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1.
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2.
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3.
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4.
Dayong Lee Seul Ki Kim Kidong Kim Jung Ryeol Lee Chang Suk Suh Seok Hyun Kim 《Journal of minimally invasive gynecology》2018,25(1):124-132
Study Objective
To compare operative outcomes of single-port laparoscopic myomectomy (SP-LM) vs conventional laparoscopic myomectomy (CLM), including subjective and objective cosmetic aspects.Design
Prospective randomized controlled trial (Canadian Task Force classification I).Setting
University hospital.Patients
Women with uterine myoma scheduled for laparoscopic myomectomy.Interventions
Sixty-six women were assigned at random to either the SP-LM or CLM group. Surgical outcomes, including patient and observer scar assessments, were evaluated between the groups according to the intention-to-treat principle.Measurements and Main Results
There were no significant differences in demographic characteristics and properties of myomectomy between the groups. There also were no differences in surgical outcomes, such as operation time, estimated blood loss, and complications, between the 2 groups. The mean total score of the Observer Scar Assessment Scale was lower in the SP-LM group at 1 week (13.0?±?3.2 vs 18.3?±?4.8; p?<?.001) and 8 weeks (9.9?±?3.2 vs 14.3?±?3.8; p?<?.001) after discharge. Similar results were obtained for the Patient Scar Assessment Scale at 1 week (11.6?±?7.2 vs 18.5?±?12.8; p?=?.024) and 8 weeks (9.5?±?6.0 vs 18.8?±?9.1; p?<?.001) after discharge. Postoperative pain and analgesic consumption did not differ between the groups, except in patient-controlled analgesia consumption at 6 hours after operation, which was lower in the SP-LM group (12.7?±?6.3?mL vs 16.4?±?6.2?mL; p?=?.039). Operative outcomes were similar in the 2 groups.Conclusion
SP-LM is associated with more favorable cosmetic outcomes and better patient satisfaction compared with CLM. There were no differences in operative outcomes and complications between the 2 modalities. 相似文献5.
Rose M. McDonnell Jade L. Hollingworth Paola Chivers Paul A. Cohen Stuart G. Salfinger 《Journal of minimally invasive gynecology》2018,25(5):810-815
Study Objective
To investigate whether surgeon factors including level of training undertaken in laparoscopic surgery, time in specialist practice, and case volume were associated with surgical morbidity for total laparoscopic hysterectomy (TLH).Design
A retrospective cohort study (Canadian Task Force classification II-2).Setting
A tertiary care setting in Western Australia.Patients
Two thousand thirteen patients who underwent TLH for benign or malignant indications.Interventions
Women undergoing TLH were allocated to 1 of 3 groups of surgeons: general gynecologists, gynecologic endoscopists, and subspecialists.Measurements and Main Results
All patients undergoing elective TLH at St John of God Subiaco Hospital, Subiaco, Perth, Western Australia, between January 1, 2011, and December 31, 2016, were included for analysis. Variables recorded included cystotomy, ureteric injury, enterotomy/colostomy, bowel serosa injury, vascular injury, conversion to laparotomy, return to the operating room, hemorrhage, blood transfusion, operating time, length of stay, and postoperative complications to 42 days. The primary outcome was any major intraoperative complication. The incidence of any major intraoperative complication was 1.8% (36/2013 cases). Forty-five patients (2.2%) had a postoperative complication, and 74 (3.7%) patients were readmitted to the hospital after discharge. The incidence of any major intraoperative complication was significantly higher among general gynecologists compared with subspecialists (3.3% vs 1.1%, p?=?.002). No association was found between time in specialist practice and the incidence of major intraoperative complications (p?=?.629). A significant association for major intraoperative complications was observed for surgeons who had performed <100 laparoscopic hysterectomies during the study period (p?=?.032).Conclusion
In this study, despite a higher level of surgical acuity and the performance of additional and more complex procedures, surgical morbidity was lower in patients undergoing TLH by gynecologic surgeons with a higher level of subspecialist training. 相似文献6.
Togas Tulandi Christian Sirois Hussein Sabban Aviad Cohen Ally Murji Sukhbir S. Singh Innie Chen Liane Belland 《Journal of minimally invasive gynecology》2018,25(3):480-483
Study Objective
To evaluate the clinical characteristics of women presenting with catamenial pneumothorax and compare them with those with noncatamenial pneumothorax.Design
A case-control study (Canadian Task Force II-2).Setting
A multicenter study.Patients
Forty-two women with pneumothorax: 21 women had catamenial pneumothorax (study group), and 21 were age-matched women with noncatamenial pneumothorax (control group).Interventions
All patients underwent video-assisted thoracoscopy and pleural biopsy. We also evaluated the presence and stage of pelvic endometriosis in 16 women with catamenial pneumothorax who had undergone laparoscopic surgery.Measurements and Main Results
The number of known episodes of catamenial pneumothorax before treatment was between 2 and 8 episodes. Symptoms were mainly chest pain and shortness of breath; 1 patient had hemoptysis. The prevalence of right-sided pneumothorax was 95.2% in the study group and 57.1% in the control group (p?=?.004). Besides 2 cases with complete collapse of the right lung, most of the cases in the study group had apical pneumothorax. Pelvic endometriosis was found in 15 of 16 women (93.7%), mainly stage 3 or 4, and thoracic endometriosis in 12 of 20 women (60%). None of the patients in the control group had thoracic endometriosis.Conclusion
Thoracic endometriosis is found in over half of women with catamenial pneumothorax but absent in those with noncatamenial pneumothorax. Right apical pneumothorax is predominant in women with catamenial pneumothorax. Endometriosis plays an important role in the mechanism of catamenial pneumothorax. 相似文献7.
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8.
Jianmin Chen Dong Huang Libing Shi Liuhang Zhang Dongjing Sun Xiaona Lin Songying Zhang 《Journal of minimally invasive gynecology》2018,25(6):1080-1087
Study Objective
To investigate the effect of cornual suture at the time of laparoscopic salpingectomy on the incidence of interstitial pregnancy (IP) after in vitro fertilization (IVF).Design
Single-center, retrospective review (Canadian Task Force classification II-2).Setting
University hospital.Patients
Patients with hydrosalpinx who were treated with salpingectomy before IVF-embryo transfer and managed in our center were included in this study.Interventions
A total of 542 patients who underwent laparoscopic salpingectomy from April 2011 to March 2014 comprised group A. A total of 502 patients who underwent cornual suture at the time of laparoscopic salpingectomy from April 2014 to February 2016 comprised group B.Measurements and Main Results
The overall IP rate was significantly lower in group B (7/293, 2.39%) than in group A (27/373, 7.24%; p?<?.05). The intrauterine pregnancy and ongoing pregnancy/live birth rates were significantly higher in group B than in group A (both p?<?.05). All 34 patients with IP underwent laparoscopic cornuostomy and cornual repair. Seven of 11 patients with combined interstitial and intrauterine pregnancies carried the intrauterine pregnancy to term and delivered via cesarean section, whereas 4 patients underwent inevitable miscarriage. IP rupture occurred in 8 of 34 patients at a mean of 23.43?±?2.77 days after embryo transfer. The earliest time of rupture was on day 20 after embryo transfer.Conclusion
An optimized salpingectomy technique plays an important role in pretreatment before embryo transfer in patients with hydrosalpinx. Cornual suture at the time of salpingectomy helps reduce the risk of IP. 相似文献9.
Sara Farag Leigh Rosen Charles Ascher-Walsh 《Journal of minimally invasive gynecology》2018,25(1):153-157
Study Objective
To compare the amount of patient displacement when a memory foam pad is used versus a bean bag with shoulder braces. The secondary aim was to evaluate for postoperative extremity symptoms including pain, numbness, and weakness.Design
A prospective randomized pilot study (Canadian Task Force classification I).Setting
A single academic institution.Patients
Women ≥18 years of age undergoing laparoscopic or robotic gynecologic surgery.Interventions
Patients were randomized to be positioned on the memory foam pad (group A) or the bean bag with shoulder braces (group B) preoperatively. The patients' positions were measured before and after the procedure, and the displacement was recorded. Patients were followed postoperatively and questioned regarding upper extremity or lower extremity weakness, numbness, and pain. Demographic characteristics were collected using the electronic medical record.Measurements and Main Results
Forty-three patients were included in the study (22 in group A and 21 in group B). The demographic and intraoperative characteristics of the patients were similar in both groups. The patients in group A moved a mean distance of 3.80?±?3.32?cm, whereas those in group B moved a mean distance of 1.07?±?1.93?cm (p?=?.002). A Pearson correlation coefficient did not yield a correlation between patient displacement and age, body mass index, length of surgery, or pathology weight. In group A, 2 patients had lower extremity numbness, and 1 patient had upper extremity numbness. In group B, 1 patient had upper extremity pain, and 1 patient had both upper and lower extremity numbness. These patients had complete resolution of their symptoms within the first 2 weeks postoperatively, with the exception of 1 patient in group A whose lower extremity numbness resolved 3 months postoperatively.Conclusion
Positioning patients on the bean bag with shoulder braces resulted in significantly less displacement during gynecologic laparoscopic surgery when compared with the memory foam pad. All postoperative extremity numbness, weakness, and pain were temporary and resolved completely in our cohort. A larger study would be necessary to determine the true incidence of peripheral nerve injuries because these are rare complications of laparoscopic surgeries. 相似文献10.
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11.
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12.
Ali Akdemir Enes Taylan Cagdas Sahin Banu Ozgurel Ayfer Karlitepe Osman Zekioglu Gulinnaz Ercan 《Journal of minimally invasive gynecology》2018,25(4):638-643
Study Objective
To investigate whether carbon dioxide pneumoperitoneum causes ischemia-reperfusion injury to the ovaries during laparoscopic surgery.Design
A prospective controlled clinical study (Canadian Task Force classification II-1).Setting
A tertiary academic center.Patients
Premenopausal women who underwent hysterectomy with bilateral salpingo-oophorectomy (HSO) via open abdominal and laparoscopic approaches between 2014 and 2015.Interventions
In both surgical approaches, unilateral oophorectomy was performed immediately after abdominal entry, and the remaining contralateral ovary was excised at the end of the hysterectomy in order to compare the effect of these surgical procedures on ovarian tissue. Additionally, plasma samples were collected at the following time points: (1) before abdominal entry, (2) at the end of hysterectomy, and (3) before contralateral oophorectomy. Plasma samples were assessed for biochemical oxidative stress markers malondialdehyde (MDA) and 8-hydroxy-2'-deoxyguanosine (8-OHdG). Ovarian tissue samples were assessed for MDA and further evaluated for ischemia-reperfusion injury using a histologic scoring method.Measurements and Main Results
Twenty premenopausal women undergoing HSO via open abdominal surgery (n?=?10) and laparoscopy (n?=?10) were included. Baseline characteristics (age, body mass index, parity, and gravida) and operative data (operative time, estimated blood loss, and intraoperative complication) were similar between groups. Perioperative plasma MDA levels, histologic scores, and tissue oxidative stress markers did not show a significant difference in either group or between groups. However, plasma 8-OHdG levels were significantly different when the second sample in the abdominal HSO group was compared with the first sample in the abdominal HSO group and the third sample in the laparoscopic HSO group (p?=?.012 and .001, respectively).Conclusion
Carbon dioxide pneumoperitoneum does not cause ischemia-reperfusion injury in the human ovaries at clinically safe levels of intra-abdominal pressure. 相似文献13.
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14.
Charlotte Lybol Sanne van der Coelen Anouk Hamelink Lidewij Ruth Bartelink Theodoor Elbert Nieboer 《Journal of minimally invasive gynecology》2018,25(7):1255-1259
Study Objective
Endometrial ablation using the NovaSure system (Hologic Inc., Marlborough, MA) is 1 of the treatment options for heavy menstrual bleeding (HMB), which has a reported success rate of 81% to 90%. We aimed to identify predictors for NovaSure endometrial ablation failure. This will contribute to a more effective and individualized preoperative counseling.Design
A retrospective multicenter cohort study (Canadian Task Force classification II-2).Setting
One university hospital and 1 large teaching hospital.Patients
Four hundred eighty-six patients with HMB who had undergone NovaSure endometrial ablation between 2008 and 2014.Interventions
The NovaSure endometrial ablation system for patients with HMB.Measurements and Main Results
In total, the required characteristics of 486 patients were collected and analyzed. With a median follow-up of 45 months, 19.3% (n?=?94) required a secondary treatment and thus were considered NovaSure failures. Multivariate logistic regression analysis showed that younger age (p?=?.019), a history of sterilization (p?=?.002), the presence of dysmenorrhea (p?<?.001) and the presence of an intramural leiomyoma on transvaginal sonography (p?=?.005) were independent predictors of NovaSure ablation failure. Preoperative hysteroscopy appeared to be a protective factor (p?=?.001).Conclusion
Within a median follow-up of 45 months, 19.3% of patients required a secondary treatment. Identification of specific predictive factors for endometrial ablation failure is important in preoperative counseling and patient selection. In the current era of personalized medicine, doctors and patients will ideally choose the therapy that results in the highest chance of success in the individual case. 相似文献15.
Alexandra Badescu Horace Roman Iulia Barsan Valentin Soldea Serban Nastasia Moutaz Aziz Lucian Puscasiu Simona Stolnicu 《Journal of minimally invasive gynecology》2018,25(3):522-527.e9
Study Objective
To document the presence of bowel invisible microscopic endometriosis implants and their relationship with deep endometriosis macronodule infiltrating the bowel.Design
A series of consecutive patients with deep endometriosis infiltrating the rectum and/or sigmoid colon (Canadian Task Force classification II-2).Settings
A university referral center.Patients
Ten patients managed by colorectal resection.Interventions
A microscopic study of endometriotic foci of the bowel involving 3272 microsection slides was established using a unique method of step serial sections using combined transverse and longitudinal macrosection. Two-dimensional reconstruction based on slide scanning highlighted the presence and localization of the deep endometriosis macronodule in contrast with bowel invisible microscopic endometriosis microimplants.Measurements and Main Results
The distance separating the microimplants and the nodule and their histologic characteristics. The mean length of the colorectal specimens was 91?±?19?mm. The maximum distance between the farthest microimplants was 7.2?cm. The maximum distance from the macroscopic nodule limit to the farthest microimplant was 31?mm. Bowel invisible microscopic endometriosis microimplants presented with similar features independently of the type of spread. They had an active appearance including stroma and glands, were sometimes decidualized, and were free of fibrosis. They were found on the distal/rectal limit of the specimen in 3 patients and on both limits (distal/rectal and proximal/sigmoid colon) in 1 patient.Conclusion
Invisible microscopic endometriosis implants surround the bowel macroscopic endometriosis nodule at variable distances, suggesting that complete surgical microscopic removal may be a challenging goal. These results may help to reconsider the principles and feasibility of the surgical management of bowel endometriosis. 相似文献16.
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17.
Nishant Sahay Shalini Sharma Umesh K. Bhadani Akhilesh Singh Chandni Sinha Anubha Sahay Alok Ranjan Mukta Agarwal 《Journal of minimally invasive gynecology》2018,25(1):147-152
Study Objective
To evaluate the effect of pneumoperitoneum and head position during laparoscopic surgery on intracranial pressures (ICPs) using sonographic measurements of optic nerve sheath diameter (ONSD).Design
Prospective observational study (Canadian Task Force classification II-1).Setting
A tertiary-level hospital.Patients
Sixty-one women aged 15 to 50 years with American Society of Anesthesiologists grade 1 risk and body mass index?≤?29?kg/m2 were admitted to the hospital between November 2015 and October 2016 for elective laparoscopic surgery and were included in this study.Intervention
Patients were placed in the Trendelenburg position with head down (group I; n?=?33) and reverse Trendelenburg position with head up (group II; n?=?28).Measurements and Main Results
ONSD was measured via sonography at 4 time points: at baseline before pneumoperitoneum, after pneumoperitoneum, after patient was placed in respective position, and once pneumoperitoneum was released. Patient demographics were comparable in all respects. ICP as indicated by ONSD showed a significant increase after pneumoperitoneum (p?=?.0001 in group I and p?=?.0011 in group II). When patients were placed in either head position, ONSD showed a further increase in ICP. This increase was more pronounced in patients assuming the head-down Trendelenburg position compared with patients in reverse Trendelenburg (head-up) position. Baseline and preoperative ONSD measurements were not reached even after 5 minutes of desufflation.Conclusions
Pneumoperitoneum causes an increase in ICP. The patient position, either head up or head down as in gynecologic laparoscopic procedures, further worsens ICP. ONSD does not revert back to baseline until 5 minutes after desufflation. 相似文献18.
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19.
Stefano Restaino Carlo Ronsini Angelo Finelli Alessandro Santarelli Giovanni Scambia Francesco Fanfani 《Journal of minimally invasive gynecology》2018,25(6):954
Study Objective
To prove the feasibility of the Shull technique by a laparoscopic approach in a patient affected by pelvic organ prolapse (POP) with apical loss of support.Design
A step-by-step video demonstration (Canadian Task Force classification III).Setting
University hospital. Ethics Committee ruled that approval was not required for this study.Patient
A 53-year-old woman with a POP-Q stage IV, left ovarian cyst.Intervention
Laparoscopic uterosacral ligament suspension.Measurements and Main Results
According to the National Health and Nutrition Examination Survey, approximately 3% of women in the United States report symptoms linked to POP, with approximately 300 000 POP surgeries each year in the United States. More recent studies show a lower reoperation rate of approximately 6% to 30%, and this lower reoperation rate may reflect improvement in surgical technique and POP surgery that includes suspension of the vaginal apex, which is associated with a decreased reoperation rate, commonly done by vaginal vault suspension to uterosacral ligaments. Suturing the apex to the high (proximal) portion of each uterosacral ligament is more commonly performed vaginally, although abdominal and laparoscopic approaches are suitable. It represents a modification of the uterosacral ligament suspension procedure described by Shull. A 53-year-old woman with a POP-Q stage IV, left ovarian cyst and an “elongatio colli” underwent a total hysterectomy and bilateral ovariectomy with vaginal dome uterosacral ligament suspension performed laparoscopically. The total operating time was 80 minutes, with a blood loss volume of less than 50?mL. The patient was hospitalized for 2 days. There were no postoperative complications in 30 days.Conclusion
The Shull laparoscopic surgery for advance POP with reconstruction of the anterior compartment is technically feasible. 相似文献20.
Souzana Choussein Serene S. Srouji Leslie V. Farland Ashley Wietsma Stacey A. Missmer Michael Hollis Richard N. Yu Charles N. Pozner Antonio R. Gargiulo 《Journal of minimally invasive gynecology》2018,25(1):76-83