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Marie Schaub Lise Lecointre Emilie Faller Thomas Boisramé Jean-Jacques Baldauf Cherif Youssef Akladios 《Journal of minimally invasive gynecology》2018,25(3):391-392
Study Objective
Laparoscopy using a single port improves morbidity while keeping the same level of requirement. This technique has been evaluated in gynecology for salpingectomy, ovarian surgery, and hysterectomy. Here, the authors illustrate a new use of a single port using the transvaginal approach.Design
Case report (Canadian Task Force classification III).Setting
Tertiary referral center in Strasbourg, France.Patient
Woman age 59 years.Intervention
Single-port platform used in the transvaginal approach for resection of sacrocolpopexy mesh. The local institutional review board approved the video.Measurements and Main Results
A 59-year-old woman suffering from insulin-dependent diabetes and a tobacco user had 2 laparoscopic sacrocolpopexies for recurrent rectocele, the first in 2007 and the second in 2012. The sequences were marked by mesh erosion and granuloma in the vagina, requiring its surgical excision in 2016. The patient was then symptomatic, with an increasingly foul-smelling vaginal discharge with recurrent mesh erosion. Magnetic resonance imaging showed an abscess formation along the length of the mesh to the promontory. The patient then underwent surgery, realized under probabilistic antibiotic therapy, consisting of complete excision of the sacrocolpopexy mesh by the transvaginal approach. After putting the single-port trocar (GelPoint; Applied Medical, Rancho Santa Margarita, CA) into the vagina and obtaining distension with the insufflator (AirSeal; Conmed, Utica, NY), classic laparoscopic instruments were introduced by the single-port trocar. The mesh was entirely resected in the retroperitoneal space. Mesh was again used because the exposed space is almost always surrounded by loose granulation tissue that facilitates dissection and also prevents injury to adjacent structures such as bladder, rectum, and peritoneum. Moreover, the opening of adjacent structures will manifest gas leaks and, consequently, loss of the pneumovagina. At the end of procedure, the vagina is not closed to permit optimal drainage with a multitubular drain in the dissection space. The surgery lasted 60 minutes. The mesh excision was completed with relative ease, and there was no blood loss. Bacteriologic examination revealed the presence of Streptococcus anginosus, Klebsiella pneumoniae, and Bacteroides fragili. The operating suites were simple with great cicatrization after 6 weeks. The principal difficulties of this surgery were obtaining a good seal by the creation of cutaneous sutures. Finally, there are less conflicts between the instruments inside the single-port trocar used in transvaginally because of a more limited dissection space. Indeed, the rate of mesh erosion reached 2.4% and, in case of infection, justifies this excision.Conclusion
The transvaginal use of a single-port trocar represents a good alternative, allowing easy resection of the sacrocolpopexy mesh while remaining in the retroperitoneal space. 相似文献3.
Juan Liu Jaden Kohn Bin Sun Zhenkun Guan Binhua Liang Xiaoming Guan 《Journal of minimally invasive gynecology》2019,26(1):38-39
Study Objective
To demonstrate helpful tips and tricks for the successful use of transvaginal natural orifice transluminal endoscopic surgery (NOTES) for performing sacrocolpopexy and salpingo-oophorectomy surgery. Minimally invasive approaches for treating pelvic organ prolapse via sacrocolpopexy have traditionally included laparoscopy either with or without robotic assistance. Transvaginal NOTES is a novel minimally invasive approach that both avoids abdominal incisions and provides improved visualization; however, it can be technically challenging.Design
Stepwise demonstration with narrated video footage (Canadian Task Force classification III).Setting
An academic tertiary care hospital in Guangdong, China.Patient
A 61-year-old gravida 3, para 3 woman with 3 spontaneous vaginal deliveries and stage III uterine prolapse, stage III cystocele, and stage III rectocele. The preoperative vaginal length was 6?cm.Intervention
After performing vaginal hysterectomy, we show the usefulness of NOTES for salpingo-oophorectomy. We also demonstrate useful techniques for transvaginal NOTES sacrocolpopexy including hydrodissection, division of the Y mesh, anchoring of the anterior mesh before reducing prolapse, retroperitoneal tunneling, and hand suturing of the mesh and vaginal cuff.Measurements and Main Results
The procedure was successfully performed in approximately 190 minutes. The postoperative vaginal length was 5?cm. Postoperative pelvic organ prolapse quantification was stage 0.Conclusion
The transvaginal NOTES approach is feasible and efficient for sacrocolpopexy and salpingo-oophorectomy; additionally, it is a reasonable option for patients who desire a minimally invasive approach with excellent cosmetic results. Surgical techniques that aid in effectively performing transvaginal NOTES sacrocolpopexy include the use of hydrodissection, Y mesh division, anterior mesh anchoring before reducing prolapse, retroperitoneal tunneling, and hand suturing. Using the techniques presented here, we were able to insert the port only 1 time, which improves the efficiency and safety of this surgery. 相似文献4.
Tanya P. Hoke Howard Goldstein Emily K. Saks Babak Vakili 《Journal of minimally invasive gynecology》2018,25(5):892-895
Study Objective
To evaluate surgical outcomes of robotic sacrocolpopexy with and without paravaginal repair for pelvic organ prolapse (POP).Design
A retrospective cohort study with a 3-month postoperative follow-up (Canadian Task Force classification II-3).Setting
An academic-affiliated community hospital with a practice comprised of 3 surgeons board certified in female pelvic medicine and reconstructive surgery.Patients
Patients undergoing robotic sacrocolpopexy for POP from April 2013 through November 2014.Interventions
Robotic paravaginal repair (RPVR) after robotic sacrocolpopexy. The decision to perform a paravaginal repair was at the discretion of the surgeon.Measurements and Main Results
One hundred fifty-six patients underwent a robotic sacrocolpopexy. Twenty-four patients were excluded because of a lack of a 3-month postoperative follow-up. Nine patients underwent concomitant vaginal paravaginal repair and were also excluded. Outcomes were defined by comparing preoperative characteristics with those at the 3-month follow-up. Of the 123 patients in this cohort, 21 patients underwent a concomitant RPVR, and 102 did not. All Pelvic Organ Prolapse Questionnaire (POP-Q) points improved within groups (p?<?.001) except for the total vaginal length (TVL) in the RPVR group (p?=?.940). The Patient Global Impression of Improvement (PGI-I) did not differ between groups (1.2 vs 1.5, p?=?.128). Subgroup analysis was performed on patients with preoperative anterior wall prolapse of stage 3 or greater. Baseline characteristics and perioperative data were not remarkably different from the main cohort. All POP-Q points improved within groups (p?<?.001) except for the TVL in the RPVR group (p?=?.572). The PGI-I did not differ between groups (1.2 vs 1.3, p?=?.378).Conclusion
In both groups, anatomic markers substantially improved within each group. There were significant differences in postoperative POP-Q findings, which may have been influenced by the fact that patients undergoing RPVR usually had worse baseline prolapse. This selection bias creates difficulty with interpretation. Although in this study RPVR did not change subjective outcomes, further study is necessary to control for the severity of prolapse. 相似文献5.
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6.
Juan Liu Qiongyan Lin Kelly Blazek Binhua Liang Xiaoming Guan 《Journal of minimally invasive gynecology》2018,25(6):959-960
Study Objective
Transvaginal surgery is the most minimally invasive surgery for a gynecologic procedure, but it has the limitation of lack of exposure and limited surgical space when using traditional vaginal surgical instrumentation, such as in a hysterectomy for a uterus without descent or for a myomectomy. Transvaginal natural orifice transluminal endoscopic surgery (NOTES) offers similar benefits of traditional vaginal surgery but also expands the horizon of transvaginal surgery by allowing the surgeon to perform procedures that are typically limited to an abdominal approach. The advantages of NOTES may include no incisional pain as well as a better cosmetic outcome. These benefits help outweigh the obstacle of learning this novel approach. Our objective is to demonstrate the transvaginal NOTES technique as a combination of traditional vaginal surgical skill with single-site surgical skill.Design
Stepwise demonstration of the transvaginal NOTES technique for myomectomy with narrated video footage (Canadian Task Force classification III).Setting
Academic tertiary care hospital.Patient
A 42-year-old woman.Interventions
Transvaginal NOTES myomectomy with combined transvaginal surgical and single-site surgical skills.Measurements and Main Results
A 42-year-old woman (gravida 2 para 2) with a preoperative transvaginal ultrasound diagnosis of a 6-cm left anterior myoma requested myoma removal with uterine preservation. She presented with a 2-year history of left pelvic pain and menorrhagia. The myoma was removed with minimal blood loss, and pathology revealed a necrotic myoma. The patient had resolution of her left-sided pelvic pain.Conclusions
Combined with traditional transvaginal anterior colpotomy, single-site surgical skills allow the surgeon to access the entire abdomen and perform myomectomy through a transvaginal single port. Transvaginal NOTES myomectomy is not only possible but allows myomectomy to be performed with no abdominal incision. 相似文献7.
Haider Jan Vishalli Ghai Stergios K. Doumouchtsis 《Journal of minimally invasive gynecology》2018,25(6):952-953
Study Objective
To demonstrate a mesh-free approach for uterine prolapse during a hysterectomy.Design
Technical video (Canadian Task Force classification III).Setting
Benign gynecology department at a university hospital.Patient
A 50-year-old woman.Intervention
Laparoscopic high uterosacral ligament suspension technique.Measurements and Main Results
A 50-year-old woman presented with irregular vaginal bleeding and grade 3 uterine prolapse. The patient was concerned regarding the use of mesh and erosion. After counseling the patient agreed to a mesh-free single procedure. The use of mesh for the treatment of pelvic organ prolapse has become the subject of controversy and litigation. Complications of mesh erosion have resulted in the US Food and Drug Administration reclassifying transvaginal meshes as high-risk devices in 2016 [1]. Mesh erosion risk is up to 23% with hysterectomy and concomitant laparoscopic sacrocolpopexy [2] and 3% with sacrohysteropexy [3]. We present an alternative laparoscopic approach of treating uterine prolapse with high uterosacral suspension during laparoscopic hysterectomy. Our method avoids the use of mesh, sacrocervicopexy and morcellation, or an interval sacrocolpopexy. Although high uterosacral ligament suspension can be performed vaginally, it carries up to an 11% risk of ureteric injury [4].Conclusion
In this video a bilateral ureterolysis is performed, before hysterectomy, isolating the uterosacral ligaments. These are then suspended to the vaginal vault in a purse-string fashion using Vicryl 0 (polyglactin 910) and intracorporeal knot-tying. Postprocedure the vault is well supported with a vaginal length of 12?cm. 相似文献8.
Xiaoming Guan Elise Bardawil Juan Liu Rosanne Kho 《Journal of minimally invasive gynecology》2018,25(7):1135-1136
Background
Transvaginal surgery is the most minimally invasive surgery for a gynecologic procedure but can be challenging for many to perform as evidenced by its declining rate. Vaginal removal of the adnexal structures can be difficult because of poor visualization. Factors such as abnormal pathology, incidental finding of early-stage endometriosis or adhesions from previous cesarean section or surgery, and obesity may further complicate the procedure. Transvaginal natural orifice transluminal endoscopic surgery (NOTES) may be performed during vaginal surgery using basic laparoscopic single-site skills as a “rescue” procedure for the complete removal of the adnexae. This allows the surgeon to complete the procedure vaginally without requiring conversion or addition of abdominal incisions. The combination of total vaginal hysterectomy (TVH) with NOTES as a “rescue” procedure may be a useful tool for gynecologic surgeons for removal of the adnexae and performance of other pelvic procedures.Study Objective
To demonstrate various common pelvic procedures that can be performed by transvaginal NOTES after completion of TVH.Design
Variety demonstrations of the transvaginal NOTES technique as a “rescure” for total vaginal hysterectomy with narrated video footage (Canadian Task Force classification III).Setting
Academic tertiary care hospital.Patients
Patients with various surgeries including prophylactic bilateral salpingectomy, salpingo-oophorectomy, adhesiolysis, and incidental finding of superficial endometriosis resection. This video is exempt from institutional review board review at our institution.Interventions
Transvaginal NOTES adnexal surgery and other procedures using basic laparoscopic single-site surgical skills.Measurements and Main Results
Salpingectomy, oophorectomy, lysis of adhesions, and resection of endometriosis can be performed using NOTES at the time of vaginal hysterectomy.Conclusion
NOTES allows the surgeon to survey the pelvis for pathology and to complete other pelvic procedures transvaginally during TVH with no additional abdominal incisions. Transvaginal NOTES can be considered a “rescue” approach and can be a helpful tool for the pelvic surgeon. 相似文献9.
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Study Objective
To demonstrate a new technique of temporary simultaneous 2 arterial occlusions (TESTOs) of the uterine and ovarian (or utero-ovarian) artery to reduce operative blood loss during laparoscopic cornual resection for cornual ectopic pregnancy.Design
A step-by-step explanation of the surgical procedure using video (Canadian Task Force classification III). This study was approved by the institutional review board.Setting
A university hospital.Patients
A 41-year-old woman presented with pelvic pain with 7 weeks of amenorrhea. A transvaginal sonogram and laboratory tests revealed left cornual pregnancy. She had a history of left salpingectomy caused by tubal pregnancy and wanted prompt surgical management without a surgical scar.Interventions
During the single-port laparoscopy, we found a 3-cm unruptured ectopic mass in the left uterine cornua. The retroperitoneum was opened using a harmonic scalpel (Ethicon Endosurgery, Cincinnati, OH) along the infundibulopelvic ligament. Then, both uterine arteries were temporarily occluded with a bulldog clamp (Aesculap, Tuttlingen, Germany) at the level where they originate from the internal iliac artery. The bulldog clamp, which is a spring-loaded crossover clamp with serrated blades that effectively occlude vessels without slippage or significant crush injury, is the laparoscopic instrument for minimizing blood loss during the surgical procedure. Each ovarian arterial vasculature was also transiently occluded at the utero-ovarian or ovarian pedicle by placing a bulldog clamp. Then, a uterine incision was made in the left cornua using a harmonic scalpel, the gestational conception was expressed through the incision, and corneal resection was completed. The uterine defect was closed using a V-Loc suture (Covidien, Mansfield, MA). In the final step, all vascular clamps were removed for reperfusion.Measurements and Main Results
The operative time was 45 minutes. The procedure time for TESTO and the occlusion time (defined as the time that the bilateral uterine and ovarian vessels were occluded by bulldog clamps) were 10 and 12 minutes, respectively. The estimated blood loss was 50?mL, and her postoperative hemoglobin was 11.9?g/dL from 13.0?g/dL preoperatively. No complications occurred in the postoperative course. Her menstruation resumed 2 months after surgery.Conclusion
Surgical management of ectopic cornual pregnancy could be performed safely and efficiently under laparoscopy with the TESTO technique. 相似文献11.
Floriana Mascilini Lorena Quagliozzi Francesca Moro Maria Cristina Moruzzi Valerio Gallotta Salvatore Gueli Alletti Giovanni Scambia Antonia Carla Testa Anna Fagotti 《Journal of minimally invasive gynecology》2018,25(5):848-854
Study Objective
To describe the potential role of intraoperative ultrasound (IOUS) in the detection and localization of recurrent disease in gynecologic cancer patients during minimally invasive surgery (MIS).Design
A prospective cohort study (Canadian Task Force classification II-1).Setting
A university hospital.Patients
Fifty-one gynecologic cancer patients with isolated recurrent disease.Interventions
IOUS during secondary cytoreductive surgery (SCS) by MIS.Measurements and Main Results
From November 2015 to February 2017 51 gynecologic cancer patients with isolated recurrent disease and candidates for SCS were treated by MIS. Recurrent tumor was preoperatively assessed at clinical examination, transvaginal and transabdominal sonography, and radiologic evaluation in all women. Twelve of 51 women (23.5%) needed IOUS. Type of disease was ovarian in 5 women (42%), endometrial in 4 (33%), cervical in 1 (8%), vaginal cancer in 1 (8%), and uterine sarcoma in 1 (8%). Recurrence was localized deep in the pelvis in 7 cases (58%), lymph nodes in 3 (25%), and extraperitoneal in 2 cases (17%). Recurrence was dimmed in the surgical field, due to either presence of adherences, deep anatomic position, small size, and/or lack of tactile feeling. IOUS was able to identify the lesions in all women, allowing MIS (83% laparoscopy and 17% robotic) complete cytoreduction, with no conversion to laparotomy. Median operative time was 150 minutes (range, 77–280). No intraoperative/postoperative complications occurred. Histologic examination confirmed the presence of recurrence in 11 of 12 cases (92%), whereas the remaining case showed inflammatory tissue. With a median follow-up time of 15 months (range, 6–19), all patients except 2 were still alive.Conclusions
About 1 of 4 patients (25%) with single gynecologic cancer recurrence needs IOUS to benefit from MIS for complete secondary cytoreduction. 相似文献12.
Ana Gomes da Costa Yves Borghesi Delphine Hudry Julie Faes Lucie Bresson Fabrice Narducci Eric Leblanc 《Journal of minimally invasive gynecology》2018,25(5):861-866
Study Objective
To evaluate the outcomes of extraperitoneal para-aortic lymphadenectomy by robot-assisted laparoscopy.Design
A retrospective study (Canadian Task Force classification III).Setting
An academic institution.Patients
Twenty-three consecutive patients with gynecologic cancer who presented for para-aortic lymphadenectomy between March 2016 and May 2017 were reviewed retrospectively.Interventions
Extraperitoneal para-aortic lymphadenectomy by robot-assisted laparoscopy was performed.Measurements and Main Results
Of the 23 patients reviewed retrospectively, 10 had cervical cancer, 7 had endometrial cancer, 5 had adnexal cancer, and 1 had vaginal cancer. Data regarding patient characteristics, indication for para-aortic lymphadenectomy, type of surgery (infrarenal or inframesenteric), operative time, surgical complications, number of nodes retrieved, and postoperative hospital length of stay were collected. Two patients were excluded because of early perforation of the peritoneum. In total, 21 para-aortic lymphadenectomies were performed (16 infrarenal and 5 inframesenteric). The median skin-to-skin operating time of infrarenal extraperitoneal para-aortic lymphadenectomy by robot-assisted laparoscopy was 170 minutes (range, 90–225 minutes), the median lymph node count was 18 (range, 11–38), and the median estimated blood loss was 50?mL (range, 10–600?mL). The median skin-to-skin operating time of inframesenteric extraperitoneal para-aortic lymphadenectomy by robot-assisted laparoscopy was 120 minutes (range, 90–220 minutes), the median lymph node count was 10 (range, 7–19), and the median estimated blood loss was 30?mL (range, 10–100). Intraoperative complications included 1 thermal lesion of the left genitofemoral nerve, 1 thermal lesion of the left mesoureter (a ureteral stent was placed to avoid ureteric necrosis and fistula without after effect), and 1 lesion of the inferior vena cava that was sutured by robot-assisted laparoscopy. There were 2 additional cases of perforation of the peritoneum that occurred in the infrarenal group. The median hospital length of stay was 1 day (range, 0–7 days). Three patients were readmitted for symptomatic lymphocysts.Conclusion
Extraperitoneal para-aortic lymphadenectomy by robot-assisted laparoscopy provides good visualization of the operative field without arm conflict. Still, perforation of the peritoneum and symptomatic lymphocysts are a postoperative concern. 相似文献13.
Tsia-Shu Lo Rami Ibrahim Nazura bt Karim Enie Akhtar Nawawi Ma Clarissa Uy-Patrimonio 《Taiwanese journal of obstetrics & gynecology》2018,57(2):311-314
Objective
To evaluate the outcome of transvaginal mesh surgery as a management of recurrent pelvic organ prolapse, in patients previously treated with sacrocolpopexy.Case report
A series of three patients who developed recurrent pelvic organ prolapse more than 9 years after sacrocolpopexy. A 50-year-old and two 77-year-old patients who presented with recurrent pelvic organ prolapse at 9, 15 and 17 years, respectively after the primary abdominal sacrocolpopexy were managed by transvaginal mesh surgery.Conclusion
Management of recurrent pelvic organ prolapse using transvaginal mesh would be an option for patients treated previously by sacrocolpopexy. 相似文献14.
Emad Matanes Amir Weissman Aleksandr Rivlin Roy Lauterbach Amnon Amit Zeev Wiener Lior Lowenstein 《Journal of minimally invasive gynecology》2018,25(1):70-75
Study Objective
The aim of this study was to investigate how steep Trendelenburg positioning with pneumoperitoneum modifies brain oxygenation and autonomic nervous system modulation of heart rate variability during robotic sacrocolpopexy.Design
Prospective study (Canadian Task Force classification III).Setting
Rambam Health Care Campus.Patients
Eighteen women who underwent robotic sacrocolpopexy for treatment of uterovaginal or vaginal apical prolapse.Interventions
Robotic sacrocolpopexy.Measurements and Main Results
A 5-minute computerized electrocardiogram, cerebral O2 saturation (cSO2), systemic O2 saturation, heart rate (HR), diastolic blood pressure (BP), systolic BP, and end-tidal CO2 tension were recorded immediately after anesthesia induction (baseline phase) and after alterations in positioning and in intra-abdominal pressure. HR variability was assessed in time and frequency domains. Cerebral oxygenation was measured by the technology of near-infrared spectrometry. cSO2 at baseline was 73%?±?9%, with minor and insignificant elevation during the operation. Mean HR decreased significantly when the steep Trendelenburg position was implemented (66?±?10 vs 55?±?9?bpm, p?<?.05) and returned gradually to baseline with advancement of the operation and the decrease in intra-abdominal pressure. Concomitant with this decrease, the power of both arms of the autonomic nervous system increased significantly (2.8?±?.8 vs 3.3?±?.9?ms2/Hz and 2.5?±?1.2 vs 3.2?±?.9?ms2/Hz, respectively, p?<?.05). All these effects occurred without any significant shifts in systolic or diastolic BP or in systemic or cerebral oxygenation.Conclusion
This study supports the safety of robotic sacrocolpopexy performed with steep Trendelenburg positioning with pneumoperitoneum. Only minor alterations were observed in cerebral oxygenation and autonomic perturbations, which did not cause clinically significant alterations in HR rate and HR variability. 相似文献15.
Gürkan Uncu Kemal Özerkan Barış Ata Işıl Kasapoğlu Mehmet Aral Atalay Adnan Orhan Kiper Aslan 《Journal of minimally invasive gynecology》2018,25(3):498-506
Objective
To describe modifications to the double-layer peritoneal pull-down laparoscopic vaginoplasty technique (Davydov operation) and evaluate anatomic and functional outcomes of the new technique, known as the Uncu modification.Design
Case series (Canadian Task Force classification III).Setting
Tertiary care university hospital.Patients
Women with Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) who underwent surgery between 2010 and 2016.Interventions
Laparoscopic double-layer peritoneal pull-down vaginoplasty with paramesonephric remnant support to the neovagina.Measurements and Main Results
Long-term anatomic and functional satisfaction results. Twenty-seven women with MRKHS underwent surgery with the Uncu-modified Davydov procedure. At 1 year after surgery, the mean vaginal length in these patients was 7.91?±?1.4?cm. Among the 23 patients who had regular vaginal intercourse, the mean functional satisfaction score was 8.65?±?1.2. One patient had a perioperative bladder injury, and another patient had a rectovaginal fistula at 3 months after the operation. One woman who did not comply with the prescribed postoperative mold exercises had complete closure of the introitus.Conclusion
The Uncu modified laparoscopic double-layer peritoneal pull-down technique appears to be an effective and safe surgical management option that is easy to learn and perform by gynecologic surgeons. 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.
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18.
Shu-Han You Chen-Ying Huang Hsuan Su Chien-Min Han Chyi-Long Lee Chih-Feng Yen 《Journal of minimally invasive gynecology》2018,25(6):994-1001
Study Objective
To analyze the surgical outcomes and learning curve of transumbilical single-port laparoscopic subtotal hysterectomy, which requires sutures of the cervical stump.Design
A prospective observational study (Canadian Task Force classification II-2).Setting
A university-affiliated center.Patients
From the first (July 2012) and consecutive patients of benign uterine disease scheduled for subtotal hysterectomy until October 2013.Interventions
All single-port laparoscopies were performed using straight instruments by 1 gynecologist. An ancillary port was added whenever technical difficulties could endanger surgical quality.Measurement and Main Results
Seventy-five patients were recruited for intention-to-treat analysis with a mean (±SD) age of 44.7?±?3.8 years and a body mass index of 24.2?±?3.7?kg/m2. No major complication was noted. The mean uterine weight was 432.5?±?344.0?g with 24 (32%) uteri ≧500?g. The patients' sequential order, or gradually increasing experience, was the determining factor in progressively decreasing operative time. Furthermore, most cases that required an additional ancillary port (67%) were clustered in the first 20 cases, whereas 4 were scattered after the 47th patient because of severe pelvic adhesion. The mean operative time decreased in the power law function of the patients' sequential order with a plateau achieved at the 20th patient.Conclusion
The patients' sequential order was identified as an independent factor of achieving purely single-port access, and the trend of decreasing operative time delineated the existence of a learning curve. Approximately 20 patients were needed for an experienced multiport laparoscopist to reach technical competency in the current series. 相似文献19.
Núria Sarasa Castelló Alexandra Toth Michel Canis Revaz Botchorishvilli 《Journal of minimally invasive gynecology》2018,25(6):957-958
Study Objective
We detected mesh erosion and serious postoperative complications in 3 women after performing laparoscopic promontofixation (LPF) using glue for mesh fixation. Glue, largely used in hernia surgery repair, is proposed by some gynecologic surgeons because it saves time and is easier to use than traditional sutures. We report 3 cases of postoperative complications after LPF in which glue had been used and provide research in the published literature about the use of glue in LPF.Methods
A research of glue use in gynecology mesh fixation was performed through PubMed on October 2016. The search was done using the Medical Subject Heading terms “POP” & “Laparoscopy” & “surgical Mesh” and the word either “glue” or “adhesive. Only 2 articles were found: Willecocq et al [1] and Estrade et al [2]. Neither study focused on postoperative complications. In this publication, we accurately edited video surgeries with an instructive purpose.Setting
University Hospital of Clermont-Ferrand, France.Case Reports
Patient A, a 65-year-old woman, complained of pelvic pain and vaginal discharge 1 month after LPF (polypropylene mesh and glue had been used). Wall mesh exposure and purulent discharge were noted. She received antibiotics and underwent mesh ablation surgery; debris of the glue was easily identified. Patient B, a 65-year-old lady with previous hysterectomy consulted for a bulging feeling in her vagina (classification: cystocele +2; rectocele +3 stage). An LPF was performed using polypropylene soft nonabsorbable mesh and glue. One month later, an apical defect of vaginal epithelialization was detected; she received long estrogenic local treatment but had to undergo surgery when presenting malodorous discharge and mesh exposure. The exposed mesh was removed, and pieces of glue were identified, having avoided mesh attachment. Patient C had a previous abdominal hysterectomy and promontofixation using a polyester mesh with glue. She consulted to us for vaginal mesh erosion covered with purulent discharge 3.5 years after LPF in another center. At the surgery, 1?cm of the prosthesis was identified in the vagina, dissected, and sutured. One year later, she consulted for dyspareunia and purulent discharge; vaginal rigid mesh exposure with an epithelization defect and inflammatory signs was seen. During laparoscopy, prosthetic exposition and glue debris on the prosthesis were identified.Discussion
In all 3 cases, debris of glue were identified in the no integrated mesh area. The suggested reasons of exposure can be the excessive amount of surgical glue applied. Moreover, a large amount of glue may be impairing tissue ingrowth through the mesh pores, causing low fibrosis and poor tissue integration [3].Conclusion
Glue seems to prevent fibrosis from occurring. Its use in pelvic organ prolapse laparoscopic mesh fixation should be done with caution. No prospective studies reporting long-term comorbidities and results have been published. 相似文献20.
Sara R. Till Kumari A. Hobbs Janelle K. Moulder John F. Steege Matthew T. Siedhoff 《Journal of minimally invasive gynecology》2018,25(4):670-678