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Minimally Invasive Hysterectomy in Large UteriNCT02826304

Vaginal Hysterectomy Versus Laparoscopically Assisted Vaginal Hysterectomy for Large Uteri

A study testing Vaginal hysterectomy and Laparoscopic assisted vaginal hysterectomy in people with Minimally Invasive Hysterectomy in Large Uteri, run by Ain Shams Maternity Hospital at 1 site in Egypt.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

The investigators compare between Vaginal Hysterectomy and Laparoscopically assisted vaginal hysterectomy in cases of large uteri weighing more than 280 gm regarding operative and Postoperative outcomes Read more about this study

Who is it for?
Ages 40 to 70 years, women only
What is being tested?
Vaginal hysterectomy and Laparoscopic assisted vaginal hysterectomy
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
50 participants
Where
1 siteEgypt
Study dates
Aug 2014to Jul 2016
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 40 to 70 years
  • Women only
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age between 40 and 70 years.
  • Uterine weight more than 280gm. the weight will be estimated sonographically using algebraic formula by Kung and Chang expressed in weights and measurements: weight(g)= 50+(4/3 x π(Pi) x L/2 x W/2 x AP/2) where (L) is the length of the uterus from the dome of the fundus to the level of the external os and (W) is the maximum width of the uterus at the level of the cornua and (AP) is the anteroposterior diameter of the uterus . Both (W) and (AP) will be taken perpendicular to the axis of the uterine length.
  • Presence of a benign cause for hysterectomy. e.g: fibroid uterus, simple endometrial hyperplasia not responding to medical treatment and adenomyosis.

Who cannot join

  • Patients medically unfit for laparoscopy as severely compromised cardiac patients.
  • Obese patients (BMI>30).
  • Presence of endometriosis.
  • Previous myomectomy
  • Presence of adnexal mass
  • Known or suspected gynecological malignancy.

Trial locations and contacts

1 site in 1 country.

Egypt1 site
  • Maternity hospital, Ain Shams University

    Cairo

Other trials in Egypt

About this study

Official title: Vaginal Hysterectomy Versus Laparoscopically Assisted Hysterectomy for Large Uteri ( A Pilot Randomized Clinical Trial)

The investigators compare between Vaginal Hysterectomy and Laparoscopically assisted vaginal hysterectomy in cases of large uteri weighing more than 280 gm regarding operative and Postoperative outcomes

Read the detailed description

Study setting : Ain Shams University Maternity Hospital Study Design : Pilot prospective randomized clinical trial Study population: The patients will be recruited from women presenting to the outpatient clinic of Ain Shams University Maternity Hospital planned to undergo hysterectomy for benign cause according to inclusion/ exclusion criteria which will be mentioned later.

Study duration : the study will be carried out during the period from August 2014 to August 2016.

Sample size: total of 50 cases will be included in the study to be divided into two groups, the first group will undergo vaginal hysterectomy and the second will undergo Laparoscopic assisted vaginal hysterectomy.

intervention: after approval of the ethical committee, a detailed explanation of the procedure will be informed to the participant and after her approval to involve in the study, an informed written consent will be taken. Detailed medical history will be obtained from all participants recruited in the study along with complete clinical examination and necessary laboratory and radiological investigations. Each patient will have a case record form in which the data regarding history, examination, investigations, operation costs and postoperative events will be recorded

Being tested
Vaginal hysterectomy, Laparoscopic assisted vaginal hysterectomy
Keywords
Vaginal Hysterectomy, Laparoscopic assisted vaginal hysterectomy, Large uteri

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Vaginal hysterectomyProcedure or surgery

    All the cases were performed by the same surgical team

    1. Incision is made at the anterior cervical lip below the bladder reflection
    2. Anterior peritoneal entry .
    3. Douglas pouch entry.
    4. The uterosacral ligaments and the cardinal ligaments are clamped, divided and ligated .
    5. Uterine artery clamping division and ligation
    6. After securing the uterine A., debulking procedures was performed in the form of bisection, coring or myomectomy
    7. Utero-ovarian and round clamping-division and ligation ( in cases where oophorectomy was performed this part was done at the level of the infundibulo-pelvic ligament).
    8. Hemostasis
    9. The vaginal vault is closed after insertion of intraperitoneal drain and
  • Laparoscopic assisted vaginal hysterectomyProcedure or surgery

    1. Uterine manipulator was inserted through the cervix to mobilize the uterus
    2. Veress needle was inserted through the base of the umbilicus
    3. creation of pneumoperitoneum
    4. Insertion of 4 trocars one at the base of umbilicus for the camera and 3 lateral trocars
    5. The round and the utero-ovarian ligament are coagulated and divided.
    6. Dissection through the vesico-uterine space to displace bladder away from the cervix.
    7. Uterine artery was coagulated and divided laparoscopically
    8. anterior colpotomy over the cup of the uterine elevator.
    9. Vaginal part starts with opening of douglas pouch and clamping , division and ligation of uterosacral and cardinal ligaments followed by removal of the uterus and closure of the vault. reinflation to ensure proper hemostasis.
Study groups in NCT02826304
Study groupRoleWhat they receive
VHActive comparatorVaginal Hysterectomy for uteri larger than 280gm
Receives: Procedure: Vaginal hysterectomy
LAVHActive comparatorLaparoscopic assisted vaginal hysterectomy for uteri larger than 280gm
Receives: Procedure: Laparoscopic assisted vaginal hysterectomy

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Operative time of the procedure

    In case of vaginal hysterectomy, the operative time will be measured from the vaginal incision to closure of the vaginal vault. in cases of Laparoscopic assisted vaginal hysterectomy, the time will be measured from the introduction of the laparoscopic camera port till stitching the laparoscopic incisions after ensuring adequate hemostasis. the time of any concomitant procedures was excluded

    Measured: Range from 90 minutes to 210 minutes

Secondary outcomes (6)
  1. Estimated intraoperative blood loss

    intraoperative blood loss will be estimated via:

    1. - amount of blood in suction bottle.
    2. - Estimation based on number of soaked gauzes by weighing the gauzes used in the procedure before and after surgery ( each 1mg corresponds to 1ml of blood)
    3. - Drop in postoperative hemoglobin and hematocrit when compared with preoperative values.

    Measured: the operative time of the procedure which range from 90 minutes to 210 minutes

  2. Hospital costs

    the costs of the following will be calculated:

    1. - Admission cost which include ward fee, pre and postoperative management costs and extra charges for post surgical complication.
    2. - anesthesia cost which includes expenses of anesthetics during the procedure. C)- operation cost which include operative material fee.

    Measured: within the period of hospital admission which range from 2 to 8 days

  3. intraoperative complications

    1. - need for blood transfusion
    2. - need for laparotomy due to either surgical difficulty or any complication
    3. - Bowel or urinary tract injuries

    Measured: the operative time of the procedure which range from 90 minutes to 210 minutes

  4. Postoperative Pain

    Postoperative pain will be assessed using the visual analogue scale after the procedure by 6hrs, 12hrs and 24hrs.

    Measured: the first 24hrs after the procedure

  5. Postoperative complications

    1. - Need for blood transfusion
    2. - Vaginal vault or pelvic hematoma
    3. - surgical site infection
    4. - urinary tract infection
    5. - postoperative bowel or urinary tract complications

    Measured: 1 month after the procedure

  6. postoperative hospital stay

    the hospital stay will be measured in hours

    Measured: range from 24 hours to 168 hours

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted7 Jul 2016 (estimated)
  2. Study startAug 2014
  3. Primary completionMay 2016
  4. Study completionJul 2016 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
50 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02826304
Sponsor's protocol ID
1
Status last verified
Jul 2016
First submitted
28 Jun 2016
Last updated
11 Jul 2016
Results posted
No
Data monitoring committee
Yes
Individual data sharing
No

Publications

  • Cho HY, Park ST, Kim HB, Kang SW, Park SH. Surgical outcome and cost comparison between total vaginal hysterectomy and laparoscopic hysterectomy for uteri weighing >500 g. J Minim Invasive Gynecol. 2014 Jan-Feb;21(1):115-9. doi: 10.1016/j.jmig.2013.07.013. Epub 2013 Aug 6.

    PubMed 23932973
  • Guvenal T, Ozsoy AZ, Kilcik MA, Yanik A. The availability of vaginal hysterectomy in benign gynecologic diseases: a prospective, non-randomized trial. J Obstet Gynaecol Res. 2010 Aug;36(4):832-7. doi: 10.1111/j.1447-0756.2010.01183.x.

    PubMed 20666953
  • Harb TS, Adam RA. Predicting uterine weight before hysterectomy: ultrasound measurements versus clinical assessment. Am J Obstet Gynecol. 2005 Dec;193(6):2122-5. doi: 10.1016/j.ajog.2005.07.014.

    PubMed 16325627
  • Harmanli OH, Gentzler CK, Byun S, Dandolu MH, Grody T. A comparison of abdominal and vaginal hysterectomy for the large uterus. Int J Gynaecol Obstet. 2004 Oct;87(1):19-23. doi: 10.1016/j.ijgo.2004.06.018.

    PubMed 15464771
  • Hawksley H. Pain assessment using a visual analogue scale. Prof Nurse. 2000 Jun;15(9):593-7.

    PubMed 11129939
  • Johns DA, Carrera B, Jones J, DeLeon F, Vincent R, Safely C. The medical and economic impact of laparoscopically assisted vaginal hysterectomy in a large, metropolitan, not-for-profit hospital. Am J Obstet Gynecol. 1995 Jun;172(6):1709-15; discussion 1715-9. doi: 10.1016/0002-9378(95)91402-1.

    PubMed 7778623
  • Kim HB, Song JE, Kim GH, Cho HY, Lee KY. Comparison of clinical effects between total vaginal hysterectomy and total laparoscopic hysterectomy on large uteruses over 300 grams. J Obstet Gynaecol Res. 2010 Jun;36(3):656-60. doi: 10.1111/j.1447-0756.2010.01185.x.

    PubMed 20598052
  • Lapaire O, Schneider MC, Stotz M, Surbek DV, Holzgreve W, Hoesli IM. Oral misoprostol vs. intravenous oxytocin in reducing blood loss after emergency cesarean delivery. Int J Gynaecol Obstet. 2006 Oct;95(1):2-7. doi: 10.1016/j.ijgo.2006.05.031. Epub 2006 Aug 23.

    PubMed 16934269
  • Nazah I, Robin F, Jais JP, Jeffry L, Lelievre L, Camatte S, Taurelle R, Lecuru F. Comparison between bisection/morcellation and myometrial coring for reducing large uteri during vaginal hysterectomy or laparoscopically assisted vaginal hysterectomy: results of a randomized prospective study. Acta Obstet Gynecol Scand. 2003 Nov;82(11):1037-42. doi: 10.1034/j.1600-0412.2003.00278.x.

    PubMed 14616278
  • Sahin Y. Vaginal hysterectomy and oophorectomy in women with 12-20 weeks' size uterus. Acta Obstet Gynecol Scand. 2007;86(11):1359-69. doi: 10.1080/00016340701657258.

    PubMed 17963064
  • Seracchioli R, Venturoli S, Vianello F, Govoni F, Cantarelli M, Gualerzi B, Colombo FM. Total laparoscopic hysterectomy compared with abdominal hysterectomy in the presence of a large uterus. J Am Assoc Gynecol Laparosc. 2002 Aug;9(3):333-8. doi: 10.1016/s1074-3804(05)60413-6.

    PubMed 12101331
  • Shiota M, Kotani Y, Umemoto M, Tobiume T, Shimaoka M, Hoshiai H. Total abdominal hysterectomy versus laparoscopically-assisted vaginal hysterectomy versus total vaginal hysterectomy. Asian J Endosc Surg. 2011 Nov;4(4):161-5. doi: 10.1111/j.1758-5910.2011.00104.x. Epub 2011 Sep 8.

    PubMed 22776300
  • Teoh TG. Vaginal hysterectomy for the large uterus. Med J Malaysia. 2001 Dec;56(4):460-2.

    PubMed 12014766
  • Wang CJ, Yen CF, Lee CL, Tashi T, Soong YK. Laparoscopically assisted vaginal hysterectomy for large uterus: a comparative study. Eur J Obstet Gynecol Reprod Biol. 2004 Aug 10;115(2):219-23. doi: 10.1016/j.ejogrb.2003.12.021.

    PubMed 15262360
  • Wang CJ, Yuen LT, Yen CF, Lee CL, Soong YK. A simplified method to decrease operative blood loss in laparoscopic-assisted vaginal hysterectomy for the large uterus. J Am Assoc Gynecol Laparosc. 2004 Aug;11(3):370-3. doi: 10.1016/s1074-3804(05)60053-9.

    PubMed 15559351

Questions about this trial

What is this clinical trial studying?

A study testing Vaginal hysterectomy and Laparoscopic assisted vaginal hysterectomy in people with Minimally Invasive Hysterectomy in Large Uteri, run by Ain Shams Maternity Hospital at 1 site in Egypt.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 11 Jul 2016. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Egypt. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Operative time of the procedure (time frame: Range from 90 minutes to 210 minutes). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02826304, which also lists 17 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 11 Jul 2016.

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