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1.

Study Objective

To estimate the incidence of infection after diagnostic and operative hysteroscopic procedures performed in an in-office setting with different distension media (saline solution or CO2).

Design

Prospective, multicenter, observational study (Canadian Task Force classification II-2).

Setting

Tertiary women's health centers.

Patients

A total of 42,934 women who underwent hysteroscopy between 2015 and 2017.

Interventions

Of the 42,934 patients evaluated, 34,248 underwent a diagnostic intervention and 8686 underwent an operative intervention; 17,973 procedures used CO2 and 24,961 used saline solution as a distension medium. Patients were contacted after the procedure to record postprocedure symptoms suggestive of infection, including 2 or more of the following signs occurring within the 3 weeks after hysteroscopy: fever; lower abdominal pain; uterine, adnexal, or cervical motion tenderness; purulent leukorrhea; vaginal discharge or itchiness; and dysuria. Vaginal culture, clinical evaluation, transvaginal ultrasound, and histological evaluation were completed to evaluate symptoms.

Measurements and Main Results

Operative hysteroscopies comprised polypectomies (n?=?7125; 82.0%), metroplasty (n?=?731; 15.0%), myomectomy (n?=?378; 7.8%), and tubal sterilization (n?=?194; 4.0%). Twenty-five of the 42,934 patients (0.06%) exhibited symptoms of infection, including 24 patients (96%) with fever, 11 (45.8%) with fever as a single symptom, 7 (29.2%) with fever with pelvic pain, and 10 (41.7%) with fever with dysuria. In 5 patients with fever and pelvic pain, clinical examination and transvaginal ultrasound revealed monolateral or bilateral tubo-ovarian abscess. In these patients, histological examination from surgical specimens revealed the presence of endometriotic lesions.

Conclusion

The present study suggests that routine antibiotic prophylaxis is not necessary before hysteroscopy because the prevalence of infections following in-office hysteroscopy is low (0.06%).  相似文献   

2.

Study Objective

To evaluate 2 cases of uterine transplant surgery that used utero-ovarian veins as outflow channels, internal iliac arteries for perfusion, and the organ harvest surgery performed laparoscopically.

Design

Case study (Canadian Task Force Classification III).

Setting

An urban, private, tertiary care hospital.

Patients

Two patients, ages 30 and 24years, diagnosed with absolute uterine factor infertility secondary to Mayer-Rokitansky-Küster-Hauser syndrome underwent related living donor uterine transplants; donors were their mothers with normal menses.

Interventions

Retrieval of organs through minilaparotomy and laparoscopic harvest of donor internal iliac arteries and ovarian veins.

Measurements and Main Results

Anastomosis was completed with bilateral donor internal iliac arteries to recipient internal iliac arteries in an end-to-end manner and with bilateral donor ovarian veins to recipient external iliac veins in an end-to-side manner. The lengths of utero-ovarian veins of both donors were 11 and 11cm on both sides; the lengths of the internal iliac arteries of both donors were 10 and 7.5cm on the left side and 10 and 6cm on the right side. The operative times for harvest surgery, bench surgery and transplant surgery were 2:40 and 3:20 hours, 34:32 and 33:30 min and 4:00 and 4:30 hours respectively for recipients 1 and 2. Daily postoperative uterine Doppler was completed through day 8 and then every other day and showed good intrauterine blood flow (i.e., low resistance arcuate vessel flow; resistance index < .5). Cervical biopsies on postoperative days 7 and 14 showed no evidence of rejection in either recipient. Both recipients started menstruating within 2 months of surgery.

Conclusion

By using ovarian veins as outflow channels, the challenges involved in dissection along the internal iliac vein are avoided, and harvesting the donor internal iliac artery reduces the tension on vascular anastomosis. The selection of vessels to be harvested could make the technique reproducible, although larger studies are warranted to confirm results.  相似文献   

3.

Study Objective

To evaluate serial generation of microparticles (MPs) after laparoscopic stripping or CO2 laser vaporization in the surgical treatment of patients with ovarian endometrioma (OE).

Design

A prospective, randomized, blinded, pilot study (Canadian Task Force classification I).

Setting

Tertiary care university hospital from December 2014 to July 2016.

Patients

Thirty women with unilateral OE undergoing laparoscopic surgery.

Intervention

Patients were randomly selected to undergo either CO2 laser vaporization (L group) or laparoscopic stripping (S group) of OE.

Measurements and Main Results

Blood samples were collected before surgery and at 2 hours, 24 hours, 1 month, and 3 months after surgery. An MP generation curve after OE surgery was created. MP generation was greater in the S group than in the L group at all time points evaluated. The MP generation curve showed a significantly higher area under the curve after excisional surgery (p <.05).

Conclusion

The higher MP levels in the S group suggest an increased inflammation and procoagulant response after this procedure.  相似文献   

4.

Study Objective

To assess the usefulness of narrowband imaging (NBI) to detect additional areas of endometriosis not identified by standard white light in patients undergoing laparoscopy for the investigation of pelvic pain.

Design

A prospective cohort trial (Canadian Task Force classification II). Evidence obtained from a well-designed cohort study.

Setting

A tertiary laparoscopic subspecialty unit in Melbourne, Australia.

Patients

Fifty-seven patients undergoing laparoscopy for the investigation of pelvic pain were recruited. Fifty-three patients were eligible for analysis.

Interventions

Patients underwent standard white-light laparoscopy of the pelvis followed by NBI survey to assess for any additional areas suspicious for endometriosis.

Measurements and Main Results

All identified areas of possible endometriosis were resected and sent for blinded histopathological analysis. The additional predictive value of NBI was 0% if the preceding white-light survey was negative and 86% if the preceding white-light survey was positive.

Conclusion

The use of NBI at laparoscopy for the investigation of pelvic pain is beneficial in finding additional areas of endometriosis if endometriosis is already suspected after white-light survey in a tertiary laparoscopic unit. Further research in nonspecialized units may show additional benefit and requires further research. NBI may also be useful as a diagnostic aid for trainees.  相似文献   

5.

Research question

Is overnight transportation of ovarian tissue before cryopreservation in a centralized cryobank from the FertiPROTEKT network feasible?

Design

Data from 1810 women with cryopreserved ovarian tissue after overnight transportation from December 2000 to December 2017 were analysed with a focus on transportation, tissue activity parameters and pregnancy, and delivery rates after transplantation.

Results

A total of 92.4% of tissue samples arrived at ideal temperatures of 2–8°C, 0.4% were transported at temperatures lower than ideal and 6.4% were transported at temperatures that were too high, generally due to mishandling of the inlayed cool packs of the transportation boxes. In 62 women, 78 tissue transplantations were carried out. A subgroup of 30 women who underwent a single orthotopic transplantation with fulfilled criteria of a complete follow-up after transplantation until the end of study, a premature ovarian insufficiency after gonadotoxic therapy as well as the absence of pelvic radiation, was further analysed. In this group, transplantations into a peritoneal pocket accounted for 90%. Transplants were still active at 1 year and above after transplantation in 93.3%. Pregnancy and delivery rates were 46.7% and 43.3%, respectively, with one ongoing pregnancy at the end of the study.

Conclusions

Overnight transportation for central cryobanking is a feasible concept that results in high reproducible success rates through standardized professional tissue freezing and storage.  相似文献   

6.

Study Objective

To evaluate the feasibility of an en-bloc salpingectomy at the time of vaginal hysterectomy for removal of Essure inserts.

Design

Prospective observational study (Canadian Task Force classification II-1).

Setting

Monocenter study at the Conception University Hospital Center, Marseille, France.

Patients

Women seeking removal of the Essure device and candidate for vaginal hysterectomy from January 1, 2017 to January 31, 2018.

Interventions

Patient underwent a total hysterectomy and bilateral salpingectomy by the vaginal route (VH-S) with en-bloc removal of each hemiuterus with the ipsilateral fallopian tube, thereby allowing for removal of the Essure inserts without fragmentation.

Measurements and Main Results

Twenty-six VH-S were performed. There was no converted case to laparoscopy or laparotomy because of issues regarding feasibility or complications. Removal of each hemiuterus with the ipsilateral tube as a single unit was feasible in all cases. There was 1 Clavien-Dindo grade 1 perioperative complication: a bladder injury that required 10days of urinary catheterization. There were 2 grade 2 postoperative complications: 1 case of metrorrhagia of a granuloma on the vaginal fundus that was treated with silver nitrate and 1 case of acute urinary retention that required urinary catheterization for 24hours.

Conclusion

Performing a VH-S with en-bloc removal of the hemiuterus with the ipsilateral tube without fragmentation orsectioning of the Essure inserts appears to be feasible. The vaginal route can hence be an approach for women who undergo hysterectomy during Essure insert surgery removal.  相似文献   

7.

Study Objective

To show the feasibility of the laparoscopic extraperitoneal approach for pelvic metastatic lymph node debulking in locally advanced cervical cancer.

Design

A surgical video article (Canadian Task Force classification III).

Setting

A university hospital.

Patient

A 52-year-old patient presented with stage IIA2 cervical adenocarcinoma according to Fédération Internationale de Gynécologie et d'Obstétrique classification. During the physical examination, a 45-mm tumor was discovered. Positron emission tomographic imaging was positive for hypermetabolic enlarged lymph nodes in the left external iliac region of 1.4-cm size and an standardized uptake value of 21 and in the right obturator region of 1.3-cm size and an standardized uptake value of 7.1; no aortic nodes were found using the imaging procedures. Before chemoradiation therapy, she underwent extraperitoneal aortic lymph node dissection for surgical staging at Vall d'Hebron University Hospital, Barcelona, Spain. Pelvic lymph node debulking was proposed to confirm positivity and, if so, to adjust the radiotherapy field and reduce lymph node radioresistance 1, 2.

Interventions

After a complete extraperitoneal aortic infrarenal lymph node dissection as described by Querleu et al [3], the presacral space is created to expose the iliac vessels. The enlarged lymph nodes are identified and dissected using blunt dissection, monopolar energy, and a vessel sealing device.

Measurements and Main Results

There were no intraoperative or postoperative complications. The anatomopathologic study confirmed positivity for adenocarcinoma metastasis in 3 pelvic nodes and 2 of 29 aortic nodes.

Conclusion

Laparoscopic debulking of enlarged pelvic lymph nodes via the extraperitoneal approach is a feasible procedure. It can be performed as an extension of extraperitoneal aortic lymphadenectomy in selected patients with locally advanced cervical cancer.  相似文献   

8.

Study Objective

To evaluate the long-term safety and efficacy of tension-free vaginal tape (TVT).

Design

Prospective observational study (Canadian Task Force classification II-2).

Setting

Tertiary referral center in China.

Patients

Between January 2004 and December 2005, 85 consecutive patients who underwent the TVT procedure were included. Patients with mixed incontinence or pelvic organ prolapse requiring surgery were excluded.

Interventions

TVT procedure.

Measurements and Main Results

The primary outcomes were long-term postoperative complications. The secondary outcomes included long-term subjective satisfaction (Patient Global Impression of Improvement), objective cure rate (stress test), quality of life, and sexual function. At the 13-year follow-up, 70 patients (82%) were available for evaluation. De novo overactive bladder was observed in 15.7% of patients, and voiding symptoms were found in 17.1% of patients. None of the patients reported voiding dysfunction that needed treatment with tape removal or catheterization. Tape exposure occurred in 2.9% of patients. The subjective satisfaction rate and objective cure rate were 78.6% and 81.4%, respectively.

Conclusion

TVT is a safe and effective treatment for stress urinary incontinence, even at the 13-year follow-up. The prevalence rates of overactive bladder and voiding symptoms are increased with advancing age and should not be considered long-term postoperative complications.  相似文献   

9.

Research question

To evaluate the immunogenicity of follitropin delta in repeated ovarian stimulation.

Design

Controlled, assessor-blind trial in IVF/intracytoplasmic sperm injection patients undergoing repeated cycles of ovarian stimulation (cycles 2 and 3), following initial stimulation with follitropin delta or follitropin alfa (cycle 1) in a preceding randomized trial. In cycles 2 and 3, 513 and 188 women, respectively, were treated as randomized in cycle 1, with dosing based on ovarian response in the previous cycle.

Results

The incidence of treatment-induced anti-FSH antibodies with follitropin delta was 0.8% and 1.1% in cycles 2 and 3, respectively, which was similar to the incidence in cycle 1 (1.1%). No antibodies were of neutralizing capacity. Women with pre-existing anti-FSH antibodies were safely treated with follitropin delta without boosting an immune response. Treatment with follitropin delta and follitropin alfa gave similar outcomes for mean number of oocytes retrieved (9.2 versus 8.6 [cycle 2]; 8.3 versus 8.9 [cycle 3]), ongoing pregnancy (27.8% versus 25.7%; 27.4% versus 28.0%) and live birth rates (27.4% versus 25.3%; 26.3% versus 26.9%). The presence of anti-FSH antibodies did not affect the ovarian response.

Conclusions

The trial demonstrated the low immunogenicity potential of follitropin delta in repeated ovarian stimulation, and confirmed the appropriateness of the follitropin delta dosing regimen in repeated cycles, with documented efficacy and safety.  相似文献   

10.

Background

Müllerian duct abnormalities are common and may be related to pregnancy complications. Few cases of ectopic pregnancy within an undescended Fallopian tube have been reported, and they present a diagnostic challenge.

Case

A 32-year-old pregnant woman had three presentations to the emergency department for increasing left upper abdominal pain, chest pain, shortness of breath, and eventual hemodynamic instability in the setting of right unicornuate uterus and undiagnosed undescended left adnexa.

Conclusion

This case presents a rare diagnosis in the differential diagnosis of chest pain and shortness of breath, as well as pregnancy of unknown location. If intraperitoneal hemorrhage is present in a woman with a positive pregnancy test but pregnancy is not detected within the pelvis, it is advisable to investigate the upper abdomen for ectopic pregnancy.  相似文献   

11.

Objective

To review the evidence and provide an opinion as to whether universal cervical length screening to prevent preterm birth should be adopted across Canada.

Outcomes

Outcomes evaluated include prevention of preterm birth.

Evidence

Literature searches using Knowledge Finder, Medline and Cochrane databases were searched for articles published up to April 2018 on cervical length screening for prevention of preterm birth.

Values

The evidence obtained was reviewed and evaluated by the Diagnostic Imaging Committee of the SOGC under the leadership of the principal authors, and recommendations were made according to guidelines developed by the Canadian Task Force on Preventive Health Care.

Benefits, Harms, and Costs

The prevention of preterm birth in a cost-effective manner is of significant importance to the health of mothers and their families. This committee opinion will summarize the current evidence for universal cervical length screening to prevent preterm birth in Canada, determine whether it meets the Junger and Wilson criteria for screening tests, and make recommendations as to its use in Canada.

Validation

These guidelines have been reviewed and approved by the Diagnostic Imaging Committee of the SOGC and The Society of Obstetricians and Gynaecologists of Canada (SOGC).

Sponsors

The Society of Obstetricians and Gynaecologists of Canada (SOGC).  相似文献   

12.
  相似文献   

13.

Study Objective

To evaluate the effect of intraoperative superior hypogastric blocks on postoperative pain management.

Design

Prospective observational cohort study (Canadian Task Force classification II-2).

Setting

Kocaeli Derince Training and Research Hospital, University of Health Sciences, Department of Anesthesiology and Reanimation, Department of Gynecology and Obstetrics, Kocaeli, Turkey.

Patients

Sixty female patients who underwent elective laparoscopic hysterectomy were included in this study. Patients were divided into 2 groups: those who had intraoperative superior hypogastric plexus (SHP) block (Hypo; n?=?30) and those who did not have intraoperative SHP block (No-Hypo; n?=?30).

Interventions

Intraoperative SHP blocks were performed with the modified laparoscopic technique previously described by us.

Measurements and Main Results

Rescue analgesic time was calculated in minutes as the time interval between the last administration of analgesic in the operating room or postanesthesia care unit and the first analgesic demand in the surgical ward. Rescue analgesic times were found to be significantly higher in the Hypo group. Nonsteroidal anti-inflammatory drugs and opioid requirements in the postanesthesia care unit and in the surgical ward were significantly lower in the Hypo group. There was no difference between groups in postoperative nausea and vomiting.

Conclusions

Intraoperative SHP block is a preferable modality for postoperative analgesia in patients undergoing hysterectomy. The surgical laparoscopic modified anterior approach we describe is an uncomplicated and easily applicable method. More effective results would be seen if used together with wound site local anesthetic infiltration or abdominal wall plane blocks. (Clinical trial registration no. NCT03427840.)  相似文献   

14.

Study Objective

To investigate ethnic differences for moderate-to-severe endometriosis.

Design

Analysis of a prospective registry (Canadian Task Force classification II-2).

Setting

Tertiary referral center.

Patients

A total of 1594 women with pelvic pain and/or endometriosis.

Interventions

None

Measurements and Main Results

On logistic regression, adjusting for potential confounders, East/South East Asians were 8.3 times more likely than whites to have a previous diagnosis of stage III/IV endometriosis before referral (adjusted odds ratio [aOR], 8.33; 95% confidence interval [CI], 3.74–18.57), 2.7 times more likely to have a palpable nodule (aOR, 2.66; 95% CI, 1.57–4.52), 4.1 times more likely to have an endometrioma on ultrasound (aOR, 4.10; 95% CI, 2.68–6.26), and 10.9 times more likely to have stage III/IV endometriosis at the time of surgery at our center (aOR, 10.87; 95% CI, 4.34–27.21).

Conclusion

Moderate-to-severe endometriosis was more common in women with East or South East Asian ethnicity in our tertiary referral center.  This could be explained by East/South East Asians with minimal to mild disease being less likely to seek care or genetic/environmental differences that increase the risk of more severe disease among East/South East Asians. (ClinicalTrials.gov, NCT02911090.)  相似文献   

15.

Study Objective

To evaluate fertility, pregnancy, and clinical outcomes after uterine arteriovenous malformation (UAVM) management.

Design

Single-center retrospective study (Canadian Task Force classification III).

Setting

One referral center.

Patients

Twenty-two patients with a UAVM diagnosed by magnetic resonance angiography or computed tomography angiography and managed by expectant management (EM) or uterine arterial embolization (UAE) during the study period were included.

Interventions

Nine of 22 patients underwent first-intention EM and 13 first-line UAE. Three of 9 EM patients (33.3%) required emergency second-intention UAE for nonresolution of the UAVM and severe genital bleeding.

Measurements and Main Results

To analyze fertility according to management approach, we defined 2 groups: EM only group (n?=?6) and UAE group (n?=?16; women who underwent first- or second-intention UAE). Overall, the median age was 29 years (range, 17–43). The mean follow-up after UAVM management was 39 months (range, 1–116). The success rate of the UAE procedure was 87.5% (14/16). Eight of 12 women (66.7%) who wished to conceive became pregnant: 2 of 5 (33.3%) in the EM group and 6 of 7 (85.7%) in the UAE group (p?=?1). Overall, 11 patients (50%) conceived: 3 in the EM group (50%) and 8 in the UAE group (50%) (p?=?.9). The live birth rate was 36.4% (8/22) for the whole population. There were no miscarriages or ectopic pregnancies. The 8 women (72.7%) wishing to conceive who became pregnant all delivered: 1 by cesarean section and 7 by vaginal delivery. Median duration of pregnancy was 39 weeks and 5 days. The remaining 3 women (i.e., women who conceived but did not wish to become pregnant) had therapeutic abortions. One complication was experienced in the EM group (small for gestational age newborn) and none in the UAE group (p?=?.3). Limitations include retrospective design and small sample size.

Conclusion

UAE for UAVM is an effective and safe technique. It does not impair fertility, and obstetric prognosis is good.  相似文献   

16.

Study Objective

To introduce an effective assisted method using the hysteroscopy transmittance test and a Foley catheter to repair previous cesarean scar defect (PCSD) by laparoscopy.

Design

A step-by-step explanation of the surgery using video.

Setting

A university hospital.

Patients

A young woman with abnormal uterine bleeding.

Interventions

First, we inspected the pelvic cavity and detached the adhesion, opened the uterovesical peritoneal reflection, and pushed down the bladder. Then, the hysteroscopy transmittance test was used to confirm the site and the size of the PCSD. Next, a Foley catheter was inserted into the diverticulum through the cervical canal, and then we removed the diverticulum along the outer edge 1, 2, 3, 4. The myometrium and the serosal layer were sutured continuously with absorbable sutures. At this point, a second hysteroscopy transmittance test was performed to verify the repair effect. Finally, we placed antiadhesive film.

Measurements and Main Results

The location, size, and boundary of the PCSD can be exactly marked by this method. The operative time was 68 minutes, blood loss was 20mL, and no complications occurred.

Conclusion

This surgical method has the following benefits: the resection of the diverticulum is complete, and the suture is exact; it is suitable for patients with a thin diverticulum wall, large diverticulum cavity, and a long duration of bleeding after menstruation; the hysteroscopy transmittance test was used to confirm the site of the PCSD and verify the repair effect; and the Foley catheter can marker the resection site, prevent gas leakage, and stop bleeding by local compression.  相似文献   

17.

Research question

Is there any difference in ovarian steroid receptor expression and pattern of fibrosis in focal and diffuse adenomyosis and response to hormonal treatment?

Design

Prospective controlled study where biopsy samples were prospectively collected after surgery from 30 women with focal adenomyosis, 21 women with diffuse adenomyosis and 20 women with uterine myoma. Some of these women underwent 3–6 months of treatment with gonadotrophin-releasing hormone agonist (GnRHa) before surgery. Tissue expression of oestrogen receptor (ER) and progesterone receptor (PR) was analysed by immunohistochemistry. Distribution of tissue fibrosis was examined by Masson's trichrome staining with computer-based image analysis of fibrosis in tissues derived from women with and without adenomyosis.

Results

There was no difference in ER/PR expression in gland cells/stromal cells of adenomyotic lesions on the ipsilateral side of focal adenomyosis and the anterior/posterior walls of diffuse adenomyosis. Compared to myoma tissues, a relatively decreased expression of ovarian steroid receptors was observed in both focal and diffuse adenomyosis. Image analysis of tissue fibrosis indicated more fibrosis in both focal and diffuse adenomyosis compared to fibrosis in the myometrium derived from women with uterine myoma. The pattern of fibrosis was no different in tissues derived from GnRHa-treated and -untreated women with focal and diffuse adenomyosis.

Conclusions

No difference was found in the expression of ER/PR and entity of fibrosis between women with focal and diffuse adenomyosis regardless of GnRHa treatment. A lower expression of ER/PR compared to myoma tissue potentially clarifies the biological rationale of non-response to hormonal therapies for adenomyosis.  相似文献   

18.

Study Objective

To prospectively evaluate the mesh exposure rate after robot-assisted laparoscopic pelvic floor surgery for the treatment of female pelvic organ prolapse (POP) in a large cohort.

Design

Prospective observational cohort study (Canadian Task Force classification II-2).

Setting

Two large teaching hospitals with a tertiary referral function for pelvic floor disorders.

Patients

Patients with symptomatic POP and simplified POP quantification (S-POP) stage ≥2. Patients with a history of mesh repair or concomitant insertion of a tension-free vaginal tape were excluded.

Interventions

Robot-assisted laparoscopic sacrocolpopexy or robot-assisted laparoscopic supracervical hysterectomy with a sacrocervicopexy.

Measurements and Main Results

A blinded vaginal examination with the aid of a transparent speculum was performed to look for mesh-related complications. Mesh exposures were described following the International Urogynecological Association/International Continence Society classification system. One hundred and ninety-two patients were included, of whom 166 (86.5%) were seen for follow-up examination. The median duration of follow-up was 15.7 months (range, 8.2–44.4 months). Two vaginal mesh exposures (1.2%) were detected, both of which were treated in the outpatient clinic. One patient without any complaints had a suture exposure, which was removed in the outpatient clinic.

Conclusion

The safety of the use of mesh in pelvic floor surgery is a matter of debate owing to the occurrence of mesh-related complications. Based on the current literature, mesh-related complications seem to be lower in transabdominal mesh surgery than in transvaginal mesh surgery. In this study, a low mesh exposure rate was observed in robot-assisted abdominal pelvic floor surgery for POP.  相似文献   

19.

Study Objective

To demonstrate a method of vaginal closure with the EndoGIA surgical stapler (Medtronic, Istanbul, Turkey) to prevent tumor spillage in laparoscopic radical hysterectomy.

Design

A step-by-step explanation of the procedure using a video.

Setting

Women's health teaching and research hospital.

Patient

A 40-year-old woman with clinical stage IBI cervical squamous cell carcinoma.

Interventions

Laparoscopic type C radical hysterectomy with pelvic lymph node dissection and ovarian transposition. Institutional ethical committee approval was not sought. However, the patient signed an informed consent that allows us to use her clinical data.

Measurements and Main Results

Minimally invasive surgery is increasingly being used in cervical cancer surgery. However, there is a current and significant debate regarding the safety of these methods. Colpotomy, which is the last step of laparoscopic radical hysterectomy, could be related to an increased risk for tumor spillage. Vaginal closure before colpotomy may be an option to prevent this spillage. In this method, after completion of the radical hysterectomy steps, the initial 5-mm left lower quadrant trocar was changed to a 15-mm trocar to allow for the placement of an EndoGIA with a green cartridge. The uterine manipulator was removed, and the uterus was elevated with a myoma screw. Then, the stapler was placed, and we checked that no other unintended structure was included in the jaws of the stapler before the firing. The EndoGIA surgical stapler was fired 2times to close the vagina. The stapler places 2 triple-staggered rows of titanium staples and knife blade cuts simultaneously between them. Once the vagina was divided, the stapler was released. The upper part of the vaginal cuff was excised and sent to pathology as a surgical margin, and the uterus was removed through the vagina. Finally, the vaginal cuff was closed with intracorporeal suturing.

Conclusion

Vaginal closure with the EndoGIA surgical stapler before colpotomy provides a safe and easy method to prevent tumor spillage and could improve the unfavorable results related to minimally invasive surgery in patients with cervical cancer.  相似文献   

20.

Study Objective

To demonstrate a safe laparoscopic procedure for diaphragmatic infiltrative endometriosis.

Design

Video case

Setting

Teaching hospital (Canadian Task Force classification III).

Patients

One patient presenting deep and severe diaphragmatic endometriosis.

Intervention

Laparoscopic cure of diaphragmatic endometriosis.

Measurements and Main Results

Throughout this video, which was approved by the institutional board review, we demonstrate safe and complete surgical treatment of a patient suffering severe pelvic and diaphragmatic endometriosis. The patient complained of menstrual dyspnea and shoulder pain persisting despite hormonal treatment, associated with persistent dyspareunia and pelvic pain despite a previous laparoscopic surgery. Patient positioning and anesthesia were adapted to the special requirements of the surgical technique and the expected risks. The operation consisted of the exposure of the right diaphragm by mobilization of the liver, CO2 laser vaporization of left and right diaphragmatic lesions, nerve-sparing excision of infiltrating nodules, and pleural exploration. Finally, we performed an excision of pelvic endometriosis. Participation of 3 surgical teams to this procedure allowed a safe and complete laparoscopic treatment with resolution of pain symptoms at a 1- and 3-month follow-up.

Conclusion

Laparoscopic treatment allows a safe and complete treatment of diaphragmatic endometriosis.  相似文献   

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