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1.
Yisong Chen Junwei Li Ying Zhang Keqin Hua 《Journal of minimally invasive gynecology》2018,25(4):585-588
Study Objective
More and more patients are pursuing minimally invasive surgery, which is becoming the trend for gynecologic surgery today. Pelvic organ prolapse (POP) is no exception. With the application of natural orifice transluminal endoscopic surgery, minimally invasive transvaginal sacrocolpopexy surgery assisted by single-port laparoendoscopy for POP becomes feasible. Here we describe our technique of transvaginal sacrocolpopexy using single-port laparoscopy for middle compartment POP.Design
Step-by-step explanation of the procedure using video.Setting
University hospital.Patient
A 59-year-old woman from China.Interventions
Transvaginal single-port laparoscopy sacrocolpopexy.Measurements and Main Results
We performed transvaginal single-port laparoscopy sacrocolpopexy on a 59-year-old woman from China who was diagnosed with POP-Q stage II anterior compartment, stage III middle compartment, stage II posterior compartment. This patient complained of a vaginal mass that had been prolapsed for 3 months. Institutional Review Board/Ethics Committee approval was obtained. Vaginal hysterectomy was performed first. Preventative bilateral salpingo-oophorectomy was done after a single-port platform was established. Right pelvic peritoneum was incised, from the promontory to the vault. Then, we exposed the rectovaginal and vesicovaginal spaces after injection of a water cushion (normal saline, 0.9% Nacl). A Y-shaped mesh (ARTISYN; Johnson & Johnson international, c/o European Logistics Centre, Diegem, Belgium) was fixed to the posterior vaginal wall and then to the sacral promontory (S1). After closing the pelvic peritoneum the anterior mesh was sutured. Before finishing the surgery we closed the vaginal cuff. The operation last for about 2 hours, with a blood loss of 50?mL. The patient was discharged with complete recovery. A 5-month follow-up showed no prolapse, mesh erosion, or other complications.Conclusion
Transvaginal single-port laparoscopic sacrocolpopexy is a considerable choice for middle compartment POP. However, more cases should be enrolled, and additional studies are required. 相似文献2.
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3.
Emily Hinchcliff Isabel Green Christopher Destephano Mary Cox Douglas Smink Amanika Kumar Erik Hokenstad Joan Bengtson Sarah L. Cohen 《Journal of minimally invasive gynecology》2018,25(6):1044-1050
Objective
To determine whether visuospatial perception (VSP) testing is correlated to simulated or intraoperative surgical performance as rated by the American College of Graduate Medical Education (ACGME) milestones.Design
(Canadian Task Force classification II-2).Setting
Two academic training institutions.Participants
Forty-one residents, including 19 from Brigham and Women's Hospital and 22 from the Mayo Clinic, from 3 different specialties: obstetrics and gynecology, general surgery, and urology.Intervention
Participants underwent 3 different tests: visuospatial perception testing (VSP), Fundamentals of Laparoscopic Surgery (FLS) peg transfer, and da Vinci robotic simulation peg transfer. Surgical grading from the ACGME milestones tool was obtained for each participant. Demographic and background information was also collected, including specialty, year of training, previous experience with simulated skills, and surgical interest. Standard statistical analyses were performed using Student's t test, and correlations were determined using adjusted linear regression models.Measurements and Main Results
In univariate analysis, Brigham and Women's Hospital and Mayo Clinic training programs differed in times and overall scores for both the FLS peg transfer and da Vinci robotic simulation peg transfer tests (p?<?.05 for all). In addition, type of residency training affected time and overall score on the robotic peg transfer test. Familiarity with tasks correlated with higher score and faster task completion (p?=?.05 for all except VSP score). There were no differences in VSP scores by program, specialty, or year of training. In adjusted linear regression modeling, VSP testing was correlated only to robotic peg transfer skills (average time, p?=?.006; overall score, p?=?.001). Milestones did not correlate to either VSP or surgical simulation testing.Conclusion
VSP score was correlated with robotic simulation skills, but not with FLS skills or ACGME milestones. This suggests that the ability of VSP score to predict competence differs between tasks. Therefore, further investigation of aptitude testing is needed, especially before its integration as an entry examination into a surgical subspecialty. 相似文献4.
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5.
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
Study Objective
To examine whether a robotic surgical platform can complement the fine motor skills of the nondominant hand, compensating for the innate difference in dexterity between surgeon's hands, thereby conferring virtual ambidexterity.Design
Crossover intervention study (Canadian Task Force classification II-1).Setting
Centers for medical simulation in 2 tertiary care hospitals of Harvard Medical School.Participants
Three groups of subjects were included: (1) surgical novices (medical graduates with no robotic/laparoscopic experience); (2) surgeons in training (postgraduate year 3–4 residents and fellows with intermediate robotic and laparoscopic experience); and (3) advanced surgeons (attending surgeons with extensive robotic and laparoscopic experience).Interventions
Each study group completed 3 dry laboratory exercises based on exercises included in the Fundamentals of Laparoscopic Surgery (FLS) curriculum. Each exercise was completed 4 times: using the dominant and nondominant hands, on a standard laparoscopic FLS box trainer, and in a robotic dry laboratory setup. Participants were randomized to the handedness and setting order in which they tackled the tasks.Measurements and Main Results
Performance was primarily measured as time to completion, with adjustments based on errors. Means of performance for the dominant versus nondominant hand for each task were calculated and compared using repeated-measures analysis of variance. A total of 36 subjects were enrolled (12 per group). In the laparoscopic setting, the mean overall time to completion of all 3 tasks with the dominant hand differed significantly from that with the nondominant hand (439.4 seconds vs 568.4 seconds; p?=?.0008). The between-hand performance difference was nullified with the robotic system (374.4 seconds vs 399.7 seconds; p?=?.48). The evaluation of performance for each individual task also revealed a statistically significant disparate performance between hands for all 3 tasks when the laparoscopic approach was used (p?=?.003, .02, and .01, respectively); however, no between-hand difference was observed when the tasks were performed robotically. On analysis across the 3 surgeon experience groups, the performance advantage of robotic technology remained significant for the surgical novice and intermediate-level experience groups.Conclusion
Robot-assisted laparoscopy may eliminate the operative handedness observed in conventional laparoscopy, allowing for virtual ambidexterity. This ergonomic advantage is particularly evident in surgical trainees. Virtual ambidexterity may represent an additional aspect of surgical robotics that facilitates mastery of minimally invasive skills. 相似文献6.
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7.
Ga Won Yim Kyung Jin Eoh Young Shin Chung Sang Wun Kim Sunghoon Kim Eun Ji Nam Jung Yun Lee Young Tae Kim 《Journal of minimally invasive gynecology》2018,25(5):823-831
Study Objective
To investigate and compare surgical outcomes of the 3 versus 4 robotic arm approaches for robotic surgery in patients with cervical cancer.Design
A retrospective analysis of prospectively collected data (Canadian Task Force classification II-2).Setting
An academic tertiary hospital.Patients
A total of 142 patients with stage 1A1 to IIB cervical carcinoma who underwent robotic surgery were included for analysis. The subjects were divided according to the surgical approach (i.e., the number of robotic arms), and the 2 groups were compared in terms of intraoperative data and postoperative outcomes.Interventions
Robotic radical hysterectomy (RRH) with lymphadenectomy using 3 robotic arms (n?=?101) versus 4 robotic arms (n?=?41).Measurements and Main Results
Perioperative surgical outcomes. The 3-arm robotic approach consisted of a camera arm, 2 robotic arms, and 1 conventional assistant port. An additional robotic arm was placed on the right side of the patient's abdomen for the 4-arm robotic approach. The mean age, body mass index, cell type, Fédération Internationale de Gynécologie et d'Obstétrique stage, and type of surgery were not significantly different between the 2 cohorts. The 3-arm approach showed favorable outcomes over the 4-arm approach in terms of postoperative pain at 6 and 24 hours (3.8?±?1.8 vs 4.5?±?1.7 and 2.8?±?1.7 vs 3.4?±?1.6, respectively; p?=?.033 and .049) and postoperative hemoglobin difference (1.8?±?0.9 vs 2.6?±?1.3 and 1.9?±?1.1 vs 2.4?±?0.9 on days 1 and 3, respectively; p?=?.002 and .004). The median length of postoperative hospital stay, total operative time, docking time, lymph node yield, and intraoperative and postoperative complication rates were comparable between the 2 cohorts.Conclusion
Surgical outcomes and complications rates of RRH for cervical cancer using the 4-arm approach were comparable with that of the 3-arm approach with decreased early postoperative pain in the 3-arm group. Cost-benefit analysis and the impact on surgical training are needed in the future. 相似文献8.
Shariska S. Petersen Samfee Doe Ilan Rubinfeld Yafa Davydova Thomas Buekers Roopina Sangha 《Journal of minimally invasive gynecology》2018,25(5):867-871
Study Objective
To evaluate rates of urologic injury in patients who underwent robotic hysterectomy compared with laparoscopic, vaginal, and open hysterectomy.Design
A retrospective analysis (Canadian Task Force classification II-2).Setting
Henry Ford Health System, 2013 to 2016.Patients
Women who underwent robotic, vaginal, laparoscopic, and open abdominal hysterectomy.Interventions
Robotic hysterectomy, laparoscopic-assisted vaginal hysterectomy, total laparoscopic hysterectomy, laparoscopic supracervical hysterectomy, vaginal hysterectomy, and abdominal hysterectomy.Measurements and Main Results
To identify patients with urologic injury, a departmental database for quality improvement was searched for reported urologic injuries. In addition, patients who had urology consultation within 90 days of hysterectomy were screened for injury. A total of 3114 hysterectomies were identified by retrospective chart review. One thousand eighty-eight robotic, 782 laparoscopic, 304 vaginal, and 940 abdominal hysterectomies were analyzed for urologic complications. A total of 27 injuries were confirmed (7 during laparoscopic hysterectomy, 10 during robotic hysterectomy, 1 during vaginal hysterectomy, and 9 during abdominal hysterectomy). The overall rate of urologic injury was 0.87% with a 0.55% risk of bladder injury and a 0.32% risk of injury to the ureter. When the route of hysterectomy was taken into account, the risk of urologic injury was 0.92% for robotic hysterectomy, 0.90% for laparoscopic hysterectomy, 0.33% for vaginal hysterectomy, and 0.96% for open hysterectomy. The mean body mass index (BMI) for all patients was 32.7?kg/m2; injured patients had a mean BMI of 34.6?kg/m2, and noninjured patients had a mean BMI of 32.0?kg/m2 (p?=?.10).Conclusion
Rates of urologic injury with robotic hysterectomy are similar to those of laparoscopic hysterectomy in our population. BMI was not significantly different in patients who had urologic injuries. Surgeon volume was not associated with risk for urologic injury. 相似文献9.
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10.
11.
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12.
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.
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15.
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16.
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17.
Kemal Ozgur Hasan Bulut Murat Berkkanoglu Kevin Coetzee 《Journal of minimally invasive gynecology》2018,25(1):105-110
Study Objective
To assess the impact of ovarian endometriomas on endometrial receptivity in frozen embryo transfer (FET) of segmented in vitro fertilization (IVF) cycles.Design
Retrospective, matched-control study (Canadian Task Force classification II-2).Setting
A single, private assisted-reproduction technology center.Patients
Thirty patients diagnosed with unilateral or bilateral endometriomas were compared with 60 patients without endometriomas in a population of 1894 patients who underwent segmented IVF treatment between September 2014 and September 2016.Intervention
Intracytoplasmic sperm injection with blastocyst freeze-all and FET.Measurements and Main Results
The primary endpoint of the study was a viable pregnancy (>14 weeks). The mean diameter of diagnosed endometriomas was 25.7?±?10.6?mm. The median antral follicle count was significantly lower in the endometrioma group compared with the entire study population (11.5; interquartile range [IQR], 6.0–17.0 vs 14.0; IQR, 9.0–22.0; p?=?.042). The median number of mature ovarian follicles (≥14?mm) per antral follicle that developed during controlled ovarian stimulation was not significantly different between the groups (11.0 [IQR, 5.8–14.3] vs 10.0 [IQR, 6.0–15.8]; p?=?.908); however, the median number of oocytes retrieved was lower in the endometrioma group (11.5 [IQR, 6.0–21.5] vs 13.5 [IQR, 9.0–20.8]; p?=?.373). The biochemical pregnancy, implantation, and ongoing pregnancy rates were not significantly different between the endometrioma and control groups.Conclusion
Although ovarian endometriomas result in reduced ovarian reserve and oocyte retrieval, their impact on reproductive outcome is limited with FET. 相似文献18.
Tiffany L. Beck Melissa A. Schiff Barbara A. Goff Renata R. Urban 《Journal of minimally invasive gynecology》2018,25(6):986-993
Study Objectives
To compare patient outcomes by surgical approach in the management of endometrial cancer (EC) in Washington State from 2008 to 2013.Design
Population-based retrospective cohort study (Canadian Task Force classification II-2).Setting
Washington State.Patients
EC patients treated with robotic-assisted surgery (RAS), laparoscopy (LS), or laparotomy (XLAP).Interventions
Comprehensive Hospital Abstract Reporting System to identify patients and assess the association of surgical approach with length of stay, readmissions, and perioperative complications.Measurements and Results
We identified 3712 cases of EC managed with either RAS, LS, or XLAP. Mean length of stay was not clinically different for RAS (1.5 days) and LS (1.6 days) but was 2.31 days longer for XLAP compared with LS (p?<?.001). Odds of any readmission did not differ for either RAS or XLAP compared with LS; however, early readmissions were half as likely for RAS compared with LS (p?=?.014). Complications were more than 2.5 times as likely for XLAP versus LS (p?<?.001), whereas complications did not differ for RAS versus LS (p?=?.931).Conclusions
RAS is as an alternative to LS in the treatment of EC and is preferable to XLAP. The use of RAS resulted in fewer early readmissions compared with LS and resulted in an increased proportion of cases via minimally invasive surgery. 相似文献19.
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20.
Chris Kliethermes Kelly Blazek Kausar Ali J. Biba Nijjar Stephanie Kliethermes Xiaoming Guan 《Journal of minimally invasive gynecology》2018,25(5):842-847