共查询到20条相似文献，搜索用时 31 毫秒
1.
2.
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3.
Study Objective
To demonstrate a minimal invasive surgical (MIS) technique for curative excision of extensive secondary disseminated peritoneal leiomyomatosis (DPL).Design
The Institutional Review Board of Human Investigation and Ethics Committee of Chang Gung Medical Foundation ruled that approval was not required for this study.Patient
Woman aged 46 years.Interventions, Measurements, and Main Results
In MIS the myoma has to be divided into small fragments for piecemeal retrieval through a small incision [1] with a widely used technique called morcellation (confined or unconfined) [2]. DPL is a rare sequellae after laparoscopic morcellation. Because this entity is rarely reported, this video demonstrates laparoscopic technique for safe removal of DPL post laparoscopic myomectomy and morcellation. A 46-year-old woman with a past history of laparoscopic myomectomy with specimen retrieval by a power morcellation 8 years ago presented with abdominal discomfort. Computed tomography revealed multiple iso-dense lesions in the uterine corpus and pelvic cavity. Upon laparoscopy multiple nodules were identified at the previous myomectomy scar, pelvic peritoneum, ovarian surface, and over the small bowel. A total laparoscopic hysterectomy with bilateral salpingo-oophorectomy along with excision of all visible lesions was performed.Conclusions
In this video we demonstrate a safe retroperitoneal approach for complete excision of DPL. Laparoscopic hysterectomy or myomectomy with unconfined morcellation appears to be associated with the risk of DPL [3]. Complete tissue fragment retrieval will minimize the sequelae of morcellation. Hence, myoma remnants should be carefully extracted and confined morcellation should be considered. Because DPL causes significant distortion of pelvic anatomy, thorough knowledge of pelvic surgical anatomy and retroperitoneal approach for complete excision of all lesions is recommended. 相似文献4.
Benjamin D. Beran Marie Shockley Katrin Arnolds Michael L. Sprague Stephen E. Zimberg Andreas Tzakis Tommaso Falcone 《Journal of minimally invasive gynecology》2018,25(2):329
Study Objective
Uterine transplantation has proven feasible since the first live birth reported in 2014. To enable attachment of the uterus in the recipient, long vascular pedicles of the uterine and internal iliac vessels were obtained during donor hysterectomy, which required a prolonged laparotomy to the living donors. To assist further attempts at uterine transplantation, our video serves to review literature reports of internal iliac vein anatomy and demonstrate a laparoscopic dissection of cadaver pelvic vascular anatomy.Design
Observational (Canadian Task Force Classification III).Setting
Academic anatomic laboratory. Institutional Review Board ruled that approval was not required for this study.Intervention
Literature review and laparoscopic dissection of cadaveric pelvic vasculature, focusing on the internal iliac vein.Measurements and Main Results
Although the internal iliac artery tends to have minimal anatomic variation, its counterpart, the internal iliac vein, shows much variation in published studies 1, 2. Relative to the internal iliac artery, the vein can lie medially or laterally. Normal anatomy is defined as some by meeting 2 criteria: bilateral common iliac vein formed by ipsilateral external and internal iliac vein at a low position and bilateral common iliac vein joining to form a right-sided inferior vena cava [2]. Reports show 79.1% of people have normal internal iliac vein anatomy by these criteria [2]. The cadaver dissection revealed internal iliac vein anatomy meeting criteria for normal anatomy.Conclusion
Understanding the complexity and variations of internal iliac vein anatomy can assist future trials of uterine transplantation. 相似文献5.
Stefano Uccella Alessandro Buda Chiara Morosi Giampaolo Di Martino Martina Delle Marchette Claudio Reato Jvan Casarin Fabio Ghezzi 《Journal of minimally invasive gynecology》2018,25(3):461-466.e1
Objective
To compare 3-mm minilaparoscopy and standard 5-mm laparoscopy for sentinel lymph node (SLN) detection in apparent early-stage endometrial cancer (EC).Design
Retrospective study (Canadian Task Force classification II-2).Setting
Two academic research centers.Patients
Consecutive women with apparent early-stage EC who underwent surgical staging with SLN detection between November 2015 and April 2016.Interventions
The surgical approach was a total laparoscopic extrafascial hysterectomy plus bilateral salpingo-oophorectomy and SLN detection. Systematic lymphadenectomy was performed in selected cases. In all patients, SLN detection was performed with cervical injection of indocyanine green and the use of an optical camera with a near-infrared high-intensity light source for detection of fluorescence imaging. All patients who underwent a minilaparoscopic approach (using one 5-mm scope and three 3-mm ancillary trocars) have been enrolled at the University of Insubria, whereas at the San Gerardo Hospital, standard laparoscopy was performed with one 10-mm scope and three 5-mm ancillary trocars.Measurements ad Main Results
A total of 38 patients were enrolled, including 15 (39.5%) in the 3-mm group and 23 (60.5%) in the 5-mm group. No between-group differences were found in terms of demographic and tumor characteristics. Bilateral SLNs were detected in 73.3% of the patients in the 3-mm group and in 73.9% in the 5-mm group. Operative time, blood loss, hemoglobin drop, hospital stay, and the incidence and severity of complications were similar in the 2 groups. One patient (4.3%) in the standard 5-mm group had a positive SLN result (a micrometastasis in the left external iliac SLN). No positive SLNs were detected in the 3-mm group.Conclusion
Minilaparoscopic SLN biopsy appears to be a promising and feasible technique for EC staging. Further research is warranted to investigate the possible benefits of 3-mm instruments in this specific setting. 相似文献6.
Study Objective
To demonstrate a simplified technique of performing laparoscopic sacrohysteropexy for uterine prolapse.Design
A technical video demonstrating a simplified method of laparoscopic sacrohysteropexy (Canadian Task force classification level III).Setting
The benign gynecology department at a university hospital.Interventions
A 38-year old woman with grade 3 uterine descent presented requesting surgical management for symptomatic prolapse.Conclusion
Laparoscopic sacrohysteropexy is becoming an increasingly popular alternative to hysterectomy to treat uterine prolapse in women. We present a novel approach of performing laparoscopic sacrohysteropexy that differs from previously described methods 1, 2; it is shorter, simpler, and reduces possible complications. Key differences include the mesh type, site of attachment, and dissection of the peritoneum while creating the possibility of future vaginal delivery after pregnancy. Our simplified technique uses a polyvinylidene fluoride mesh woven with a square weave secured to the posterior aspect of the cervix under a layer of visceral peritoneum. Because there is no longitudinal give of the mesh, unlike polypropylene meshes with a diamond weave, a wrap method [2] is not required. No dissection of the broad ligament and bladder is needed, eliminating the risk of bladder perforation and anterior mesh erosion with fewer adhesions and simplifying hysterectomy if required in the future. We also uniquely “tunnel” the peritoneum, reducing the size of defect for suture closure, and reperitonize the mesh. Previous methods restrict cervical dilatation and require women to have cesarean sections. The method described in the video allows women to deliver vaginally and, in the event of late miscarriage, avoid the need for hysterotomy. We have performed 25 cases with 1 mild cystocoele recurrence requiring no surgery, 1 reoperation for posterior compartment repair, and 1 case of cervical elongation requiring Manchester repair. No cases of recurrent uterine prolapse have occurred. 相似文献7.
Konstantinos Nirgianakis Susanne Lanz Sara Imboden Mathias Worni Michael D. Mueller 《Journal of minimally invasive gynecology》2018,25(5):771-772
Study Objective
To present an unusual consequence of laparoscopic treatment of diaphragmatic endometriosis, to discuss the possible etiologies, and to propose proper management.Design
A step-by-step explanation of 2 surgeries of the same patient using intraoperative video sequences (Canadian Task Force classification III).Setting
University hospital.Patient
A 32-year-old woman.Interventions
Two Laparoscopic surgeries.Measurements and Main Results
Endometriosis is estimated to affect 11% of the population 1, 2, with an estimated 12% of these patients having extrapelvic endometriosis [3]. When the diaphragm is involved, the disease potentially causes severe and debilitating symptoms such as catamenial chest or shoulder pain. Serious complications may involve pneumothorax and hemopneumothorax 4, 5, 6. Diaphragmatic endometriosis is more common than realized and has been shown to occur simultaneously in 50% to 80% of cases with pelvic endometriosis 7, 8. A 32-year-old woman was admitted to our hospital with severe disabling dysmenorrhea and right shoulder pain. Despite progestin, nonsteroidal anti-inflammatory drug, and opioid treatment, pain relief remained inadequate. A laparoscopy was performed revealing diaphragmatic endometriosis, which was completely excised. A revision was necessary 14 months later because of pain recurrence in the right hemithorax and suspicion of new or persistent endometriotic lesions. The laparoscopy revealed small diaphragm fenestrations that were closed after exclusion of recurrent diaphragmatic or pleural endometriosis. No chest tube was placed, and the postoperative course was uneventful. Hormonal suppressive treatment was continued. Since the operation the patient has been pain free. Institutional Review Board/Ethics Committee ruled that approval was not required for this study (Req-2017-00415).Conclusion
The diaphragm fenestrations were possibly the result of tissue necrosis caused by thermocoagulation after excision of deep endometriotic lesions during the first surgery. Using a CO2 laser for the vaporization of superficial lesions is favorable because of the smaller depth of penetration compared with electrocautery and better access to hard to reach areas 9, 10. Endometriotic lesions involving the entire thickness of the diaphragm should be completely excised and the defect repaired with either sutures or staples 11, 12, 13. 相似文献8.
Berta Díaz-Feijoo Melisa Bradbury Assumpció Pérez-Benavente Silvia Franco-Camps Antonio Gil-Moreno 《Journal of minimally invasive gynecology》2018,25(7):1144-1145
Study Objective
To show the feasibility and safety of nerve-preserving laparoscopic radical hysterectomy (type C1 Querleu-Morrow Classification [1]) for the treatment of early cervical cancer.Design
A surgical video article (Canadian Task Force classification III).Setting
A university hospital (University Hospital of Barcelona, Barcelona, Spain).Patients
Nerve-preserving radical hysterectomy is performed in a patient with Fédération Internationale de Gynécologie et d'Obstétrique stage 1B1 cervical cancer with deep stromal invasion.Interventions
Three steps are fundamental for the removal of the cérvix with a safe oncologic margin and preservation of the pelvic autonomic nerves [2].1. Step 1: for the correct preservation of the pelvic splanchnic nerves (ventral roots from spinal nerves S2-S4) and the inferior hypogastric plexus during the section of the paracervix, it is essential to identify the deep uterine vein. This vein will correspond with the inferior limit of the dissection.2. Step 2: during the dissection of the uterosacral ligament and after dissecting the Okabayashi space, the inferior hypogastric nerve is isolated. This nerve runs 2?cm parallel below the uterosacral ligament in the peritoneal leaf of the broad ligament.3. Step 3: during the section of the vesicouterine ligament, the lateral side must be preserved because it includes the medial and inferior vesical veins that drain to the deep uterine vein.Conclusion
Nerve-sparing laparoscopic radical hysterectomy is an attractive surgical approach for early-stage cervical cancer. Direct visualization of the pelvic autonomic nervous system (sympathetic and parasympathetic branches) innervating the bladder and rectum makes the nerve-sparing approach a safe and feasible procedure. 相似文献9.
10.
11.
Stacey A. Scheib 《Journal of minimally invasive gynecology》2018,25(2):326-327
Study Objective
To demonstrate a laparoendoscopic single-site (LESS) surgical approach to salpingectomy.Design
A technical video showing step-by-step a LESS surgical approach to salpingectomy (Canadian Task Force classification level III). Institutional review board approval was not required for this study.Setting
Of all gynecologic cancer types, ovarian cancer has the highest mortality rate and is the fifth leading cause of cancer deaths among women 1, 2. The leading theory of epithelial ovarian carcinogenesis indicates that serous, endometrioid, and clear cell ovarian carcinomas originated from the fallopian tube and endometrium and not directly from the ovary itself 1, 2, 3, 4, 5, 6, 7, 8, 9, 10. This has led to the use of prophylactic salpingectomy as a theoretical form of ovarian cancer risk reduction at the time of hysterectomy or as a means of tubal sterilization. Prophylactic salpingectomy does not appear to increase the risk of complications and appears to be safe [2]. Ovarian function does not seem to be compromised by salpingectomy based on serum markers or response rates with in vitro fertilization 11, 12, 13, 14, 15, 16. A LESS approach may reduce the morbidity associated with the placement of multiple ports and can improve cosmetic outcomes. Prophylactic LESS bilateral salpingo-oohorectomy was shown to be feasible and safe for high-risk patients for ovarian cancer [17].Interventions
Laparoscopic salpingectomy at the time of hysterectomy or as a means of tubal sterilization using the LESS technique.Conclusion
This is a simple and reproducible technique for preventing major complications associated with LESS salpingectomy. This approach permits easier specimen retrieval because of the large solitary incision that is made. There is a significant improvement in cosmetic satisfaction when compared with a traditional laparoscopic approach in the setting of prophylactic risk reduction surgery [18]. 相似文献12.
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13.
Filipa Osório João Alves João Pereira Marta Magro Sónia Barata Adalgisa Guerra António Setúbal 《Journal of minimally invasive gynecology》2018,25(2):330-333
Study Objective
To describe our surgical approach in a rare case of deep infiltrating endometriosis of the obturator internus muscle with obturator nerve involvement.Design
A step-by-step surgical explanation using video and literature review (Canadian Task Force Classification III).Setting
Endometriosis can be pelvic or rarely extrapelvic and is classically defined as the presence of endometrial glands and stroma outside the uterine cavity 1, 2. Pain along the sensitive area of the obturator nerve, thigh adduction weakness and difficulty in ambulation are extremely rare presenting symptoms 2, 3, 4.Patient
We report a case of a 32-year-old patient who presented with cyclic leg pain in the inner right thigh radiating to the knee caused by a cystic endometriotic mass in the obturator internus muscle with nerve retraction. The patient provided informed consent to use the surgical video. Institutional review board approval was obtained.Interventions
Pelvic magnetic resonance imaging was performed and confirmed a nodular lesion of about 2.3?cm with high signal on T1WI and T2WI and without fat suppression on T2FS inside the right obturator internus muscle, suggesting an endometriotic lesion (Fig. 1). Surgical removal of the mass was performed using the laparoscopic approach. A normal pelvic cavity was found, and the retroperitoneal space was dissected. A mass located within the right obturator internus muscle, below the right iliac external vein, behind the corona mortis vein, and lateral to the right obturator nerve was identified. The whole region was inflamed, and the nerve was partially involved. Dissection was performed carefully with rupture of the tumor, releasing a chocolatelike fluid (Fig. 2), and the cyst was removed. Pathology examination was consistent with endometriosis. Patient improvement was observed, with pain relief and improved ability for right limb mobilization. No recurrence of endometriosis was found at the follow-up visit 6 months later.Measurements and Main Results
The obturator nerve is responsible for motor and sensitive innervation of the joins and internal muscles of thigh and knee as well as the innervation of skin in the internal thigh. Pain along the sensitive area of the obturator nerve at the time of menstruation, thigh adduction weakness, difficulty ambulating, or paresthesia can be presenting symptoms with the involvement of the obturator nerve [5]. Besides paresthesia, our patient presented all the symptoms. The suspected diagnosis of obturator internus muscle endometriosis with retraction of the obturator nerve was confirmed by laparoscopic surgery and pathological examination of the excised tissue. To our knowledge, only 4 cases of endometriosis involving the obturator nerve have been described (according to MEDLINE searched in January 2017) 5, 6, 7, 8. The laparoscopic approach provided an excellent access to the retroperitoneal space, allowing fine dissection of the obturator nerve and the surrounding structures with complete removal of the cystic mass.Conclusion
We report a rare case of endometriosis with a single mass located inside the right obturator internus muscle with neuronal involvement of the obturator nerve. The fundamental role of laparoscopy was clearly demonstrated for the diagnosis and treatment of our patient. 相似文献14.
Yu Chang Nari Kay Minpheus R. Huang S. Joseph Huang Eing Mei Tsai 《Journal of minimally invasive gynecology》2018,25(6):1094-1100
Study Objective
To evaluate the feasibility, efficiency, and safety of manual morcellation in laparoendoscopic single-site (LESS) supracervical hysterectomy.Design
Retrospective study (Canadian Task Force classification II-2).Setting
A teaching hospital.Patients
One hundred and ninety patients with symptomatic uterine leiomyomas and/or adenomyosis who underwent LESS supracervical hysterectomy.Interventions
Manual morcellation through the umbilical wound.Measurements and Main Results
Time of operation, blood loss volume, specimen weights, rate of morcellation, requirement for blood transfusion, hospital length of stay, and prevalence of postoperative cyclic spotting were recorded. The median weight of the uterine corpus was 245?g (range, 100–1960?g). The median total operation time was 69 minutes (range, 36–183 minutes). The median volume of blood loss was 50?mL (range, 10–850?mL). The median level of hemoglobin reduction was 1?g/dL (range, ?1 to 3.2?g/dL). The incidence of intraoperative blood transfusion was 3.2%, and the mean manual morcellation rate was 38.9?±?15?g/minute. The incidence of postoperative cyclic spotting was 10.5%.Conclusion
Safe and effective LESS surgery requires a minimal surgical incision compared with conventional laparoscopic surgery and laparotomy. Manual morcellation was found to be effective and safe in removing solid tumors in this population. 相似文献15.
16.
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17.
Huseyin Kiyak Lale Susan Wetherilt Kerem Doga Seckin Ibrahim Polat Pınar Kadirogullari Tolga Karacan 《Journal of minimally invasive gynecology》2018,25(4):582
Study Objective
Laparoscopic excision of a scar pregnancy and isthmocele repair with a barbed suture.Design
A step-by-step explanation of the laparoscopic excision technique of a scar pregnancy and isthmocele repair.Setting
Cesarean scar pregnancy occurs as a result of attachment of the products of conception to the uterine scar 1, 2, 3. In the present case, a 34-year-old, gravida 4, para 1 patient with a history of 1 miscarriage and 1 ectopic pregnancy was diagnosed with type 2 cesarean scar pregnancy at 7 weeks of gestation. Dilation and curretage was performed at the 8th week of gestation to terminate the pregnancy. On ultrasonography performed 1 month later, placental material underlying the isthmocele was observed. Her beta human chorionic gonadotropin level was 13 836 mIU/mL. She was followed up for 1.5 months until the beta human chorionic gonadotropin levels were negative. However, the mass underneath the scar had grown larger, measuring up to 5?×?6?cm. Laparoscopy was performed because the patient reported vaginal spotting and pelvic pain. The incision was sutured with a synthetic absorbable unidirectional barbed suture (Stratafix Knotless Tissue Control Device; Ethicon Inc., Somerville, NJ). No residual scar defect was visible on follow-up ultrasonography 1 week and 1 month after surgery.Conclusion
Barbed sutures ease the repair of uterine scar defects and can provide ideal reapproximation of thick myometrial tissue. Laparoscopic treatment of a scar pregnancy and isthmocele repair are effective and safe modes of treatment. 相似文献18.
Julian Di Guilmi Maria Cecilia Darin Maria Toscano Gustavo Maya 《Journal of minimally invasive gynecology》2018,25(3):378-379
Study Objective
To demonstrate the initial experience in Argentina using the iSpies indocyanine green (ICG) platform in sentinel lymph node mapping in patients with early-stage cervical cancer.Design
Step-by-step demonstration of the technique using a video and pictures (educative video) (Canadian Task Force classification III).Setting
Laparoscopic and robotic sentinel lymph node mapping using ICG has been shown to be safe and feasible; however, in developing countries, the opportunities to use fluorescent imaging through a minimally invasive approach are very limited, given the cost restrictions of acquiring the near-infrared technology and the fluorescent dyes.Intervention
A 47-year-old woman presented with a stage IB1 squamous cervical cancer. Physical examination revealed a 1.5-cm tumor without evidence of parametrial involvement. Magnetic resonance imaging did not show any evidence of metastatic disease. The patient underwent laparoscopic radical hysterectomy with sentinel lymph node mapping. On laparoscopic exposure of the pelvic spaces, a cervical injection of ICG (1?mL superficial and deep) was administered using a spinal needle at the 3 o'clock and 9 o'clock positions. Sentinel lymph node mapping was then performed using the ICG (Pulsion Medical Systems, Feldkirchen, Germany) and an iSpies near-infrared camera (Karl Storz Endoskope, Tuttlingen, Germany). Bilateral sentinel lymph nodes were detected on the left external iliac artery and in the right obturator space. Both were confirmed ex vivo. The total operative time was 170 minutes. No intraoperative or postoperative complications were reported, and the patient was discharged at 48 hours after surgery. Estimated blood loss was minimal. Sentinel lymph node mapping alone is not the standard of care in our institution, and thus bilateral lymphadenectomy was performed. Ultrastaging is routinely performed when a sentinel lymph node is evaluated. Final pathology revealed a tumor confined to the cervix, with tumor-free margins, and a total of 10 lymph nodes that were negative for any evidence of disease. Disadvantages of this technology compared with the Pinpoint ICG system (Novadaq Technologies; Bonita Springs, FL) is the lack of simultaneous white vision and fluorescence ICG detection, and the to manually change normal vision to infrared vision. An advantage of the Storz iSpies system is its availability in our country, considering that the technology developed by Novadaq is not yet approved in Argentina.Conclusion
Although ICG sentinel lymph node mapping is becoming a standard of care 1, 2, a lack of ICG dye or laparoscopic near-infrared technologies could be a deterrent to its use in developing countries. A focus on expanding this technology in countries with limited resources would allow patients the opportunity to avoid the morbidity associated with full lymphadenectomy. 相似文献19.
Study Objective
To describe a technique for hysteroscopic removal of retained products of conception (RPOC) implanted over an area of adenomyosis.Design
A case report (Canadian Task Force classification III).Setting
RPOC is an unfortunate complication that may occur after the resolution of a normal pregnancy; it is more common after early pregnancy termination or spontaneous miscarriage [1]. Immediate consequences of RPOC include persistent vaginal bleeding, abdominal pain, pelvic infection, fever, and dilated cervix. Moreover, known long-term complications include the formation of intrauterine adhesions (IUAs) with the potential creation of Asherman syndrome resulting in adverse reproductive outcomes caused by subfertility, chronic pelvic pain, menstrual disturbances, and severe pregnancy complications such as abnormal placentation including the placenta accreta spectrum 2, 3. A recently published American Association of Gynecologic Laparoscopists practice report on IUAs suggests that the surgical approach used to treat intrauterine pathology could have an impact with greater risk for IUA formation when blind versus procedures under direct visualization are performed [4].Interventions
A 35-year-old patient who presented with persistent bleeding for over 5 weeks. The patient has a long history of dysmenorrhea and heavy menstrual bleeding. Magnetic resonance imaging revealed the presence of adenomyosis. She had an unfortunate spontaneous abortion at 8 weeks of gestation. On physical examination, she was found to have a dilated uterine cervix with persistent vaginal bleeding; there were no signs of infection. Pelvic ultrasound revealed an intrauterine hyperechogenic vascularized area of 2?×?2, 8?×?2?cm implanted over a focal area of adenomyosis, which is consistent with the presence of RPOC. With the aim of minimizing possible acute complications such as bleeding, infection, and uterine perforation, a hysteroscopic approach was taken to avoid performing a blind dilation and curettage. A secondary benefit of a hysteroscopic approach is a lower incidence of long-term complications such as IUAs and the consequent Asherman syndrome. We describe a hysteroscopic technique in which the use of electrosurgery is limited to minimize thermal damage of the endometrium, highlighting important tips and tricks of the procedure.Conclusion
Hysteroscopic removal of RPOC is a feasible and safe management option of this complication of pregnancy. We strongly suggest avoiding performing blind procedures such as dilation and curettage and favor the adoption of this modality that allows the removal of retained products of conception under direct visualization. 相似文献20.
Gaby N. Moawad Paul Tyan Elias D. Abi Khalil David Samuel Vincent Obias 《Journal of minimally invasive gynecology》2018,25(3):389-390