Bakgrund: Benigna gynekologiska åkommor är något som påverkar kvinnors hälsa och livskvalitet. Hysterektomi är den andra vanligaste operationen inom gynekologin och kvinnor som är drabbade av benigna gynekologiska åkommor kan genomgå en hysterektomi som behandling. Livskvaliteten påverkas även av att genomgå en hysterektomi. Syfte: Att beskriva livskvaliteten efter genomgången hysterektomi för kvinnor som drabbats av benigna gynekologiska åkommor. Metod: En litteraturöversikt baserad på 14 artiklar har utförts. Artiklarna är publicerade mellan 2000-2016 och är från olika länder. Sökningar har gjorts i databaserna PubMed, Cinahl, Web of Science och psykINFO. Resultat: Resultatet presenteras i sju kategorier där undertexten handlar om kvinnors livskvalitet efter hysterektomi. Kategorierna presenterar livskvalitetens olika aspekter och om förbättring eller försämring i symtom kan ses. Kategorierna är: smärta och blödning kan kvarstå, för tidig menopaus inträder, det sexuella samlivet, förlust av fertilitet, faktorer som kan påverka livskvaliteten relaterat till total hysterektomi, psykiska upplevelser av att ha genomgått en hysterektomi och informationsbehov. Slutsats: Livskvaliteten förbättras för de allra flesta kvinnor efter genomgången hysterektomi. Vissa symtom kan kvarstå, även om de blir förbättrade. / Background: Benign gynecologic condition are something that affects women's health and quality of life. Hysterectomy is the second most common surgery in gynecology and women who suffer from benign condition may undergo a hysterectomy as treatment. The quality of life is also affected by undergoing a hysterectomy. Aim: To describe the quality of life after a hysterectomy for women who suffers from benign gynecologic condition. Method: A literature review based on 14 articles have been performed. The articles are published between 2000-2016 and are from different countries. Searches have been made in the databases PubMed, CINAHL, Web of Science and psykINFO. Results: The result are presented in seven categories and the sub-texts describes women's quality of life after hysterectomy. The results present quality of life in different aspects, and if the symptoms gets worse or improves. The categories are: early menopaus, the sexual life, loss of infertility, factors that affects the quality of life related to total hysterectomy, psychological experience of undergoing hysterectomy and information needs. Conclusion: Quality of life were improved for most women after the hysterectomy. Some symptoms may persist, although the most were improved.

Base Teórica: A histerectomia ainda é um procedimento cirúrgico frequente. Nos últimos 25 anos, muitos esforços foram feitos para reduzir o número de histerectomias abdominais, como o avanço tecnológico, que permitiu cirurgias menos invasivas. Visando ampliar o uso da cirurgia minimamente invasiva, foi desenvolvida a cirurgia robótica, com a vantagem de facilitar o uso da laparoscopia proporcionando movimentos mais ergonômicos e precisos. Apesar de ser tecnologia recente e do alto custo, vem ganhando cada vez mais espaço na prática clínica. Dados sobre tempo cirúrgico e tempo de internação pós-operatória tem sido alvo de várias publicações, uma vez que afetam os custos do procedimento. Objetivo: O presente projeto visa à documentação da experiência inicial do Hospital de Clínicas de Porto Alegre na realização da histerectomia robótica, e comparação dos seus dados com outras vias de histerectomia já realizados no nosso meio. Métodos: Foi realizado estudo caso-controle para comparação de dados pré-operatórios, operatórios (como tempo cirúrgico total e sangramento) e pós-operatórios (tempo de recuperação pós-operatória, complicações, dor nas primeiras 24 horas após a cirurgia), em 80 pacientes, submetidas à histerectomia para tratamento de patologias uterinas benignas. Nós incluímos quatro grupos de pacientes: robótico, vaginal, abdominal e laparoscópico. O grupo robótico foi composto pelas primeiras 20 cirurgias realizadas em nosso hospital, e os grupos controle foram selecionados retrospectivamente a partir da data da última cirurgia robótica, constituindo uma amostragem não probabilística. Também foi realizado estudo transversal utilizando apenas as pacientes submetidas à cirurgia robótica em nosso serviço, para fins de documentação de nossa experiência inicial. Resultados: O grupo robótico foi responsável pelo maior tempo cirúrgico total (180,7 minutos), e pelo menor tempo de recuperação pós-operatória (23,7 horas), entre os quatro grupos. Não houve diferença entre os grupos na análise do sangramento transoperatório e das complicações pós-operatórias. Dados analisados sobre a dor pós-operatória não diferiram entre os grupos. No estudo transversal, foi demonstrada curva de aprendizado em tempo de docking e undocking, e houve correlação forte entre tempo cirúrgico total e índice de massa corporal da paciente. Conclusão: Análise do tempo cirúrgico total e do tempo de recuperação pós-operatória são relevantes, pois podem ser ferramentas necessárias para redução dos custos da cirurgia robótica. Nossa experiência inicial demonstra curva de aprendizado em alguns aspectos. / Background: Hysterectomy is a frequent surgical procedure. In the last 25 years, many efforts have been made to reduce the number of abdominal hysterectomies, such as the technological advances, which allowed less invasive procedures. Aiming to increase the use of minimally invasive surgery, the robotic surgery was developed, which advantage of more precise and ergonomic movements than laparoscopy. Although it is a recent and expensive technology, robotic surgery is gaining more space in clinical practice. Data from Total Surgical Time and Time of Postoperative Recovery has been target of publications, once they can affect the costs. Objective: The purpose of this study is to compare the surgical outcomes of patients undergoing robotic hysterectomy for benign cases to patients undergoing another types of hysterectomy performed in our institution. Methods: It was performed a case-control study to compare pre-operative, operative (as Total Surgical Time and bleeding) and postoperative (Time of Postoperative Recovery, complications, and pain at the first 24 hours after the surgery) in 80 patients undergoing hysterectomy for treatment of various benign uterine conditions. We have included four groups of patients: robotic, vaginal, abdominal and laparoscopic. The robotic group was composed by the first twenty patients undergoing robotic hysterectomy at our hospital, and the control groups were retrospectively selected from the date of the last robotic surgery, constituting a non-probabilistic sample. We also performed a crosssectional study with the 20 patients of robotic group, to document our initial experience. Results: The robotic group was responsible for the longer Total Surgical Time (180.7 minutes), and for the shortest Time of Postoperative Recovery (23.7 hours) among the four groups. There were no difference between the groups in analysis of estimated blood loss and postoperative complications. Data related to postoperative pain showed no difference between the groups. At cross-sectional study, it was demonstrated learning curve of docking and undocking times, and was found a strong correlation between Total Surgical Time and body mass index. Conclusion: Analysis of Total Surgical Time and Time of Postoperative Recovery are relevant, because they can be necessary tools to reduce the costs of robotic surgery. Our initial experience demonstrated learning curve in some ways.

Oavsiktlig hypotermi är ett ämne som hamnat i skymundan i den hektiska intraoperativa fasen för anestesisjuksköterskan. Patientens nedkylning påbörjas redan vid de preoperativa förberedelserna. En salstemperatur under 22˚C är den vanligaste orsaken till hypotermi hos patienterna och deras kroppstemperatur bör inte understiga 36,5˚C. Förebyggande åtgärder som att använda värmefiltar, salstemperatur på 22˚C-23˚C, varma infusioner i blodvärmare, inte exponera mer hud än nödvändigt samt postoperativt använda sig av värmetak. Kroppstemperaturen bör övervakas vid operationer längre än 30 minuter. Genom ökat fokus på kroppstemperaturen i den intraoperativa fasen kan postoperativa komplikationer minskas samt förkorta vårdtiden. Kan påverkbara faktorer under den intraoperativa fasen påverka och minska risken för oavsiktlig hypotermi? Fokus ligger på utvärdering av metod och mätinstrument. Syftet med den randomiserade pilotstudien är att undersöka patienter som drabbas av oavsiktlig hypotermi som genomgår hysterektomi med generell anestesi. Metoden är en kvantitativ pilotstudie med randomiserat urval samt en litteraturgranskning för förbättring av instrumentutveckling. Antalet deltagare i studien var 15 stycken, inga generella slutsatser kan dras. Mild hypotermi har 60 % av deltagarna redan innan operationsstart. Tio av 15 patienter uppnår ej 37°C under de första 30 minuterna oavsett bair hugger eller ej. Temperaturtagning 30 minuter efter ankomst till postoperativaavdelningen är mellan 35,4°C-37,2˚C. För att få ett heltäckande formulär om den perioperativa vården utförs en instrumentutveckling inför kommande primärstudie. Anestesisjuksköterskan är ansvarig för att förebygga och åtgärda hypotermi i enlighet med vad som är bäst för patienten. Vårdtagaren ska alltid stå i centrum och hypotermi är något som lätt kan åtgärdas bara medvetandet inom kunskapsområdet ökar. / Program: Specialistsjuksköterskeutbildning med inriktning mot anestesisjukvård

Objetivo: O propósito desse estudo foi avaliar os impactos isolados e associados da terapia hormonal (estradiol valerate 1 mg orally/day) e do exercício físico (exercício aeróbico moderado, 3h/semana) na qualidade de vida (QV), qualidade de vida relacionada à saúde (QVRS), e sintomas climatéricos entre mulheres histerectomizadas na pós-menopausa. Métodos:Foi um estudo longitudinal, duplocego, placebo-controlado realizado com 44 mulheres histerectomizadas na pósmenopausa. Os 4 grupos estudados de acordo com a terapia e os exercícios foram: exercício físico e terapia hormonal (TFTH, n=9); sedentárias e terapia hormonal (SEDTH, n=14); exercício físico e placebo (TFPLA; n=11) e sedentárias e placebo (SEDPLA, n= 10). A QVRS foi avaliada pela versão brasileira do SF-36, a QV pelo WHOQOL-BREF e os sintomas pelo IMK, no início e no sexto mês de estudo. Resultados: Houve um decréscimo nos sintomas em todos os grupos, mas apenas os grupos que realizaram EF obtiveram aumentos na QV e na QVRS. A ANOVA demonstrou diferenças significativas nos componentes, capacidade funcional (P=0.001) e dor (P=0.012) do SF-36, e nos domínios, físico (P=0,013), psicológico (P<0,001) e relações sociais (P=0,028) após seis meses de estudo entre os grupos que realizaram exercícios em comparação aos sedentários independente da TH. Não foram demonstrados efeitos da TH, nem da associação entre exercícios e TH sobre os escores da QV e da QVRS. Conclusão: Exercícios físicos podem reduzir os sintomas da menopausa, melhorar a QV e a QVRS, independente da TH / Objective: The purpose of this study was to evaluate the isolated and associated effects of estrogen therapy (estradiol valerate 1 mg orally/day) and physical exercises (moderate aerobic exercise, 3h/weekly) on quality of life (QOL), health related quality of life (HRQOL) and menopausal symptoms among women who had undergone hysterectomy. Design: It was a six-months, randomized, double-blind, placebocontrolled clinical trial with 44 postmenopausal women who had undergone hysterectomy. The interventions were: physical exercise and hormone therapy (PEHT, n=9); sedentary and hormone therapy (SEDHT, n=14); physical exercise and placebo (PEPLA; n=11), sedentary and placebo (SEDPLA, n= 10). HRQOL was assessed by a Brazilian standard version of SF-36, QOL by WHOQOL-BREF and symptoms by Kupperman Scale, at baseline and after 6 months. Results: There was a decrease of symptoms in all groups, but only groups which performed physical exercises showed increases in QOL and in HRQOL. ANOVA showed that changes in physical functioning (P=0.001), bodily pain (P=0.012), physical domain (P=0,013), psychological domain (P<0,001), and social relationship (P=0,028) scores over the six months period differed significantly between exercisers and sedentaries, regardless of hormone therapy. There were no effects of hormone therapy, and no significant association between physical exercise and hormone therapy in HRQOL. Conclusions: Physical exercises can reduce menopausal symptoms and enhance QOL and HRQOL, independently of taking or not hormone therapy

Bakgrund: Många patienter som är födda med en livmoder upplever livmodern som ett sexuellt organ och är vid hysterektomi rädda att förlora sin sexuella identitet. Hysterektomi, avlägsnande av livmodern, är ett av det vanligaste gynekologiska ingreppen och i Sverige genomgår cirka en av tio patienter födda med livmoder behandlingen. Teoretiskt sett kan hysterektomi påverka sexualiteten och den sexuella förmågan. Syfte: Beskriva patientens sexuella förmåga efter hysterektomi. Metod: En litteraturöversikt av tio kvantitativa artiklar som undersöker den sexuella förmågan efter hysterektomi. Datainsamlingen gjordes i databaserna PubMed och CINAHL. Resultat: Första halvåret efter hysterektomi är den sexuella förmågan försämrad för många patienter. Sex månader till två år efter operationen förbättras den sexuella förmågan eller upplevdes oförändrad. Trots försämrad sexuell förmåga efter hysterektomi upplever många patienter sexuell tillfredställelse. Dyspareuni och depressionssymtom minskas efter hysterektomi. Information innan hysterektomin om möjliga sexuella förändringar efter operationen är en bidragande faktor för sexuell tillfredställelse. Ingen skillnad mellan typ och metod av hysterektomi påvisas. Slutsats: Resultatet av studien visar att den sexuella förmågan förändras efter hysterektomi, oberoende typ av hysterektomi eller operationsmetod. Information är en bidragande faktor till att patienter upplever sexuell tillfredställelse. Klinisk Betydelse: Det är viktigt att sjuksköterskan diskuterar sexualitet med patienten innan, under och efter hysterektomi, för att kunna säkerställa en god omvårdnad. / Background: Many patients, who are born with a uterus sees the uterus as a sexual organ. In conjunction with the hysterectomy a lot of patients are anxious of losing their sexual identity. Hysterectomy, removal of the uterus, is one of the most common gynecological surgeries and in Sweden approximately one of ten patients undergo the operation. Theoretically the hysterectomy could affect sexuality and sexual function. Objective: Describe the patient's sexual function after hysterectomy. Method: A literature review of ten quantitative articles that examines sexual functioning after hysterectomy. The data was collected in PubMed and CINAHL. Results: The first six months after the hysterectomy sexual function decreased for many patients. Six months to two years after the surgery the sexual function improves or perceived unchanged. Despite if the sexual function got worsened after hysterectomy many patients experience sexual satisfaction. Dyspareunia and depression symptoms decreased after hysterectomy. Information before the hysterectomy about possible sexual changes after surgery is a contributing factor for sexual satisfaction. There was no difference between the type and method of hysterectomy. Conclusion: The results of the study show that sexual function changes after hysterectomy, regardless type of hysterectomy or surgical procedure. Information is a contributing factor to patients experiencing sexual satisfaction. Clinical Significance: It is important that the nurses are discussing sexuality with the patient before, during and after hysterectomy in order to ensure good care.

SAMMANFATTNING Bakgrund: Hysterektomi är en vanlig operationsmetod för avlägsnande av livmodern. Tidigare studier har påvisat att dessa kvinnor löper stor risk att drabbas av psykisk ohälsa, dock saknas beskrivande information om upplevelsen av att genomgå en hysterektomi.   Syfte: Syftet med litteraturstudien var att undersöka kvinnors upplevelse av psykisk hälsa före och efter hysterektomi.   Metodbeskrivning: En allmän litteraturstudie användes. Sökning av vetenskapliga artiklar gjordes i databaserna PubMed, CINAHL, Cochrane, Statens Beredning medicinsk och social utvärdering [SBU] samt PsycINFO. Totalt tio artiklar med kvalitativ metod inkluderades i denna studie.   Huvudresultat: Sex kategorier identifierades: oro kring infertilitet och föräldraskap, vikten av stöd från omgivningen, upplevelser av den bakomliggande diagnosen, syn på livet, sexualitet och intima relationer samt kvinnans syn på sin egen kropp. Studiens resultat tyder på att hysterektomi påverkar många aspekter i kvinnans liv. Negativa konsekvenser som identifierades var infertilitet och separation från det nyfödda barnet. Frihet från tidigare symtom och utveckling genom lidande var positiva resultat från hysterektomin. Sexualiteten och kroppsbilden ansågs väldigt individuell, då det framkom skilda upplevelser kring detta. Genom hela sjukdomsförloppet var omgivningens stöd otroligt viktigt för kvinnorna.   Slutsats: Sammanfattat tyder studiens resultat på att kvinnors psykiska hälsa påverkas i samband med hysterektomi, upplevelser både före och efter operationen belyser känslor som förknippas med psykisk ohälsa. Kvinnor som genomgår hysterektomi anses ha en högre risk för psykiska besvär, dock framkom att många kvinnors tillstånd förbättrats genom det kirurgiska ingreppet. Vid vård av denna patientgrupp bör sjukvårdspersonal sträva efter en personcentrerad vård. / ABSTRACT Background: Hysterectomy is a common method for removal of the uterus. Previous studies have shown that these women run a high risk of mental illness, but there is a lack of narrative information about the experience of undergoing hysterectomy.   Aim: The purpose of this literature study was to investigate women's experience of mental health before and after hysterectomy.   Method: A general literature study was used. The search for articles was made in the databases PubMed, CINAHL, Cochrane, Swedish Agency for Health Technology And Assessment of Social Services [SBU] and PsycINFO. A total of ten articles with qualitative method were included in this study.   Results: Six categories were identified: concerns about infertility and parenting, the importance of support, experiences of the underlying diagnosis, view of life, sexuality and intimate relationships and the woman's view of her own body. The study results indicate that hysterectomy affects many aspects of the woman's life. Negative consequences identified were infertility and separation from the newborn child. Freedom from past symptoms and development through suffering was positive results from the hysterectomy. Sexuality and body image were considered very individual, this because the different experiences. Throughout the course of illness, the support from others was incredibly important for the women.   Conclusions: The result of the literature study shows that women's mental health is affected in conjunction with hysterectomy, experiences before and after the operation highlight emotions associated with mental ill health. Women undergoing hysterectomy are considered to be at higher risk of mental discomfort, however, founds shows that the condition of many women was improved by the surgical procedure. Healthcare professionals should strive for a person-centered care.

BACKGROUND: Hysterectomies are one of the most frequently performed surgical procedures in the United States. There are a wide variety of diagnoses that require a patient to obtain this procedure, but the majority of hysterectomies are performed for benign indications. Currently, gynecologists do not follow a standardized protocol surrounding postoperative laboratory ordering, and healthcare professionals can order a wide range of tests as often as they choose. Extraneous laboratory orders are disruptive to the patients’ well-being and risk their health following surgery. These orders are costly for hospital systems, take up precious time of hospital employees, and influence the course of patient treatment only in extremely rare circumstances. There are few studies that develop exclusion criteria for patients who may not require a laboratory test following surgery. Though systems to predict postoperative hematocrit have been created, they are complicated and difficult to use. The few studies that were performed are yet to be accepted by the medical community, in part because of their limited scope. This study will be the first to incorporate the results of robotic surgery in the analysis. OBJECTIVE: The purpose of this study is to determine concrete parameters to indicate that a patient is in need of postoperative laboratory work and at risk for anemia or transfusion. We aim to develop two comprehensive models that guide surgical practitioners to identify the cases which do not require laboratory data. METHODS: A total of 1027 gynecologic surgeries were performed at Saint Francis Hospital and Medical Center between April 1, 2014 and May 31, 2016. This retrospective study extracted data from EPIC EMR according to 42 variables preconceived to be the leading indicators of postoperative hematocrit and overall healing. Five healthcare professionals were surveyed to identify the variables that influence their postsurgical patient assessments and their decisions to order blood testing. This information was developed into score sheets with differing levels of stringency. Correlation highlighted 14 of the initial 42 variables as contributors to postoperative hematocrit and an equation model was built. Stepwise linear regression was used for univariate and multivariate analyses, from which we created our equation to predict all patients’ postoperative hematocrit. RESULTS: Out of the 1027 initial cases, a total of 602 cases were identified as hysterectomies for benign indications. Survey data gave the highest value to urine output and heart rate as key indicators of postoperative anemia. From the survey data, two clinical scoring sheets with differing stringency were created to guide practitioner laboratory ordering. These sheets gave parameters of heart rate and urine output the largest correlative weight in determining postoperative hematocrit. However, based on regression analysis, parameters of age (AGE), body mass index (BMI), preoperative platelet count (PPC), estimated blood loss during surgery (IO EBL), preoperative hematocrit (PHCT) and postoperative fluid bolus orders (POSTOP FB) proved to be the key variables impacting postoperative hematocrit (POSTOP HCT). These items were translated into the equation: POSTOP HCT = 22.51 – 0.40*POSTOP FB – 0.01*IO EBL + 0.25 PHCT + 0.09*BMI + 0.06*AGE – 0.01*PPC (R-squared = 0.310). CONCLUSIONS: This study aims to decrease superfluous laboratory testing, as well as to contribute to a larger conversation considering the potential merits of clinical judgement in a data-driven healthcare system. We have created a number of comparable strategies in order to reduce the number of unnecessary blood draws: two clinical scoring sheets and an equation. The score sheets indicate when to order additional testing. These sheets are representative of a range of surgical practitioners’ conventional clinical judgement. The equation serves as an evidence-based guide for determining postoperative hematocrit following benign gynecologic surgery. These predictive mechanisms will be validated and a superior method determined as our research continues with prospective application. We eventually expect to use the most accurate mechanism to reduce postoperative blood testing following all surgeries.

Base Teórica: A histerectomia ainda é um procedimento cirúrgico frequente. Nos últimos 25 anos, muitos esforços foram feitos para reduzir o número de histerectomias abdominais, como o avanço tecnológico, que permitiu cirurgias menos invasivas. Visando ampliar o uso da cirurgia minimamente invasiva, foi desenvolvida a cirurgia robótica, com a vantagem de facilitar o uso da laparoscopia proporcionando movimentos mais ergonômicos e precisos. Apesar de ser tecnologia recente e do alto custo, vem ganhando cada vez mais espaço na prática clínica. Dados sobre tempo cirúrgico e tempo de internação pós-operatória tem sido alvo de várias publicações, uma vez que afetam os custos do procedimento. Objetivo: O presente projeto visa à documentação da experiência inicial do Hospital de Clínicas de Porto Alegre na realização da histerectomia robótica, e comparação dos seus dados com outras vias de histerectomia já realizados no nosso meio. Métodos: Foi realizado estudo caso-controle para comparação de dados pré-operatórios, operatórios (como tempo cirúrgico total e sangramento) e pós-operatórios (tempo de recuperação pós-operatória, complicações, dor nas primeiras 24 horas após a cirurgia), em 80 pacientes, submetidas à histerectomia para tratamento de patologias uterinas benignas. Nós incluímos quatro grupos de pacientes: robótico, vaginal, abdominal e laparoscópico. O grupo robótico foi composto pelas primeiras 20 cirurgias realizadas em nosso hospital, e os grupos controle foram selecionados retrospectivamente a partir da data da última cirurgia robótica, constituindo uma amostragem não probabilística. Também foi realizado estudo transversal utilizando apenas as pacientes submetidas à cirurgia robótica em nosso serviço, para fins de documentação de nossa experiência inicial. Resultados: O grupo robótico foi responsável pelo maior tempo cirúrgico total (180,7 minutos), e pelo menor tempo de recuperação pós-operatória (23,7 horas), entre os quatro grupos. Não houve diferença entre os grupos na análise do sangramento transoperatório e das complicações pós-operatórias. Dados analisados sobre a dor pós-operatória não diferiram entre os grupos. No estudo transversal, foi demonstrada curva de aprendizado em tempo de docking e undocking, e houve correlação forte entre tempo cirúrgico total e índice de massa corporal da paciente. Conclusão: Análise do tempo cirúrgico total e do tempo de recuperação pós-operatória são relevantes, pois podem ser ferramentas necessárias para redução dos custos da cirurgia robótica. Nossa experiência inicial demonstra curva de aprendizado em alguns aspectos. / Background: Hysterectomy is a frequent surgical procedure. In the last 25 years, many efforts have been made to reduce the number of abdominal hysterectomies, such as the technological advances, which allowed less invasive procedures. Aiming to increase the use of minimally invasive surgery, the robotic surgery was developed, which advantage of more precise and ergonomic movements than laparoscopy. Although it is a recent and expensive technology, robotic surgery is gaining more space in clinical practice. Data from Total Surgical Time and Time of Postoperative Recovery has been target of publications, once they can affect the costs. Objective: The purpose of this study is to compare the surgical outcomes of patients undergoing robotic hysterectomy for benign cases to patients undergoing another types of hysterectomy performed in our institution. Methods: It was performed a case-control study to compare pre-operative, operative (as Total Surgical Time and bleeding) and postoperative (Time of Postoperative Recovery, complications, and pain at the first 24 hours after the surgery) in 80 patients undergoing hysterectomy for treatment of various benign uterine conditions. We have included four groups of patients: robotic, vaginal, abdominal and laparoscopic. The robotic group was composed by the first twenty patients undergoing robotic hysterectomy at our hospital, and the control groups were retrospectively selected from the date of the last robotic surgery, constituting a non-probabilistic sample. We also performed a crosssectional study with the 20 patients of robotic group, to document our initial experience. Results: The robotic group was responsible for the longer Total Surgical Time (180.7 minutes), and for the shortest Time of Postoperative Recovery (23.7 hours) among the four groups. There were no difference between the groups in analysis of estimated blood loss and postoperative complications. Data related to postoperative pain showed no difference between the groups. At cross-sectional study, it was demonstrated learning curve of docking and undocking times, and was found a strong correlation between Total Surgical Time and body mass index. Conclusion: Analysis of Total Surgical Time and Time of Postoperative Recovery are relevant, because they can be necessary tools to reduce the costs of robotic surgery. Our initial experience demonstrated learning curve in some ways.

Made available in DSpace on 2015-05-14T13:16:36Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 901873 bytes, checksum: d2f876e8032e989e3e8d8d8aa8b622bb (MD5) Previous issue date: 2008-02-26 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Hysterectomy is a gynecological surgery of uterus remotion and it consists, nowadays, on one of the most frequent female surgeries at the occidental world, affecting the woman's condition physical, social and emotional that, front to the events unchained stressors, makes use of coping strategies with the intention of adapting to the new situations and life context. Through the theoric referential of Coping, this study had the objective of investigating the coping constructions and psychosocial repercussions of hysterectomy surgery. The sample was made of 10 women, aging 44 years old, belonging to less favored social class, with diagnosis time varying from 5 months to 2 years. For the data collecting was used the Scale of Mode to Coping Problems (EMEP) and semi-structures interviews. This was a longitudinal, descriptive study in pré and powder-surgical. For data analysis was realized descriptive statistics, besides bivarying tests between scores of the EMEP and variables relating to the socialdemographic and clinical characterization oh the patients. The Statistical Package for Social Sciences (SPSS) was used at the quantitative analysis of data and the interviews were submitted to the Content Analysis form emergent categories. The statistic results concerning the EMEP indicated distinct media for the four factors of the scale, whose results showed that the most used coping method was the search for religious practicing/fanciful thinking, followed by problem focusing coping. The strategies focused on the search of social support and on emotion were related with less frequency. From the results if the interview at the pre-surgical time, it was observed the arisement of a fear of loss of feminity, feelings of fear, anxiety and insecurity, negative thoughts about the hospitalization, negative self-perception and great misinformation about the surgery. On the interviews at the 6 months after the post-surgical time it was observed the arisement of guilting and reliefing feelings, positive evaluation of the hospitalization, female identity preserved and some secondary gains with the surgery, more attention from family, start of self-care and improved self-esteem. The results show that the hysterectomy surgery is a stressor event that disturbs the feminity, mobilize fear feeling about the hospitalization and also affect family issues, with repercussion on emotional aspects of women. Such results show psychosocial issues and difficulties that affect these women on the pre-surgical time, causing a re-meaning of their lives, including questions related to sexuality and that could be attenuated with a work focused on the pre-surgical care, indicating the importance of the prevalence of communication as humanized attention. / A histerectomia é uma cirurgia ginecológica de retirada do útero e constitui, atualmente, uma das cirurgias femininas mais freqüentes no mundo ocidental, afetando a condição física, social e emocional da mulher que, frente aos eventos estressores desencadeados, faz uso de estratégias de enfrentamento com o intuito de se adaptar às novas situações e contexto de vida. Através do referencial teórico do Enfrentamento (Coping), este estudo teve como objetivo investigar as construções de enfrentamento e repercussões psicossociais da cirurgia de histerectomia. A amostra foi composta por 10 mulheres, com faixa etária de 46 anos, classe pertencentes à classe social menos favorecida, com tempo de diagnóstico variando de 5 meses a 2 anos. Para a coleta de dados foi utilizada a Escala de Modo de Enfrentamento de Problemas (EMEP) e entrevistas semi-estruturadas. Tratou-se de um estudo descritivo, longitudinal em pré e pós-cirúrgico. Para análise dos dados, foram realizadas estatísticas descritivas, além de testes bivariados entre escores da EMEP e variáveis relativas à caracterização sociodemográfica e clínica das pacientes. O pacote estatístico SPSS (Statistical Package for Social Sciences), foi utilizado na análise quantitativa de dados e as entrevistas submetidas à análise de conteúdo a partir de categorias emergentes. Os resultados estatísticos concernentes à EMEP indicaram que a modalidade de enfrentamento mais usada foi busca de práticas religiosas/pensamento fantasioso, seguida de enfrentamento focalizado no problema. As estratégias focalizadas na no suporte social e na emoção foram relatadas em menor freqüência. A partir dos resultados das entrevistas em pré-operatório, observou-se o surgimento de um temor quanto a perda da feminilidade, sentimentos de medo, ansiedade e insegurança, pensamento negativo quanto a hospitalização, percepção de si negativa e falta de informação quanto a cirurgia. Nas entrevistas aos 6 meses do pós-operatório, observou-se o sentimento de culpa e de alívio, avaliação positiva frente à hospitalização, identidade feminina preservada e ganhos secundários com cirurgia, maior atenção de familiares, ativação do auto-cuidado e auto-estima. Os resultados evidenciam que a cirurgia de histerectomia é um evento estressor que abala a feminilidade, mobiliza sentimentos de temor quanto à hospitalização e afeta questões familiares, com repercussão no aspecto emocional das mulheres. Tais resultados evidenciam questões psicossociais e dificuldades que afetam estas mulheres no pré-cirúrgico, provocando uma ressignificação de suas vidas, inclusive ligadas à sexualidade e que poderiam ser resolvido com atendimentos pré-cirúrgicos, indicando a importância da comunicação como atenção humanizada.

Base Teórica: A histerectomia ainda é um procedimento cirúrgico frequente. Nos últimos 25 anos, muitos esforços foram feitos para reduzir o número de histerectomias abdominais, como o avanço tecnológico, que permitiu cirurgias menos invasivas. Visando ampliar o uso da cirurgia minimamente invasiva, foi desenvolvida a cirurgia robótica, com a vantagem de facilitar o uso da laparoscopia proporcionando movimentos mais ergonômicos e precisos. Apesar de ser tecnologia recente e do alto custo, vem ganhando cada vez mais espaço na prática clínica. Dados sobre tempo cirúrgico e tempo de internação pós-operatória tem sido alvo de várias publicações, uma vez que afetam os custos do procedimento. Objetivo: O presente projeto visa à documentação da experiência inicial do Hospital de Clínicas de Porto Alegre na realização da histerectomia robótica, e comparação dos seus dados com outras vias de histerectomia já realizados no nosso meio. Métodos: Foi realizado estudo caso-controle para comparação de dados pré-operatórios, operatórios (como tempo cirúrgico total e sangramento) e pós-operatórios (tempo de recuperação pós-operatória, complicações, dor nas primeiras 24 horas após a cirurgia), em 80 pacientes, submetidas à histerectomia para tratamento de patologias uterinas benignas. Nós incluímos quatro grupos de pacientes: robótico, vaginal, abdominal e laparoscópico. O grupo robótico foi composto pelas primeiras 20 cirurgias realizadas em nosso hospital, e os grupos controle foram selecionados retrospectivamente a partir da data da última cirurgia robótica, constituindo uma amostragem não probabilística. Também foi realizado estudo transversal utilizando apenas as pacientes submetidas à cirurgia robótica em nosso serviço, para fins de documentação de nossa experiência inicial. Resultados: O grupo robótico foi responsável pelo maior tempo cirúrgico total (180,7 minutos), e pelo menor tempo de recuperação pós-operatória (23,7 horas), entre os quatro grupos. Não houve diferença entre os grupos na análise do sangramento transoperatório e das complicações pós-operatórias. Dados analisados sobre a dor pós-operatória não diferiram entre os grupos. No estudo transversal, foi demonstrada curva de aprendizado em tempo de docking e undocking, e houve correlação forte entre tempo cirúrgico total e índice de massa corporal da paciente. Conclusão: Análise do tempo cirúrgico total e do tempo de recuperação pós-operatória são relevantes, pois podem ser ferramentas necessárias para redução dos custos da cirurgia robótica. Nossa experiência inicial demonstra curva de aprendizado em alguns aspectos. / Background: Hysterectomy is a frequent surgical procedure. In the last 25 years, many efforts have been made to reduce the number of abdominal hysterectomies, such as the technological advances, which allowed less invasive procedures. Aiming to increase the use of minimally invasive surgery, the robotic surgery was developed, which advantage of more precise and ergonomic movements than laparoscopy. Although it is a recent and expensive technology, robotic surgery is gaining more space in clinical practice. Data from Total Surgical Time and Time of Postoperative Recovery has been target of publications, once they can affect the costs. Objective: The purpose of this study is to compare the surgical outcomes of patients undergoing robotic hysterectomy for benign cases to patients undergoing another types of hysterectomy performed in our institution. Methods: It was performed a case-control study to compare pre-operative, operative (as Total Surgical Time and bleeding) and postoperative (Time of Postoperative Recovery, complications, and pain at the first 24 hours after the surgery) in 80 patients undergoing hysterectomy for treatment of various benign uterine conditions. We have included four groups of patients: robotic, vaginal, abdominal and laparoscopic. The robotic group was composed by the first twenty patients undergoing robotic hysterectomy at our hospital, and the control groups were retrospectively selected from the date of the last robotic surgery, constituting a non-probabilistic sample. We also performed a crosssectional study with the 20 patients of robotic group, to document our initial experience. Results: The robotic group was responsible for the longer Total Surgical Time (180.7 minutes), and for the shortest Time of Postoperative Recovery (23.7 hours) among the four groups. There were no difference between the groups in analysis of estimated blood loss and postoperative complications. Data related to postoperative pain showed no difference between the groups. At cross-sectional study, it was demonstrated learning curve of docking and undocking times, and was found a strong correlation between Total Surgical Time and body mass index. Conclusion: Analysis of Total Surgical Time and Time of Postoperative Recovery are relevant, because they can be necessary tools to reduce the costs of robotic surgery. Our initial experience demonstrated learning curve in some ways.