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1.
Study Objective
To provide surgeons with techniques for preemptive analgesia during minimally invasive gynecologic surgery. Postoperative pain management is an important component of patient care after gynecologic surgery. There have been numerous advances in pain management, including studies that show that preoperative administration of analgesics decreases postoperative pain scores and narcotic medication requirements 1, 2, 3. However, there is limited information on the techniques for preemptive analgesia 4, 5.Design
An instructional video showing a variety of preemptive analgesia techniques and the corresponding neuroanatomy (Canadian Task Force classification III). Mayo Clinic Institutional Review Board approval was not required for this video article.Setting
Academic Medical CenterInterventions
Relevant abdominopelvic neuroanatomy is reviewed. This is followed by a demonstration of the preemptive analgesia techniques based on neuroanatomy principles.Conclusion
Techniques for preemptive analgesia are simple and effective. These tools can be used for patients undergoing gynecologic surgeries via a vaginal or abdominal approach and can help optimize postoperative pain and narcotic usage. 相似文献2.
Wancheng Zhao Qing Yang Ningning Zhang Yu Wang Guangwei Wang Dandan Wang 《Journal of minimally invasive gynecology》2019,26(4):605-606
Study Objective
To introduce an effective assisted method using the hysteroscopy transmittance test and a Foley catheter to repair previous cesarean scar defect (PCSD) by laparoscopy.Design
A step-by-step explanation of the surgery using video.Setting
A university hospital.Patients
A young woman with abnormal uterine bleeding.Interventions
First, we inspected the pelvic cavity and detached the adhesion, opened the uterovesical peritoneal reflection, and pushed down the bladder. Then, the hysteroscopy transmittance test was used to confirm the site and the size of the PCSD. Next, a Foley catheter was inserted into the diverticulum through the cervical canal, and then we removed the diverticulum along the outer edge 1, 2, 3, 4. The myometrium and the serosal layer were sutured continuously with absorbable sutures. At this point, a second hysteroscopy transmittance test was performed to verify the repair effect. Finally, we placed antiadhesive film.Measurements and Main Results
The location, size, and boundary of the PCSD can be exactly marked by this method. The operative time was 68 minutes, blood loss was 20mL, and no complications occurred.Conclusion
This surgical method has the following benefits: the resection of the diverticulum is complete, and the suture is exact; it is suitable for patients with a thin diverticulum wall, large diverticulum cavity, and a long duration of bleeding after menstruation; the hysteroscopy transmittance test was used to confirm the site of the PCSD and verify the repair effect; and the Foley catheter can marker the resection site, prevent gas leakage, and stop bleeding by local compression. 相似文献3.
Study Objective
To demonstrate a modified technique of laparoscopic lateral suspension for pelvic organ prolapse (POP).Design
A video illustrating this modified technique of laparoscopic lateral suspension (Canadian Task Force classification III).Setting
The benign gynecology department at a university hospital.Interventions
Laparoscopic lateral suspension using mesh is a minimally invasive technique that effectively treats POP [1, 2, 3, 4]. We present a modified technique of laparoscopic lateral suspension that differs from previously described methods [1, 2, 3, 4]. The prominent differences are as follows: first, our modified technique uses Mersilene tape on a 48-mm round-bodied needle (Ethicon Inc, Somerville, NJ,USA). We suspend the vaginal vault, taking a double bite using Mersilene tape without knotting placed as a transversal hammock. Thanks to the Mersilene tape, meshes, sutures, tackers, or fasteners are not needed. Mersilene tape ensures much easier suturing and an inexpensive artificial material. The second difference is that port placement sites (Fig. 1). The third difference is the number of incisions we make (Fig. 1). We do not need 2 additional incisions as used in previously described methods references [1, 2, 3, 4]. We use the same incision for lateral trocar insertion and for pulling out the distal end of the Mersilene tape, which is 2 cm above the iliac crest and 4 cm posterior to the anterior superior iliac spine (Fig. 1). Our technique has the potential to be easier, shorter, more cost-efficient, less invasive, and safer when compared with previously described methods.Conclusion
Modified laparoscopic lateral suspension, the so-called Mulayim technique, might be considered as an alternative treatment for POP surgery; however, studies should be conducted in a larger number of patients with longer postoperative follow-up periods (Fig. 1). 相似文献4.
Study Objective
To show a step-by-step approach to laparoscopic enucleation and excision of retroperitoneal cysts using a technical video.Design
A technical video (Canadian Task Force classification III).Setting
A benign gynecology department at a university hospital.Intervention
Laparoscopic enucleation and excision of retroperitoneal cysts.Conclusion
Retroperitoneal cysts are rare lesions associated with numerous complications including compression on neighboring organs, infection, rupture, and malignant transformation. Excision of retroperitoneal cysts can be challenging, and dissection of the retroperitoneal space is associated with bowel and vascular injury [1]. Laparoscopic drainage and fenestration have been promoted to prevent visceral injury [2]. Such approaches are ineffective, with increased recurrences and fluid accumulation requiring repeat surgical procedures 3, 4. Successful laparoscopic excision of retroperitoneal cysts has been reported although there are no published videos of the technique [5]. In this video, we use 2 separate cases to show our step-by-step laparoscopic approach to enucleate and excise retroperitoneal cysts. Various methods to safely enter retroperitoneal spaces to avoid inadvertent damage to surrounding structures are detailed. A combination of careful blunt and sharp dissection is used to find specific planes to separate the cyst from the overlying peritoneum and underlying pelvic sidewall structures such as the ureter, vasculature, and nerves. We minimize energy use, and, when it is used, we are mindful regarding active blade positioning of the ultrasonic dissector to prevent inadvertent cyst rupture and injury to the surrounding structures. Keeping the cysts intact aids in leverage and prevents inadvertent spillage of potentially malignant contents. The cysts are retrieved laparoscopically by contained bag decompression. 相似文献5.
Gabriele Centini Luca Labanca Karolina Afors Istvan Argay Rodrigo Fernandes Nassir Habib Arnaud Wattiez 《Journal of minimally invasive gynecology》2019,26(4):604
Study Objective
To point out the relevant anatomy of the ureter and to demonstrate its rules of dissection.Design
An educational video to explain how to use ureteral relevant anatomy and the principle of dissection to perform safe ureterolysis during laparoscopic procedures.Setting
A tertiary care university hospital and endometriosis referential center.Interventions
Anatomic keynotes of the ureter and examples of ureterolysis.Conclusion
This video shows the feasibility of laparoscopic ureteral dissection and provides safety rules to perform ureterolysis. Identification and dissection of the ureter should be part of all gynecologic surgeons’ background to reduce the risk of complications [1]. Knowledge of anatomy plays a pivotal role, allowing the surgeon to keep the ureter at a distance and minimizing the need for ureterolysis. Unfortunately, the need for ureteral dissection is not always predictable preoperatively, and gynecologic surgeons need to master this technique, especially when approaching more complex procedures such as endometriosis [2]. An implicit risk of damage cannot be denied when performing ureterolysis; therefore, the ureter should be dissected only when strictly necessary and handled with care to minimize the use of energy [3]. 相似文献6.
Berta Diaz-Feijoo Rocio Luna-Guibourg Silvia Cabrera Susana Manrique Antonio Gil-Moreno 《Journal of minimally invasive gynecology》2019,26(2):366
Study Objective
To show the feasibility of the laparoscopic extraperitoneal approach for pelvic metastatic lymph node debulking in locally advanced cervical cancer.Design
A surgical video article (Canadian Task Force classification III).Setting
A university hospital.Patient
A 52-year-old patient presented with stage IIA2 cervical adenocarcinoma according to Fédération Internationale de Gynécologie et d'Obstétrique classification. During the physical examination, a 45-mm tumor was discovered. Positron emission tomographic imaging was positive for hypermetabolic enlarged lymph nodes in the left external iliac region of 1.4-cm size and an standardized uptake value of 21 and in the right obturator region of 1.3-cm size and an standardized uptake value of 7.1; no aortic nodes were found using the imaging procedures. Before chemoradiation therapy, she underwent extraperitoneal aortic lymph node dissection for surgical staging at Vall d'Hebron University Hospital, Barcelona, Spain. Pelvic lymph node debulking was proposed to confirm positivity and, if so, to adjust the radiotherapy field and reduce lymph node radioresistance 1, 2.Interventions
After a complete extraperitoneal aortic infrarenal lymph node dissection as described by Querleu et al [3], the presacral space is created to expose the iliac vessels. The enlarged lymph nodes are identified and dissected using blunt dissection, monopolar energy, and a vessel sealing device.Measurements and Main Results
There were no intraoperative or postoperative complications. The anatomopathologic study confirmed positivity for adenocarcinoma metastasis in 3 pelvic nodes and 2 of 29 aortic nodes.Conclusion
Laparoscopic debulking of enlarged pelvic lymph nodes via the extraperitoneal approach is a feasible procedure. It can be performed as an extension of extraperitoneal aortic lymphadenectomy in selected patients with locally advanced cervical cancer. 相似文献7.
Xuyin Zhang Yan Ding Keqin Hua Songping Liu Nan Jia 《Journal of minimally invasive gynecology》2019,26(3):396-397
Study Objective
To introduce a creation that combines laparoscopic and Wharton-Sheares-George cervicovaginal reconstruction using a small intestinal submucosa (SIS) graft in a patient with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome who had a rudimentary cavity (U5aC4V4) [1].Design
A video article introducing a new surgical technique.Setting
A university hospital.Patients
A 24-year-old patient had primary amenorrhea and irregular lower abdominal pain for 9 years. The patient was Tanner stage 3 for pubic hair and Tanner stage 4 for breast development. The physical examination revealed no vagina. A primordial uterus and a uterus with a rudimentary cavity were detected by magnetic resonance imaging 2, 3. However, the rudimentary cavity had no hematometra. Magnetic resonance imaging also found a left solitary kidney. The diagnosis was MRKH syndrome with a rudimentary cavity (U5aC4V4) [4]. The patient desired resumption of menses and possible future fertility.Interventions
Combined laparoscopic and Wharton-Sheares-George cervicovaginal reconstruction using an SIS graft was performed.Measurements and Main Results
With the Wharton-Sheares-George neovaginoplasty, a vaginal mold with a surrounding SIS graft was inserted into the newly created cavity [5]. Using laparoscopy, the lower uterine segment was incised by shape dissection. The proximal segment of the SIS graft to the lower uterine segment was sutured. A T-shaped intrauterine device with a Foley catheter was fixed in the uterine cavity by the delay of absorbed sutures to prevent cervical or vaginal stenosis. The distal segment of the SIS graft was sutured with the high vaginal or vestibular mucosa vaginally. The operation was successfully completed. The operating time was 2 hours. Hospitalization was 4 days. There were no blood transfusions or complications. The patient had resumption of menses for 2 cycles postoperatively, and she had no dysmenorrhea. The patient did not have sexual intercourse because of the mode in the vagina to prevent vagina stenosis. No cervical stenosis occurred because of the Foley catheter.Conclusion
In the past, a uterus with a rudimentary cavity in patients with MRKH was always excised, and patients lost the chance of menstrual onset and fertility. Combined laparoscopic and Wharton-Sheares-George cervicovaginal reconstruction using an SIS graft provided a minimally invasive, safe, and effective surgical option for the young patient with MRKH syndrome with a rudimentary cavity. The technique is not complex, is easy to learn and perform, and provided a result with functional and anatomic satisfaction. No special surgical apparatus is needed with this technique. 相似文献8.
Study Objective
To demonstrate techniques of ureterolysis during complex laparoscopic hysterectomy.Design
Technical video demonstrating different approaches to ureterolysis for complex benign pathology during laparoscopic hysterectomy (Canadian Task Force classification III).Setting
Benign gynecology department at a university hospital.Intervention
Performance of ureterolysis during laparoscopic hysterectomy for benign pathology.Conclusion
Ureteric injury has significant morbidity and is the most common reason for litigation following hysterectomy, with an estimated risk of 0.02% to 0.4%. 1, 2. Ureterolysis is infrequently practiced by benign gynecologists; however, it may be necessary during complex surgery. Benign pathology requiring hysterectomy, such as endometriosis, myomas, large uteri, and adnexal masses, are recognized risk factors for ureteric injury [3]. Most injuries occur during division of the uterine artery at the level of the internal cervical os. The average distance between the ureter and cervix is 2 cm, but it is only 0.5 cm in 3.2% of the population with a normal pelvis [4]. Preventive strategies, such as the use of a uterine manipulator, may increase this distance, although it still might not be sufficient to prevent injury in women with normal anatomic variants and complex pathology. Visualizing the ureter at the pelvic brim and side wall without retroperitoneal dissection may be inadequate because the segment of ureter between the intersection of the uterine artery and the bladder is not visible. The ureter can be safely dissected up to 15 cm without compromising its viability. In this educational video, we demonstrate various simple, quick, and reproducible techniques to perform ureterolysis for complex benign pathology. These techniques can be used by both expert and novice surgeons to perform and teach ureterolysis. Our method determines the course of the ureter throughout the pelvis and relation to the uterine artery to reduce intraoperative injury. We have performed more than 350 cases with no injuries. 相似文献9.
Hiroyuki Kanao Yoichi Aoki Terumi Tanigawa Maki Matoda Sanshiro Okamoto Hidetaka Nomura Kohei Omatsu Kazuyoshi Kato Kuniko Utsugi Nobuhiro Takeshima 《Journal of minimally invasive gynecology》2019,26(4):598-599
Study Objective
To show a novel combination laparoscopic and open perineal approach to complete resection of aggressive angiomyxoma.Design
Step-by-step video demonstration of the combination approach (Canadian Task Force classification III).Setting
Combined laparoscopic and open perineal approach was performed in the tertiary center.Patient
A 46-year-old woman presented with an 8-cm vulvar mass, diagnosed as an aggressive angiomyxoma. The patient, who strongly desired to preserve her uterus and ovaries, provided informed consent for resection of the tumor by our combination approach, also approved by our Institutional Review Board.Intervention
Combined laparoscopic and open perineal approach.Measurements and Main Results
Aggressive angiomyxoma is a rare mesenchymal neoplasm that occurs most often in the female pelviperineal region [1]. Aggressive angiomyxoma is locally infiltrative, and high postoperative local recurrence rates (36%–72%) due to incomplete resection have been reported [2]. Therefore, until recently, wide surgical excision with tumor-free margins have been the most commonly accepted treatment. However, aggressive angiomyxoma is a benign, slow-growing tumor, and because extensive surgical resection, which is associated with high operative morbidity rates, has not been shown to have a significant effect on prognosis, a more conservative procedure may be preferable [3]. The mass was located mainly at the left ischiorectal fossa, but it extended above the pelvic diaphragm and was attached to internal obturator muscle, vagina, bladder, urethra, and rectum. We excised the tumor completely and without complications by a combined laparoscopic and open perineal approach. Twelve months have passed since the surgery, and there has been no adjuvant treatment and no sign of recurrence.Conclusion
Our combination approach to aggressive angiomyxoma in the pelviperineal region is technically feasible, and the good visualization and meticulous dissection provided during the laparoscopic portion of the surgery contribute to complete resection. 相似文献10.
11.
Haider Jan Michael Katesmark Vishalli Ghai 《Journal of minimally invasive gynecology》2019,26(4):600-601
Study Objective
To demonstrate our approach to laparoscopic excision of a noncommunicating rudimentary horn (AmericanSociety for Reproductive Medicine classification II(b), European Society of Human Reproduction and Embryology/European Society of Gynaecological Endoscop classification class U4a).Design
Technical video (Canadian Task Force classification level III).Setting
University Hospital.Patient
A 25-year-old women with a left-sided pelvic mass.Intervention
Laparoscopic excision of noncommunicating rudimentary horn with hysteroscopy and cystoscopy. Institutional Review Board/Ethics Committee ruled that approval was not required for this study.Measurements and Main Results
Noncommunicating rudimentary horns are present in 20% to 25% of women with a unicornuate uterus [1]. Noncommunicating rudimentary horns may be associated with dysmenorrhea, pelvic pain, subfertility, and poor obstetric outcomes. Laparoscopic excision of rudimentary horns can be challenging and complex. Factors to consider in relation to the rudimentary horn are attachment to the uterus, presence and course of the ureter, and vascular supply. In this video we demonstrate our approach to laparoscopic excision of a rudimentary horn including preoperative imaging to plan surgical care. A 25-year-old women presented with pelvic pain and underwent a laparotomy for a left-sided pelvic mass. Intraoperatively, a rudimentary horn was suspected, and she was started on a gonadotropin-releasing hormone analogue pending diagnostic imaging and definitive surgery. Computed tomography demonstrated an absent left kidney and ureter. Intraoperatively, we began with a cystoscopy to identify and confirm an efflux from ureteral openings. A real-time hysteroscopy was performed to identify the unicornuate uterus from the rudimentary horn and to exclude vaginal or cervical anomalies. Through hysteroscopic transillumination the plane of dissection was identified between the rudimentary horn and uterus 2, 3. This technique is especially useful when the rudimentary horn is densely fused to the unicornuate uterus. Retroperitoneal dissection was performed ipsilateral to the rudimentary horn. A lateral approach was used to coagulate the uterine artery at its origin. The bladder was reflected from the horn to allow excision. A Thunderbeat device (Olympus Medical Systems, Tokyo, Japan) was used to excise the rudimentary horn, keeping very close to the specimen to ensure no penetration of the unicornuate uterus. Hemostasis was achieved, and no additional sutures were required. The specimen was removed using in-bag morcellation.Conclusion
A stepwise hysteroscopic and laparoscopic approach can be used to safely resect a rudimentary horn as demonstrated by this case. 相似文献12.
Ye Zhang Xiaochen Song Meng Mao Jia Kang Fangfang Ai Lan Zhu 《Journal of minimally invasive gynecology》2019,26(4):754-759
Study Objective
To evaluate the long-term safety and efficacy of tension-free vaginal tape (TVT).Design
Prospective observational study (Canadian Task Force classification II-2).Setting
Tertiary referral center in China.Patients
Between January 2004 and December 2005, 85 consecutive patients who underwent the TVT procedure were included. Patients with mixed incontinence or pelvic organ prolapse requiring surgery were excluded.Interventions
TVT procedure.Measurements and Main Results
The primary outcomes were long-term postoperative complications. The secondary outcomes included long-term subjective satisfaction (Patient Global Impression of Improvement), objective cure rate (stress test), quality of life, and sexual function. At the 13-year follow-up, 70 patients (82%) were available for evaluation. De novo overactive bladder was observed in 15.7% of patients, and voiding symptoms were found in 17.1% of patients. None of the patients reported voiding dysfunction that needed treatment with tape removal or catheterization. Tape exposure occurred in 2.9% of patients. The subjective satisfaction rate and objective cure rate were 78.6% and 81.4%, respectively.Conclusion
TVT is a safe and effective treatment for stress urinary incontinence, even at the 13-year follow-up. The prevalence rates of overactive bladder and voiding symptoms are increased with advancing age and should not be considered long-term postoperative complications. 相似文献13.
Emilie Schwartz Emilie Faller Chérif Youssef Akladios Michel Greget Catherine Roy Arnaud Wattiez 《Journal of minimally invasive gynecology》2019,26(2):363-364
Study Objective
To show laparoscopic management of an arteriovenous malformation in a patient with deep pelvic endometriosisDesign
A step-by-step explanation of the surgery using an instructive video.Setting
Hautepierre University Hospital, Strasbourg, France.Interventions
We describe the case of a 37-year-old patient presenting with deep pelvic endometriosis and a uterine arteriovenous malformation. Deep pelvic endometriosis was diagnosed during a tubal ligation in 2015. Laparoscopy also showed some pelvic varicosities. Hysteroscopy was performed to increase the diagnostic precision. Huge blood vessels with an arterial pulse on the anterior wall of the uterus were found. The endometriosis of the patient was very symptomatic; she suffered from dysmenorrhea, menorrhagia, intense dyspareunia, and dyschezia. Magnetic resonance imaging indicated a large arteriovenous shunt in the anterior part of the uterus and bladder endometriosis. After a pluridisciplinary medical staff meeting, we decided to begin treatment with luteinizing hormone-releasing hormone analogs. Then, she underwent embolization of the arteriovenous malformation, which produced regression of the lesions as indicated by reevaluation with magnetic resonance imaging. We decided to perform laparoscopic hysterectomy. Evaluation of the abdominal cavity showed diaphragm endometriosis, deep pelvic endometriosis, and the arteriovenous malformation. We started with left ureterolysis and opening of the rectovaginal septum. After that, we radically dissected the left side of the uterus with a left oophorectomy and then the right side, conserving the ovary. Then, we shaved the bladder for endometriosis removal. To finish, we performed a right salpingectomy with a right ovariopexy, vaginal closure, and coagulation of the diaphragm's nodules. The patient agreed to record and publish the surgery, and the local institutional review board gave its approval.Conclusion
To conclude, preoperative embolization of the arteriovenous shunt improves surgery, avoiding excessive bleeding and permitting easier radical hysterectomy for deep pelvic endometriosis. Similar cases have been published [1], but to our knowledge, our video is the first regarding this subject. It appears that embolization can fail, but hysterectomy remains the gold standard treatment [2]. 相似文献14.
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15.
Study Objective
To demonstrate a technique of performing laparoscopic resection of a post–cesarean section scar uterine cyst.Design
Technical video (Canadian Task Force classification III).Setting
University Hospital.Patient
A 38-year old woman.Intervention
Laparoscopic excision of a uterine cyst within a cesarean section scar.Measurements and Main Results
A 38-year-old woman presented with secondary subfertility requesting removal of a cesarean section scar defect to prepare the uterine cavity for in vitro fertilization. Preoperative ultrasound demonstrated a 17.7?×?12.2?mm scar defect. At rigid hysteroscopy the anterior uterine wall cyst was observed and noted to be narrowing the uterine cavity. A laparoscopic approach was used to excise the uterine cyst. We carefully mobilized the bladder from its adhesions at the site of the previous cesarean section scar. The uterine cyst was located and margins of the defect identified. An ultrasonic-energy device was used to enucleate and excise the cyst. A uterine manipulator helped to identify the cervical canal and protect the posterior wall from inadvertent suture placement. The defect was closed with 1 vicryl interrupted sutures, being careful to incorporate the full thickness of the uterine wall to an able maximal opposition. An adhesion barrier was applied to the area. Transvaginal ultrasound scanning performed 6 weeks postoperatively demonstrated full healing with no residual defect.Conclusion
Niches are recognized complications of cesarean sections resulting from incomplete healing of the scar and more likely in single-layer closures [1]. They can be associated with postmenstrual spotting, dysmenorrhea, chronic pain, subfertility, and poorer reproductive and obstetric outcomes 1, 2, 3, 4, 5. Laparoscopic resection of niches is well established, showing symptomatic relief and an increase in residual myometrium [6]. Although cesarean section scar defects have been described as niches, we presented a further variety of defect that has not been previously described, a uterine cyst. 相似文献16.
Laurentiu Pirtea Oana Balint Cristina Secosan Dorin Grigoras Razvan Ilina 《Journal of minimally invasive gynecology》2019,26(3):399-400
Study Objective
To present a case of a cesarean scar ectopic pregnancy treated by laparoscopic resection followed by isthmocele repair.Design
A case report.Settings
The University Gynecology Clinic of the Emergency Clinical City Hospital Timi?oara, Timi?oara, România.Background
Cesarean scar pregnancy is a rare form of ectopic pregnancy. In recent years, its prevalence has risen because of the increasing number of cesarean sections. An early diagnosis can lead to early management, decreasing the risk of life-threatening complications such as uterine rupture and massive hemorrhage. Many therapeutic options are available, medical and surgical, but the current literature suggests that the laparoscopic approach with ectopic pregnancy resection is the best option.Case Report
We present the case of a 30-year-old woman with a previous cesarean section in 2012 who was diagnosed by transvaginal ultrasound with a 6-week live pregnancy implanted at the level of the cesarean scar. The initial management was the administration of a 2-dose methotrexate protocol, but after 72 hours the transvaginal ultrasound showed an embryo with cardiac activity still present associated with an increased beta human chorionic gonadotropin level. We decided on laparoscopic surgical treatment, aiming to extract the pregnancy and repair the scar defect. A similar case was presented by Mahgoub et al [1], but their case had a different evolution, with decreasing levels of hCG.Interventions
In order to reduce the blood loss, the anterior trunks of the hypogastric arteries were clipped. The side wall peritoneum was cut bilaterally, and the ureters and the hypogastric arteries were dissected. Next, we performed the dissection of the vesicouterine space. Because of the previous cesarean section, the identification of the correct dissection plane was difficult. A uterine manipulator was used to facilitate the dissection. The exact location of the gestational sac was demonstrated using intraoperative transvaginal ultrasound. To reduce the bleeding, Glypressin (Ferring GmbH, Saint Prex, Switzerland) was injected at the level of the uterine scar. The cesarean scar was cut using a monopolar knife. The gestation sac was reached easily and then extracted from the abdominal cavity with the use of an endobag. In order to obtain proper healing, the margins of the scar were resected using cold scissors. The hysterotomy was closed using a double-layered suture with 2.0 Vicryl (Ethicon Inc., Cincinnati, OH). We used methylene blue to verify the tightness of the suture. The final step was the removal of the clips.Measurements and Main Results
The operative time was 85 minutes with minimal blood loss of about 20 mL. The patient recovered well and was discharged 2 days after the procedure. A transvaginal ultrasound was performed 1 month after the surgery showing good healing of the anterior uterine wall.Conclusion
The laparoscopic approach with excision and repair of the uterine wall represents a safe and efficient therapeutic option for the treatment of the cesarean scar ectopic pregnancy. 相似文献17.
Stephanie Seidler Stas Shabanov Axel Andres Wolfram Karenovics Jean-Marie Wenger Nicola Pluchino 《Journal of minimally invasive gynecology》2019,26(3):404
Study Objective
To demonstrate a safe laparoscopic procedure for diaphragmatic infiltrative endometriosis.Design
Video caseSetting
Teaching hospital (Canadian Task Force classification III).Patients
One patient presenting deep and severe diaphragmatic endometriosis.Intervention
Laparoscopic cure of diaphragmatic endometriosis.Measurements and Main Results
Throughout this video, which was approved by the institutional board review, we demonstrate safe and complete surgical treatment of a patient suffering severe pelvic and diaphragmatic endometriosis. The patient complained of menstrual dyspnea and shoulder pain persisting despite hormonal treatment, associated with persistent dyspareunia and pelvic pain despite a previous laparoscopic surgery. Patient positioning and anesthesia were adapted to the special requirements of the surgical technique and the expected risks. The operation consisted of the exposure of the right diaphragm by mobilization of the liver, CO2 laser vaporization of left and right diaphragmatic lesions, nerve-sparing excision of infiltrating nodules, and pleural exploration. Finally, we performed an excision of pelvic endometriosis. Participation of 3 surgical teams to this procedure allowed a safe and complete laparoscopic treatment with resolution of pain symptoms at a 1- and 3-month follow-up.Conclusion
Laparoscopic treatment allows a safe and complete treatment of diaphragmatic endometriosis. 相似文献18.
Kimberly Butt Joan Crane Jennifer Hutcheon Ken Lim Ori Nevo 《Journal d'obstetrique et gynecologie du Canada》2019,41(3):363-374.e1
Objective
To review the evidence and provide an opinion as to whether universal cervical length screening to prevent preterm birth should be adopted across Canada.Outcomes
Outcomes evaluated include prevention of preterm birth.Evidence
Literature searches using Knowledge Finder, Medline and Cochrane databases were searched for articles published up to April 2018 on cervical length screening for prevention of preterm birth.Values
The evidence obtained was reviewed and evaluated by the Diagnostic Imaging Committee of the SOGC under the leadership of the principal authors, and recommendations were made according to guidelines developed by the Canadian Task Force on Preventive Health Care.Benefits, Harms, and Costs
The prevention of preterm birth in a cost-effective manner is of significant importance to the health of mothers and their families. This committee opinion will summarize the current evidence for universal cervical length screening to prevent preterm birth in Canada, determine whether it meets the Junger and Wilson criteria for screening tests, and make recommendations as to its use in Canada.Validation
These guidelines have been reviewed and approved by the Diagnostic Imaging Committee of the SOGC and The Society of Obstetricians and Gynaecologists of Canada (SOGC).Sponsors
The Society of Obstetricians and Gynaecologists of Canada (SOGC). 相似文献19.
Jordina Munrós Maria-Angeles Martínez-Zamora Dolors Tàssies Juan Carlos Reverter Mariona Rius Meritxell Gracia Cristina Ros Francisco Carmona 《Journal of minimally invasive gynecology》2019,26(3):450-455
Study Objective
To evaluate serial generation of microparticles (MPs) after laparoscopic stripping or CO2 laser vaporization in the surgical treatment of patients with ovarian endometrioma (OE).Design
A prospective, randomized, blinded, pilot study (Canadian Task Force classification I).Setting
Tertiary care university hospital from December 2014 to July 2016.Patients
Thirty women with unilateral OE undergoing laparoscopic surgery.Intervention
Patients were randomly selected to undergo either CO2 laser vaporization (L group) or laparoscopic stripping (S group) of OE.Measurements and Main Results
Blood samples were collected before surgery and at 2 hours, 24 hours, 1 month, and 3 months after surgery. An MP generation curve after OE surgery was created. MP generation was greater in the S group than in the L group at all time points evaluated. The MP generation curve showed a significantly higher area under the curve after excisional surgery (p <.05).Conclusion
The higher MP levels in the S group suggest an increased inflammation and procoagulant response after this procedure. 相似文献20.
Axelle Charavil Aubert Agostini Caroline Rambeaud Andy Schmitt Claire Tourette Patrice Crochet 《Journal of minimally invasive gynecology》2019,26(4):695-701