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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.
Akihiro Takeda Shiori Tsuge Mayu Shibata Sanae Shinone Hiromi Nakamura Kazuko Watanabe 《Journal of minimally invasive gynecology》2018,25(7):1266-1273
Study Objective
To examine whether peritoneal washings during laparoscopic-assisted myomectomy with in-bag manual tissue extraction can contain spilled leiomyoma cell sheets.Design
Retrospective observational study (Canadian Task Force classification II-2).Setting
Departments of Obstetrics and Gynecology and Diagnostic Pathology at a general hospital.Patients
Twenty-four women.Interventions
Hysterotomy followed by complete enucleation by blunt and sharp dissection was performed. Enucleated myomas were placed into a retriever bag and extracted through a suprapubic or umbilical mini-laparotomic incision by manual morcellation with a surgical scalpel. A histological examination was performed to identify the dispersed leiomyoma cell sheets in trapped tissues on the surface of a defoaming sponge equipped in the reservoir of an intraoperative red blood cell salvage device, which was used to collect peritoneal washing fluid along with blood.Measurements and Main Results
Bag rupture was not observed in any case; however, apparent leiomyoma cell sheets were identified in 20 of 24 cases (83.3%). No devices or procedures that were used for myomectomy could completely prevent leiomyoma cells from appearing in the peritoneal washing fluid.Conclusion
Even when careful in-bag tissue extraction of myomas was performed in laparoscopic-assisted myomectomy, dispersion of leiomyoma cell was identified in most cases. Further study is needed to show that the feasibility of rigorous washing to reduce the potential risk of leiomyoma cell dissemination. 相似文献3.
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4.
Study Objective
To demonstrate the proper use of vessel-sealing devices during vaginal hysterectomy.Design
Educational video (Canadian Task Force classification level III).Setting
University hospital.Intervention
The video reviews the principles on the use of energy in minimally invasive surgery. We focus on how vessel-sealing devices function and the benefits of their use in difficult vaginal hysterectomy. The video explains the 2 major types of complications, inadequate vessel sealing and undesired thermal injury, and demonstrates techniques to avoid these complications.Measurements and Main Results
Laboratory, intraoperative, and cadaveric recordings demonstrate proper use and the complications that may arise in the setting of improper use.Conclusion
Vessel-sealing devices may be a useful tool for surgeons performing vaginal hysterectomy. This video demonstrates their use and underlines the importance of understanding the principles of energy devices and their proper usage in surgery. 相似文献5.
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6.
7.
Morgan Wolfe Scott Biest Nhial Tutlam Candice Woolfolk Brooke Winner 《Journal of minimally invasive gynecology》2018,25(1):158-162
Study Objective
To determine which preoperative factors best predict the need for uterine morcellation at the time of total laparoscopic hysterectomy (TLH) and to identify cut-offs that can help guide clinical decision-making.Design
Retrospective cohort (Canadian Task Force classification II).Setting
Tertiary care center.Patients
Women (n?=?420) who underwent TLH between July 2012 and June 2015: 223 cases without and 197 cases with morcellation.Interventions
Laparoscopic hysterectomies with either laparoscopic power, vaginal, or open morcellation via mini-laparotomy were analyzed.Measurements and Main Results
Preoperative factors assessed included uterine volume, cross-sectional area, length, size of largest leiomyoma, and bimanual exam. Receiver operator curves (ROC) were used to establish cut-offs that maximized sensitivity and specificity for each factor. Bivariate and multivariate Poisson regression analyses were used to calculate relative risks associated with these objective cut-offs. ROC curves demonstrated maximized sensitivities and specificities with a cross-sectional area of 48.6?cm2, largest leiomyoma dimension of 4.4?cm, bimanual exam of 11.5 weeks, and uterine volume of 262?mL. Multivariate Poisson regression analysis revealed that the strongest predictors of morcellation were cross-sectional area (adjusted relative risk, 2.94; 95% confidence interval, 1.20–7.19), largest leiomyoma diameter (adjusted relative risk, 2.06; 95% confidence interval, 1.24–3.41), and bimanual exam (adjusted relative risk, 1.88; 95% confidence interval, 1.05–3.37).Conclusion
Uterine cross-sectional area, largest leiomyoma dimension, and uterine size on bimanual exam can all be used to predict the need to morcellate at the time of TLH. 相似文献8.
Juan Liu Qiongyan Lin Kelly Blazek Binhua Liang Xiaoming Guan 《Journal of minimally invasive gynecology》2018,25(6):959-960
Study Objective
Transvaginal surgery is the most minimally invasive surgery for a gynecologic procedure, but it has the limitation of lack of exposure and limited surgical space when using traditional vaginal surgical instrumentation, such as in a hysterectomy for a uterus without descent or for a myomectomy. Transvaginal natural orifice transluminal endoscopic surgery (NOTES) offers similar benefits of traditional vaginal surgery but also expands the horizon of transvaginal surgery by allowing the surgeon to perform procedures that are typically limited to an abdominal approach. The advantages of NOTES may include no incisional pain as well as a better cosmetic outcome. These benefits help outweigh the obstacle of learning this novel approach. Our objective is to demonstrate the transvaginal NOTES technique as a combination of traditional vaginal surgical skill with single-site surgical skill.Design
Stepwise demonstration of the transvaginal NOTES technique for myomectomy with narrated video footage (Canadian Task Force classification III).Setting
Academic tertiary care hospital.Patient
A 42-year-old woman.Interventions
Transvaginal NOTES myomectomy with combined transvaginal surgical and single-site surgical skills.Measurements and Main Results
A 42-year-old woman (gravida 2 para 2) with a preoperative transvaginal ultrasound diagnosis of a 6-cm left anterior myoma requested myoma removal with uterine preservation. She presented with a 2-year history of left pelvic pain and menorrhagia. The myoma was removed with minimal blood loss, and pathology revealed a necrotic myoma. The patient had resolution of her left-sided pelvic pain.Conclusions
Combined with traditional transvaginal anterior colpotomy, single-site surgical skills allow the surgeon to access the entire abdomen and perform myomectomy through a transvaginal single port. Transvaginal NOTES myomectomy is not only possible but allows myomectomy to be performed with no abdominal incision. 相似文献9.
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.
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12.
Hiroyuki Kanao Tsuyoshi Hisa Makiko Omi Minoru Nagashima Shuhei Okamoto Yoichi Aoki Terumi Tanigawa Maki Matoda Sanshiro Okamoto Hidetaka Nomura Kohei Omatsu Kazuyoshi Kato Kuniko Utsugi Nobuhiro Takeshima 《Journal of minimally invasive gynecology》2019,26(1):34-35
Study Objective
To show total laparoscopic complete resection of a recurrent low-grade endometrial sarcoma.Design
Step-by-step demonstration of the technique of laparoscopic anterior pelvic exenteration with super radical parametrectomy, including the explanation of detailed pelvic anatomy (Canadian Task Force classification III).Setting
Low-grade endometrial stromal sarcoma (LGESS) is a rare malignancy that makes up around 0.2% of all uterine malignancies [1]. Total abdominal hysterectomy and bilateral salpingo-oophorectomy is a standard treatment; however, the recurrence risk is quite high [2]. For a recurrent LGESS that is resistant to hormone therapy and chemotherapy, complete resection with negative surgical margins (R0 resection) can be the most promising method [3].Patient
The patient had undergone total abdominal hysterectomy and bilateral salpingo-oophorectomy because of a LGESS. Almost 20 years later, a recurrent LGESS was detected at the vaginal stump, and the patient underwent several rounds of chemotherapy and hormonal therapy. These treatments were inefficacious, and the recurrent tumor progressed. An abdominal computed tomographic scan revealed that the recurrent tumor occupied the vaginal stump, involved the bladder and the left ureter, and extended to the left pelvic sidewall.Interventions
Anterior pelvic exenteration with super radical parametrectomy was performed laparoscopically with no blood transfusion. R0 resection could be achieved without any intraoperative and postoperative complications. Without any adjuvant treatment, there has been no sign of recurrence during the 12 months that have passed since the surgery. This video obtained institutional review board approval through our local ethics committee in the Cancer Institutional Hospital (institutional review board number 2016-1007).Conclusion
The good visualization and meticulous dissection provided during laparoscopic surgery can make the approach advantageous and may contribute to R0 achievement. 相似文献13.
Alexandra Badescu Horace Roman Iulia Barsan Valentin Soldea Serban Nastasia Moutaz Aziz Lucian Puscasiu Simona Stolnicu 《Journal of minimally invasive gynecology》2018,25(3):522-527.e9
Study Objective
To document the presence of bowel invisible microscopic endometriosis implants and their relationship with deep endometriosis macronodule infiltrating the bowel.Design
A series of consecutive patients with deep endometriosis infiltrating the rectum and/or sigmoid colon (Canadian Task Force classification II-2).Settings
A university referral center.Patients
Ten patients managed by colorectal resection.Interventions
A microscopic study of endometriotic foci of the bowel involving 3272 microsection slides was established using a unique method of step serial sections using combined transverse and longitudinal macrosection. Two-dimensional reconstruction based on slide scanning highlighted the presence and localization of the deep endometriosis macronodule in contrast with bowel invisible microscopic endometriosis microimplants.Measurements and Main Results
The distance separating the microimplants and the nodule and their histologic characteristics. The mean length of the colorectal specimens was 91?±?19?mm. The maximum distance between the farthest microimplants was 7.2?cm. The maximum distance from the macroscopic nodule limit to the farthest microimplant was 31?mm. Bowel invisible microscopic endometriosis microimplants presented with similar features independently of the type of spread. They had an active appearance including stroma and glands, were sometimes decidualized, and were free of fibrosis. They were found on the distal/rectal limit of the specimen in 3 patients and on both limits (distal/rectal and proximal/sigmoid colon) in 1 patient.Conclusion
Invisible microscopic endometriosis implants surround the bowel macroscopic endometriosis nodule at variable distances, suggesting that complete surgical microscopic removal may be a challenging goal. These results may help to reconsider the principles and feasibility of the surgical management of bowel endometriosis. 相似文献14.
Roberta Venturella Gianmarco Miele Katia Cefalì Daniela Lico Pietro D&#x;Alessandro Bruno Arduino Annalisa Di Cello Fulvio Zullo Constantino Di Carlo 《Journal of minimally invasive gynecology》2019,26(1):143-147
Study Objective
To investigate the effects of 3 cycles of subcutaneous progesterone administered during the luteal phase on the regression rate of symptomatic and asymptomatic endometrial polyps in premenopausal woman.Design
A retrospective study (Canadian Task Force classification II-2).Setting
A department of obstetrics and gynecology in a university hospital.Patients
One hundred twenty-seven reproductive-aged women presented with endometrial polyps from January to December 2016.Interventions
A retrospective comparison of patients treated with subcutaneous progesterone and those managed by the “wait and see” approach.Measurements and Main Results
Patients were divided into 2 groups: the group treated with subcutaneous progesterone (cases) and the wait and see group (controls). Women in the treatment group were administered 25?mg subcutaneous progesterone during the luteal phase for 7 days for 3 months. The wait and see group included patients refusing progesterone therapy who were reevaluated 3 menstrual cycles after the transvaginal sonographic diagnosis. Both the treatment group (n?=?61) and the wait and see group (n?=?32) were evaluated with a follow-up ultrasound examination after 3 months. The regression rate of endometrial polyps in women treated with subcutaneous progesterone was compared with the wait and see patients. The regression in the number and/or dimensions of the polyps was greater in the treatment group than the control group. The regression rate was 47.5% and 12.5%, respectively (p?<?.001).Conclusion
Progesterone appears to be a valid therapeutic alternative for the management of endometrial polyps. A prospective, randomized study is ongoing at our institution to further validate these findings. 相似文献15.
Jaimin S. Shah Michael Mackelvie David M. Gershenson Preetha Ramalingam Marylee M. Kott Jubilee Brown Polly Gauthier Elizabeth Nugent Lois M. Ramondetta Michael Frumovitz 《Journal of minimally invasive gynecology》2019,26(1):87-93
Study Objective
To compare the accuracy of frozen section diagnosis of borderline ovarian tumors among 3 distinct types of hospital—academic hospital with gynecologic pathologists, academic hospital with nongynecologic pathologists, and community hospital with nongynecologic pathologists—and to determine if surgical staging alters patient care or outcomes for women with a frozen section diagnosis of borderline ovarian tumor.Design
Retrospective study (Canadian Task Force classification II-1).Setting
Tertiary care, academic, and community hospitals.Patients
Women with an intraoperative frozen section diagnosis of borderline ovarian tumor at 1 of 3 types of hospital from April 1998 through June 2016.Interventions
Comparison of final pathology with intraoperative frozen section diagnosis.Measurements and Main Results
Two hundred twelve women met the inclusion criteria. The frozen section diagnosis of borderline ovarian tumor correlated with the final pathologic diagnosis in 192 of 212 cases (90.6%), and the rate of correlation did not differ among the 3 hospital types (p?=?.82). Seven tumors (3.3%) were downgraded to benign on final pathologic analysis and 13 (6.1%) upgraded to invasive carcinoma. The 3 hospital types did not differ with respect to the proportion of tumors upgraded to invasive carcinoma (p?=?.62). Mucinous (odds ratio, 7.1; 95% confidence interval, 2.1–23.7; p?=?.002) and endometrioid borderline ovarian tumors (odds ratio, 32.4; 95% confidence interval, 1.8–595.5; p?=?.02) were more likely than serous ovarian tumors to be upgraded to carcinoma. Only 88 patients (41.5%) underwent lymphadenectomy, and only 1 (1.1%) had invasive carcinoma in a lymph node.Conclusions
A frozen section diagnosis of borderline ovarian tumor correlates with the final pathologic diagnosis in a variety of hospital types. 相似文献16.
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17.
Irrigation after Laparoscopic Power Morcellation and the Dispersal of Leiomyoma Cells: A Pilot Study
Steve P. Yu Bruce B. Lee Michelle N. Han Clara Chan Jianyu Rao Mary Levin Po Chu Fung William Parker 《Journal of minimally invasive gynecology》2018,25(4):632-637
Study Objective
To evaluate if copious irrigation and suctioning after electromechanical power morcellation will reduce myoma cell dissemination and if there is a difference between sterile water and normal saline.Design
Prospective single-center cohort pilot study (Canadian Task Force classification II-2).Setting
Academic tertiary referral center.Patients
Sixteen women undergoing laparoscopic myomectomy with 1 surgeon between January 1, 2017 and August 31, 2017.Interventions
Peritoneal washings were collected 3 specific times during surgery: after dissection of myoma(s) and hysterotomy repair but before morcellation, after morcellation, and after irrigation with 3?L normal saline or sterile water. The primary outcome was the detection of benign spindle cells (BSCs) in peritoneal washings.Measurements and Main Results
Sixteen patients were enrolled in the study. Eight were randomized to the normal saline group and 8 to the sterile water group. In the normal saline group BSCs were detected in 3 of 8 patients (37.5%) after closure of the hysterotomy but before morcellation, in 3 of 8 (37.5%) after morcellation, and in 0 of 8 (0%) after irrigation and suctioning of the peritoneal cavity with 3?L normal saline. In the sterile water group BSCs were detected in 3 of 8 patients (37.5%) after closure of the hysterotomy but before morcellation, 2 of 8 (25%) after morcellation, and in 0 of 8 (0%) after irrigation and suctioning with 3?L sterile water. Thus, no differences were found between the normal saline and sterile water groups.Conclusion
In this pilot study myoma cells were disseminated before electromechanical morcellation. Irrigation and suctioning with 3?L normal saline or sterile water after morcellation may reduce myoma cell dissemination. 相似文献18.
Juan Liu Jaden Kohn Bin Sun Zhenkun Guan Binhua Liang Xiaoming Guan 《Journal of minimally invasive gynecology》2019,26(1):38-39
Study Objective
To demonstrate helpful tips and tricks for the successful use of transvaginal natural orifice transluminal endoscopic surgery (NOTES) for performing sacrocolpopexy and salpingo-oophorectomy surgery. Minimally invasive approaches for treating pelvic organ prolapse via sacrocolpopexy have traditionally included laparoscopy either with or without robotic assistance. Transvaginal NOTES is a novel minimally invasive approach that both avoids abdominal incisions and provides improved visualization; however, it can be technically challenging.Design
Stepwise demonstration with narrated video footage (Canadian Task Force classification III).Setting
An academic tertiary care hospital in Guangdong, China.Patient
A 61-year-old gravida 3, para 3 woman with 3 spontaneous vaginal deliveries and stage III uterine prolapse, stage III cystocele, and stage III rectocele. The preoperative vaginal length was 6?cm.Intervention
After performing vaginal hysterectomy, we show the usefulness of NOTES for salpingo-oophorectomy. We also demonstrate useful techniques for transvaginal NOTES sacrocolpopexy including hydrodissection, division of the Y mesh, anchoring of the anterior mesh before reducing prolapse, retroperitoneal tunneling, and hand suturing of the mesh and vaginal cuff.Measurements and Main Results
The procedure was successfully performed in approximately 190 minutes. The postoperative vaginal length was 5?cm. Postoperative pelvic organ prolapse quantification was stage 0.Conclusion
The transvaginal NOTES approach is feasible and efficient for sacrocolpopexy and salpingo-oophorectomy; additionally, it is a reasonable option for patients who desire a minimally invasive approach with excellent cosmetic results. Surgical techniques that aid in effectively performing transvaginal NOTES sacrocolpopexy include the use of hydrodissection, Y mesh division, anterior mesh anchoring before reducing prolapse, retroperitoneal tunneling, and hand suturing. Using the techniques presented here, we were able to insert the port only 1 time, which improves the efficiency and safety of this surgery. 相似文献19.
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20.
Hisao Osada Shokichi Teramoto Hirotsune Kaijima Tomoya Segawa Osamu Miyauchi Masaji Nagaishi Makio Shozu Keiichi Kato Victor Gomel 《Journal of minimally invasive gynecology》2019,26(1):129-134