共查询到20条相似文献，搜索用时 31 毫秒
1.
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2.
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3.
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4.
Mario Franchini Giuseppe Lippi Stefano Calzolari Giovanna Giarrè Giampietro Gubbini Ursula Catena Attilio Di Spiezio Sardo Pasquale Florio 《Journal of minimally invasive gynecology》2018,25(3):418-425
Study Objective
To compare the costs of hysteroscopic polypectomy using mechanical and electrosurgical systems in the hospital operating room and an office-based setting.Design
Retrospective cohort study (Canadian Task Force classification II-2).Setting
Tertiary referral hospital and center for gynecologic care.Patients
Seven hundred and fifty-four women who underwent endometrial polypectomy between January 20, 2015, and April 27, 2016.Interventions
Hysteroscopic endometrial polypectomy performed in the same-day hospital setting or office setting using one of the following: bipolar electrode, loop electrode, mechanical device, or hysteroscopic tissue removal system.Measurements and Main Results
The various costs associated with the 2 clinical settings at Palagi Hospital, Florence, Italy were compiled, and a direct cost comparison was made using an activity-based cost-management system. The costs for using reusable loop electrode resection-16 or loop electrode resection-26 were significantly less expensive than using disposable loop electrode resection-27, the tissue removal system, or bipolar electrode resection (p?=?.0002). Total hospital costs for polypectomy with all systems were significantly less expensive in an office setting compared with same-day surgery in the hospital setting (p?=?.0001). Office-based hysteroscopic tissue removal was associated with shorter operative time compared with the other procedures (p?=?.0002)Conclusion
The total cost of hysteroscopic polypectomy is markedly higher when using disposable equipment compared with reusable equipment, both in the hospital operating room and the office setting. Same-day hospital or office-based surgery with reusable loop electrode resection is the most cost-effective approach in each settings, but requires experienced surgeons. Finally, the shorter surgical time should be taken into consideration for patients undergoing vaginal polypectomy in the office setting, owing more to patient comfort than to cost savings. 相似文献5.
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6.
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7.
Huan Huang Chunxia Cheng Grace Johnson Ruoyi Wang Min Xue Aiqian Zhang Dabao Xu Xiaoming Guan 《Journal of minimally invasive gynecology》2018,25(4):583-584
Study Objective
To demonstrate step-by-step the technique of hysteroscopic adhesiolysis (HA) by means of a blunt spreading technique using double-action forceps to dissect and restore the layer between the anterior and posterior uterine walls in a patient with severe intrauterine adhesions (IUAs), particularly in cases in which the endometrial lining is obscured on ultrasound imaging and the endometrial cavity is completely occluded on hysteroscopy.Design
A step-by-step explanation of the technique using videos and pictures (educative video) (Canadian Task Force Classification III).Setting
A university-affiliated hospital.Patient
A 36-year-old, gravida 3, para 1, abortus 2 woman presenting with amenorrhea for 5 months after surgical termination of a 53-day intrauterine pregnancy. She had no cyclic lower abdominal pain. Ultrasound revealed an obscure endometrial stripe and no obvious hematometra. Both the urine human chorionic gonadotropin test and the progesterone withdrawal test were negative. One month before admission, hysteroscopic adhesiolysis failed because the uterine cavity was inaccessible because of adhesions completely occluding the lower uterine cavity. Additionally, the uterine cavity could not be explored with a probe because the anatomic layer of the endometrial lining could not be easily identified by transabdominal ultrasound.Intervention
HA using a blunt spreading dissection technique with double-action forceps to restore the uterine cavity followed by “ploughing” of the intrauterine scar tissue using cold scissors [1].Measurements and Main Results
An intraoperative technique with commentary highlighting tips for a successful dissection. The uterine cavity was successfully restored using the blunt spreading dissection technique. There were no complications, including false uterine wall passage, uterine perforation, or fluid overload. Postoperative hysteroscopy at 1 month revealed an almost normal uterine cavity.Conclusions
HA using a blunt spreading dissection technique to restore the uterine cavity is a simple, effective, and safe hysteroscopic skill, especially when the endometrial stripe is obscured on ultrasound imaging and exploring the uterine cavity by means of a probe has failed. Furthermore, this technique may serve as an alternative to resectoscopic techniques because it uses cold forceps and scissors, which provide better protection for the endometrium. 相似文献8.
Neha Jeirath Cindy M. Basinski Max A. Hammond 《Journal of minimally invasive gynecology》2018,25(5):836-841
Study Objective
To assess if follow-up confirmation testing 3 months after hysteroscopic sterilization with the Essure device (Bayer HealthCare Pharmaceuticals, Inc., Whippany, NJ) improved with recommendation for transvaginal ultrasound (TVUS) versus hysterosalpingogram (HSG).Design
Retrospective, observational case-controlled cohort study (Canadian Task Force classification II-2).Setting
Two-physician private practice in Evansville, Indiana.Patients
Compliance rates for a TVUS confirmation test on 100 women who underwent hysteroscopic sterilization compared with a previously published cohort of 1004 women who were scheduled to undergo an HSG confirmation test.Intervention
Acquisition of 3-month confirmation testing after Essure hysteroscopic sterilization.Measurement and Main Results
All women who underwent Essure hysteroscopic sterilization with recommendation for TVUS confirmation testing between July 2015 and January 2017 were compared with a previously published cohort of 1004 patients with recommendation for HSG confirmation testing (HSG cohort). In addition, an HSG subgroup cohort (HSG subgroup) similar in size and closest chronology to the TVUS cohort was drawn from the original 1004 patients and analyzed for HSG follow-up. Records for all patients were reviewed for demographic, procedural, and confirmation testing and outcome data. One hundred patients were identified with successful Essure device placement and a recommendation for TVUS confirmation testing. Eighty-eight patients (88.0%) returned for TVUS at 3 months. In the HSG cohort 1004 successful Essure devices were placed, and 778 patients returned for the recommended HSG follow-up (77.5%). There was a significantly higher follow-up rate for TVUS compared with the HSG cohort (88.0% vs 77.5%, p?=?.008). In the HSG subgroup 184 patients were identified, and 133 patients presented for HSG follow-up (72.3%), indicating a significantly higher follow-up rate in the TVUS cohort (88.0% vs 72.3%, p?=?.001). No pregnancies after any confirmation testing were noted.Conclusion
Confirmation testing with TVUS rather than HSG 3 months after Essure device placement results in increased patient compliance that may lead to improved patient outcomes with reduction of unintended pregnancy. 相似文献9.
Omar M. Abuzeid John Hebert Mohammad Ashraf Mohamed Mitwally Michael P. Diamond Mostafa I. Abuzeid 《Journal of minimally invasive gynecology》2018,25(1):133-138
Study Objective
To determine the incidence of postoperative ascending infection without antibiotics with the use of a pediatric Foley catheter (PFC) after operative hysteroscopy for intrauterine pathology.Design
Retrospective case series (Canadian Task Force classification III).Setting
University-affiliated outpatient medical center.Patients
Patients who underwent operative hysteroscopy for uterine septum, arcuate uterine anomaly, or multiple submucosal myomas between 1992 and 2015.Interventions
In all patients, a PFC was placed in the endometrial cavity at the conclusion of operative hysteroscopy and left in place for 7 days to reduce intrauterine adhesion formation.Measurements and Main Results
A total of 1010 patients who underwent operative hysteroscopy for uterine septum (n?=?479), arcuate uterine anomaly (n?=?483), or multiple submucosal myomas (n?=?48) were studied. All patients presented with infertility, recurrent pregnancy loss, or excessive uterine bleeding (in patients with submucous myomas). In all patients, a PFC was placed at the conclusion of the procedure and left in place for 7 days. An 8Fr PFC was used after hysteroscopic division of uterine septum or arcuate uterine anomaly, and a 10Fr PFC was used after hysteroscopic myomectomy. Patients with a history of pelvic inflammatory disease were excluded. Following PFC placement, patients were prescribed estrogen for 6 weeks and progestogen for the last 10 days of the estrogen course. No prophylactic antibiotic therapy was provided. All patients were discharged to home on the same day. Postoperative pain was well controlled with oral pain medication in 98.5% of the patients. There were no reported postoperative infections, and all patients had an uneventful recovery.Conclusion
In 1010 consecutive operative hysteroscopies followed by temporary (7-day) PFC placement, no clinically significant uterine infection was observed. 相似文献10.
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11.
Study Objective
To evaluate the optimal dose of vaginal misoprostol (200 and 400?µg) for cervical priming before operative hysteroscopy.Design
A randomized, controlled, double-blind trial (Canadian Task Force classification I).Setting
A university hospital.Patients
Sixty-eight patients undergoing operative hysteroscopy.Interventions
Patients were randomized to receive a low (200?µg) or high (400?µg) dose of misoprostol administered vaginally 8 hours before operative hysteroscopy.Measurements and Main Results
The primary outcome was perioperative dilatation time, and the secondary outcome measurements included the subjective difficulty of cervical dilatation assessed by the surgeon, operative time, self-reported adverse events after vaginal administration and before the start of the operation, and complications during the procedure. A comparison of the 200-µg (n?=?34) and 400-µg (n?=?34) misoprostol cohorts revealed similarities when comparing time with cervical dilatation, operative difficulty, result, and time. Misoprostol-related adverse events were significantly lower in the 200-µg cohort than the 400-µg cohort (58.8% vs 85.3%, p?=?.015). Abdominal pain was the most common adverse event and was higher in the 400-µg cohort compared with the 200-µg cohort (73.5% vs 50.0%, p?=?.046). However, there were no operative delays resulting from adverse events, and all individuals reported the procedure to be tolerable and recovered without medication or treatment.Conclusion
Both 200?µg and 400?µg vaginally administered misoprostol are effective for cervical dilatation, and we recommend vaginal administration of 200?µg misoprostol for cervical dilatation 8 hours before operative hysteroscopy because of lower adverse events in the 200-µg group as well as similar efficacy between cohorts. 相似文献12.
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13.
Henriette Strøm Kahr Ole Thorlacius-Ussing Ole Bjarne Christiansen Regitze Kuhr Skals Christian Torp-Pedersen Aage Knudsen 《Journal of minimally invasive gynecology》2018,25(4):715-723.e2
Study Objective
To estimate the risk of venous thromboembolic complications after abdominal, laparoscopic, and vaginal hysterectomy when performed for benign disorders.Design
A nationwide cohort study (Canadian Task Force classification II-2).Setting
Data from Danish national registers on all women undergoing hysterectomy for benign conditions from 1996 to 2015.Patients
Women aged 18 years and older who underwent hysterectomy for benign disease were stratified into 3 groups according to the hysterectomy approach: abdominal, laparoscopic, or vaginal.Interventions
Hysterectomy.Measurements and Main Results
Eighty-nine thousand nine hundred thirty-one women met the inclusion criteria. Venous thromboembolism (VTE) as a diagnosis or cause of death was identified. The risk of postoperative VTE was examined with Cox proportional hazard models adjusting for age, surgical approach, and relevant comorbidities. The mean age was 49.9, 47.9, and 54.3 years for women with abdominal, laparoscopic, and vaginal hysterectomy, respectively. The crude incidences of VTE within 30 days after hysterectomy were 0.24% (n?=?142), 0.13% (n?=?12), and 0.10% (n?=?21). The most important predictors of VTE were the approach to hysterectomy and a history of thromboembolic disease. In the multivariable analysis, the risk of VTE was significantly reduced with laparoscopic hysterectomy (hazard ratio [HR]?=?0.51; 95% confidence interval [CI], 0.28–0.92; p?=?.03) and vaginal hysterectomy (HR?=?0.39; 95% CI, 0.24–0.63; p?<?.001) when compared with the abdominal procedure. Data on postoperative heparin thromboprophylaxis were available in 53?566 patients, and the adjusted HR was 0.63 (95% CI, 0.42–0.96; p?=?.03) in patients receiving heparin thromboprophylaxis.Conclusion
The 30-day cumulative incidence of VTE after hysterectomy for benign conditions was low overall (0.19%). Laparoscopic hysterectomy and vaginal hysterectomy carry a lower risk than the abdominal procedure. Postoperative heparin thromboprophylaxis significantly reduces the risk of VTE and should be considered, especially if risk factors are present. 相似文献14.
Meritxell Gracia Marta Alcalà Janisse Ferreri Mariona Rius Cristina Ros María Adela Saco María Ángeles Martínez-Zamora Francisco Carmona 《Journal of minimally invasive gynecology》2018,25(7):1274-1280
Study Objective
To study the effects of ulipristal acetate (UPA) on adenomyosis-associated clinical symptoms.Design
A retrospective, single-center observational study (Canadian Task Force classification II-2).Setting
A university tertiary referral center.Patients
Premenopausal women (163) with adenomyosis and symptomatic uterine myomas (41 patients, A?+?F group) versus a control group with only myomas (122 patients, F group) treated with the first course of UPA.Interventions
This was a retrospective study to assess the effects of a 12-week course of UPA (5?mg/d).Measurements and Main Results
Clinical symptoms including bleeding control, amenorrhea, pain outcomes, and self-perceived severity of the disease and quality of life. Amenorrhea was present in 90.4% of the A?+?F group compared with 77.6% in the F group (p?=?.0017). Optimal bleeding control was significantly higher in the adenomyosis group (pictorial blood loss assessment chart?<?75) than in the F group (90.2% vs 73.8%, p?=?.028). At the end of the first UPA course, the self-reported visual analog scale scores in the A?+?F group were significantly higher than in the F group (p?=?.017), reflecting greater improvement in pain outcomes for women with adenomyosis. UPA treatment improved the quality of life in both study groups. Most of the women rated their global health status as “better” after the first UPA course than before the treatment (A?+?F group: 67.00% and F group: 80.50%, p?=?.223).Conclusion
Treatment with UPA led to a significant reduction in the clinical symptoms of adenomyosis (bleeding and pain) and achieved a high rate of amenorrhea in a cohort of women with concomitant uterine myomas. Despite the limitations of the study, our results showed that UPA might be a good alternative treatment for adenomyosis. 相似文献15.
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16.
Monique H. Vaughan Shunaha Kim-Fine Kathie L. Hullfish Tovia M. Smith Nazema Y. Siddiqui Elisa R. Trowbridge 《Journal of minimally invasive gynecology》2018,25(6):1101-1106
Study Objective
To establish construct validity of the simulated vaginal hysterectomy trainer (SimVaHT).Design
A cross-sectional validation study (Canadian Task Force classification II-2).Setting
A single academic medical center in the United States.Subjects
Fourteen residents in obstetrics and gynecology (4 postgraduate year [PGY] 1, 4 PGY-2, 3 PGY-3 and 3 PGY-4). PGY-1 and PGY-2 residents were grouped to form the “junior level” cohort, whereas PGY-3 and PGY-4 residents comprised the “senior level” cohort.Interventions
Each participant underwent surgical skill simulation by performing a simulated vaginal hysterectomy on a practical, inexpensive vaginal hysterectomy trainer.Measurements and Main Results
The primary outcome was resident surgical skill as assessed by the Objective Structured Assessment of Technical Skills Global Rating Scale (GRS). All obstetrics and gynecology residents were videotaped performing a simulated vaginal hysterectomy on the SimVaHT. The tapes were reviewed independently by 2 blinded urogynecology experts, each of whom provided a GRS score. The primary outcome was overall GRS scores. The secondary outcome was time to complete the exercise. GRS scores were compared between junior- and senior-level residents. Senior-level residents scored significantly higher on the GRS overall compared with junior-level residents (p?=?.008).Conclusion
Construct validity was demonstrated for the SimVaHT. The SimVaHT is a practical and inexpensive tool that may improve resident vaginal surgical skills before their first case in the operating room. 相似文献17.
18.
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19.
《Journal of minimally invasive gynecology》2020,27(1):135-140
Study ObjectiveTo evaluate whether the presence of a visualizable “flow” effect in the fallopian tube ostia in hysteroscopy was predictive of tubal patency.DesignA prospective cohort study.SettingIn a prospective study, infertile women who underwent surgery because of infertility between March and November 2018 were included. The main outcome parameter was fallopian tube patency assessed by laparoscopic chromopertubation. The predictive parameter tested was the presence of hysteroscopic tube flow.PatientsSeventy-two infertile women.InterventionsCombined hysteroscopy and laparoscopy with chromopertubation.ResultsOne-hundred forty-four fallopian tubes were evaluated, with 88 (61.1%) patent tubes at laparoscopic chromopertubation. A positive hysteroscopic flow effect was recorded for 94 (65.3%) ostia and was accurate in predicting patency (p < .001), with a sensitivity of 85.3% (95% confidence interval [CI], 76.1–91.9) and a specificity of 66.1% (95% CI, 52.2–78.2). A multivariate binary regression model revealed that the presence of a hydrosalpinx (odds ratio = 8.216; 95% CI, 1.062–63.574; p = .044) and peritubal adhesions (odds ratio = 3.439; 95% CI, 1.142–10.353; p = .028) were associated with a false-normal flow result. A hazy hysteroscopic picture was found in 15 of 21 (71.4%) and 5 of 51 (9.8%) cases with and without bilateral tubal occlusion, respectively (p < .001, sensitivity = 71.4% [95% CI, 47.8–88.7], specificity = 90.2% [95% CI, 78.6–96.7]).ConclusionsThe presence of hysteroscopic tubal flow was a reliable indicator of tubal patency. A hydrosalpinx or peritubal adhesions increase the risk for a false-normal result. A hazy hysteroscopic picture suggests bilateral tubal occlusion. Using the hysteroscopic flow effect, one can provide additional information for the patient. 相似文献
20.
Lara F.B. Harvey Vandana G. Abramson Jimena Alvarez Christopher DeStephano Hye-Chun Hur Katherine Lee Patricia Mattingly Beau Park Carolyn Piszczek Farinaz Seifi Mallory Stuparich Amanda Yunker 《Journal of minimally invasive gynecology》2018,25(1):111-115