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Nathan JH, Goldberg RP, Chill HH, Scherr D, Shveiky D. Novel Incision-free Device for Transvaginal Apical Pelvic Organ Prolapse Repair. J Minim Invasive Gynecol 2019; 27:959-965. [PMID: 31301468 DOI: 10.1016/j.jmig.2019.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/03/2019] [Accepted: 07/06/2019] [Indexed: 10/26/2022]
Abstract
STUDY OBJECTIVE The purpose of this study was to present the feasibility and potential clinical advantages of Apyx (Escala Medical, Israel), a minimally invasive incision-free anchoring device, for apical prolapse repair. DESIGN An experimental prospective animal and cadaver study. SETTING Animal facility and a cadaver laboratory of a tertiary care teaching hospital. PATIENTS Included in this study were 7 ovine models, 2 porcine specimens, and 3 fresh unembalmed female human cadavers. INTERVENTIONS The Apyx device for sacrospinous ligament (SSL) suspension was tested on ovine and porcine models. The pullout force needed to detach the Apyx anchor from the SSL was measured. Safety, reliability, and feasibility of this new incision-free procedure were also tested on an ovine model and human cadavers. The precision in deployment of the Apyx device to the SSL was tested via palpation by the surgeon, tissue dissection, and x-ray imaging. The efficacy was tested both by pullout forces and histologic analysis of the vaginal attachment to the SSL. MEASUREMENTS AND MAIN RESULTS Forty-two anchors were inserted into the SSLs on ovine and porcine models and on cadaver SSLs. No abnormalities or malfunctions were noted in the functional performance of the anchors or the retrieval device. Mean pullout force for the ovine animal model was 38.64 ± 2.80 N. Pullout force in the porcine model was found to be in correlation with the values observed in the ovine model. None of the measured forces was below 20 N. Accuracy and safety tests showed good consistency when deploying the Apyx device to the SSL with no damage to surrounding organs in the ovine or the human cadaver model. Histology demonstrated biologic adhesion characterized by a gross assessment of a newly formed, firm fibrotic tissue 12 weeks after anchor deployment. CONCLUSION The Apyx anchoring system, a novel incision-free minimally invasive prolapse repair device, demonstrated an anatomically feasible, easy-to-use procedure for suspending the vaginal apex to the SSLs. Its clinical safety, efficacy, and impact on patient symptoms and quality of life should be further studied.
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Shveiky D, Iglesia CB, Sarkar Das S, Ben Menachem-Zidon O, Chill HH, Ji H, Sandberg K. Age-associated impairments in tissue strength and immune response in a rat vaginal injury model. Int Urogynecol J 2019; 31:1435-1441. [PMID: 31243497 DOI: 10.1007/s00192-019-04008-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/30/2019] [Indexed: 01/24/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Surgical repair of pelvic organ prolapse often includes native tissue repair during which the patient's own vaginal connective tissue is used to achieve pelvic support. This method, based on plication and suspension often yields suboptimal anatomical outcomes, possibly due to inadequate healing of the vaginal connective tissue. We hypothesized that age might have a negative effect on the time course and tissue biomechanics of vaginal wound healing in a rat model. METHODS Fifty young (12 weeks) and old (12 months) female 344BN Fischer rats were subjected to a posterior midline vaginal incision. The time course of repair was determined by measuring the size of the wound on days 1, 3, 7, and 14 post-injury. These findings correlated with the immune response to injury using a marker of impaired wound healing, the inflammatory cytokine macrophage migration inhibitory factor in the vaginal muscularis. Biomechanical properties of the healed vaginal tissue were tested 30 days post-injury. RESULTS Wound healing was assessed on days 1, 3, 7, and 14 post-injury. On day 3 post-injury, the wounds in the young animals had all closed whereas the wounds in the old animals remained open. Furthermore, on day 7, the wound gap was still filled with granulation tissue in the old rats, whereas for the young rats, the wound area was almost indistinguishable from the non-injured area. Macrophage migration inhibitory factor was highly expressed in the vaginal epithelium and in the vaginal muscularis after injury. When compared with young animals, macrophage migration inhibitory factor levels of old rats began to rise more than 2 days later and the increased tissue expression persisted for 7 days longer. The breakpoint force of the healed vagina of old rats was almost 4-fold weaker than in young rats. At 30 days post-injury, the healed vagina in old rats regained less of the original (healthy) force at breakpoint than the young rats. CONCLUSIONS In this rat model, age impaired vaginal wound healing, which was reflected in the altered inflammatory response to injury and reduced tissue strength.
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Antosh DD, Yurteri-Kaplan LA, Shveiky D, Liu M, Heisler C, Hegde A, Grimes CL. FPMRS challenges on behalf of the Collaborative Research in Pelvic Surgery Consortium (CoRPS): managing complicated cases : Series 3: Challenging recurrent prolapse in a medically complicated patient. Int Urogynecol J 2019; 30:1039-1043. [PMID: 31037413 DOI: 10.1007/s00192-019-03955-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/11/2019] [Indexed: 11/26/2022]
Abstract
This case presents the work-up and management of a spina bifida patient with recurrent prolapse. Four international experts also provide their evaluation of and approach to this complex case. According to the literature, little is known regarding the approach to the management of this specific patient population.
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Levin G, Rottenstreich A, Shveiky D, Yanai N, Porat S. The Torsed Minimally Affected Adnexa. J Minim Invasive Gynecol 2019; 26:585-586. [DOI: 10.1016/j.jmig.2018.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 07/31/2018] [Accepted: 08/02/2018] [Indexed: 10/28/2022]
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Shveiky D, Patchen L, Chill HH, Pehlivanova M, Landy HJ. Prevalence and Location of Obstetric Lacerations in Adolescent Mothers. J Pediatr Adolesc Gynecol 2019; 32:135-138. [PMID: 30447292 DOI: 10.1016/j.jpag.2018.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 08/27/2018] [Accepted: 11/09/2018] [Indexed: 10/27/2022]
Abstract
STUDY OBJECTIVE The objective of this study was to describe prevalence and location of obstetric lacerations in adolescents. DESIGN Retrospective cohort study. SETTING We performed an analysis of the Consortium on Safe Labor database including tertiary care university-affiliated urban hospitals. PARTICIPANTS All primiparous women who delivered vaginally were included. INTERVENTIONS Vaginal and perineal lacerations were compared between age groups 15 or younger, 16-21, 22-34, 35-39, and older than 40 years. MAIN OUTCOME MEASURES Outcome measures included vaginal, perineal, labial, and periurethral lacerations. χ2 and Fisher exact tests were used as appropriate, with P < .05 considered significant. RESULTS A total of 9777 patients were included in the analysis. Young adolescents and adolescents had significantly higher rates of labial and periurethral lacerations compared with individuals aged 22-34 years. The prevalence of third- and fourth-degree perineal tears increased with age. CONCLUSION Adolescent primiparous women are less likely to have severe perineal obstetric tears, but have higher rates of labial and periurethral tears.
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Levin G, Rottenstreich A, Benshushan A, Dior U, Shveiky D, Shushan A, Elchalal U. The role of supracervical hysterectomy in reducing blood products requirement in the management of placenta accreta: a case-control study. J Matern Fetal Neonatal Med 2019; 33:2522-2526. [PMID: 30486702 DOI: 10.1080/14767058.2018.1554049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: While surgical management is the treatment of choice for abnormally invasive placenta, the role of supracervical hysterectomy in this setting is not well established. We aimed to compare supracervical versus total cesarean hysterectomy as a surgical option for abnormally invasive placenta.Methods: We carried out an 8-year retrospective case-control study. Six cases of a patient treated by total hysterectomy were matched and compared to 30 controls treated by supracervical hysterectomy. Matching of cases with controls was based on coexisting placenta previa, a number of previous cesarean sections, and age, with five controls per case. Cases and controls were comparable in placental invasion topography. We compared the operative approach in all histologically identified cases of abnormally invasive placenta.Results: Overall, 36 women with histologically proven abnormally invasive placenta were identified. Composite blood products morbidity was higher among total hysterectomy patients (p = .02). Freshly frozen plasma utilization was greater among total hysterectomy patients (p = .01). Median operative time (142 ± 48 versus 136 ± 58 minutes) and hospitalization time (8.9 ± 3.1 versus 7.3 ± 1.5 days) were comparable between those who underwent supracervical versus total hysterectomy (p > .05). No case of maternal or neonatal death was encountered.Conclusion: The favorable maternal and perinatal outcomes observed in our study, suggest that supracervical hysterectomy should be considered as the first-line approach in cases of abnormally invasive placenta managed operatively.
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Shlain I, Lavy Y, Arbel R, Shveiky D, Woloski Wruble A, Liebergall-Wischnitzer M. Urinary incontinence type, symptoms, and quality of life: A comparison between grand multipara and non-grand multipara women aged ≥50 years. Jpn J Nurs Sci 2018; 15:309-317. [DOI: 10.1111/jjns.12200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 08/31/2017] [Accepted: 10/01/2017] [Indexed: 12/22/2022]
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Chill HH, Malyanker N, Karavani G, Haj-Yahya R, Herzberg S, Bahar R, Shveiky D, Dior UP. Association between uterine position and transvaginal misoprostol treatment for early pregnancy failure. J Obstet Gynaecol Res 2017; 44:248-252. [PMID: 29094502 DOI: 10.1111/jog.13512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 08/15/2017] [Indexed: 11/27/2022]
Abstract
AIM We aimed to determine the importance of uterine position as a predicting factor of success rate in medically treated early pregnancy failure (EPF). METHODS We carried out a retrospective cohort study at the Obstetrics and Gynecology Department of a tertiary medical center between January 2011 and June 2012. We included women diagnosed with EPF, which we defined as women diagnosed with missed abortion up to 13 gestational weeks. Patients were treated with one or two doses of 800 μg of misoprostol vaginally in accordance with the department's protocol. Demographic, clinical, and treatment success data were collected from patient electronic records. RESULTS A total of 255 women were included in our study. The success rate after treatment with misoprostol for the anterior uterine group was 78.7% as compared to the non-anterior uterine group, which achieved a success rate of 88.1%. This difference was not statistically significant (P = 0.180). In a multivariate analysis comparing patients for whom treatment with misoprostol was successful as opposed to patients for whom treatment failed, only embryonic sac size showed a statistically significant difference, measuring shorter in the success group. CONCLUSION Uterine position has no effect on success rate of misoprostol treatment for EPF.
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Shveiky D, Hants Y, Helman S. Drug Delivery in Obstetrics and Gynecology. Drug Deliv 2017. [DOI: 10.1201/9781315117584-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Liebergall-Wischnitzer M, Braverman N, Shveiky D, Noble A. Obstetric anal sphincter injuries and the role of the midwife. THE PRACTISING MIDWIFE 2017; 20:28-30. [PMID: 30549959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Obstetric anal sphincter injuries (OASIS) can have a very negative impact on women's health and quality of life. Literature exists concerning the role of the surgeon and physiotherapist after OASIS, but there is a dearth of literature pertaining to the role of the midwife in the management of women following an obstetric anal sphincter injury. This article examines the midwife's role and describes a new service instituted at Hadassah-Hebrew University medical centre, Jerusalem, utilised in the early postpartum period while the woman is still in hospital, entitled Special Services for Perineal Trauma.
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Haj YR, Asfour A, Levin G, Lesser S, Shveiky D. Short-Term Anatomical Outcome and Patient Satisfaction After Laparoscopic Uterine-Preserving Uterosacral Ligament Suspension for Anterior and Apical Prolapse. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Friedman N, Shushan A, Rojansky N, Shveiky D, Levitzki R, Chaouat M, Ben-Bassat H. Targeting leiomyomas with all-trans-retinoic acid at phosphoinositide 3-kinase pathway suppression: Effective roles of β-catenin and of signaling interactions. J Obstet Gynaecol Res 2016; 42:1343-1353. [PMID: 27354299 DOI: 10.1111/jog.13068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 05/01/2016] [Indexed: 12/31/2022]
Abstract
AIM Leiomyomas, monoclonal tumors developed by the transformation of myometrium somatic stem cells, are a major health concern that can severely impair quality of life. Pathological alterations of signaling pathways have been recognized as a key feature in a variety of human diseases. Our objective was to analyze treatment with all-trans-retinoic acid (ATRA) by suppression of the phosphoinositide 3-kinase (PI3K) pathway on growth, signaling pattern and interactions among PI3K/B-cell lymphoma 2 (Bcl2)/retinol leiomyoma proteins. METHODS Cultures of paired myometrium and leiomyoma cells from premenopausal women undergoing hysterectomy were collected. Western blot and analysis of variance were used for analysis. RESULTS Significant differences were detected between treatment with ATRA alone or with LY294002 (a PI3K growth suppressor) in response to treatment and among cell samples and cell numbers. Leiomyoma cells were less affected. Immunochemical analysis of signaling patterns demonstrated that treatments affected most of the examined protein levels differently. Significant differences between the cell type responses to treatment in pyruvate phosphate dikinase 1 (pPDK1), Bad and pβ-catenin levels were identified. The pβ-catenin level showed highly significant interaction between response to treatment and cell type. CONCLUSIONS ATRA treatment on PI3K pathway suppression significantly affected growth, signaling pattern and interactions among PI3K/Bcl2/retinol proteins involved in the growth, survival and apoptosis of leiomyomas. Interpretation of our results suggests that increasing knowledge of the role of signaling interplay in the pathogenesis of leiomyomas may present an opportunity to use specific signal transduction inhibitors for treating and preventing this disorder.
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Yurteri-Kaplan LA, Antosh DD, Iglesia CB, Sokol AI, Shveiky D, Gutman RE. Significance of cystoscopic bladder trabeculations in women undergoing midurethral sling. THE CANADIAN JOURNAL OF UROLOGY 2015; 22:7890-7895. [PMID: 26267027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION To determine the significance of bladder trabeculations seen on preoperative cystoscopy prior to midurethral sling surgery with respect to lower urinary tract symptoms and sling outcomes. MATERIALS AND METHODS This retrospective study included women with preoperative cystoscopy who underwent midurethral slings for urinary incontinence from 2006-2009. Cystoscopic findings of bladder trabeculations, as well as pre and postoperative urinary symptoms were recorded. Patients with and without bladder trabeculations were compared with respect to baseline characteristics, lower urinary tract symptoms, and sling outcomes. RESULTS Of the 241 women included in the study, 14.9% had trabeculations on preoperative cystoscopy. At baseline, women with trabeculations were more likely to be older (64.8 years versus 57.8 years, p < 0.01), and have lower mean maximum cystometric capacity (341 mL +/- 136 versus 436 mL +/- 148, p < 0.01), compared to those without trabeculations. More women with trabeculations had mixed incontinence (p < 0.01) and less pure stress incontinence (p < 0.01) preoperatively. There was no difference between women with and without trabeculations with respect to pre and postoperative symptoms of urgency, frequency, and nocturia. Women with preoperative trabeculations were more likely to have preoperative treatment with anticholinergics (p = 0.02) and had a three times higher risk of postoperative sling failure (HR 2.95 [CI 1.11-7.85], p = 0.03). CONCLUSIONS Preoperative cystoscopic bladder trabeculations are associated with significantly higher rate of midurethral sling failure. Trabeculations were not associated with pre or postoperative lower urinary tract symptoms.
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Parkes IL, Shveiky D. Sacrocolpopexy for Treatment of Vaginal Apical Prolapse: Evidence-Based Surgery. J Minim Invasive Gynecol 2014; 21:546-57. [DOI: 10.1016/j.jmig.2014.01.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 12/29/2013] [Accepted: 01/06/2014] [Indexed: 11/16/2022]
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Kudish BI, Shveiky D, Gutman RE, Jacoby V, Sokol AI, Rodabough R, Howard BV, Blanchette P, Iglesia CB. Hysterectomy and urinary incontinence in postmenopausal women. Int Urogynecol J 2014; 25:1523-31. [DOI: 10.1007/s00192-014-2422-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 04/27/2014] [Indexed: 10/25/2022]
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Feghali MN, Khoury JC, Timofeev J, Shveiky D, Driggers RW, Miodovnik M. Asymmetric large for gestational age newborns in pregnancies complicated by diabetes mellitus: is maternal obesity a culprit? J Matern Fetal Neonatal Med 2012; 25:32-5. [PMID: 21957900 DOI: 10.3109/14767058.2012.626925] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Evaluate the association between body mass index (BMI) and the delivery of an asymmetrically large for gestational age (A-LGA) newborn in women with diabetes. METHODS Retrospective analysis of 306 pregnancies complicated by Type 1 and 55 by Type 2 diabetes. RESULTS The prevalence of Type 1 and Type 2 diabetics delivering large for gestational age (LGA) infants was 42% and 49%, respectively. Of these 49% and 55% were A-LGA, respectively. Pre-pregnancy BMI was not associated with increased odds of delivering an A-LGA newborn in women with Type 1 or 2 diabetes. However, in Type 1 diabetics, each one-pound increase in maternal weight during pregnancy resulted in 4% increased odds of delivering an A-LGA newborn. For Type 2 diabetics, the odds of delivering an A-LGA infant was decreased by 10% for each 0.1 unit/kg increase in insulin dose. CONCLUSION Although there is a known association between obesity and LGA in women with diabetes, we found that overweight and obese women with Type 1 or Type 2 diabetes do not have increased odds of delivering an A-LGA newborn. However, insulin dose in Type 2 diabetes and maternal weight gain in Type 1 diabetes were significantly associated with the odds of delivering an A-LGA neonate.
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Sokol AI, Iglesia CB, Kudish BI, Gutman RE, Shveiky D, Bercik R, Sokol ER. One-year objective and functional outcomes of a randomized clinical trial of vaginal mesh for prolapse. Am J Obstet Gynecol 2012; 206:86.e1-9. [PMID: 21974992 DOI: 10.1016/j.ajog.2011.08.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 07/06/2011] [Accepted: 08/04/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to show 12-month outcomes of a randomized trial that compared vaginal prolapse repair with and without mesh. STUDY DESIGN Women with stage ≥2 prolapse were assigned randomly to vaginal repair with or without mesh. The primary outcome was prolapse stage ≤1 at 12 months. Secondary outcomes included quality of life and complications. RESULTS All 65 evaluable participants were followed for 12 months after trial stoppage for mesh exposures. Thirty-two women had mesh repair; 33 women had traditional repair. At 12 months, both groups had improvement of pelvic organ prolapse-quantification test points to similar recurrence rates. The quality of life improved and did not differ between groups: 96.2% mesh vs 90.9% no-mesh subjects reported a cure of bulge symptoms; 15.6% had mesh exposures, and reoperation rates were higher with mesh. CONCLUSION Objective and subjective improvement is seen after vaginal prolapse repair with or without mesh. However, mesh resulted in a higher reoperation rate and did not improve 1-year cure.
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Feghali M, Khoury JC, Shveiky D, Miodovnik M. Association of vaginal delivery efforts with retinal disease in women with type I diabetes. J Matern Fetal Neonatal Med 2011; 25:27-31. [DOI: 10.3109/14767058.2012.626924] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mejia-Gomez J, Kogan L, Mintz Y, Shveiky D, Benshushan A. [Robotic-assisted gynecological surgeries: a series of the first 14 cases]. HAREFUAH 2011; 150:709-751. [PMID: 22026054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE To present the outcomes of the first 14 robotic-assisted gynecological surgeries from Israel. METHOD A total of 14 patients, who underwent robotic-assisted gynecological surgeries including total and subtotal hysterectomies with and without bilateral salpingo-oopherectomy, as well as one unilateral salpingo-oopherectomy and omental biopsy, were included in this study. Patients' demographics, surgical procedures, operative and postoperative complications, hospital stay, conversion to laparotomy, time data including all operative times and pathological specimen's weight were recorded. All the surgeries were performed by the same surgeon. RESULTS All surgeries were completed robotically with no conversion to taparotomy. The mean and range of operating time were 156.6 and 108-218 minutes, respectively. The mean docking time was 9.5 min. [range 4-20 minutes]. The mean anesthesia time was 214.5 min. (range 160-280 min.). The mean specimen's weight was 138.8 grams (range 55-240 grams). The mean and range of the hospital stay were 2.8 days (range 1-7.5 days). Only one complication occurred: one partial ureteral stenosis which was treated by insertion of ureteral stent. CONCLUSION Robotic-assisted gynecological surgeries are feasible and safe for women with benign and precancerous pathologies, although there are limitations that may be overcome with further experience.
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Shveiky D, Sokol AI, Gutman RE, Kudish BI, Iglesia CB. Vaginal mesh colpopexy for the treatment of concomitant full thickness rectal and pelvic organ prolapse: a case series. Eur J Obstet Gynecol Reprod Biol 2011; 157:113-5. [PMID: 21439707 DOI: 10.1016/j.ejogrb.2011.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 01/18/2011] [Accepted: 02/23/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To present our case series of concomitant rectal and pelvic organ prolapse (POP) treated with vaginal colpopexy with synthetic mesh. STUDY DESIGN Charts of patients with full thickness rectal prolapse and POP were reviewed for presenting symptoms, physical examination with POP-Q including rectal prolapse evaluation, and perioperative complications and outcomes. RESULTS Four patients aged 63-78 were identified with full thickness rectal prolapse and POP. All of them had symptoms related to both conditions. Rectal prolapse protrusion ranged from 2 cm to 3 cm outside the anus. All patients had vaginal mesh colpopexy; two of them with anterior and posterior vaginal mesh and 2 with posterior mesh only. At a follow-up of 6-44 months, all patients had resolution of both POP and rectal prolapse signs and symptoms. CONCLUSION Vaginal colpopexy with mesh may be a unique treatment to address both POP and full thickness rectal prolapse in selected patients. Further research is needed to determine the safety and efficacy of this method.
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Spies J, Shveiky D, Iglesia C, Lee J, Jones M, Peterson J, Huang C. Abstract No. 168: The impact of uterine fibroid embolization (UFE) on lower urinary tract symptoms. J Vasc Interv Radiol 2011. [DOI: 10.1016/j.jvir.2011.01.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Naaman Y, Shveiky D, Ben-Shachar I, Shushan A, Mejia-Gomez J, Benshushan A. Uterine sarcoma: prognostic factors and treatment evaluation. THE ISRAEL MEDICAL ASSOCIATION JOURNAL : IMAJ 2011; 13:76-79. [PMID: 21443030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Uterine sarcoma constitutes a highly malignant group of uterine tumors. It accounts for 2-6% of uterine malignancies and its incidence is 1.7 in 100,000 women. The three most common variants of uterine sarcoma are endometrial stromal sarcoma, leiomyosarcoma and carcinosarcoma. Based on relatively small case series, the literature provides little information on the risk factors, the natural course of the disease and the preferred treatment. OBJECTIVES To evaluate uterine sarcoma patients treated in a tertiary referral center in Israel over a 20 year period (1980-2005). METHODS We conducted a retrospective review of the charts of 40 uterine sarcoma patients, including their tumor characteristics, stage at diagnosis, treatment modalities, follow-up and survival. RESULTS The patients' mean age was 53 years (range 32-76); 30% of the patients had carcinosarcoma, 55% had leiomyosarcoma and 15% had ESS. Half of the patients presented with stage I disease, 23% stage II, 10% stage III and 15% stage IV. Thirty-nine patients were treated with surgery. Adjuvant radiotherapy was administered to 39% of the patients, adjuvant chemotherapy to 21% and combined radiotherapy and chemotherapy to 9%. The mean follow-up period was 44 months, at which time disease had recurred in 44% of the patients. The disease stage was correlated with the 5-year survival rate, which was 73.1% for stages I-II and 22.2% for stages III- IV. CONCLUSIONS In accordance with other larger studies our data show that the only prognostic factor that was significantly correlated with prognosis was the stage of the disease at diagnosis. Despite advances in diagnosis and treatment, survival has not improved over the last 25 years.
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Liebergall-Wischnitzer M, Paltiel O, Hochner-Celnikier D, Lavy Y, Shveiky D, Manor O. Concordance Between One-hour Pad Test and Subjective Assessment of Stress Incontinence. Urology 2010; 76:1364-8. [DOI: 10.1016/j.urology.2010.05.048] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 05/27/2010] [Accepted: 05/27/2010] [Indexed: 10/19/2022]
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Marshall D, George S, McDonald M, Shveiky D, Park A, Gutman R, Sokol A. Short-Term Outcomes of Robotic vs. Conventional Laparoscopic Sacrocolpopexy. J Minim Invasive Gynecol 2010. [DOI: 10.1016/j.jmig.2010.08.387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Sokol A, Shveiky D, Nghiem H, Gutman R, Paraiso M, Iglesia C. Steps To Improve Efficiency of Robotic Sacral Colpopexy. J Minim Invasive Gynecol 2010. [DOI: 10.1016/j.jmig.2010.08.652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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