Background: Cervical carcinoma is frequently diagnosis of young, sexually active women. Radical hysterectomy, as a basic therapeutic modality of early stages of cervical cancer, has very positive oncogynaecologic results. On the opposite site it has it's significant morbidity including bladder and rectal dysfunctions, lymphedemas, and deterioration in patient's sexual life. Methods: Data of forty one patients undergoing radical hysterectomy for cervical cancer were used for analysis, as well as data of forty nine patients undergoing simple hysterectomy for benign gynacologic disease and fifty three healthy controls Participants filled out sexual function and quality of life questionnaires before surgery and three and six months postoperatively. Results: The most important finding was statistically significant worsening in objective arousal in cervical cancer patients (p = 0,041). Also decrease in libido and higher frequency of dyspareunia was registered. Patients undergoing simple hysterectomy showed decreasing trend in sexual dysfunctions, mainly in severe dyspareunia. Conclusions: Radical hysterectomy for cervical carcinoma has a risk of arousal disorder, libido decrease and worsening of dyspareunia. Psychosexual counselling decreases frequency of early postoperative sexual dysfunctions.

Bakgrund: Hysterektomi är ett operativt ingrepp där livmodern avlägsnas. Indikationen kan vara en tumör, framfall eller proliferation och det är världens näst mest förekommande gynekologiska operation. Syfte: Att beskriva kvinnors upplevelser efter en hysterektomi. Metod: Genom en systematisk litteraturstudie valdes åtta artiklar ut. Sökningen gjordes i databaserna Cinahl, PubMed och PsycINFO. Innehållsanalys användes som analysmetod. Artiklarna inkluderade kvinnor som genomgått en hysterektomi för minst en månad sedan och som längst för tre år sedan.  Resultat: Tre teman påträffades vilka var sexuella upplevelser, symtomatiska upplevelser samt kognitiva och emotionella upplevelser. Kvinnors sexuella upplevelser påverkades efter hysterektomin. De upplevde även olika symtom efter ingreppet som exempelvis ångest och smärta. Yngre kvinnor förknippade livmodern med kvinnlighet i högre utsträckning än äldre kvinnor.  Slutsats: Hysterektomin hade en inverkan på kvinnors sexualliv, kvinnlighet, fertilitet, smärta, välbefinnandet samt sociala funktioner.

Foram estudados, prospectivamente, por um período médio de 4,9 anos, os resultados do tratamento de 31 mulheres com incontinência urinária e afecção benigna do útero que foram submetidas à cirurgia de sling fascial associada à histerectomia vaginal, atendidas na Clínica Ginecológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, no período de fevereiro de 2000 a outubro de 2006. O objetivo foi avaliar os resultados do tratamento comparando-se os diagnósticos urodinâmicos pré- e pós-tratamento. As mulheres foram submetidas à cirurgia de histerectomia vaginal, para tratamento da afecção benigna do útero e sling fascial para correção da incontinência urinária. Realizou-se estudo urodinâmico no pré- e pós-tratamento, para avaliação da taxa de cura da incontinência urinária e do comportamento vesical nas fases de enchimento e esvaziamento, os quais foram avaliados por meio dos parâmetros urodinâmicos de fluxometria e cistometria. Na fluxometria avaliou-se o fluxo urinário máximo, fluxo urinário médio e volume de urina residual e na cistometria, determinou-se a capacidade vesical no 1° desejo miccional, capacidade vesical máxima e a pressão vesical necessária para ocorrer ou não a perda de urina. Os resultados mostraram, em relação á fluxometria diminuição significante do fluxo máximo, tendência à diminuição do fluxo médio e redução significante do volume de urina residual. Em relação à cistometria, houve aumento estatisticamente significante da capacidade vesical no 1° desejo miccional, da capacidade vesical máxima e valor da pressão vesical necessária para avaliar a presença ou não de perda urinária. Com relação ao diagnóstico urodinâmico, foi demonstrada a cura da incontinência urinária em 96,8% dos casos. Avaliando-se os parâmetros de cura objetiva da incontinência urinária, em seguimento de 4,9 anos, podemos inferir que o tratamento da incontinência urinária de esforço pode ser realizado simultaneamente, quando houver também, a indicação de histerectomia vaginal / We studied, prospectively, for a 4.9 years period the results of the treatment of 31 women with urinary incontinence and benign uterine disease that were submitted the surgery fascial sling associated to vaginal hysterectomy, the patients were all treated in the Gynecology Department of the Clinic Hospital of the University of Sao Paulo, in the period between February 2000 to October 2006. The objective was evaluate the results of the treatment comparing the urodinamic diagnosis pre and post treatment. All women were submitted to vaginal hysterectomy for treatment of benign uterine disorders and to facial sling to treat the urinary incontinence. An urodinamic study was performed pre and post treatment to define the rate of cure of the urinary incontinence and vesical behaviour in the filling and emptying fases, witch will evaluate through urodinamic parameters of flowmetry and cystometry, In the flowmetry were evaluated maximum urinary flow, medium urinary flow and residual urinary volume; and in the cystometry were determinated the bowel capacity in the first urinary desire, maximum bowel capacity in the first urinary desire, maximum bowel capacity and the needed bowel pressure to occur or not the urinary loss. The results showed in relation to the flowmetry significant reduction of the maximum flow, medium flow and urinary residual volume. In relation to cystometry we demonstrated an increase statistically significant in the vesical capacity in the first miccional desire, in the maximum bowel capacity and the value of the bowel pressure to evaluate the presence or not of urinary lost. In relation to the urodimanic diagnosis we could demonstrate the cure of urinary incontinence in 96.8% of cases. Evaluating the parameters of objective cure of urinary incontinence, in a follow up of 4.9 years, we can affirm that the treatment of urinary incontinence should be always be together with the vaginal hysterectomy when it is needed

Foram estudados, prospectivamente, por um período médio de 4,9 anos, os resultados do tratamento de 31 mulheres com incontinência urinária e afecção benigna do útero que foram submetidas à cirurgia de sling fascial associada à histerectomia vaginal, atendidas na Clínica Ginecológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, no período de fevereiro de 2000 a outubro de 2006. O objetivo foi avaliar os resultados do tratamento comparando-se os diagnósticos urodinâmicos pré- e pós-tratamento. As mulheres foram submetidas à cirurgia de histerectomia vaginal, para tratamento da afecção benigna do útero e sling fascial para correção da incontinência urinária. Realizou-se estudo urodinâmico no pré- e pós-tratamento, para avaliação da taxa de cura da incontinência urinária e do comportamento vesical nas fases de enchimento e esvaziamento, os quais foram avaliados por meio dos parâmetros urodinâmicos de fluxometria e cistometria. Na fluxometria avaliou-se o fluxo urinário máximo, fluxo urinário médio e volume de urina residual e na cistometria, determinou-se a capacidade vesical no 1° desejo miccional, capacidade vesical máxima e a pressão vesical necessária para ocorrer ou não a perda de urina. Os resultados mostraram, em relação á fluxometria diminuição significante do fluxo máximo, tendência à diminuição do fluxo médio e redução significante do volume de urina residual. Em relação à cistometria, houve aumento estatisticamente significante da capacidade vesical no 1° desejo miccional, da capacidade vesical máxima e valor da pressão vesical necessária para avaliar a presença ou não de perda urinária. Com relação ao diagnóstico urodinâmico, foi demonstrada a cura da incontinência urinária em 96,8% dos casos. Avaliando-se os parâmetros de cura objetiva da incontinência urinária, em seguimento de 4,9 anos, podemos inferir que o tratamento da incontinência urinária de esforço pode ser realizado simultaneamente, quando houver também, a indicação de histerectomia vaginal / We studied, prospectively, for a 4.9 years period the results of the treatment of 31 women with urinary incontinence and benign uterine disease that were submitted the surgery fascial sling associated to vaginal hysterectomy, the patients were all treated in the Gynecology Department of the Clinic Hospital of the University of Sao Paulo, in the period between February 2000 to October 2006. The objective was evaluate the results of the treatment comparing the urodinamic diagnosis pre and post treatment. All women were submitted to vaginal hysterectomy for treatment of benign uterine disorders and to facial sling to treat the urinary incontinence. An urodinamic study was performed pre and post treatment to define the rate of cure of the urinary incontinence and vesical behaviour in the filling and emptying fases, witch will evaluate through urodinamic parameters of flowmetry and cystometry, In the flowmetry were evaluated maximum urinary flow, medium urinary flow and residual urinary volume; and in the cystometry were determinated the bowel capacity in the first urinary desire, maximum bowel capacity in the first urinary desire, maximum bowel capacity and the needed bowel pressure to occur or not the urinary loss. The results showed in relation to the flowmetry significant reduction of the maximum flow, medium flow and urinary residual volume. In relation to cystometry we demonstrated an increase statistically significant in the vesical capacity in the first miccional desire, in the maximum bowel capacity and the value of the bowel pressure to evaluate the presence or not of urinary lost. In relation to the urodimanic diagnosis we could demonstrate the cure of urinary incontinence in 96.8% of cases. Evaluating the parameters of objective cure of urinary incontinence, in a follow up of 4.9 years, we can affirm that the treatment of urinary incontinence should be always be together with the vaginal hysterectomy when it is needed

Submitted by Sandra Pereira (srpereira@ufrrj.br) on 2017-05-30T11:58:08Z No. of bitstreams: 1 2008 - Fabiane Azeredo Atallah.pdf: 2871575 bytes, checksum: e1634a7beeeaf1a05ff40e3641148f81 (MD5) / Made available in DSpace on 2017-05-30T11:58:08Z (GMT). No. of bitstreams: 1 2008 - Fabiane Azeredo Atallah.pdf: 2871575 bytes, checksum: e1634a7beeeaf1a05ff40e3641148f81 (MD5) Previous issue date: 2008-01-16 / This study aimed to evaluate the postoperative complications in 20 bitches previously submitted to ovariohysterectomy, correct these complications by surgery, and correlate the findings observed in preoperative diagnostic exams with those found during exploratory laparotomy. The animals were evaluated from the first day to the third month after consultation. Questionnaires were filled out by the owners. Bitches were submitted to clinical and laboratory exams, and ultrasound of the pelvic and abdominal regions. The most important complications observed were fistulas, ovarian and uterine stump granuloma, intestinal adherence, presence of ovarian remnants, hydronephrosis, and hydroureter. Two bitches died, and normal physiological functions were restored in all the other bitches. This study identified that mistakes that lead to these problems occur frequently during nonprofit reproductive control activities and in animal protection organizations as well as in private clinics, and are made not only by veterinary medicine students prematurely acting as veterinarians at the owners? homes, but also by veterinary medicine professionals. This study showed that mistakes made during ovariohysterectomy may cause several alterations in organs of the abdominal cavity that may lead to death. / Esse estudo teve o objetivo de avaliar as complica??es p?s-operat?rias em 20 cadelas anteriormente submetidas a ov?rio-histerectomia e corrigir cirurgicamente essas complica??es, bem como correlacionar as altera??es observadas nos exames diagn?sticos pr?-operat?rios com as observadas durante a laparotomia explorat?ria. Os animais foram avaliados desde o primeiro dia de atendimento at? o terceiro m?s. Foram aplicados question?rios aos propriet?rios e as cadelas foram submetidas a exames cl?nicos, laboratoriais e ultra-sonografia das regi?es p?lvica e abdominal. As complica??es mais importantes na p?s ov?rio-histerectomia observadas durante a laparotomia explorat?ria foram f?stulas, granuloma de coto ovariano e uterino, ader?ncias intestinais, ov?rio remanescente, hidronefrose e hidroureter. Duas cadelas vieram a ?bito e, em todas as outras se conseguiu restabelecer as fun??es fisiol?gicas. Essa pesquisa identificou que esses erros est?o sendo corriqueiramente cometidos, n?o s? em projetos de castra??o como em entidades protetoras de animais, mas tamb?m em cl?nicas particulares, por acad?micos de Medicina Veterin?ria que atuam precocemente em domic?lios e por profissionais da Medicina Veterin?ria. Esse estudo indicou que os diversos equ?vocos cometidos durante a realiza??o de uma ov?rio-histerectomia podem provocar severas altera??es em diversos sistemas da cavidade abdominal animal que podem at? culminar com o ?bito.

Die in der Bundesrepublik Deutschland übliche Therapie für das Zervixkarzinom der FIGO-Stadien IB-IIB ist die Wertheim-Meigs-Operation. Bei bestimmten Risikofaktoren wird häufig eine adjuvante Bestrahlung, gegebenenfalls eine postoperative Radioche-motherapie angeschlossen. Die Folge können zahlreiche Einschränkungen der gesund-heitsbezogenen Lebensqualität sein. Zur Verbesserung der postoperativen gesund-heitsbezogenen Lebensqualität wurde eine neue nervenschonende Operationsmetho-de, die totale mesometriale Resektion (TMMR), von Höckel und Kollegen der Universi-tätsfrauenklinik Leipzig entwickelt. Die vorliegende retrospektive Querschnittsstudie untersucht erstmals die Auswirkungen der TMMR im Vergleich zur Wertheim-Meigs-Operation in Bezug auf die postoperative gesundheitsbezogene Lebensqualität. Dazu wurden 110 Zervixkarzinompatientinnen mit der Hilfe der Fragebögen EORTC-QLQ-C30 und EORTC-QLQ-CX24 befragt. Die Ergebnisse dieser Pilotstudie deuten daraufhin, dass Patientinnen nach einer TMMR-Operation im Vergleich zu Frauen nach einer Wert-heim-Meigs-Operation in einigen Teilaspekten eine bessere Lebensqualität haben. So fanden sich bezüglich der postoperativen körperlichen Funktionsfähigkeit und der Rol-lenfunktion sowie der postoperative Ausprägung der Symptome Fatigue, Schmerzen, Diarrhö, Appetitlosigkeit und Dyspnoe in der vorliegenden Untersuchung signifikant bessere Werte in der Gruppe der mittels TMMR operierten Frauen im Vergleich zur Wertheim-Meigs-Gruppe. Dies kann zum Anlass genommen werden große multizentri-sche prospektive Studien durchzuführen.

Hysterektomi är idag en av de vanligaste operationerna som utförs på kvinnor, näst efter sectio både i Sverige som utomlands. Detta gör att kvinnors psykiska hälsa post hysterektomi är något som sjukvården bör ha kunskap om. Att genomföra en hysterektomi innebär att avlägsna uterus och de vanligaste anledningarna till att en hysterektomi genomförs är menorragi och kronisk smärta i pelvis.I huvudsak genomgår kvinnor en hysterektomi för att förbättra sin livskvalitet, det finns även andra anledningar till att genomföra en hysterektomi som cancer i uterus. Syftet med litteraturstudien var att undersöka om kvinnors upplevda psykiska hälsa förändras post hysterektomi. Studien är genomförd som en litteraturstudie där 13 vetenskapliga artiklar granskades.Resultatet visade att den upplevda livskvaliteten och hälsan ökade postoperativt. Faktorer som depression och ångest minskade post hysterektomi samtidigt som den upplevda sexualiteten hos kvinnorna ökade. Kvinnorna uttryckte en önskan om mer information och stöd; före, under och efter sin hysterektomi. Genom att få kunskap om hysterektomiserade kvinnors psykiska hälsa post hysterektomi kan sjuksköterskan få bättre förståelse för dessa patienter och utifrån det utöva en god omvårdnad. / Hysterectomy is today one of the most common surgery’s in Sweden as well as abroad. Health care providers need to have knowledge about women’s mental health post hysterectomy. Hysterectomy means to remove the uterus and the most common reasons to undergo this surgery are because of menorrhagia and chronic pain in the pelvis. The motivation to undergo a hysterectomy is to improve women’s quality of life. But there are also other reasons for the surgery as cervix cancer. The aim of this study was to examine if women’s mental health changes post hysterectomy. The study was conducted as a literature review where 13 research articles were collected and examined.The results showed that the perceived quality of life and health increased postoperatively. Factors such as depression and anxiety decreased post hysterectomy while the perceived sexuality of women increased. The women expressed a desire for more information and support in the form of information before, during and after her hysterectomy.By gaining knowledge of women’s mental health post hysterectomy the nurse can obtain better understanding for these patients and therefore provide better health care.

Minimally invasive or laparoscopic surgery has completely changed the focus of surgery becoming an alternative to various types of open surgery. Minimally invasive surgery avoids invasive open surgery as the operation is performed through one or more small incisions in the abdomen and using a small camera called laparoscope. Through these incisions, surgeons insert specialized surgical instruments to perform the operation resulting in less postoperative pain, shorter hospital stay, and faster recovery. However, the main problems during minimally-invasive surgery are the limited space for operating instruments and the reduced visibility and range of motion inside the patient’s body. During minimally-invasive surgery, one of the most difficult and time consuming surgical procedures is suturing and knot tying. This procedure significantly increases the operation time as it requires advanced techniques and extensive experience by surgeons.The main goal of this research is to investigate, design, and develop a new suturing instrument to facilitate suturing procedures during minimally invasive surgery.Qualitative research data was collected through interviews with a surgeon and six indepth observations of minimally invasive surgeries at Tampa General Hospital. Different design concepts and mechanisms were created using SolidWorks CAD software, and tested using SimulationXpress in order to identify dimensions, materials and expected performance of the design and its components. The prototypes of the device were made using a Dimension SST 768 FDM machine and tested by the surgeon to ensure that the final design meets the specified needs and criteria. This new device will eliminate the use of many different devices during the operation and allow the use of any type of suture. The proposed suturing device aims to benefit both patients and surgeons. For surgeons, the new device aims to decrease the number of steps for laparoscopic suturing through an intuitive and ergonomic design. For patients, the proposed device will reduce time during surgery and under general anesthesia leading towards improved health care.

Diss. (sammanfattning) Linköping : Univ., 2002. / Härtill 5 uppsatser.

Submitted by Geandra Rodrigues (geandrar@gmail.com) on 2018-08-27T18:12:50Z No. of bitstreams: 1 marcelaoliveirasouzaribeiro.pdf: 1466691 bytes, checksum: bdc69a78d287586a59e006a2456d79cb (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2018-08-28T12:20:07Z (GMT) No. of bitstreams: 1 marcelaoliveirasouzaribeiro.pdf: 1466691 bytes, checksum: bdc69a78d287586a59e006a2456d79cb (MD5) / Made available in DSpace on 2018-08-28T12:20:08Z (GMT). No. of bitstreams: 1 marcelaoliveirasouzaribeiro.pdf: 1466691 bytes, checksum: bdc69a78d287586a59e006a2456d79cb (MD5) Previous issue date: 2018-07-18 / A histerectomia representa o procedimento cirúrgico ginecológico não obstétrico mais realizado nos países desenvolvidos. As alterações corporais resultam em consequências psicoemocionais, logo a retirada do útero causa mudanças na autoestima, autoimagem e em conceitos que envolvem o ser mulher. A fase pré-operatória é momento fundamental do auxílio à paciente, visando compreender o preparo do processo cirúrgico, o ato cirúrgico propriamente dito e o momento pós-operatório, com suas restrições e cuidados necessários ao reestabelecimento de sua saúde. Objetivou-se compreender os significados e desvelar os sentidos do ser mulher que vivencia o pré-operatório de histerectomia. Estudo de natureza qualitativa, de abordagem fenomenológica, pautada no referencial teórico, filosófico e metodológico de Martin Heidegger. As participantes do estudo foram quatorze mulheres em pré-operatório de histerectomia. A análise foi possível após a transcrição na íntegra, leitura e sucessivas releituras das entrevistas a fim de captar as estruturas essenciais, possibilitando a identificação das Unidades de Significação: aceitar fazer a cirurgia; sofrer com a menstruação desregulada, sangramentos, dores, cólicas e passar por exames; vivenciar ansiedade, preocupação, nervosismo, insegurança, tristeza e medo; sentir-se aliviada e acreditar que a cirurgia trará melhora; apoiar-se em Deus e sentir-se bem cuidada no hospital. Foi construída a Análise Compreensiva e, após emergir o fio condutor da hermenêutica, a Análise Interpretativa. Na facticidade, o ser-mulher-em-pré-operatório-de-histerectomia, foi acometido pela patologia uterina que levou à necessidade da cirurgia. Na cotidianidade as mulheres vivenciaram períodos de sangramentos intensos e dores que impactaram em seu ser-no-mundo, limitando-a no mundo público e circundante, desvelando-se na inautenticidade e na impessoalidade. Sua compreensão do momento cirúrgico desvelou-se por meio do falatório, curiosidade e ambiguidade. Decaiu ao transferir a segurança da cirurgia para a equipe de saúde e sua possibilidade de cura para Deus. No mundo com-partilhado, sendo-no-mundo-com-a-família, vivenciou o pavor, horror e terror. Desvelar os sentidos do ser-mulher-que-vivencia-o-pré-operatório-de-histerectomia possibilitou enfatizar o papel fundamental da equipe de saúde, que recorre à visita pré-operatória como um instrumento importante para a relação enfermeiro-paciente, momento de orientações e escuta, que propicia o entendimento de suas necessidades e auxilia no planejamento e elaboração de um plano de ação voltado às suas especificidades. É fundamental que os serviços acolham o ser-mulher e não apenas o ente. Que os profissionais pausem a mecanicidade em que executam seus trabalhos e compreendam o ser-mulher em sua dimensão existencial. / Hysterectomy represents the most frequently non-obstetrical gynecological surgical procedure in developed countries. The body changes result in psychoemotional consequences, so the removal of the uterus causes changes in self-esteem, self-image and concepts that involve being woman. The preoperative phase is a fundamental moment of patient assistance, aiming to understand the preparation of the surgical process, the surgical act itself and the postoperative moment with its restrictions and necessary care to the reestablishment of her health. The objective was to understand the meanings and unveil the senses of being a woman that experience the hysterectomy’s preoperative. Research of a qualitative nature with a phenomenological approach, based on the theoretical, philosophical and methodological reference of Martin Heidegger. The participants of the research were fourteen women in hysterectomy’s preoperative. The analysis was possible after the transcript in full, reading and successive re-reading of the interviews in order to identify the essential structures, making possible the identification of Units of Significance: to accept to do the surgery; suffer with deregulated menstruation, bleeding, pain, cramps and to do exams; to experience anxiety, worries, nervousness, insecurity, sadness and fear; to feel relieved and believe that the surgery will bring improvement; support herself in God and feel well care in the hospital. The Comprehensive Analysis was constructed and, after emerge the guiding thread of hermeneutics, the Interpretive Analysis. In the facticity, the being-woman-in-preoperative-of-hysterectomy was affected by the uterine pathology that caused to the necessity of surgery. Everyday women experienced periods of intense bleeding and pain that impacted their being-in-world, limiting in the public world and surrounding, unveiling in inauthenticity and impersonality. Her understanding of the surgical moment was unveiled through talk, curiosity and ambiguity. She decayed while transferring the safety of surgery to the the health team and her possibility of cure to God. In the shared world, being-in-the-world-with-the-family, she experienced the dread, horror and terror. Unveil the senses of being-woman-in- hysterectomy’s-preoperative made it possible to emphasize the fundamental role of health team, which uses the preoperative visit as an important instrument for the nurse-patient relationship, moment of orientation and listening, which propitiates the understanding of their needs and assists in the planning and elaboration of an action plan focused on their specificities. It’s fundamental that services welcome the being-woman and not just the body. That the professionals pause the mechanicity in which they perform their works and understand the being-woman in her existential dimension.