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1.
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.
4.
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5.
6.
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7.
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8.
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9.
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10.
Study Objective
To demonstrate a mesh-free laparoscopic uterosacral suture sacrohysteropexy (LUSSH).Design
Technical video demonstrating LUSSH for uterine prolapse (Canadian Task Force classification III).Setting
University hospital.Patient
A 37-year-old woman with grade 3 uterine descent requested uterine-sparing surgery for symptomatic prolapse. The patient declined all mesh procedures.Intervention
Mesh-free laparoscopic uterosacral suture sacrohysteropexy (LUSSH).Measurements and Main Results
Laparoscopic sacrohysteropexy is a uterine-preserving technique for uterine prolapse with high cure rates (92%) but with a mesh erosion risk of up to 2.5% 1, 2. Complications have resulted in reclassification of transvaginal meshes as restricted-use high-risk medical devices 3, 4. Sacrospinous hysteropexy and uterosacral ligament suspension are mesh-free alternatives, but they have increased rates of anterior-compartment failures and a 20% recurrence rate in the latter 5, 6. Laparoscopic suture sacrohysteropexy has been described with reported success rates of 95% [7]. This video demonstrates a modified-technique offering a simple, robust, and reproducible mesh-free approach to uterine-preserving prolapse surgery. We used 2 horizontal loop mattress sutures acting as a pulley to distribute the force evenly throughout the suture strand, leading to a significantly stronger and more secure hold and reducing risk of avulsion [8]. The technique starts with a careful dissection of the peritoneum from the sacral promontory to the cervix. Two permanent sutures are used, taking bites at the anterior longitudinal ligament, the uterosacral, a loop mattress in the midline at the cervix, the uterosacral on the way back, and finally at the sacral promontory. Damage to the uterine vessels is minimized by maintaining a central uterine position. The stitch is tied with caudal pressure on the uterus, applied via the uterine manipulator, approximating the cervix to the sacral promontory. The peritoneum is closed with dissolvable sutures, burying the Ethibond to prevent exposure and bowel obstruction.Conclusion
Post-procedure, the uterus was well supported with a vaginal length of 15 cm. 相似文献11.
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12.
Xiaoming Guan Juan Liu Yanzhou Wang Jordan Gisseman Zhenkun Guan Christopher Kleithermes 《Journal of minimally invasive gynecology》2018,25(5):768
Objective
To describe and demonstrate the single-incision laparoscopic technique with an articulated energy device for a uterus larger than 20?cm.Design
Stepwise demonstration of the single-site surgical technique and tissue extraction with narrated video footage (Canadian Task Force classification III).Setting
Single-incision laparoscopic hysterectomy can be difficult because of the long operating time, steep learning curve, and need for articulated instruments, and it is especially challenging in patients with a uterus larger than 20?cm. However, the advantages of single-site laparoscopic surgery may include less bleeding, infection, and pain and a better cosmetic outcome.Interventions
A 49-year-old G3P3 female with a 24 weeks-sized fibroid uterus requesting supracervical hysterectomy presented to our tertiary academic medical center with a 2-year history of pelvic pain and menorrhagia with a normal Pap smear history. Uterine weight was 1900?g. Laparoscopic single-incision supracervical hysterectomy with contained bag tissue extraction was performed. Rotating between the patient's right and left side allowed the surgeon to access the entire abdomen from a single umbilical port. There was no complications or conversions to multiport in the surgery.Conclusion
Single-incision laparoscopic hysterectomy for a uterus larger than 20?cm is possible and leads to better outcomes. 相似文献13.
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14.
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15.
Clarissa Frascà Gianmarco Tuzzato Alessandro Arena Eugenia Degli Esposti Margherita Zanello Diego Raimondo Renato Seracchioli 《Journal of minimally invasive gynecology》2018,25(4):679-683
Study Objective
To determine the accuracy of pelvic ultrasonography (US) in preoperative evaluation before laparoscopic myomectomy.Design
A prospective cohort study (Canadian Task Force classification II-2).Setting
A tertiary level referral center of minimally invasive gynecologic surgery, Sant'Orsola University Hospital, Bologna, Italy.Patients
One hundred one of the 125 women undergoing laparoscopic myomectomy from September 2015 to May 2016 were included.Interventions
Preoperative pelvic US was performed 2 weeks before surgery.Measurements and Main Results
Among the 101 women enrolled in this study, preoperative US correctly identified the number of myomas in 73 patients (72.3%). A total of 208 myomas were preoperatively identified by US; 197 (94.7%) were surgically removed, and 11 (5.3%) were not visualized during laparoscopic myomectomy. The 11 undetected myomas were intramural (International Federation of Gynecology and Obstetrics [FIGO] type 3 and 4), with a mean diameter of 19.05?±?5.91?mm. The type, site, and location of the 197 myomas identified by US preoperatively and removed via laparoscopy were confirmed at surgery in 78.7% (155/197), 80.7% (159/197), and 84.3% (166/197) of the cases, respectively. Two-hundred fifty-four total myomas were removed laparoscopically; 197 (77.6%) were preoperatively identified by US, and 57 (22.4%) were missed by US, having had a mean diameter of 13.51?±?7.84?mm and predominantly being the subserosal type (FIGO type 5, 6, and 7) (57.9%, p?<?.05).Conclusion
Pelvic US is a valuable tool in preoperative evaluation and should be systematically performed when planning laparoscopic myomectomy. 相似文献16.
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17.
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18.
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19.
Vito Chiantera Marco Petrillo Elene Abesadze Giulio Sozzi Margherita Dessole Mariano Catello Di Donna Giovanni Scambia Jalid Sehouli Sylvia Mechsner 《Journal of minimally invasive gynecology》2018,25(7):1217-1223
Study Objective
To evaluate the clinical presentation and surgical outcome in patients with deep lateral pelvic endometriosis (dLPE).Design
A retrospective multicentric study (Canadian Task Force classification II-2).Setting
University tertiary referral centers.Patients
One hundred forty-eight women with deep infiltrating endometriosis (DIE).Interventions
Laparoscopic excision of DIE. Disease distribution was classified as follows: central pelvic endometriosis (CPE) when DIE involved 1 of the following anatomic sites: cervix, vagina, uterosacral ligaments, rectum, bladder, or pelvic peritoneum; superficial lateral pelvic endometriosis when parametria, ureters, or hypogastric plexus were involved; and dLPE in the presence of sacral plexus and/or sciatic nerve infiltration.Measurements and Main Results
All patients showed CPE. LPE was detected in 116 cases (78.4%); among these, we observed dLPE in 41 patients (35.3%). dLPE occurred in 40% of women with CPE and in 72.7% of patients with hypogastric plexus involvement. Thirty women with dLPE (73.2%) received gastrointestinal or urologic resection in addition to gynecologic procedures compared with 40 patients (57.1%) without dLPE (p?=?.001). No differences were observed in terms of perioperative complications according to the presence of dLPE. According to univariate/multivariate analysis, chronic pelvic pain was the only predictor of dLPE (odds ratio?=?3.041, p?=?.003). The median preoperative visual analog scale for dysmenorrhea (median?=?8, range, 0–10) and dyspareunia (median?=?5; range, 0–10) dropped to 0 after surgery. The median follow-up was 36 months (range, 6–66 months) with a recurrence rate of 8.8%.Conclusions
dLPE is not a rare event in women with DIE. Complete laparoscopic removal of endometriosis seems to ensure benefit in terms of recurrence rate without increased surgical morbidities. 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