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Okam PC, Ikechebelu JI, Eleje GU, Albert IC, Okpala BC, Okam CF, Nwajiaku LA, Joe-Ikechebelu NN, Ezeigwe CO, Chigbo CG, Okafor CG. Efficacy and safety of diclofenac suppository for postoperative pain relief after diagnostic hystero-laparoscopy and dye test: A double-blind, placebo-controlled, randomized trial. Eur J Obstet Gynecol Reprod Biol X 2024; 23:100326. [PMID: 39104867 PMCID: PMC11298888 DOI: 10.1016/j.eurox.2024.100326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 04/22/2024] [Accepted: 07/10/2024] [Indexed: 08/07/2024] Open
Abstract
Objective To determine the efficacy and safety of rectal diclofenac for relieving postoperative pain following diagnostic hystero-laparoscopy and dye test (dHLD). Methods A prospective, double-blind, placebo-controlled, randomized trial was conducted among women who underwent dHLD to evaluate fertility. The women received either rectal diclofenac with intramuscular pentazocine or intramuscular pentazocine with rectal placebo for postoperative analgesia. The median pain scores at different time points were assessed as the primary outcome measures using the Numerical Rating Scale for pain. The secondary outcome measures were analgesic consumption, time at which first analgesic was requested, satisfaction with pain relief and any adverse events. Results In total, 108 participants were analysed (54 in each group, 1:1 ratio). The median score for postoperative pain was lower for the diclofenac group compared with the placebo group at 4 h (52.53 vs 56.47; p = 0.507), 6 h (50.48 vs 58.52; p = 0.174), 8 h (51.42 vs 57.65; p = 0.296), 10 h (51.35 vs 57.65; p = 0.285) and 12 h (52.45 vs 56.55; p = 0.485) post surgery, although the difference was not significant (p > 0.05). Seventeen participants required rescue analgesia with 30 mg of pentazocine: 11 at 4 h post surgery [5 (62.5 %) vs 6 (66.7 %)], three at 6 h post surgery [2 (25.0 %) vs 1 (11.1 %)], two at 8 h post surgery [1 (12.5 %) vs 1 (11.1 %)], and one at 12 h post surgery [0 vs 1 (11.1 %)] for the diclofenac and placebo groups respectively (p = 0.713). There were no significant differences in postoperative adverse effect profiles, overall patient satisfaction, and need for rescue analgesia between the two groups (p > 0.05). Conclusions Postoperative use of rectal diclofenac and pentazocine is safe, but did not significantly improve pain scores, patient satisfaction and need for rescue analgesia following dHLD, compared with patients who received pentazocine and placebo. While a multi-modal approach to pain relief following dHLD does not appear to be significantly beneficial, a multi-centre study is needed to confirm or refute these findings.
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Affiliation(s)
- Princeston C. Okam
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
- Life Specialist Hospital Nnewi and Life International Hospital, Awka, Anambra State, Nigeria
- Department of Pharmacology and Therapeutics, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Joseph I. Ikechebelu
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
- Life Specialist Hospital Nnewi and Life International Hospital, Awka, Anambra State, Nigeria
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - George U. Eleje
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Innocent C. Albert
- Life Specialist Hospital Nnewi and Life International Hospital, Awka, Anambra State, Nigeria
| | - Boniface C. Okpala
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
- Life Specialist Hospital Nnewi and Life International Hospital, Awka, Anambra State, Nigeria
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Chioma F. Okam
- Department of Paediatrics, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Louis A. Nwajiaku
- Life Specialist Hospital Nnewi and Life International Hospital, Awka, Anambra State, Nigeria
| | - Ngozi N. Joe-Ikechebelu
- Life Specialist Hospital Nnewi and Life International Hospital, Awka, Anambra State, Nigeria
- Department of Community Medicine and Primary Heath Care, Faculty of Medicine, Chukwuemeka Odumegwu University, Awka, Anambra State, Nigeria
| | - Chijioke O. Ezeigwe
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Chisom G. Chigbo
- Institute of Public Health, University of Port-Harcourt, Rivers State, Nigeria
| | - Chigozie G. Okafor
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
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Tetteh E, Wang T, Kim JY, Smith T, Norasi H, Van Straaten MG, Lal G, Chrouser KL, Shao JM, Hallbeck MS. Optimizing ergonomics during open, laparoscopic, and robotic-assisted surgery: A review of surgical ergonomics literature and development of educational illustrations. Am J Surg 2024; 235:115551. [PMID: 37981518 DOI: 10.1016/j.amjsurg.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/01/2023] [Accepted: 11/03/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND The surgical profession is plagued with a high prevalence of work-related musculoskeletal disorders. While numerous interventions have been tested over the years, surgical ergonomics education is still uncommon. METHODS The available literature on surgical ergonomics was reviewed, and with input from surgeons, recommendations from the review were used to create pictorial reminders for open, laparoscopic, and robot-assisted surgical modalities. These simple pictorial ergonomic recommendations were then assessed for practicality by residents and surgeons. RESULTS A review of the current literature on surgical ergonomics covered evidence-based ergonomic recommendations on equipment during open and laparoscopic surgery, as well as proper adjustment of the surgical robot for robot-assisted surgeries. Ergonomic operative postures for the three modalities were examined, illustrated, and assessed. CONCLUSIONS The resulting illustrations of ergonomic guidelines across surgical modalities may be employed in developing ergonomic education materials and improving the identification and mitigation of ergonomic risks in the operating room.
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Affiliation(s)
- Emmanuel Tetteh
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Tianke Wang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Joseph Y Kim
- Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Tianqi Smith
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Hamid Norasi
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | | | - Geeta Lal
- Department of Surgery, University of Iowa, Iowa City, USA
| | | | - Jenny M Shao
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - M Susan Hallbeck
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA; Department of Surgery, Mayo Clinic, Rochester, MN, USA.
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Mardon AK, Chalmers KJ, Heathcote LC, Curtis LA, Freedman L, Malani R, Parker R, Neumann PB, Moseley GL, Leake HB. "I wish I knew then what I know now" - pain science education concepts important for female persistent pelvic pain: a reflexive thematic analysis. Pain 2024; 165:1990-2001. [PMID: 38452219 DOI: 10.1097/j.pain.0000000000003205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/18/2024] [Indexed: 03/09/2024]
Abstract
ABSTRACT Pain science education (PSE) provides people with an understanding of "how pain works" grounded in the biopsychosocial model of pain; it has been demonstrated to improve outcomes in musculoskeletal pain conditions. Preliminary evidence suggests PSE may be effective for female individuals with persistent pelvic pain, but how the content of PSE needs to be modified for this group remains to be determined. A reflexive thematic analysis of qualitative data was performed to identify PSE concepts that female individuals with persistent pelvic pain consider important and why. Twenty individual, semistructured interviews were conducted with adult females who had engaged with PSE and had self-identified as having "improved" pelvic pain. Most participants had been diagnosed with endometriosis (n = 16). Four themes were generated capturing PSE concepts considered important by female individuals with "improved" pelvic pain: (1) "A sensitised nervous system leads to overprotective pain" validated their pelvic pain as being real; (2) "Pain does not have to mean the body is damaged (although sometimes it does)" provided reassurance that pelvic pain does not mean their condition is worsening; (3) "How I think, feel, and 'see' my pain can make it worse" enabled participants to find optimal ways to manage their pain; and (4) "I can change my pain… slowly" provided hope that pelvic pain can improve and empowered them to pursue pain improvement as a viable goal. This study generated 4 PSE learning concepts that were important to female individuals with improved pelvic pain and may be incorporated into PSE curricula for female individuals with pelvic pain.
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Affiliation(s)
- Amelia K Mardon
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
| | - K Jane Chalmers
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
| | - Lauren C Heathcote
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
- Health Psychology Section, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Lee-Anne Curtis
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia
| | | | - Rinkle Malani
- MGM School of Physiotherapy, Aurangabad, A Constituent Unit of MGMIHS, Maharashtra, India
| | - Romy Parker
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Patricia B Neumann
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia
| | - G Lorimer Moseley
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
| | - Hayley B Leake
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
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Chen M, Huang S, Song C, Chen X, Chen J, Bu G, Zhang H, Huang W, Fu J, Xu E. Value of painless transvaginal four-dimensional hysterosalpingo contrast sonography in reducing venous intravasation: a comparative study. J Ultrasound 2024; 27:511-517. [PMID: 38219240 PMCID: PMC11333643 DOI: 10.1007/s40477-023-00847-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/11/2023] [Indexed: 01/16/2024] Open
Abstract
OBJECTIVE To investigate the value of painless transvaginal four-dimensional hysterosalpingo contrast sonography (TV 4-D HyCoSy) in reducing venous intravasation and its influencing factors through a retrospective comparative study on conventional TV 4-D HyCoSy. MATERIALS AND METHODS A total of 451 patients were enrolled in this study from Jan. 2019 to Oct. 2021. There were 249 patients in the painless TV 4-D HyCoSy group and 202 patients in the conventional TV 4-D HyCoSy group. The incidence of venous intravasation and its related influencing factors were analyzed and compared between these two groups. The difficulty of image evaluation for the diagnosis was also compared. RESULTS There was no significant difference in the baseline characteristics between the painless group and the conventional group (p > 0.05). Compared with the conventional group, the painless group had a lower incidence of venous intravasation (16.9 vs. 24.8%; p = 0.039). Painless TV 4-D HyCoSy was more effective in reducing venous intravasation in patients with primary infertility (p = 0.032) without a history of pelvic surgery (p = 0.008) or ectopic pregnancy (p = 0.018). Logistic regression analysis demonstrated that painless TV 4-D HyCoSy and endometrial thickness > 5 mm were protective factors for venous intravasation. Moreover, the diagnostic procedure was easier in the painless group than in the conventional group (p = 0.002). CONCLUSIONS Painless TV 4D-HyCoSy may be an effective mode in reducing the incidence of venous intravasation and improving the diagnosis of patency of fallopian tubes.
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Affiliation(s)
- Mengjie Chen
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518033, China
| | - Shiying Huang
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518033, China
| | - Changlin Song
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518033, China
| | - Xiaomin Chen
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518033, China
| | - Jiajia Chen
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518033, China
| | - Guojuan Bu
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518033, China
| | - Huiying Zhang
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518033, China
| | - Wanling Huang
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518033, China
| | - Juan Fu
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518033, China.
| | - Erjiao Xu
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518033, China.
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Tasset J, Rodriguez M. "Permanent" Contraception - Reexamining Modern Tubal Sterilization Effectiveness. NEJM EVIDENCE 2024; 3:EVIDe2400263. [PMID: 39189860 DOI: 10.1056/evide2400263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Affiliation(s)
- Julia Tasset
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
| | - Maria Rodriguez
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
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Pecorella G, De Rosa F, Licchelli M, Panese G, Carugno JT, Morciano A, Tinelli A. Postoperative cognitive disorders and delirium in gynecologic surgery: Which surgery and anesthetic techniques to use to reduce the risk? Int J Gynaecol Obstet 2024; 166:954-968. [PMID: 38557928 DOI: 10.1002/ijgo.15464] [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: 04/17/2023] [Revised: 02/13/2024] [Accepted: 02/25/2024] [Indexed: 04/04/2024]
Abstract
Despite their general good health, an increasing proportion of elderly individuals require surgery due to an increase in average lifespan. However, because of their increased vulnerability, these patients need to be handled carefully to make sure that surgery does not cause more harm than good. Age-related postoperative cognitive disorders (POCD) and postoperative delirium (POD), two serious consequences that are marked by adverse neuropsychologic alterations after surgery, are particularly dangerous for the elderly. In the context of gynecologic procedures, POCD and POD are examined in this narrative review. The main question is how to limit the rates of POCD and POD in older women undergoing gynecologic procedures by maximizing the risk-benefit balance. Three crucial endpoints are considered: (1) surgical procedures to lower the rates of POCD and POD, (2) anesthetic techniques to lessen the occurrence and (3) the identification of individuals at high risk for post-surgery cognitive impairments. Risks associated with laparoscopic gynecologic procedures include the Trendelenburg posture and CO2 exposure during pneumoperitoneum, despite statistical similarities in POD and POCD frequency between laparoscopic and laparotomy techniques. Numerous risk factors are associated with surgical interventions, such as blood loss, length of operation, and position holding, all of which reduce the chance of complications when they are minimized. In order to emphasize the essential role that anesthesia and surgery play in patient care, anesthesiologists are vital in making sure that anesthesia is given as sparingly and quickly as feasible. In addition, people who are genetically predisposed to POCD may be more susceptible to the disorder. The significance of a thorough strategy combining surgical and anesthetic concerns is highlighted in this article, in order to maximize results for senior patients having gynecologic surgery.
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Affiliation(s)
- Giovanni Pecorella
- Department of Gynecology, Obstetrics and Reproduction Medicine, Saarland University, Homburg, Germany
| | - Filippo De Rosa
- Department of Anesthesia and Intensive Care, and CERICSAL (CEntro di RIcerca Clinico SALentino), "Veris delli Ponti Hospital", Scorrano, Lecce, Italy
| | - Martina Licchelli
- Department of Obstetrics and Gynecology, and CERICSAL (CEntro di RIcerca Clinico SALentino), "Veris delli Ponti Hospital", Scorrano, Lecce, Italy
| | - Gaetano Panese
- Department of Obstetrics and Gynecology, and CERICSAL (CEntro di RIcerca Clinico SALentino), "Veris delli Ponti Hospital", Scorrano, Lecce, Italy
| | - Josè Tony Carugno
- Obstetrics and Gynecology Department, Minimally Invasive Gynecology Division, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Andrea Morciano
- Panico Pelvic Floor Center, Department of Gynecology and Obstetrics, Pia Fondazione "Card. G. Panico", Tricase, Lecce, Italy
| | - Andrea Tinelli
- Department of Obstetrics and Gynecology, and CERICSAL (CEntro di RIcerca Clinico SALentino), "Veris delli Ponti Hospital", Scorrano, Lecce, Italy
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Le MT, Vo BH, Le HP, Pham AP, Vu AL, Pham TD, Truong TT, Ho TM, Dang VQ. Diagnostic accuracy of hysterosalpingo-foam sonography for assessment of fallopian tube patency in infertile women. Reprod Biomed Online 2024; 49:104112. [PMID: 39013260 DOI: 10.1016/j.rbmo.2024.104112] [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: 01/19/2024] [Revised: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 07/18/2024]
Abstract
RESEARCH QUESTION What is the diagnostic accuracy of hysterosalpingo-foam sonography (HyFoSy), using two-dimensional ultrasound in tubal patency assessment in infertile women compared with laparoscopy with dye chromotubation? DESIGN This prospective study was conducted at My Duc Hospital, Vietnam. Infertile women aged 18 years or older, who were scheduled for laparoscopy, were included. Visual Analogue Scale (VAS) score for perception of pain during HyFoSy was used. Laparoscopy was carried out on the same day. Clinicians undertaking laparoscopy were blinded to HyFoSy results. Sensitivity, specificity, negative and positive predictive value, and 95% confidence intervals were calculated. A sample size of 455 women (n = 910 fallopian tubes) was needed to demonstrate a fluctuation hypothesis, not exceeding 6%, for sensitivity and specificity (power 0.80, two-sided alpha 5%, loss to follow-up 5%). RESULTS Between 2019 and 2022, 455 participants were recruited. Hysterosalpingo-foam sonography was unsuccessfully carried out in six participants. Two withdrew their consent. Data analysis was conducted on the remaining 447 participants (n = 868 fallopian tubes). The sensitivity and specificity of hysterosalpingo-foam sonography compared with laparoscopy were 0.75 (95% CI 0.71 to 0.79) and 0.70 (95% CI 0.65 to 0.74), respectively. Hysterosalpingo-foam sonography gave a positive predictive value of 0.76 (95% CI 0.73 to 0.80) and negative predictive value of 0.68 (95% CI 0.64 to 0.73). A total of 42.8% of women reported a VAS score of no pain. No adverse event was reported. CONCLUSION Compared with laparoscopy with dye chromotubation, two-dimensional HyFoSy is a well-tolerated, reliable technique for assessing tubal patency.
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Affiliation(s)
- My T Le
- Department of Obstetrics and Gynaecology, My Duc Hospital, Ho Chi Minh City, Vietnam.
| | - Binh H Vo
- Department of Obstetrics and Gynaecology, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Hoa P Le
- Department of Obstetrics and Gynaecology, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Anh P Pham
- Department of Obstetrics and Gynaecology, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Anh L Vu
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Toan D Pham
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Tham T Truong
- Department of Obstetrics and Gynaecology, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Tuong M Ho
- Department of Obstetrics and Gynaecology, My Duc Hospital, Ho Chi Minh City, Vietnam; HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam
| | - Vinh Q Dang
- HOPE Research Center, My Duc Hospital, Ho Chi Minh City, Vietnam; Department of Obstetrics and Gynaecology, School of Clinical Science, Monash University, Melbourne, Australia
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Hess P, Athanasiadis D, Lee NK, Monfared S, Cleveland PM, Stefanidis D. Preventing Surgeon Work-Related Musculoskeletal Disorders: A Pilot Study of the Comprehensive Operating Room Ergonomics (CORE) Program. Am J Occup Ther 2024; 78:7805205090. [PMID: 39087879 DOI: 10.5014/ajot.2024.050395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024] Open
Abstract
IMPORTANCE Work-related musculoskeletal disorders (WMSDs) among surgeons are markedly increasing. Several proposed interventions to reduce WMSDs among surgeons have been studied, but few follow an occupational therapy-oriented approach addressing biomechanical, psychophysical, and psychosocial risk factors. OBJECTIVE To design, implement, and assess the potential of the Comprehensive Operating Room Ergonomics (CORE) program for surgeons, a holistic evidence-based ergonomics and wellness intervention grounded in occupational therapy principles. DESIGN Mixed-methods pilot study with the quantitative strand embedded in the qualitative strand. SETTING University-affiliated hospital. PARTICIPANTS Six laparoscopic surgeons. OUTCOMES AND MEASURES CORE program outcomes were assessed using qualitative and quantitative data to indicate changes in posture, physical discomfort, sense of wellness, and operating room (OR) ergonomic performance. The Rapid Upper Limb Assessment (RULA) was used to quantify surgeons' WMSD risk level before and after intervention. RESULTS There were 12 baseline observations (two for each participant), and two or three post-CORE implementation observations. A statistically significant difference, F(1, 6) = 8.57, p = .03, was found between pre- and post-occupational therapy intervention RULA scores. Thematic analysis of surgeon feedback, which was overwhelmingly positive, identified five themes: postural alignment, areas of commonly reported physical pain or discomfort, setup of the OR environment, surgical ergonomics training, and ergonomics in everyday life. CONCLUSIONS AND RELEVANCE The CORE program effectively decreased ergonomic risk factors to optimize surgeons' occupational performance in the OR. This study demonstrates a potential solution to how occupational therapists can holistically support surgeons and health care providers who are at risk for WMSDs. Plain-Language Summary: By 2025, a surgeon shortage is expected, partly because of the increase in surgeons' work-related musculoskeletal disorders, which affect their health and job continuity. This pilot study shows that the Comprehensive Operating Room Ergonomics program effectively addresses these problems. The study also serves as a framework for occupational therapy professionals to work with health care providers on ergonomics, benefiting population health. Results suggest that this approach could enhance surgeons' work conditions, supporting the American Occupational Therapy Association's Vision 2025 to improve health and quality of life.
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Affiliation(s)
- Pamela Hess
- Pamela Hess, OTD, OTR, PMH-C, NCPT, is Clinical Assistant Professor, Department of Occupational Therapy, University of Florida, Gainesville. At the time of this research, Hess was Clinical Assistant Professor and Academic Fieldwork Coordinator, School of Health and Human Science, Indiana University-Indianapolis;
| | - Dimitrios Athanasiadis
- Dimitrios Athanasiadis, MD, is PGY4, Department of Surgery, Indiana University, Indianapolis
| | - Nicole Kissane Lee
- Nicole Kissane Lee, MD, EdM, FACS, is Bariatric/Minimally Invasive Surgeon, Department of Surgery, VA Boston Healthcare, Boston, MA
| | - Sara Monfared
- Sara Monfared, MD, MS, is Bariatric/Minimally Invasive Surgeon, Department of Surgery, Cleveland Clinic Akron General Hospital, Akron, OH
| | - Penelope Moyers Cleveland
- Penelope Moyers Cleveland, EdD, OT, FAOTA, is Adjunct Professor, Department of Occupational Therapy, Nova Southeastern University, Fort Lauderdale, FL
| | - Dimitrios Stefanidis
- Dimitrios Stefanidis, MD, PhD, FACS, FASMBS, is Professor of Surgery, Department of Surgery, Indiana University, Indianapolis
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Gurumurthy M, McGee AE, Saraswat L. Prophylactic ureteric catheterisation during complex gynaecological surgery: A systematic review and meta-analysis. BJOG 2024; 131:1341-1351. [PMID: 38602151 DOI: 10.1111/1471-0528.17823] [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: 11/14/2023] [Revised: 03/17/2024] [Accepted: 03/26/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND There is a lack of robust evidence to recommend the use of perioperative ureteric catheterisation or stenting in complex gynaecological surgery. OBJECTIVES To evaluate the evidence on the benefits and risks of perioperative ureteric catheterisation or stenting in complex gynaecological surgery. SEARCH STRATEGY A literature search was performed in CINAHL, the Cochrane Library, Embase and MEDLINE, from 1946 to January 2024, using a combination of keywords and Medical Subject Headings (MeSH) terminology. SELECTION CRITERIA Randomised controlled trials (RCTs) and observational studies were included. DATA COLLECTION AND ANALYSIS Meta-analysis of the RCTs and observational studies were performed separately. Cochrane RevMan 6.5.1 was used to undertake meta-analysis. Risk ratios with 95% CIs were calculated for the outcome measures. MAIN RESULTS Ten studies were included: three RCTs and seven observational studies, comprising 8661 patients. The three RCTs, comprising a total of 3277 patients, showed no difference in the risk of immediate complications in the form of ureteric injury between the ureteric stent and the control groups (RR 0.9, 95% CI 0.49-1.65). The observational studies included 5384 patients. Four studies that explored the ureteric injury as an outcome did not show any difference between the two groups (RR 0.76, 95% CI 0.27-2.16). One case-control study with 862 participants found that the rate of ureteric injury was higher in the non-stented group, although this was observed in only three patients. The risk of urinary tract infection (UTI) was increased in the stent group, although not with statistical significance (RR 1.84, 95% CI 0.47-7.17). There was no significant difference in the risk of ureteric fistulae (RR 1.91, 95% CI 0.62-5.83), although the number of studies was limited. CONCLUSIONS Prophylactic ureteric catheterisation or stenting for complex gynaecological surgery is not associated with a lower risk of ureteric injury.
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Affiliation(s)
| | - Alice E McGee
- Aberdeen Centre for Women's Health Research, Aberdeen, UK
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Levin I, Rapoport Ferman J, Bar O, Ben Ayoun D, Cohen A, Wolf T. Introducing surgical intelligence in gynecology: Automated identification of key steps in hysterectomy. Int J Gynaecol Obstet 2024; 166:1273-1278. [PMID: 38546527 DOI: 10.1002/ijgo.15490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 02/27/2024] [Accepted: 03/10/2024] [Indexed: 08/16/2024]
Abstract
OBJECTIVE The analysis of surgical videos using artificial intelligence holds great promise for the future of surgery by facilitating the development of surgical best practices, identifying key pitfalls, enhancing situational awareness, and disseminating that information via real-time, intraoperative decision-making. The objective of the present study was to examine the feasibility and accuracy of a novel computer vision algorithm for hysterectomy surgical step identification. METHODS This was a retrospective study conducted on surgical videos of laparoscopic hysterectomies performed in 277 patients in five medical centers. We used a surgical intelligence platform (Theator Inc.) that employs advanced computer vision and AI technology to automatically capture video data during surgery, deidentify, and upload procedures to a secure cloud infrastructure. Videos were manually annotated with sequential steps of surgery by a team of annotation specialists. Subsequently, a computer vision system was trained to perform automated step detection in hysterectomy. Analyzing automated video annotations in comparison to manual human annotations was used to determine accuracy. RESULTS The mean duration of the videos was 103 ± 43 min. Accuracy between AI-based predictions and manual human annotations was 93.1% on average. Accuracy was highest for the dissection and mobilization step (96.9%) and lowest for the adhesiolysis step (70.3%). CONCLUSION The results of the present study demonstrate that a novel AI-based model achieves high accuracy for automated steps identification in hysterectomy. This lays the foundations for the next phase of AI, focused on real-time clinical decision support and prediction of outcome measures, to optimize surgeon workflow and elevate patient care.
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Affiliation(s)
- Ishai Levin
- Department of Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Omri Bar
- Theator Inc, Palo Alto, California, USA
| | | | - Aviad Cohen
- Department of Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Gruhl SL, Yusoff MA, Chin HMS, Nadarajah R. An eight-year analysis of robotic surgery in morbidly obese women with endometrial cancer in a tertiary center in Singapore. Eur J Obstet Gynecol Reprod Biol X 2024; 23:100330. [PMID: 39188906 PMCID: PMC11347051 DOI: 10.1016/j.eurox.2024.100330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/24/2024] [Accepted: 07/26/2024] [Indexed: 08/28/2024] Open
Abstract
Introduction Surgical management of endometrial cancer is a total hysterectomy, bilateral salphingo-oophorectomy and pelvic lymph node dissection (THBSO-PLND), which is a challenging surgery in the morbidly obese. Data on morbidly obese women undergoing robotic surgery is limited in Asia. We share our experience in Singapore and aim to demonstrate that robotic surgery is safe and effective in morbidly obese women with endometrial cancer. Materials and Methods We performed a retrospective analysis of patients with BMI > 40 kg/m2, who underwent robotic surgery from January 2016 to September 2023 at the Singapore General Hospital. We recruited a total of 33 patients who underwent robotic surgery for endometrial malignancy and analysed surgical outcomes, operative complications, and survival rates. Results The average age of patients was 53 years and mean BMI 45.7. The average operative time was 232 min and average blood loss 184 ml. 3 patients had THBSO while 27 underwent THBSO-PLND. None required conversion to laparotomy. 4 patients required a mini-laparotomy for the retrieval of bulky uterus. 12 required adhesiolysis. 6 patients had additional omentectomy done. The average inpatient stay was 4.8 days. The 1-year mortality rate is 0. However, 1 patient passed away 13 months after surgery due to complications from bowel obstruction and another passed away 39 months later due to disease recurrence. 1 patient readmitted on POD6 due to post-op ileus and another for port-site hematoma. Both were managed conservatively. Conclusion Robotic surgery is a safe and effective alternative surgical tool for women who are morbidly obese with endometrial cancer.
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Affiliation(s)
- Sabrina Lasini Gruhl
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Outram Rd, 169608, Singapore
| | - Muhammad Ashraf Yusoff
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Outram Rd, 169608, Singapore
| | - Hui Men Selina Chin
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Outram Rd, 169608, Singapore
| | - Ravichandran Nadarajah
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Outram Rd, 169608, Singapore
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Toale C, Morris M, Roche A, Voborsky M, Traynor O, Kavanagh D. Development and validation of a simulation-based assessment of operative competence for higher specialist trainees in general surgery. Surg Endosc 2024; 38:5086-5095. [PMID: 39020120 DOI: 10.1007/s00464-024-11024-1] [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: 03/25/2024] [Accepted: 06/30/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND Simulation is increasingly being explored as an assessment modality. This study sought to develop and collate validity evidence for a novel simulation-based assessment of operative competence. We describe the approach to assessment design, development, pilot testing, and validity investigation. METHODS Eight procedural stations were generated using both virtual reality and bio-hybrid models. Content was identified from a previously conducted Delphi consensus study of trainers. Trainee performance was scored using an equally weighted Objective Structured Assessment of Technical Skills (OSATS) tool and a modified Procedure-Based Assessment (PBA) tool. Validity evidence was analyzed in accordance with Messick's validity framework. Both 'junior' (ST2-ST4) and 'senior' trainees (ST 5-ST8) were included to allow for comparative analysis. RESULTS Thirteen trainees were assessed by ten assessors across eight stations. Inter-station reliability was high (α = 0.81), and inter-rater reliability was acceptable (inter-class correlation coefficient 0.77). A significant difference in mean station score was observed between junior and senior trainees (44.82 vs 58.18, p = .004), while overall mean scores were moderately correlated with increasing training year (rs = .74, p = .004, Kendall's tau-b .57, p = 0.009). A pass-fail score generated using borderline regression methodology resulted in all 'senior' trainees passing and 4/6 of junior trainees failing the assessment. CONCLUSION This study reports validity evidence for a novel simulation-based assessment, designed to assess the operative competence of higher specialist trainees in general surgery.
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Affiliation(s)
- Conor Toale
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, 121 St. Stephen's Green, Dublin, Ireland.
| | - Marie Morris
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, 121 St. Stephen's Green, Dublin, Ireland
| | - Adam Roche
- SIM Centre for Simulation Education and Research, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin, Ireland
| | - Miroslav Voborsky
- SIM Centre for Simulation Education and Research, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin, Ireland
| | - Oscar Traynor
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, 121 St. Stephen's Green, Dublin, Ireland
| | - Dara Kavanagh
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, 121 St. Stephen's Green, Dublin, Ireland
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Ouyang J, Dong H, Wei C, Yu R, Yang S, Xu H. Reproductive outcome after laparoscopic ovarian cystectomy using barbed sutures versus conventional smooth sutures: A retrospective cohort study. Int J Gynaecol Obstet 2024; 166:1351-1358. [PMID: 38607329 DOI: 10.1002/ijgo.15523] [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: 10/17/2023] [Revised: 03/12/2024] [Accepted: 03/24/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE To investigate the effects of barbed and conventional sutures on reproductive outcomes and ovarian reserve after laparoscopic treatment for benign non-endometrioma ovarian cysts. METHODS This retrospective study was conducted at an affiliated women's hospital between May 2017 and December 2019. Patients with benign non-endometriotic ovarian cysts undergoing laparoscopic cystectomy were included. RESULTS Patients received barbed sutures (221 patients) or conventional smooth sutures (203 patients) intraoperatively. The two groups had comparable baseline characteristics. The surgical duration and ovarian suturing time were significantly shorter in the barbed suture group than in the conventional smooth suture group (P < 0.001 and P = 0.002, respectively). The rate of postoperative hemoglobin decline and serum anti-Müllerian hormone decline were similar between the two groups (P > 0.05). A total of 316 (74.53%) patients experienced at least one pregnancy postoperatively: 170 (76.92%) and 146 (71.92%) patients in the barbed suture and conventional smooth suture groups, respectively (χ2 = 1.395, P = 0.238). Multivariate Poisson regression demonstrated that barbed sutures had no significant effect on the overall postoperative pregnancy rate (adjusted incidence rate ratio, 1.10; 95% confidence interval, 0.93-1.36; P = 0.382). CONCLUSION In patients with benign non-endometriotic ovarian cysts undergoing laparoscopic ovarian cystectomy, barbed sutures had a reproductive outcome similar to that of conventional smooth sutures while providing higher surgical efficiency without adverse effects on the postoperative ovarian reserve. Barbed sutures are probably a viable option to conventional smooth sutures.
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Affiliation(s)
- Jing Ouyang
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Huan Dong
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Chenxuan Wei
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Ruoer Yu
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Siqin Yang
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Hong Xu
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
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Chen W, Ma J, Yang Z, Han X, Hu C, Wang H, Peng Y, Zhang L, Jiang B. Robotic-assisted laparoscopic versus abdominal and laparoscopic myomectomy: A systematic review and meta-analysis. Int J Gynaecol Obstet 2024; 166:994-1005. [PMID: 38588036 DOI: 10.1002/ijgo.15485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/27/2024] [Accepted: 03/10/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Myomectomy is the preferred treatment for women with uterine fibroids and fertility requirements. There are three modalities are used in clinical practice for myomectomy: abdominal myomectomy (AM), laparoscopic myomectomy (LM), and robot-assisted laparoscopic myomectomy (RLM). OBJECTIVES To compare the perioperative and postoperative outcomes of RLM, AM, and LM. SEARCH STRATEGY We searched PubMed, Web of Science, Embase, and Clinical Trials for relevant literature published between January 2000 and January 2023. SELECTION CRITERIA We included all studies reporting peri- and postoperative outcomes of myomectomy in patients with uterine myomas. Surgical treatments were classified as RLM, LM, or AM. DATA COLLECTION AND ANALYSIS Two or more authors selected studies independently, assessed risk of bias, and extracted data. We derived mean difference (MD) or odds ratio (OR) with 95% confidence intervals (CIs) for each outcome, subgrouping trials by the patient characteristics and myoma characteristics. We used the I2 statistic to quantify heterogeneity and the random-effects model for meta-analysis when appropriate. We used the funnel plot to assess the publication bias. MAIN RESULTS A total of 32 studies with 6357 patients were included, of which 1982 women had undergone RLM. The operating time was significantly longer (MD = 43.58, 95% confidence interval [CI]: 25.22-61.93, P < 0.001), and the incidence of cesarean section after myomectomy was significantly lower (OR = 0.27, 95% CI: 0.10-0.78, P = 0.02) in RLM than in LM. Compared with AM, the operation time, blood loss, blood transfusion rate, complication rate, total cost, length of hospital stay, and pregnancy rate of patients with RLM were significantly different. CONCLUSIONS The safety and effectiveness of RLM are superior to those of AM but inferior to those of LM.
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Affiliation(s)
- Weiqi Chen
- School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
- Public Policy Research Center, Peking University, Beijing, China
| | - Jun Ma
- School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
| | - Zhao Yang
- Public Policy Research Center, Peking University, Beijing, China
- Peking University First Hospital, Beijing, China
| | - Xiao Han
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Chenyang Hu
- School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
| | - Huai Wang
- School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
| | - Ying Peng
- Peking University Third Hospital, Beijing, China
| | - Lei Zhang
- Peking University First Hospital, Beijing, China
| | - Bin Jiang
- School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
- Public Policy Research Center, Peking University, Beijing, China
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Lim ET, Kostic A, Tsampras N. Laparoscopic myomectomy for a large uterine fibroid: A video case report. Eur J Obstet Gynecol Reprod Biol 2024; 300:347-348. [PMID: 39079855 DOI: 10.1016/j.ejogrb.2024.07.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/15/2024] [Accepted: 07/21/2024] [Indexed: 08/26/2024]
Affiliation(s)
- Ee Thong Lim
- Manchester University NHS Foundation Trust, United Kingdom.
| | - Andras Kostic
- Manchester University NHS Foundation Trust, United Kingdom
| | - Nikolaos Tsampras
- Developmental Biology and Medicine, School of Medical Sciences, The University of Manchester, United Kingdom
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Hellman KM, Tu FF. Hal, how many types of pelvic pain are there? Pain 2024; 165:1897-1898. [PMID: 38564003 PMCID: PMC11333176 DOI: 10.1097/j.pain.0000000000003219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 04/04/2024]
Affiliation(s)
- Kevin M. Hellman
- Dept. of Ob/Gyn, Endeavor Health, Evanston, IL 60201
- Dept. of Ob/Gyn, The University of Chicago Pritzker School of Medicine, Chicago, IL 60637
| | - Frank F. Tu
- Dept. of Ob/Gyn, Endeavor Health, Evanston, IL 60201
- Dept. of Ob/Gyn, The University of Chicago Pritzker School of Medicine, Chicago, IL 60637
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Cingiloglu P, Mooney S, McNamara H, Wong A, Hicks L, Ellett L, Readman E. Pain experience with outpatient hysteroscopy: A prospective cohort study. Eur J Obstet Gynecol Reprod Biol 2024; 300:302-308. [PMID: 39068843 DOI: 10.1016/j.ejogrb.2024.07.047] [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: 02/12/2024] [Revised: 07/11/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Abnormal uterine bleeding (AUB) affects women of all ages and is one of the most common reasons for referral to a gynaecological clinic. Operative hysteroscopic procedures allow for a see-and-treat approach to AUB, and these techniques have been shown to be feasible and acceptable in the outpatient setting. OBJECTIVE To assess if there is an increase in pain scores for women who are undergoing an operative hysteroscopic procedure with Myosure LITE® (Hologic; mechanical hysteroscopic tissue removal system) compared to outpatient diagnostic hysteroscopy alone. STUDY DESIGN A prospective cohort study was performed. All participants attending the outpatient hysteroscopy clinic at Mercy Hospital for Women completed a pre-and post-procedure questionnaire. This included a visual analogue scale (VAS) for any pre-existing pain, anticipated pain, and actual pain experienced during procedure. Factors influencing overall satisfaction and willingness to attend again were also assessed. Data was entered into RedCap® for analysis. A difference in VAS of 10 mm or more was considered clinically significant. An alpha of p < 0.05 was assigned for statistical significance. RESULTS Between February 2020 and November 2022, 208 women underwent outpatient diagnostic hysteroscopy followed by an operative hysteroscopy with MyoSure®. To allow for standardisation of analgesia, only participants who had a cervical block before their Myosure® procedure were included for analysis (n = 111). There was statistical evidence (t(111) = 2.36, p = 0.02) of a lower mean VAS pain score for operative Myosure (36.5 mm, 95 % CI: 31.1-41.8 mm) compared to outpatient diagnostic hysteroscopy (44.1 mm, 95 % CI: 39.0-49.2 mm). The mean difference in VAS pain score was estimated as 7.7 mm (95 % CI: 1.2-14.1 mm) lower for Myosure compared to hysteroscopy. Given the threshold for clinical significance was considered as 10 mm difference in VAS, the variance in pain scores is under the likely clinically significant range. There was no significant difference in pain scores for diagnostic hysteroscopy with or without paracervical block (mean difference = 1.42; 95 % CI: -6.35 to 9.20). There was no association between pre-existing pain, and actual pain for hysteroscopy, or Myosure (p = 0.997 and p = 0.065 respectively). The anticipated pain score was weakly associated with actual pain during the operative Myosure procedure (p = 0.02), and with outpatient diagnostic hysteroscopy (p = 0.019). CONCLUSION Outpatient hysteroscopy procedures are generally well tolerated. The pain experience with operative Myosure was less than that reported during the diagnostic hysteroscopy by the same patient although this is unlikely of clinical significance. Importantly, Myosure was not more painful than the initial diagnostic procedure, and most patients were satisfied with the outcome and would choose to have the procedure again in an outpatient setting. This is in keeping with other studies which have shown a high degree of patient tolerance and satisfaction with this approach.
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Affiliation(s)
- Pinar Cingiloglu
- Mercy Hospital for Women, Endosurgery Department, Heidelberg, Australia; Royal Women's Hospital, Parkville, Australia.
| | - Samantha Mooney
- Mercy Hospital for Women, Endosurgery Department, Heidelberg, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Australia
| | - Helen McNamara
- Mercy Hospital for Women, Endosurgery Department, Heidelberg, Australia; Royal Women's Hospital, Parkville, Australia
| | - Avelyn Wong
- Mercy Hospital for Women, Endosurgery Department, Heidelberg, Australia; Royal Women's Hospital, Parkville, Australia
| | - Lauren Hicks
- Mercy Hospital for Women, Endosurgery Department, Heidelberg, Australia; Royal Women's Hospital, Parkville, Australia
| | - Lenore Ellett
- Mercy Hospital for Women, Endosurgery Department, Heidelberg, Australia
| | - Emma Readman
- Mercy Hospital for Women, Endosurgery Department, Heidelberg, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Australia
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Gracia M, Alonso-Espías M, Zapardiel I. Impact of sentinel node use in lymphedema formation among gynecologic cancer patients. Curr Opin Oncol 2024; 36:406-411. [PMID: 39007239 DOI: 10.1097/cco.0000000000001059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
PURPOSE OF REVIEW The most common surgical procedure associated with lymphedema formation is the regional lymphadenectomy. One of the advantages of sentinel node biopsy is the reduction of the risk of lymphedema formation. The purpose of this review is to collect and analyze the most relevant and recent evidence of the use of sentinel node biopsy and its implication on the development of postoperative lymphedema in gynecological cancer. RECENT FINDINGS The current evidence of the use of sentinel node biopsy in cervical cancer to reduce lymphedema is heterogeneous and more data is needed to establish its role.Sentinel lymph node biopsy in endometrial cancer is a staging procedure with lower surgical complications, as well as lymphedema formation; while the results of prospective trials evaluating its impact on quality of life are still lacking.Sentinel lymph node biopsy in vulvar cancer minimizes the need for extensive dissection and reduces the incidence of complications associated with overharvesting of lymph nodes such as lymphedema without compromising oncological outcomes. SUMMARY The prevalence of lymphedema in gynecological cancer varies based on the surgical treatment or additional therapies applied. Over the past years, one of the most important surgical modifications to decrease lymphedema formation has been implementation of sentinel lymph node technique mainly in vulvar cancer patients.
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Affiliation(s)
- Myriam Gracia
- Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
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Bullo S, Hearn JH. Visual reconstructions of endometriosis pain: An interdisciplinary visual methodology for illness representation. Br J Health Psychol 2024; 29:676-693. [PMID: 38462537 DOI: 10.1111/bjhp.12720] [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: 04/20/2023] [Revised: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVES Endometriosis is a chronic condition in which tissue resembling the endometrium grows outside of the womb, causing severe chronic pain. Research demonstrates the physical, emotional and quality of life impact on people with endometriosis, but pain is reportedly difficult to communicate, resulting in lengthier diagnosis. This work aimed to gain insight into the value of imagery production as a pain communication strategy through a novel synergy of psychological and linguistic/socio-semiotic approaches. DESIGN A qualitative, multimodal, participant-generated imagery study. METHODS Interpretative phenomenological analysis (IPA) and conceptual metaphor and metonymy analysis were utilized to examine visual representations of endometriosis pain. Data were collected in two focus groups with four and six women, respectively; all with a diagnosis of endometriosis, aged 25-40 years old (M = 34.5, SD = 4.2) and a mean diagnosis delay of 8.4 years (SD = 3.6). RESULTS The overarching theme across visual representations was 'Pain as Physical Violence' with 'colour as emotional representation', 'texture as sensory qualities' and 'materials as sensation' as sub-themes. These are realized through metaphorical and metonymical relations in both the visual representations as well as the accompanying linguistic representation of the process. CONCLUSIONS This study demonstrates the value of a creative mixed-methodologies approach to capture experiential aspects of pain and its impact that are not verbalized in linguistic accounts alone. This can facilitate a deeper understanding of one's pain, acting as a medium for therapeutic adjustment to occur, while facilitating effective and empathic patient-professional conversations surrounding pain.
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Mitchell AM, Lensen S, Kamper SJ, Frawley H, Cheng C, Healey M, Chalmers KJ. The most impactful endometriosis symptom: An international, cross-sectional, two-round survey study. Acta Obstet Gynecol Scand 2024; 103:1736-1744. [PMID: 39041353 PMCID: PMC11324914 DOI: 10.1111/aogs.14927] [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: 05/09/2024] [Revised: 07/04/2024] [Accepted: 07/05/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION There is considerable variation in the types of symptoms experienced by people living with endometriosis, and it is unclear which symptoms impact people the most. This study aimed to identify the specific symptoms that are "most impactful" to people living with the condition. MATERIAL AND METHODS Two sequential online surveys were conducted. Women aged over 18 years with a diagnosis of endometriosis were eligible to participate. Participants first provided a free-text list of all the endometriosis symptoms they experienced (Survey 1, Australian only). Responses were condensed into a shorter list by grouping symptom types and selecting the top 20 most common and most impactful. Survey 2 (international) participants reviewed the list and selected all that they had experienced in the last 3 months, nominated one as their single "most impactful symptom", and rated its impact on one of five randomized scale types. RESULTS Survey 1 and Survey 2 had 195 and 983 responses, respectively. The mean age of respondents was 30.8 ± 7.9 years. There were 275 separate symptom descriptions from Survey 1, which were condensed into 104 groups, of which 25 met criteria for inclusion in Survey 2. The most commonly experienced symptoms were abdominal pain (93% of respondents), bloating (92%), and fatigue (90%), and the symptoms nominated as causing the most impact were pelvic pain (20%), abdominal pain (15%), and cramps (7%). Nearly everyone (99.7%) in Survey 2 reported experiencing at least one pain symptom. The symptoms that generated the highest impact scores were infertility (99.8/100), irregular menstrual cycles (95.3/100), and constipation (92/100). The average impact score was 87.5/100. CONCLUSIONS There was substantial variation in the symptom selected as causing the most impact, and the level of impact was high. A focus on measuring the "most impactful symptom" in future research may enable us to better capture and measure the true symptom experience.
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Affiliation(s)
- Alice M Mitchell
- Department of Obstetrics, Gynaecology and Newborn Health, Royal Women's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Sarah Lensen
- Department of Obstetrics, Gynaecology and Newborn Health, Royal Women's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Steven J Kamper
- School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
- Nepean Blue Mountains Local Health District, Penrith, New South Wales, Australia
| | - Helena Frawley
- School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Royal Women's Hospital, Parkville, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Claudia Cheng
- Department of Obstetrics, Gynaecology and Newborn Health, Royal Women's Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Royal Women's Hospital, Parkville, Victoria, Australia
| | - Martin Healey
- Department of Obstetrics, Gynaecology and Newborn Health, Royal Women's Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Royal Women's Hospital, Parkville, Victoria, Australia
- Newlife IVF, Box Hill, Victoria, Australia
| | - K Jane Chalmers
- IIMPACT in Health Research, University of South Australia, Adelaide, South Australia, Australia
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Winkel AF, Katz NT. The Role of Obstetrics and Gynecology in Shaping Gender-diverse Leadership in Medicine. Clin Obstet Gynecol 2024; 67:531-538. [PMID: 38666712 DOI: 10.1097/grf.0000000000000871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
Gender inequity persists in academic medicine. This article reviews the historical context, ongoing leadership challenges, and societal biases. The persistent barriers to gender equity in leadership roles, pay, and professional recognition are considered through the lens of obstetrics and gynecology where these issues persist despite a significant presence of women in the field. The impact of gender stereotypes, the role of intersectionality, and the need for systemic change are evident. Embracing diverse leadership styles and creating inclusive pathways to leadership will help actualize the potential benefits of a gender-diverse workforce, enhancing health care outcomes and fostering innovation.
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Affiliation(s)
- Abigail Ford Winkel
- Department of Obstetrics and Gynecology, Grossman School of Medicine, New York University, New York, New York
| | - Nadine T Katz
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, New York
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Bekkers IP, Henschen R, Smeets NA, van Vliet HA, Damoiseaux A, Wassen MM. Vaginal assisted NOTES hysterectomy in The Netherlands; A prospective cohort study. Eur J Obstet Gynecol Reprod Biol X 2024; 23:100323. [PMID: 39091980 PMCID: PMC11292541 DOI: 10.1016/j.eurox.2024.100323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/08/2024] [Accepted: 06/16/2024] [Indexed: 08/04/2024] Open
Abstract
Objectives Vaginal assisted Natural Orifice Transluminal Endoscopic Surgery (NOTES) combines the benefits of vaginal and endoscopic surgery. This study presents the results of the first vaginal assisted NOTES hysterectomies (VANH) in The Netherlands. Study design A prospective cohort study was performed in two non-academic teaching hospitals in The Netherlands. Data was collected from patients who underwent a VANH for benign indications between August 2019 and April 2023. Baseline characteristics and data of intra- and postoperative surgical outcomes were recorded and analysed. The VANHs were performed by four experienced vaginal and endoscopic gynaecological surgeons. Results A total of 200 patients underwent a VANH. Indications were dysfunctional menstrual bleeding (61 %; n = 122), abnormal cervical cytology (15.5 %; n = 31), abdominal pain (11.5 %; n = 23), post ablation/sterilization pain syndrome (3.5 %; n = 7), uterine fibroids (5.0 %; n = 10), atypical endometrial hyperplasia (2.5 %; n = 5) and Lynch or BRCA gene mutation carriers (1.0 %, n = 2). The mean surgical time was 61.4 min ( ± 22.8 min) with a mean blood loss of 88 mL ( ± 89 mL) and a mean uterine weight of 150 g ( ± 112 g). In 2.0 % (n = 4) of the cases a conversion was necessary. Same day discharge (SDD) was feasible in 80.2 % (n = 105) of the patients planned in day-care. In 2.0 % (n = 4) an intra-operative complication and in 9.0 % (n = 18) a post-operative complication occurred. Conclusion This study shows vNOTES to be a safe and feasible surgical technique and can be safely implemented with appropriate patient selection and skilled surgeons. It highlights the importance of surgeon awareness of the challenges inherent in the initial stages of the implementation of a new surgical technique when performing their first vNOTES procedures. Additional randomized clinical trials are needed to show superiority of vNOTES compared to traditional surgery.
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Affiliation(s)
- Ilse P.W. Bekkers
- Department of Obstetrics & Gynecology, Zuyderland Medical Centre Heerlen, Henri Dunantstraat 5, 6419 PC Heerlen, Limburg, the Netherlands
- GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, the Netherlands
- Maastricht University, Maastricht, the Netherlands
| | - Rebecca Henschen
- Department of Obstetrics & Gynecology, Zuyderland Medical Centre Heerlen, Henri Dunantstraat 5, 6419 PC Heerlen, Limburg, the Netherlands
- GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, the Netherlands
- Maastricht University, Maastricht, the Netherlands
| | - Nicol A.C. Smeets
- Department of Obstetrics & Gynecology, Zuyderland Medical Centre Heerlen, Henri Dunantstraat 5, 6419 PC Heerlen, Limburg, the Netherlands
| | - Huib A.A.M. van Vliet
- Department of Obstetrics & Gynecology, Catharina Hospital Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands
- Department Obstetrics and Gynecology, Universitair Ziekenhuis Gent, Corneel Heymanslaan 10, 9000 Gent, Oost-Vlaanderen, Belgium
| | - Anne Damoiseaux
- Department of Obstetrics & Gynecology, Catharina Hospital Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands
| | - Martine M.L.H. Wassen
- Department of Obstetrics & Gynecology, Zuyderland Medical Centre Heerlen, Henri Dunantstraat 5, 6419 PC Heerlen, Limburg, the Netherlands
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Gayete-Lafuente S, Vilà Famada A, Albayrak N, Espinós Gómez JJ, Checa Vizcaíno MÁ, Moreno-Sepulveda J. Indirect markers of oocyte quality in patients with ovarian endometriosis undergoing IVF/ICSI: a systematic review and meta-analysis. Reprod Biomed Online 2024; 49:104075. [PMID: 38943812 DOI: 10.1016/j.rbmo.2024.104075] [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: 10/25/2023] [Revised: 04/08/2024] [Accepted: 04/16/2024] [Indexed: 07/01/2024]
Abstract
This systematic review and meta-analysis aimed to evaluate the impact of ovarian endometriomas (OMA) on indirect markers of oocyte quality in patients undergoing IVF, compared with women without anatomical or functional ovarian abnormalities. The search spanned original randomized controlled trials, case-control studies and cohort studies published in MEDLINE, the Cochrane Controlled Trials Register and the ClinicalTrials.gov database up to October 2023. Thirty-one studies were included in the meta-analysis, showing no significant differences in fertilization (OR 1.10, 95% CI 0.94-1.30), blastulation (OR 0.86, 95% CI 0.64-1.14) and cancellation (OR 1.06, 95% CI 0.78-1.44) rates. However, patients with OMA exhibited significantly lower numbers of total and mature (metaphase II) oocytes retrieved (mean difference -1.59, 95% CI -2.25 to -0.94; mean difference -1.86, 95% CI -2.46 to -1.26, respectively), and lower numbers of top-quality embryos (mean difference -0.49, 95% CI -0.92 to -0.06). The Ovarian Sensitivity Index was similar between the groups (mean difference -1.55, 95% CI -3.27 to 0.18). The lack of data published to date prevented meta-analysis on euploidy rate. In conclusion, although the presence of OMA could decrease the oocyte yield in patients undergoing IVF/intracytoplasmic sperm injection, it does not appear to have an adverse impact on oocyte quality.
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Affiliation(s)
- Sonia Gayete-Lafuente
- Obstetrics and Gynaecology Department, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain; Department of Gynecology, Obstetrics and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA.
| | - Anna Vilà Famada
- Department of Obstetrics and Gynaecology, Catalan Health Institute, Barcelona, Spain
| | - Nazli Albayrak
- Department of Obstetrics and Gynaecology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Juan José Espinós Gómez
- Obstetrics and Gynaecology Department, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain; Fertty Clinic, Barcelona, Spain
| | - Miguel Ángel Checa Vizcaíno
- Fertty Clinic, Barcelona, Spain; Faculty of Medicine and Life Sciences, Pompeu Fabra University, Barcelona, Spain
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Macciò A, Abis P, Sole G, D'Angelo N, Nemolato S, Madeddu C. A giant pelvic infiltrating schwannoma misdiagnosed as an ovarian neoplasm that was resected using a laparoscopic approach: A case report. Int J Surg Case Rep 2024; 122:110138. [PMID: 39128216 DOI: 10.1016/j.ijscr.2024.110138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 07/31/2024] [Accepted: 08/07/2024] [Indexed: 08/13/2024] Open
Abstract
Introduction and importance: Large retroperitoneal schwannomas are rare and present significant challenges in surgical management, particularly when located in the pelvic region. Gynecologists can encounter rare problems when a pelvic schwannoma is mistaken for an adnexal pathology. Case Presentation: A 62-year-old woman presented with a giant retroperitoneal mass suspected of a potentially malignant ovarian tumor preoperatively. Computed tomography revealed a large mixed solid-cystic mass near the right adnexa measuring 118 × 100 × 80 mm. The cancer antigen 125 level was 196 U/mL. We performed a diagnostic-operative laparoscopy, which showed a retroperitoneal neoformation below the cava and aortic bifurcation adherent to the sacrum, right pelvic vessels, and hypogastric nerve up to the vagina. We carefully detached the mass from the nearby tissues using the most appropriate laparoscopic devices. The entire neoplasm was removed through the vagina into a surgical bag. The surgery lasted 180 min without complications. Histology revealed a grade I benign schwannoma. At the 12-month follow-up, the patient was asymptomatic without signs of recurrence. Clinical Discussion: Pelvic retroperitoneal schwannomas can mimic ovarian carcinomas; misdiagnosis may occur due to their rarity and the difficulty of interpreting preoperative imaging. In case of unexpected giant presacral schwannomas surgical management is challenging due to their peculiar location. Conclusion: This case underscores the need for a skilled, experienced team of gynecological oncologists to achieve favorable outcomes when performing laparoscopic surgery of giant pelvic retroperitoneal schwannoma. Adequate knowledge of the complex pelvic anatomy, careful surgical planning, and familiarity with the most appropriate surgical tools are critical points.
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Affiliation(s)
- Antonio Macciò
- Department of Obstetrics and Gynecology, ARNAS G. Brotzu, via Jenner, 09100 Cagliari, Italy; Department of Surgical Sciences, University of Cagliari, SS 554, km 4,500, 09042 Monserrato, Italy
| | - Paola Abis
- Department of Obstetrics and Gynecology, ARNAS G. Brotzu, via Jenner, 09100 Cagliari, Italy
| | - Gabriele Sole
- Department of Obstetrics and Gynecology, ARNAS G. Brotzu, via Jenner, 09100 Cagliari, Italy
| | - Nicola D'Angelo
- Department of Obstetrics and Gynecology, ARNAS G. Brotzu, via Jenner, 09100 Cagliari, Italy
| | - Sonia Nemolato
- Unit of Anatomic Pathology, ARNAS G. Brotzu, via Jenner, 09100 Cagliari, Italy
| | - Clelia Madeddu
- Department of Medical Sciences and Public Health, University of Cagliari, SS 554, km 4,500, 09042 Monserrato, Italy.
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Chekol AM, Anteneh D, Hassen BM, Anelay BA, Abdulkadir K. Spontaneous umbilical endometriosis: Rare occurrence in nulliparous women - Case report & literature review. Int J Surg Case Rep 2024; 122:110155. [PMID: 39142186 DOI: 10.1016/j.ijscr.2024.110155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 08/08/2024] [Accepted: 08/10/2024] [Indexed: 08/16/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Endometriosis is an inflammatory disease associated with pelvic pain and infertility that is characterized by lesions of endometrial-like tissue outside of the uterus. It affects roughly 10 % of reproductive age women and girls globally. Umbilical endometriosis is a rare pathology accounting for 0.5 to 1 % of all extra-pelvic endometriosis. Due to the varied presentations and rare incidence of endometriosis, it remains a diagnostic dilemma and challenge to treat it timely and properly. CASE PRESENTATION A 32-year-old nulliparous lady who presented with umbilical lump, cyclical pain, and bleeding during menstrual cycle without any prior history of abdominal surgery of a year duration. Ultrasound and magnetic resonance imaging support the diagnosis of umbilical endometriosis and ruled out multifocal involvement. She was managed with surgical excision with free margin followed by umbilical reconstruction and the diagnosis was confirmed by biopsy. DISCUSSION Umbilical endometriosis could be either secondary to endometrial tissue implantation during laparoscopic or open surgical procedures also called scar endometriosis or as a primary umbilical endometriosis with no previous surgery. The characteristic presentation for umbilical endometriosis is a brown to dark nodule in the umbilicus, which may be swollen, painful, and sometimes bleed during menstrual periods. CONCLUSION Umbilical endometriosis is a rare condition that should be considered as a differential diagnosis in women with umbilical lump, cyclical pain, and bleeding. The diagnosis is clinical and confirmed by histopathology. Surgical excision is the treatment of choice with a low risk of recurrence or malignancy.
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Ellis K, Armour W, Wood R. 'I never see anyone like myself represented in discussions about endometriosis': priorities of LGBTQIA + endometriosis patients in New Zealand. CULTURE, HEALTH & SEXUALITY 2024:1-21. [PMID: 39196785 DOI: 10.1080/13691058.2024.2394650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 08/16/2024] [Indexed: 08/30/2024]
Abstract
Limited information is available regarding the experiences and perspectives of LGBTQIA + patients internationally, and no literature exists for New Zealand. Twenty-eight LGBTQIA + endometriosis patients took part in asynchronous, online text-based discussions about their experiences navigating endometriosis diagnosis and management in Aotearoa New Zealand. Their qualitative responses were coded in an iterative thematic manner. The mean delay to diagnosis of this cohort was 10.2 ± 5.6 years from symptom onset, longer than previously reported delays in Aotearoa New Zealand. Participants shared a strong discomfort with the predominant focus of endometriosis management strategies on penetrative sex and pregnancy, and the sense they were dismissed if prioritising these functions was not their priority. Several potential improvements to current treatment and care for LGBTQIA + endometriosis patients were generally agreed upon by the cohort, including research to better understand a practice approach for managing the symptoms of transmasculine patients; expanding the management strategies for patients who are not prioritising fertility and penetrative sex; improving awareness of LGBTQIA + people and experiences amongst medical practitioners to reduce homophobia, transphobia, misogyny, misgendering and mistreatment in care; and the development of gender-neutral spaces for the support of patients who feel uncomfortable in cisgender women-centric endometriosis spaces.
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Affiliation(s)
- Katherine Ellis
- Department of Chemical and Process Engineering, University of Canterbury, Christchurch, New Zealand
- Endometriosis New Zealand, Christchurch, New Zealand
| | | | - Rachael Wood
- Department of Chemical and Process Engineering, University of Canterbury, Christchurch, New Zealand
- Biomolecular Interaction Centre, University of Canterbury, Christchurch, New Zealand
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Kamphuis D, van Welie N, van Rijswijk J, van Hooff MHA, de Bruin JP, Verhoeve HR, Mol F, van Baal WM, Lambalk CB, Stoker J, van Wely M, Bossuyt PMM, Mol BWJ, Dreyer K, Mijatovic V. The effect of prior hysterosalpingo-foam sonography or hysterosalpingography on tubal patency: a secondary analysis of a randomized controlled trial. Hum Reprod 2024:deae194. [PMID: 39190881 DOI: 10.1093/humrep/deae194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/05/2024] [Indexed: 08/29/2024] Open
Abstract
STUDY QUESTION Does hysterosalpingo-foam sonography (HyFoSy) prior to hysterosalpingography (HSG) or HSG prior to HyFoSy affect visible tubal patency when compared HSG or HyFoSy alone? SUMMARY ANSWER Undergoing either HyFoSy or HSG prior to tubal patency testing by the alternative method does not demonstrate a significant difference in visible tubal patency when compared to HyFoSy or HSG alone. WHAT IS KNOWN ALREADY HyFoSy and HSG are two commonly used visual tubal patency tests with a high and comparable diagnostic accuracy for evaluating tubal patency. These tests may also improve fertility, although the underlying mechanism is still not fully understood. One of the hypotheses points to a dislodgment of mucus plugs that may have disrupted the patency of the Fallopian tubes. STUDY DESIGN, SIZE, DURATION This is a secondary analysis of the randomized controlled FOAM study, in which women underwent tubal patency testing by HyFoSy and HSG, randomized for order of the procedure. Participants either had HyFoSy first and then HSG, or vice versa. Here, we evaluate the relative effectiveness of tubal patency testing by HyFoSy or HSG prior to the alternative tubal patency testing method on visible tubal patency, compared to each method alone. PARTICIPANTS/MATERIALS, SETTING, METHODS Infertile women aged between 18 and 41 years scheduled for tubal patency testing were eligible for participating in the FOAM study. Women with anovulatory cycles, endometriosis, or with a partner with male infertility were excluded. To evaluate the effect HyFoSy on tubal patency, we relied on HSG results by comparing the proportion of women with bilateral tubal patency visible on HSG in those who underwent and who did not undergo HyFoSy prior to their HSG (HyFoSy prior to HSG versus HSG alone). To evaluate the effect of HSG on tubal patency, we relied on HyFoSy results by comparing the proportion of women with bilateral tubal patency visible on HyFoSy in those who underwent and who did not undergo HSG prior to their HyFoSy (HSG prior to HyFoSy versus HyFoSy alone). MAIN RESULTS AND THE ROLE OF CHANCE Between May 2015 and January 2019, we randomized 1160 women (576 underwent HyFoSy first followed by HSG, and 584 underwent HSG first followed by HyFoSy). Among the women randomized to HyFoSy prior to HSG, bilateral tubal patency was visible on HSG in 467/537 (87%) women, compared with 472/544 (87%) women who underwent HSG alone (risk difference 0.2%; 95% CI: -3.8% to 4.2%). Among the women randomized to HSG prior to HyFoSy, bilateral tubal patency was visible on HyFoSy in 394/471 (84%) women, compared with 428/486 (88%) women who underwent HyFoSy alone (risk difference -4.4%; 95% CI: -8.8% to 0.0%). LIMITATIONS, REASONS FOR CAUTION The results of this secondary analysis should be interpreted as exploratory and cannot be regarded as definitive evidence. Furthermore, it has to be noted that pregnancy outcomes were not considered in this analysis. WIDER IMPLICATIONS OF THE FINDINGS Tubal patency testing by either HyFoSy or HSG, prior to the alternative tubal patency testing method does not significantly affect visible tubal patency, when compared to alternative method alone. This suggests that both methods may have comparable abilities to dislodge mucus plugs in the Fallopian tubes. STUDY FUNDING/COMPETING INTEREST(S) The FOAM study was an investigator-initiated study, funded by ZonMw, a Dutch organization for Health Research and Development (project number 837001504). IQ Medical Ventures provided the ExEm®-FOAM kits free of charge. The funders had no role in study design, collection, analysis, or interpretation of the data. H.R.V. reports consultancy fees from Ferring. M.v.W. received a travel grant from Oxford University Press in the role of Deputy Editor for Human Reproduction and participates in a Data Safety and Monitoring Board as an independent methodologist in obstetrics studies in which she has no other role. M.v.W. is coordinating editor of Cochrane Fertility and Gynaecology. B.W.J.M. received an investigator grant from NHMRC (GNT1176437) and research funding from Merck KGaA. B.W.J.M. reports consultancy for Organon and Merck KGaA, and travel support from Merck KGaA. B.W.J.M. reports holding stocks of ObsEva. V.M. received research grants from Guerbet, Merck and Ferring and travel and speaker fees from Guerbet. The other authors do not report conflicts of interest. TRIAL REGISTRATION NUMBER International Clinical Trials Registry Platform No. NTR4746.
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Affiliation(s)
- Danah Kamphuis
- Department of Reproductive Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Nienke van Welie
- Department of Reproductive Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, OLVG, Amsterdam, The Netherlands
| | - Joukje van Rijswijk
- Department of Reproductive Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Marcel H A van Hooff
- Department of Obstetrics and Gynaecology, Franciscus Hospital, Rotterdam, The Netherlands
| | - Jan-Peter de Bruin
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Harold R Verhoeve
- Department of Obstetrics and Gynaecology, OLVG, Amsterdam, The Netherlands
| | - Femke Mol
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Centre for Reproductive Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | | | - Cornelis B Lambalk
- Department of Reproductive Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Madelon van Wely
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Centre for Reproductive Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Department of Epidemiology & Data Science, Amsterdam Public Health, Amsterdam UMC, Amsterdam, The Netherlands
| | - Patrick M M Bossuyt
- Department of Epidemiology & Data Science, Amsterdam Public Health, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
- Aberdeen Centre for Women's Health Research, University of Aberdeen, King's College, Aberdeen, UK
| | - Kim Dreyer
- Department of Reproductive Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Velja Mijatovic
- Department of Reproductive Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
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Saito Y, Takeuchi H, Tokumine J, Sawada R, Watanabe K, Yorozu T. Ultrasound-guided peripheral nerve blocks for anterior cutaneous nerve entrapment syndrome after robot-assisted gastrectomy: A case report. World J Gastrointest Surg 2024; 16:2719-2723. [DOI: 10.4240/wjgs.v16.i8.2719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 07/17/2024] [Accepted: 07/23/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Anterior cutaneous nerve entrapment syndrome (ACNES) is a condition manifesting with pain caused by strangulation of the anterior cutaneous branch of the lower intercostal nerves. This case report aims to provide new insight into the selection of peripheral nerve blocks for the ACNES treatment.
CASE SUMMARY A 66-year-old woman manifested ACNES after a robot-assisted distal gastrectomy. An ultrasound-guided rectal sheath block was effective for pain triggered by the port scar. However, the sudden severe pain, which radiated laterally from the previous site, remained. A transversus abdominis plane block was performed for the remaining pain and effectively relieved it.
CONCLUSION In this case, the trocar port was inserted between the rectus and transverse abdominis muscles. The intercostal nerves might have been entrapped on both sides of the rectus and transversus abdominis muscles. Hence, rectus sheath and transverse abdominis plane blocks were required to achieve complete pain relief. To the best of our knowledge, this is the first report on use of a combination of rectus sheath and transverse abdominis plane blocks for pain relief in ACNES.
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Affiliation(s)
- Yukiko Saito
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Hirohisa Takeuchi
- Department of Surgery, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Joho Tokumine
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Ryuji Sawada
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Kunitaro Watanabe
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Tomoko Yorozu
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo 181-8611, Japan
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Brunner S, Müller D, Krauss DT, Datta RR, Eckhoff JA, Storms C, von Reis B, Chon SH, Schmidt T, Bruns CJ, Fuchs HF. Cologne ergonomic measurement for robotic surgery (CEMRobSurg) using the Hugo™ RAS System. Surg Endosc 2024:10.1007/s00464-024-11129-7. [PMID: 39187727 DOI: 10.1007/s00464-024-11129-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 07/27/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND The ergonomic advantages and potential challenges that robotic surgery poses to the well-being of surgeons are mainly unexplored. The most recent surgical robot introduced on the European market is the Hugo™ RAS System by Medtronic. This study aims to evaluate the ergonomic benefits of the Hugo™ RAS System, which is available in our training laboratory, CeMIT (Center for Medical Innovation and Technology Cologne). METHODS AND PROCEDURES Using the previously established Cologne Ergonomic Measurement Setup for Robotic Surgery (CEMRobSurg), we measured three parameters related to ergonomic posture from subjects with different levels of surgical expertise (laypeople, medical students, surgical residents, and expert robotic surgeons). The heart rate was measured continuously using a polar band. The noise level was measured while using the Hugo™ RAS System, and automated photographs using our locally developed methodology were captured of the participant every 2 s to assess body posture. The ergonomic measurements were conducted while the subject performed the same standardized robotic training exercises (Peg Board, Rope Walk, and Ring Walk). RESULTS A total of 53 participants were enrolled in this study. The average noise level during all measurements was 54.87 dB. The highest stress level was measured in surgical residents with a sympathetic nervous system index (SNS index) of 1.15 (min - 1.43, max 3.56). The lowest stress level was measured in robotic experts with an SNS index of 0.23 (min - 0.18, max 0.91). We observed a risk-prone positioning of the neck and elbow in medical students (mean 39.6° and 129.48°, respectively). Robotic experts showed a risk positioning in the knee and hip region (mean 107.89° and 90.31°, respectively). CONCLUSION This is the first study to analyze and objectify the ergonomic posture of medical students, surgical trainees, surgeons, and laypeople using the open console, modular Hugo™ RAS System. Our findings offer recommendations for operating surgeons and allow for a comparative analysis between the different robotic systems. Further evaluations in real-time operative scenarios will follow.
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Affiliation(s)
- Stefanie Brunner
- Department of General, Visceral, Cancer and Transplant Surgery, University Hospital of Cologne, 50937, Cologne, Germany.
| | - Dean Müller
- Faculty of Medicine, University of Cologne, 50923, Cologne, Germany
| | - Dolores T Krauss
- Department of General, Visceral, Cancer and Transplant Surgery, University Hospital of Cologne, 50937, Cologne, Germany
| | - Rabi Raj Datta
- Department of General, Visceral, Cancer and Transplant Surgery, University Hospital of Cologne, 50937, Cologne, Germany
| | - Jennifer A Eckhoff
- Department of General, Visceral, Cancer and Transplant Surgery, University Hospital of Cologne, 50937, Cologne, Germany
- Surgical Artificial Intelligence and Innovation Laboratory, Massachusetts General Hospital, 55 Fruit Street, Wang C3-339, Boston, USA
| | - Christian Storms
- Faculty of Medicine, University of Cologne, 50923, Cologne, Germany
| | - Benedikt von Reis
- Medical University of Białystok, ul. Kilinskiego 1, 15-089, Białystok, Poland
| | - Seung-Hun Chon
- Department of General, Visceral, Cancer and Transplant Surgery, University Hospital of Cologne, 50937, Cologne, Germany
| | - Thomas Schmidt
- Department of General, Visceral, Cancer and Transplant Surgery, University Hospital of Cologne, 50937, Cologne, Germany
| | - Christiane J Bruns
- Department of General, Visceral, Cancer and Transplant Surgery, University Hospital of Cologne, 50937, Cologne, Germany
| | - Hans F Fuchs
- Department of General, Visceral, Cancer and Transplant Surgery, University Hospital of Cologne, 50937, Cologne, Germany.
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Cai P, Zheng M, Wang Q, Wen Y, Chen H, Gong F, Lin G, Li X, Ouyang Y. Diagnosis and management of heterotopic intramural pregnancy after in vitro fertilization: an eight-case series. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2024. [PMID: 39187241 DOI: 10.1055/a-2375-0319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
PURPOSE To analyze the ultrasound characteristics, clinical management, and pregnancy outcomes of heterotopic intramural pregnancies (HIMPs) after embryo transfer. METHODS This was a retrospective observational study of women who were diagnosed with HIMPs. The ultrasound characteristics, clinical treatment, and pregnancy outcomes of patients with HIMPs were evaluated. RESULTS Eight women with HIMPs were included. Among them, 6 patients were diagnosed by transvaginal sonography, and 2 patients were misdiagnosed with heterotopic interstitial pregnancy. The diagnostic accuracy was 75% (6/8). Five patients with HIMPs were diagnosed at the time of the initial scan (5+6-6+3 weeks). An intramural gestational sac was observed in all 6 patients, and an embryo with cardiac activity was detected in one patient on the follow-up scans. Intrauterine pregnancies (IUPs) were revealed in all 6 patients, and embryo(s) with cardiac activity were observed in 5 patients at the time of the initial diagnosis or later. The patients receiving expectant treatment all presented with bagel signs, while patients with embryos with cardiac activity all underwent surgery. Among the 6 diagnosed women, 1 patient was initially treated medically, 4 were treated expectantly, and 1 was treated surgically. Among the 6 diagnosed patients, the IUPs of 5 patients resulted in live infants. CONCLUSION Single ET should be recommended to decrease the possibility of HIMP. An accurate diagnosis of HIMP was reached in most cases by detailed ultrasound early in the first trimester. Most IUPs of HIMPs seem to have good outcomes with timely and proper management. Expectant management might be a possible choice for nonviable intramural pregnancies.
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Affiliation(s)
- Pei Cai
- Imaging Department, Reproductive & Genetic Hospital of CITIC-Xiangya, Changsha City, China
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Changsha City, China
| | - Mingxiang Zheng
- Imaging Department, Reproductive & Genetic Hospital of CITIC-Xiangya, Changsha City, China
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Changsha City, China
| | - Qian Wang
- Imaging Department, Reproductive & Genetic Hospital of CITIC-Xiangya, Changsha City, China
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Changsha City, China
| | - Yi Wen
- Imaging Department, Reproductive & Genetic Hospital of CITIC-Xiangya, Changsha City, China
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Changsha City, China
| | - Hui Chen
- Endoscope center, Reproductive & Genetic Hospital of CITIC-Xiangya, Changsha City, China
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Changsha City, China
| | - Fei Gong
- Reproductive center, Reproductive & Genetic Hospital of CITIC-Xiangya, Changsha City, China
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Changsha City, China
- NHC Key Laboratory of Human Stem Cell and Reproductive Engineering, School of Basic Medical Sciences, Central South University, Changsha City, China
| | - Ge Lin
- Reproductive center, Reproductive & Genetic Hospital of CITIC-Xiangya, Changsha City, China
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Changsha City, China
- NHC Key Laboratory of Human Stem Cell and Reproductive Engineering, School of Basic Medical Sciences, Central South University, Changsha City, China
| | - Xihong Li
- Imaging Department, Reproductive & Genetic Hospital of CITIC-Xiangya, Changsha City, China
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Changsha City, China
| | - Yan Ouyang
- Imaging Department, Reproductive & Genetic Hospital of CITIC-Xiangya, Changsha City, China
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Changsha City, China
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Chatziisaak D, Sparn M, Krstic D, Bauci G, Warschkow R, Brunner W, Schmied B, Hahnloser D, Bischofberger S. Be prepared! Impact of structured video-assisted coaching on performance in a simulated bleeding exercise during laparoscopic surgery. Surg Endosc 2024:10.1007/s00464-024-11173-3. [PMID: 39187730 DOI: 10.1007/s00464-024-11173-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 08/05/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Bleeding during laparoscopic surgery is stressful and requires immediate efficient management. Skills for complication management are rarely trained. This study aims to investigate the impact of video-assisted coaching on laparoscopic skills acquisition and performance in emergency bleeding situations. METHODS Participants faced simulated emergency scenarios during laparoscopy involving bleeding management in porcine aorta/kidney specimens. Four sequences were conducted over two days, with a structured video-assisted coaching provided between sequences. Performance was assessed using the Global Operative Assessment of Laparoscopic Skills (GOALS) score. The study involved 27 participants attending the advanced colorectal surgery module at the 40th Annual Davos Course in 2023. RESULTS 54 video sequences were analyzed. Structured video-assisted coaching improved the GOALS sum score by 0.36 (95%CI: 0.21-0.50, P < 0.001) in contrast to simple repetition (0.05 with 95%CI: -0.43 to 0.53, P = 0.826). This association was observed for depth of perception (P < 0.001), bimanual dexterity (P < 0.001), tissue handling (P < 0.001), overall performance (P < 0.001), and efficiency (P < 0.001). Autonomy did not significantly improve (P = 0.55). Findings were consistent regardless of age, gender, and overall laparoscopic experience of the participants. However, a weaker effect of structured video-assisted coaching was observed in participants with experience in laparoscopic surgery. CONCLUSION Structured video-assisted coaching improved performance in laparoscopic skills in complex and stress-inducing bleeding scenarios. The findings of this study support the incorporation of video-assisted coaching and complication management exercises into surgical training curricula.
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Affiliation(s)
- Dimitrios Chatziisaak
- Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
- Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - Moritz Sparn
- Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Daniel Krstic
- Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Gabriele Bauci
- Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Réne Warschkow
- Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Walter Brunner
- Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
- Paracelsus Medical University, Salzburg, Austria
| | - Bruno Schmied
- Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Dieter Hahnloser
- Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland.
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Bourdon M, Maignien C, Marcellin L, Maitrot Mantelet L, Parpex G, Santulli P, Chapron C. Distribution of endometriosis phenotypes according to patients' age in adult women with surgical evaluation. Hum Reprod 2024:deae180. [PMID: 39186806 DOI: 10.1093/humrep/deae180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 07/01/2024] [Indexed: 08/28/2024] Open
Abstract
STUDY QUESTION What is the distribution of endometriosis phenotypes according to age in adult women undergoing surgery? SUMMARY ANSWER The phenotype of endometriosis did not significantly vary after 24 years old. WHAT IS KNOWN ALREADY The phenotypic evolution of endometriosis over time remains unclear. While adolescents can exhibit any type of endometriosis lesions, ovarian endometriosis (OMA) and/or deep-infiltrating endometriosis (DIE) tend to increase with age in young adults. In adulthood, understanding the evolution of lesions is crucial for disease management, but the literature on this subject is limited. This study aims to examine the distribution of endometriosis phenotypes in relation to age among adult patients requiring surgical treatment. STUDY DESIGN, SIZE, DURATION This observational cohort study included patients aged between ≥18 and ≤42 years, who underwent surgery for benign gynecological conditions at our institution between January 2004 and December 2022. A standardized questionnaire was completed for each patient during a face-to-face interview conducted by the surgeon in the month preceding surgery. Women with histologically proven endometriosis were included. PARTICIPANTS/MATERIALS, SETTING, METHODS The distribution of endometriosis phenotypes (isolated superficial (SUP) endometriosis, OMA ± SUP, DIE ± SUP/OMA) was compared between young adults (≤24 years) and adults (>24 years) and among adults (25-28 years, 29-33 years, 34-38 years, 39 to ≤42 years) using univariate and multivariate analysis. The distribution of different subtypes of DIE (uterosacral ligament(s), vagina, bladder, intestine, and ureter), OMA size, and intensity of pain symptoms were also examined. MAIN RESULTS AND THE ROLE OF CHANCE A total of 1311 adult women with histologically proven endometriosis were included. In women aged 24 years or younger (n = 116), the distribution of endometriosis phenotypes differed significantly from women older than 24 years (n = 1195): The frequency of the DIE ± SUP/OMA phenotype was lower (41.4% versus 56.1%, respectively), while the rate of isolated superficial lesions was higher (from 32.0% versus 25.9%) (P = 0.001). In the group of women aged >24 years, a significantly higher proportion of vaginal DIE lesions (P = 0.012) and a lower proportion of uterosacral ligament DIE lesions (P = 0.004) were found compared to women aged ≤24 years. No significant differences were observed in terms of endometrioma size. Between the ages of 25 and 42 years, there were no significant changes in the distribution of endometriosis phenotypes after univariate and multivariate analysis. The distribution of subtype of DIE lesions did not significantly change with age between 25 and 42 years. Concerning pain symptom scores, there was a significant decrease with age for dysmenorrhea and dyspareunia. LIMITATIONS, REASONS FOR CAUTION Inclusion of only surgical patients may have introduced a selection bias. Women referred to our center may have suffered from particularly severe clinical forms of endometriosis. WIDER IMPLICATIONS OF THE FINDINGS This study highlights that endometriosis presentation did not change with age in adult women. Further research on endometriosis phenotype evolution is necessary to assist practitioners in clinical decisions and treatment strategies. STUDY FUNDING/COMPETING INTERESTS None declared. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- M Bourdon
- Faculté de Médecine, Université de Paris Cité, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department "Development, Reproduction and Cancer", Cochin Institute, INSERM U1016, Paris, France
| | - C Maignien
- Department of Gynecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
| | - L Marcellin
- Faculté de Médecine, Université de Paris Cité, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department "Development, Reproduction and Cancer", Cochin Institute, INSERM U1016, Paris, France
| | - L Maitrot Mantelet
- Department of Gynecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
| | - G Parpex
- Faculté de Médecine, Université de Paris Cité, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department "Development, Reproduction and Cancer", Cochin Institute, INSERM U1016, Paris, France
| | - P Santulli
- Faculté de Médecine, Université de Paris Cité, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department "Development, Reproduction and Cancer", Cochin Institute, INSERM U1016, Paris, France
| | - C Chapron
- Faculté de Médecine, Université de Paris Cité, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department "Development, Reproduction and Cancer", Cochin Institute, INSERM U1016, Paris, France
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Imakando MM, Maya E, Owiredu D, Monde MW, Jacobs C, Fwemba I, Akuffo KO, Danso-Appiah A. The burden of iatrogenic obstetric fistulas in Sub-Saharan Africa: Systematic review and meta-analysis protocol. PLoS One 2024; 19:e0302529. [PMID: 39186485 PMCID: PMC11346637 DOI: 10.1371/journal.pone.0302529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 04/07/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Obstetric fistulas are abnormal open connection(s) between the vagina and the urinary tract or the rectum resulting from tragic injuries sustained by mothers during childbirth that lead to urine and/or faecal incontinence. Due to the rapidly growing middle class in sub-Saharan Africa (SSA) and the corresponding quest for hospital delivery and caesarean section, surgery-related (iatrogenic) obstetric fistulas are on the rise. Worryingly, there is scanty data on surgery-related fistulas. This review aims to collate empirical evidence on the magnitude of iatrogenic obstetric fistulas in SSA, generate country-specific data and explore factors that influence obstetric surgery-related fistulas. METHODS All relevant databases, PubMed, LILACS, CINAHL, SCOPUS and Google Scholar will be searched from 1st January 2000 to 31st March 2024 using search terms developed from the major concepts in the title without restrictions by language. The Cochrane Library, African Journals Online, Data Base of African Thesis and Dissertations Including Research (DATAD-R D Space) and preprint repositories will also be searched. Reference lists of relevant studies will be searched and experts in the field will be contacted for additional (unpublished) studies. The search output will be exported to Endnote where duplicate studies will be removed. The deduplicated studies will be exported to Rayyan where study screening and selection will be conducted. At least two authors will independently select studies, extract data and assess quality in the included studies using pretested tools. Disagreements between reviewers will be resolved through discussion. Data analysis will be performed with RevMan 5.4. Comparative binary outcomes will be reported as odds ratio (OR) or risk ratio (RR) and for continuous outcomes, mean difference and standard deviations (SDs) will be used. Non-comparative studies will be analysed as weighted proportions. Heterogeneity between studies will be assessed graphically and statistically, and where a significant level is detected, the random-effects model meta-analysis will be performed. All estimates will be reported with their 95% confidence intervals (CIs). Where data permit, we will conduct subgroup and sensitivity analyses to test the robustness of the estimates on key quality domains. The overall quality of the evidence will be assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation). EXPECTED STUDY OUTCOMES This systematic review and meta-analysis uses rigorous methods and best practices to attempt to collate all empirical evidence and estimate country-specific proportions of iatrogenic (surgery-related) fistulas among obstetric fistula patients across countries in SSA. This review will explore context-specific variables, provide insights into their impact and relate them to the type and experience of personnel performing the obstetric procedures that lead to obstetric fistulas. The findings of the full review are expected to inform the development of national and regional Training Programs for Medical Officers, support the development of a consensus "minimum acceptable standard of care" and inform quality assurance standards for clinicians involved in the provision of surgical obstetric care.
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Affiliation(s)
- Mercy M. Imakando
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
- Department of Obstetrics and Gynaecology, Women and Newborn Hospital, University Teaching Hospitals, Lusaka, Zambia
| | - Ernest Maya
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - David Owiredu
- Centre for Evidence Synthesis and Policy, University of Ghana, Accra, Ghana
| | | | - Choolwe Jacobs
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Isaac Fwemba
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Kwadwo Owusu Akuffo
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Anthony Danso-Appiah
- Centre for Evidence Synthesis and Policy, University of Ghana, Accra, Ghana
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana
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Zhang G, Zhang M, Feng Q, Wang R, Mei H, Xing K, Li J. Supramolecular Composite Hydrogel Loaded with CaF 2 Nanoparticles Promotes the Recovery of Periodontitis Bone Resorption. ACS APPLIED MATERIALS & INTERFACES 2024. [PMID: 39183483 DOI: 10.1021/acsami.4c07210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
Treatments to reduce periodontal inflammation and rescue periodontitis bone resorption have been of interest to researchers. Bone tissue engineering materials have been gradually used in the treatment of bone defects, but periodontal bone tissue regeneration still faces challenges. Considering the biocompatibility factor, constructing bionic scaffolds with natural extracellular matrix properties is an ideal therapeutic pathway. Based on the pathological mechanism of periodontitis, in this study, short peptide and nanometer inorganic particles were comingled to construct NapKFF-nano CaF2 supramolecular composite hydrogels with different ratios. Material characterization experiments confirmed that the composite hydrogel had suitable mechanical properties and a three-dimensional structure that can function in the resorption region of the alveolar bone and provide spaces for cell proliferation and adhesion. The release of low concentrations of fluoride and calcium ions has been shown to have positive biological effects in both in vivo and in vitro experiments. Vitro experiments confirmed that the composite hydrogel had good biocompatibility and promoted osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs). Microbiological experiments confirmed that the composite hydrogel inhibited the activity of periodontal pathogenic bacteria. In animal studies, composite hydrogel applied to periodontitis rats in vivo can effectively repair alveolar bone resorption. This composite hydrogel has a simple preparation method and is inexpensive to produce, yet it has antibacterial and osteogenesis-promoting incremental effects, which makes it well suited for the treatment of periodontitis bone resorption, providing a new strategy for periodontal bone tissue engineering.
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Affiliation(s)
- Guanning Zhang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, Third Section, Renmin South Rd, Chengdu 610041, Sichuan, China
| | - Mei Zhang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, Third Section, Renmin South Rd, Chengdu 610041, Sichuan, China
| | - Qingchen Feng
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, Third Section, Renmin South Rd, Chengdu 610041, Sichuan, China
| | - Ruohan Wang
- National Engineering Research Center for Biomaterials, College of Biomedical Engineering, Sichuan University, Chengdu 610064, Sichuan, China
| | - Hongxiang Mei
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, Third Section, Renmin South Rd, Chengdu 610041, Sichuan, China
| | - Ke Xing
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, Third Section, Renmin South Rd, Chengdu 610041, Sichuan, China
| | - Juan Li
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, Third Section, Renmin South Rd, Chengdu 610041, Sichuan, China
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85
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Kasuga Y, Tanigaki S, Seo K, Harada A, Kuwabara Y, Ishioka S, Tanaka M. Obstetric outcomes of transabdominal cerclage: A retrospective observational study in Japan. J Obstet Gynaecol Res 2024. [PMID: 39183504 DOI: 10.1111/jog.16063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 08/08/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVE This study aimed to investigate the obstetric outcomes of transabdominal cerclage (TAC) in Japan. METHODS Questionnaires on TAC were sent to 183 institutions performing high-quality perinatal management in Japan. As a first-step questionnaire, we asked whether TAC was performed between January 1, 2011, and December 31, 2022. In the second step of the questionnaire, the characteristics of all cases were asked from all institutions in which TAC was performed. RESULTS The response rate for the first survey was 59% (108/183). Of the 108 institutions, 27 performed TAC (25%) in 133 pregnancies. Of these 27 institutions, 19 responded to the second survey. One hundred twenty-five pregnancies were included in this study, five of which were aborted (gestational weeks <22 weeks), and 69 babies were born after 37 gestational weeks (55%). Eighty-two open abdominal cerclages were performed at 17 institutions and 43 laparoscopic TACs at three institutions. There were no differences in the age at TAC, gestational weeks at TAC, operative time of TAC, gestational weeks at delivery, incidence rate of second-trimester loss, or preterm delivery (before 37 gestational weeks) rate between the two groups. However, blood loss during open TAC was greater than that during laparoscopic TAC. CONCLUSION TAC is a rare surgery for cervical insufficiency in Japan. TAC may be a safe and useful method for preventing second-trimester loss and preterm delivery in high-risk patients. TAC may also be a key option in Japan to improve perinatal outcomes in patients with cervical insufficiency.
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Affiliation(s)
- Yoshifumi Kasuga
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Shinji Tanigaki
- Department of Obstetrics and Gynecology, Kyorin University, Tokyo, Japan
| | - Kohei Seo
- Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Ayumi Harada
- Department of Obstetrics and Gynecology, Nagasaki University Hospital, Nagasaki, Japan
| | - Yoshimitsu Kuwabara
- Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan
| | - Shinichi Ishioka
- Department of Obstetrics and Gynecology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Mamoru Tanaka
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
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Ferla S, Virgilio A, Arena A, Raimondo D, Raffone A, Seracchioli R, Casadio P. "Hysteroscopic management of complete vaginal and uterine septum with double cervix: tips & tricks for a safe surgery". J Pediatr Adolesc Gynecol 2024:S1083-3188(24)00288-2. [PMID: 39187117 DOI: 10.1016/j.jpag.2024.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 08/17/2024] [Accepted: 08/20/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND The septate uterus is the most common uterine abnormality, comprising 35% of all identified uterine malformations. According to the ESHRE/ESGE 2013 classification, the class U2bC2V1 is a rare congenital malformation characterized by a complete septate uterus with double cervix and nonobstructive longitudinal vaginal septum. STUDY OBJECTIVE to share the decision-making process, the preoperative ultrasonographic assessment and our step-by-step hysteroscopic surgery technique to manage this complex malformation: including how to access the septate uterine cavity, the resection of the septum and its post-operative management. The goal of the surgical treatment is to restore the regular morphology of the vaginal canal and the uterine cavity with the right amount of myometrium. METHODS we present video footage of a hysteroscopic approach at a tertiary care academic medical center for managing a 21-year-old patient with a symptomatic uterine septum with double cervix and non-obstructive longitudinal vaginal septum. RESULTS Both the Intraoperative and postoperative periods were uneventful: a complete resolution of the vaginal septum and creation of a single uterine cavity were obtained. CONCLUSION Due to the significant anatomic variability of this condition, this type of surgery can be challenging. The goal of this video is also educational, aiming to illustrate a reproducible technique that can be utilized by younger or less experienced surgeons. In our experience, this hysteroscopic technique appears to be a valid option for patients with symptomatic Mullerian malformation or those with a history of recurrent miscarriages or unexplained infertility.
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Affiliation(s)
- Stefano Ferla
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero - Universitaria di Bologna, Bologna, 40138 Italy; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, 40138, Italy
| | - Agnese Virgilio
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero - Universitaria di Bologna, Bologna, 40138 Italy; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, 40138, Italy.
| | - Alessandro Arena
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero - Universitaria di Bologna, Bologna, 40138 Italy; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, 40138, Italy
| | - Diego Raimondo
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero - Universitaria di Bologna, Bologna, 40138 Italy
| | - Antonio Raffone
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, 40138, Italy
| | - Renato Seracchioli
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero - Universitaria di Bologna, Bologna, 40138 Italy; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, 40138, Italy
| | - Paolo Casadio
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero - Universitaria di Bologna, Bologna, 40138 Italy; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, 40138, Italy
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Heus C, Stelten S, Kenter GG, Buffart LM, van Lonkhuijzen LRCW. Body composition and peri- and postoperative complications in patients with gynaecological malignancies: A systematic review. Gynecol Oncol 2024; 190:131-138. [PMID: 39182424 DOI: 10.1016/j.ygyno.2024.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/13/2024] [Accepted: 08/14/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND In general abdominal surgery, the ratio of fat to muscle mass, or body composition measures, shows a stronger association with complications than body mass index. These studies include male and female patients. Women have a different body composition than men. Therefore, findings from general abdominal surgery cannot be extrapolated to women with cancer. The aim of this systematic review is to summarise the evidence on the association between body composition and peri- and postoperative complications in patients with gynaecological cancer. METHODS Pubmed, Embase and the Cochrane Central databases were searched in June 2023. Studies were eligible if they included patients undergoing surgery for gynaecological cancer and reported on the association between body composition (muscle or fat mass) and surgical complications. The quality of the studies was assessed using the Newcastle-Ottawa quality assessment scale. A best-evidence synthesis was used to summarise the level of evidence. RESULTS Fifteen studies were included that assessed muscle mass (n = 9) or fat mass (n = 6). We found strong evidence that there was no association between visceral fat and length of hospital stay. We found moderate evidence that a higher amount of good quality muscle was associated with a lower risk of postoperative complications. We found moderate evidence that there was no association between muscle or fat mass (i.e., muscle- or subcutaneous fat) and postoperative complications or fat mass and intraoperative complications. There was insufficient evidence for an association between visceral fat and intraoperative or postoperative complications, and for an association between muscle mass or -quality and length of hospital stay. There was high heterogeneity in the methods used to measure body composition, hampering meta-analyses. CONCLUSION The association between body composition, particularly adipose tissue and muscle quality, and complications suggests that these measures may be of interest in determining postoperative risk in women undergoing surgery for gynaecological cancer.
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Affiliation(s)
- C Heus
- Amsterdam UMC, Department of Obstetrics and Gynaecologic Oncology Amsterdam (CGOA), Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands; Northwest Clinics Den Helder, Department of Gynaecology, Huisduinerweg 3, 1782GZ Den Helder, the Netherlands.
| | - S Stelten
- Radboud University Medical Center, Department of Medical BioSciences, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - G G Kenter
- Amsterdam UMC, Department of Obstetrics and Gynaecologic Oncology Amsterdam (CGOA), Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands
| | - L M Buffart
- Radboud University Medical Center, Department of Medical BioSciences, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - L R C W van Lonkhuijzen
- Amsterdam UMC, Department of Obstetrics and Gynaecologic Oncology Amsterdam (CGOA), Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands
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88
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Wang C, Zhang X. Pelvic organ-preserving radical cystectomy versus standard radical cystectomy in female patients diagnosed with bladder cancer. World J Surg Oncol 2024; 22:218. [PMID: 39182105 PMCID: PMC11344460 DOI: 10.1186/s12957-024-03502-6] [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: 03/09/2024] [Accepted: 08/13/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND Pelvic organ-preserving radical cystectomy (POPRC) has been reported to result in a better postoperative quality of life in female with bladder cancer compared to standard radical cystectomy (SRC). However, its oncological outcomes remain a concern. PATIENTS AND METHODS Female patients with bladder cancer who underwent POPRC or SRC were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Logistic regression was used to identify predictors of POPRC usage. To avoid the potential impact of baseline differences between groups on survival, a 1:2 propensity score matching (PSM) was implemented. After that, Kaplan-Meier curves and Log-rank tests were used to determine the significance of overall survival (OS) differences between patients in the SRC group and POPRC group. Finally, subgroup analysis based on predetermined indicators was performed. RESULTS A total of 2193 patients were included with a median follow-up of 53 months, of whom 233 (10.6%) received POPRC and 1960 (89.4%) received SRC. No definitive predictors of POPRC were identified. Before PSM, POPRC resulted in comparable OS to SRC (HR = 1.09, p = 0.309), while after PSM, POPRC was associated with significantly worse OS (HR = 1.23, p = 0.038). In subgroup analyses, POPRC led to non-inferior OS (HR = 1.18, 95%CI 0.71-1.95, p = 0.531) in patients with non-muscle invasive bladder cancer (NMIBC) and T2 patients (HR = 1.07, p = 0.669), but significantly worse OS in T3 patients (HR = 1.41, p = 0.02). CONCLUSION Currently, patients undergoing POPRC have not undergone strict screening, and candidates for POPRC should have more stringent criteria in the future to achieve satisfactory oncological outcomes. However, flaws in the study make more evidence needed to support our findings.
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Affiliation(s)
- Chuanlin Wang
- Department of Urology, Chongqing University Fuling Hospital, No.2 Gaosuntang Road, Fuling District, Chongqing, 408000, China
| | - Xin Zhang
- Department of Urology, Chongqing University Fuling Hospital, No.2 Gaosuntang Road, Fuling District, Chongqing, 408000, China.
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89
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Iavazzo C, Fotiou A, Kokkali K, Gkegkes ID. Transvaginal morcellation: tips and tricks and the role of "Iavazzo score". Arch Gynecol Obstet 2024:10.1007/s00404-024-07716-7. [PMID: 39180565 DOI: 10.1007/s00404-024-07716-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Accepted: 08/19/2024] [Indexed: 08/26/2024]
Affiliation(s)
- Christos Iavazzo
- Gynaecological Oncology Department, Metaxa Cancer Hospital, Piraeus, Greece
| | - Alexandros Fotiou
- Gynaecological Oncology Department, Metaxa Cancer Hospital, Piraeus, Greece
| | - Kalliopi Kokkali
- Gynaecological Oncology Department, Metaxa Cancer Hospital, Piraeus, Greece
| | - Ioannis D Gkegkes
- Athens Colorectal Laboratory, Athens, Greece.
- Department of Colorectal Surgery, Royal Devon and Exeter NHS Foundation Trust, 17C James House, Residential Village, Bovemoors Lane, Exeter, EX2 5DS, UK.
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90
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Gu W, Yuan J, Zhou Y, Li Y, Wang Y. Impact of ultrasound-guided high-intensity focused ultrasound for the treatment of uterine fibroids on ovarian reserve and quality of life: a single-center prospective cohort study. BMC Womens Health 2024; 24:470. [PMID: 39182055 PMCID: PMC11344425 DOI: 10.1186/s12905-024-03315-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 08/14/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND We aimed to evaluate changes in ovarian reserve and quality of life in women treated with ultrasound-guided high-intensity focused ultrasound (USgHIFU) for uterine fibroids. METHODS In this single-center prospective study, a total of 69 patients with uterine fibroids treated with USgHIFU from October 2018 to November 2021 were enrolled. Fibroid volume, anti-Müllerian hormone (AMH) levels, uterine fibroid symptom scores, and uterine fibroid symptoms and quality of life (UFS-QOL) questionnaire scores before and 1, 3, and 6 months after USgHIFU treatment were analyzed. Correlations between AMH levels and age, fibroid type, and fibroid location were assessed. RESULTS Data from 54 of the 69 patients included in the present study were analyzed. The UFS-QOL scores at baseline and at 1 month and 6 months after USgHIFU treatment were 70 (50.75-87.50), 57 (44.75-80.00), and 52 (40.75-69.00) points, respectively (p < 0.001). The rate of fibroid volume reduction increased significantly at the 3-month follow-up compared with the 1-month follow-up (p < 0.001), and no significant change was observed between the 3-month and 6-month follow-ups (p > 0.99). The median AMH levels before and at 1, 3 and 6 months after treatment were 1.22 (0.16-3.28) ng/ml, 1.12 (0.18-2.52) ng/ml, 1.15 (0.19-2.08) ng/ml and 1.18 (0.36-2.43) ng/ml, respectively (p = 0.2). Multivariate linear regression analyses revealed that age was independently associated with AMH levels. CONCLUSIONS USgHIFU treatment for uterine fibroids can significantly improve quality of life with minimal adverse effects on ovarian function.
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Affiliation(s)
- Wei Gu
- Department of Gynecologic Oncology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Jiangjing Yuan
- Department of Gynecologic Oncology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Yun Zhou
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
- Department of Ultrasonography, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Yuhong Li
- Department of Gynecologic Oncology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Yudong Wang
- Department of Gynecologic Oncology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China.
- Shanghai Municipal Key Clinical Specialty, Shanghai, China.
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.
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91
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Celik HG, Buyuker C, Aksakal B, Buyru F. Uterine artery embolization due to intraabdominal bleeding eight weeks after myomectomy: Uterine artery embolization after myomectomy. J Minim Invasive Gynecol 2024:S1553-4650(24)00356-X. [PMID: 39182571 DOI: 10.1016/j.jmig.2024.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 08/13/2024] [Accepted: 08/16/2024] [Indexed: 08/27/2024]
Affiliation(s)
- Hale Goksever Celik
- Acibadem Mehmet Ali Aydinlar University, Acibadem Fulya Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.
| | - Ceyda Buyuker
- Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey.
| | - Boran Aksakal
- Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey.
| | - Faruk Buyru
- Acibadem Fulya Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.
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Hwang J, Kim B, Jin C, Lee G, Jeong H, Lee H, Noh J, Lim SJ, Kim JY, Choi H. Shortwave Infrared Imaging of a Quantum Dot-Based Magnetic Guidewire Toward Non-Fluoroscopic Peripheral Vascular Interventions. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024:e2404251. [PMID: 39175372 DOI: 10.1002/smll.202404251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 08/14/2024] [Indexed: 08/24/2024]
Abstract
Peripheral vascular interventions (PVIs) offer several benefits to patients with lower extremity arterial diseases, including reduced pain, simpler anesthesia, and shorter recovery time, compared to open surgery. However, to monitor the endovascular tools inside the body, PVIs are conducted under X-ray fluoroscopy, which poses serious long-term health risks to physicians and patients. Shortwave infrared (SWIR) imaging of quantum dots (QDs) has shown great potential in bioimaging due to the non-ionizing penetration of SWIR light through tissues. In this paper, a QD-based magnetic guidewire and its system is introduced that allows X-ray-free detection under SWIR imaging and precise steering via magnetic manipulation. The QD magnetic guidewire contains a flexible silicone tube encapsulating a QD polydimethylsiloxane (PDMS) composite, where HgCdSe/HgS/CdS/CdZnS/ZnS/SiO2 core/multi-shell QDs are dispersed in the PDMS matrix for SWIR imaging upon near-infrared excitation, as well as a permanent magnet for magnetic steering. The SWIR penetration of the QD magnetic guidewire is investigated within an artificial tissue model (1% Intralipid) and explore the potential for non-fluoroscopic PVIs within a vascular phantom model. The QD magnetic guidewire is biocompatible in its entirety, with excellent resistance to photobleaching and chemical alteration, which is a promising sign for its future clinical implementation.
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Affiliation(s)
- Junsun Hwang
- Department of Robotics and Mechatronics Engineering, Daegu Gyeongbuk Institute of Science and Technology (DGIST), Daegu, 42988, Republic of Korea
- DGIST-ETH Microrobotics Research Center, DGIST, Daegu, 42988, Republic of Korea
- Robotics and Mechatronics Engineering Research Center, DGIST, Daegu, 42988, Republic of Korea
- Institute of Mechanical Engineering, École polytechnique fédérale de Lausanne (EPFL), Lausanne, 1015, Switzerland
| | - Beomjoo Kim
- Department of Robotics and Mechatronics Engineering, Daegu Gyeongbuk Institute of Science and Technology (DGIST), Daegu, 42988, Republic of Korea
- DGIST-ETH Microrobotics Research Center, DGIST, Daegu, 42988, Republic of Korea
| | - Chaewon Jin
- Division of Biotechnology, DGIST, Daegu, 42988, Republic of Korea
| | - Gyudong Lee
- DGIST-ETH Microrobotics Research Center, DGIST, Daegu, 42988, Republic of Korea
- Division of Nanotechnology, DGIST, Daegu, 42988, Republic of Korea
| | - Hwajun Jeong
- DGIST-ETH Microrobotics Research Center, DGIST, Daegu, 42988, Republic of Korea
- Division of Nanotechnology, DGIST, Daegu, 42988, Republic of Korea
| | - Hyunki Lee
- DGIST-ETH Microrobotics Research Center, DGIST, Daegu, 42988, Republic of Korea
- Division of Intelligent Robotics, DGIST, Daegu, 42988, Republic of Korea
| | - Jonggu Noh
- Division of Intelligent Robotics, DGIST, Daegu, 42988, Republic of Korea
| | - Sung Jun Lim
- DGIST-ETH Microrobotics Research Center, DGIST, Daegu, 42988, Republic of Korea
- Division of Nanotechnology, DGIST, Daegu, 42988, Republic of Korea
| | - Jin-Young Kim
- DGIST-ETH Microrobotics Research Center, DGIST, Daegu, 42988, Republic of Korea
- Division of Biotechnology, DGIST, Daegu, 42988, Republic of Korea
- Department of Interdisciplinary Engineering, DGIST, Daegu, 42988, Republic of Korea
| | - Hongsoo Choi
- Department of Robotics and Mechatronics Engineering, Daegu Gyeongbuk Institute of Science and Technology (DGIST), Daegu, 42988, Republic of Korea
- DGIST-ETH Microrobotics Research Center, DGIST, Daegu, 42988, Republic of Korea
- Robotics and Mechatronics Engineering Research Center, DGIST, Daegu, 42988, Republic of Korea
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93
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Ahmed TM, Coco A, Vaught AJ, Gomez EN. MR imaging for preoperative characterization of pelvic adhesions: role in diagnosis and surgical planning. Abdom Radiol (NY) 2024:10.1007/s00261-024-04527-x. [PMID: 39177777 DOI: 10.1007/s00261-024-04527-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/06/2024] [Accepted: 08/10/2024] [Indexed: 08/24/2024]
Abstract
Pelvic adhesions are nonanatomic connections between organs and normal peritoneal surfaces that develop secondary to a maladaptive inflammatory response to tissue insults. Comprised of fibrous tissue, adhesions can result in the distortion of operative dissection planes, which can complicate the establishment of abdominal access in patients undergoing surgery, prolong the length of surgery, and increase the risk of injury to bowel and other structures if involved by extensive adhesive disease. This can adversely impact patient outcomes by increasing the risk of surgical complications including bleeding, infection, and prolonging postoperative length of stay. Literature on the characterization of adhesions with imaging is limited and a systematic framework for evaluating adhesive disease on cross-sectional imaging of the pelvis does not currently exist. In this review, we discuss the MR imaging features of pelvic adhesions, highlighting unique teaching cases in which surgical exploration was significantly complicated by the presence of adhesive disease. We will also review the correlation between MR imaging and intraoperative findings in these cases. A proposed standardized framework for the detection and characterization of adhesions on pelvic MRI will be reviewed with multiple imaging examples. Identification and characterization of pelvic adhesive disease on preoperative imaging provides radiologists with an opportunity to inform the referring clinician of their presence, potentially improving outcomes and the quality of patient care.
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Affiliation(s)
- Taha M Ahmed
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 601 N Caroline St, Baltimore, MD, 21205, USA
| | - Abigail Coco
- The Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, USA
| | - Arthur J Vaught
- Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, 600 N Wolfe Street, Baltimore, MD, 21287, USA
| | - Erin N Gomez
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 601 N Caroline St, Baltimore, MD, 21205, USA.
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94
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Liu S, Zhang Y, Ma X, Zhan C, Ding N, Shi M, Zhang W, Yang S. Protective effects of engineered Lactobacillus crispatus strains expressing G-CSF on thin endometrium of mice. Hum Reprod 2024:deae190. [PMID: 39178354 DOI: 10.1093/humrep/deae190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 06/26/2024] [Indexed: 08/25/2024] Open
Abstract
STUDY QUESTION Does recombinant Lactobacillus expressing granulocyte colony-stimulating factor (G-CSF) have a better protective effect than the current treatment of thin endometrium (TE)? SUMMARY ANSWER This study suggested that the intrauterine injection of Lactobacillus crispastus (L. crispastus)-pPG612-G-CSF has a positive effect on preventing TE induced by 95% alcohol in mice. WHAT IS KNOWN ALREADY TE has a negative impact on the success rate of ART in patients, and is usually caused by intrauterine surgery, endometrial infection, or hormone drugs. Exogenous G-CSF can promote endometrial vascular remodelling and increase endometrial receptivity and the embryo implantation rate. Moreover, Lactobacillus plays a crucial role in maintaining and regulating the local microecological balance of the reproductive tract, and it could be a delivery carrier of the endometrial repair drug G-CSF. STUDY DESIGN, SIZE, DURATION We constructed engineered L. crispastus strains expressing G-CSF. The mice were divided into five groups: (i) Control group (C, n = 28), uteri were treated with preheated saline solution via intrauterine injection on the third and sixth day of oestrus; (ii) Model group (M, n = 35), where uteri were treated with 95% alcohol on the third day of oestrus and preheated saline solution on the sixth day of oestrus via intrauterine injection; (iii) L. crispatus-pPG612-treatment group (L, n = 45), where uteri were treated with 95% alcohol on the third day of oestrus and 0.1 ml × 108 CFU/ml L. crispatus-pPG612 on the sixth day of oestrus via intrauterine injection; (iv) L. crispatus-pPG612-treatment group (LG, n = 45), where uteri were treated with 95% alcohol on the third day of oestrus and 0.1 ml × 108 CFU/ml L. crispatus-pPG612-G-CSF on the sixth day of oestrus via intrauterine injection; (v) G-CSF-treatment group (G, n = 52), where uteri were treated with 95% alcohol on the third day of oestrus and 30 µg/kg G-CSF on the sixth day of oestrus via intrauterine injection. Then, we compared the effects of L. crispastus, L. crispatus-pPG612-G-CSF and G-CSF on endometrial thickness, angiogenesis, fibrosis, and inflammation in the TE mouse. PARTICIPANTS/MATERIALS, SETTING, METHODS We collected uterine tissues for haematoxylin-eosin staining, immunohistochemical staining, Western blot and RT-PCR, as well as serum for ELISA and uterine flushing solution for high-throughput sequencing. MAIN RESULTS AND THE ROLE OF CHANCE Compared with those in the M group (the mice of the group were intrauterine injected 95% alcohol and treated with saline solution), the L. crispatus-pPG612-G-CSF strain increased the thickness of the endometrium (P < 0.001) and the number of blood vessels and glands (both P < 0.001), enhanced the expression of cytokeratin 19 (CK19) (P < 0.001), vimentin (Vim) (P < 0.001), vascular endothelial growth factor-A (P < 0.001), and CD34 (P < 0.001), and decreased fibrosis levels (P = 0.004). In addition, the high-throughput sequencing results indicated that the L. crispatus-pPG612-G-CSF strain could decrease the abundance of Pseudomonas (P = 0.044) and Actinomyces spp. (P = 0.094) in TE mice and increased the average number of embryos (P = 0.036). Finally, the L. crispatus-pPG612-G-CSF strain was preliminarily confirmed to activate the phosphoinositide 3-kinase/protein kinase B (PI3K/AKT) signalling pathway and enhance the mRNA expression of hypoxia-inducible factor-1α (P < 0.001), vascular endometrial growth factor (P = 0.003), and endothelial cell nitric oxide synthase (P = 0.003) in mouse uterine tissue. LARGE SCALE DATA N/A. LIMITATIONS, REASONS FOR CAUTION Therapy with the L. crispatus-pPG612-G-CSF strain has tremendous potential to accelerate the reparative processes of TE. However, we have reported only the expression of genes and proteins related to the PI3K/AKT pathway, and numerous other mechanisms may also be involved in the restoration of the endometrium by L. crispatus-pPG612-G-CSF. WIDER IMPLICATIONS OF THE FINDINGS The results from the study provide new ideas and suggest new methods for TE treatment. STUDY FUNDING/COMPETING INTEREST(S) This work was financially supported by the Project of Science and Technology Development Plan of Jilin Province (grant number 20210101232JC), the Science and Technology Plan Item of Jilin Provincial Education Department (grant number JT53101022010), and the Doctoral Research Start-up Fund of Jilin Medical University (grant numbers JYBS2021014LK and 2022JYBS006KJ). The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest.
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Affiliation(s)
- Shuang Liu
- Reproductive Immunology Laboratory, Basic Medical College, Jilin Medical University, Jilin, China
- Histology Development Laboratory, College of Animal Science and Technology, Jilin Agricultural University, Changchun, China
| | - Yingnan Zhang
- Chronic Disease Laboratory, School of Public Health, Jilin Medical University, Jilin, China
- Department of Biology, College of Life Science, Changchun Sci-Tech University, Changchun, China
| | - Xin Ma
- Histology Development Laboratory, College of Animal Science and Technology, Jilin Agricultural University, Changchun, China
| | - Chenglin Zhan
- Histology Development Laboratory, College of Animal Science and Technology, Jilin Agricultural University, Changchun, China
| | - Ning Ding
- Histology Development Laboratory, College of Animal Science and Technology, Jilin Agricultural University, Changchun, China
| | - Mai Shi
- Chronic Disease Laboratory, School of Public Health, Jilin Medical University, Jilin, China
| | - Wei Zhang
- Department of Biochemistry and Molecular Biology, Basic Medical College, Jilin Medical University, Jilin, China
| | - Shubao Yang
- Reproductive Immunology Laboratory, Basic Medical College, Jilin Medical University, Jilin, China
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Freeman HD, Mudgway R, Tran Z, Kim R, Lum SS, Namm JP, O'Leary MP, Reeves ME, Wu E, Caba Molina D. Oncologic outcomes and survival of modern surgical approaches for gastric gastrointestinal stromal tumor (GIST). Surg Endosc 2024:10.1007/s00464-024-11152-8. [PMID: 39179690 DOI: 10.1007/s00464-024-11152-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 08/04/2024] [Indexed: 08/26/2024]
Abstract
BACKGROUND Studies have demonstrated comparable outcomes between laparoscopic and open resection of gastrointestinal stromal tumor (GIST). We sought to compare outcomes among robotic, laparoscopic, and open resection of gastric GIST in the era of expanding minimally invasive surgery. METHODS A retrospective analysis was performed of adult patients with gastric GIST undergoing definitive surgery using the National Cancer Database from 2010 to 2020, excluding cases converted to open. Patients were stratified into minimally invasive surgery (MIS), (combined robotic (R) and laparoscopic (L)), and open (O). Hospital length of stay (LOS), 30-day mortality, 90-day mortality, and margin status were assessed. Subgroup analysis was performed to evaluate outcomes between R and L cohorts. Entropy balancing was used to adjust for intergroup differences. Kaplan-Meier survival estimates were used to compare unadjusted 5-year survival. RESULTS Of the 15,022 patients (R = 10.4%, L = 44.3%, O = 45.3%), 63.2% were stage I and 70.6% underwent partial gastrectomy. MIS approach was associated with shorter hospital LOS (β: - 2.58; 95% CI: - 2.82 to - 2.33) and lower odds of 30-day (OR 0.45; 95% CI: 0.30-0.68) and 90-day mortality (OR 0.54; 95% CI: 0.39-0.74) compared to O. Likelihood of R0 resection similar between groups (OR 1.00; 95% CI: 0.88-1.14). Hospital LOS (β: + 0.25; 95% CI: - 0.14-0.64), odds of 30-day (OR 0.99; 95% CI: 0.40-2.46) and 90-day mortality (OR 0.89; 95% CI: 0.47-1.70), and rate of R0 resection (OR 1.02; 95% CI: 0.82-1.27) were comparable between R and L cohorts. Compared to O, MIS approach was associated with improved 5-year OS (log rank p < 0.001). Overall survival was not significantly different between R and L (log rank p = 0.44). CONCLUSION These findings suggest that MIS approach may be considered for resection of gastric GIST in select patients. Among patients receiving an MIS approach, the robotic technique can be considered an oncologically safe alternative to laparoscopic surgery.
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Affiliation(s)
- Hadley D Freeman
- Department of Surgery, Loma Linda University Health, Loma Linda, CA, USA.
| | - Ross Mudgway
- Department of Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Zachary Tran
- Department of Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Rachael Kim
- Department of Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Sharon S Lum
- Department of Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Jukes P Namm
- Department of Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Michael P O'Leary
- Department of Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Mark E Reeves
- Department of Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Esther Wu
- Department of Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - David Caba Molina
- Department of Surgery, Loma Linda University Health, Loma Linda, CA, USA
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Vilos GA, Vilos AG, Abu-Rafea B, Ternamian A, Laberge P, Munro MG. Good practice with fluid management in operative hysteroscopy. Int J Gynaecol Obstet 2024. [PMID: 39171580 DOI: 10.1002/ijgo.15860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 07/31/2024] [Accepted: 08/05/2024] [Indexed: 08/23/2024]
Abstract
Hysteroscopic surgery requires a balance of continuous controlled irrigation and aspiration to distend the endometrial cavity to a degree that provides the clear and stable visual environment necessary for diagnostic and therapeutic procedures. Whereas the preferred distending solution should be isotonic and isonatremic, radiofrequency (RF) electrosurgery with monopolar instrumentation can only be performed with non-ionic (hyponatremic) solutions. Absorption of as little as 500 mL and certainly more than 1000 mL of non-ionic solutions can result in fluid overload and/or dilutional hyponatremia with potentially serious adverse effects under certain conditions and patient characteristics. Both hysteroscopic RF electrosurgery with bipolar instrumentation and electro-mechanical morcellation and aspiration systems use isotonic and isonatremic solutions. Depending on the clinical context, absorption of more than 1500 mL of isonatremic solutions can also result in serious adverse effects. Automated fluid management systems are preferred and recommended, and surgeons should aim to maintain the maximum allowable intravasation of distending media below 1000 and 1500 mL for non-ionic and ionic fluids, respectively.
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Affiliation(s)
- George A Vilos
- Department of Obstetrics and Gynecology, Western University, London, Ontario, Canada
| | - Angelos G Vilos
- Department of Obstetrics and Gynecology, Western University, London, Ontario, Canada
| | - Basim Abu-Rafea
- Department of Obstetrics and Gynecology, Western University, London, Ontario, Canada
| | - Artin Ternamian
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Philippe Laberge
- Department of Obstetrics and Gynecology, Université Laval, Quebec City, Québec, Canada
| | - Malcolm G Munro
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, California, Los Angeles, USA
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97
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Zhan S, Zhu Z, Yu H, Xia Y, Xu T, Wan Z. Meta-analysis of robotic-assisted NOSE versus traditional TWSR in colorectal cancer surgery: postoperative outcomes and efficacy. BMC Surg 2024; 24:238. [PMID: 39174999 PMCID: PMC11342584 DOI: 10.1186/s12893-024-02516-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 07/29/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND This meta-analysis aimed to assess the safety and efficacy of robotic-assisted natural orifice specimen extraction surgery (NOSE) compared to traditional robotic transabdominal wall specimen retrieval surgery (TWSR) for colorectal cancer. METHODS A systematic search was conducted in three electronic databases (PubMed, Web of Science and Embase) from inception to August 2023. Primary outcomes included postoperative complications, the number of lymph nodes harvested, overall survival and disease-free survival. Secondary outcomes included the postoperative visual analog scale (VAS) score, the additional use of analgesics, the restoration of gastrointestinal function, blood loss, the mean operation time, and length of postoperative hospital stay. RESULTS In this meta-analysis, a total of 717 patients from 6 observational studies met the inclusion criteria. Compared with the TWSR group, the NOSE group had greater benefits in terms of overall postoperative complications [odds ratios (OR) 0.55; 95% confidence intervals (CI) = 0.34 to 0.89; P = 0.01, I2 = 0%)], the number of lymph nodes harvested [weighted mean differences (WMD) = 1.18; 95% CI = 0.15 to 2.21; P = 0.02, I2 = 0%)], the rate of wound infection (OR 0.17; 95% CI = 0.04 to 0.80; P = 0.02, I2 = 0%), the passed flatus time (WMD = - 0.35 days; 95% CI = - 0.60 to - 0.10; P = 0.007, I2 = 73%), the additional use of analgesics (OR 0.25; 95% CI = 0.15 to 0.40; P < 0.001, I2 = 0%), the diet recovery time (WMD = - 0.56; 95% CI = - 1.00 to - 0.11; P = 0.01, I2 = 78%) and the postoperative VAS score (WMD = - 1.23; 95% CI = - 1.63 to - 0.83; P < 0.001, I2 = 65%). There were no significant differences in the blood loss (WMD = - 5.78 ml; 95% CI = - 17.57 to 6.00; P = 0.34, I2 = 90%), mean operation time (WMD = 14.10 min; 95% CI = - 3.76 to 31.96; P = 0.12) (I2 = 93%), length of postoperative hospital stay (WMD = - 0.47 day; 95% CI = - 0.98 to 0.03; P = 0.07, I2 = 51%), incidences of postoperative ileus (OR 1.0; 95% CI = 0.22 to 4.46; P = 1.00, I2 = 0%), anastomotic leakage (OR 0.73; 95% CI = 0.33 to 1.60; P = 0.43, I2 = 0%), and intra-abdominal abscess (OR 1.59; 95% CI = 0.47 to 5.40; P = 0.46, I2 = 0%), or 3-year overall survival [hazard ratio (HR) = 1.07, 95% CI = 0.60 to 1.94; P = 0.81)] or disease-free survival (HR = 0.94, 95% CI = 0.54 to 1.63; P = 0.82, I2 = 0%). CONCLUSION This meta-analysis showed that the NOSE group had better postoperative outcomes than did the TWSR group and that NOSE was a safe and viable alternative to TWSR. More large-sample reviews and further randomized trials are warranted.
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Affiliation(s)
- Shixiong Zhan
- Department of Gastrointestinal Surgery, Jiangxi Province Hospital of Integrated Chinese and Western Medicine, No. 90, Bayi Road, Xihu District, Nanchang City, Jiangxi Province, China
| | - Zhicheng Zhu
- Department of Gastrointestinal Surgery, Jiangxi Province Hospital of Integrated Chinese and Western Medicine, No. 90, Bayi Road, Xihu District, Nanchang City, Jiangxi Province, China
| | - Haitao Yu
- Department of Gastrointestinal Surgery, Jiangxi Province Hospital of Integrated Chinese and Western Medicine, No. 90, Bayi Road, Xihu District, Nanchang City, Jiangxi Province, China
| | - Yu Xia
- Department of Gastrointestinal Surgery, Jiangxi Province Hospital of Integrated Chinese and Western Medicine, No. 90, Bayi Road, Xihu District, Nanchang City, Jiangxi Province, China
| | - Tian Xu
- Department of Gastrointestinal Surgery, Jiangxi Province Hospital of Integrated Chinese and Western Medicine, No. 90, Bayi Road, Xihu District, Nanchang City, Jiangxi Province, China
| | - Zhenda Wan
- Department of Gastrointestinal Surgery, Jiangxi Province Hospital of Integrated Chinese and Western Medicine, No. 90, Bayi Road, Xihu District, Nanchang City, Jiangxi Province, China.
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98
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Tsuboyama T, Fukuzawa T, Nakaya M, Toyama Y, Ohya A, Sano K, Takahata A, Kido K, Tomiyama N. Pseudo-myometrial thinning in placental site trophoblastic tumors: a case series with multiparametric MRI. Abdom Radiol (NY) 2024:10.1007/s00261-024-04535-x. [PMID: 39167238 DOI: 10.1007/s00261-024-04535-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/14/2024] [Accepted: 08/15/2024] [Indexed: 08/23/2024]
Abstract
PURPOSE Placental site trophoblastic tumor (PSTT) is a rare form of gestational trophoblastic neoplasm with few previous imaging case reports. We report multiparametric MRI findings in four cases of PSTT with special emphasis on the "pseudo-myometrial thinning" underlying the tumor. METHODS We reviewed multiparametric MRI and pathologic findings in four cases of PSTT from four institutions. Signal intensity, enhancement pattern, margins, and location of the tumors were evaluated, and myometrial thickness underlying the tumor and normal myometrial thickness contralateral to the tumor were measured on MRI. The myometrial thickness underlying the tumor was also measured in the resected specimen and compared with the myometrial thickness measured on MRI using the Friedman test. RESULTS All tumors showed heterogeneous signal intensity on T1-weighted imaging, T2-weighted imaging (T2WI), and diffusion-weighted imaging. Three of the four tumors had a hypervascular area on dynamic contrast-enhanced (DCE) MRI. A hypointense rim on T2WI and DCE-MRI was seen in all tumors. All tumors protruded into the uterine cavity to varying degrees and extended into the myometrium close to the serosa. The myometrial thickness underlying the tumor measured on MRI (median thickness, 1.2 mm) was significantly thinner than that measured on pathology (median thickness, 9.5 mm) and normal myometrial thickness contralateral to the tumor on MRI (median thickness, 10.3 mm) (P = 0.02), and there was no significant difference between the latter two. CONCLUSIONS The thickness of the myometrium underlying the tumor on MRI was approximately one tenth of the thickness on pathology. Thus, the tumors appeared to have almost transmural invasion even when pathologically located within the superficial myometrium. This "pseudo-thinning" of the underlying myometrium and the hypointense rim on MRI could be caused by focal compression of the myometrium by the tumor, possibly due to the fragility of the myometrium at the placental site.
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99
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Tomassetti C. Assessing the Long-term Impact of Major Gynecological Surgery Is in Everybody's Interest. J Minim Invasive Gynecol 2024:S1553-4650(24)00351-0. [PMID: 39154659 DOI: 10.1016/j.jmig.2024.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Accepted: 08/10/2024] [Indexed: 08/20/2024]
Affiliation(s)
- Carla Tomassetti
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven University Fertility Center, Leuven, Belgium (Dr. Tomassetti)..
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100
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Kotsopoulos J, Lubinski J, Huzarski T, Bychkovsky BL, Moller P, Kim RH, Tung N, Eisen A, Foulkes W, Singer CF, Aeilts A, Neuhausen SL, Bordeleau L, Karlan B, Fruscio R, Eng C, Olopade O, Zakalik D, Couch F, Y Cajal TR, Sun P, Gronwald J, Narod SA. Incidence of endometrial cancer in BRCA mutation carriers. Gynecol Oncol 2024; 189:148-155. [PMID: 39173195 DOI: 10.1016/j.ygyno.2024.07.687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 07/29/2024] [Accepted: 07/31/2024] [Indexed: 08/24/2024]
Abstract
OBJECTIVE Whether or not women who harbor a germline pathogenic variant ('mutation') in the BRCA1 or BRCA2 genes are at elevated risk of developing endometrial cancer is yet to be determined. METHODS We conducted a prospective analysis of 4959 BRCA mutation carriers with no prior history of cancer (except for breast or melanoma) and an intact uterus. RESULTS After a mean of 6.7 years of follow-up there were 38 incident cases of endometrial cancer diagnosed; 30 among BRCA1 carriers and eight among BRCA2 carriers. The mean age at diagnosis was 58.4 years (range 46.8-76.1). The majority were of the endometrioid subtype (n = 16), followed by mixed endometroid and serous (n = 4), serous (n = 3) or clear cell (n = 1) (missing = 13). The cumulative incidence from age 40 to age 70 was 3.4% for BRCA1 carriers and was 1.6% for BRCA2 mutation carriers. Prior tamoxifen use was associated with a significant two-fold increased risk (HR = 2.24; 95% CI 1.10-4.55). There was no significant association between exogenous hormone use, oophorectomy, smoking or BMI at age 40 and risk (P ≥ 0.32). CONCLUSIONS Compared to the general population, we observed higher rates of endometrial cancer among young BRCA1 mutation carriers; however, lifetime risks were similar. Women with prior tamoxifen exposure were at a significantly increased risk. These findings were based. on a small number of incident cases and require confirmation with additional follow-up of our aging cohort.
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Affiliation(s)
- Joanne Kotsopoulos
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jan Lubinski
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Huzarski
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Brittany L Bychkovsky
- Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Pal Moller
- Department of Tumour Biology, Institute of Cancer Research, The Norwegian Radium Hospital, 0379 Oslo, Norway
| | - Raymond H Kim
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Sinai Health System, Hospital for Sick Children, Ontario Institute for Cancer Research, Department of Medicine, University of Toronto, Canada
| | - Nadine Tung
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Andrea Eisen
- Toronto-Sunnybrook Regional Cancer Center, Toronto, ON, Canada
| | - William Foulkes
- McGill Program in Cancer Genetics, Department of Oncology, McGill University, Montreal, QC, Canada
| | - Christian F Singer
- Department of Obstetrics and Gynecology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Amber Aeilts
- Division of Human Genetics, the Ohio State University Medical Center, Comprehensive Cancer Center, Columbus, OH, USA
| | - Susan L Neuhausen
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA
| | - Louise Bordeleau
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Beth Karlan
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, CA, USA
| | - Robert Fruscio
- Clinic of Obstetrics and Gynecology, IRCCS Fondazione San Gerardo dei Tintori, Monza, Italy
| | - Charis Eng
- Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Olufunmilayo Olopade
- Department of Medicine and Human Genetics, University of Chicago, Chicago, IL, USA
| | - Dana Zakalik
- Cancer Genetics Program, Beaumont Hospital, Royal Oak, MI, USA
| | - Fergus Couch
- Division of Experimental Pathology and Laboratory Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Teresa Ramon Y Cajal
- Familial Cancer Clinic, Medical Oncology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Ping Sun
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Jacek Gronwald
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Steven A Narod
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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