Hysterectomy for benign uterine disease: the effect of the introduction of laparoscopic‐assisted hysterectomy on the selection of surgical access
Bibliographic record
Abstract
Objective To investigate the effect of the introduction of laparoscopic surgery on the use of traditional techniques of hysterectomy. Design A retrospective study of hysterectomies performed for benign uterine disease, between August 1991 and July 1997. Setting University hospital. Subjects Patients requiring hysterectomy for benign uterine disease without prolapse or pelvic floor relaxation. Interventions 359 hysterectomies including vaginal ( n = 211), laparoscopically assisted vaginal ( n = 56), and abdominal ( n = 92). Results The main indications for hysterectomy were profuse uterine bleeding and pelvic pain; uterine fibroids were a common occurrence (87%). There were no statistical differences between the mean ages of the patients in the three groups. The mean parity was significantly lower ( P = 0.04) for patients undergoing abdominal hysterectomy (AH) (1.3 ± 1.4) than for those whose surgery was either vaginal (2 ± 1.5) or laparoscopic (1.8 ± 1.6) . Before the introduction of laparoscopic‐assisted vaginal hysterectomy (LAVH) (1989–90), the rates of vaginal hysterectomy (VH) and abdominal hysterectomy (AH) in our department were, respectively, 42% and 58%. In the initial 3 years of the study period, the rate of abdominal hysterectomy stayed stable around 30%, then dropped gradually to 18% ( P < 0.05). The rate of LAVH stayed stable during the initial 4 years (between 22 and 24%) and declined thereafter to 7% ( P < 0.05). The rate of VH stayed stable during the initial 4 years (between 46 and 56%) and then increased gradually to 75% ( P < 0.05) and more specifically to 90% in patients who had no prior vaginal childbirth. During the last 2 years of the study there was a decrease in the use of the laparoscopic approach in favour of the vaginal route. Conclusion In our institution the introduction of LAVH led to expected changes during the initial 3 years of the study period, producing a major decline in the rate of AH in favour of LAVH. The unexpected development during the second 3 years of the study period was a further decline in the rate of AH along with a significant decline in the rate of LAVH, both in favour of VH.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".