two groups: a study group using a uterine manipulator (n=35) and a control group (n=50). The study recorded demographic characteristics, indications for hysterectomy, intraoperative blood loss, changes in postoperative hemoglobin, and postoperative vaginal lengths. Vaginal length was measured preoperatively and on the first postoperative day. The primary outcome, the effect of uterine manipulator usage on vaginal length, was analyzed using a Student’s t-test.. Pearson’s correlation test was used to evaluate the correlation between intraoperative blood loss and postoperative vaginal length. P values < 0,05 were considered significant.
Results: No significant differences were found between the groups regarding demographic data and hysterectomy indications. Postoperative vaginal length change was statistically less in the study group than in the control group (p<0,001). We also observed that less intraoperative blood loss was associated with less shortening of postoperative vaginal length (p<0,001). Intraoperative blood loss was significantly less in the study group compared to the control group (study group: 347±169 ml; control group: 439±150 ml; p=0,010). There was no significant difference in operation time between the groups (p=0.178), and no correlation was found between postoperative vaginal length and BMI.
Conclusion: The result of this study indicated that using a uterine manipulator in abdominal hysterectomy might be preferable due to better postoperative vaginal length and less intraoperative blood loss.
References
Lonnee-Hoffmann, R., & Pinas, I. (2014). Effects of hysterectomy on sexual function. Current Sexual Health Reports, 6, 244–251. https://doi.org/10.1007/s11930-014-0029-3
Committee Opinion No 701: Choosing the Route of Hysterectomy for Benign Disease. (2017). Obstetrics and gynecology, 129(6), e155–e159. https://doi.org/10.1097/AOG.0000000000002112
Clayton, R. D. (2006). Hysterectomy. Best Practice & Research Clinical Obstetrics & Gynaecology, 20(1), 73–87. https://doi.org/10.1016/j.bpobgyn.2005.09.007
Whiteman, M. K., Hillis, S. D., Jamieson, D. J., Morrow, M., Podgornik, M. N., Brett, K. M., & Marchbanks, P. A. (2008). Inpatient hysterectomy surveillance in the United States, 2000–2004. American Journal of Obstetrics and Gynecology, 198(1), 34.e1-7. https://doi.org/10.1016/j.ajog.2007.05.039
Farquhar, C. M., & Steiner, C. A. (2002). Hysterectomy rates in the United States 1990-1997. Obstetrics & Gynecology, 99, 229. https://doi.org/10.1016/s0029-7844(01)01723-9
Spilsburry, K., Semmens, J. B., Hammond, I., & Bolck, A. (2006). Persistent high rates of hysterectomy in Western Australia: A population-based study of 83,000 procedures over 23 years. BJOG: An International Journal of Obstetrics & Gynaecology, 113, 804. https://doi.org/10.1111/j.1471-0528.2006.00962.x
Multinu, F., Casarin, J., Hanson, K. T., Angioni, S., Mariani, A., Habermann, E. B., & Laughlin-Tommaso, S. K. (2018). Practice patterns and complications of benign hysterectomy following the FDA statement warning against the use of power morcellation. JAMA Surgery, 153(6), e180141. https://doi.org/10.1001/jamasurg.2018.0141
Parker, W. H. (2010). Bilateral oophorectomy versus ovarian conservation: Effects on long term women’s health. Journal of Minimally Invasive Gynecology, 17(2), 161–166. https://doi.org/10.1016/j.jmig.2009.12.016
Hassan, H., Allen, I., Sofianopoulou, E., Walburga, Y., Turnbull, C., Eccles, D. M., Tischkowitz, M., Pharoah, P., & Antoniou, A. C. (2024). Long-term outcomes of hysterectomy with bilateral salpingo-oophorectomy: A systematic review and meta-analysis. American Journal of Obstetrics and Gynecology, 230(1), 44–57. https://doi.org/10.1016/j.ajog.2023.06.043
Cusimano, M. C., Chiu, M., Ferguson, S. E., Moineddin, R., Aktar, S., Liu, N., & Baxter, N. N. (2021). Association of bilateral salpingo-oophorectomy with all cause and cause specific mortality: Population based cohort study. BMJ, 375, e067528. https://doi.org/10.1136/bmj-2021-067528
Kavallaris, A., Chalvatzas, N., Kelling, K., Bohlmann, M. K., Diedrich, K., & Hornemann, A. (2011). Total laparoscopic hysterectomy without uterine manipulator: Description of a new technique and its outcome. Archives of Gynecology and Obstetrics, 283, 1053–1057. https://doi.org/10.1007/s00404-010-1494-1
Ercan, Ö., Özer, A., Köstü, B., Bakacak, M., Kıran, G., & Avcı, F. (2016). Comparison of postoperative vaginal length and sexual function after abdominal, vaginal, and laparoscopic hysterectomy. International Journal of Gynecology and Obstetrics, 132, 39–41. https://doi.org/10.1016/j.ijgo.2015.07.006
Polat, M., Kahramanoglu, I., Senol, T., Senturk, B., Ozkaya, E., & Karateke, A. (2016). Comparison of the effect of laparoscopic and abdominal hysterectomy on lower urinary tract function, vaginal length, and dyspareunia: A randomized clinical trial. Journal of Laparoendoscopic & Advanced Surgical Techniques, 26(2), 159-163. https://doi.org/10.1089/lap.2015.0437
Aarts, J. W., Nieboer, T. E., Johnson, N., Tavender, E., Garry, R., Mol, B. W., & Kluivers, K. B. (2015). Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD003677.pub5
Johnson, N., Barlow, D., Lethaby, A., Tavender, E., Curr, L., & Garry, R. (2005). Methods of hysterectomy: Systematic review and meta-analysis of randomised controlled trials. BMJ, 330, 1478. https://doi.org/10.1136/bmj.330.7506.1478
Garry, R., Fountain, J., Mason, S., Hawe, J., Napp, V., Abbott, J., Clayton, R., Phillips, G., Whittakr, M., Lilford, R., Bridgman, S., & Brown, J. (2004). The eVALuate study: Two parallel randomized trails, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy. BMJ, 328(7432), 129. https://doi.org/10.1136/bmj.37984.623889.F6
Tan, J. S., Lukacz, E. S., Menefee, S. A., Luber, K. M., Albo, M. E., & Nager, C. W. (2006). Determinants of vaginal length. American Journal of Obstetrics & Gynecology, 195, 1846–1850. https://doi.org/10.1016/j.ajog.2006.06.063
Vassallo, B. J., Culpepper, C., Segal, J. L., Moen, M. D., & Noone, M. B. (2006). A randomized trial comparing methods of vaginal cuff closure at vaginal hysterectomy and the effect on vaginal length. American Journal of Obstetrics & Gynecology, 195, 1805–1808. https://doi.org/10.1016/j.ajog.2006.07.010
Pergialiotis, V., Daskalakis, G., Thomakos, N., Haidopoulos, D., Loutradis, D., & Rodolakis, A. (2019). Impact of vertical versus horizontal vaginal cuff closure on vaginal length following hysterectomy: A meta-analysis of randomized trials. International Urogynecology Journal, 30(8), 1239–1245. https://doi.org/10.1007/s00192-019-03881-5
Kiremitli, S., Kiremitli, T., Ulug, P., Yilmaz, N., Yilmaz, B., Kulhan, M., Kulhan, N. G., Dinc, K., Kirkinci, A., & Kurnuc, F. Z. (2022). The effect of hysterectomy types on vaginal length, vaginal shortening rate and FSFI scores. Taiwanese Journal of Obstetrics & Gynecology, 61(3), 427–432. https://doi.org/10.1016/j.tjog.2022.02.042
Chen, B., Ren, D. P., Li, J. X., & Li, C. D. (2014). Comparison of vaginal and abdominal hysterectomy: A prospective non-randomized trial. Pakistan Journal of Medical Sciences, 30(4), 875–879. https://doi.org/10.12669/pjms.304.4436
De La Cruz, J. F., Mayers, E. M., & Geller, E. J. (2014). Vaginal versus robotic hysterectomy and concomitant pelvic support surgery: A comparison of postoperative vaginal length and sexual function. Journal of Minimally Invasive Gynecology, 21(4), 629-634. https://doi.org/10.1016/j.jmig.2014.04.011
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