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1.
Akarawit Jitchanwichai Karanrat Soonthornpun 《Journal of minimally invasive gynecology》2019,26(1):110-116
Study Objective
To assess the effect of hyoscine-N-butylbromide (HBB) as premedication on the rate of proximal tubal obstruction during hysterosalpingography (HSG).Design
A randomized, double-blind controlled trial (Canadian Task Force classification I).Setting
The Infertility Clinic of Songklanagarind Hospital.Patients
One hundred and forty-six infertile women indicated for HSG investigation.Interventions
Between May 1, 2016, and March 31, 2017, patients were assigned at random to receive either oral HBB 20?mg or placebo 30 minutes before the HSG procedure. If proximal tubal obstruction was found, participants were be assigned to undergo a second confirming HSG or laparoscopy with chromopertubation within 6 months.Measurements and Main Results
The primary outcome was the rate of proximal tubal obstruction. The secondary outcome was the false-positive result of proximal tubal occlusion from HSG. Proximal tubal obstruction was found in 6 of 70 patients in the HBB group and in 16 of 71 in the placebo group. The rate of proximal tubal obstruction was significantly lower in the HBB group than in the placebo group (8.6% vs 22.5%; p?=?.04; absolute difference, 13.9%; 95% confidence interval [CI], 0.02–0.26; relative risk, 0.38; 95% CI, 0.16–0.92). After the second HSG or laparoscopy was performed (n?=?22), the rate of false occlusion was 20% (1 of 6 patients) in the HBB group, compared with 69.2% (9 of 16 patients) in the placebo group.Conclusion
Premedication with HBB before HSG can reduce the rate of diagnosis of proximal tubal obstruction and false occlusion. 相似文献2.
Kristin A. Riley Andrea S. Benton Timothy A. Deimling Allen R. Kunselman Gerald J. Harkins 《Journal of minimally invasive gynecology》2019,26(1):71-77
Study Objective
To compare surgical excision and ablation of endometriosis for treatment of chronic pelvic pain.Design
Randomized clinical trial with 12-month follow-up (Canadian Task Force classification I).Setting
Single academic tertiary care hospital.Patients
Women with minimal to mild endometriosis undergoing laparoscopy.Interventions
Excision or ablation of superficial endometriosis at the time of robot-assisted laparoscopy.Measurements and Main Results
Primary outcome was visual analog scale (VAS) scoring at baseline and 6 and 12 months for menstrual pain, nonmenstrual pain, dyspareunia, and dyschezia. Secondary outcomes included survey results at baseline and 6 and 12 months from the Short Form Health Survey, Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire, and the International Pelvic Pain Assessment. From December 2013 to October 2014, 73 patients were randomized intraoperatively to excision (n?=?37) or ablation (n?=?36) of endometriosis. Patients were followed at 6 and 12 months to evaluate the above outcomes. After ablation of endometriosis, dyspareunia (VAS scores) improved at 6 months (mean change [MC], ?14.07; 95% confidence interval [CI], ?25.93 to ?2.21; p?=?.02), but improvement was not maintained at 12 months. Dysmenorrhea improved at 6 months (MC, ?26.99; 95% CI, ?41.48 to ?12.50; p?<?.001) and 12 months (MC, ?24.15; 95% CI, 39.62 to ?8.68; p?=?.003) with ablation. No significant changes were seen in VAS scores after excision at 6 or 12 months. When comparing ablation and excision, the only significant difference was a change in dyspareunia at 6 months (MC, ?22.96; 95% CI, ?39.06 to ?6.86; p?=?.01).Conclusion
Treatment with ablation improved dysmenorrhea at 6 and 12 months and improved dyspareunia at 6 months as compared with preoperative data. However, only dyspareunia demonstrated a significant difference between ablation and excision. Excision and ablation showed similar effectiveness for the treatment of pain associated with superficial endometriosis, with ablation showing more significant individual changes. Careful patient counseling regarding expectations of surgical intervention is vital in the management of endometriosis. 相似文献3.
Angelos G. Vilos Cici Zhu Basim Abu-Rafea Helen C. Ettler Michele M. Weir George A. Vilos 《Journal of minimally invasive gynecology》2019,26(1):105-109
Study Objectives
To report 2 cases of uterine tumors resembling ovarian sex cord tumors (UTROSCTs) and examine the clinical significance of these tumors found during hysteroscopic endometrial ablation despite benign preoperative endometrial biopsy analysis and imaging suggestive of leiomyoma.Design
Case report (Canadian Task Force classification III).Setting
Tertiary care hospital.Patients
Two patients with abnormal uterine bleeding.Interventions
Hysteroscopic endometrial ablation/resection.Measurements and Main Results
Pathological analysis of intrauterine tissue/lesions obtained by curettage or resection identified 2 unexpected UTROSCTs masquerading as leiomyomas. Following hysterectomy, no residual UTROSCT was identified in the specimens, and both women are well, one at 1 year postsurgery and the other at 3 years postsurgery.Conclusion
Obtaining additional tissue by routine curettage before endometrial ablation and/or endomyometrial resection, in conjunction with removal of any intrauterine lesions, can identify rare unexpected endometrial lesions not sampled by endometrial biopsy, not detected with ultrasound, and masquerading as leiomyomas during endometrial ablation. 相似文献4.
Rajiv Shah Alexandra Davidson Michael Arnason Anita Shah Nicolette Caccia Eliane M. Shore 《Journal d'obstetrique et gynecologie du Canada》2019,41(2):197-203.e3
Introduction
There is no formalized hands-on teaching of suturing skills for clerkship students during their dedicated obstetrics and gynaecology (OB/GYN) teaching sessions at the University of Toronto. Nevertheless, the students are exposed to suturing during gynaecologic surgery, Caesarean sections, and perineal repairs. As a result, a formal pilot workshop on knot-tying and perineal laceration repair was developed for incorporation into the third-year clerkship curriculum with the goals of increasing students' knowledge and technical skills.Methods
Participants consisted of students enrolled in their OB/GYN clerkship rotation at St. Michael's Hospital at the University of Toronto from December 2016 to August 2017. Prior to the workshop, students' (n?=?82) baseline knowledge of perineal lacerations was assessed with a pre-test quiz and their knot-tying speeds (two hand-ties and two instrument ties) were recorded. Students were then taught perineal anatomy, laceration types and repair techniques, suturing, and knot-tying. Under direct supervision, students practiced the technical skills for 45 minutes. Knowledge and knot-tying speeds were then reassessed following the educational session.Results
There was a statistically significant improvement in both knowledge (51% to 71%; P?<?0.05) and technical skills (258.8 seconds to 197.4 seconds; P?<?0.05) after the workshop. Importantly, 94% of students “agreed” or “strongly agreed” that this method of learning was more enjoyable than traditional methods.Conclusions
This pilot project demonstrates that a formal hands-on workshop improves medical knowledge, technical skills, and student satisfaction. This has the potential for students to have increased opportunities at the bedside, with higher patient acceptance and safety. 相似文献5.
Yi-Le Lee Teh-Fu Hsu Ling-Yu Jiang Hsiang-Tai Chao Peng-Hui Wang Yi-Jen Chen 《Journal of minimally invasive gynecology》2019,26(1):135-142
Study Objective
Previous studies suggest female-to-male transgender men tend to choose less invasive procedures, but the superior route of hysterectomy for them remains undetermined.Design
A retrospective study (Canadian Task Force Classification II-3).Setting
An academic tertiary hospital.Patients
Fifty-six female-to-male transsexuals received total vaginal hysterectomy (VH) with bilateral salpingo-oophorectomy (BSO) between April 2008 and August 2016 at Taipei Veterans General Hospital, Taipei, Taiwan.Interventions
The patients underwent natural orifice transluminal endoscopic surgery (NOTES) (n?=?14) or the conventional approach (n?=?42).Measurements and Main Results
Medical charts and surgical records were reviewed retrospectively. The general characteristics of the patients were similar in both groups. There were no statistically significant differences in operative time, estimated blood loss, intraoperative and immediate postoperative complications, or length of hospital stay between the 2 groups. However, postoperative pain was significantly reduced in the NOTES group compared with the conventional group as evidenced by lower mean scores on the visual analog scale (4.9?±?3.0 vs 7.1?±?1.4 at 2 hours, p?=?.008; 1.5?±?1.2 vs 3.0?±?1.7 at 48 hours, p?=?.001; and 1.7?±?1.0 vs 2.7?±?1.1 at 72 hours, p?<?.001) and a lower mean accumulated dose of postoperative analgesics (38.9?±?49.2?mg vs 88.8?±?82.3?mg meperidine hydrochloride, p?=?.037). Analysis of variance with repeated measures with a Greenhouse-Geisser correction also showed that the mean scores for wound pain were statistically lower in the NOTES group (p?<?.001). There was no significant difference in the complication rate between the NOTES and conventional groups (7% vs 12%, p?=?.618). There were no severe complications, including infection episodes or internal bleeding events, within the NOTES group.Conclusion
NOTES VH with BSO in female-to-male transgender men significantly decreases postoperative pain and analgesic use. NOTES in female-to-male sex reassignment surgery provides a novel choice for transgender men, with equivalent safety compared with VH. 相似文献6.
Xueying Li Ling Wu Yanfei Zhou Xing Fan Jufang Huang Juhua Wu Renxiu Yu Jianying Lou Mengjie Yang Zhihong Yao Min Xue 《Journal of minimally invasive gynecology》2019,26(1):94-99
Study Objectives
To evaluate the efficacy of a new crosslinked hyaluronan (NCH) gel in reducing the formation of intrauterine adhesions (IUAs) after dilation and curettage (D&C).Design
Randomized controlled trial (Canadian Task Force classification I).Settings
Six hospitals for maternal and child healthcare in China.Patients
A total of 300 patients were randomized to undergo D&C for delayed miscarriage without previous history of D&C. Twenty-six patients (9%) were lost to follow-up and were excluded from the analysis.Interventions
Women were randomly assigned to D&C alone (control group; n?=?150) or D&C plus NCH gel application (NCH gel group; n?=?150) with 1:1 allocation.Measurements and Main Results
All patients were evaluated using the American Fertility Society classification of IUAs during follow-up diagnostic hysteroscopy, scheduled at 3 months after D&C procedure. The primary endpoint was the number of women with IUAs at 3 months, and the secondary endpoints were adhesion scores and severity of IUAs. Postoperative efficacy data were available for 274 women (137 in each group). Intrauterine adhesion formations were observed in 13 of the 137 women (9.5%) in the NCH gel group and in 33 of the 137 women (24.1%) in the control group (p?=?.0012; relative risk [RR], 0.3939; 95% confidence interval [CI], 0.2107–0.7153), a difference of 14.6% (95% CI, 5.92%–23.28%) between the 2 groups. The extent of intrauterine cavity involved, type of adhesion and menstrual pattern, and cumulative adhesion scores were significantly lower in the NCH gel group compared with the control group (p?=?.0007, .008, .0012, and .0006, respectively). The proportion of women with moderate to severe IUAs was significantly lower in the NCH gel group than that in the control group (1 of 137 [0.7%] vs 16 of 137 [11.7%]; p?=?.0002; RR, 0.0625; 95% CI, 0.0084–0.4648), a difference of 11.95% (95% CI, 5.39%–16.51%) between the 2 groups.Conclusions
The current study demonstrates that IUAs are frequently formed after D&C for delayed miscarriage in women without a previous history of D&C procedures, and the application of NCH gel significantly reduces IUA formation. 相似文献7.
Kim Paquette Stephanie Markey Stephanie Roberge Mario Girard Emmanuel Bujold Suzanne Demers 《Journal d'obstetrique et gynecologie du Canada》2019,41(1):59-63
Background
Lower uterine segment (LUS) thickness in the third trimester of gestation is associated with the risk of uterine scar defect at delivery. It was suggested that first trimester residual myometrial thickness (RMT) could also predict uterine scar defect at delivery.Objective
This study sought to correlate the RMT measured at the site of uterine scar in the first trimester with the LUS thickness measured in the third trimester.Methods
This was a prospective cohort study of women with a singleton pregnancy and a single prior low-transverse CS. All participants underwent an evaluation of uterine scar by using transvaginal ultrasound at 11 to 13 weeks, including the presence of a scar defect and measurement of RMT; and a second evaluation at 35 to 38 weeks, combining both transvaginal and transabdominal ultrasound, for the measurement of LUS thickness. Spearman's correlation test was used to compare first and third trimester measurements.Results
A total of 166 eligible participants were recruited at mean GA of 12.7?±?0.5 weeks. We observed an absence of correlation between first trimester RMT and third trimester LUS thickness (correlation coefficient 0.10; P?=?0.20). First trimester RMTs below 2.0?mm and below 2.85?mm are poor predictors of third trimester LUS thickness below 2.0?mm (sensitivity, 8% and 23%; specificity, 98% and 87%; positive predictive value, 25% and 14%, respectively).Conclusion
There is a poor correlation between first trimester RMT and third trimester LUS thickness in women with a previous CS. First trimester RMT should not be used to inform women on their risk of uterine rupture or to guide clinical management. 相似文献8.
Jaimin S. Shah Michael Mackelvie David M. Gershenson Preetha Ramalingam Marylee M. Kott Jubilee Brown Polly Gauthier Elizabeth Nugent Lois M. Ramondetta Michael Frumovitz 《Journal of minimally invasive gynecology》2019,26(1):87-93
Study Objective
To compare the accuracy of frozen section diagnosis of borderline ovarian tumors among 3 distinct types of hospital—academic hospital with gynecologic pathologists, academic hospital with nongynecologic pathologists, and community hospital with nongynecologic pathologists—and to determine if surgical staging alters patient care or outcomes for women with a frozen section diagnosis of borderline ovarian tumor.Design
Retrospective study (Canadian Task Force classification II-1).Setting
Tertiary care, academic, and community hospitals.Patients
Women with an intraoperative frozen section diagnosis of borderline ovarian tumor at 1 of 3 types of hospital from April 1998 through June 2016.Interventions
Comparison of final pathology with intraoperative frozen section diagnosis.Measurements and Main Results
Two hundred twelve women met the inclusion criteria. The frozen section diagnosis of borderline ovarian tumor correlated with the final pathologic diagnosis in 192 of 212 cases (90.6%), and the rate of correlation did not differ among the 3 hospital types (p?=?.82). Seven tumors (3.3%) were downgraded to benign on final pathologic analysis and 13 (6.1%) upgraded to invasive carcinoma. The 3 hospital types did not differ with respect to the proportion of tumors upgraded to invasive carcinoma (p?=?.62). Mucinous (odds ratio, 7.1; 95% confidence interval, 2.1–23.7; p?=?.002) and endometrioid borderline ovarian tumors (odds ratio, 32.4; 95% confidence interval, 1.8–595.5; p?=?.02) were more likely than serous ovarian tumors to be upgraded to carcinoma. Only 88 patients (41.5%) underwent lymphadenectomy, and only 1 (1.1%) had invasive carcinoma in a lymph node.Conclusions
A frozen section diagnosis of borderline ovarian tumor correlates with the final pathologic diagnosis in a variety of hospital types. 相似文献9.
Study Objective
To demonstrate the proper use of vessel-sealing devices during vaginal hysterectomy.Design
Educational video (Canadian Task Force classification level III).Setting
University hospital.Intervention
The video reviews the principles on the use of energy in minimally invasive surgery. We focus on how vessel-sealing devices function and the benefits of their use in difficult vaginal hysterectomy. The video explains the 2 major types of complications, inadequate vessel sealing and undesired thermal injury, and demonstrates techniques to avoid these complications.Measurements and Main Results
Laboratory, intraoperative, and cadaveric recordings demonstrate proper use and the complications that may arise in the setting of improper use.Conclusion
Vessel-sealing devices may be a useful tool for surgeons performing vaginal hysterectomy. This video demonstrates their use and underlines the importance of understanding the principles of energy devices and their proper usage in surgery. 相似文献10.
Yair Daykan Rona Bogin Merav Sharvit Zvi Klein Dana Josephy Meir Pomeranz Nissim Arbib Tal Biron-Shental Ron Schonman 《Journal of minimally invasive gynecology》2019,26(1):117-121
Study Objective
To investigate the pregnancy and neonatal outcomes of surgical treatment for adnexal torsion (AT) during pregnancy.Design
A retrospective case-control study (Canadian Task Force classification II-2).Setting
A tertiary care academic medical center.Measurements and Main Results
The study group included all parturients who underwent surgery for suspected AT during pregnancy from January 2005 to January 2017. The control group included parturients with an uneventful pregnancy matched by maternal age, parity, multiple gestation, and pregnancy complications. The primary outcome was gestational age at delivery. Secondary outcomes were perinatal outcomes and intraoperative and immediate postoperative complications. Among 85 study group patients with suspected AT, 78 (91.7%) underwent laparoscopy and 7 (8.3%) laparotomy. Torsion was diagnosed in 84 patients (98.8%). The gestational age at delivery was similar between the study and control groups (38.7?±?1.5 vs 38.6?±?1.6 weeks, respectively; p?=?.908) as was preterm labor (5.8% in both groups, p?=?1.00). There was no significant difference between the study and control groups in pregnancy and neonatal outcomes, including Apgar scores, mean cord blood pH (7.25?±?0.1 and 7.26?±?0.08, respectively), and birth weight (3040?±?473?g and 3115?±?584?g, respectively). In the study group, the mean gestational age at surgery was 11.2?±?6 weeks (range, 4–34 weeks). The average operative time was 40.2?±?22 minutes. In the postoperative follow-up, 3 (3.5%) patients had a first trimester miscarriage. A previous cesarean delivery was a risk factor for ovarian torsion during pregnancy (p?=?.012).Conclusion
Adnexal detorsion with or without additional surgical procedures during pregnancy did not affect the gestational age at delivery and did not appear to increase fetal or maternal complication rates. 相似文献11.
Pouya Javadian Alexander Juusela Farr Nezhat 《Journal of minimally invasive gynecology》2019,26(1):31
Study Objective
To illustrate a robotic-assisted laparoscopic resection for cervicovaginal myomectomy.Design
Step-wise instruction using video and case report (Canadian Task Force classification III).Setting
A tertiary referral center.Patient
A 39-year-old woman.Intervention
Robotic-assisted laparoscopy resection of leiomyoma.Measurements and Main Results
A 39-year-old woman, gravida 0, body mass index of 23.0?kg/m2, with a known cervicovaginal myoma that in the past underwent uterine artery embolization, presented with recurrence of her severe abnormal vaginal bleeding. She was referred for surgical resection of the mass. Magnetic resonance imaging revealed a 5-cm posterior cervicovaginal leiomyoma. The patient wanted to preserve her reproductive organs. A total robotic procedure lasted 123 minutes, with an estimated blood loss of 100?mL. She was discharged uneventfully on the day 0 postoperatively. Pathology results showed a 37-g leiomyoma of the uterus. The patient presented at her 2-weeks postoperative visit with no more complaint of vaginal bleeding.Conclusion
Robot-assisted laparoscopic surgery is a feasible approach for cervicovaginal myoma with minimal complications. 相似文献12.
Marcello Ceccaroni Matteo Ceccarello Giuseppe Caleffi Roberto Clarizia Stefano Scarperi Mauro Pastorello Alberto Molinari Giacomo Ruffo Stefano Cavalleri 《Journal of minimally invasive gynecology》2019,26(1):78-86
Study Objective
To investigate the efficacy of laparoscopic ureteroneocystostomy in patients with deep infiltrating endometriosis (DIE) with ureteral, parametrial, and bowel involvement.Design
Prospective study (Canadian Task Force classification II-2).Setting
Tertiary referral center for endometriosis care.Patients
One hundred sixty patients with DIE underwent laparoscopic radical eradication and ureteroneocystostomy between January 2009 and December 2016.Interventions
Laparoscopic nerve-sparing radical treatment with ureteroneocystostomy, parametrectomy, and, if necessary, segmental bowel resection.Measurements and Main Results
Surgical eradication was radical, and ureteral endometriosis was histologically confirmed in all patients (45.6% intrinsic and 54.4% extrinsic). In 58.7% of patients ureteroneocystostomy was performed with the psoas hitch technique. Bowel resection was performed in 121 patients (75.6%), and 115 of them had a concomitant ileostomy (71.9%). Unilateral parametrectomy was performed on the left side in 61.9% of patients and on the right side in 30% of patients, respectively, whereas bilateral parametrectomy was completed in 33 patients (20.6%). Postoperative complications were infrequent: 7 patients underwent reoperation (4.4%), 8 patients experienced fever (5%), 4 patients required blood transfusion (2.5%), 3 patients had intestinal fistulas (1.9%), and 24 patients experienced impaired bladder voiding (15%) after 6 months. Mean follow-up time was 20.5 months (range, 1–60). The study reported good clinical and surgical results, with a regression of symptoms (p?<?.001) and recurrence of parametrial endometriosis of 1.2% that required opposite-side ureteroneocystostomy.Conclusion
This is the largest documented series of patients with DIE undergoing laparoscopic radical eradication and ureteroneocystostomy. The collected data show that in patients with ureteral endometriosis, this technique is feasible, effective, and safe and provides good results in terms of relapses and symptoms' control. 相似文献13.
Elisa Bertocchi Giuliano Barugola Marco Benini Paolo Bocus Roberto Rossini Marcello Ceccaroni Giacomo Ruffo 《Journal of minimally invasive gynecology》2019,26(1):100-104
Study Objective
To evaluate the incidence, risk factors, and treatment of colorectal anastomotic stenosis in patients who undergo rectosigmoid resection for deep infiltrating endometriosis (DIE).Design
Retrospective analysis of a prospective database (Canadian Task Force classification III).Setting
Public medical center.Patients
All women who underwent laparoscopic rectosigmoid resections for DIE at our hospital between January 2002 and December 2016.Intervention
All patients were evaluated clinically and endoscopically at 1 month and 3 months after bowel resection. Stenosis was defined as a lack of passage through the anastomosis of a 12-mm proctoscope. Symptomatic stenosis was defined as the presence of endoscopically confirmed stricture accompanied by at least 2 of the following symptoms: constipation, need to push, tenesmus, and ribbon stools. Only patients with symptomatic stenosis were studied. Demographic data, surgical techniques, and postoperative complications were recorded prospectively. Treatments and outcomes of anastomotic symptomatic strictures were analyzed.Measurements and Main Results
A total of 1643 patients underwent laparoscopic rectosigmoid resection at our hospital between January 2002 and December 2016. Among these, 104 patients (6.3%) presented with symptomatic anastomotic stenosis. The median patient age was 27 years (range, 23–44 years), and the median interval between diagnosis and the onset of symptomatic stenosis was 57 days (range, 21–64 days). The only statistically significant predictors of anastomotic stenosis were the presence of ileostomy (p?=?.01) and previous pelvic surgery (p?=?.002). Treatment of choice was always conservative. Of the 104 patients in the study cohort, 90 (86.5%) underwent 3 endoscopic dilatations. No patient required reoperation.Conclusion
The anastomotic stricture is a recognized complication in patients following intestinal resection for DIE, and protective ileostomy is the sole modifiable factor related to anastomotic stenosis. Endoscopic dilatation is a valid option to treat this complication. 相似文献14.
Roberta Venturella Gianmarco Miele Katia Cefalì Daniela Lico Pietro D&#x;Alessandro Bruno Arduino Annalisa Di Cello Fulvio Zullo Constantino Di Carlo 《Journal of minimally invasive gynecology》2019,26(1):143-147
Study Objective
To investigate the effects of 3 cycles of subcutaneous progesterone administered during the luteal phase on the regression rate of symptomatic and asymptomatic endometrial polyps in premenopausal woman.Design
A retrospective study (Canadian Task Force classification II-2).Setting
A department of obstetrics and gynecology in a university hospital.Patients
One hundred twenty-seven reproductive-aged women presented with endometrial polyps from January to December 2016.Interventions
A retrospective comparison of patients treated with subcutaneous progesterone and those managed by the “wait and see” approach.Measurements and Main Results
Patients were divided into 2 groups: the group treated with subcutaneous progesterone (cases) and the wait and see group (controls). Women in the treatment group were administered 25?mg subcutaneous progesterone during the luteal phase for 7 days for 3 months. The wait and see group included patients refusing progesterone therapy who were reevaluated 3 menstrual cycles after the transvaginal sonographic diagnosis. Both the treatment group (n?=?61) and the wait and see group (n?=?32) were evaluated with a follow-up ultrasound examination after 3 months. The regression rate of endometrial polyps in women treated with subcutaneous progesterone was compared with the wait and see patients. The regression in the number and/or dimensions of the polyps was greater in the treatment group than the control group. The regression rate was 47.5% and 12.5%, respectively (p?<?.001).Conclusion
Progesterone appears to be a valid therapeutic alternative for the management of endometrial polyps. A prospective, randomized study is ongoing at our institution to further validate these findings. 相似文献15.
Hisao Osada Shokichi Teramoto Hirotsune Kaijima Tomoya Segawa Osamu Miyauchi Masaji Nagaishi Makio Shozu Keiichi Kato Victor Gomel 《Journal of minimally invasive gynecology》2019,26(1):129-134
Study Objective
To evaluate the efficacy of a nonsurgical treatment for cervical pregnancy (CP) and cesarean section scar pregnancy (CSP).Design
Retrospective clinical study (Canadian Task Force classification III).Setting
Private assisted reproductive technology practice.Patients
Nineteen women with CP (n?=?16) or CSP (n?=?3), including 6 patients with positive fetal heartbeat.Intervention
Transvaginal local injection of absolute ethanol (AE) into the hyperechoic ring (lacunar space) around the gestational sac under ultrasound guidance.Measurements and Main Results
Serum beta-human chorionic gonadotropin (β-hCG) was measured at frequent intervals, and ultrasound and/or magnetic resonance imaging was used to observe the gestational sac. In 9 patients, the serum β-hCG level was effectively reduced with a single AE injection at 2 hours. In the remaining 10 patients, the level decreased but then increased in 4 and slowly decreased in the other 6; all of these 10 patients required 2 to 5 repeat AE injections. In all patients, serum β-hCG level was reduced by 50% within 3 days and decreased to <10% of the initial level within 14 days. In 18 patients (95%), the level was decreased to 1.0 mIU/mL within 40 days. Seven patients were treated on an outpatient basis. Twelve patients received no anesthesia. Five patients subsequently became pregnant, and each had a live birth. There was no recurrent CP or CSP. The procedure was successful in all 19 patients.Conclusion
This procedure is an effective treatment for CP or CSP that could be used in place of conventional surgical interventions and medical treatment using MTX. 相似文献16.
Alberto Morales Osvaldo Reyes Gerardo Cárdenas 《Journal d'obstetrique et gynecologie du Canada》2019,41(3):306-311
Objective
To evaluate two techniques of uterine incision expansion (cephalad-caudad vs. transverse) during Caesarean section (CS).Methods
A total of 839 patients were randomized to either a cephalad-caudad blunt expansion of uterine incision during CS versus a transverse (lateral-lateral) expansion. The primary outcome was blood loss, measured with the descent of hemoglobin level. Secondary outcomes were the need for blood transfusion and the number of surgical or postoperative complications presented in both groups.Results
There was no statistical difference with regard to decrease in hemoglobin level, but there was a higher number of surgical complications in the transverse expansion group (Cephalad-caudad: 11.53% vs. transverse: 16.42%; odds ratio [OR] 0.66; 95% confidence interval [CI] 0.45–0.98; P?=?0.04). There were more cases of unintended extensions of uterine incision (10.35% vs. 16.18%; OR 0.6; 95% CI 0.4–0.9; P?=?0.01) but no statistical difference in the number of hematomas, uterine vessel injury, or the need to transfuse.Conclusion
The cephalad-caudad blunt expansion technique of the low transverse uterine incision is safer than the transverse expansion. There was no difference in regard to decrease in hemoglobin level, but there is a lower risk of surgical complications not associated with an increased need for blood transfusions when compared with the transverse expansion. 相似文献17.
Eliane M. Shore Alexandra Davidson Michael Arnason Husayn Kara Anita Shah Rajiv Shah 《Journal d'obstetrique et gynecologie du Canada》2019,41(2):191-196.e2
Introduction
Currently, simulation training is not part of the clinical clerkship rotation in obstetrics and gynaecology (OB/GYN) at the University of Toronto. Instead, students are taught formally through lectures and informally on the ward or in the operating room. This study aimed to incorporate simulation using a high fidelity postpartum hemorrhage (PPH) workshop into the teaching curriculum, with the goal of improving both medical knowledge of PPH and nontechnical skills (NTS).Method
A novel teaching session was introduced for the third-year clerks on their OB/GYN rotation. Students (n?=?88) were invited to participate in the research component to evaluate the effectiveness of this session. Students' (n?=?83) baseline knowledge of PPH and teamwork attitudes were measured using a multiple-choice questionnaire (MCQ) and the TeamSTEPPS Questionnaire. Students participated in small-group learning about PPH and NTS, followed by a high-fidelity PPH simulation using a Laerdal SimMom Mannequin in a mock operating room. Students were debriefed, followed by a different MCQ and the TeamSTEPPS Questionnaire.Results
Statistically significant improvements in students' comprehension (MCQ scores 63.9% vs. 76.5%, P?<?0.05) and NTS (4.35/5 vs. 4.51/5, P?<?0.05) were noted after simulation. The majority (92%) of students agreed that this method of learning was more enjoyable than traditional methods.Conclusions
Simulation in undergraduate education offers an exciting alternative to deliver information that is traditionally taught with didactic sessions while incorporating essential NTS. The authors hope that this study will encourage discussion of current simulation practices across Canada and standardized simulation techniques in OB/GYN. 相似文献18.
Boshra Hosseini Marli Leibl Jayson Stoffman Amanda Morris 《Journal d'obstetrique et gynecologie du Canada》2019,41(5):660-665
Objective
To discuss the finding of hypercalcemia in pediatric ovarian dysgerminoma.Methods
Two cases of pediatric ovarian dysgerminoma that presented with hypercalcemia are discussed.Results
Hypercalcemia is a rare finding in ovarian dysgerminoma.Conclusion
Ovarian dysgerminoma should be considered in pediatric patients presenting with signs of hypercalcemia. Parathyroid hormone, parathyroid hormone related protein, and 1,25 dihydroxyvitamin D may elucidate the cause of hypercalcemia. 相似文献19.
Juan Liu Jaden Kohn Bin Sun Zhenkun Guan Binhua Liang Xiaoming Guan 《Journal of minimally invasive gynecology》2019,26(1):38-39
Study Objective
To demonstrate helpful tips and tricks for the successful use of transvaginal natural orifice transluminal endoscopic surgery (NOTES) for performing sacrocolpopexy and salpingo-oophorectomy surgery. Minimally invasive approaches for treating pelvic organ prolapse via sacrocolpopexy have traditionally included laparoscopy either with or without robotic assistance. Transvaginal NOTES is a novel minimally invasive approach that both avoids abdominal incisions and provides improved visualization; however, it can be technically challenging.Design
Stepwise demonstration with narrated video footage (Canadian Task Force classification III).Setting
An academic tertiary care hospital in Guangdong, China.Patient
A 61-year-old gravida 3, para 3 woman with 3 spontaneous vaginal deliveries and stage III uterine prolapse, stage III cystocele, and stage III rectocele. The preoperative vaginal length was 6?cm.Intervention
After performing vaginal hysterectomy, we show the usefulness of NOTES for salpingo-oophorectomy. We also demonstrate useful techniques for transvaginal NOTES sacrocolpopexy including hydrodissection, division of the Y mesh, anchoring of the anterior mesh before reducing prolapse, retroperitoneal tunneling, and hand suturing of the mesh and vaginal cuff.Measurements and Main Results
The procedure was successfully performed in approximately 190 minutes. The postoperative vaginal length was 5?cm. Postoperative pelvic organ prolapse quantification was stage 0.Conclusion
The transvaginal NOTES approach is feasible and efficient for sacrocolpopexy and salpingo-oophorectomy; additionally, it is a reasonable option for patients who desire a minimally invasive approach with excellent cosmetic results. Surgical techniques that aid in effectively performing transvaginal NOTES sacrocolpopexy include the use of hydrodissection, Y mesh division, anterior mesh anchoring before reducing prolapse, retroperitoneal tunneling, and hand suturing. Using the techniques presented here, we were able to insert the port only 1 time, which improves the efficiency and safety of this surgery. 相似文献20.
David Sheyn Sherif El-Nashar Megan Billow Sangeeta Mahajan Mary Duarte Robert Pollard 《Journal of minimally invasive gynecology》2018,25(3):484-490