Non-landmark Gynae Flashcards
Cochrane. 2015,, benign hysterectomy route
4 approaches. Including. robotic-assisted
Objective: Assess the effectiveness and safety of difference surgical approaches to hysterectomy. For women with benign gynaecological conditions
Primary outcomes: return. To normal activities,, satisfaction, qol, intraoperative visceral injury and major long term complications
47 studies, 5102 women
Conclusion: VH superior to LH and AH - faster Return to Normal activities; less urinary tract injuries and shorter op time than LH,, quicker recovery, less post-op fever than AH
Total vs subtotal hysterectomy for benign gynae conditions - Cochrane 2012
Included RCTs
9 trials with 1553 participants
Objective: to compare short term and long term outcomes of STH with TH for benign gynae
No difference in the rates of urinary, bowel or sexual function both in short term or long term
Shorter length of operation and less blood loss with Sub-total
Unlikely clinical benefit
Adhesion prevention agents for gynae surgery - Cochrane 2015
Objective: to summarize clinical safety and effectiveness of solid agents, gel agents, liquid agents, and pharmacological agents used to prevent adhesions
Two reviews, with control or compared to other agents
Insufficient evidence on effectiveness and safety of anti-adhesion agents due to lack of data on pelvic pain, fertility outcomes, quality of life or safety
LACC
L2018 NEJM
RCT 600pts
Multicentre
Shows higher rate of recurrences (up to 4x) and poorer survival in those treated with laparoscopic surgery
Unknown mechanism of action
Limitations Low volume centers Poorer salvage rates High survival rates for open arm 5 non cancer deaths in the laparoscopic arm
Radical trachelectomy
Radical excision of cervix with preservation of the uterus
(Cervix, parametrial, upper third of vagina removed following lymphadenectomy
Cervical cerclage placed
**only for those whom fertility is required
Indications for trachelectomy
Stage 1A2 or 1B1 Fertility required <2cm Squamous or adeno Negative endocervical margin ?No LVSI
Chemo-RT required for:
Positive nodes
Positive parametrial
Positive or close surgical margins
High risk features (deep stromal invasion, >4cm, LVSI) - any 2 of these
Can be primary treatment for advanced cancers
Stage 1B2
Complications of pelvic RT
Short-term: Fatigue Diarrhea Cystitis Proctor is
Long-term: Vaginal stenosis Sexual dysfunction Lymph ode a Fistula Bone necrosis
Exteneration
Removal of central disease with bladder and rectum
LACC trial
Compared overall survival with open surgery vs laparoscopy or robot in early cervical cancer (IA1-1B1)
N=631
Laparoscopy and robotic had higher rates of recurrence
Trial underpowered to evaluate outcomes for Rumours <2cm or no LVSI, <10mm depth, an no LN involvement
Cochrane review UAE vs myomectomy or hyst
2014
Increased : minor complications, surgical reinterventions, unplanned presentations
Decreased: length of stay, procedure duration, resumption of ADL
No change in intraprocedural complications, short or long term complications, patient satisfaction 2-5 years, no diff in ovarian function
Poppy trial
2014 Multicentre RCT 447 PFMT vs leaflet with stage 1-3 prolapse At 6 months and 12 months symptom severity score lower; more likely to report improvement in those with PFMT
PP PFMT and POP
2015 AJOG Blinded RCT 175 Major locator ani defects or NO defect PFMT 4/12 at 6-8/PP No difference between groups - prolapse doesn’t get better
PREVPROL
2017
Multicentre RCT
PFMT, PFMT plus Pilates and DVD for home use, or DVD alone
Severity ty symptom score improved OR 7; QOL not different but intervention group sought less further treatment
Optimal
2x2 factorial mca RCT UI and apical prolapse randomized to perioperative BPMT vs standard care and USLS+ TVT vs SSF + TVT 374 2 year f/u No sig diff between PFMT and surgery 5 year f/u no difference 50% women happy with surgery Improved QOL in each group
