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1.
Jeong Namkung So Yeun Kang Youn Jee Chung Hyun Hee Cho Jang Heub Kim Mee-Ran Kim 《Journal of minimally invasive gynecology》2019,26(4):643-647
Study Objective
To evaluate the safety and effectiveness of hysteroscopic myomectomy after uterine artery embolization (UAE) for the treatment of large-sized submucosal myomas with deep intramural invasion that are difficult to treat with 1-step hysteroscopy.Design
A retrospective cohort study (Canadian Task Force classification II-2).Setting
An academic university hospital.Patients
Eight premenopausal patients with symptomatic submucosal myomas with intramural invasion.Interventions
All of the patients after bilateral UAE underwent subsequent hysteroscopic operation 3 to 15 months after UAE.Measurements and Main Results
A total of 8 patients who had a large-sized submucosal myoma with deep myometrial invasion were included. The average volume of the submucosal myomas was 87.7±39.9 cm3 as confirmed by magnetic resonance imaging, and the average patient age was 37.6 years. The mean volume reduction of the submucosal myomas was 83.3±16.4% after UAE, and no immediate complications were observed. One-step hysteroscopic myomectomy after UAE was successfully performed in all patients. Leiomyomas with hyaline degeneration were pathologically confirmed. All women showed improved symptoms, and there was no evidence of recurrence 1 year later. One patient conceived naturally and delivered a full-term baby.Conclusion
In premenopausal women with large-sized symptomatic submucosal myomas with deep myometrial invasion, hysteroscopic myomectomy after UAE is very effective and safe. 相似文献2.
Yu Yang Yanli Hao Jing Zhang Zhiyu Han Jie Yu Fangyi Liu Xia Ma Ruifang Xu 《Journal of minimally invasive gynecology》2019,26(3):544-550
Study Objective
To prospectively evaluate the clinical effectiveness and safety of ultrasound-guided percutaneous microwave ablation for symptomatic subserosal uterine myomas.Design
Prospective observational study (Canadian Task Force classification II-1).Setting
A teaching hospital (Department of Interventional Ultrasound, General Hospital of Chinese PLA, Beijing, China).Patients
Sixty-nine patients with symptomatic subserosal uterine myomas treated with ultrasound-guided percutaneous microwave ablation.Interventions
All 69 patients underwent ultrasound-guided percutaneous microwave ablation. The number of patients lost to follow-up at was 21 at 3 months, 34 at 6 months, and 35 at 12 months.Measurements and Main Results
The efficacy of treatment was evaluated based the mean myoma volume shrinkage rate and changes in Uterine Fibroid Symptom and Quality of Life Questionnaire scores at 3, 6, and 12 months after therapy. Treatment safety was evaluated based on the Society of Interventional Radiology practice guidelines. The mean patient age was 40.3 ± 4.9 years (range, 26–49 years). The mean myoma volume was 221.74 ± 153.18 cm3 before ablation, decreasing to 87.24 ± 45.93 cm3 at 3 months after ablation (p < .001), 46.68 ± 24.7 cm3 at 6 months after ablation (p < .001), and 38.05 ± 24.93 cm3 at 12 months after ablation (p <.001), respectively. Between pretreatment and 3-month follow-up, the mean symptom severity score decreased from 34.53 ± 3.83 to 12.74 ± 3.07 (p < .001), and the mean health-related quality of life score increased from 45.25 ± 10.97 to 78.48 ± 11.39 (p < .001). Both scores remained stable at the 6- and 12-month follow-up time points. No permanent injury or fatal complications were seen in this series.Conclusion
Ultrasound-guided percutaneous microwave ablation of subserosal uterine myomas is a promising treatment method. Further studies with larger sample sizes and a control group are needed. 相似文献3.
Shailesh Puntambekar Seema Puntambekar Milind Telang Pankaj Kulkarni Shardul Date Mangesh Panse Ravindra Sathe Nikhil Agarkhedkar Neeta Warty Sandesh Kade Manoj Manchekar Mihir Chitale Hirav Parekh Kajal Parikh Mehul Mehta Bhushan Kinholkar Joy Shankar Jana Avinash Pare Raviraj Tiruke 《Journal of minimally invasive gynecology》2019,26(4):628-635
Study Objective
To evaluate 2 cases of uterine transplant surgery that used utero-ovarian veins as outflow channels, internal iliac arteries for perfusion, and the organ harvest surgery performed laparoscopically.Design
Case study (Canadian Task Force Classification III).Setting
An urban, private, tertiary care hospital.Patients
Two patients, ages 30 and 24years, diagnosed with absolute uterine factor infertility secondary to Mayer-Rokitansky-Küster-Hauser syndrome underwent related living donor uterine transplants; donors were their mothers with normal menses.Interventions
Retrieval of organs through minilaparotomy and laparoscopic harvest of donor internal iliac arteries and ovarian veins.Measurements and Main Results
Anastomosis was completed with bilateral donor internal iliac arteries to recipient internal iliac arteries in an end-to-end manner and with bilateral donor ovarian veins to recipient external iliac veins in an end-to-side manner. The lengths of utero-ovarian veins of both donors were 11 and 11cm on both sides; the lengths of the internal iliac arteries of both donors were 10 and 7.5cm on the left side and 10 and 6cm on the right side. The operative times for harvest surgery, bench surgery and transplant surgery were 2:40 and 3:20 hours, 34:32 and 33:30 min and 4:00 and 4:30 hours respectively for recipients 1 and 2. Daily postoperative uterine Doppler was completed through day 8 and then every other day and showed good intrauterine blood flow (i.e., low resistance arcuate vessel flow; resistance index < .5). Cervical biopsies on postoperative days 7 and 14 showed no evidence of rejection in either recipient. Both recipients started menstruating within 2 months of surgery.Conclusion
By using ovarian veins as outflow channels, the challenges involved in dissection along the internal iliac vein are avoided, and harvesting the donor internal iliac artery reduces the tension on vascular anastomosis. The selection of vessels to be harvested could make the technique reproducible, although larger studies are warranted to confirm results. 相似文献4.
Daisuke Shigemi Shotaro Aso Hiroki Matsui Kiyohide Fushimi Hideo Yasunaga 《Journal of minimally invasive gynecology》2019,26(3):501-506
Study Objective
To compare fetal, maternal, and operative outcomes of laparoscopic surgery versus laparotomy for major benign diseases including appendicitis, cholecystitis, adnexal masses, and uterine myoma during pregnancy.Design
Retrospective cohort study (Canadian Task Force classification II-2).Setting
The Diagnosis Procedure Combination database, a national inpatient database for acute care inpatients in Japan.Patients
Eligible patients (n?=?6018) underwent abdominal surgery (4047 laparotomy and 1971 laparoscopy patients) from July 2010 through March 2016.Interventions
The 2 groups were compared using propensity score matching analysis.Measurements and Main Results
The primary outcome was fetal adverse events, including abortion or stillbirth within 7 days after surgery and premature delivery during hospitalization. Secondary outcomes were operative time, blood transfusion, and length of hospital stay after surgery. Propensity score matching created 740 pairs. Significant difference was observed in the primary outcome between propensity score–matched patients in the laparotomy versus laparoscopy group (1.8% vs .41%, respectively; risk difference, ?1.4%; 95% confidence interval, ?2.4 to ?.30; p?=?.01). Compared with the laparotomy group, the laparoscopy group had a significantly lower incidence of blood transfusion (2.3% vs .41%, pConclusion
Our current study using propensity score matching suggests the advantages of laparoscopic surgery for benign diseases compared with laparotomy because laparoscopic surgery had advantages in short-term fetal adverse events, incidence of blood transfusion, operative time, and hospital stay. 相似文献5.
Athanasios Protopapas George Giannoulis Ioannis Chatzipapas Stavros Athanasiou Themistoklis Grigoriadis Nikolaos Kathopoulis Dimitrios-Efthymios Vlachos Dimitrios Zaharakis Dimitrios Loutradis 《Journal of minimally invasive gynecology》2019,26(3):441-449
Study Objective
Τo investigate whether the use of vasopressin played an important role in the safe expansion of the indications of laparoscopic myomectomy in our practice.Design
A retrospective comparison of prospectively collected data (Canadian Task Force classification II2).Setting
A gynecologic endoscopy unit in a tertiary university hospital.Patients
One hundred fifty patients undergoing laparoscopic myomectomy; 50 were treated without the use of any vasoconstrictive agent (group 1), and 100 were treated with intraoperative intramyometrial injection of dilute vasopressin (20 IU/100 mL normal saline) (group 2).Interventions
Laparoscopic myomectomy.Measurements and Main Results
We compared the 2 groups in terms of size, number, and type of myomas; estimated blood loss (EBL); procedure length; transfusion rates; laparoconversion rates; and rates of complications. Two cases in group 1 (4%) were laparoconverted versus none (0%) in group 2. Overall, the mean EBL was 321.8 ± 246.0 mL in group 1 compared with 147.8 ± 171.8 mL in group 2, respectively (p <.001). Additionally, EBL was significantly lower in the vasopressin group in all of the study's subgroups of patients stratified according to the size and number of myomas. Procedure length did not differ significantly between the 2 groups (130.8 ± 49.5 vs 115.6 ± 49.4 minutes, p?=?.078). The risk factors for prolongation of the procedure included size and number of myomas independently of vasopressin. The rates of hypercapnea and subcutaneous emphysema were higher in group 1. The risk factors for hypercapnea and subcutaneous emphysema included the size and intramural position of the largest myoma. Vasopressin was not associated with serious cardiovascular adverse events.Conclusions
Vasopressin is effective in reducing blood loss during laparoscopic myomectomy. Although experienced surgeons may achieve comparable operation times without vasopressin, even in the most challenging cases, blood loss may still be considerable. The occurrence of hypercapnea is higher in untreated cases and may contribute to laparoconversion. 相似文献6.
7.
Chyi-Long Lee Jiah-Min Lee Chih-Hui Lin Yi-Pin Chen Chen-Yin Huang Pei-Shan Lee Kai-Yun Wu Chih-Feng Yen 《Journal of minimally invasive gynecology》2019,26(4):657-666
Study Objective
To study the outcome of a novel method of laparoscopic neovaginal reconstruction using rudimentary uterine horn serosa and the pelvic peritoneum as a graft.Design
Canadian Task Force classification II-1.Setting
A university hospital.Patients
A retrospective study of 14 patients from 2000 to 2014 of patients with vaginal agenesis who underwent laparoscopic neovagina reconstruction using rudimentary uterine horn serosa and the pelvic peritoneum as a graft.Intervention
Patients with vaginal agenesis associated with müllerian agenesis who requested surgery. Tertiary referral center and laparoscopic unit. The creation of a neovagina using rudimentary uterine horn serosa and the pelvic peritoneum as a graft via a combined laparoscopic and vaginal route.Measurements and Main Results
Data were collected retrospectively including postoperative vaginal length and width, complications, stenosis or reoperations, dyspareunia, and sexual satisfaction. There were no major complications from the surgery with no rectal perforation or bladder or ureteric injury. The postoperative mean (±SD) vaginal length was 6.0±0.7 cm and a width of 2 fingerbreadths. The mean operation time was 142.7±45.9 min. Median blood loss was 100 ml (range: 10 to 300 mL). The mean duration of the hospital stay was 6.6±1.6 days. The follow-up period ranged from 3 to 84 months with a median follow-up of 11 months.Conclusion
Lee's method of neovaginoplasty using rudimentary uterine horn serosa and the pelvic peritoneum as a graft is a good method for neovagina creation with minimal morbidity, fast recovery, and minimal complications. This method results in good anatomic and functional outcome and can be a method that is widely used. 相似文献8.
Kemal Ozerkan Adnan Orhan Isil Kasapoglu Bilge Cetinkaya Demir Gurkan Uncu 《Journal of minimally invasive gynecology》2019,26(3):398
Study Objective
Minimally invasive surgical procedures have shown significant improvement over the last 20 years. Today, nearly half of the surgeries, including oncology, are performed with minimally invasive methods. In obstetrics and gynecology surgery practice, laparoscopy can now be used in almost all operations. In this video, we performed a laparoscopic evacuation of a 12-week missed abortion case like a cesarean section at the time of bilateral salpingectomy.Design
A case report (Canadian Task Force classification III).Setting
A tertiary referral center in Bursa, Turkey.Patient
A 38-year-old patient.Intervention
Laparoscopic evacuation of the pregnancy product (like a cesarean section) and bilateral salpingectomy. The local institutional review board approved the video.Measurements and Main Results
Gravida: 4, parity: 3. The patient was in the 12th week of her gestation when we diagnosed a missed abortion. In situs of the operation, there was a 12-week pregnancy filling the pouch of Douglas. We clipped the uterine arteries bilaterally and retracted the bladder flap to create a safe surgical incision in the low anterior segment of the uterus. We used the monopolar cautery to incise the uterus from superior to inferior similar to the low vertical classic uterine incision in the cesarean section. The abortus material was removed with the laparoscopic endobag, and bilateral salpingectomy was performed.Conclusion
Developments in minimally invasive surgery are progressing day by day. As advances in laparoscopic and robotic surgery progress, complicated surgical procedures would be done efficiently. 相似文献9.
Stephanie Seidler Stas Shabanov Axel Andres Wolfram Karenovics Jean-Marie Wenger Nicola Pluchino 《Journal of minimally invasive gynecology》2019,26(3):404
Study Objective
To demonstrate a safe laparoscopic procedure for diaphragmatic infiltrative endometriosis.Design
Video caseSetting
Teaching hospital (Canadian Task Force classification III).Patients
One patient presenting deep and severe diaphragmatic endometriosis.Intervention
Laparoscopic cure of diaphragmatic endometriosis.Measurements and Main Results
Throughout this video, which was approved by the institutional board review, we demonstrate safe and complete surgical treatment of a patient suffering severe pelvic and diaphragmatic endometriosis. The patient complained of menstrual dyspnea and shoulder pain persisting despite hormonal treatment, associated with persistent dyspareunia and pelvic pain despite a previous laparoscopic surgery. Patient positioning and anesthesia were adapted to the special requirements of the surgical technique and the expected risks. The operation consisted of the exposure of the right diaphragm by mobilization of the liver, CO2 laser vaporization of left and right diaphragmatic lesions, nerve-sparing excision of infiltrating nodules, and pleural exploration. Finally, we performed an excision of pelvic endometriosis. Participation of 3 surgical teams to this procedure allowed a safe and complete laparoscopic treatment with resolution of pain symptoms at a 1- and 3-month follow-up.Conclusion
Laparoscopic treatment allows a safe and complete treatment of diaphragmatic endometriosis. 相似文献10.
11.
Sarah L. Cohen Nisse V. Clark Mobolaji O. Ajao Douglas N. Brown Antonio R. Gargiulo Xiangmei Gu Jon I. Einarsson 《Journal of minimally invasive gynecology》2019,26(4):702-708
Study Objective
To compare the number of days required to return to daily activities after laparoscopic hysterectomy with 2 tissue extraction methods: manual morcellation via colpotomy or minilaparotomy. Secondary outcomes were additional measures of patient recovery, perioperative outcomes, containment bag integrity, and tissue spillage.Design
Multicenter prospective cohort study and follow-up survey (Canadian Task Force classification II-2).Setting
Two tertiary care academic centers in northeastern United States.Patients
Seventy women undergoing laparoscopic hysterectomy with anticipated need for manual morcellation.Interventions
Tissue extraction by either contained minilaparotomy or contained vaginal extraction method, along with patient-completed recovery diary.Measurements and Main Results
Recovery diaries were returned by 85.3% of participants. There were no significant differences found in terms of average pain at 1, 2, or 3 weeks after surgery or in time to return to normal activities. Patients in both groups used narcotic pain medication for an average of 3 days. After adjusting for patient body mass index, history of prior surgery, uterine weight, and surgeon, there were no differences found for blood loss, operative time, length of stay, or incidence of any intra- or postoperative complication between groups. All patients had benign findings on final pathology. More cases in the vaginal contained extraction group were noted to have bag leakage on postprocedure testing (13 [40.6%] vs 3 [8.3%] tears in vaginal and minilaparotomy groups, respectively; p?=?.003).Conclusion
Regarding route of tissue extraction, contained minilaparotomy and contained vaginal extraction methods are associated with similar patient outcomes and recovery characteristics. 相似文献12.
Kimberly Butt Joan Crane Jennifer Hutcheon Ken Lim Ori Nevo 《Journal d'obstetrique et gynecologie du Canada》2019,41(3):363-374.e1
Objective
To review the evidence and provide an opinion as to whether universal cervical length screening to prevent preterm birth should be adopted across Canada.Outcomes
Outcomes evaluated include prevention of preterm birth.Evidence
Literature searches using Knowledge Finder, Medline and Cochrane databases were searched for articles published up to April 2018 on cervical length screening for prevention of preterm birth.Values
The evidence obtained was reviewed and evaluated by the Diagnostic Imaging Committee of the SOGC under the leadership of the principal authors, and recommendations were made according to guidelines developed by the Canadian Task Force on Preventive Health Care.Benefits, Harms, and Costs
The prevention of preterm birth in a cost-effective manner is of significant importance to the health of mothers and their families. This committee opinion will summarize the current evidence for universal cervical length screening to prevent preterm birth in Canada, determine whether it meets the Junger and Wilson criteria for screening tests, and make recommendations as to its use in Canada.Validation
These guidelines have been reviewed and approved by the Diagnostic Imaging Committee of the SOGC and The Society of Obstetricians and Gynaecologists of Canada (SOGC).Sponsors
The Society of Obstetricians and Gynaecologists of Canada (SOGC). 相似文献13.
Marion Tissot Solène Petry Lise Lecointre Emilie Faller Jean-Jacques Baldauf Chérif Akladios Thomas Boisrame 《Journal of minimally invasive gynecology》2019,26(4):603
Study Objective
To describe 2 different surgical techniques for Essure removal on the same patient: the hysteroscopic and laparoscopic techniques.Design
An educational video approved by the local institutional review board (Canadian Task Force classification III).Setting
A university hospital (University Hospital of Strasbourg, Strasbourg, France).Patient
A 46-year-old woman with many symptoms after Essure device implantation. An ultrasound found a right implant in the uterine cavity and a left intratubal implant.Interventions
The first step was the hysteroscopic removal of the right implant. We viewed the 2 internal and external spirals, allowing the gripping of the whole device without risking any fragmentation or tubal lesion. The second step was bilateral salpingectomy with resection of the left interstitial tubal portion. We longitudinally incised the antimesial edge of the fallopian tube 2 to 3 cm from the tubal serous to the implant contact. A circumferential incision was performed at the uterine horn to circumscribe the interstitial tubal portion. The implant was released from the surrounding tissue. It was gently pulled to completely extract it and avoid spiral fragmentation. Then, we performed a bilateral total salpingectomy. An X-ray of the implants and pelvis was performed to ensure complete removal of the device. We made an X-stitch in the uterine horn to avoid the risk of fistula.Conclusion
More and more patients are asking for the removal of their implants. The surgical technique has to be adapted to the location of the implants and has to allow their complete removal to avoid leaving fragments that can cause the persistence of side effects. 相似文献14.
Jordina Munrós Maria-Angeles Martínez-Zamora Dolors Tàssies Juan Carlos Reverter Mariona Rius Meritxell Gracia Cristina Ros Francisco Carmona 《Journal of minimally invasive gynecology》2019,26(3):450-455
Study Objective
To evaluate serial generation of microparticles (MPs) after laparoscopic stripping or CO2 laser vaporization in the surgical treatment of patients with ovarian endometrioma (OE).Design
A prospective, randomized, blinded, pilot study (Canadian Task Force classification I).Setting
Tertiary care university hospital from December 2014 to July 2016.Patients
Thirty women with unilateral OE undergoing laparoscopic surgery.Intervention
Patients were randomly selected to undergo either CO2 laser vaporization (L group) or laparoscopic stripping (S group) of OE.Measurements and Main Results
Blood samples were collected before surgery and at 2 hours, 24 hours, 1 month, and 3 months after surgery. An MP generation curve after OE surgery was created. MP generation was greater in the S group than in the L group at all time points evaluated. The MP generation curve showed a significantly higher area under the curve after excisional surgery (p <.05).Conclusion
The higher MP levels in the S group suggest an increased inflammation and procoagulant response after this procedure. 相似文献15.
Pasquale Florio Luigi Nappi Luca Mannini Giovanni Pontrelli Raffaele Fimiani Paolo Casadio Ivano Mazzon Gioacchino Gonzales Vittorio Villani Mario Franchini Giampietro Gubbini Liliana Mereu Fabrizia Santangelo Attilio Di Spiezio Sardo 《Journal of minimally invasive gynecology》2019,26(4):733-739
Study Objective
To estimate the incidence of infection after diagnostic and operative hysteroscopic procedures performed in an in-office setting with different distension media (saline solution or CO2).Design
Prospective, multicenter, observational study (Canadian Task Force classification II-2).Setting
Tertiary women's health centers.Patients
A total of 42,934 women who underwent hysteroscopy between 2015 and 2017.Interventions
Of the 42,934 patients evaluated, 34,248 underwent a diagnostic intervention and 8686 underwent an operative intervention; 17,973 procedures used CO2 and 24,961 used saline solution as a distension medium. Patients were contacted after the procedure to record postprocedure symptoms suggestive of infection, including 2 or more of the following signs occurring within the 3 weeks after hysteroscopy: fever; lower abdominal pain; uterine, adnexal, or cervical motion tenderness; purulent leukorrhea; vaginal discharge or itchiness; and dysuria. Vaginal culture, clinical evaluation, transvaginal ultrasound, and histological evaluation were completed to evaluate symptoms.Measurements and Main Results
Operative hysteroscopies comprised polypectomies (n?=?7125; 82.0%), metroplasty (n?=?731; 15.0%), myomectomy (n?=?378; 7.8%), and tubal sterilization (n?=?194; 4.0%). Twenty-five of the 42,934 patients (0.06%) exhibited symptoms of infection, including 24 patients (96%) with fever, 11 (45.8%) with fever as a single symptom, 7 (29.2%) with fever with pelvic pain, and 10 (41.7%) with fever with dysuria. In 5 patients with fever and pelvic pain, clinical examination and transvaginal ultrasound revealed monolateral or bilateral tubo-ovarian abscess. In these patients, histological examination from surgical specimens revealed the presence of endometriotic lesions.Conclusion
The present study suggests that routine antibiotic prophylaxis is not necessary before hysteroscopy because the prevalence of infections following in-office hysteroscopy is low (0.06%). 相似文献16.
Axelle Charavil Aubert Agostini Caroline Rambeaud Andy Schmitt Claire Tourette Patrice Crochet 《Journal of minimally invasive gynecology》2019,26(4):695-701
Study Objective
To evaluate the feasibility of an en-bloc salpingectomy at the time of vaginal hysterectomy for removal of Essure inserts.Design
Prospective observational study (Canadian Task Force classification II-1).Setting
Monocenter study at the Conception University Hospital Center, Marseille, France.Patients
Women seeking removal of the Essure device and candidate for vaginal hysterectomy from January 1, 2017 to January 31, 2018.Interventions
Patient underwent a total hysterectomy and bilateral salpingectomy by the vaginal route (VH-S) with en-bloc removal of each hemiuterus with the ipsilateral fallopian tube, thereby allowing for removal of the Essure inserts without fragmentation.Measurements and Main Results
Twenty-six VH-S were performed. There was no converted case to laparoscopy or laparotomy because of issues regarding feasibility or complications. Removal of each hemiuterus with the ipsilateral tube as a single unit was feasible in all cases. There was 1 Clavien-Dindo grade 1 perioperative complication: a bladder injury that required 10days of urinary catheterization. There were 2 grade 2 postoperative complications: 1 case of metrorrhagia of a granuloma on the vaginal fundus that was treated with silver nitrate and 1 case of acute urinary retention that required urinary catheterization for 24hours.Conclusion
Performing a VH-S with en-bloc removal of the hemiuterus with the ipsilateral tube without fragmentation orsectioning of the Essure inserts appears to be feasible. The vaginal route can hence be an approach for women who undergo hysterectomy during Essure insert surgery removal. 相似文献17.
Tony Ma Prathima Chowdary Alex Eskander Lenore Ellett Kate McIlwaine Janine Manwaring Emma Readman Peter Maher 《Journal of minimally invasive gynecology》2019,26(3):427-433
Study Objective
To assess the usefulness of narrowband imaging (NBI) to detect additional areas of endometriosis not identified by standard white light in patients undergoing laparoscopy for the investigation of pelvic pain.Design
A prospective cohort trial (Canadian Task Force classification II). Evidence obtained from a well-designed cohort study.Setting
A tertiary laparoscopic subspecialty unit in Melbourne, Australia.Patients
Fifty-seven patients undergoing laparoscopy for the investigation of pelvic pain were recruited. Fifty-three patients were eligible for analysis.Interventions
Patients underwent standard white-light laparoscopy of the pelvis followed by NBI survey to assess for any additional areas suspicious for endometriosis.Measurements and Main Results
All identified areas of possible endometriosis were resected and sent for blinded histopathological analysis. The additional predictive value of NBI was 0% if the preceding white-light survey was negative and 86% if the preceding white-light survey was positive.Conclusion
The use of NBI at laparoscopy for the investigation of pelvic pain is beneficial in finding additional areas of endometriosis if endometriosis is already suspected after white-light survey in a tertiary laparoscopic unit. Further research in nonspecialized units may show additional benefit and requires further research. NBI may also be useful as a diagnostic aid for trainees. 相似文献18.
Christina Williams Alicia J. Long Heather Noga Catherine Allaire Mohamed A. Bedaiwy Sarka Lisonkova Paul J. Yong 《Journal of minimally invasive gynecology》2019,26(3):507-515
Study Objective
To investigate ethnic differences for moderate-to-severe endometriosis.Design
Analysis of a prospective registry (Canadian Task Force classification II-2).Setting
Tertiary referral center.Patients
A total of 1594 women with pelvic pain and/or endometriosis.Interventions
NoneMeasurements and Main Results
On logistic regression, adjusting for potential confounders, East/South East Asians were 8.3 times more likely than whites to have a previous diagnosis of stage III/IV endometriosis before referral (adjusted odds ratio [aOR], 8.33; 95% confidence interval [CI], 3.74–18.57), 2.7 times more likely to have a palpable nodule (aOR, 2.66; 95% CI, 1.57–4.52), 4.1 times more likely to have an endometrioma on ultrasound (aOR, 4.10; 95% CI, 2.68–6.26), and 10.9 times more likely to have stage III/IV endometriosis at the time of surgery at our center (aOR, 10.87; 95% CI, 4.34–27.21).Conclusion
Moderate-to-severe endometriosis was more common in women with East or South East Asian ethnicity in our tertiary referral center. This could be explained by East/South East Asians with minimal to mild disease being less likely to seek care or genetic/environmental differences that increase the risk of more severe disease among East/South East Asians. (ClinicalTrials.gov, NCT02911090.) 相似文献19.
Amanika Kumar Sumer A. Wallace William A. Cliby Gretchen E. Glaser Andrea Mariani Mario M. Leitao Michael Frumovitz Carrie L. Langstraat 《Journal of minimally invasive gynecology》2019,26(4):727-732
Study Objective
We sought to estimate the impact of sentinel nodes in gynecologic oncology on fellowship training and discuss potential solutions.Design
Retrospective multi-institution cohort (Canadian Task Force classification II-2).Setting
Three tertiary cancer referral cancer centers.Patients
Patients with endometrial and vulvar cancer undergoing lymph node evaluation.Interventions
Patient history and fellow case volumes were evaluated retrospectively for type of lymph node assessment.Measurements and Main Results
Minimally invasive endometrial cancer and vulvar cancer fellow case volumes in 3 large institutions were reviewed and average annual volumes calculated for each clinical gynecologic oncology fellow. For vulvar cancer, probabilities of sentinel lymph node mapping and laterality of lesions were estimated from the literature. For endometrial cancer, estimates of lymphadenectomy rates were determined using probabilities calculated from our historic database and from review of the literature. Modeling the approaches to lymphadenectomy in endometrial cancer (full, selective, and sentinel), 100% versus 68% versus 24%, respectively, of patients would require complete pelvic lymphadenectomy and 100% versus 34% versus 12% would require para-aortic lymphadenectomy. In vulvar cancer, rates of inguinal femoral lymphadenectomy are expected to drop from 81% of unilateral groins to only 12% of groins.Conclusions
Sentinel lymph node biopsy for endometrial and vulvar cancer will play an increasing role in practice, and coincident with this will be a dramatic decrease in pelvic, para-aortic, and inguinal femoral lymphadenectomies. The declining numbers will require new strategies to maintain competency in our specialty. New approaches to surgical training and continued medical education will be necessary to ensure adequate training for fellows and young faculty across gynecologic surgery. 相似文献20.
Ye Zhang Xiaochen Song Meng Mao Jia Kang Fangfang Ai Lan Zhu 《Journal of minimally invasive gynecology》2019,26(4):754-759