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Haider Jan Vishalli Ghai Stergios K. Doumouchtsis 《Journal of minimally invasive gynecology》2018,25(6):952-953
Study Objective
To demonstrate a mesh-free approach for uterine prolapse during a hysterectomy.Design
Technical video (Canadian Task Force classification III).Setting
Benign gynecology department at a university hospital.Patient
A 50-year-old woman.Intervention
Laparoscopic high uterosacral ligament suspension technique.Measurements and Main Results
A 50-year-old woman presented with irregular vaginal bleeding and grade 3 uterine prolapse. The patient was concerned regarding the use of mesh and erosion. After counseling the patient agreed to a mesh-free single procedure. The use of mesh for the treatment of pelvic organ prolapse has become the subject of controversy and litigation. Complications of mesh erosion have resulted in the US Food and Drug Administration reclassifying transvaginal meshes as high-risk devices in 2016 [1]. Mesh erosion risk is up to 23% with hysterectomy and concomitant laparoscopic sacrocolpopexy [2] and 3% with sacrohysteropexy [3]. We present an alternative laparoscopic approach of treating uterine prolapse with high uterosacral suspension during laparoscopic hysterectomy. Our method avoids the use of mesh, sacrocervicopexy and morcellation, or an interval sacrocolpopexy. Although high uterosacral ligament suspension can be performed vaginally, it carries up to an 11% risk of ureteric injury [4].Conclusion
In this video a bilateral ureterolysis is performed, before hysterectomy, isolating the uterosacral ligaments. These are then suspended to the vaginal vault in a purse-string fashion using Vicryl 0 (polyglactin 910) and intracorporeal knot-tying. Postprocedure the vault is well supported with a vaginal length of 12?cm. 相似文献3.
Femke van Zanten Jan J. van Iersel Francis E. Hartog Karin I.M. Aalders Egbert Lenters Ivo A.M.J. Broeders Steven E. Schraffordt Koops 《Journal of minimally invasive gynecology》2019,26(4):636-642
Study Objective
To prospectively evaluate the mesh exposure rate after robot-assisted laparoscopic pelvic floor surgery for the treatment of female pelvic organ prolapse (POP) in a large cohort.Design
Prospective observational cohort study (Canadian Task Force classification II-2).Setting
Two large teaching hospitals with a tertiary referral function for pelvic floor disorders.Patients
Patients with symptomatic POP and simplified POP quantification (S-POP) stage ≥2. Patients with a history of mesh repair or concomitant insertion of a tension-free vaginal tape were excluded.Interventions
Robot-assisted laparoscopic sacrocolpopexy or robot-assisted laparoscopic supracervical hysterectomy with a sacrocervicopexy.Measurements and Main Results
A blinded vaginal examination with the aid of a transparent speculum was performed to look for mesh-related complications. Mesh exposures were described following the International Urogynecological Association/International Continence Society classification system. One hundred and ninety-two patients were included, of whom 166 (86.5%) were seen for follow-up examination. The median duration of follow-up was 15.7 months (range, 8.2–44.4 months). Two vaginal mesh exposures (1.2%) were detected, both of which were treated in the outpatient clinic. One patient without any complaints had a suture exposure, which was removed in the outpatient clinic.Conclusion
The safety of the use of mesh in pelvic floor surgery is a matter of debate owing to the occurrence of mesh-related complications. Based on the current literature, mesh-related complications seem to be lower in transabdominal mesh surgery than in transvaginal mesh surgery. In this study, a low mesh exposure rate was observed in robot-assisted abdominal pelvic floor surgery for POP. 相似文献4.
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5.
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6.
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7.
Tanya P. Hoke Howard Goldstein Emily K. Saks Babak Vakili 《Journal of minimally invasive gynecology》2018,25(5):892-895
Study Objective
To evaluate surgical outcomes of robotic sacrocolpopexy with and without paravaginal repair for pelvic organ prolapse (POP).Design
A retrospective cohort study with a 3-month postoperative follow-up (Canadian Task Force classification II-3).Setting
An academic-affiliated community hospital with a practice comprised of 3 surgeons board certified in female pelvic medicine and reconstructive surgery.Patients
Patients undergoing robotic sacrocolpopexy for POP from April 2013 through November 2014.Interventions
Robotic paravaginal repair (RPVR) after robotic sacrocolpopexy. The decision to perform a paravaginal repair was at the discretion of the surgeon.Measurements and Main Results
One hundred fifty-six patients underwent a robotic sacrocolpopexy. Twenty-four patients were excluded because of a lack of a 3-month postoperative follow-up. Nine patients underwent concomitant vaginal paravaginal repair and were also excluded. Outcomes were defined by comparing preoperative characteristics with those at the 3-month follow-up. Of the 123 patients in this cohort, 21 patients underwent a concomitant RPVR, and 102 did not. All Pelvic Organ Prolapse Questionnaire (POP-Q) points improved within groups (p?<?.001) except for the total vaginal length (TVL) in the RPVR group (p?=?.940). The Patient Global Impression of Improvement (PGI-I) did not differ between groups (1.2 vs 1.5, p?=?.128). Subgroup analysis was performed on patients with preoperative anterior wall prolapse of stage 3 or greater. Baseline characteristics and perioperative data were not remarkably different from the main cohort. All POP-Q points improved within groups (p?<?.001) except for the TVL in the RPVR group (p?=?.572). The PGI-I did not differ between groups (1.2 vs 1.3, p?=?.378).Conclusion
In both groups, anatomic markers substantially improved within each group. There were significant differences in postoperative POP-Q findings, which may have been influenced by the fact that patients undergoing RPVR usually had worse baseline prolapse. This selection bias creates difficulty with interpretation. Although in this study RPVR did not change subjective outcomes, further study is necessary to control for the severity of prolapse. 相似文献8.
Yung-Wen Cheng Tsung-Hsien Su Hsuan Wang Wen-Chu Huang Hui-Hsuan Lau 《Taiwanese journal of obstetrics & gynecology》2017,56(2):184-187
Objective
Mesh erosion is a serious and not uncommon complication in women undergoing vaginal mesh repair. We hypothesized that mesh erosion is associated with the patient’s comorbidities, surgical procedures, and mesh material. The aims of this study were to identify the risk factors and optimal management for mesh erosion.Materials and Methods
All women who underwent vaginal mesh repair from 2004 to 2014 were retrospectively reviewed. Data on patients’ characteristics, presenting symptoms, treatment and outcomes were collected from their medical records.Results
A total of 741 women underwent vaginal mesh repairs, of whom 47 had mesh erosion. The median follow-up period was 13 months (range 3–84 months). Another nine patients with mesh erosion were referred form other hospitals. Multivariate analysis revealed that concomitant hysterectomy (odds ratio 27.02, 95% confidence interval 12.35–58.82; p < 0.01) and hypertension (odds ratio 5.95, 95% confidence interval 2.43–14.49; p < 0.01) were independent risk factors for mesh erosion. Of these 56 women, 20 (36%) were successfully treated by conservative management, while 36 (64%) required subsequent surgical revision. Compared with surgery, conservative treatment was successful if the size of the erosion was smaller than 0.5 cm (p < 0.01). Six patients (17%) had recurrent erosions after primary revision, but all successfully healed after the second surgery.Conclusion
Concomitant hysterectomy and hypertension were associated with mesh erosion. In the management of mesh erosion, conservative treatment can be tried as the first-line treatment for smaller erosions, while surgical repair for larger erosions. Recurrent erosions could happen and requires repairs several times. 相似文献9.
Study Objective
To demonstrate a simplified technique of performing laparoscopic sacrohysteropexy for uterine prolapse.Design
A technical video demonstrating a simplified method of laparoscopic sacrohysteropexy (Canadian Task force classification level III).Setting
The benign gynecology department at a university hospital.Interventions
A 38-year old woman with grade 3 uterine descent presented requesting surgical management for symptomatic prolapse.Conclusion
Laparoscopic sacrohysteropexy is becoming an increasingly popular alternative to hysterectomy to treat uterine prolapse in women. We present a novel approach of performing laparoscopic sacrohysteropexy that differs from previously described methods 1, 2; it is shorter, simpler, and reduces possible complications. Key differences include the mesh type, site of attachment, and dissection of the peritoneum while creating the possibility of future vaginal delivery after pregnancy. Our simplified technique uses a polyvinylidene fluoride mesh woven with a square weave secured to the posterior aspect of the cervix under a layer of visceral peritoneum. Because there is no longitudinal give of the mesh, unlike polypropylene meshes with a diamond weave, a wrap method [2] is not required. No dissection of the broad ligament and bladder is needed, eliminating the risk of bladder perforation and anterior mesh erosion with fewer adhesions and simplifying hysterectomy if required in the future. We also uniquely “tunnel” the peritoneum, reducing the size of defect for suture closure, and reperitonize the mesh. Previous methods restrict cervical dilatation and require women to have cesarean sections. The method described in the video allows women to deliver vaginally and, in the event of late miscarriage, avoid the need for hysterotomy. We have performed 25 cases with 1 mild cystocoele recurrence requiring no surgery, 1 reoperation for posterior compartment repair, and 1 case of cervical elongation requiring Manchester repair. No cases of recurrent uterine prolapse have occurred. 相似文献10.
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11.
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12.
Berna Haliloglu Peker Erdin Ilter Hakan Peker Aygen Celik Ali Gursoy Onur Gunaldi 《Journal of minimally invasive gynecology》2018,25(7):1146-1147
Study Objective
To demonstrate laparoscopic sacrohysteropexy for a case of uterine prolapse in a 12 weeks, 3 days pregnant woman. To our knowledge this is the first case of laparoscopic sacrohysteropexy performed at 12 weeks of gestation to be reported in literature.Design
A step-by-step explanation of the surgical procedure (Canadian Task Force classification III).Setting
Maltepe University Hospital.Patient
A 37-year-old pregnant woman.Intervention
Laparoscopic sacrohysteropexy. Institutional Review Board ruled that approval was not required for this study.Measurements and Main Results
Uterine prolapse is very rare condition, manifesting in an estimated 10 000 to 15 000 pregnancies [1]. The management plan must be individualized, and the obstetrician should aware of possible complications, such as preterm labor, high incidence of abortion, cervical ulceration, and cervical dystocia. In general, bedrest, good genital hygiene, and pessary use is recommended. Alternatively, in cases where conservative solutions have failed, laparoscopic surgery in the pregnant patient may be considered. To date, only 1 case of laparoscopic promontohysteropexy at 10th weeks of gestation was reported by Pirtea et al [2]. A 37-year-old woman, at 12 weeks and 3 days of gestation, with stage III pelvic organ prolapse was referred to our clinic. Conservative management with pessary failed. The patient underwent laparoscopic sacrohysteropexy after written informed consent form was obtained. In exploration, uterine manipulation was difficult because of softness and large size of the uterus. First, the sigmoid colon was suspended at the abdominal wall to gain an adequate surgical field. The promontorium was dissected and the parietal peritoneum incised on the right pelvic side wall after ureter visualization. A polypropylene mesh was fixed to the cervix at the level of the uterosacral ligaments. The other edge of the mesh was fixed at the level of the promontory using the Uplift device (Neomedic International, Barcelona, Spain). Then, the peritoneum was sutured to cover the mesh. The patient was discharged 2 days after surgery. At the examination the pelvic floor was detected to be normal. The patient delivered a healthy baby weighing 3030?g by cesarean section at 38 weeks of gestation. The position of the mesh was controlled during surgery. There was no peritoneal fold detected on the cervical part of mesh; however, no adhesion was observed.Conclusion
Laparoscopic sacrohysteropexy may be an alternative and safe approach, if conservative treatment fails, for pelvic organ prolapse during pregnancy. 相似文献13.
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14.
Yisong Chen Junwei Li Ying Zhang Keqin Hua 《Journal of minimally invasive gynecology》2018,25(4):585-588
Study Objective
More and more patients are pursuing minimally invasive surgery, which is becoming the trend for gynecologic surgery today. Pelvic organ prolapse (POP) is no exception. With the application of natural orifice transluminal endoscopic surgery, minimally invasive transvaginal sacrocolpopexy surgery assisted by single-port laparoendoscopy for POP becomes feasible. Here we describe our technique of transvaginal sacrocolpopexy using single-port laparoscopy for middle compartment POP.Design
Step-by-step explanation of the procedure using video.Setting
University hospital.Patient
A 59-year-old woman from China.Interventions
Transvaginal single-port laparoscopy sacrocolpopexy.Measurements and Main Results
We performed transvaginal single-port laparoscopy sacrocolpopexy on a 59-year-old woman from China who was diagnosed with POP-Q stage II anterior compartment, stage III middle compartment, stage II posterior compartment. This patient complained of a vaginal mass that had been prolapsed for 3 months. Institutional Review Board/Ethics Committee approval was obtained. Vaginal hysterectomy was performed first. Preventative bilateral salpingo-oophorectomy was done after a single-port platform was established. Right pelvic peritoneum was incised, from the promontory to the vault. Then, we exposed the rectovaginal and vesicovaginal spaces after injection of a water cushion (normal saline, 0.9% Nacl). A Y-shaped mesh (ARTISYN; Johnson & Johnson international, c/o European Logistics Centre, Diegem, Belgium) was fixed to the posterior vaginal wall and then to the sacral promontory (S1). After closing the pelvic peritoneum the anterior mesh was sutured. Before finishing the surgery we closed the vaginal cuff. The operation last for about 2 hours, with a blood loss of 50?mL. The patient was discharged with complete recovery. A 5-month follow-up showed no prolapse, mesh erosion, or other complications.Conclusion
Transvaginal single-port laparoscopic sacrocolpopexy is a considerable choice for middle compartment POP. However, more cases should be enrolled, and additional studies are required. 相似文献15.
Study Objective
To demonstrate laparoscopic colposuspension for recurrent stress incontinence after failed tension-free vaginal tape (TVT).Design
A technical video showing laparoscopic colposuspension for previously surgically treated stress incontinence (Canadian Task Force classification III).Setting
A university hospital.Patient
A 58-year-old woman with previous TVT presents with recurrent stress urinary incontinence.Measurements and Main Results
Midurethral slings have equivalent cure rates to the more invasive colposuspension. They are preferentially used for stress urinary incontinence despite a mesh erosion rate of 3.5% with 2.5% requiring further surgery, sling removal, or revision over 9 years 1, 2. Recent negative publicity concerning synthetic mesh tape has led to a resurgence of interest in mesh-free alternatives, including urethral bulking agents, rectus fascia slings, and colposuspension. Laparoscopic colposuspension is a well-established minimally invasive surgery that avoids synthetic mesh, with a quicker recovery, less scarring, and equivalent success to an open approach [3]. Bladder neck mobility is an important marker during selection of this technique. In this video, we demonstrate our transperitoneal technique of colposuspension in the case of failed TVT. This technique allows clear visualization of the operating field and is faster and less bloody than a full dissection. Because complications can ensue from extensive excision and extraction, unless the previous TVT has caused problems such as pain, we normally leave it in situ. Careful dissection is undertaken into the Retzius space to the paravaginal tissues where the iliopectineal ligament is located. On each side, we apply 2 extracorporeally tied nonabsorbable Ethibond (Johnson and Johnson Medical NV, Bruxelles, Belgium) sutures as recommended [4], caudal and lateral to the TVT, lifting the paravaginal tissues to the ligament. The knot is placed on the ligament side to minimize erosion risk. The peritoneal defect is closed with a Vicryl 2.0 (Johnson and Johnson Medical NV) suture. This technique offers a viable mesh-free option for the treatment of recurrent stress incontinence in women who have had failed TVT. 相似文献16.
Hiroyuki Kanao Tsuyoshi Hisa Makiko Omi Minoru Nagashima Shuhei Okamoto Yoichi Aoki Terumi Tanigawa Maki Matoda Sanshiro Okamoto Hidetaka Nomura Kohei Omatsu Kazuyoshi Kato Kuniko Utsugi Nobuhiro Takeshima 《Journal of minimally invasive gynecology》2019,26(1):34-35
Study Objective
To show total laparoscopic complete resection of a recurrent low-grade endometrial sarcoma.Design
Step-by-step demonstration of the technique of laparoscopic anterior pelvic exenteration with super radical parametrectomy, including the explanation of detailed pelvic anatomy (Canadian Task Force classification III).Setting
Low-grade endometrial stromal sarcoma (LGESS) is a rare malignancy that makes up around 0.2% of all uterine malignancies [1]. Total abdominal hysterectomy and bilateral salpingo-oophorectomy is a standard treatment; however, the recurrence risk is quite high [2]. For a recurrent LGESS that is resistant to hormone therapy and chemotherapy, complete resection with negative surgical margins (R0 resection) can be the most promising method [3].Patient
The patient had undergone total abdominal hysterectomy and bilateral salpingo-oophorectomy because of a LGESS. Almost 20 years later, a recurrent LGESS was detected at the vaginal stump, and the patient underwent several rounds of chemotherapy and hormonal therapy. These treatments were inefficacious, and the recurrent tumor progressed. An abdominal computed tomographic scan revealed that the recurrent tumor occupied the vaginal stump, involved the bladder and the left ureter, and extended to the left pelvic sidewall.Interventions
Anterior pelvic exenteration with super radical parametrectomy was performed laparoscopically with no blood transfusion. R0 resection could be achieved without any intraoperative and postoperative complications. Without any adjuvant treatment, there has been no sign of recurrence during the 12 months that have passed since the surgery. This video obtained institutional review board approval through our local ethics committee in the Cancer Institutional Hospital (institutional review board number 2016-1007).Conclusion
The good visualization and meticulous dissection provided during laparoscopic surgery can make the approach advantageous and may contribute to R0 achievement. 相似文献17.
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18.
Darron A. Halliday Khadija Warfa Máire A. Duggan Jill Nation Pamela Chu Gregg Nelson Sarah Glaze Jennifer Mateshaytis Prafull Ghatage 《Journal d'obstetrique et gynecologie du Canada》2019,41(2):180-184.e1
Objective
The goal of this study was to determine the impact of tumour board rounds (TBRs) on the additional management of patients with gynaecologic malignancy.Methods
A retrospective chart review of 1604 patients discussed between January 2011 and December 2013 at gynaecologic TBRs was conducted to determine the frequency and type of diagnostic discrepancies found post-TBRs and their potential impact on additional patient management. A discrepancy was defined as major if it affected patient management by cancelling, initiating, or modifying treatment; otherwise, the discrepancy was minor. Data collected included patients' demographics, pre- and post-TBR diagnoses, and management.Results
The patients' mean age was 57.6?±?14.1. Endometrial disease accounted for (43%) of the TBRs. The remaining sites were ovarian (25%), cervical (23%), and others (9%). Overall, 13.2% (n?=?212) had a discrepancy; 3.4% (n?=?54) of these discrepancies were major, and 9.9% (n?=?158) were minor. Most major discrepancies related to changes in the tumours' primary site or stage, and most minor discrepancies were related to changes in tumour histotype. Among the 54 (25.5%) major discrepancies, 18 (33.3%) occurred in patients who had their additional management cancelled, 17 (31.5%) required chemotherapy, 4 (7.4%) required a change in the chemotherapy regimen, 10 (18.5%) required additional surgery, and 5 (9.3%) required chemoradiation.Conclusion
The 13% frequency of discrepancies, approximately 26% of which were major and resulted in changes in patient management, highlights the importance of TBRs as a quality tool. 相似文献19.
20.