A Comparison of Single-, Two- and Three-Port Laparoscopic Myomectomy

Background and Objective:

A recent FDA safety communication has discouraged the use of a power morcellator for myoma extraction and has called for a change in surgical techniques for myomectomy. The objective of this study was to compare surgical outcomes of laparoscopic single-, two-, and conventional three-port myomectomy and to evaluate the feasibility of contained manual morcellation for uterine myoma.

Methods:

This retrospective study was a review and analysis of data from 191 consecutive women who underwent single-, two-, or three-port myomectomy for the management of uterine myoma from January 1, 2009, through December 31, 2014.

Results:

The 3 study groups did not differ demographically. Apart from operative time, the single- and two-port groups showed operative outcomes comparable to those of the multiport group. The single-port group had significantly longer operative times (P = .0053) than the two- and three-port groups. However, in the latter half of the single-port cases, the operative time was similar to those in the three-port group. The two-port surgery group showed a consistent operative time without a learning period.

Conclusion:

Single- or two-port myomectomy with transumbilical myoma morcellation is feasible and safe, with outcomes comparable to those of three-port myomectomy. These results suggest the potential for minimally invasive management of symptomatic uterine myoma, without the use of a power morcellator.     

The Feasibility of Extracorporeal Membrane Oxygenation in the Variant Airway Problems

Introduction: Extracorporeal membrane oxygenation (ECMO) is widely used to treat respiratory distress during cardiac or respiratory arrest; moreover, its use is being extended to a wide variety of clinical fields. In this study we assess the utility of ECMO in the management of airway obstruction.Patients and Methods: 15 patients underwent ECMO for airway obstruction. We retrospectively analyzed and evaluated the feasibility of ECMO in the treatment of airway problems.Results: Seven patients received ECMO to facilitate respiration and promote stability during trachea surgery. In six cases ECMO ceased immediately following the operation; in the remaining case ECMO cessation was delayed due to post-operative ARDS. In three cases emergency ECMO was used in response to respiratory arrest; two patients died. In five cases ECMO was emergently inserted to prevent death, following airway blockade by massive hemoptysis. One patient was not discharged from the intensive care unit. Another patient was transferred to a general ward but died from other causes.Conclusion: ECMO is useful during anesthesia in patients at high risk of airway blockade, for example due to endobronchial bleeding, and during complex thoracic surgery. ECMO confers a safer environment during airway surgery, and its complication rate is acceptable.     

分化抑制蛋白-1在套细胞淋巴瘤中的表达及预后关系

目的 探讨分化抑制蛋白-1(Inhibitor of differentiation-1,Id1)在套细胞淋巴瘤患者中的表达情况及其临床意义.方法 采用SP免疫组化法检测并分析45例套细胞淋巴瘤和20例淋巴结反应性增生淋巴结组织中Id1表达水平,以及Id1的表达与其临床预后指标的关系.结果 Id1在套细胞淋巴瘤和淋巴结反应性增生淋巴结组织中阴性、弱阳性和强阳性的表达率分别是15.56％,31.11％,53.33％和65.00％,25.00％,10.00％(P＜0.05).套细胞淋巴瘤组织中Id1阳性表达与患者LDH、临床分期、结外累及部位和近期疗效有关(P均＜0.05);年龄、性别、WBC计数、PLT计数、HB含量无相关(P均＞0.05).经过Log-rank检验显示,Id1低表达组和Id1高表达组的1年生存率分别是90.48％和79.17％ (P ＞0.05);3年生存率分别是66.67％和33.33％(P＜0.05);5年生存率分别是47.62％和16.67％ (P ＜0.05),Kaplan-Meier生存分析显示Id1高表达组3年、5年生存率低于Id1低表达组(P＜0.05).结论 Id1在套细胞淋巴瘤淋巴结中呈高表达,并与部分预后相关指标有关,Id1高表达组表现出低生存率,Id1可能成为套细胞淋巴瘤预后不良的评价指标.     

Struma ovarii: management and follow-up of a rare ovarian tumour

INTRODUCTION

Struma ovarii represents about 1.0% of all ovarian tumours. While management involves surgery, there is a paucity of data regarding the extent and approach of surgery, and postoperative management. This study aimed to delineate the management of struma ovarii, its associated complications, and postoperative follow-up and investigations.

METHODS

We retrospectively reviewed cases of benign struma ovarii treated at KK Women’s and Children’s Hospital, Singapore, between January 2000 and May 2011.

RESULTS

A total of 68 patients underwent surgical removal of ovarian cyst or mass (24 cystectomy, 20 salpingo-oopherectomy and 24 total hysterectomy and bilateral salpingo-oopherectomy). Of the 68 surgeries, 39 (57.4%) included intraoperative frozen section sampling or procedures for staging of ovarian malignancy. The majority (73.5%) of surgeries were laparotomies. Histology revealed benign struma ovarii in all (98.5%) but one patient. Only 7 (10.3%) patients had postoperative complications – 3 wound-related, 2 thyroid-related, 1 incisional hernia and 1 nonspecific. The mean length of hospital stay was 4.2 days. During follow-up, 45 (66.2%) patients required no additional investigations. The most common investigation done was ultrasonography (n = 18, 26.5%). While no recurrences were diagnosed histologically, two patients were subsequently found to have complex/dermoid ovarian cysts on the ipsilateral side of the previous struma ovarii on ultrasonography.

CONCLUSION

Simple surgery is recommended for patients with struma ovarii, especially if they have fertility potential. Laparoscopic surgery is the recommended approach due to its shorter recovery time and lower morbidity. Most patients do not require extended periods of follow-up or postoperative investigations.