Yurtkal Aslihan, Canday Mujde
Department of Obstetrics and Gynecology, Faculty of Medicine, Kafkas University, 36000 Kars, Turkey.
J Pers Med. 2024 Feb 29;14(3):265. doi: 10.3390/jpm14030265.
To investigate diverse hysterectomy techniques to determine their influence on patient outcomes, including pain levels, sexual function, anxiety, and quality of life. Of particular focus is the comparison between vessel sealing and traditional suturing in abdominal, vaginal, and laparoscopic hysterectomies. This study is unique in its comprehensive evaluation, considering patient satisfaction, recommendation rates, recovery times, and various other aspects.
Our prospective cohort study adhered to ethical guidelines, involving a meticulous assessment of patients, including medical history, anxiety levels, pelvic pain, sexual function, and quality of life. Surgical methods were explained to patients, allowing them to actively participate in the decision-making process. Sociodemographic information was collected, and exclusion criteria were applied. Hysterectomy methods included total abdominal hysterectomy (TAH), laparoscopic hysterectomy (TLH), vaginal hysterectomy (VH), and a modified vaginal technique known as VH Mujas. Several parameters were recorded, including operation indications, uterine volume, hospital stay, operation duration, pre-operative and post-operative complications, and more.
In all groups, a statistically significant increase was found in pre-operative-post-operative FSFI sexual function values ( < 0.001). The patient's basal Beck Anxiety Scale scores significantly decreased following the decision for vaginal surgery, both in the VH and VH Mujas groups ( < 0.05). However, Beck Anxiety Scale scores at patients' initial assessments significantly increased following the decision for abdominal and laparoscopic surgery ( < 0.001). According to the results of the SF-36 quality of life assessment, an increase was observed in all post-operative quality of life parameters in patients who underwent surgery with different methods due to VH ( < 0.05).
Our comprehensive comparison of hysterectomy techniques demonstrated that VH, particularly when utilizing the Mujas technique, outperforms other hysterectomy methods regarding patient safety and post-operative satisfaction but also offers the benefit of minimal invasiveness. Notably, this is reflected in improved quality of life, enhanced sexual function, lower pain scores, and favorable cosmetic results. The success of a hysterectomy procedure depends on precise indications, surgical planning, proper patient selection, and effective communication. This study emphasizes the significance of these factors in achieving optimal outcomes. The development of specialized vascular closure devices can further enhance the feasibility of vaginal hysterectomy, making it a preferable choice in gynecological surgery. The study contributes valuable insights into selecting the most suitable hysterectomy method for patients and optimizing their recovery.
探讨多种子宫切除术技术，以确定它们对患者预后的影响，包括疼痛程度、性功能、焦虑和生活质量。特别关注腹部、阴道和腹腔镜子宫切除术中血管封闭与传统缝合的比较。本研究在全面评估方面独具特色，考虑了患者满意度、推荐率、恢复时间和其他各个方面。
我们的前瞻性队列研究遵循伦理准则，对患者进行了细致评估，包括病史、焦虑水平、盆腔疼痛、性功能和生活质量。向患者解释了手术方法，使他们能够积极参与决策过程。收集了社会人口统计学信息，并应用了排除标准。子宫切除术方法包括全腹子宫切除术（TAH）、腹腔镜子宫切除术（TLH）、阴道子宫切除术（VH）以及一种改良的阴道技术，即VH Mujas。记录了多个参数，包括手术指征、子宫体积、住院时间、手术时长、术前和术后并发症等。
在所有组中，术前至术后的FSFI性功能值均有统计学意义的增加（<0.001）。在VH和VH Mujas组中，决定进行阴道手术后，患者的基础贝克焦虑量表评分显著降低（<0.05）。然而，在决定进行腹部和腹腔镜手术后，患者初始评估时的贝克焦虑量表评分显著增加（<0.001）。根据SF - 36生活质量评估结果，因VH采用不同手术方法的患者术后所有生活质量参数均有所提高（<0.05）。
我们对子宫切除术技术的全面比较表明，VH，特别是采用Mujas技术时，在患者安全性和术后满意度方面优于其他子宫切除术方法，而且具有微创的优势。值得注意的是，这体现在生活质量改善、性功能增强、疼痛评分降低和良好的美容效果上。子宫切除手术的成功取决于精确的指征、手术规划、合适的患者选择和有效的沟通。本研究强调了这些因素在实现最佳预后中的重要性。专门血管封闭装置的开发可进一步提高阴道子宫切除术的可行性，使其成为妇科手术中更可取的选择。该研究为为患者选择最合适的子宫切除术方法并优化其恢复提供了有价值的见解。
