共查询到20条相似文献，搜索用时 15 毫秒
1.
Angelos G. Vilos Cici Zhu Basim Abu-Rafea Helen C. Ettler Michele M. Weir George A. Vilos 《Journal of minimally invasive gynecology》2019,26(1):105-109
Study Objectives
To report 2 cases of uterine tumors resembling ovarian sex cord tumors (UTROSCTs) and examine the clinical significance of these tumors found during hysteroscopic endometrial ablation despite benign preoperative endometrial biopsy analysis and imaging suggestive of leiomyoma.Design
Case report (Canadian Task Force classification III).Setting
Tertiary care hospital.Patients
Two patients with abnormal uterine bleeding.Interventions
Hysteroscopic endometrial ablation/resection.Measurements and Main Results
Pathological analysis of intrauterine tissue/lesions obtained by curettage or resection identified 2 unexpected UTROSCTs masquerading as leiomyomas. Following hysterectomy, no residual UTROSCT was identified in the specimens, and both women are well, one at 1 year postsurgery and the other at 3 years postsurgery.Conclusion
Obtaining additional tissue by routine curettage before endometrial ablation and/or endomyometrial resection, in conjunction with removal of any intrauterine lesions, can identify rare unexpected endometrial lesions not sampled by endometrial biopsy, not detected with ultrasound, and masquerading as leiomyomas during endometrial ablation. 相似文献2.
Elisa Bertocchi Giuliano Barugola Marco Benini Paolo Bocus Roberto Rossini Marcello Ceccaroni Giacomo Ruffo 《Journal of minimally invasive gynecology》2019,26(1):100-104
Study Objective
To evaluate the incidence, risk factors, and treatment of colorectal anastomotic stenosis in patients who undergo rectosigmoid resection for deep infiltrating endometriosis (DIE).Design
Retrospective analysis of a prospective database (Canadian Task Force classification III).Setting
Public medical center.Patients
All women who underwent laparoscopic rectosigmoid resections for DIE at our hospital between January 2002 and December 2016.Intervention
All patients were evaluated clinically and endoscopically at 1 month and 3 months after bowel resection. Stenosis was defined as a lack of passage through the anastomosis of a 12-mm proctoscope. Symptomatic stenosis was defined as the presence of endoscopically confirmed stricture accompanied by at least 2 of the following symptoms: constipation, need to push, tenesmus, and ribbon stools. Only patients with symptomatic stenosis were studied. Demographic data, surgical techniques, and postoperative complications were recorded prospectively. Treatments and outcomes of anastomotic symptomatic strictures were analyzed.Measurements and Main Results
A total of 1643 patients underwent laparoscopic rectosigmoid resection at our hospital between January 2002 and December 2016. Among these, 104 patients (6.3%) presented with symptomatic anastomotic stenosis. The median patient age was 27 years (range, 23–44 years), and the median interval between diagnosis and the onset of symptomatic stenosis was 57 days (range, 21–64 days). The only statistically significant predictors of anastomotic stenosis were the presence of ileostomy (p?=?.01) and previous pelvic surgery (p?=?.002). Treatment of choice was always conservative. Of the 104 patients in the study cohort, 90 (86.5%) underwent 3 endoscopic dilatations. No patient required reoperation.Conclusion
The anastomotic stricture is a recognized complication in patients following intestinal resection for DIE, and protective ileostomy is the sole modifiable factor related to anastomotic stenosis. Endoscopic dilatation is a valid option to treat this complication. 相似文献3.
Gaby Moawad Paul Tyan Victoria Vargas Daniel Park Hannah Young Cherie Marfori 《Journal of minimally invasive gynecology》2019,26(1):122-128
Study Objective
To identify predictors of overnight admission after laparoscopic and robot-assisted hysterectomy to improve preoperative counseling and patient optimization.Design
A single-center retrospective cohort study (Canadian Task Force classification III).Setting
Academic university hospital.Patients
Patients undergoing straight-stick laparoscopic and robot-assisted hysterectomy by fellowship-trained minimally invasive gynecologic surgeons for benign indicationsInterventions
Straight-stick laparoscopic and robot-assisted hysterectomy.Measurements and Main Results
Data from 396 consecutive minimally invasive hysterectomy procedures were collected for analysis. Three hundred twelve patients (79%) were discharged the same day, and 84 (21%) were admitted for at least 1 night. Data from the 2 groups were compared. Overnight stay compared with same-day discharge was associated with older age (47.3 vs 43.4 years, p?<?.001), lower preoperation hematocrit (35.8% vs 37.3%, p?=?.035), history of prior laparotomy (31% vs 14.1%, p?=?.003), prolonged operative time (190.5 vs 115.2 minutes, p?<?.001), estimated blood loss (244.6 vs 104.1?mL, p?<?.001), lysis of adhesion (27.4% vs 13.5%), and intraoperative organ injury (17% vs 3%, p?=?.005). Logistic regression analysis, adjusting for all included variables as confounders, showed that hematocrit increments of 5% were protective against any overnight stay (odds ratio, .622; p?=?.015), and a 30-minute increase in operative time increased the odds of an overnight stay by 1.6 (p?<?.001). History of a laparotomy remained a significant predictive factor for an overnight stay (odds ratio, 3.2; p?=?.006). Later surgery end time, in 60-minute increments, increased the odds of an overnight stay by 1.2 (p?<?.01).Conclusion
Perioperative factors such as age, hematocrit, surgery time, and surgical history as well as intraoperative factors such as prolonged operative time are predictive of overnight hospital stay. 相似文献4.
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5.
Kemal Ozgur Hasan Bulut Murat Berkkanoglu Kevin Coetzee 《Journal of minimally invasive gynecology》2018,25(1):105-110
Study Objective
To assess the impact of ovarian endometriomas on endometrial receptivity in frozen embryo transfer (FET) of segmented in vitro fertilization (IVF) cycles.Design
Retrospective, matched-control study (Canadian Task Force classification II-2).Setting
A single, private assisted-reproduction technology center.Patients
Thirty patients diagnosed with unilateral or bilateral endometriomas were compared with 60 patients without endometriomas in a population of 1894 patients who underwent segmented IVF treatment between September 2014 and September 2016.Intervention
Intracytoplasmic sperm injection with blastocyst freeze-all and FET.Measurements and Main Results
The primary endpoint of the study was a viable pregnancy (>14 weeks). The mean diameter of diagnosed endometriomas was 25.7?±?10.6?mm. The median antral follicle count was significantly lower in the endometrioma group compared with the entire study population (11.5; interquartile range [IQR], 6.0–17.0 vs 14.0; IQR, 9.0–22.0; p?=?.042). The median number of mature ovarian follicles (≥14?mm) per antral follicle that developed during controlled ovarian stimulation was not significantly different between the groups (11.0 [IQR, 5.8–14.3] vs 10.0 [IQR, 6.0–15.8]; p?=?.908); however, the median number of oocytes retrieved was lower in the endometrioma group (11.5 [IQR, 6.0–21.5] vs 13.5 [IQR, 9.0–20.8]; p?=?.373). The biochemical pregnancy, implantation, and ongoing pregnancy rates were not significantly different between the endometrioma and control groups.Conclusion
Although ovarian endometriomas result in reduced ovarian reserve and oocyte retrieval, their impact on reproductive outcome is limited with FET. 相似文献6.
Boshra Hosseini Marli Leibl Jayson Stoffman Amanda Morris 《Journal d'obstetrique et gynecologie du Canada》2019,41(5):660-665
Objective
To discuss the finding of hypercalcemia in pediatric ovarian dysgerminoma.Methods
Two cases of pediatric ovarian dysgerminoma that presented with hypercalcemia are discussed.Results
Hypercalcemia is a rare finding in ovarian dysgerminoma.Conclusion
Ovarian dysgerminoma should be considered in pediatric patients presenting with signs of hypercalcemia. Parathyroid hormone, parathyroid hormone related protein, and 1,25 dihydroxyvitamin D may elucidate the cause of hypercalcemia. 相似文献7.
Kristin A. Riley Andrea S. Benton Timothy A. Deimling Allen R. Kunselman Gerald J. Harkins 《Journal of minimally invasive gynecology》2019,26(1):71-77
Study Objective
To compare surgical excision and ablation of endometriosis for treatment of chronic pelvic pain.Design
Randomized clinical trial with 12-month follow-up (Canadian Task Force classification I).Setting
Single academic tertiary care hospital.Patients
Women with minimal to mild endometriosis undergoing laparoscopy.Interventions
Excision or ablation of superficial endometriosis at the time of robot-assisted laparoscopy.Measurements and Main Results
Primary outcome was visual analog scale (VAS) scoring at baseline and 6 and 12 months for menstrual pain, nonmenstrual pain, dyspareunia, and dyschezia. Secondary outcomes included survey results at baseline and 6 and 12 months from the Short Form Health Survey, Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire, and the International Pelvic Pain Assessment. From December 2013 to October 2014, 73 patients were randomized intraoperatively to excision (n?=?37) or ablation (n?=?36) of endometriosis. Patients were followed at 6 and 12 months to evaluate the above outcomes. After ablation of endometriosis, dyspareunia (VAS scores) improved at 6 months (mean change [MC], ?14.07; 95% confidence interval [CI], ?25.93 to ?2.21; p?=?.02), but improvement was not maintained at 12 months. Dysmenorrhea improved at 6 months (MC, ?26.99; 95% CI, ?41.48 to ?12.50; p?<?.001) and 12 months (MC, ?24.15; 95% CI, 39.62 to ?8.68; p?=?.003) with ablation. No significant changes were seen in VAS scores after excision at 6 or 12 months. When comparing ablation and excision, the only significant difference was a change in dyspareunia at 6 months (MC, ?22.96; 95% CI, ?39.06 to ?6.86; p?=?.01).Conclusion
Treatment with ablation improved dysmenorrhea at 6 and 12 months and improved dyspareunia at 6 months as compared with preoperative data. However, only dyspareunia demonstrated a significant difference between ablation and excision. Excision and ablation showed similar effectiveness for the treatment of pain associated with superficial endometriosis, with ablation showing more significant individual changes. Careful patient counseling regarding expectations of surgical intervention is vital in the management of endometriosis. 相似文献8.
9.
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10.
Aude Jayot Krystel Nyangoh Timoh Sofiane Bendifallah Marcos Ballester Emile Darai 《Journal of minimally invasive gynecology》2018,25(3):440-446
Study Objective
Our primary endpoint was to compare the intra- and postoperative complications, whereas secondary endpoints were the occurrence of voiding dysfunction and evaluation of the quality or life of segmental and discoid resection in patients with colorectal endometriosis.Design
Retrospective study (Canadian Task Force classification II-2).Setting
Tenon University Hospital in Paris.Patients
Thirty-one 31 patients who underwent a conservative surgery and 31 patients who underwent.Interventions
The 2 groups were compared using propensity score matching (PSM) analysis, with a median follow-up of 247 days (8.2 months).Measurements and Main Results
Discoid colorectal resection was associated with a shorter operating time (155 vs 180 minutes, p?=?.03) and hospital stay (7 vs 8 days, p?=?.002) than segmental colorectal resection; however, a similar intra- and postoperative complication rate was found. A higher rate of postoperative voiding dysfunction was observed in the segmental resection group (19% vs 45%, p?=?.03) as well as duration of voiding dysfunction requiring bladder self-catheterization longer than 30 days (0 vs 22%, p?=?.005).Conclusion
Our PSM analysis suggests the advantages of discoid resection because it results in a similar surgical complication rate to segmental resection but with advantages in operating time, hospital stay, and voiding dysfunction. 相似文献11.
Yair Daykan Rona Bogin Merav Sharvit Zvi Klein Dana Josephy Meir Pomeranz Nissim Arbib Tal Biron-Shental Ron Schonman 《Journal of minimally invasive gynecology》2019,26(1):117-121
Study Objective
To investigate the pregnancy and neonatal outcomes of surgical treatment for adnexal torsion (AT) during pregnancy.Design
A retrospective case-control study (Canadian Task Force classification II-2).Setting
A tertiary care academic medical center.Measurements and Main Results
The study group included all parturients who underwent surgery for suspected AT during pregnancy from January 2005 to January 2017. The control group included parturients with an uneventful pregnancy matched by maternal age, parity, multiple gestation, and pregnancy complications. The primary outcome was gestational age at delivery. Secondary outcomes were perinatal outcomes and intraoperative and immediate postoperative complications. Among 85 study group patients with suspected AT, 78 (91.7%) underwent laparoscopy and 7 (8.3%) laparotomy. Torsion was diagnosed in 84 patients (98.8%). The gestational age at delivery was similar between the study and control groups (38.7?±?1.5 vs 38.6?±?1.6 weeks, respectively; p?=?.908) as was preterm labor (5.8% in both groups, p?=?1.00). There was no significant difference between the study and control groups in pregnancy and neonatal outcomes, including Apgar scores, mean cord blood pH (7.25?±?0.1 and 7.26?±?0.08, respectively), and birth weight (3040?±?473?g and 3115?±?584?g, respectively). In the study group, the mean gestational age at surgery was 11.2?±?6 weeks (range, 4–34 weeks). The average operative time was 40.2?±?22 minutes. In the postoperative follow-up, 3 (3.5%) patients had a first trimester miscarriage. A previous cesarean delivery was a risk factor for ovarian torsion during pregnancy (p?=?.012).Conclusion
Adnexal detorsion with or without additional surgical procedures during pregnancy did not affect the gestational age at delivery and did not appear to increase fetal or maternal complication rates. 相似文献12.
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13.
Xueying Li Ling Wu Yanfei Zhou Xing Fan Jufang Huang Juhua Wu Renxiu Yu Jianying Lou Mengjie Yang Zhihong Yao Min Xue 《Journal of minimally invasive gynecology》2019,26(1):94-99
Study Objectives
To evaluate the efficacy of a new crosslinked hyaluronan (NCH) gel in reducing the formation of intrauterine adhesions (IUAs) after dilation and curettage (D&C).Design
Randomized controlled trial (Canadian Task Force classification I).Settings
Six hospitals for maternal and child healthcare in China.Patients
A total of 300 patients were randomized to undergo D&C for delayed miscarriage without previous history of D&C. Twenty-six patients (9%) were lost to follow-up and were excluded from the analysis.Interventions
Women were randomly assigned to D&C alone (control group; n?=?150) or D&C plus NCH gel application (NCH gel group; n?=?150) with 1:1 allocation.Measurements and Main Results
All patients were evaluated using the American Fertility Society classification of IUAs during follow-up diagnostic hysteroscopy, scheduled at 3 months after D&C procedure. The primary endpoint was the number of women with IUAs at 3 months, and the secondary endpoints were adhesion scores and severity of IUAs. Postoperative efficacy data were available for 274 women (137 in each group). Intrauterine adhesion formations were observed in 13 of the 137 women (9.5%) in the NCH gel group and in 33 of the 137 women (24.1%) in the control group (p?=?.0012; relative risk [RR], 0.3939; 95% confidence interval [CI], 0.2107–0.7153), a difference of 14.6% (95% CI, 5.92%–23.28%) between the 2 groups. The extent of intrauterine cavity involved, type of adhesion and menstrual pattern, and cumulative adhesion scores were significantly lower in the NCH gel group compared with the control group (p?=?.0007, .008, .0012, and .0006, respectively). The proportion of women with moderate to severe IUAs was significantly lower in the NCH gel group than that in the control group (1 of 137 [0.7%] vs 16 of 137 [11.7%]; p?=?.0002; RR, 0.0625; 95% CI, 0.0084–0.4648), a difference of 11.95% (95% CI, 5.39%–16.51%) between the 2 groups.Conclusions
The current study demonstrates that IUAs are frequently formed after D&C for delayed miscarriage in women without a previous history of D&C procedures, and the application of NCH gel significantly reduces IUA formation. 相似文献14.
Charlotte Lybol Sanne van der Coelen Anouk Hamelink Lidewij Ruth Bartelink Theodoor Elbert Nieboer 《Journal of minimally invasive gynecology》2018,25(7):1255-1259
Study Objective
Endometrial ablation using the NovaSure system (Hologic Inc., Marlborough, MA) is 1 of the treatment options for heavy menstrual bleeding (HMB), which has a reported success rate of 81% to 90%. We aimed to identify predictors for NovaSure endometrial ablation failure. This will contribute to a more effective and individualized preoperative counseling.Design
A retrospective multicenter cohort study (Canadian Task Force classification II-2).Setting
One university hospital and 1 large teaching hospital.Patients
Four hundred eighty-six patients with HMB who had undergone NovaSure endometrial ablation between 2008 and 2014.Interventions
The NovaSure endometrial ablation system for patients with HMB.Measurements and Main Results
In total, the required characteristics of 486 patients were collected and analyzed. With a median follow-up of 45 months, 19.3% (n?=?94) required a secondary treatment and thus were considered NovaSure failures. Multivariate logistic regression analysis showed that younger age (p?=?.019), a history of sterilization (p?=?.002), the presence of dysmenorrhea (p?<?.001) and the presence of an intramural leiomyoma on transvaginal sonography (p?=?.005) were independent predictors of NovaSure ablation failure. Preoperative hysteroscopy appeared to be a protective factor (p?=?.001).Conclusion
Within a median follow-up of 45 months, 19.3% of patients required a secondary treatment. Identification of specific predictive factors for endometrial ablation failure is important in preoperative counseling and patient selection. In the current era of personalized medicine, doctors and patients will ideally choose the therapy that results in the highest chance of success in the individual case. 相似文献15.
Roberta Venturella Gianmarco Miele Katia Cefalì Daniela Lico Pietro D&#x;Alessandro Bruno Arduino Annalisa Di Cello Fulvio Zullo Constantino Di Carlo 《Journal of minimally invasive gynecology》2019,26(1):143-147
Study Objective
To investigate the effects of 3 cycles of subcutaneous progesterone administered during the luteal phase on the regression rate of symptomatic and asymptomatic endometrial polyps in premenopausal woman.Design
A retrospective study (Canadian Task Force classification II-2).Setting
A department of obstetrics and gynecology in a university hospital.Patients
One hundred twenty-seven reproductive-aged women presented with endometrial polyps from January to December 2016.Interventions
A retrospective comparison of patients treated with subcutaneous progesterone and those managed by the “wait and see” approach.Measurements and Main Results
Patients were divided into 2 groups: the group treated with subcutaneous progesterone (cases) and the wait and see group (controls). Women in the treatment group were administered 25?mg subcutaneous progesterone during the luteal phase for 7 days for 3 months. The wait and see group included patients refusing progesterone therapy who were reevaluated 3 menstrual cycles after the transvaginal sonographic diagnosis. Both the treatment group (n?=?61) and the wait and see group (n?=?32) were evaluated with a follow-up ultrasound examination after 3 months. The regression rate of endometrial polyps in women treated with subcutaneous progesterone was compared with the wait and see patients. The regression in the number and/or dimensions of the polyps was greater in the treatment group than the control group. The regression rate was 47.5% and 12.5%, respectively (p?<?.001).Conclusion
Progesterone appears to be a valid therapeutic alternative for the management of endometrial polyps. A prospective, randomized study is ongoing at our institution to further validate these findings. 相似文献16.
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17.
Mario Franchini Giuseppe Lippi Stefano Calzolari Giovanna Giarrè Giampietro Gubbini Ursula Catena Attilio Di Spiezio Sardo Pasquale Florio 《Journal of minimally invasive gynecology》2018,25(3):418-425
Study Objective
To compare the costs of hysteroscopic polypectomy using mechanical and electrosurgical systems in the hospital operating room and an office-based setting.Design
Retrospective cohort study (Canadian Task Force classification II-2).Setting
Tertiary referral hospital and center for gynecologic care.Patients
Seven hundred and fifty-four women who underwent endometrial polypectomy between January 20, 2015, and April 27, 2016.Interventions
Hysteroscopic endometrial polypectomy performed in the same-day hospital setting or office setting using one of the following: bipolar electrode, loop electrode, mechanical device, or hysteroscopic tissue removal system.Measurements and Main Results
The various costs associated with the 2 clinical settings at Palagi Hospital, Florence, Italy were compiled, and a direct cost comparison was made using an activity-based cost-management system. The costs for using reusable loop electrode resection-16 or loop electrode resection-26 were significantly less expensive than using disposable loop electrode resection-27, the tissue removal system, or bipolar electrode resection (p?=?.0002). Total hospital costs for polypectomy with all systems were significantly less expensive in an office setting compared with same-day surgery in the hospital setting (p?=?.0001). Office-based hysteroscopic tissue removal was associated with shorter operative time compared with the other procedures (p?=?.0002)Conclusion
The total cost of hysteroscopic polypectomy is markedly higher when using disposable equipment compared with reusable equipment, both in the hospital operating room and the office setting. Same-day hospital or office-based surgery with reusable loop electrode resection is the most cost-effective approach in each settings, but requires experienced surgeons. Finally, the shorter surgical time should be taken into consideration for patients undergoing vaginal polypectomy in the office setting, owing more to patient comfort than to cost savings. 相似文献18.
Scott M. Eisenkop 《Journal of minimally invasive gynecology》2018,25(5):800-809
Study Objective
To investigate the influence of the use of passive instrument positioners (PIPs) on laparoscopic operative outcomes for endometrial cancer relative to other independent variables.Design
Retrospective case-controlled study (Canadian Task Force classification II-2).Setting
Laparoscopies performed by the author in multiple community hospitals.Patients
A total of 297 consecutive patients between December 2009 and October 2016 with clinically isolated endometrial cancer or retroperitoneal lymphadenopathy on imaging studies.Interventions
Total laparoscopic hysterectomy with bilateral salpingo-oophorectomy and pelvic/aortic lymph node dissection using passive instrument positioners to secure the laparoscope (PIP group) and using instruments providing exposure and historical control by hand control of all instruments (HC group).Measurements and Main Results
The overall group mean age was 63.2 years (range, 32.4–90.9 years), and patient characteristics were equivalent in the 2 groups. In the PIP group, 1 procedure was converted to a laparotomy (0.5%), and in the HC group, 6 procedures were converted (5.4%; p?=?.008). The mean operative time was 140.1 minutes for the PIP group and 153.8 minutes for the HC group (p?<?.001). The mean length of hospital stay was 44.8 hours for the PIP group and 58.6 hours for the HC group (p?<?.001). Multivariate analysis confirmed that study group (PIP vs HC; p?=?.014) and the presence vs absence of metastatic disease (p?=?.001) influenced conversion; study group (PIP vs HC; p?<?.001), body mass index (p?<?.001), past surgical history (p?=?.010), and assistant training (p?=?.011) influenced operative time; and study group (PIP vs HC; p?<?.001), Eastern Cooperative Oncology Group performance status (p?<?.001), and operative time (p?=?.051) influenced hospital stay.Conclusion
For clinically localized endometrial cancer managed laparoscopically, the use of PIPs reduces conversions, operative time, and hospital stay. 相似文献19.
Objective
A growing number of studies suggest that some ovarian cancers can arise from benign and borderline ovarian tumors. However, studies on the association between benign and borderline ovarian tumors are lacking. We studied the overall- and histotype-specific risk of borderline ovarian tumors among women with a benign ovarian tumor.Methods
This nationwide cohort study included all Danish women diagnosed with a benign ovarian tumor (n = 139,466) during 1978–2012. The cohort was linked to the Danish Pathology Data Bank and standardized incidence ratios (SIR) with 95% confidence intervals (CI) were calculated.Results
Women with benign ovarian tumors had increased risks for subsequent borderline ovarian tumors (SIR 1.62, 95% CI 1.43–1.82), and this applied to both serous (SIR 1.69, 95% CI 1.39–2.03) and mucinous (SIR 1.75, 95% CI 1.45–2.10) histotypes of borderline ovarian tumors. The risk for borderline ovarian tumors was primarily increased for women diagnosed with a benign ovarian tumor before 40 years of age. The risk remained increased up to 9 years after a benign ovarian tumor diagnosis. Finally, the associations did not change markedly when analyzed for the different histotypes of benign (solid and cystic tumors) and borderline (serous and mucinous tumors) ovarian tumors.Conclusions
Women with benign ovarian tumors have a long-term increased risk for borderline ovarian tumors. However, as all associations in this study were only adjusted for age and calendar period of diagnosis, more studies that are able to adjust for additional potential confounding variables are required to further understand these associations. 相似文献20.
Bingying Xie Cuifeng Qian Bingyi Yang Chengcheng Ning Xiaoying Yao Yan Du Yue Shi Xuezhen Luo Xiaojun Chen 《Journal of minimally invasive gynecology》2018,25(4):724-729