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Adel Sedrati Amal Drizi Bruno van Herendael Dusan Djokovic 《Journal of minimally invasive gynecology》2019,26(1):29-30
Study Objective
To present and discuss the hysteroscopic aspects of incarcerated omentum through uterine perforation caused by previous dilation and curettage (D&C) for an incomplete first-trimester abortion.Design
A case report.Setting
Constantine University Hospital, Constantine, Algeria.Patient
A 40-year-old, gravida 3, para 2 patient, with a history of an incomplete first-trimester spontaneous abortion treated 6 months before by D&C requiring medical assistance because of moderate, chronic pelvic pain. No other clinical or biological alteration was found. The ultrasound showed intracavitary hyperechogenic formation infiltrating the myometrium posteriorly.Interventions
Hysteroscopy revealed a fatlike lesion arousing suspicion of a residual trophoblast; the differential diagnosis included intramyometrial fat metaplasia as well [1]. A mechanical cold loop resection was initiated. Instrumental manipulation of the mass released yellow drops, probably of lipid nature, subsequently leading to the discovery of a uterine perforation giving passage to the omentum. Histologic examination confirmed fat tissue. There was immediate resolution of symptoms. Laparoscopic repair was subsequently performed and consisted of suturing the defect. There were no further complications.Measurements and Main Results
Few cases of omentum incarceration in a perforated uterus diagnosed during laparotomy or by magnetic resonance imaging have previously been reported 2, 3, 4. To our knowledge, this is the first case revealed through hysteroscopy.Conclusion
In women with a history of intracavitary interventions such as D&C, omentum incarceration should be considered when hysteroscopy demonstrates a fatlike formation and yellow droplets released by pressing or mobilizing the formation. Surgeons should be cautious, never using electrosurgery on formations whose origin arouses suspicion. 相似文献3.
Study Objective
To demonstrate a technique of performing laparoscopic resection of a post–cesarean section scar uterine cyst.Design
Technical video (Canadian Task Force classification III).Setting
University Hospital.Patient
A 38-year old woman.Intervention
Laparoscopic excision of a uterine cyst within a cesarean section scar.Measurements and Main Results
A 38-year-old woman presented with secondary subfertility requesting removal of a cesarean section scar defect to prepare the uterine cavity for in vitro fertilization. Preoperative ultrasound demonstrated a 17.7?×?12.2?mm scar defect. At rigid hysteroscopy the anterior uterine wall cyst was observed and noted to be narrowing the uterine cavity. A laparoscopic approach was used to excise the uterine cyst. We carefully mobilized the bladder from its adhesions at the site of the previous cesarean section scar. The uterine cyst was located and margins of the defect identified. An ultrasonic-energy device was used to enucleate and excise the cyst. A uterine manipulator helped to identify the cervical canal and protect the posterior wall from inadvertent suture placement. The defect was closed with 1 vicryl interrupted sutures, being careful to incorporate the full thickness of the uterine wall to an able maximal opposition. An adhesion barrier was applied to the area. Transvaginal ultrasound scanning performed 6 weeks postoperatively demonstrated full healing with no residual defect.Conclusion
Niches are recognized complications of cesarean sections resulting from incomplete healing of the scar and more likely in single-layer closures [1]. They can be associated with postmenstrual spotting, dysmenorrhea, chronic pain, subfertility, and poorer reproductive and obstetric outcomes 1, 2, 3, 4, 5. Laparoscopic resection of niches is well established, showing symptomatic relief and an increase in residual myometrium [6]. Although cesarean section scar defects have been described as niches, we presented a further variety of defect that has not been previously described, a uterine cyst. 相似文献4.
Study Objective
To demonstrate a mesh-free laparoscopic uterosacral suture sacrohysteropexy (LUSSH).Design
Technical video demonstrating LUSSH for uterine prolapse (Canadian Task Force classification III).Setting
University hospital.Patient
A 37-year-old woman with grade 3 uterine descent requested uterine-sparing surgery for symptomatic prolapse. The patient declined all mesh procedures.Intervention
Mesh-free laparoscopic uterosacral suture sacrohysteropexy (LUSSH).Measurements and Main Results
Laparoscopic sacrohysteropexy is a uterine-preserving technique for uterine prolapse with high cure rates (92%) but with a mesh erosion risk of up to 2.5% 1, 2. Complications have resulted in reclassification of transvaginal meshes as restricted-use high-risk medical devices 3, 4. Sacrospinous hysteropexy and uterosacral ligament suspension are mesh-free alternatives, but they have increased rates of anterior-compartment failures and a 20% recurrence rate in the latter 5, 6. Laparoscopic suture sacrohysteropexy has been described with reported success rates of 95% [7]. This video demonstrates a modified-technique offering a simple, robust, and reproducible mesh-free approach to uterine-preserving prolapse surgery. We used 2 horizontal loop mattress sutures acting as a pulley to distribute the force evenly throughout the suture strand, leading to a significantly stronger and more secure hold and reducing risk of avulsion [8]. The technique starts with a careful dissection of the peritoneum from the sacral promontory to the cervix. Two permanent sutures are used, taking bites at the anterior longitudinal ligament, the uterosacral, a loop mattress in the midline at the cervix, the uterosacral on the way back, and finally at the sacral promontory. Damage to the uterine vessels is minimized by maintaining a central uterine position. The stitch is tied with caudal pressure on the uterus, applied via the uterine manipulator, approximating the cervix to the sacral promontory. The peritoneum is closed with dissolvable sutures, burying the Ethibond to prevent exposure and bowel obstruction.Conclusion
Post-procedure, the uterus was well supported with a vaginal length of 15 cm. 相似文献5.
Antonio Mollo Antonio Raffone Francesco Paolo Improda Antonio Travaglino Gabriele Saccone Pierluigi Giampaolino Fulvio Zullo Giuseppe De Placido 《Journal of minimally invasive gynecology》2019,26(1):32-33
Study Objective
Angular pregnancy is a rare and life-threatening condition in which the embryo is implanted in the lateral angle of the uterine cavity, medial to the uterotubal junction and round ligament. Angular pregnancy is associated with a high risk of uterine rupture of about 23% [1]. No consensus has been achieved regarding the diagnostic and therapeutic approach of angular pregnancy [2]. Thus, the aim of this study was to report a case of hysteroscopic treatment of an angular pregnancy in a 34-year-old women.Design
Step-by-step video presentation of the surgical treatment (Canadian Task Force classification III).Setting
Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.Patient
A 34-year-old woman. Written informed consent was obtained from the patient.Intervention
Hysteroscopy.Measurements and Main Results
A 34-year-old woman was admitted to our Department with pelvic pain at 6 weeks of gestation. β-Human chorionic gonadotropin (β-hCG) was 5331 mIU/mL. The transvaginal ultrasound showed a gestational sac of 15?×?11?mm in the left uterine angle of an embryo without cardiac activity. The woman opted for a conservative approach with multiple-dose methotrexate [3]. Five days later the β-hCG increased to 7589 mIU/mL with no regression of pregnancy at the transvaginal ultrasound. Therefore, a surgical approach was offered to the patient 4, 5. Laparoscopy showed normal salpinges, whereas hysteroscopy identified the gestational sac in the left uterine angle. A 5Fr bipolar electrode was used to open the gestational capsular decidua. The chorionic villi were progressively separated from the implantation site. Using grasping forceps we removed the specimen for histologic examination. Histologic examination confirmed the diagnosis of angular pregnancy. On the second postoperative day β-hCG was 1131 mIU/mL, and the patient was discharged the day after. At the 1-month follow-up visit, β-hCG and transvaginal ultrasound were negative for pregnancy. The office hysteroscopy showed an empty uterine cavity at 3-months' follow-up.Conclusion
Our case shows that hysteroscopy may be used as a diagnostic and therapeutic tool for angular pregnancy, providing a unique image of the intact removal of the gestational sac. 相似文献6.
Ahmet Kale Gulfem Basol Taner Usta Isa Cam 《Journal of minimally invasive gynecology》2019,26(2):360-361
Study Objective
To demonstrate the laparoscopic approach to malformed branches of the vessels entrapping the nerves of the sacral plexus.Design
A step-by-step explanation of the surgery using video (educative video) (Canadian Task force classification II). The university's Ethics Committee ruled that approval was not required for this video.Setting
Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey.Patient
A 26-year-old patient who had failed medical therapy and presented with complaints of numbness and burning pain on the right side of her vagina and pain radiating to her lower limbs for a period of approximately 36 months.Intervention
The peritoneum was incised along the external iliac vessels, and these vessels were separated from the iliopsoas muscle on the right side of the pelvis. The laparoscopic decompression of intrapelvic vascular entrapment was performed at 3 sites: the lumbosacral trunk, sciatic nerve, and pudendal nerve. The aberrant dilated veins were gently dissected from nerves, and then coagulated and cut with the LigaSure sealing device (Medtronic, Minneapolis, Minn).Measurements and Main Results
The operation was completed successfully with no complications, and the patient was discharged from the hospital 24 hours after the operation. At a 6-month follow-up, she reported complete resolution of dyspareunia and sciatica (visual analog scale score 1 of 10).Conclusion
A less well-known cause of chronic pelvic pain is compression of the sacral plexus by dilated or malformed branches of the internal iliac vessels. Laparoscopic management of vascular entrapment of the sacral plexus has been described by Possover et al 1, 2 and Lemos et al [3]. This procedure appears to be feasible and effective, but requires significant experience and familiarity with laparoscopy techniques and pelvic nerve anatomy. 相似文献7.
Matthew T. Siedhoff Michelle Louie Meenal Misal Janelle K. Moulder 《Journal of minimally invasive gynecology》2019,26(1):25-28
Study Objective
To demonstrate techniques for addressing the unique challenges for a minimally invasive approach to hysterectomy presented by a massive myomatous uterus.Design
Technical video of an operation demonstrating the methods used to perform hysterectomy in this setting, highlighting such aspects as port placement (Fig. 1), uterine manipulation (Fig. 2), exposure, and vascular control (Fig.?3, Fig.?4) (Canadian Task Force classification III).Setting
Academic tertiary care hospital.Intervention
A 49-year-old woman elected to proceed with laparoscopic hysterectomy after years of suffering from bleeding and bulk symptoms from a massively enlarged myomatous uterus. A computed tomography scan estimated uterine dimensions of 32?×?27?×?24?cm, for a volume of >7000?mL (Fig. 5). Her surgical history included a ventral herniorrhaphy with mesh, and her body mass index was 43?kg/m2. She was a Jehovah's Witness, and thus blood transfusion was not an acceptable option for her due to a religious prohibition. Intraoperatively, the uterus extended deep into the pararectal and paravesical spaces on the right, from the caudad below the cervix (Fig. 6) to superiorly near the liver edge (Fig. 7).Measurements and Main Results
Laparoscopic hysterectomy was successfully completed (Table), and the patient was discharged on the day after surgery. Final pathology revealed a 6095-g uterus with benign leiomyomata. She presented 9 days after surgery with nausea and vomiting, suspicious for an incarcerated hernia at the tissue extraction site. Her symptoms were ultimately determined to be due to either ileus or small bowel obstruction, which likely could have been managed nonoperatively with bowel rest and fluids. She stayed an additional 2 days after readmission and was then discharged, with no further complications.Conclusions
The size of the uterus was once considered a barrier to the use of laparoscopy for hysterectomy, but experience has shown that the benefits of minimally invasive surgery are particularly relevant for large myomas 1, 2, 3, 4, given that a vaginal approach is not feasible and that other risks, such as wound complications and venous thromboembolism, would be greater with the large incision required to perform the procedure by laparotomy. This video uses a particularly challenging case to demonstrate a roadmap for addressing myomas in laparoscopic hysterectomy through exposure and vascular control. Although the presentation focused on the initial steps of the procedure and not on uterine extraction, this patient's readmission highlights potential complications associated with various methods of tissue removal for very large specimens. 相似文献8.
9.
Konstantinos Nirgianakis Susanne Lanz Sara Imboden Mathias Worni Michael D. Mueller 《Journal of minimally invasive gynecology》2018,25(5):771-772
Study Objective
To present an unusual consequence of laparoscopic treatment of diaphragmatic endometriosis, to discuss the possible etiologies, and to propose proper management.Design
A step-by-step explanation of 2 surgeries of the same patient using intraoperative video sequences (Canadian Task Force classification III).Setting
University hospital.Patient
A 32-year-old woman.Interventions
Two Laparoscopic surgeries.Measurements and Main Results
Endometriosis is estimated to affect 11% of the population 1, 2, with an estimated 12% of these patients having extrapelvic endometriosis [3]. When the diaphragm is involved, the disease potentially causes severe and debilitating symptoms such as catamenial chest or shoulder pain. Serious complications may involve pneumothorax and hemopneumothorax 4, 5, 6. Diaphragmatic endometriosis is more common than realized and has been shown to occur simultaneously in 50% to 80% of cases with pelvic endometriosis 7, 8. A 32-year-old woman was admitted to our hospital with severe disabling dysmenorrhea and right shoulder pain. Despite progestin, nonsteroidal anti-inflammatory drug, and opioid treatment, pain relief remained inadequate. A laparoscopy was performed revealing diaphragmatic endometriosis, which was completely excised. A revision was necessary 14 months later because of pain recurrence in the right hemithorax and suspicion of new or persistent endometriotic lesions. The laparoscopy revealed small diaphragm fenestrations that were closed after exclusion of recurrent diaphragmatic or pleural endometriosis. No chest tube was placed, and the postoperative course was uneventful. Hormonal suppressive treatment was continued. Since the operation the patient has been pain free. Institutional Review Board/Ethics Committee ruled that approval was not required for this study (Req-2017-00415).Conclusion
The diaphragm fenestrations were possibly the result of tissue necrosis caused by thermocoagulation after excision of deep endometriotic lesions during the first surgery. Using a CO2 laser for the vaporization of superficial lesions is favorable because of the smaller depth of penetration compared with electrocautery and better access to hard to reach areas 9, 10. Endometriotic lesions involving the entire thickness of the diaphragm should be completely excised and the defect repaired with either sutures or staples 11, 12, 13. 相似文献10.
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11.
Benjamin D. Beran Marie Shockley Katrin Arnolds Michael L. Sprague Stephen E. Zimberg Andreas Tzakis Tommaso Falcone 《Journal of minimally invasive gynecology》2018,25(2):329
Study Objective
Uterine transplantation has proven feasible since the first live birth reported in 2014. To enable attachment of the uterus in the recipient, long vascular pedicles of the uterine and internal iliac vessels were obtained during donor hysterectomy, which required a prolonged laparotomy to the living donors. To assist further attempts at uterine transplantation, our video serves to review literature reports of internal iliac vein anatomy and demonstrate a laparoscopic dissection of cadaver pelvic vascular anatomy.Design
Observational (Canadian Task Force Classification III).Setting
Academic anatomic laboratory. Institutional Review Board ruled that approval was not required for this study.Intervention
Literature review and laparoscopic dissection of cadaveric pelvic vasculature, focusing on the internal iliac vein.Measurements and Main Results
Although the internal iliac artery tends to have minimal anatomic variation, its counterpart, the internal iliac vein, shows much variation in published studies 1, 2. Relative to the internal iliac artery, the vein can lie medially or laterally. Normal anatomy is defined as some by meeting 2 criteria: bilateral common iliac vein formed by ipsilateral external and internal iliac vein at a low position and bilateral common iliac vein joining to form a right-sided inferior vena cava [2]. Reports show 79.1% of people have normal internal iliac vein anatomy by these criteria [2]. The cadaver dissection revealed internal iliac vein anatomy meeting criteria for normal anatomy.Conclusion
Understanding the complexity and variations of internal iliac vein anatomy can assist future trials of uterine transplantation. 相似文献12.
Study Objective
To demonstrate a minimal invasive surgical (MIS) technique for curative excision of extensive secondary disseminated peritoneal leiomyomatosis (DPL).Design
The Institutional Review Board of Human Investigation and Ethics Committee of Chang Gung Medical Foundation ruled that approval was not required for this study.Patient
Woman aged 46 years.Interventions, Measurements, and Main Results
In MIS the myoma has to be divided into small fragments for piecemeal retrieval through a small incision [1] with a widely used technique called morcellation (confined or unconfined) [2]. DPL is a rare sequellae after laparoscopic morcellation. Because this entity is rarely reported, this video demonstrates laparoscopic technique for safe removal of DPL post laparoscopic myomectomy and morcellation. A 46-year-old woman with a past history of laparoscopic myomectomy with specimen retrieval by a power morcellation 8 years ago presented with abdominal discomfort. Computed tomography revealed multiple iso-dense lesions in the uterine corpus and pelvic cavity. Upon laparoscopy multiple nodules were identified at the previous myomectomy scar, pelvic peritoneum, ovarian surface, and over the small bowel. A total laparoscopic hysterectomy with bilateral salpingo-oophorectomy along with excision of all visible lesions was performed.Conclusions
In this video we demonstrate a safe retroperitoneal approach for complete excision of DPL. Laparoscopic hysterectomy or myomectomy with unconfined morcellation appears to be associated with the risk of DPL [3]. Complete tissue fragment retrieval will minimize the sequelae of morcellation. Hence, myoma remnants should be carefully extracted and confined morcellation should be considered. Because DPL causes significant distortion of pelvic anatomy, thorough knowledge of pelvic surgical anatomy and retroperitoneal approach for complete excision of all lesions is recommended. 相似文献13.
Filipa Osório João Alves João Pereira Marta Magro Sónia Barata Adalgisa Guerra António Setúbal 《Journal of minimally invasive gynecology》2018,25(2):330-333
Study Objective
To describe our surgical approach in a rare case of deep infiltrating endometriosis of the obturator internus muscle with obturator nerve involvement.Design
A step-by-step surgical explanation using video and literature review (Canadian Task Force Classification III).Setting
Endometriosis can be pelvic or rarely extrapelvic and is classically defined as the presence of endometrial glands and stroma outside the uterine cavity 1, 2. Pain along the sensitive area of the obturator nerve, thigh adduction weakness and difficulty in ambulation are extremely rare presenting symptoms 2, 3, 4.Patient
We report a case of a 32-year-old patient who presented with cyclic leg pain in the inner right thigh radiating to the knee caused by a cystic endometriotic mass in the obturator internus muscle with nerve retraction. The patient provided informed consent to use the surgical video. Institutional review board approval was obtained.Interventions
Pelvic magnetic resonance imaging was performed and confirmed a nodular lesion of about 2.3?cm with high signal on T1WI and T2WI and without fat suppression on T2FS inside the right obturator internus muscle, suggesting an endometriotic lesion (Fig. 1). Surgical removal of the mass was performed using the laparoscopic approach. A normal pelvic cavity was found, and the retroperitoneal space was dissected. A mass located within the right obturator internus muscle, below the right iliac external vein, behind the corona mortis vein, and lateral to the right obturator nerve was identified. The whole region was inflamed, and the nerve was partially involved. Dissection was performed carefully with rupture of the tumor, releasing a chocolatelike fluid (Fig. 2), and the cyst was removed. Pathology examination was consistent with endometriosis. Patient improvement was observed, with pain relief and improved ability for right limb mobilization. No recurrence of endometriosis was found at the follow-up visit 6 months later.Measurements and Main Results
The obturator nerve is responsible for motor and sensitive innervation of the joins and internal muscles of thigh and knee as well as the innervation of skin in the internal thigh. Pain along the sensitive area of the obturator nerve at the time of menstruation, thigh adduction weakness, difficulty ambulating, or paresthesia can be presenting symptoms with the involvement of the obturator nerve [5]. Besides paresthesia, our patient presented all the symptoms. The suspected diagnosis of obturator internus muscle endometriosis with retraction of the obturator nerve was confirmed by laparoscopic surgery and pathological examination of the excised tissue. To our knowledge, only 4 cases of endometriosis involving the obturator nerve have been described (according to MEDLINE searched in January 2017) 5, 6, 7, 8. The laparoscopic approach provided an excellent access to the retroperitoneal space, allowing fine dissection of the obturator nerve and the surrounding structures with complete removal of the cystic mass.Conclusion
We report a rare case of endometriosis with a single mass located inside the right obturator internus muscle with neuronal involvement of the obturator nerve. The fundamental role of laparoscopy was clearly demonstrated for the diagnosis and treatment of our patient. 相似文献14.
15.
Study Objective
To demonstrate a modified technique of laparoscopic lateral suspension for pelvic organ prolapse (POP).Design
A video illustrating this modified technique of laparoscopic lateral suspension (Canadian Task Force classification III).Setting
The benign gynecology department at a university hospital.Interventions
Laparoscopic lateral suspension using mesh is a minimally invasive technique that effectively treats POP [1, 2, 3, 4]. We present a modified technique of laparoscopic lateral suspension that differs from previously described methods [1, 2, 3, 4]. The prominent differences are as follows: first, our modified technique uses Mersilene tape on a 48-mm round-bodied needle (Ethicon Inc, Somerville, NJ,USA). We suspend the vaginal vault, taking a double bite using Mersilene tape without knotting placed as a transversal hammock. Thanks to the Mersilene tape, meshes, sutures, tackers, or fasteners are not needed. Mersilene tape ensures much easier suturing and an inexpensive artificial material. The second difference is that port placement sites (Fig. 1). The third difference is the number of incisions we make (Fig. 1). We do not need 2 additional incisions as used in previously described methods references [1, 2, 3, 4]. We use the same incision for lateral trocar insertion and for pulling out the distal end of the Mersilene tape, which is 2 cm above the iliac crest and 4 cm posterior to the anterior superior iliac spine (Fig. 1). Our technique has the potential to be easier, shorter, more cost-efficient, less invasive, and safer when compared with previously described methods.Conclusion
Modified laparoscopic lateral suspension, the so-called Mulayim technique, might be considered as an alternative treatment for POP surgery; however, studies should be conducted in a larger number of patients with longer postoperative follow-up periods (Fig. 1). 相似文献16.
Huseyin Kiyak Lale Susan Wetherilt Kerem Doga Seckin Ibrahim Polat Pınar Kadirogullari Tolga Karacan 《Journal of minimally invasive gynecology》2018,25(4):582
Study Objective
Laparoscopic excision of a scar pregnancy and isthmocele repair with a barbed suture.Design
A step-by-step explanation of the laparoscopic excision technique of a scar pregnancy and isthmocele repair.Setting
Cesarean scar pregnancy occurs as a result of attachment of the products of conception to the uterine scar 1, 2, 3. In the present case, a 34-year-old, gravida 4, para 1 patient with a history of 1 miscarriage and 1 ectopic pregnancy was diagnosed with type 2 cesarean scar pregnancy at 7 weeks of gestation. Dilation and curretage was performed at the 8th week of gestation to terminate the pregnancy. On ultrasonography performed 1 month later, placental material underlying the isthmocele was observed. Her beta human chorionic gonadotropin level was 13 836 mIU/mL. She was followed up for 1.5 months until the beta human chorionic gonadotropin levels were negative. However, the mass underneath the scar had grown larger, measuring up to 5?×?6?cm. Laparoscopy was performed because the patient reported vaginal spotting and pelvic pain. The incision was sutured with a synthetic absorbable unidirectional barbed suture (Stratafix Knotless Tissue Control Device; Ethicon Inc., Somerville, NJ). No residual scar defect was visible on follow-up ultrasonography 1 week and 1 month after surgery.Conclusion
Barbed sutures ease the repair of uterine scar defects and can provide ideal reapproximation of thick myometrial tissue. Laparoscopic treatment of a scar pregnancy and isthmocele repair are effective and safe modes of treatment. 相似文献17.
Study Objective
To describe a technique for hysteroscopic removal of retained products of conception (RPOC) implanted over an area of adenomyosis.Design
A case report (Canadian Task Force classification III).Setting
RPOC is an unfortunate complication that may occur after the resolution of a normal pregnancy; it is more common after early pregnancy termination or spontaneous miscarriage [1]. Immediate consequences of RPOC include persistent vaginal bleeding, abdominal pain, pelvic infection, fever, and dilated cervix. Moreover, known long-term complications include the formation of intrauterine adhesions (IUAs) with the potential creation of Asherman syndrome resulting in adverse reproductive outcomes caused by subfertility, chronic pelvic pain, menstrual disturbances, and severe pregnancy complications such as abnormal placentation including the placenta accreta spectrum 2, 3. A recently published American Association of Gynecologic Laparoscopists practice report on IUAs suggests that the surgical approach used to treat intrauterine pathology could have an impact with greater risk for IUA formation when blind versus procedures under direct visualization are performed [4].Interventions
A 35-year-old patient who presented with persistent bleeding for over 5 weeks. The patient has a long history of dysmenorrhea and heavy menstrual bleeding. Magnetic resonance imaging revealed the presence of adenomyosis. She had an unfortunate spontaneous abortion at 8 weeks of gestation. On physical examination, she was found to have a dilated uterine cervix with persistent vaginal bleeding; there were no signs of infection. Pelvic ultrasound revealed an intrauterine hyperechogenic vascularized area of 2?×?2, 8?×?2?cm implanted over a focal area of adenomyosis, which is consistent with the presence of RPOC. With the aim of minimizing possible acute complications such as bleeding, infection, and uterine perforation, a hysteroscopic approach was taken to avoid performing a blind dilation and curettage. A secondary benefit of a hysteroscopic approach is a lower incidence of long-term complications such as IUAs and the consequent Asherman syndrome. We describe a hysteroscopic technique in which the use of electrosurgery is limited to minimize thermal damage of the endometrium, highlighting important tips and tricks of the procedure.Conclusion
Hysteroscopic removal of RPOC is a feasible and safe management option of this complication of pregnancy. We strongly suggest avoiding performing blind procedures such as dilation and curettage and favor the adoption of this modality that allows the removal of retained products of conception under direct visualization. 相似文献18.
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19.
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20.
Gulden Menderes Daisy Leon-Martinez Masoud Azodi 《Journal of minimally invasive gynecology》2019,26(1):36-37