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1.
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2.
Yuval Fouks Aviad Cohen Udi Shapira Neta Solomon Benny Almog Ishai Levin 《Journal of minimally invasive gynecology》2019,26(3):535-543
Study Objective
To identify the clinical characteristics associated with surgical intervention in patients with tubo-ovarian abscess (TOA).Design
Retrospective cohort study (Canadian Task Force classification II-2).Setting
Tertiary university-affiliated hospital.Patients
Three hundred thirty-five patients were diagnosed with TOA based on sonographic and clinical criteria. Patients who underwent surgical intervention were compared with patients managed conservatively.Intervention
Electronic medical records were used to identify patients who were diagnosed with TOA between 2007 and 2015. All patients received the same antibiotic regimen upon admission. The data extracted included microbial and pathologic reports. Clinical characteristics such as disease severity and outcomes were compared. The clinical predictors available on patient admission for surgical intervention were identified retrospectively. A logistic regression was used to determine the independent predictors of treatment failure. A risk score was created by giving a nominal weight to each predictor. The score was validated by a random bootstrap analysis. An additional validation cohort that consisted of patients diagnosed with TOA during the 2 years after the original study period was applied to the final score.Measurements and Main Results
The following variables of patients who underwent surgical intervention in comparison with those successfully treated and were enrolled into the score analysis differed significantly: age at admission (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.3–3.5), mean leukocytosis at admission (OR, 2.2; 95% CI, 1.3–3.6), ultrasonographic measurement of abscess diameter (OR, 3.6 95% CI, 2.0–6.3), and the presence of bilateral abscess (OR, 2.2; 95% CI, 1.3–3.9). Risk groups A, B, C, and D were positively correlated with the need for surgical intervention. Those in the highest risk group D had an antibiotic failure rate of 92%, as compared with those with the lowest risk group, in which there was a 20% risk of antibiotic failure.Conclusions
Antibiotic treatment failure for TOA can be predicted on patient admission using a novel risk assessment score. 相似文献3.
Sabrina Piedimonte Nicholas Czuzoj-Shulman Walter Gotlieb Haim Arie Abenhaim 《Journal of minimally invasive gynecology》2019,26(3):551-557
Study Objective
To compare the use of robotic radical hysterectomy (RRH) and abdominal radical hysterectomy (ARH) in the United States, with secondary outcomes of perioperative complications, hospital length of stay (LOS), immediate postoperative mortality, cost and a subanalysis compared with laparoscopic radical hysterectomy (LRH).Design
Retrospective cohort study (Canadian Task Force classification II-2).Setting
Data from the National Inpatient Sample (NIS), a government-funded database of hospitalization in the United States.Patients and Interventions
All women with cervical cancer undergoing RH between 2008 and 2015 in the United States and included in the NIS database.Measurements and Main Results
Trends in surgical modality, baseline characteristics, LOS, perioperative outcomes, mortality, and hospital charges were compared between RRH and ARH. Regression models were adjusted for baseline characteristics. Among 41,317 women with cervical cancer, 3563 underwent RH, including 21.0% with a robotic procedure, 6.5% with a laparoscopic procedure, and 72.5% with open surgery. The annual rates of ARH declined significantly over the study period, whereas those of RRH increased. Baseline characteristics were comparable between the RRH and ARH groups. Compared with the ARH group, women undergoing RRH had a lower rate of cumulative postoperative complications (18.16% vs 21.21%; odds ratio [OR], 0.81; 95% confidence interval [CI], 0.6–1.0; p?=?.05), including lower rates of wound infection (0.27% vs 1.82%; OR, 0.14; 95% CI, 0.03–0.6; p < .01), sepsis (0.27% vs 1.20%; OR, 0.22; 95% CI, 0.05–0.9; p?=?.03), fever (1.87% vs 4.06%; OR, 0.44, 95% CI, 0.3–0.8; p < .01), and ileus (2.8% vs 9.13%; OR, 0.28; 95% CI, 0.12–0.4; p < .01). The LOS was significantly shorter in the RRH group (median, 2 days vs 4 days; p < .01). The total median hospitalization charge was $47,218 for the RRH group, compared with $38,877 for the ARH group (p < .01).Conclusion
RRH is being increasingly performed in the United States and is associated with shorter LOS and less postoperative morbidity; however, long-term oncologic outcomes require additional attention. 相似文献4.
Aila Coello Eva Sanchez Begoña Vallejo Marcos Meseguer José Remohí Ana Cobo 《Reproductive biomedicine online》2019,38(3):313-320
Research question
Does the presence of dysmorphisms affect post-warming survival and embryo development in vitrified autologous oocytes?Design
A retrospective study comparing post-warming survival, fertilization and embryo development between morphologically normal (n?=?269) and dysmorphic oocytes (n?=?147).Results
The survival rate was 81.4% in the morphologically normal oocytes and 87.1% in the dysmorphic oocyte group (OR 1.53; 95% CI 0.86 to 2.72). The fertilization rate was 69.9 versus 66.4% (OR 0.85; 95% CI 0.53 to 1.36), the proportion of good-quality embryos on day 3 was 30.3% versus 32.0% (OR 1.08; 95% CI 0.59 to 1.97) and the blastocyst formation rate was 54.5% versus 60.5% (OR 1.27; 95% CI 0.60 to 2.72) for the morphologically normal and the dysmorphic oocytes group, respectively. No statistical differences were found when the number and type of dysmorphism were analysed.Conclusion
Oocyte dysmorphisms did not seem to affect survival, fertilization and embryo development in vitrified autologous oocytes, and yielded comparable results to the morphologically normal oocytes. 相似文献5.
Margit Dueholm Ina Marie Dueholm Hjorth Katja Dahl Estrid Stær Hansen Gitte Ørtoft 《Journal of minimally invasive gynecology》2019,26(3):516-525
Study Objective
To evaluate the risk of endometrial cancer (REC) scoring system for the prediction of high and low probability of endometrial cancer (EC) in women with postmenopausal bleeding (PMB).Design
A prospective study (Canadian Task Force classification II-1).Setting
An academic hospital.Patients
Nine hundred fifty consecutive patients with PMB underwent transvaginal ultrasonography (TVS) and REC scoring between November 2013 and December 2015.Interventions
Obstetrics and gynecology residents supervised by trained physicians scored endometrial patterns according to the previously established REC scoring system. The reference standard was endometrial samples, endometrial thickness (ET, 4–4.9 mm), operative hysteroscopy or hysterectomy (ET ≥5 mm), and 1-year follow-up in all patients presenting with ET <4 mm. Diagnostic performance for the prediction of probability of malignancy was assessed using the REC scoring system.Measurements and Main Results
The area under the receiver operating characteristic curve of the TVS REC scoring system was 97% (95% confidence interval [CI], 95%–98%) for the prediction of malignancy. In 656 patients with ET ≥4 mm, REC scoring effectively predicted a high probability of malignancy with sensitivity (95% confidence interval) of 92% (95% CI, 87%–95%) and specificity of 94% (95% CI, 91%–96%). An REC score of 0 was present in 206 (32%) patients with ET ≥4 mm and was associated with a low negative likelihood ratio of 0.026 for EC. There were only 7 patients with EC/atypical hyperplasia among these 206 patients.Conclusion
The REC scoring system identified or ruled out most ECs, clearly showing that more specific image analysis at first-line TVS can accelerate the diagnosis of EC in patients with PMB and may allow for improved selection of second-line strategies in patients with ET ≥4 mm. 相似文献6.
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7.
Kazuyoshi Aoyama Joel G. Ray Ruxandra Pinto Andrea Hill Damon C. Scales Stephen E. Lapinsky Robert A. Fowler 《Journal d'obstetrique et gynecologie du Canada》2019,41(5):631-640
Objective
Pregnancy-associated morbidity results in hundreds of thousands of deaths annually worldwide. Reducing maternal mortality is a key United Nations Millennium Development Goal. Although maternal mortality has declined in high-income countries, contemporary estimates of maternal morbidity and mortality trends in Canada are lacking.Methods
This population-based study investigated all antepartum, peripartum, and postpartum women presenting to an acute care hospital in Canada from April 1, 2004 to March 31, 2015. The primary outcome was the change in rates of severe maternal morbidity over time. Secondary outcomes included severe maternal mortality and intensive care unit admission, including by province and territory (level of evidence: II2).Results
The cohort comprised 2 035 453 mothers with 3 162 303 pregnancies. There were 17.7 per 1000 episodes of severe maternal morbidity, with annual increases of 1.3% (95% confidence interval [CI] 0.60–2.0) for severe maternal morbidity. The maternal mortality rate was 6.2 per 100 000 deliveries and stable over time (estimated percentage of annual change of ?0.46%; 95% CI ?5.0 to 4.3). The most common causes of severe maternal morbidity were postpartum hemorrhage (5.5 per 1000 deliveries), sepsis (3.8 per 1,000 deliveries), and cardiac failure (1.5 per 1000 deliveries). Severe maternal morbidity varied across Canadian regions but was highest in the Territories at 22.8 per 1000 deliveries.Conclusion
Although maternal mortality has been stable in Canada over time, rates of severe maternal morbidity are increasing and are associated with substantial regional variation, with the highest rates experienced by women in the northern Territories. 相似文献8.
Isabelle Cédrin-Durnerin Tiphaine Isnard Sarah Mahdjoub Charlotte Sonigo Alice Seroka Marjorie Comtet Charlène Herbemont Christophe Sifer Michael Grynberg 《Reproductive biomedicine online》2019,38(3):472-480
Research question
Is serum progesterone measurement on the day of embryo transfer associated with outcome of frozen–thawed embryo transfer (FET) in cycles using hormonal replacement therapy (HRT) for endometrium preparation?Design
This single-centre retrospective study assessed the relationship between serum progesterone on embryo transfer day and live birth rates in 227 FET cycles. Endometrial preparation was performed by sequential administration of vaginal oestradiol until endometrial thickness was >7 mm, followed by transdermal oestradiol combined with 600 mg vaginal micronized progesterone.Results
Mean serum embryo transfer day progesterone was 11.4 ng/ml. Serum progesterone <10 ng/ml was observed in 37% of cycles and was associated with significantly lower pregnancy (34% versus 48%, P= 0.04) and live birth rates (17% versus 31%, P= 0.01). Multivariate logistic regression analysis identified serum embryo transfer day progesterone as a significant prognostic factor for live birth rate (odds ratio [OR]: 2.75, 95% confidence interval [CI]: 1.40–5.43]). Receiver operator curve analysis for live birth rates by serum progesterone levels on embryo transfer day gave an area under the curve of 0.62 (95% CI: 0.53–0.72).Conclusions
The data show that serum progesterone concentration is associated with live birth rate. This outlines the importance of measuring serum progesterone in FET with HRT although progesterone monitoring is not usually performed in routine practice. However, the optimal timing for measurement and further adaptive management in the presence of low values remain to be determined. 相似文献9.
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10.
Birgit Alsbjerg Thor Haahr Helle O Elbaek Rita Laursen Betina B Povlsen Peter Humaidan 《Reproductive biomedicine online》2019,38(5):677-682
Research question
What are the reproductive outcomes of Bologna criteria poor responders undergoing dual stimulation (DuoStim) and subsequent cryopreserved embryo transfer?Design
Case series of patients treated during the period August 2015 to March 2018 in a public fertility clinic. The study included 54 Bologna criteria poor responder IVF patients younger than 42 years receiving a follicular stimulation (DuoStim 1) followed by a luteal phase stimulation (DuoStim 2) within the same cycle, both stimulations being performed with corifollitropin alfa followed by a subsequent cryopreserved embryo transfer cycle. The primary endpoint was the number of oocytes retrieved in DuoStim 1 compared with DuoStim 2. The secondary endpoint was ongoing pregnancy rate (OPR) at 12 weeks of gestation.Results
The mean number of oocytes retrieved in DuoStim 1 and DuoStim 2 was 2.4 ± 2.1 versus 3.7 ± 2.6, respectively; thus, a total of 1.2 (95% CI, 0.46–1.96) more oocytes was retrieved in DuoStim 2 compared with DuoStim 1 (P = 0.002). The OPR at 12 weeks was 20% (11/54) in this poor ovarian response population with a mean age of 36.7 years.Conclusions
Luteal phase stimulation results in more oocytes in poor responders compared with follicular phase stimulation. DuoStim, using corifollitropin alfa followed by individualized FSH dosing, appears to be an alternative to conventional follicular phase stimulation, decreasing the risk of cycle cancellation. 相似文献11.
Sarah Maheux-Lacroix Catherine Bergeron Lynne Moore Marie-Ève Bergeron Jessica Lefebvre Iseult Grenier-Ouellette Sylvie Dodin 《Journal d'obstetrique et gynecologie du Canada》2019,41(5):593-598
Objective
This study sought to examine whether hysterosalpingosonography (sono-HSG) is as effective as hysterosalpingography (HSG) in facilitating conception by comparing pregnancy rates in the 6 months following the procedures.Methods
This retrospective noninferiority study (Canadian Task Force classification II-2) was conducted at a tertiary university centre. The investigators studied 440 consecutive eligible infertile women. Bilateral tubal occlusion, severe male infertility, and having undergone both procedures were exclusion criteria. Tubal testing, as part of the infertility workup, was performed by either sono-HSG or HSG. The primary outcome was pregnancy, defined as a positive fetal heartbeat on ultrasonographic examination, in the 6 months following the procedure.Results
A total of 57 pregnancies (26%) were observed in the HSG group and 33 (15%) in the sono-HSG group. Adjusted and non-adjusted relative risks of pregnancy in the 6 months following sono-HSG compared with HSG were 0.61 (95% CI 0.42–0.89) and 0.58 (95% CI 0.39–0.85). Adverse events were infrequent with both procedures (sono-HSG, 1%; HSG, 4%; P?=?0.16).Conclusion
This study suggests that uterine flushing as performed during sono-HSG is not as effective as when performed during HSG to increase the chances of pregnancy, but further studies will be required because of bias related to the retrospective study design. 相似文献12.
HodaMaaly Harb Jayasish Ghosh Firas Al-Rshoud Bala Karunakaran Ioannis D. Gallos Arri Coomarasamy 《Reproductive biomedicine online》2019,38(3):427-441
Research question
What is the association between hydrosalpinx and pregnancy loss and the effects of treatment for hydrosalpinx?Design
A systematic review and meta-analysis was conducted to investigate the risk of pregnancy loss, and the benefit of treatment in women with hydrosalpinx. Searches were conducted on MEDLINE, Embase, the Cochrane Library and Web of Science.Results
A meta-analysis of 14 observational studies showed a 74% relative increase in the risk of pregnancy loss in women with hydrosalpinx compared with women without hydrosalpinx (relative risk [RR]?=?1.74, 95% confidence interval [CI]: 1.43, 2.12, P< 0.00001, I2?=?31%). Pooling of risk ratios from seven randomized trials and six observational studies of treatment of hydrosalpinx showed a reduction in pregnancy loss of approximately half when compared with no treatment (RR?=?0.46, 95% CI: 0.34, 0.63, P <0.00001, I2?=?0%).Conclusions
This evidence suggests that the presence of hydrosalpinx increases the risk of pregnancy loss and that treatment can reduce this risk. However, in all studies apart from one, participants conceived through IVF so the evidence is less certain for women conceiving naturally. Further research should consider whether women with recurrent miscarriages should have routine screening for hydrosalpinx. 相似文献13.
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14.
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15.
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16.
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 K. Rasmussen Estrid S. Hansen Erik Ernst Margit Dueholm 《Reproductive biomedicine online》2019,38(5):750-760
Research question
How diagnostically accurate is two-dimensional (2D-TVS) compared with three-dimensional transvaginal ultrasonography (3D-TVS) in diagnosing adenomyosis of the inner myometrium. What is the most accurate combination of ultrasonographic features?Design
Premenopausal women (n?=?110) scheduled for hysterectomy or transcervical resection of the endomyometrium owing to abnormal uterine bleeding were consecutively enrolled. All participants had real-time 2D-TVS and, later, blinded off-line 3D-TVS to diagnose adenomyosis. Results were compared with a detailed histopathological examination of the inner myometrium as gold standard.Results
Prevalence of adenomyosis of the inner myometrium was 29%. For 2D-TVS and 3D-TVS, respectively, the diagnostic accuracy was sensitivity 72% (95% CI 53 to 86) and 69% (95% CI 50 to 84); specificity 76% (95% CI 65 to 85) and 86% (95% CI 76–93); and area under the curve (AUC) 0.74 (95% CI 0.7 to 0.8) and 0.77 (95% CI 0.7 to 0.9). Specificity of 3D-TVS was not statistically significantly better than 2D-TVS; the difference between them almost reached statistical significance (P?=?0.06). The most accurate three-dimensional feature was junctional zone irregularity (JZmax–JZmin ≥5mm) (AUC: 0.78). A combination of two or more two-dimensional and two or more three-dimensional features was highly accurate (AUC: 0.77).Conclusions
For diagnosing adenomyosis of the inner myometrium, 3D-TVS offers a high accuracy similar to 2D-TVS. Identification of junctional zone irregularity with 3D-TVS may be beneficial to diagnosis. Two or more two-dimensional features and two or more three-dimensional features combined may give a more objective diagnosis, and may be useful for clinical practice and future research. 相似文献19.
Ye Zhang Xiaochen Song Meng Mao Jia Kang Fangfang Ai Lan Zhu 《Journal of minimally invasive gynecology》2019,26(4):754-759
Study Objective
To evaluate the long-term safety and efficacy of tension-free vaginal tape (TVT).Design
Prospective observational study (Canadian Task Force classification II-2).Setting
Tertiary referral center in China.Patients
Between January 2004 and December 2005, 85 consecutive patients who underwent the TVT procedure were included. Patients with mixed incontinence or pelvic organ prolapse requiring surgery were excluded.Interventions
TVT procedure.Measurements and Main Results
The primary outcomes were long-term postoperative complications. The secondary outcomes included long-term subjective satisfaction (Patient Global Impression of Improvement), objective cure rate (stress test), quality of life, and sexual function. At the 13-year follow-up, 70 patients (82%) were available for evaluation. De novo overactive bladder was observed in 15.7% of patients, and voiding symptoms were found in 17.1% of patients. None of the patients reported voiding dysfunction that needed treatment with tape removal or catheterization. Tape exposure occurred in 2.9% of patients. The subjective satisfaction rate and objective cure rate were 78.6% and 81.4%, respectively.Conclusion
TVT is a safe and effective treatment for stress urinary incontinence, even at the 13-year follow-up. The prevalence rates of overactive bladder and voiding symptoms are increased with advancing age and should not be considered long-term postoperative complications. 相似文献20.
Wei Xia Jian Zhang Duo Zhang Qian Zhu Huiyu Zhang Zhen Huang Feng Sun Hongjie Pan Hua Duan 《Journal of minimally invasive gynecology》2019,26(4):671-678