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Related Experiment Video

Updated: May 28, 2026

Laparoscopic Extracorporeal Knot-Tying for Uterine Vessel Occlusion during Hysterectomy with Cervical Cerclage in Large Uteri
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Minimally Invasive Versus Open Total Hysterectomy: From Practice Variability to a Decision Algorithm.

Nicoleta Alina Mareș1,2, Alexandru Iordache1,3, Niculae Iordache1,4,5

  • 1General Medicine Faculty, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania.

Life (Basel, Switzerland)
|May 27, 2026
PubMed
Summary
This summary is machine-generated.

A new algorithm standardizes total hysterectomy approaches based on patient risk. This decision tool prioritizes laparoscopic surgery for low-risk patients, improving gynecological surgical efficiency.

Keywords:
benign gynecological pathologyclinical advancementshysterectomylaparoscopyminimally invasive surgery

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Area of Science:

  • Gynecological Surgery
  • Surgical Decision-Making
  • Patient Risk Stratification

Background:

  • Hysterectomy is a common procedure for benign conditions, but approach selection is often biased by technology.
  • Standardized clinical criteria are lacking for choosing between laparoscopic, vaginal, or abdominal hysterectomy.
  • This study addresses the need for an objective decision-making algorithm.

Purpose of the Study:

  • To propose a standardized algorithm for selecting the surgical approach in total hysterectomy.
  • To base decisions on objective clinical criteria and quantified risk factors.
  • To improve the efficiency and predictability of gynecological surgery.

Main Methods:

  • Prospective, observational, analytical study of 332 patients undergoing total hysterectomy (laparoscopic, vaginal, abdominal).
  • Development of a decision algorithm using predictive modeling and risk factor quantification.
  • Data collected from two major centers in Bucharest between November 2021 and June 2025.

Main Results:

  • Surgical approach choice significantly impacts hematological stability.
  • Comorbidities and anesthetic risk (ASA III-IV) influenced the approach selection (p < 0.001).
  • Laparoscopic hysterectomy was favored in patients without comorbidities (48.85%), while vaginal or abdominal routes were preferred for higher anesthetic risk.

Conclusions:

  • The proposed algorithm can standardize therapeutic decisions in total hysterectomy.
  • This tool offers a modern, predictable framework for gynecological surgery.
  • Standardization improves intervention efficiency and patient outcomes.