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1.
Caterina Exacoustos Giovanna De Felice Alessandra Pizzo Giulia Morosetti Lucia Lazzeri Gabriele Centini Emilio Piccione Errico Zupi 《Journal of minimally invasive gynecology》2018,25(5):884-891
Study Objective
To assess the association between ovarian endometriomas detectable at transvaginal ultrasound (TVS) and other specific extraovarian lesions including adhesions, deep infiltrating endometriosis (DIE), and adenomyosis.Design
Retrospective observational study (Canadian Task Force classification II-2).Setting
Two university hospitals.Patients
Two hundred fifty-five symptomatic women with at least 1 ovarian endometrioma found on ultrasound after presentation with pain or irregular menstruation.Interventions
Patients underwent TVS followed by either medical or surgical treatment.Measurements and Main Results
Two hundred fifty-five women, aged 20 to 40 years, underwent TVS and were found to have at least 1 endometrioma with a diameter?>?20?mm. Associated sonographic signs of pelvic endometriosis (adhesions, DIE, and adenomyosis) were recorded, and a subgroup of patients (n?=?50) underwent laparoscopic surgery within 3 months of TVS. Mean endometrioma diameter was 40.0?±?18.1?mm, and bilateral endometriomas were observed in 65 patients (25.5%). TVS showed posterior rectal DIE in 55 patients (21.5%) and a thickening of at least 1 uterosacral ligament in 93 patients (36.4%). One hundred eighty-six patients (73%) had adhesions, and 134 patients (53%) showed signs of myometrial adenomyosis on TVS. Thirty-eight patients (15%) exhibited only a single isolated endometrioma with a mobile ovary and no other signs of pelvic endometriosis/adenomyosis at TVS.Conclusion
Ovarian endometriomas are indicators for pelvic endometriosis and are rarely isolated. Particularly, left endometriomas were found to be associated with rectal DIE and left uterosacral ligament localization and bilateral endometriomas correlated with adhesions and pouch of Douglas obliteration, whereas no correlation was found between endometrioma size and DIE. Determining appropriate management, whether clinical or surgical, is critical for ovarian endometriomas and concomitant adhesions, endometriosis, and adenomyosis in patients desiring future fertility. 相似文献2.
Louis Marcellin Pietro Santulli Sara Bortolato Cécile Morin Anne Elodie Millischer Bruno Borghese Charles Chapron 《Journal of minimally invasive gynecology》2018,25(5):896-901
Study Objective
To evaluate the association between bladder deep infiltrating endometriosis (DIE) and anterior focal adenomyosis of the outer myometrium (aFAOM) diagnosed by preoperative magnetic resonance imaging (MRI).Design
An observational, cross-sectional study using prospectively collected data (Canadian Task Force classification II-2).Setting
Single university tertiary referral center.Patients
All nonpregnant women younger than 42 years who had undergone complete surgical exeresis of endometriotic lesions. For each patient a standardized questionnaire was completed during a face-to-face interview conducted by the surgeon during the month preceding the surgery. Only women with preoperative standardized uterine MRI were retained for this study.Interventions
Thirty-nine women with histologically proven bladder DIE and an available preoperative MRI were enrolled in the study. Patients were divided into 2 groups: women with aFAOM (aFAOM (+), n?=?19) and women without aFAOM (aFAOM (–), n?=?20). Both groups were compared for general characteristics, medical history, MRI findings, and disease severity.Measurements and Main Results
Nineteen patients (48.7%) with bladder DIE had aFAOM at preoperative MRI. The rate of associated diffuse adenomyosis was similar in the 2 groups (63.2% [n?=?12] vs 73.7% [n?=?14]; p?=?.48). The rate of an associated ovarian endometrioma (OMA) was significantly lower in the aFAOM (+) group (10.5% [n?=?2] vs 40.0% [n?=?8]; p?=?.03). There were fewer associated intestinal DIE lesions in the aFAOM (+) group compared with the aFAOM (–) group (26.3% vs 75.0%; p?=?.02), with lower involvement of the pouch of Douglas (26.3% vs 70%; p?<?.01). Total American Society for Reproductive Medicine score was significantly lower in the aFAOM (+) group (13.8?±?12.2 vs 62.2?±?46.2; p?<?.01).Conclusion
aFAOM is present in only half of women with bladder DIE and appears to be associated with lower associated posterior DIE. 相似文献3.
Basheer AlKudmani Itai Gat Danielle Buell Joveriyah Salman Khaled Zohni Clifford Librach Prati Sharma 《Journal of minimally invasive gynecology》2018,25(1):99-104
Study Objective
To evaluate the impact of endometriosis staging and endometriomas on in vitro fertilization (IVF) outcome and to assess the optimal time interval between laparoscopy and IVF.Design
A retrospective clinical study (Canadian Task Force classification II1).Setting
A university-affiliated private infertility clinic.Patients
Two hundred sixteen infertile patients with endometriosis and 209 infertile patients without endometriosis.Interventions
Laparoscopy, IVF.Measurements and Main Results: Patients with endometriosis were classified according to American Society for Reproductive Medicine criteria; 58, 67, 63, and 28 patients had stages 1 through 4 disease, respectively. Patients with endometriosis had significantly lower estradiol on trigger day (9986?±?6710 vs 12 220?±?9414?pg/mL, respectively) and number of retrieved oocytes (12.7?±?8.6 vs 14.0?±?10, respectively) compared with controls. We found a consistent decline in clinical and ongoing pregnancy rates with increasing stage of endometriosis. The presence of endometrioma in patients with stages 3 and 4 endometriosis did not alter IVF outcome. Patients with a time interval of 7 to 12 and 13 to 25 months after surgery had a favorable outcome.Conclusion
IVF pregnancy rate was negatively correlated with endometriosis severity. The presence of endometriomas had no impact on IVF clinical outcome. The optimal time to perform IVF appears to be between 7 and 25 months after endometriosis surgery. 相似文献4.
Sadikah Behbehani Stefano Polesello Joseph Hasson Justin Silver Weon-Young Son Michael Dahan 《Journal of minimally invasive gynecology》2018,25(7):1241-1248
Study Objective
To assess clinical pregnancy rate (CPR) and live birth rate (LBR) in the presence of non–cavity-deforming intramural myomas in single fresh blastocyst transfer cycles.Design
Retrospective cohort study (Canadian Task Force classification II-2).Setting
Academic fertility center.Patients
A total of 929 fresh single blastocyst transfer cycles were included, 94 with only non–cavity-distorting intramural myomas and 764 without myomas. Cleavage embryo transfers were excluded to reduce bias based on embryo quality.Interventions
None.Measurements and Main Results
CPR and LBR were assessed. There were no differences noted in gravidity, parity, or body mass index between patients with myomas and those without myomas. Women with myomas required higher doses of gonadotropins (mean, 2653?±?404?IU vs 2350?±?1368?IU; p?=?.04) than women without myomas. However, the total number of mature oocytes collected and the total number of blastocysts created were similar. CPR (47% vs 32%; p?=?.005) and LBR (37.8% vs 25.5%; p?=?.02) were lower in patients who had intramural myomas compared with those without myomas. CPR and LBR were significantly reduced in the presence of even 1 myoma (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.33–0.83 and OR, 0.56; 95% CI, 0.35–0.92, respectively). In patients with myomas >1.5?cm, LBR was also significantly reduced, even after adjusting for age, smoking, quality of embryo transferred, antral follicle count, and dose of gonadotropins (OR, 0.53; 95% CI, 0.29–0.97). This LBR finding was not significant if all myomas were included (including those <1.5?cm in diameter), but CPR was still significantly reduced.Conclusion
Relatively small (>1.5?cm) non–cavity-distorting intramural myomas negatively affect CPR and LBR in in vitro fertilization cycles, even in the presence of only 1 myoma. 相似文献5.
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
Study Objective
To determine the risk factors for Pipelle diagnostic failure, which might help healthcare providers choose the appropriate protocol for endometrial evaluation individually.Design
A single-center prospective study (Canadian Task Force classification II).Setting
The Obstetrics and Gynecology Hospital of Fudan University.Patients
Patients (n?=?466) with an indication for endometrial biopsy.Interventions
All patients received Pipelle and then diagnostic dilation and curettage. The samples were sent for histopathologic diagnosis separately.Measurements and Main Results
The Pipelle procedure failed in 10 of 466 patients (2.146%). The general sample inadequacy and histopathologic diagnosis inconsistency of Pipelle was 5.921% (27/456) and 14.254% (65/456), respectively. Upon multivariate analysis, history of cervical operation(s) (odds ratio [OR], 26.510; 95% coefficient interval [CI], 2.932–239.784; p?=?.004), prior intrauterine procedure(s) (OR, .096; 95% CI, .017–.554; p?=?.009), and pinpoint cervical os (OR, 5.939; 95% CI, 1.134–31.108; p?=?.035) were significantly associated with Pipelle procedure failure. Meanwhile, uterine volume?<?43?cm3 (OR, 8.229; 95% CI, 1.902–35.601; p?=?.005) and uneven endometrium detected by ultrasound (OR, .176; 95% CI, .042–.734; p?=?.017) had significant correlation with sample inadequacy. Pipelle detected all endometrial cancer cases, whereas only 50.000% (7/14) of endometrial hyperplasia with atypia, 26.471% (9/34) of polyps, and 18.182% (2/11) of polyps with endometrial hyperplasia without atypia cases were detected by Pipelle.Conclusion
Although Pipelle is the first-line method for endometrial biopsy, it might fail in women with risk factors identified in this study. More considerations should be taken when choosing Pipelle. 相似文献6.
David Sheyn Sherif El-Nashar Megan Billow Sangeeta Mahajan Mary Duarte Robert Pollard 《Journal of minimally invasive gynecology》2018,25(3):484-490
Study Objective
To determine if there is a difference in readmission rates after same-day discharge compared with postoperative day 1 discharges after laparoscopic hysterectomy.Design
A retrospective cohort study with 1:2 propensity score matching (Canadian Task Force classification II-2).Setting
American College of Surgeons National Surgical Quality Improvement Program database.Patients
Women undergoing benign laparoscopic total or supracervical hysterectomy or laparoscopic-assisted vaginal hysterectomy with or without adnexal surgery between the years 2010 to 2015.Interventions
Three thousand thirty-two low-risk women discharged on postoperative day 0 and 6064 women discharged on postoperative day 1 were included in the analysis.Measurements and Main Results
The overall readmission rate was 1.8%; after same-day discharge, the readmission rate was 2.2%, and after postoperative day 1 discharge the readmission rate was 1.7% (p?=?.10). After logistic regression analysis, smoking (adjusted odds ratio [aOR]?=?2.06; 95% confidence interval [CI], 1.49–2.88), nonwhite race (aOR?=?1.53; 95% CI, 1.1007–2.14), and cystoscopy (aOR?=?2.05; 95% CI, 1.49–2.82) were associated with an increased risk of readmission.Conclusion
There was no statistically significant difference in readmission rates after laparoscopic hysterectomy between women discharged on the day of surgery or postoperative day 1. 相似文献7.
Ali Bassi Nicholas Czuzoj-Shulman Haim Arie Abenhaim 《Journal of minimally invasive gynecology》2018,25(7):1260-1265
Study Objective
To compare the treatment and surgical outcomes of ovarian torsion in pregnant and nonpregnant women.Design
A population-based matched cohort study (Canadian Task Force classification II.1).Setting
The United States Health Care Cost and Utilization Project Nationwide Inpatient Sample from 2003 to 2011.Patients
All cases of ovarian torsion among pregnant women and nonpregnant women with ovarian torsion (matched by age in a ratio of 1:1).Interventions
Outcomes of interest included the type of treatment received for ovarian torsion and the complications of surgery.Measurements and Main Results
There were 1366 women diagnosed with ovarian torsion among 8 532 163 pregnant women for an incidence of 1.6 in 10 000. Surgery was the predominant treatment, with laparotomy being more commonly performed on pregnant women versus nonpregnant women (57.0% vs 51.0%; odds ratio?=?1.28; 95% confidence interval, 1.08–1.51; p?<?.01). Overall conservative management was less likely performed; however, it was more common among pregnant women versus nonpregnant women (odds ratio?=?1.85; 95% confidence interval, 1.44–2.37; p?<?.01). In general, adverse events were uncommon in both groups although ovarian infarction was more commonly reported among nonpregnant women.Conclusion
The diagnosis of ovarian torsion in pregnancy is rare. Compared with nonpregnant women, laparotomy and conservative management are more common among pregnant women. Treatment of ovarian torsion in pregnancy has comparable outcomes with treatment in nonpregnant women. 相似文献8.
Alessandro Favilli Ivan Mazzon Mario Grasso Stefano Horvath Vittorio Bini Gian Carlo Di Renzo Sandro Gerli 《Journal of minimally invasive gynecology》2018,25(4):706-714
Study Objective
To evaluate the intraoperative effects of gonadotropin-releasing hormone (GnRH) analogue pretreatment in patients undergoing cold loop hysteroscopic myomectomy.Design
Randomized controlled trial (Canadian Task Force classification I).Setting
Arbor Vitae Center for Endoscopic Gynecology, Rome, Italy.Patients
A total of 99 patients were randomized and subsequently allocated to the GnRH analogue group or to the nonpharmacologic treatment control group. Fifteen patients were lost after allocation, and 42 patients per group underwent hysteroscopic myomectomy.Interventions
Cold loop hysteroscopic myomectomy.Measurements and Main Results
The control group accomplished the treatment in a 1-step procedure more frequently than the GnRH analogue group (92.85% and 73.8% of cases, respectively; p?=?.040). The completion of the treatment was more unlikely in case of G2 myomas (p?=?.006), whereas no differences were recorded for G1 and G0 myomas. The multivariate analysis showed a significant correlation between the multiple-step treatment and the use of GnRH analogue (odds ratio, 5.365; 95% confidence interval [CI], 1.018–28.284; p?=?.048), grading (odds ratio, 4.503; 95% CI, 1.049–19.329; p?=?.043), and size of myomas (odds ratio, 1.128; 95% CI, 1.026–1.239; p?=?.013).Conclusions
Preoperative GnRH analogue administration did not facilitate the completion of cold loop hysteroscopic myomectomy in a single surgical procedure in G2 myomas and was correlated with a longer duration of the surgery. No significant benefits were found for G0 and G1 myomas. (ClinicalTrials.gov: NCT01873378.) 相似文献9.
Regina Promberger Inga-Malin Simek Kazem Nouri Karin Obermaier Christine Kurz Johannes Ott 《Journal of minimally invasive gynecology》2018,25(5):794-799
Study Objective
To evaluate whether the presence of a visualizable “flow” effect in the fallopian tube ostia in hysteroscopic routine evaluation is predictive of tube patency.Design
A retrospective cohort study (Canadian Task Force Classification II-2).Setting
Data from all patients who underwent surgery because of infertility at the study center between 2008 and 2016 were analyzed retrospectively. The main outcome parameter was fallopian tube patency as assessed by laparoscopic chromopertubation. The predictive parameters tested were the presence of hysteroscopic tube “flow,” general patient characteristics, and intraoperative findings.Patients
Five hundred eleven infertile women who underwent combined hysteroscopy and laparoscopy were included.Interventions
All women underwent combined hysteroscopy and laparoscopy. Some had other interventions when necessary, but no additional interventions were taken because of this study.Results
In an analysis of 998 fallopian tubes, the hysteroscopic assessment of fallopian tube “flow” was highly accurate in predicting fallopian tube patency (p?<?.001), with a sensitivity of 86.4% (95% confidence interval [CI], 83.7–88.8) and a specificity of 77.6% (95% CI, 72.1–82.5). Risk factors for a false-negative hysteroscopy result were the presence of uterine myomas (odds ratio [OR]?=?2.11; 95% CI, 1.10–4.05; p?=?.025), the presence of a hydrosalpinx on the analyzed side (OR?=?2.50, 95% CI, 1.17–5.34; p?=?.019), and the presence of peritubal adhesions surrounding the analyzed tube (OR?=?2.87; 95% CI, 1.21–6.76; p?=?.016).Conclusion
A visualizable tube “flow” in hysteroscopy was accurate in the prediction of tubal patency, with a positive predictive value of about 91%. Knowledge about hysteroscopic fallopian tube “flow” can help to plan the future approach in an individual patient. 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.
Mohamed Kandil Mohamed Rezk Alaa Al-Halaby Mohamed Emarh Ibrahim Saif El-Nasr 《Journal of minimally invasive gynecology》2018,25(6):1075-1079
Study Objective
To compare the impact of ultrasound-guided transvaginal ovarian needle drilling (TND) versus laparoscopic ovarian drilling (LOD) on ovarian reserve and pregnancy rate in patients with clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS).Design
A randomized clinical trial (Canadian Task Force classification I).Setting
A university hospital.Patients
Of 644 patients who presented at an infertility clinic, 246 with CC-resistant PCOS were randomized for treatment.Interventions
Patients were randomly allocated to ultrasound-guided TND (n?=?124) and LOD (n?=?122).Measurements and Main Results
Ovarian reserve parameters (serum antimüllerian hormone [AMH] and antral follicle count [AFC]) and pregnancy rate at 3 and 6 months were evaluated. At 3 months, patients in the LOD group experienced a significantly lower AMH (p?<?.001) and a higher ovulation rate (p?<?.05) with comparable AFC and pregnancy rate to patients in the TND group (p?>?.05) and a significant decrease in AMH and AFC within each individual group when compared with baseline (p?<?.001). At 6 months, patients in the LOD group experienced a significantly lower AMH (p?<?.001), lower AFC (p?<?.001), higher ovulation rate (p?<?.001) and higher pregnancy rate (p?<?.001) when compared with patients in the TND group. This effect started to diminish between the fourth and sixth month with an increase of AMH and AFC compared with baseline values (p?<?.05).Conclusions
Although TND is simple, safe, and less invasive than LOD, its effect on ovarian reserve appears to be transient and diminishes at 6 months. Multicenter studies are warranted to confirm efficacy as a second-line treatment in patients with CC-resistant PCOS. 相似文献12.
Ally Murji Marta Wais Sabrina Lee Alice Pham Melissa Tai Grace Liu 《Journal of minimally invasive gynecology》2018,25(3):514-521
Study Objective
To compare surgical experience at myomectomy between patients with myomas pretreated with ulipristal acetate versus no pretreatment.Design
A prospective, observational, multicenter study of myomectomy procedures by any route (hysteroscopic, laparoscopic, or laparotomy) (Canadian Task Force classification II-2).Setting
Five university-affiliated hospitals including tertiary care and community sites.Patients
Any patient who underwent hysteroscopic, laparotomic, or laparoscopic myomectomy regardless of medical pretreatment.Interventions
Surgeons completed a Web-based questionnaire after each myomectomy procedure. Surgeons evaluated visualization, the myoma-myometrium relationship, extrusion, fluid deficit, blood loss, and overall ease of hysteroscopic myomectomies. For laparotomic/laparoscopic myomectomies, plane delineation, myoma separation, blood loss, and overall ease were assessed. The total surgical experience score was calculated by summing the values for each subscale.Measurements and Main Results
A total of 309 myomectomies were evaluated by 52 surgeons (response rate?=?83%) at 5 institutions. Of 140 hysteroscopic myomectomies, 84 (60%) were performed without pretreatment, 29 (21%) after ulipristal acetate pretreatment, and 27 (19%) after pretreatment with gonadotropin-releasing hormone agonist/other. Of 169 laparotomic/laparoscopic myomectomies, 104 (62%) were performed without pretreatment, 46 (27%) after ulipristal acetate, and 19 (11%) after gonadotropin-releasing hormone agonist/other. The mean surgical experience score (±standard deviation) was comparable between the no pretreatment and ulipristal acetate groups for hysteroscopic myomectomies (13.8?±?2.2 vs 13.3?±?2.2, p?=?.35) and laparotomic/laparoscopic myomectomies (12.9?±?4.1 vs 12.1?±?4.2, p?=?.30). Compared with no pretreatment, more laparotomic/laparoscopic myomectomies after ulipristal acetate pretreatment were associated with difficult delineation of surgical planes (22 [47.8%] vs 23 [22.1%], p?=?.002) and difficult myoma separation (20 [43.5%] vs 21 [20.2%], p?=?.003). More myomas were described as soft with ulipristal acetate pretreatment (14 [30.4%] vs 17 [16.4%], p?=?.049). The rates of profuse/abundant endometrium during hysteroscopy were similar between the no pretreatment (21 [25.0%]) and ulipristal acetate (7 [24.1%], p?=?.93) groups.Conclusion
Despite differences in surgical nuances, the overall myomectomy experience was not negatively affected by ulipristal acetate pretreatment. 相似文献13.
Christopher C. DeStephano Anita H. Chen Michael G. Heckman Nicolette T. Chimato Paulami Guha Mariana Espinal Tri A. Dinh 《Journal of minimally invasive gynecology》2018,25(6):1051-1059
Study Objective
To demonstrate the process for establishing or refuting validity for the Limbs and Things hysterectomy model.Design
Prospective study using Kane's framework for establishing validity (Canadian Task Force classification: II-2).Setting
Total laparoscopic hysterectomy (TLH) assessments completed in the operating room (OR) and simulation at 3 academic medical centers.Participants
Obstetrics and gynecology residents (n?=?26 postgraduate years 3–4), a gynecologic oncology fellow (postgraduate year 5), and a gynecology oncology attending.Interventions
Participants were rated with the myTIPreport feedback application by nonblinded faculty in the OR after TLH. In-person, simulation-based assessments were provided by 2 faculty members blinded to experience level using myTIPreport and Global Operative Assessment of Laparoscopic Skills (GOALS). Videos of simulated TLHs were rated by 2 minimally invasive gynecology fellows.Measurements and Main Results
OR scores for TLH steps were significantly higher than simulation assessments (p?<?.001) with “competent” marked more frequently in the OR. Number of robotic?+?conventional TLHs performed as primary surgeon was not significantly correlated with OR myTIPreport rating (Spearman r?=?.30, p?=?.14) but was significantly correlated with myTIPreport and GOALS in-person simulation ratings (Spearman r?=?.39–.58, p?=?.001–.04). Agreement between in-person simulation rater 1 and 2 myTIPreport assessments was 71.4% (weighted κ, .68; 95% confidence interval, .45–.90), and intraclass correlation for the GOALS overall assessment was .71 (95% confidence interval, .46–.85), indicating substantial agreement. Blinded video reviews showed similar agreement (73.1%) between raters but less correlation with experience (Spearman r?=?.32–.42, p?=?.11–.03) than in-person reviews. Using area under the receiver operating characteristic curve, mean score for the individual components of GOALS that best differentiated myTIPreport noncompetent and competent levels of performance was 4.3. Feedback acceptability and model realism were rated highly.Conclusion
The scoring and generalization validity inferences for Limbs and Things and myTIPreport are supported when global assessments of performance are evaluated but not for individual components of the assessment instruments. 相似文献14.
Study Objective
To compare the surgical technique of temporary bilateral uterine artery blockage with titanium clips in laparoscopic myomectomy with traditional surgery for uterine myomas to determine efficacy, ability to control bleeding, and recurrence.Design
Randomized, controlled, prospective study (Canadian Task Force classification I).Setting
Obstetrics and gynecology department in Jinhua Municipal Central Hospital.Patients
Women with symptomatic uterine myoma.Interventions
Sixty-four patients with symptomatic uterine myomas were randomly divided into trial (group A, n?=?33) and control groups (group B, n?=?31). Temporary bilateral uterine artery occlusion and myomectomy were used in group A and laparoscopic myomectomy only in group B. Operative time, perioperative bleeding, follow-up relief of menorrhagia, and recurrence of myomas were evaluated.Measurements and Main Results
All patients in this study underwent successful laparoscopic operation without intraoperative complications. Operative time between groups was not significantly different (p?=?.255 in single-myoma group and p?=?.811 in multiple-myoma group), blood loss in group A was notably lower than the conventional surgery group (p?<?.001). At final follow-up (2 years), recurrence rate and menorrhagia symptom relief were not statistically significant (p?=?.828 and p?>?.999, respectively). The fertility index of antimüllerian hormone showed no statistical difference between groups preoperatively or at 2 days, 3 months, 6 months, and 1 year postoperatively (p?=?.086, p?=?.247, p?=?.670, p?=?.753, and p?=?.857, respectively).Conclusion
Temporary bilateral uterine artery occlusion during laparoscopic myomectomy does not increase mean operative time, offers a possible option to reduce blood loss effectively, improves menorrhagia, and does not impact recurrence rate compared with conventional surgery. 相似文献15.
Stefano Uccella Chiara Morosi Nicola Marconi Anna Arrigo Baldo Gisone Jvan Casarin Ciro Pinelli Camilla Borghi Fabio Ghezzi 《Journal of minimally invasive gynecology》2018,25(1):62-69
Study Objective
To present a large single-center series of hysterectomies for uteri ≥1?kg and to compare the laparoscopic and open abdominal approach in terms of perioperative outcomes and complications.Design
A retrospective analysis of prospectively collected data (Canadian Task Force classification II-2).Setting
An academic research center.Patients
Consecutive women who underwent hysterectomy for uteri ≥1?kg between January 2000 and December 2016. Patients with a preoperative diagnosis of uterine malignancy or suspected uterine malignancy were excluded. The subjects were divided according to the intended initial surgical approach (i.e., open or laparoscopic). The 2 groups were compared in terms of intraoperative data and postoperative outcomes. Multivariable analysis was performed to identify possible independent predictors of overall complications. A subanalysis including only obese women was accomplished.Interventions
Total laparoscopic versus abdominal hysterectomy (±bilateral adnexectomy).Measurements and Main Results
Intra- and postoperative surgical outcomes. A total of 258 patients were included; 55 (21.3%) women were initially approached by open surgery and 203 (78.7%) by laparoscopy. Nine (4.4%) conversions from laparoscopic to open surgery were registered. The median operative time was longer in the laparoscopic group (120 [range, 50–360] vs 85 [range, 35–240] minutes, p?=?.014). The estimated blood loss (150 [range, 0–1700] vs 200 [50–3000] mL, p?=?.04), postoperative hemoglobin drop, and hospital stay (1 [range, 1–8] vs 3 [range, 1–8] days, p?<?.001) were lower among patients operated by laparoscopy. No difference was found between groups in terms of intra- and postoperative complications. However, the overall rate of complications (10.8% vs. 27.2%, p?=?.015) and the incidence of significant complications (defined as intraoperative adverse events or postoperative Clavien-Dindo ≥2 events, 4.4% vs 10.9%, p?=?.04) were significantly higher among patients who initially received open surgery. The laparoscopic approach was found to be the only independent predictor of a lower incidence of overall complications (odds ratio?=?0.42; 95% confidence interval, 0.19–0.9). The overall morbidity of minimally invasive hysterectomy was lower also in the subanalysis concerning only obese patients.Conclusion
In experienced hands and in dedicated centers, laparoscopic hysterectomy for uteri weighing ≥1?kg is feasible and safe. Minimally invasive surgery retains its well-known advantages over open surgery even in patients with extremely enlarged uteri. 相似文献16.
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17.
Alessandro Buda Giampaolo Di Martino Elena De Ponti Paolo Passoni Federica Sina Claudio Reato Francesca Vecchione Daniela Giuliani 《Journal of minimally invasive gynecology》2018,25(1):93-98
Study Objective
The goal of this study was to evaluate the intraoperative and perioperative surgical outcomes of 2 different florescence systems commonly used for sentinel lymph node (SLN) mapping in women with early-stage cervical cancer or endometrial cancer.Design
Case-control study (Canadian Task Force classification II-2).Setting
The Gynecology Oncology Surgical Unit of the San Gerardo Hospital, Italy.Patients
Thirty-four consecutive women with early stage-cervical cancer (stage IA-1B1) or apparent confined stage I endometrial cancer were included in the study.Interventions
Between October 2016 and May 2017, 34 patients underwent laparoscopic surgery with SLN mapping using indocyanine green dye: 22 women were mapped with the Storz 1S system (Karl Storz Endoscopy, Tuttlingen, Germany; Group A), whereas 12 women underwent planned surgery with the Novadaq PinPoint system (Novadaq, Mississauga, Ontario, Canada; Group B).Measurement and Main Results
We compared the surgical and perioperative outcomes of Group A and Group B. Patients in Group B had a shorter duration of the SLN mapping time than those in Group A (p?=?.0003). The median number of SLNs removed was 2 (range, 0–5) in Group A and 2 (range, 1–3) in Group B (p?=?.501). Bilateral mapping was 77.3% in Group A and 83.3% in Group B (p?=?.334), respectively. No differences were recorded in terms of body mass index, length of hospital stay, type of tumor, bilateral mapping, or number of lymph nodes removed. Body mass index was found to have no impact on the duration of the mapping (p?=?.353).Conclusion
From our preliminary experience we can conclude that both fluorescence systems are valid and applicable for SLN detection in the case of early-stage cervical or endometrial cancer. The PinPoint system seems to allow surgeons easier and faster identification of the SLNs, particularly in endometrial cancer patients. 相似文献18.
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19.
Meagan S. Cramer Jordan S. Klebanoff Matthew K. Hoffman 《Journal of minimally invasive gynecology》2018,25(6):1018-1023
Study Objective
To determine whether pain, as part of an indication for global endometrial ablation, is an independent risk factor for failure.Design
Retrospective cohort study (Canadian Task Force classification II-2).Setting
Academic-affiliated community hospital.Patients
Women undergoing global endometrial ablation with radiofrequency ablation (RFA), hydrothermablation (HTA), or uterine balloon ablation (UBA) between January 2003 and December 2015.Interventions
Procedure failure was defined as subsequent hysterectomy after the index ablation.Measurements and Main Results
A total of 5818 women who underwent an endometrial ablation were identified, including 3706 with RFA (63.7%), 1786 with HTA (30.7%), and 326 with UBA (5.6%). Of the 5818 ablations, 437 (7.5%) involved pain (i.e., pelvic pain, dysmenorrhea, dyspareunia, lower abdominal pain, endometriosis, or adenomyosis) before ablation, along with abnormal uterine bleeding. Pain as part of the preoperative diagnoses before endometrial ablation was a significant risk factor for subsequent hysterectomy compared with all other diagnoses (19.2% vs 13.5%; p?=?.001). Consistent with previous studies, women who underwent ablation at an older age were less likely to fail, which held true even when one of the indications for ablation was related to pain (odds ratio, 0.96/year; 95% confidence interval, 0.95–0.97). When the pathology reports of women who underwent a hysterectomy were examined, women in the pain group had lower rates of adenomyosis than women without pain (38.1% vs 50.1%; p?=?.04). However, there was a trend toward a higher rate of endometriosis on pathology reports (14.3% vs 8.7%; p?=?.09) and even higher rates of visualized endometriosis identified by operative reports in women who had pain before their ablation (42.9% vs 15.8%; p?<?.001). Patients who had pain before their ablation were less likely to have myomas/polyps (p?=?.01).Conclusion
Pelvic pain before global endometrial ablation is an independent risk factor for failure. 相似文献20.
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