Objective: The aim of this study was to compare intraoperative and postoperative outcomes of two routes of salpingo-oophorectomy. Materials and Methods: Forty-two women undergoing vaginal hysterectomy were randomly assigned to 2 groups (1:1): group 1, laparoscopic oophorectomy with vaginal hysterectomy; or group 2, vaginal hysterectomy with vaginal oophorectomy. Outcome measures were operating time, blood loss, technical difficulty, intraoperative and postoperative complications, postoperative pain, and discharge time. Results: Vaginal oophorectomy was associated with a shorter operating time than laparoscopic oophorectomy at 37.06 ± 10.16 minutes (95% confidence interval [95% CI]: 32.36–41.75) and 20.75 ± 5.56 minutes (95% CI: 18.31–23.18), p = 0.001, in groups 1 and 2, respectively. The mean operating time for hysterectomy was similar in both groups at 48.06 ± 10.709 minutes for group 1 and 49.25 ± 11.318 minutes for group 2, p = 0.746. No statistically significant difference was noted for blood loss, level of technical difficulty, intraoperative or postoperative complications, postoperative pain, and discharge time. Conclusions: Vaginal and laparoscopic routes of oophorectomy can be used during vaginal hysterectomy. The vaginal route is a better option, with shorter operating time, feasibility with regional anesthesia, and a comparable surgical outcome to laparoscopy. When salpingo-oophorectomy cannot be completed vaginally, laparoscopic oophorectomy can be performed. (J GYNECOL SURG 32:220)
Get full access to this article
View all access options for this article.
References
1.
GibsonCJ, JoffeH, BrombergerJT, ThurstonRC, LewisTT, KhalilN, MatthewsKA. Mood symptoms after natural menopause and hysterectomy with and without bilateral oophorectomy among women in midlife. Obstet Gynecol, 2012; 119:935.
2.
DuanL, XuX, KoebnickC, et al.Bilateral oophorectomy is not associated with increased mortality: The California Teachers Study. Fertil Steril, 2012; 97:111.
3.
EreksonEA, MartinDK, ZhuK, CiarleglioMM, PatelDA, GuessMK, RatnerES. Sexual function in older women after oophorectomy. Obstet Gynecol, 2012; 120:833.
4.
NovetskyAP, BoydLR, CurtinJP. Trends in bilateral oophorectomy at the time of hysterectomy for benign disease. Obstet Gynecol, 2011; 118:1280.
5.
LowderJL, OliphantSS, GhettiC, BurrowsLJ, MeynLA, BalkJ. Prophylactic bilateral oophorectomy or removal of remaining ovary at the time of hysterectomy in the United States, 1979–2004. Am J Obstet Gynecol, 2010; 202:538.e1.
6.
DasN, KayVJ, MahmoodTA. Current knowledge of risks and benefits of prophylactic oophorectomy at hysterectomy for benign disease in United Kingdom and Republic of Ireland. Eur J Obstet Gynecol Reprod Biol, 2003; 109:76.
7.
RimanT, DickmanPW, NilssonS, CorreiaN, NordlinderH, MagnussenCM, PerssonIR. Risk factors for invasive epithelial ovarian cancer: Results from a Swedish case-control study. Am J Epidemiol, 2002; 156:363.
8.
HickeyM, AmbekarM, HammondI. Should the ovaries be removed or retained at the time of hysterectomy for benign disease. Hum Reprod Update, 2010; 16:131.
HalperinR, MordechaiE, ZehaviS, SchneiderD. Pathological characteristics of ovarian cancer occurring after hysterectomy. Eur J Gynaecol Oncol, 2004; 25:308.
11.
DavisonSL, BellR, DonathS, MontaltoJG, DavisSR. Androgen levels in adult females: Changes with age, menopause, and oophorectomy. J Clin Endocrinol Metab, 2005; 90:3847.
12.
CouzinetB, MeduriG, LecceMG, et al.The postmenopausal ovary is not a major androgen-producing gland. J Clin Endocrinol Metab, 2001; 86:5060.
13.
DrahonovskyJ, HaakovaL, OtcenasekM, KroftaL, KuceraE, FeyereislJ. A prospective randomized comparison of vaginal hysterectomy, laparoscopically assisted vaginal hysterectomy, and total laparoscopic hysterectomy in women with benign uterine disease. Eur J Obstet Gynecol Reprod Biol, 2010; 148:172.
14.
DargentD. Vaginal hysterectomy. In: DargentD, QuerleuD, PlanteM, ReynoldsK, eds. Vaginal and Laparoscopic Vaginal Surgery. London: Taylor & Francis, 2004:47.
15.
SizziO, PaparellaP, BonitoC, PaparellaR, RossettiA. Laparoscopic assistance after vaginal hysterectomy and unsuccessful access to the ovaries or failed uterine mobilization: Changing trends. JSLS, 2004; 8:339.
16.
GoelN, RajaramS. Vaginal oophorectomy. In: GoelN, AgarwalR, RajaramS, MehtaS, eds. Step by Step® Non-Descent Vaginal Hysterectomy, 2nd ed. New Delhi: Jaypee Brothers Medical Publishers, 2010:128.
17.
ShepherdJP, ZyczynskiHM. Removal of adnexa at the time of vaginal hysterectomy. Clin Obstet Gynecol, 2010; 53:17.
18.
ShethSS. Adnexectomy for benign pathology at vaginal hysterectomy without laparoscopic assistance. BJOG, 2002; 109:1401.
19.
AgostiniA, VejuxN, BretelleF, ColletteE, De LapparentT, CravelloL, BlancB. Value of laparoscopic assistance for vaginal hysterectomy with prophylactic bilateral oophorectomy. Am J Obstet Gynecol, 2006; 194:351.
20.
SestiF, RuggeriV, PietropolliA, PiccioneE. Laparoscopically assisted vaginal hysterectomy versus vaginal hysterectomy for enlarged uterus. JSLS, 2008; 12:246.
21.
WallensteinMR, AnanthCV, KimJH, et al.Effect of surgical volume on outcomes for laparoscopic hysterectomy for benign indications. Obstet Gynecol, 2012; 119:709.
22.
SestiF, CalonziF, RuggeriV, PietropolliA, PiccioneE. A comparison of vaginal, laparoscopic-assisted vaginal, and minilaparotomy hysterectomies for enlarged myomatous uteri. Int J Gynaecol Obstet, 2008; 103:227.
