Abstract
Purpose
This comparative cohort study evaluated the influence of surgical route for prolapse hysterectomy (vaginal or laparoscopically assisted) on the achievement of intended elective salpingo-oophorectomy, which was a procedural goal planned with the patient before primary vaginal native-tissue prolapse surgery.
Methods
Consecutive patients who underwent total vaginal hysterectomy (TVH; n = 163) or laparoscopically assisted vaginal hysterectomy (LAVH; n = 144) and vaginal native-tissue repair for pelvic organ prolapse at Jena University Hospital were enrolled.
Results
Peri- and postoperative parameters, including Clavien–Dindo (CD) classification of surgical complications, were compared between groups using Student’s t test, Fisher’s exact test, and multivariable regression. Patient characteristics were similar, except that grade IV prolapse was more common in the LAVH group (p < 0.001). The following parameters differed between the TVH and LAVH groups: concomitant salpingectomy (1.2% vs. 34%) and salpingo-oophorectomy (45% vs. 66%), non-performance of intended salpingo-oophorectomy (36% vs. 0% OR 0.006, 95% CI < 0.001–0.083), adhesiolysis (0% vs. 44%), CD II–III complications (51% vs. 14.6% p < 0.001), operating time (153 ± 61 vs. 142 ± 27 min), and postoperative in-patient days (9.02 ± 4.9 vs. 4.99 ± 0.96; all p < 0.001).
Conclusions
LAVH enabled the safe performance of planned concomitant salpingo-oophorectomy in all cases. To achieve the procedural goal in such cases, laparoscopic assistance in prolapse hysterectomy should be considered.
Similar content being viewed by others
Abbreviations
- BMI:
-
Body mass index
- CD:
-
Clavien–Dindo
- IUGA:
-
International Urogynecological Association
- LAVH:
-
Laparoscopically assisted vaginal hysterectomy
- POP:
-
Pelvic organ prolapse
- TVH:
-
Total vaginal hysterectomy
References
Piek JM, van Diest PJ, Zweemer RP, Jansen JW, Poort-Keesom RJ, Menko FH, Gille JJ, Jongsma AP, Pals G, Kenemans P, Verheijen RH (2001) Dysplastic changes in prophylactically removed Fallopian tubes of women predisposed to developing ovarian cancer. J Pathol. 195(4):451–456
Carlson JW, Miron A, Jarboe EA, Parast MM, Hirsch MS, Lee Y, Muto MG, Kindelberger D, Crum CP (2008) Serous tubal intraepithelial carcinoma: its potential role in primary peritoneal serous carcinoma and serous cancer prevention. J Clin Oncol. 26(25):4160–4165
Levine DA, Argenta PA, Yee CJ, Marshall DS, Olvera N, Bogomolniy F, Rahaman JA, Robson ME, Offit K, Barakat RR, Soslow RA, Boyd J (2003) Fallopian tube and primary peritoneal carcinomas associated with BRCA mutations. J Clin Oncol 21(22):4222–4227
Bowtell DD (2010) The genesis and evolution of high-grade serous ovarian cancer. Nat Rev Cancer 10(11):803–808
Kurman RJ, Shih IEM (2011) Molecular pathogenesis and extraovarian origin of epithelial ovarian cancer–shifting the paradigm. Hum Pathol 42(7):918–931
Tone AA, Salvador S, Finlayson SJ, Tinker AV, Kwon JS, Lee CH, Cohen T, Ehlen T, Lee M, Carey MS, Heywood M, Pike J, Hoskins PJ, Stuart GC, Swenerton KD, Huntsman DG, Gilks CB, Miller DM, McAlpine JN (2012) The role of the fallopian tube in ovarian cancer. Clin Adv Hematol Oncol. 10(5):296–306
Falconer H, Yin L, Grönberg H, Altman D (2015) Ovarian cancer risk after salpingectomy: a nationwide population-based study. JNCI 107(2):1–6
Vorwergk J, Radosa MP, Nicolaus K, Baus N, Jimenez Cruz J, Rensberger M et al (2014) Prophylactic bilateral salpingectomy (PBS) to reduce ovarian cancer risk incorporated in standard premenopausal hysterectomy: complications and re-operation rate. J Cancer Res Clin Oncol 140:859–865
Dietl J, Wischhusen J, Häusler SFM (2011) The post-reproductive Fallopian tube: better removed? Human Reprod 26(11):2918–2924
Dwyer PL (2012) Ovarian cancer and the pelvic floor surgeon: the case for prophylactic bilateral salpingectomy during POP surgery. Int Urogynecol J 23:655–656
Royal College of Obstetricians and Gynaecologists (2014) The distal Fallopian tube as the origin of non-uterine pelvic high-grade serous carcinomas. Scientific Impact Paper No. 44
Bougie O, Weberpals JI (2011) Clinical considerations of BRCA1- and BRCA2-mutation carriers: a review. Int J Surg Oncol 2011:374012
King MC, Marks JH, Mandell JB (2003) New York Breast Cancer Study Group: Breast and ovarian cancer risks due to inherited mutations in BRCA1 and BRCA2. Science 302:643–646
Surveillance, Epidemiology, and End Results (SEER) Program. Research Data (1973–2009), National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch. [released April 2012 based on November 2011 submission]. http://www.seer.cancer.gov
Marchetti C, De Felice F, Palaia I et al (2014) Risk-reducing salpingo-oophorectomy: a meta-analysis on impact on ovarian cancer risk and all cause mortality in BRCA 1 and BRCA 2 mutation carriers. BMC Womens Health. 12(14):150. https://doi.org/10.1186/s12905-014-0150-5
Rhiem K, Foth D, Wappenschmidt B, Gevensleben H, Büttner R, Ulrich U, Schmutzler RK (2011) Risk-reducing salpingo-oophorectomy in BRCA1 and BRCA2 mutation carriers. Arch Gynecol Obstet 283:623–627
Mothes AR, Radosa MP, Altendorf-Hofmann A, Runnebaum IB (2016) Risk index for pelvic organ prolapse based on established individual risk factors. Arch Gynecol Obstet 293:617–624
Farthmann J, Watermann D, Zamperoni H, Wolf C, Fink T, Gabriel B (2017) Pelvic organ prolapse surgery in elderly patients. Arch Gynecol Obstet 295:1421–1425
Asante A, Whiteman MK, Kulkarni A, Cox S, Marchbanks PA, Jamieson DJ (2010) Elective oophorectomy in the United States. Trends and in-hospital complications, 1987–2006. Obstet Gynecol 116(5):1088–1095
Mothes AR, Radosa MP, Runnebaum IB (2015) Systematic assessment of surgical complications in laparoscopically assisted vaginal hysterectomy for pelvic organ prolapse. Eur J Obstet Gynecol Reprod Biol 194:228–232
Mothes AR, Mothes HK, Radosa MP, Runnebaum IB (2015) Systematic assessment of surgical complications in 438 cases of vaginal native tissue repair for pelvic organ prolapse adopting Clavien–Dindo classification. Arch Gynecol Obstet 291:1297–1301
Schmidt EH, De Wilde RL (1998) Standardverfahren der minimal-invasiven Chirurgie in der Frauenheilkunde. Gerog Thieme, Stuttgart/New York
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213
Brown JS, Waetjen LE, Subak LL, Thom DH, Van den Eeden S, Vittinghoff E (2002) Pelvic organ prolapse surgery in the United States, 1997. Am J Obstet Gynecol 186(4):712–716
Bongers M (2016) Advances in laparoscopic surgery have made vaginal hysterectomy in the absence of prolapse obsolete: FOR: The laparoscopic approach is suitable for almost all hysterectomies. BJOG 123(4):633
Dain L, Abramov Y (2011) Factors affecting the feasibility of bilateral salpingo-oophorectomy during vaginal hysterectomy for uterine prolapse. Aust N Z J Obstet Gynaecol 51(4):307–309
Jacoby VL, Grady D, Wactawski-Wende J, Manson JE, Allison MA, Kuppermann M, Sarto GE, Robbins J, Phillips L, Martin LW, O’Sullivan MJ, Jackson R, Rodabough RJ, Stefanick ML (2011) Oophorectomy vs ovarian conservation with hysterectomy: cardiovascular disease, hip fracture, and cancer in the Women’s health initiative observational study. Arch Intern Med 171(8):760–768
Ghoniem G, Hammett J (2015) Female pelvic medicine and reconstructive surgery practice patterns: IUGA member survey. Int Urogynecol J 26(10):1489–1494
Gross CP, Nicholson W, Powe NR (1999) Factors affecting prophylactic oophorectomy in postmenopausal women. Obstet Gynecol. 94(6):962–968
Nwosu CR, Gupta JK (1999) Abdominal, laparoscopic, and vaginal hysterectomy with bilateral salpingo-oophorectomy: a feasibility study for further evaluation in randomized trials. Surg Endosc 13(2):148–150
Oliver Perez MR, Magriñá J, García AT, Jiménez Lopez JS (2015) Prophylactic salpingectomy and prophylactic salpingoophorectomy for adnexal high-grade serous epithelial carcinoma: A reappraisal. Surg Oncol. 24(4):335–344
Yoon SH, Kim SN, Shim SH, Kang SB, Lee SJ (2016) Bilateral salpingectomy can reduce the risk of ovarian cancer in the general population: a meta-analysis. Eur J Cancer 55:38–46
Morelli M, Venturella R, Mocciaro R, Di Cello A, Rania E, Lico D, D’Alessandro P, Zullo F (2013) Prophylactic salpingectomy in premenopausal low-risk women for ovarian cancer: primum non nocere. Gynecol Oncol 129(3):448–451
Venturella R, Morelli M, Lico D, Di Cello A, Rocca M, Sacchinelli A, Mocciaro R, D’Alessandro P, Maiorana A, Gizzo S, Zullo F (2015) Wide excision of soft tissues adjacent to the ovary and fallopian tube does not impair the ovarian reserve in women undergoing prophylactic bilateral salpingectomy: results from a randomized, controlled trial. Fertil Steril 104(5):1332–1339
Song T, Kim MK, Kim ML, Jung YW, Yun BS, Seong SJ, Kwon SH (2016 ) Impact of opportunistic salpingectomy on anti-Müllerian hormone in patients undergoing laparoscopic hysterectomy: a multicentre randomised controlled trial. BJOG (Epub ahead of print)
Robert M, Cenaiko D, Sepandj J, Iwanicki S (2015) Success and complications of salpingectomy at the time of vaginal hysterectomy. J Minim Invasive Gynecol 22(5):864–869
Author information
Authors and Affiliations
Contributions
ARM: protocol/project development, data collection and data management, patient recruitment, responsible surgeon, and manuscript writing/editing. AS: patient recruitment, data collection, and data management. KN: data collection and management. JV: data collection and management. TL: statistics and data management. MPR: responsible surgeon and data management. HKM: project development and data management, and editing of manuscript. IBR: patient recruitment, responsible surgeon, and editing of manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no competing interests.
Rights and permissions
About this article
Cite this article
Mothes, A.R., Schlachetzki, A., Nicolaus, K. et al. LAVH superior to TVH when concomitant salpingo-oophorectomy is intended in prolapse hysterectomy: a comparative cohort study. Arch Gynecol Obstet 298, 1131–1137 (2018). https://doi.org/10.1007/s00404-018-4909-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-018-4909-z