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Woo HY, Cho A, Ko M, Shin J, Min SK, Min S, Han A, Ha J, Ahn S. The impact of simulator training of vascular anastomosis and video assessment for surgical residents. Ann Vasc Surg 2024:S0890-5096(24)00482-5. [PMID: 39122209 DOI: 10.1016/j.avsg.2024.03.034] [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: 12/18/2023] [Revised: 03/28/2024] [Accepted: 03/31/2024] [Indexed: 08/12/2024]
Abstract
INTRODUCTION The rapid increase of minimally invasive surgery and the shortened training period for surgical residents has resulted in limited opportunities to acquire proficiency in open surgical techniques, such as vascular anastomosis. However, vascular anastomosis remains an essential skill in every surgery for bleeding control. This study aimed to validate the effectiveness of surgical education model for vascular anastomosis and assess the impact on the comprehension, skill, and confidence of surgical residents in performing vascular anastomosis. METHODS A total of 21 surgical residents with 1st to 3rd years of experience at Seoul National University Hospital participated in a four-week vascular anastomosis training program. The program included an educational lecture and the performance of an end-to-side anastomosis on a procedural model, with evaluations being conducted using the Objective Structured Assessment of Technical Skills (OSATS) and the End Product Rating Score (EPRS) in pre- and post-training surveys. RESULTS Significant improvement was observed in the OSATS score (from 9.22 ± 2.4 in week 1 to 12.87 ± 3.1 in week 4; P < 0.001) and the EPRS score (from 12.47 ± 4.1 in week 1 to 17.57 ± 2.2 in week 4; P < 0.001). Additionally, the surgical performance time significantly decreased from 20.99 ± 4.6 minutes to 16.33 ± 4.2 minutes (P = 0.019) CONCLUSIONS: Simulator training of in vitro vascular anastomosis, when accompanied by expert-led instruction, can effectively enhance the surgical proficiency, confidence, and overall surgical outcomes of residents, as inferred from the observed improvements in OSATS and EPRS scores. The results suggest that integration of this training model into surgical curricula could be a promising strategy for enhancing vascular surgical training.
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Affiliation(s)
- Hye Young Woo
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ara Cho
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Myeonghyeon Ko
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jiyoung Shin
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung-Kee Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sangil Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ahram Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jongwon Ha
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sanghyun Ahn
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
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152
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Wang G, Li Q, HonglingXu, Zhao Z, Wang D, Zhang Y, Gao L, Chen Z. Comparative efficacy of bilateral mesh sacrospinous ligament suspension versus laparoscopic sacrocolpopexy in patients with metroptosis. Sci Rep 2024; 14:18367. [PMID: 39112592 PMCID: PMC11306242 DOI: 10.1038/s41598-024-69221-w] [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: 04/07/2024] [Accepted: 08/01/2024] [Indexed: 08/10/2024] Open
Abstract
This study assesses the efficacy of bilateral mesh sacrospinous ligament suspension (MSSLS) compared to laparoscopic sacrocolpopexy (LSC) in patients with uterine prolapse. Ninety-eight patients with uterine prolapse were evaluated at our hospital from January 2021 to January 2023. Patients were equally divided into two groups: the study group (undergoing MSSLS) and the control group (undergoing LSC) using a random number table. Various parameters including operation time, bleeding volume, indwelling catheter time, exhaust time, hospital stay, pelvic organ prolapse stage, postoperative recurrence rate, pain severity, quality of life, pelvic floor function, impact on sexual life, complications, and recurrence rate were recorded. The study group showed significant reductions in operation time, bleeding volume, indwelling catheter time, exhaust time, and hospital stay compared to the control group (P < 0.05). There were no significant differences in Aa, Ba, Ap, Bp, and C between the two groups before surgery (P > 0.05), but six months postoperatively, these indexes were significantly lower in the study group (P < 0.05). Pain severity did not differ significantly between the two groups before surgery (P > 0.05), but was significantly lower in the study group six months postoperatively (P < 0.05). Quality of life, pelvic floor function, and sexual life quality did not significantly differ before surgery, at 6 months, and at 12 months postoperatively (P > 0.05). All patients were followed up for 12-14 months, with an average follow-up time of (13.02 ± 1.36) months. The incidence of complications was significantly lower in the study group (P < 0.05), but there were no recurrences in either group, thus the difference was not statistically significant (P > 0.05). MSSLS emerges as a safe and efficacious treatment for uterine prolapse, notably reducing both complications and recurrence rates, rendering it suitable for broad clinical application.
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Affiliation(s)
- Gensheng Wang
- Department of Obstetrics and Gynecology, Anqing Municipal Hospital, No.87 Tianzhushan East Road, Yixiu District, Anqing, 246004, China
| | - Qing Li
- Department of Obstetrics and Gynecology, Anqing Municipal Hospital, No.87 Tianzhushan East Road, Yixiu District, Anqing, 246004, China.
| | - HonglingXu
- Department of Obstetrics and Gynecology, Anqing Municipal Hospital, No.87 Tianzhushan East Road, Yixiu District, Anqing, 246004, China
| | - Zhu Zhao
- Department of Obstetrics and Gynecology, Anqing Municipal Hospital, No.87 Tianzhushan East Road, Yixiu District, Anqing, 246004, China
| | - Dan Wang
- Department of Obstetrics and Gynecology, Anqing Municipal Hospital, No.87 Tianzhushan East Road, Yixiu District, Anqing, 246004, China
| | - Yuyan Zhang
- Department of Obstetrics and Gynecology, Anqing Municipal Hospital, No.87 Tianzhushan East Road, Yixiu District, Anqing, 246004, China
| | - Liuqin Gao
- Department of Obstetrics and Gynecology, Anqing Municipal Hospital, No.87 Tianzhushan East Road, Yixiu District, Anqing, 246004, China
| | - Zaoqin Chen
- Department of Obstetrics and Gynecology, Anqing Municipal Hospital, No.87 Tianzhushan East Road, Yixiu District, Anqing, 246004, China
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Louwerse MD, Tasma ML, Ijspeert JEG, Hehenkamp WJK, Lissenberg BI, Brölmann HAM, Huirne JAF. Gel instillation sonohysterography (GIS) using Endosgel versus ExEmgel, comparison of pain and image quality and cost benefit analysis: A double blind randomised controlled trial. GISPAIN trial. Eur J Obstet Gynecol Reprod Biol 2024; 301:173-179. [PMID: 39142060 DOI: 10.1016/j.ejogrb.2024.08.005] [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: 04/25/2024] [Revised: 07/31/2024] [Accepted: 08/04/2024] [Indexed: 08/16/2024]
Abstract
INTRODUCTION Pain experience, physical reaction, image quality and adverse events during Gel Instillation Sonohysterography (GIS) can differ using gels with different compositions. As a result, patient satisfaction can also be affected. The effect of two instillation gels, Endosgel versus ExEmgel, using both the Visual Analogue Scale (VAS) and a Continuous Pain Score Meter (CPSM) was therefore compared. METHODS This single centre double blind randomised controlled trial included 80 women planned for outpatient GIS, diagnosed with abnormal intrauterine bleeding or fertility disorders and suspicion on an intrauterine abnormality. Patients were randomly allocated to the instillation of Endosgel containing chlorhexidine or ExEmgel without chlorhexidine. Primary outcome was reported pain during the procedure using VAS. Secondary outcomes included pain score measured using CPSM, satisfaction to the procedure and preference at 3 weeks and 3 months after the procedure and image quality. A cost benefit analysis was also performed. RESULTS The reported median VAS concerning pain during gel instillation was comparable in the Endosgel and ExEmgel group, 2.50 (IQR 0.00-5.00) and 2.00 (IQR 0.00-5.75) respectively (p = 0.69). The median VAS of the entire procedure was also similar: both 2.00 (IQR 0.00-5.00) (p = 0.86). CPSM-scores were not significantly different either. Both groups were similar in image quality (p = 0.83) and patient's satisfaction (p = 0.36). CONCLUSION Concerning the pain experienced during a GIS procedure and patients' satisfaction, the ExEmgel was not proven to be superior to the Endosgel. Our advice is to use the gel that is available at the lowest costs, as the image quality is the same for both Endosgel and ExEmgel.
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Affiliation(s)
- Marjoleine D Louwerse
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centres, Location VUmc, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
| | - Maaike L Tasma
- Department of Obstetrics and Gynaecology, Ikazia Hospital, Montessoriweg 1, 3083 AN Rotterdam, the Netherlands
| | - Joep E G Ijspeert
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centres, Location VUmc, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Wouter J K Hehenkamp
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centres, Location VUmc, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Birgit I Lissenberg
- Department of Epidemiology and Data Science, Amsterdam University Medical Centres, Location VUmc, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Hans A M Brölmann
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centres, Location VUmc, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Judith A F Huirne
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centres, Location VUmc, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
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Artsitas S, Artsitas D, Koronaki I, Toutouzas KG, Zografos GC. Comparing robotic and open partial nephrectomy under the prism of surgical precision: a meta-analysis of the average blood loss rate as a novel variable. J Robot Surg 2024; 18:313. [PMID: 39112829 PMCID: PMC11306375 DOI: 10.1007/s11701-024-02060-z] [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: 07/11/2024] [Accepted: 07/22/2024] [Indexed: 08/10/2024]
Abstract
Exploration of surgical precision in robotic procedures is extensive, yet lacks a unified framework for comparability. This study examines tissue handling precision by comparing the per-minute blood loss rate between robotic and open partial nephrectomy. A literature search from August 2022 to June 2024 identified 43 relevant studies providing data on estimated blood loss and procedure duration. The expected values and standard errors of these variables were used to compute the per-minute blood loss rate (Q). Meta-analytical methods estimated pooled and subgroup-level mean differences, favoring robotic surgery (MDQ = - 1.043 ml/min, CI95% = [- 1.338; - 0.747]). Subgroup analyses by publication year, patient matching, referral center count, and ROBINS-I status consistently supported this advantage. Sensitivity analyses confirmed the above benefit in studies with increased accuracy in reported results (MDQ = - 0.957 ml/min, CI95% = [- 1.269; - 0.646]), low risk of bias involving matched comparisons (MDQ = - 0.563 ml/min, CI95% = [- 0.716; - 0.410]), large sample sizes and increased statistical power (MDQ = - 0.780 ml/min, CI95% = [- 1.134; - 0.425]), and multicenter analyses with patient matching (MDQ = - 0.481 ml/min, CI95% = [- 0.698; - 0.263]). The subsequent analysis of correlation between the original variables suggested a slight reduction in the robotic advantage when the latter were proportionally related. Multilevel meta-regression at both temporal and qualitative scales consistently indicated a comparative benefit of the robotic approach. Potentially, lower per-minute blood loss compared to open surgery suggests that robotic partial nephrectomy demonstrates enhanced precision in tissue handling.
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Affiliation(s)
- Sotirios Artsitas
- Geniko Nosokomeio Athenon Ippokrateio, Vasilisis Sofias str. 114, 11527, Athens, Greece.
- 1st Propaedeutic Department of Surgery, School of Medicine, National and Kapodistrian University of Athens (NKUA), Mikras Asias str. 75, 11527, Athens, Greece.
- National and Kapodistrian University of Athens (NKUA), Mikras Asias str. 75, 11527, Athens, Greece.
| | - Dimitrios Artsitas
- 2nd Department of Orthopaedics, KAT Attica General Hospital, Nikis str. 2, Kifissia, 14561, Athens, Greece
| | - Irene Koronaki
- National Technical University of Athens (NTUA), Zografou Campus, Heroon Polytechniou str. 9, 15780, Athens, Greece
- Laboratory of Applied Thermodynamics, School of Mechanical Engineering, National Technical University of Athens (NTUA), Heroon Polytechniou str. 9, 15780, Athens, Greece
| | - Konstantinos G Toutouzas
- Geniko Nosokomeio Athenon Ippokrateio, Vasilisis Sofias str. 114, 11527, Athens, Greece
- 1st Propaedeutic Department of Surgery, School of Medicine, National and Kapodistrian University of Athens (NKUA), Mikras Asias str. 75, 11527, Athens, Greece
- National and Kapodistrian University of Athens (NKUA), Mikras Asias str. 75, 11527, Athens, Greece
| | - George C Zografos
- Geniko Nosokomeio Athenon Ippokrateio, Vasilisis Sofias str. 114, 11527, Athens, Greece
- 1st Propaedeutic Department of Surgery, School of Medicine, National and Kapodistrian University of Athens (NKUA), Mikras Asias str. 75, 11527, Athens, Greece
- National and Kapodistrian University of Athens (NKUA), Mikras Asias str. 75, 11527, Athens, Greece
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155
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Holdsworth-Carson SJ, Chung J, Machalek DA, Li R, Jun BK, Griffiths MJ, Churchill M, McCaughey T, Nisbet D, Dior U, Donoghue JF, Montgomery GW, Reddington C, Girling JE, Healey M, Rogers PAW. Predicting disease recurrence in patients with endometriosis: an observational study. BMC Med 2024; 22:320. [PMID: 39113136 PMCID: PMC11304583 DOI: 10.1186/s12916-024-03508-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 07/01/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND Despite surgical and pharmacological interventions, endometriosis can recur. Reliable information regarding risk of recurrence following a first diagnosis is scant. The aim of this study was to examine clinical and survey data in the setting of disease recurrence to identify predictors of risk of endometriosis recurrence. METHODS This observational study reviewed data from 794 patients having surgery for pelvic pain or endometriosis. Patients were stratified into two analytic groups based on self-reported or surgically confirmed recurrent endometriosis. Statistical analyses included univariate, followed by multivariate logistic regression to identify risk factors of recurrence, with least absolute shrinkage and selection operator (Lasso) regularisation. Risk-calibrated Supersparse Linear Integer Models (RiskSLIM) and survival analyses (with Lasso) were undertaken to identify predictive features of recurrence. RESULTS Several significant features were repeatedly identified in association with recurrence, including adhesions, high rASRM score, deep disease, bowel lesions, adenomyosis, emergency room attendance for pelvic pain, younger age at menarche, higher gravidity, high blood pressure and older age. In the surgically confirmed group, with a score of 5, the RiskSLIM method was able to predict the risk of recurrence (compared to a single diagnosis) at 95.3% and included adenomyosis and adhesions in the model. Survival analysis further highlighted bowel lesions, adhesions and adenomyosis. CONCLUSIONS Following an initial diagnosis of endometriosis, clinical decision-making regarding disease management should take into consideration the presence of bowel lesions, adhesions and adenomyosis, which increase the risk of endometriosis recurrence.
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Affiliation(s)
- Sarah J Holdsworth-Carson
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and Gynaecology Research Centre, Royal Women's Hospital, Grattan St & Flemington Rd, Parkville, VIC, 3052, Australia.
- The Julia Argyrou Endometriosis Centre, Epworth HealthCare, Ground Floor, 185-187 Hoddle Street, Richmond, VIC, 3121, Australia.
| | - Jessica Chung
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and Gynaecology Research Centre, Royal Women's Hospital, Grattan St & Flemington Rd, Parkville, VIC, 3052, Australia
- Melbourne Bioinformatics, University of Melbourne, 21 Bedford St, North Melbourne, VIC, 3051, Australia
| | - Dorothy A Machalek
- The Kirby Institute, University of New South Wales, High Street, Kensington, NSW, 2052, Australia
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Grattan St & Flemington Rd, Parkville, VIC, 3052, Australia
| | - Rebecca Li
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and Gynaecology Research Centre, Royal Women's Hospital, Grattan St & Flemington Rd, Parkville, VIC, 3052, Australia
| | - Byung Kyu Jun
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and Gynaecology Research Centre, Royal Women's Hospital, Grattan St & Flemington Rd, Parkville, VIC, 3052, Australia
| | - Meaghan J Griffiths
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and Gynaecology Research Centre, Royal Women's Hospital, Grattan St & Flemington Rd, Parkville, VIC, 3052, Australia
| | - Molly Churchill
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and Gynaecology Research Centre, Royal Women's Hospital, Grattan St & Flemington Rd, Parkville, VIC, 3052, Australia
| | - Tristan McCaughey
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and Gynaecology Research Centre, Royal Women's Hospital, Grattan St & Flemington Rd, Parkville, VIC, 3052, Australia
| | - Debbie Nisbet
- Ultrasound Services, Royal Women's Hospital, Grattan St & Flemington Rd, Parkville, VIC, 3052, Australia
- Department of Radiology, University of Melbourne, Royal Melbourne Hospital, Royal Parade, Parkville, VIC, 3050, Australia
| | - Uri Dior
- Faculty of Medicine, Department of Obstetrics and Gynaecology, Hadassah Medical Center, P.O Box 12000, Jerusalem, 91120, Israel
| | - Jacqueline F Donoghue
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and Gynaecology Research Centre, Royal Women's Hospital, Grattan St & Flemington Rd, Parkville, VIC, 3052, Australia
| | - Grant W Montgomery
- Institute for Molecular Bioscience, University of Queensland, 306 Carmody Road, St Lucia, Brisbane, QLD, 4072, Australia
| | - Charlotte Reddington
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and Gynaecology Research Centre, Royal Women's Hospital, Grattan St & Flemington Rd, Parkville, VIC, 3052, Australia
| | - Jane E Girling
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and Gynaecology Research Centre, Royal Women's Hospital, Grattan St & Flemington Rd, Parkville, VIC, 3052, Australia
- Department of Anatomy, School of Biomedical Sciences, University of Otago, 270 Great King Street, Dunedin, 9016, New Zealand
| | - Martin Healey
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and Gynaecology Research Centre, Royal Women's Hospital, Grattan St & Flemington Rd, Parkville, VIC, 3052, Australia
- The Julia Argyrou Endometriosis Centre, Epworth HealthCare, Ground Floor, 185-187 Hoddle Street, Richmond, VIC, 3121, Australia
| | - Peter A W Rogers
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and Gynaecology Research Centre, Royal Women's Hospital, Grattan St & Flemington Rd, Parkville, VIC, 3052, Australia
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156
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Abdelhadi S, Tzatzarakis E, Hermann M, Orth V, Vedder K, Briscoe J, Reissfelder C, Șandra-Petrescu F. The impact of anastomotic leakage characteristics on the occurrence of anastomotic stenosis after colorectal resection, a retrospective cohort study. Int J Colorectal Dis 2024; 39:126. [PMID: 39105987 PMCID: PMC11303457 DOI: 10.1007/s00384-024-04699-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2024] [Indexed: 08/07/2024]
Abstract
INTRODUCTION Anastomotic stenosis (AS) is a common complication after colorectal resection. However, the predisposing factors for stricture formation are not fully understood. Previous studies have shown anastomotic leakage (AL) to be a risk factor for the occurrence of AS. Therefore, we aim to investigate the impact of anastomotic leakage characteristics on the occurrence of anastomotic stenosis after colorectal resection. METHODS Consecutive patients with AL following elective, sphincter preserving, colorectal resection, with or without diversion ostomy, between January 2009 and March 2023 were identified from a prospectively collected database. The characteristics of the anastomotic leakage, patient baseline and operative characteristics as well as the postoperative outcomes were analyzed using univariate and multivariate logistic regression to identify factors associated with the occurrence of post-leakage AS. RESULTS A total of 129 patients developed AL and met the inclusion criteria. Among these, 28 (21.7%) patients were diagnosed with post-leakage AS. There was a significantly higher frequency of patients with neoadjuvant radiotherapy (18% vs 3%; p = .026) and hand-sewn anastomoses (39% vs 17%; p = .011) within the AS group. Furthermore, the extent of the anastomotic defect was significantly higher in the AS group compared with the non-AS group (50%, IQR 27-71 vs. 20%, IQR 9-40, p = 0.011). Similar findings were observed between the study groups regarding age, sex, BMI, ASA score, medical comorbidities, diagnosis, surgical procedure, surgical approach (open vs. minimally invasive), and anastomotic fashioning (side-to-end vs. end-to-end). On multivariate analysis, the extent of the anastomotic defect (OR 1.01; 95% CI 1.00-1.03; p = 0.034) and hand-sewn anastomoses (OR 2.68; 95% CI 1.01-6.98; p = 0.043) were confirmed as independent risk factors for post-leakage AS. No correlation could be observed between the occurrence of post-leakage AS and the ISREC grading of AL, the anastomotic height or the management of AL. Time to ostomy reversal was significantly longer in the AS group (202d, IQR 169-275 vs. 318d IQR 192-416, p = 0.014). CONCLUSION The extent of the anastomotic defect and hand-sewn anastomoses were confirmed as independent risk factors for the occurrence of post-leakage AS. No correlation could be observed between the ISREC grading of AL, the anastomotic height or AL management, and the occurrence of post-leakage AS.
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Affiliation(s)
- Schaima Abdelhadi
- Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Emmanouil Tzatzarakis
- Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Maike Hermann
- Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Vanessa Orth
- Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Katharina Vedder
- Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Jannis Briscoe
- Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Christoph Reissfelder
- Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- DKFZ Hector Cancer Institute at the University Medical Center, Mannheim, Germany
| | - Flavius Șandra-Petrescu
- Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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157
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Aimagambetova G, Bapayeva G, Ukybassova T, Zemlyanskiy V, Gusmanov A, Terzic M. The role of VEGF and TGF-β blood levels for fibroid shrinkage, menorrhagia score, and quality of life improvement after uterine artery embolization for uterine fibroids: a study protocol. Front Med (Lausanne) 2024; 11:1382822. [PMID: 39165371 PMCID: PMC11334076 DOI: 10.3389/fmed.2024.1382822] [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: 02/06/2024] [Accepted: 06/12/2024] [Indexed: 08/22/2024] Open
Abstract
Uterine leiomyoma is a common condition affecting women that occurs in more than 70% of females. Women with leiomyomas overall have lower quality of life and deficiency in many specific spheres of life including work-related productivity, sexuality, relationships, social-emotional health, and physical well-being that might be present even in pre-and extended throughout early postmenopausal life. Choices for symptomatic fibroid management include medical, interventional radiology procedures, surgical, and expectant management. The uterine artery embolization (UAE) procedure has gained justified popularity for myoma management. Growth factors, vascular endothelial growth factor (VEGF) and tumor growth factor β (TGF-β), hold an important role in leiomyoma progression. However, blood levels of VEGF and TGF-β in patients before and after UAE are not fully investigated and the possible relationship with myoma shrinkage has not been evaluated. Therefore, this study aims to assess menorrhagia score and quality of life improvement after UAE for uterine fibroids and compare blood levels of VEGF and TGF-β in patients with uterine leiomyoma before and after UAE. This cross-sectional study will be performed at the University Medical Center, Astana, Kazakhstan. Women undergoing the UAE procedure for uterine leiomyoma will be involved in the study following the precisely defined inclusion/exclusion criteria. Uterine leiomyoma nodules' structural changes after UAE will be assessed along with the blood levels of growth factors (VEGF and TGF-β), menorrhagia score, and quality of life. An important outcome of this project will be an investigation of the blood levels of growth factors (VEGF and TGF-β) before and after the procedure and their association with leiomyoma shrinkage in correlation with the menorrhagia score and quality of life alterations among patients undergoing UAE.
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Affiliation(s)
| | - Gauri Bapayeva
- Clinical Academic Department of Women’s Health, CF “University Medical Center”, Astana, Kazakhstan
| | - Talshyn Ukybassova
- Clinical Academic Department of Women’s Health, CF “University Medical Center”, Astana, Kazakhstan
| | - Viktor Zemlyanskiy
- Clinical Academic Department of Radiology and Nuclear Medicine, CF “University Medical Center”, Astana, Kazakhstan
| | - Arnur Gusmanov
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Milan Terzic
- Department of Surgery, School of Medicine, Nazarbayev University, Astana, Kazakhstan
- Clinical Academic Department of Women’s Health, CF “University Medical Center”, Astana, Kazakhstan
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158
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Bell S, Smith K, Kim H, Orellana T, Harinath L, Rush S, Olawaiye A, Lesnock J. Hysterectomy with sentinel lymph node dissection in the setting of preoperative endometrial intraepithelial neoplasia and an endometrial stripe ≥20 mm: a cost-effectiveness analysis . Int J Gynecol Cancer 2024:ijgc-2024-005658. [PMID: 39107049 DOI: 10.1136/ijgc-2024-005658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2024] Open
Abstract
OBJECTIVES Routine lymph node assessment in patients with endometrial intraepithelial neoplasia is institution and surgeon-dependent without clear guidelines. We sought to determine if routine sentinel lymph node (SLN) dissection at the time of laparoscopic hysterectomy for patients with a preoperative diagnosis of endometrial intraepithelial neoplasia and a preoperative ultrasound with endometrial stripe ≥20 mm is cost-effective. METHODS A decision model was created to perform two cost-effectiveness analyses: (1) hysterectomy with frozen section versus hysterectomy with SLN dissection in patients with a preoperative diagnosis of endometrial intraepithelial neoplasia and an endometrial stripe of 20 mm or greater, and (2) the same options in all patients with a preoperative diagnosis of endometrial intraepithelial neoplasia. Costs obtained from Centers for Medicare and Medicaid Services and event probabilities and quality of life utility values were obtained through literature review. RESULTS In the case of preoperative endometrial stripe ≥20 mm, hysterectomy with SLN dissection cost $2469 more than hysterectomy with frozen section and gained 0.010 quality adjusted life years, or $44,997/quality-adjusted life years gained. In one-way sensitivity analyses, SLN dissection remained the favored strategy at a willingness to pay threshold of $100,000/quality-adjusted life years unless chronic lower extremity lymphedema after full lymphadenectomy had a likelihood <13.1% (base case value 18.1%); otherwise, SLN dissection was favored with individual variation of all other parameters over plausible ranges. When considering all patients with endometrial intraepithelial neoplasia, hysterectomy with frozen section was favored, with results most sensitive to variation of lymphedema risk after full lymphadenectomy. CONCLUSION Hysterectomy with SLN dissection in patients with a preoperative endometrial stripe ≥20mm on ultrasound is cost-effective when compared with hysterectomy with frozen section.
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Affiliation(s)
- Sarah Bell
- Gynecologic Oncology, Magee Womens Hospital of UPMC, Pittsburgh, Pennsylvania, USA
| | - Kenneth Smith
- General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Haeyon Kim
- Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Taylor Orellana
- Gynecologic Oncology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lakshmi Harinath
- Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Shannon Rush
- Gynecologic Oncology, Magee Womens Hospital of UPMC, Pittsburgh, Pennsylvania, USA
| | - Alexander Olawaiye
- Gynecologic Oncology, Magee Womens Hospital of UPMC, Pittsburgh, Pennsylvania, USA
| | - Jamie Lesnock
- Gynecologic Oncology, Magee Womens Hospital of UPMC, Pittsburgh, Pennsylvania, USA
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Lin J, Yang T, Li L, Sun X, Li H. Analysis of assisted reproductive outcomes for gynecologic cancer survivors: a retrospective study. Reprod Biol Endocrinol 2024; 22:97. [PMID: 39107798 PMCID: PMC11301938 DOI: 10.1186/s12958-024-01272-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 07/31/2024] [Indexed: 08/10/2024] Open
Abstract
OBJECTIVE To examine the reproductive outcomes of assisted reproductive technology (ART) in gynecologic cancer patients and to assess maternal and neonatal complications. METHODS Women diagnosed with gynecologic cancer who underwent their first in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment between 2013 and 2021 at Shanghai Ji Ai Genetics and IVF Institute were included in this study. Infertile women without any history of cancer were matched to the cancer group. The primary outcome was the cumulative live birth rate. Baseline and follow-up data were compared between groups using Student's t-tests for normally distributed variables and with Chi-square test for categorical variables. A propensity score-based patient-matching approach was adopted to ensure comparability between individuals with and without specific cancer type. RESULTS A total of 136 patients with a history of gynecologic cancer and 241 healthy infertile controls were included in this study. Endometrial cancer constituted 50.70% of the cases and cervical cancer constituted 34.60% of the cases. The cancer group exhibited significantly shorter duration of stimulation, lower levels of estradiol, lower number of retrieved oocytes, day-3 embryos, and blastocysts compared to the control group (P < 0.05). The cumulative live birth rate of the gynecologic cancer group was significantly lower than that of the control group (36.10% vs. 60.50%, P < 0.001). Maternal and neonatal complications did not significantly differ between the groups (P > 0.05). The endometrial cancer and cervical cancer groups showed significantly lower cumulative live birth rates than their matched controls (38.60% vs. 64.50%, P = 0.011 and 24.20% vs. 68.60%, P < 0.001, respectively). CONCLUSIONS These findings highlight the decreased occurrence of pregnancy and live birth in female gynecologic cancer patients undergoing ART, particularly in endometrial cancers and cervical cancers. These findings have important implications for counseling and managing gynecologic cancer patients undergoing ART.
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Affiliation(s)
- Jing Lin
- Center for Reproductive Medicine, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianying Yang
- Shanghai Ji Ai Genetics and IVF Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Lu Li
- Shanghai Ji Ai Genetics and IVF Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Xiaoxi Sun
- Shanghai Ji Ai Genetics and IVF Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.
- Key Laboratory of Female Reproductive Endocrine Related Diseases, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.
| | - He Li
- Shanghai Ji Ai Genetics and IVF Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.
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160
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Saçıntı KG, Razeghian H, Bornstein J. Surgical Treatment for Provoked Vulvodynia: A Systematic Review. J Low Genit Tract Dis 2024:00128360-990000000-00132. [PMID: 39105455 DOI: 10.1097/lgt.0000000000000834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
OBJECTIVE Provoked vulvodynia (PV), characterized by vulvar pain upon touch or pressure, is the leading cause of pain during sexual intercourse. It causes a significant decline in overall quality of life, including sexual dysfunction and mental distress. Surgical interventions, such as perineoplasty and vestibulectomy, are considered a last resort for PV cases unresponsive to less invasive therapies. This systematic review evaluates the efficacy of surgery for PV and suggests areas for future research. MATERIALS AND METHODS The literature search encompassed PubMed, Scopus, Web of Science, and Cochrane Library, identifying relevant peer-reviewed studies up to August 21, 2023. RESULTS Out of 1102 records retrieved, 29 met the eligibility criteria. Surgery was typically considered after failed conservative treatments. In 15 of the 29 studies defining surgical success as a significant reduction in dyspareunia, success rates ranged from 52% to 93%. Six studies using validated scales for pain assessment noted a significant reduction in vulvar pain following surgery (p < .001). Two studies reported enhancements in sexual function ranging from 57% to 87%, while 3 studies found 89%-97% of women regained the ability to engage in sexual intercourse after surgery. Patient satisfaction rates ranged from 79% to 93%. Bartholin cysts occurred in up to 9% of cases, the most common complication reported. CONCLUSION Surgery seems to be an effective and safe PV treatment option with success rates ranging from 52% to 97%, depending on the variation of outcome measures. Randomized clinical trials with established outcome measures are needed to determine the best surgical approach with minimal operative risk and optimal long-term outcomes.
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Affiliation(s)
| | - Hosna Razeghian
- Luigi Vanvitelli University of Campania School of Medicine and Surgery, Naples, Italy
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161
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Marais M, Wall S, Smith M, Allorto N. Factors Predicting Burn Surgery Operative Time in a Middle-Income Country Regional Burn Service. J Burn Care Res 2024; 45:963-968. [PMID: 38206865 DOI: 10.1093/jbcr/irae002] [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: 09/24/2023] [Indexed: 01/13/2024]
Abstract
Access to theater is essential for the surgical management of deep burns. This is a scarce resource in low-middle-income countries. It underpins the importance of optimizing theater time. We sought to look at specific factors and their influence on operative time in minor to moderate burn surgery. This knowledge can assist teams where theater planning and optimization may be beneficial in resource-limited settings. Operative records between January and December 2018 at the Regional Hospital were analyzed. Data fields included age, gender, TBSA of burn, surface area burn operated on, intraoperative position change, seniority of surgeon, presence of an assistant, inclusion of special areas, predicted operative time, and actual operative time. Operative records for 265 patients were analyzed, with a median operative time of 40 minutes (interquartile range 25-64). Overall factors that predict longer operating time are larger total body surface area burn, larger surface area burn operated on, an operation involving at least one special area, number of special areas operated on, position change, presence of an assistant, and longer predicted operative time. Total percentage burn, operated percentage, special areas to be operated, and position change are overall factors to be considered when planning a burns list for the nonspecialist burn surgeon. This knowledge may be useful for an inexperienced surgeon to understand and aid in the effective utilization of limited operative time available for the surgical management of deep burns in resource-limited settings.
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Affiliation(s)
- Marlé Marais
- Department of Paediatric Surgery, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, 2017, South Africa
- Chris Hani Baragwanath Academic Hospital, Soweto, 2013, South Africa
| | - Shelley Wall
- Developing Research, Innovation, Localization and Leadership (DRILL), College of Health Sciences, University of KwaZulu-Natal, Durban, 4000, South Africa
| | - Michelle Smith
- Department of Anaesthetics and Critical Care, Greys Hospital, Pietermaritzburg, 3201, South Africa
- Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, 4013, South Africa
| | - Nikki Allorto
- Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, 4013, South Africa
- Pietermaritzburg Metropolitan Department of Surgery, Pietermaritzburg, 3201, South Africa
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Pecorari IL, Reynolds JA, Agarwal V. The Relationship Between Race, Social Vulnerability Index, and Clinical Follow-Up After Surgical Resection of Pituitary Tumors. World Neurosurg 2024:S1878-8750(24)01362-7. [PMID: 39116941 DOI: 10.1016/j.wneu.2024.08.005] [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: 04/16/2024] [Revised: 07/31/2024] [Accepted: 08/01/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE Socioeconomic status and race have been found to influence patient outcomes for various cancer subtypes. In particular, minority and economically vulnerable patients present with more advanced disease and experience decreased survival compared to others. The aim of this study was to analyze the association between demographic or socioeconomic variables and rates of postsurgical follow-up after pituitary neuroendocrine tumor (PitNET) resection. METHODS A retrospective review was completed for patients with PitNETs who underwent surgery between 2018 and 2021. Patient demographics and information related to postoperative appointments and magnetic resonance imagings were obtained. Social vulnerability index (SVI) scores were recorded from the Centers for Disease Control based on nationwide census tracts. RESULTS One hundred and sixteen patients were included in the analysis (57 males). In this cohort, 50% were Black, 34% Hispanic, 9% White, and 1% Asian. The mean overall SVI score was 0.81 ± 0.23. The mean number of canceled appointments was significantly higher in the moderate-high/high SVI group (P = 0.034). Additionally, 30% of patients with moderate-high/high SVI had ≥2 canceled follow-up visits compared to 0% among patients with low/low-moderate SVI (P = 0.035). On average, White patients were less likely than non-White patients to have at least one canceled follow-up appointment (P = 0.048). CONCLUSIONS Black patients and those with high social vulnerability have decreased rates of follow-up after PitNET resection. Follow-up delays can lead to failed identification of tumor recurrence, potentially resulting in more advanced disease by the time medical care is reinitiated and increasing rates of patient morbidity and mortality. As a result, further work is needed to address and bridge these care gaps.
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Affiliation(s)
- Isabella L Pecorari
- Department of Neurological Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA.
| | - Joshua A Reynolds
- Department of Neurological Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | - Vijay Agarwal
- Department of Neurological Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
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163
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Qin X, Yin Y, Liu L, Gao L, Han S, Duan Y, Ren W, Wang J. A retrospective cohort study on enhanced recovery after surgery (ERAS) in patients with diabetic foot ulcer. Sci Rep 2024; 14:18171. [PMID: 39107400 PMCID: PMC11303749 DOI: 10.1038/s41598-024-69150-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 08/01/2024] [Indexed: 08/10/2024] Open
Abstract
Enhanced recovery after surgery (ERAS) has been successfully integrated into a diverse array of surgical fields to improve the quality and efficacy of treatment intervention. Nonetheless, the application of the ERAS protocol for patients with diabetic foot ulcer (DFU) subsequent to undergoing surgical procedures has not been previously explored. Therefore, this study aimed to investigate the effect of an enhanced recovery protocol on perioperative outcomes in patients with DFU following surgical procedures. A retrospective analysis was conducted on 112 patients with DFU who underwent surgery between January 2020 and December 2021 at a tertiary referral care center. In total, 57 patients received standard perioperative care (the non-ERAS group), and 55 patients received ERAS care (the ERAS group). The primary outcomes included the length of stay (LOS), wound healing time, patient satisfaction, and costs, serving as the basis for assessing the effectiveness of the two approaches. Secondary outcomes included preoperative anxiety (APAIS score), nutritional status (PG-SGA), pain (NRS score), the incidence of lower-extremity deep vein thrombosis (DVT), the reduction in lower-limb circumference, and the activity of daily living scale (Barthel Index). The ERAS group exhibited significantly shorter LOS (11.36 vs. 26.74 days; P < 0.001) and lower hospital costs (CNY 62,165.27 vs. CNY 118,326.84; P < 0.001), as well as a higher patient satisfaction score and Barthel Index score (P < 0.05). Additionally, we found a lower APAIS score, incidence of DVT, and circumference reduction in lower limbs in the ERAS group compared to the non-ERAS group (P < 0.05). In comparison, the wound healing time, nutritional status, and pain levels of participants in both groups showed no significant difference (P > 0.05). By reducing the LOS and hospital costs, and by minimizing perioperative complications, the ERAS protocol improves the quality and efficacy of treatment intervention in patients with DFU who underwent surgical procedures.Trial registration number: ChiCTR 2200064223 (Registration Date: 30/09/2022).
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Affiliation(s)
- Xinyuan Qin
- Department of Orthopedic Surgery, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing, 100038, China
| | - Yefeng Yin
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Lei Liu
- Department of Science and Technology, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing, 100038, China
| | - Lei Gao
- Department of Orthopedic Surgery, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing, 100038, China
| | - Siyang Han
- Department of Orthopedic Surgery, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing, 100038, China
| | - Yijie Duan
- School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China
| | - Weiyan Ren
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, School of Engineering Medicine, Beihang University, Beijing, 100191, China
| | - Jiangning Wang
- Department of Orthopedic Surgery, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing, 100038, China.
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Äyräväinen A, Vahteristo M, Khamaiseh S, Heikkinen T, Ahvenainen T, Härkki P, Vahteristo P. Quality of life after myomectomy according to the surgical approach and MED12 mutation status. Eur J Obstet Gynecol Reprod Biol 2024; 301:142-146. [PMID: 39137592 DOI: 10.1016/j.ejogrb.2024.08.010] [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: 03/26/2024] [Revised: 07/29/2024] [Accepted: 08/05/2024] [Indexed: 08/15/2024]
Abstract
OBJECTIVE Molecular status of uterine leiomyomas has been shown to affect both tumor characteristics and treatment response. Mutations in mediator complex subunit 12 (MED12), the most prevalent alterations in leiomyomas, are associated with tumor size and number of leiomyomas. Myomectomy can be performed by laparoscopy or by open abdominal surgery, depending on the size and number of leiomyomas removed. The aim of this study was to examine the association between MED12 mutation status and surgical approach of myomectomy. We also evaluated myomectomy patients' quality of life after laparoscopic or abdominal surgery and according to the MED12 mutation status. STUDY DESIGN The prospective cohort study included 104 women who underwent laparoscopic or abdominal myomectomy at the Helsinki University Hospital during 2015-2019. Patients filled in the validated Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaire before the operation and 6 and 12 months after the operation. Medical records were reviewed to collect clinical data. Leiomyoma tissue samples were collected and screened for MED12 mutations. RESULTS Patients undergoing abdominal myomectomy had larger and more numerous leiomyomas compared to patients with laparoscopic myomectomy (10 cm vs 7.4 cm, p < 0.001 and 3 vs 1 leiomyomas, p < 0.001, respectively). A mean change of over 20 points was seen in UFS-QOL scores at 6 months after both laparoscopic and abdominal myomectomy (p < 0.001). MED12 mutations were detected in 178/242 (74 %) of leiomyomas. Of the patients, 45/97 (46 %) had only MED12 positive leiomyomas, while 39/97 (40 %) had only MED12 wild type leiomyomas. The number of leiomyomas removed was higher among patients with MED12 positive leiomyomas than in patients with MED12 wild type tumors (p < 0.001). Laparoscopic approach was equally common in both groups (62 % and 64 %), and there was no statistically significant difference in the UFS-QOL scores. CONCLUSION Both laparoscopic and abdominal myomectomy significantly improved the quality of life. While MED12 mutations were related with multiple leiomyomas and therefore potentially generated a greater leiomyoma burden, they were not associated with the surgical approach. Pre- and postoperative quality of life was comparable between patients regardless of MED12 status.
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Affiliation(s)
- Anna Äyräväinen
- Applied Tumor Genomics Research Program and Department of Medical and Clinical Genetics, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maija Vahteristo
- Applied Tumor Genomics Research Program and Department of Medical and Clinical Genetics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Sara Khamaiseh
- Applied Tumor Genomics Research Program and Department of Medical and Clinical Genetics, Faculty of Medicine, University of Helsinki, Helsinki, Finland; iCAN Digital Precision Cancer Medicine Flagship, University of Helsinki, Helsinki, Finland
| | - Tuomas Heikkinen
- Applied Tumor Genomics Research Program and Department of Medical and Clinical Genetics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Terhi Ahvenainen
- Applied Tumor Genomics Research Program and Department of Medical and Clinical Genetics, Faculty of Medicine, University of Helsinki, Helsinki, Finland; iCAN Digital Precision Cancer Medicine Flagship, University of Helsinki, Helsinki, Finland
| | - Päivi Härkki
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pia Vahteristo
- Applied Tumor Genomics Research Program and Department of Medical and Clinical Genetics, Faculty of Medicine, University of Helsinki, Helsinki, Finland; iCAN Digital Precision Cancer Medicine Flagship, University of Helsinki, Helsinki, Finland.
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165
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Tan K, Wei L, Deng Z, Yao D, Jiang L. Learning curve of ovarian cystectomy by vaginal natural orifice transluminal endoscopic surgery: a cumulative sum analysis. Front Med (Lausanne) 2024; 11:1449446. [PMID: 39161409 PMCID: PMC11330758 DOI: 10.3389/fmed.2024.1449446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Accepted: 07/22/2024] [Indexed: 08/21/2024] Open
Abstract
Purpose To identify the learning curve in ovarian cystectomy by vaginal natural orifice transluminal endoscopic surgery. Methods Data consist of consecutively ordered patients who underwent ovarian cystectomy via vaginal natural orifice transluminal endoscopic surgery between May 2020 and June 2023. The learning curve of ovarian cystectomy via vaginal natural orifice transluminal endoscopic surgery was measured in terms of the operating time adjusted by multivariate linear regression. A cumulative sum analysis was performed to establish the learning curve. Patients' characteristics and surgical outcomes were compared based on the inflection points of this curve. Results The learning curve was divided into two unique phases: phase 1 (1-26 patients), and phase 2 (27-40 patients). The expected operating time in phase 2 was shorter than in phase 1 (86.4 ± 11.2 min vs. 102.0 ± 22.7 min, p = 0.021). The time to first postoperative flatus was shorter in phase 2 compared with phase 1 (14.6 ± 6.5 h vs. 20.6 ± 6.3 h, respectively, p = 0.008). No significant differences were observed in terms of patient's age, BMI, tumor size, parity, bilateral ovarian tumor, pathological diagnoses, estimated blood loss, postoperative pain score, or perioperative complications between the two phases. Conclusion Proficiency in ovarian cystectomy by vaginal natural orifice transluminal endoscopic surgery was achieved after 26 surgeries based on cumulative sum analysis. These findings may provide insight for structured training programs of ovarian cystectomy via vaginal natural orifice transluminal endoscopic surgery.
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Affiliation(s)
- Kailiang Tan
- Department of Gynecological Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
- Department of Obstetrics and Gynecology, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Liufei Wei
- Department of Obstetrics and Gynecology, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Zengmei Deng
- Department of Obstetrics and Gynecology, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Desheng Yao
- Department of Gynecological Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Li Jiang
- Department of Obstetrics and Gynecology, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
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Gao Y, Xu G, Yang M, Chen K, Wang Y. Risk factors of chronic endometritis in women who have undergone hysteroscopy: a prospective nested case-control study. Sci Rep 2024; 14:18099. [PMID: 39103391 PMCID: PMC11300859 DOI: 10.1038/s41598-024-69095-y] [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: 12/07/2023] [Accepted: 07/31/2024] [Indexed: 08/07/2024] Open
Abstract
There is limited research on risk factors for chronic endometritis regarding reproductive history and clinical symptoms. Thus, this nested case-control study identified risk factors for chronic endometritis in women who have undergone hysteroscopy. Endometrial tissue sections were obtained from 502 women with intrauterine disorders who underwent hysteroscopy. Chronic endometritis was diagnosed via CD138 immunostaining. The women were divided into two groups: 271 women without chronic endometritis and 231 women with chronic endometritis. The prevalence of chronic endometritis was 46%. Univariate logistic regression revealed that prolonged menstruation and intermenstrual bleeding were associated with chronic endometritis, and subsequent multivariate logistic regression analyses showed that these were further independently associated. With univariable logistic regression, the gravidity and abortion history were correlated with chronic endometritis; however, no significant correlation was found with the adjusted odds ratio (OR) of 0.74 (95% confidence interval [CI] 0.46-1.19) or 0.76 (95% CI 0.58-1.11), respectively. No significant correlation was found between caesarean section history and the rates of chronic endometritis. No significant difference was found in all other variables between the three groups with > 5, ≤ 5 plasma cells and in a unknown group. Prolonged menstruation and intermenstrual bleeding were risk factors associated with chronic endometritis. Chronic endometritis should be considered and CD138 immunohistochemical examination should be recommended in women with these symptoms.
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Affiliation(s)
- Yun Gao
- Department of Ambulatory Surgery, Women's Hospital, Zhejiang University School of Medicine, No.1 Xueshi Road, Hangzhou, 31000, China
| | - Gufeng Xu
- Department of Ambulatory Surgery, Women's Hospital, Zhejiang University School of Medicine, No.1 Xueshi Road, Hangzhou, 31000, China
| | - Min Yang
- Department of Ambulatory Surgery, Women's Hospital, Zhejiang University School of Medicine, No.1 Xueshi Road, Hangzhou, 31000, China
| | - Kaiting Chen
- Department of Ambulatory Surgery, Women's Hospital, Zhejiang University School of Medicine, No.1 Xueshi Road, Hangzhou, 31000, China
| | - Yue Wang
- Department of Ambulatory Surgery, Women's Hospital, Zhejiang University School of Medicine, No.1 Xueshi Road, Hangzhou, 31000, China.
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Spiller M, Esmaeili N, Sühn T, Boese A, Turial S, Gumbs AA, Croner R, Friebe M, Illanes A. Enhancing Veress Needle Entry with Proximal Vibroacoustic Sensing for Automatic Identification of Peritoneum Puncture. Diagnostics (Basel) 2024; 14:1698. [PMID: 39125574 PMCID: PMC11311580 DOI: 10.3390/diagnostics14151698] [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: 06/24/2024] [Revised: 07/12/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024] Open
Abstract
Laparoscopic access, a critical yet challenging step in surgical procedures, often leads to complications. Existing systems, such as improved Veress needles and optical trocars, offer limited safety benefits but come with elevated costs. In this study, a prototype of a novel technology for guiding needle interventions based on vibroacoustic signals is evaluated in porcine cadavers. The prototype consistently detected successful abdominal cavity entry in 100% of cases during 193 insertions across eight porcine cadavers. The high signal quality allowed for the precise identification of all Veress needle insertion phases, including peritoneum puncture. The findings suggest that this vibroacoustic-based guidance technology could enhance surgeons' situational awareness and provide valuable support during laparoscopic access. Unlike existing solutions, this technology does not require sensing elements in the instrument's tip and remains compatible with medical instruments from various manufacturers.
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Affiliation(s)
- Moritz Spiller
- SURAG Medical GmbH, 04229 Leipzig, Germany; (N.E.); (T.S.); (A.I.)
| | - Nazila Esmaeili
- SURAG Medical GmbH, 04229 Leipzig, Germany; (N.E.); (T.S.); (A.I.)
- Chair for Computer Aided Medical Procedures and Augmented Reality, Technical University of Munich, 85748 Munich, Germany
| | - Thomas Sühn
- SURAG Medical GmbH, 04229 Leipzig, Germany; (N.E.); (T.S.); (A.I.)
- Department of Orthopaedic Surgery, Otto-von-Guericke University Magdeburg, 39106 Magdeburg, Germany
| | - Axel Boese
- INKA—Innovation Laboratory for Image Guided Therapy, Otto-von-Guericke University Magdeburg, 39106 Magdeburg, Germany; (A.B.); (M.F.)
| | - Salmai Turial
- Department of Pediatric Surgery and Pediatric Traumatology, University Clinic for General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany;
| | - Andrew A. Gumbs
- University Clinic for General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany; (A.A.G.); (R.C.)
- Advanced & Minimally Invasive Surgery Excellence Center, American Hospital Tblisi, 0102 Tblisi, Georgia
| | - Roland Croner
- University Clinic for General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany; (A.A.G.); (R.C.)
| | - Michael Friebe
- INKA—Innovation Laboratory for Image Guided Therapy, Otto-von-Guericke University Magdeburg, 39106 Magdeburg, Germany; (A.B.); (M.F.)
- Faculty of Computer Science, AGH University of Science and Technology, 30-059 Krakow, Poland
- Center for Innovation, Business Development & Entrepreneurship, FOM University of Applied Sciences, 45141 Essen, Germany
| | - Alfredo Illanes
- SURAG Medical GmbH, 04229 Leipzig, Germany; (N.E.); (T.S.); (A.I.)
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Ashmore S, Geller EJ, Bretschneider CE. Minimally Invasive Sacrocolpopexy: Impact on Sexual Function. Int Urogynecol J 2024:10.1007/s00192-024-05834-z. [PMID: 39101957 DOI: 10.1007/s00192-024-05834-z] [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: 03/08/2024] [Accepted: 05/10/2024] [Indexed: 08/06/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Sacrocolpopexy (SCP) is the gold standard surgical management of apical pelvic organ prolapse (POP), and increasingly, minimally invasive SCP is being adopted as a primary treatment for advanced uterovaginal prolapse. Patients undergoing surgery for POP consider postoperative improvement in sexual function to be a highly important outcome, and sexual dysfunction and dyspareunia severe adverse events. Therefore, it is crucial to understand the impact of minimally invasive SCP on postoperative sexual function. We aimed to analyze the current literature available to discuss the impact of minimally invasive SCP on postoperative sexual function. METHODS We performed a narrative review of minimally invasive SCP and its impact on sexual function. PubMed and EMBASE were searched from inception through 28 January 2024 for studies that reported sexual function following surgery for POP. Baseline and postoperative sexual activity, dyspareunia, and validated questionnaire scores for sexual function were documented. RESULTS Minimally invasive SCP is associated with improved postoperative sexual function, increased rates of postoperative sexual activity, and low rates of dyspareunia. Dyspareunia was not associated with mesh related complications. Patients with baseline dyspareunia or pain were more likely to experience persistent dyspareunia after surgery. CONCLUSION The rates of POP are increasing in our aging population, and sexual function is very important to patients undergoing surgery for POP. Clinicians should consider all factors related to sexual function when planning surgery for POP and address dyspareunia prior to surgery. Sexual function appears to improve overall after minimally invasive SCP and de novo dyspareunia rates are low.
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Affiliation(s)
- Sarah Ashmore
- Section of Urogynecology and Reconstructive Pelvic Surgery, University of Chicago, Chicago, IL, USA
| | - Elizabeth J Geller
- Division of Urogynecology and Reconstructive Pelvic Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - C Emi Bretschneider
- Division of Urogynecology and Reconstructive Pelvic Surgery, Northwestern University, Chicago, IL, USA.
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169
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Alavi-Arjas F, Nahidi F, Simbar M, Majd HA, Rastegar F. The role of sexual partner in women's seeking for labiaplasty: a systematic review and meta-analysis. J Sex Med 2024:qdae091. [PMID: 39104202 DOI: 10.1093/jsxmed/qdae091] [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: 01/09/2024] [Revised: 05/27/2024] [Accepted: 07/21/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND The primary reasons for labiaplasty usually revolve around aesthetic, sexual, and functional concerns. Upon delving deeper into these issues, it becomes apparent that sexual partners play a controversial role in influencing women's decisions to undergo surgery. AIM This study aimed to investigate the impact of sexual partners on women's choices to pursue labiaplasty. METHODS A comprehensive search was conducted across electronic databases covering the period from January 2000 to February 2024. After removing duplicates, a total of 931 articles were retrieved by searching keywords in titles and abstracts. OUTCOMES The meta-analysis revealed that 36.7% of women who sought labiaplasty cited their partners' negative comments as a factor influencing their decision. RESULTS After applying the eligibility criteria and excluding irrelevant articles, a total of 12 articles involving 962 participants were included in the analysis. With the exception of 2 articles, the majority of the studies suggested a discernible influence of male partners on women's decisions to seek labiaplasty. Frequently, sexual partners are not the primary decision makers, nor do they exert significant pressure when it comes to seeking labiaplasty. In certain instances, women seeking labiaplasty acknowledged that their sexual partners did influence their decisions, either by making disparaging comments about their genitalia or by directly pressuring or requesting them to undergo labiaplasty. Additionally, women might opt for labiaplasty out of fear of their partner's negative remarks or to enhance sexual pleasure for their partners. For a more accurate result, a meta-analysis was conducted noting a considerable heterogeneity. CLINICAL IMPLICATIONS The findings of this study can be applied in prelabiaplasty counseling sessions to acknowledge and explore the role of the sexual partner in women's decision making. STRENGTHS AND LIMITATIONS This study stands as the inaugural systematic review examining the impact of sexual partners on women seeking labiaplasty, encompassing all original studies exploring the role of the sexual partner. However, a notable limitation lies in the varied interpretations of the sexual partner's role, that the heterogeneous nature of these interpretations poses a challenge to providing a more precise answer through meta-analysis. CONCLUSION Based on the findings of this systematic review, it is evident that sexual partners exert multifaceted influences on women's decisions to seek labiaplasty. While not serving as the primary decision makers, women opt for labiaplasty with the aim of enhancing attractiveness in sexual relationships and mitigating potential negative comments from their partners.
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Affiliation(s)
- Fatemeh Alavi-Arjas
- Student Research Committee, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran 1996835119, Iran
| | - Fatemeh Nahidi
- Midwifery and Reproductive Health Research Center, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran 1996835119, Iran
| | - Masoumeh Simbar
- Midwifery and Reproductive Health Research Center, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran 1996835119, Iran
| | - Hamid Alavi Majd
- Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran 1971653313, Iran
| | - Fereshteh Rastegar
- OB/GYN, Modarres and 17th Shahrivar Hospital Complex, Saveh Faculty of Medical Sciences, Saveh University, of Medical Sciences, Saveh 3919676651, Iran
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Kang OJ, Park Y, Lee EM, Lee JJ, Lee SW, Kim DY, Suh DS, Kim JH, Kim YM, Park JY. Predictive value of SUVmax from initial 18F-FDG PET/CT scans for treatment outcomes in endometrial cancer patients undergoing fertility sparing management. Int J Gynecol Cancer 2024; 34:1189-1195. [PMID: 38754967 DOI: 10.1136/ijgc-2024-005441] [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] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVE To evaluate whether the maximum standardized uptake value (SUVmax) from initial 18F-FDG PET/CT (fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography) scans could be a predictor of complete response and recurrence in patients with endometrial cancer who are undergoing fertility sparing management. METHODS We conducted a retrospective review of patients who were diagnosed with endometrial cancer through biopsy and chose to undergo fertility sparing management using progestin at the Asan Medical Center, from January 2011 to December 2020. Of these, 113 patients who had an 18-FDG-PET/CT scan before starting treatment were included in our study. We measured SUVmax and examined its correlation with complete response and time to progression after achieving complete response to progestin therapy. RESULTS Of 113 patients, 73 (64.6%) achieved a complete response through fertility sparing management. The receiver operating characteristic curve analysis revealed that the optimal cut-off value of SUVmax for predicting complete response was 6.2 (sensitivity 79.5%, specificity 57.5%, p=0.006). After analyzing recurrence in the 73 patients who achieved complete response, we found that patients with an SUVmax value >6.2 had a significantly shorter time to progression compared with those with a value <6.2. (p=0.04). CONCLUSIONS SUVmax values of PET-CT, along with other clinicopathological parameters, could be used to predict treatment response and recurrence risk in patients with stage I endometrial cancer undergoing fertility sparing management.
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Affiliation(s)
- Ok-Ju Kang
- Department of Obstetrics and Gynecology, Asan Medical Center, Songpa-gu, Seoul, Korea
| | - Yonghee Park
- Department of Obstetrics and Gynecology, Asan Medical Center, Songpa-gu, Seoul, Korea
| | - Eun Min Lee
- Department of Obstetrics and Gynecology, Asan Medical Center, Songpa-gu, Seoul, Korea
| | - Jong Jin Lee
- Department of Nuclear Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea
| | - Shin-Wha Lee
- Department of Obstetrics and Gynecology, Asan Medical Center, Songpa-gu, Seoul, Korea
| | - Dae-Yeon Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, Songpa-gu, Seoul, Korea
| | - Dae-Shik Suh
- Department of Obstetrics and Gynecology, Asan Medical Center, Songpa-gu, Seoul, Korea
| | - Jong-Hyeok Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, Songpa-gu, Seoul, Korea
| | - Yong-Man Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, Songpa-gu, Seoul, Korea
| | - Jeong-Yeol Park
- Department of Obstetrics and Gynecology, Asan Medical Center, Songpa-gu, Seoul, Korea
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Alomari O, Mokresh ME, Muvaffak E, Bakir RN, Al Shomali R, Akis S, Acar S, Api M. Transvaginal morcellation within an enclosed bag in gynecological surgeries: a comprehensive systematic review and analysis of safety, efficacy, and outcomes. Arch Gynecol Obstet 2024:10.1007/s00404-024-07676-y. [PMID: 39097538 DOI: 10.1007/s00404-024-07676-y] [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: 12/11/2023] [Accepted: 07/26/2024] [Indexed: 08/05/2024]
Abstract
PURPOSE This systematic review aims to comprehensively assess the safety and efficacy of transvaginal morcellation within an enclosed bag in gynecological surgeries, with a focus on its benefits, potential risks, and recommendations for its use. METHODS We conducted a comprehensive search of Epistemonikos, Web of Science, Medline (PubMed), Scopus, and Cochrane databases for studies on transvaginal contained morcellation in adult patients undergoing gynecological surgeries. The review included 22 studies that met the inclusion criteria, encompassing diverse surgical procedures, patient profiles, and outcomes. These studies were thoroughly reviewed and analyzed to assess the safety and efficacy of the morcellation technique. RESULTS Key findings from the selected studies indicate that transvaginal morcellation within an enclosed bag offers several advantages in gynecological surgeries, including reduced invasiveness, shorter operative times, and minimal blood loss when compared to conventional methods. The risk of tumor recurrence or dissemination appears to be low when appropriate precautions are taken, emphasizing the technique's safety, especially when performed by experienced surgical teams. While some studies reported complications, these were generally not directly associated with the morcellation technique. CONCLUSION Transvaginal morcellation within an enclosed bag demonstrates potential as a safe and effective option for gynecological surgeries. The technique offers the benefits of minimally invasive procedures, including reduced bleeding, shorter recovery times, and improved cosmetic outcomes. This review also highlights the need for standardization in study methodologies and reporting, as the heterogeneity in outcomes across the selected studies poses challenges in drawing definitive conclusions.
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Affiliation(s)
- Omar Alomari
- Hamidiye International Faculty of Medicine, University of Health Sciences, Istanbul, 34668, Türkiye
| | - Muhammed Edib Mokresh
- Hamidiye International Faculty of Medicine, University of Health Sciences, Istanbul, 34668, Türkiye.
| | - Emir Muvaffak
- Hamidiye International Faculty of Medicine, University of Health Sciences, Istanbul, 34668, Türkiye
| | - Rahime Nurbanu Bakir
- Hamidiye International Faculty of Medicine, University of Health Sciences, Istanbul, 34668, Türkiye
| | - Raghad Al Shomali
- Hamidiye International Faculty of Medicine, University of Health Sciences, Istanbul, 34668, Türkiye
| | - Serkan Akis
- Faculty of Medicine, Department of Gynecologic Oncology, Marmara University, Pendik Training and Research Hospital, Istanbul, Türkiye
| | - Sami Acar
- Faculty of Medicine, Department of General Surgery, Tekirdağ Namık Kemal University, 59100, Terkirdağ, Türkiye
| | - Murat Api
- Department of Gynecologic Oncology, University of Health Sciences Turkey, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Türkiye
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172
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Zhang M, Jin H. Robotic transumbilical laparoendoscopic single site surgery improves performance of complicated gynecological surgeries and facilitates multidisciplinary collaboration. Asian J Surg 2024:S1015-9584(24)01648-8. [PMID: 39098516 DOI: 10.1016/j.asjsur.2024.07.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 07/02/2024] [Accepted: 07/22/2024] [Indexed: 08/06/2024] Open
Affiliation(s)
- Man Zhang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China
| | - Hongyu Jin
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China.
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173
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Holtzman S, Gellman C, Kaplowitz E, Barber E, Huh W, Blank SV. Yes, it's true: Benign hysterectomy trends for gynecologic oncologists in the United States from 2015 to 2021. Gynecol Oncol 2024; 189:125-128. [PMID: 39098119 DOI: 10.1016/j.ygyno.2024.07.670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/15/2024] [Accepted: 07/16/2024] [Indexed: 08/06/2024]
Abstract
INTRODUCTION The objective of this study was to determine the trends in benign surgery in GO practice across the United States. METHODS This was a retrospective cohort analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2015 to 2021. Subjects were selected by filtering for cases of hysterectomy using current procedural terminology (CPT codes). Trends over time were assessed using linear regression for continuous outcomes and logistic regression for categorical outcomes. RESULTS From the 2015 to 2021, the dataset contained 246,743 hysterectomies that were performed across the United States. For all gynecologic specialties, 188,534 (76%) were performed for benign indications and 59,209 (24%) were gynecologic cancer cases. The proportion of hysterectomies done by all specialists for benign indications increased with increasing year. When looking at hysterectomy cases by surgeon's subspecialty, GOs performed 35,680 (23%) of all benign cases over the entire time period. Over our study time period, the proportion of benign hysterectomies performed by GOs increased with increasing year with the proportion of benign hysterectomies done by GO in 2016 was 37.8% and reached 45.2% in 202. The proportion of hysterectomies done by all sub-specialists for cancer indications decreased with increasing year including the proportion of cancer cases performed by GOs for cancer indications. CONCLUSIONS The proportion of benign hysterectomies performed by GO consistently increased every year. This study corroborates existing survey data and hypothesizes that the practice of GO is increasingly being consumed by general gynecology.
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Affiliation(s)
- Sharonne Holtzman
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
| | - Caroline Gellman
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | | | | | - Warner Huh
- University of Alabama, Tuscaloosa, AL, USA
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174
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Zhao Q, Yang T, Xu C, Hu J, Shuai Y, Zou H, Hu W. Automatic diagnosis for adenomyosis in ultrasound images by deep neural networks. Eur J Obstet Gynecol Reprod Biol 2024; 301:128-134. [PMID: 39121648 DOI: 10.1016/j.ejogrb.2024.07.046] [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: 12/07/2023] [Revised: 07/08/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVE To present a new noninvasive technique for automatic diagnosis of adenomyosis, using a novel end-to-end unified network framework based on transformer networks. STUDY DESIGN This is a prospective descriptive study conducted at a university hospital.1654 patients were recruited to the study according to adenomyosis diagnosed by transvaginal ultrasound (TVS). For adenomyosis characteristics and ultrasound images, automatic identification of adenomyosis were performed based on deep learning methods. We called this unique technique A2DNet: Adenomyosis Auto Diagnosis Network. RESULTS The A2DNet exhibits excellent performance in diagnosis of adenomyosis, achieving an accuracy of 92.33%, a precision of 96.06%, a recall of 91.71% and an F1 score of 93.80% in the test group. The confusion matrix of experimental results show that the A2DNet can achieve a correct diagnosis rate of 92% or more for both normal and adenomyosis samples, which demonstrate the superiority of the A2DNet comparing with the state-of-the-arts. CONCLUSION The A2DNet is a safe and effective technique to aid in automatic diagnosis of adenomyosis. The technique which is nondestructive and non-invasive, is new and unique due to the advantages of artificial intelligence.
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Affiliation(s)
- Qinghong Zhao
- Department of Ultrasound in Medicine, Renmin Hospital of Wuhan University, China
| | - Tongyu Yang
- School of Cyber Science and Engineering, Wuhan University, China
| | - Changyong Xu
- IT Department, China Southern Airlines Hubei Branch, Wuhan, China
| | - Jiaqi Hu
- Department of Ultrasound in Medicine, Renmin Hospital of Wuhan University, China
| | - Yu Shuai
- Department of Ultrasound in Medicine, Renmin Hospital of Wuhan University, China
| | - Hua Zou
- School of Computer Science, Wuhan University, China.
| | - Wei Hu
- Department of Ultrasound in Medicine, Renmin Hospital of Wuhan University, China.
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175
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Garg M, Rajanbabu A, Nair IR. Smooth muscle tumors of uncertain malignant potential or atypical leiomyomas: A long-term evaluation of surgical outcomes and clinicopathological features. Eur J Obstet Gynecol Reprod Biol 2024; 301:201-205. [PMID: 39154515 DOI: 10.1016/j.ejogrb.2024.07.062] [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: 03/29/2024] [Revised: 07/26/2024] [Accepted: 07/29/2024] [Indexed: 08/20/2024]
Abstract
OBJECTIVE The Primary Objective of this study was to analyse reproductive outcomes in patients with STUMP (Smooth Muscle Tumour of Uncertain Potential) or ALM (Atypical Leiomyoma) who underwent fertility-preserving surgeries. Secondary Objectives were to analyse long-term prognosis for these patients and to study the basic demographic and pathological characteristics of patients with STUMP or ALM. STUDY DESIGN This retrospective study was conducted at Amrita Institute of Medical Sciences. Cases of STUMP and ALM were retrieved from the hospital medical database between June 2014 and December 2022. Demographic parameters, clinical presentations, pathological features and clinical outcomes were analysed. Categorical variables were expressed in numbers and percentages. Normal distribution data were presented as mean while non-normal distribution was expressed as median and range. RESULTS Thirty-eight patients were included in the study with a diagnosis of STUMP or ALM in postoperative histology. Seven patients (18.4%) were nulliparous. Myomectomy was performed in 9 (23.6%), while hysterectomy was done in 29 patients (76.3%). Fertility-preserving surgeries were performed on six patients (15.7%). Of these six patients, 4(66.6%) conceived spontaneously and had successful pregnancies. Recurrences were found in 3 patients (7.8%) out of which one had undergone fertility-sparing surgery. All the patients with recurrences had previous history of myomectomies. Morcellation was reportedly done in 2 of these three patients. CONCLUSION Good reproductive outcomes have been demonstrated in patients diagnosed with STUMP or ALM and desiring fertility. However, these patients should be kept under follow-up care as they are prone for recurrences. Patients who have undergone morcellation mayhave an increased chance of recurrence.
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Affiliation(s)
- Monal Garg
- Department of Gynaecological Oncology, Amrita Institute of Medical Sciences, Ponekkara Rd, Edappally, Kochi, Ernakulam, Kerala 682041, India
| | - Anupama Rajanbabu
- Department of Gynaecological Oncology, Amrita Institute of Medical Sciences, Ponekkara Rd, Edappally, Kochi, Ernakulam, Kerala 682041, India; Department of Gynaecological Oncology, James Cook University Hospital, Marton Rd, Middlesbrough TS4 3BW, UK.
| | - Indu R Nair
- Department of Pathology, Amrita Institute of Medical Sciences, Ponekkara Rd, Edappally, Kochi, Ernakulam, Kerala 682041, India.
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176
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Mandato VD, Paterlini M, Torricelli F, Rabitti E, Mastrofilippo V, Aguzzoli L. Perceived social support and quality of life in endometrial cancer patients: a longitudinal study. Front Oncol 2024; 14:1447644. [PMID: 39156703 PMCID: PMC11327120 DOI: 10.3389/fonc.2024.1447644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 07/17/2024] [Indexed: 08/20/2024] Open
Abstract
Objective This study aimed to assess the influence of medical history, perceived physician-patient communication, and perceived social support on changes in the quality of life (QoL) during the first year of follow-up in patients undergoing surgery for endometrial cancer (EC), the most prevalent gynecological cancer in Western countries, especially in Central and Eastern Europe and North America. Methods This prospective longitudinal study included 98 EC patients. All participants completed the Short Form 36 (SF-36) and the Multidimensional Scale of Perceived Social Support (MSPSS) one month and one year after surgery. Additionally, one month after surgery, they responded to a questionnaire designed by the researchers concerning the key aspects of physician-patient communication. Results Our findings revealed that patients reporting high social support one month after surgery demonstrated significantly improved emotional well-being (EWB) at both one month and one year after the surgery, with statistically significant higher scores in the dimension of EWB (p<0.05). The support from a significant other at one year correlates with greater PF (p<0.005), fewer limitations due to physical health (p<0.05), less pain (p<0.05), less fatigue (p<0.05), and better general and EWB (p<0.05). Conclusion This study underscores the significance of perceived social support for patients cross endometrial cancer. The multifaceted nature of social support, encompassing emotional assistance and information sharing, emerges as a pivotal factor aiding patients in confronting the challenges inherent to EC. This form of support contributes to bolstering psychological well-being and enhancing overall QoL.
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Affiliation(s)
- Vincenzo Dario Mandato
- Obstetrics and Gynecological Oncology, Azienda Unità Sanitaria Locale (AUSL) - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia, Reggio Emilia, Italy
| | - Marcella Paterlini
- Department of Obstetrics and Pediatrics, Azienda Unità Sanitaria Locale (AUSL) - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia, Reggio Emilia, Italy
| | - Federica Torricelli
- Laboratory of Translational Research, Azienda Unità Sanitaria Locale (AUSL) - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia, Reggio Emilia, Italy
| | - Elisa Rabitti
- Psycho-oncology Unit, Azienda Unità Sanitaria Locale (AUSL) - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia, Reggio Emilia, Italy
| | - Valentina Mastrofilippo
- Obstetrics and Gynecological Oncology, Azienda Unità Sanitaria Locale (AUSL) - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia, Reggio Emilia, Italy
| | - Lorenzo Aguzzoli
- Obstetrics and Gynecological Oncology, Azienda Unità Sanitaria Locale (AUSL) - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia, Reggio Emilia, Italy
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Coutinho SS, Braga LDM, Costa MES, Veloso MO, Alves APNN, Júnior EML, Bruno ZV, Filho MOM, Paier CRKP, Rodrigues FARR, Bezerra LRPS. NEOVAGINOPLASTY WITH NILE TILAPIA SKIN GRAFT IN A PATIENT WITH GONADAL DYSGENESIS: A CASE REPORT. J Pediatr Adolesc Gynecol 2024:S1083-3188(24)00257-2. [PMID: 39098545 DOI: 10.1016/j.jpag.2024.07.008] [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: 04/01/2024] [Revised: 07/07/2024] [Accepted: 07/26/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Gonadal dysgenesis, a genetic condition characterized by incomplete of defective formation of the gonads, can present with vaginal agenesis in individuals with 46,XY karyotype. CASE We report an innovative intervention in the management of vaginal agenesis in a 19-year-old female with gonadal dysgenesis. Despite initial attempts with vaginal dilators, the patient presented unresponsive, leading to the adoption of a neovaginoplasty using Nile Tilapia Fish Skin (NTFS) as graft. The procedure, based on the McIndoe technique, involved the creation of a 10cm x 3cm vaginal canal with an NTFS-wrapped acrylic mold without complications. DISCUSSION The use of NTFS as a graft for neovaginoplasty in gonadal dysgenesis, a novel approach not previously reported in medical literature for this diagnosis, demonstrated favorable outcomes in terms of functionality and patient well-being.
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Affiliation(s)
| | - L D M Braga
- Federal University of Ceará. Fortaleza, Brazil
| | - M E S Costa
- Federal University of Ceará. Fortaleza, Brazil
| | - M O Veloso
- Federal University of Ceará. Fortaleza, Brazil
| | | | | | - Z V Bruno
- Maternidade Escola Assis-Chateaubriand. Fortaleza, Brazil
| | - M O M Filho
- Federal University of Ceará. Fortaleza, Brazil
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Appelbaum H. Perioperative and Operative Considerations for Minimally Invasive Surgery in Pediatric and Adolescent Gynecology. J Pediatr Adolesc Gynecol 2024:S1083-3188(24)00261-4. [PMID: 39098547 DOI: 10.1016/j.jpag.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 07/07/2024] [Accepted: 07/26/2024] [Indexed: 08/06/2024]
Abstract
Minimally invasive surgery (MIS) techniques, including vaginoscopy, laparoscopy and robotic-assisted surgery (RAS), have revolutionized the field of gynecology, offering numerous benefits such as reduced postoperative pain, shorter hospital stays, and faster recovery. While these techniques are widely employed in adult gynecologic surgery, their application in pediatric and adolescent patients requires careful consideration due to anatomical differences, patient size, and specific surgical requirements in children. Various aspects of MIS in pediatric and adolescent gynecology, including patient positioning, laparoscopic and robotic instrument choices, trocar placement, surgical techniques, and perioperative pediatric adaptations to MIS are discussed. The findings highlight the unique challenges and opportunities in performing MIS for pediatric and adolescent patients undergoing gyn surgery, emphasizing the need for specialized training and multidisciplinary collaboration.
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Affiliation(s)
- Heather Appelbaum
- Associate Professor, Obstetrics and Gynecology, Hackensack School of Medicine, Chief, Division of Pediatric and Adolescent Gynecology; K. Hovnanian Children's Hospital at Jersey Shore University Medical Center
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179
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Cheng M, Liu H, Pu C, Chen G, Zhang Y, Yan L. Catastrophic Cognition Is a Stronger Predictor Than Emotional Factors of Acute Postoperative Pain in Patients With Traumatic Orthopedic Injuries. Pain Manag Nurs 2024:S1524-9042(24)00192-9. [PMID: 39097418 DOI: 10.1016/j.pmn.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 05/23/2024] [Accepted: 06/04/2024] [Indexed: 08/05/2024]
Abstract
BACKGROUND Both cognitive (pain catastrophizing [PC]) and emotional factors (anxiety, depression, and optimism) play vital roles in acute postoperative pain (APOP) management among patients with traumatic orthopedic injuries (TOIs). It remains uncertain if these psychological factors independently or collectively impact APOP in patients with TOIs, and the underlying mechanisms by which various psychological factors impact APOP in patients with TOIs are also ambiguous. PURPOSE The aims of the current research were to analyze the effects of PC and emotional factors (anxiety, depression, and optimism) on APOP in patients with TOIs and explore the potential mechanisms by which PC and emotional factors influence APOP based on a hypothetical moderated mediation pathway mediated by pain-related fear. METHODS This was an observational cross-sectional study. RESULTS PC was a significantly positive predictor of APOP regardless of coexistence with emotional factors. TOI patients who had higher PC had more severe APOP (β = 0.57, standard error [SE] = 0.005, p < .01, adjusted R2 = 0.78; β = 0.84, SE = 0.003, p < .01, adjusted R2 = 0.77, respectively). Furthermore, when positive and negative emotions coexisted (adjusted R2 = 0.74), anxiety levels were a significant positive predictor of APOP (β = 0.71, SE = 0.009, p < .01) and optimism was a significant negative predictor of APOP (β = -0.24, SE = 0.008, p < .01). Pain-related fear played a mediating role in the association between the level of PC (effect = 0.044, 95% confidence interval [CI] = 0.027 to 0.062), anxiety (effect = 0.102, 95% CI = 0.075 to 0.137), and APOP in patients with TOIs. Optimism moderated the strength of the relationship between PC (95% CI = -0.020 to -0.010), anxiety (95% CI = -0.045 to -0.003), and APOP mediated by pain-related fear. CONCLUSIONS Clinical staff should assess the level of PC and emotional factors to identify TOI patients at high risk for APOP, subsequently facilitating the optimization of pain management and efficient utilization of nursing resources through early discussion.
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Affiliation(s)
- Ming Cheng
- Department of Nursing, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
| | - Huan Liu
- Orthopedics Department, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
| | - Chenxi Pu
- Orthopedics Department, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Guoying Chen
- Orthopedics Department, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yaer Zhang
- Orthopedics Department, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Li Yan
- Orthopedics Department, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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180
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Costa FR, Pires L, Martins RA, Costa BR, Santos GS, Lana JF. ViSCNOVAS: A Novel Classification System for Hyaluronic Acid-Based Gels in Orthobiologic Products and Regenerative Medicine. Gels 2024; 10:510. [PMID: 39195039 DOI: 10.3390/gels10080510] [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: 05/07/2024] [Revised: 07/29/2024] [Accepted: 07/31/2024] [Indexed: 08/29/2024] Open
Abstract
Hyaluronic acid (HA), a naturally occurring polysaccharide, holds immense potential in regenerative medicine due to its diverse biological functions and clinical applications, particularly in gel formulations. This paper presents a comprehensive exploration of HA, encompassing its origins, molecular characteristics, and therapeutic roles in gel-based interventions. Initially identified in bovine vitreous humor, HA has since been found in various tissues and fluids across vertebrate organisms and bacterial sources, exhibiting consistent physicochemical properties. The synthesis of HA by diverse cell types underscores its integral role in the extracellular matrix and its relevance to tissue homeostasis and repair. Clinical applications of HA, particularly in addressing musculoskeletal ailments such as osteoarthritis, are examined, highlighting its efficacy and safety in promoting tissue regeneration and pain relief. Building upon this foundation, a novel classification system for HA-based interventions is proposed, aiming to standardize treatment protocols and optimize patient outcomes. The ViSCNOVAS classification system refers to viscosity, storage, chain, number, origin, volume, amount, and size. This classification is specifically designed for HA-based orthobiologic products used in regenerative medicine, including orthopedics, sports medicine, aesthetics, cosmetic dermatology, and wound healing. It aims to provide clinicians with a structured framework for personalized treatment strategies. Future directions in HA research are also discussed, emphasizing the need for further validation and refinement of the proposed classification system to advance the field of regenerative medicine. Overall, this manuscript elucidates the biological functions of hyaluronic acid and its potential in clinical practice while advocating for standardization to enhance patient care in various regenerative applications.
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Affiliation(s)
- Fábio Ramos Costa
- Department of Orthopedics, FC Sports Traumatology, Salvador 40296-210, BA, Brazil
| | - Luyddy Pires
- Department of Orthopedics, Brazilian Institute of Regenerative Medicine (BIRM), Indaiatuba 13334-170, SP, Brazil
- Regenerative Medicine, Orthoregen International Course, Indaiatuba 13334-170, SP, Brazil
| | | | | | - Gabriel Silva Santos
- Department of Orthopedics, Brazilian Institute of Regenerative Medicine (BIRM), Indaiatuba 13334-170, SP, Brazil
- Regenerative Medicine, Orthoregen International Course, Indaiatuba 13334-170, SP, Brazil
| | - José Fábio Lana
- Department of Orthopedics, Brazilian Institute of Regenerative Medicine (BIRM), Indaiatuba 13334-170, SP, Brazil
- Regenerative Medicine, Orthoregen International Course, Indaiatuba 13334-170, SP, Brazil
- Clinical Research, Anna Vitória Lana Institute (IAVL), Indaiatuba 13334-170, SP, Brazil
- Medical School, Max Planck University Center (UniMAX), Indaiatuba 13343-060, SP, Brazil
- Medical School, Jaguariúna University Center (UniFAJ), Jaguariúna 13911-094, SP, Brazil
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181
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Doescher J, Emmanuel B, Greve J, Schuler PJ, Sommer F, Laban S, Veit J, Hoffmann TK. Barbed suture in neck dissection: a randomized clinical study on efficacy, safety and aesthetic outcome. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08869-6. [PMID: 39095537 DOI: 10.1007/s00405-024-08869-6] [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: 06/21/2024] [Accepted: 07/22/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE The resection of lymph nodes/neck dissection is a typical part of the surgical treatment of head and neck malignancies. The aim of this study was to compare subcutaneous closure using single knotted, braided suture (VicrylTM, standard arm) with continuous self-locking, monofilament barbed suture (V-LocTM, experimental arm). METHODS Neck Lock was a randomized clinical trial at a single tertiary referral center. It was conducted from 2016 till 2022 with a follow-up period of 3 months. Assessment of safety and aesthetic outcome was double-blinded. 68 patients were randomized after application of exclusion criteria. Subcutaneous wound closure was performed in an intrapatient randomized fashion for suture technique. The primary endpoint was the duration of subcutaneous sutures. Wound healing and scar formation were recorded at multiple postoperative intervals as secondary endpoints. RESULTS The median age was 61 years, 89.7% were male. 92.6% suffered from a squamous cell carcinoma. There was a significant difference in median subcutaneous suture time (p = 0.024) between the experimental (6:11 ± 2:30 min) and standard (7:01 ± 2.42 min) arms. There was no significant difference in safety when assessing adverse events (AEs). At least one AE occurred in 14.7% vs. 5.9%, for barbed and smooth sutures respectively (p = 0.16). CONCLUSION For neck dissection of head and neck malignancies, subcutaneous wound closure with self-locking sutures offers significant time savings over the single knot technique with similar safety and aesthetic results. TRIAL REGISTRATION INFORMATION The trial was registered with WHO acknowledged primary registry "German Clinical Trials Register" under the ID DRKS00025831 ( https://drks.de/search/de/trial/DRKS00025831 ).
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Affiliation(s)
- Johannes Doescher
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Ulm, Ulm, Germany.
- Department of Otorhinolaryngology, University Hospital Augsburg, Sauerbruchstraße 6, 86153, Augsburg, Germany.
| | - Benjamin Emmanuel
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Ulm, Ulm, Germany
| | - Jens Greve
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Ulm, Ulm, Germany
| | - Patrick J Schuler
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Ulm, Ulm, Germany
| | - Fabian Sommer
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Ulm, Ulm, Germany
| | - Simon Laban
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Ulm, Ulm, Germany
| | - Johannes Veit
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Ulm, Ulm, Germany
- Nasenchirurgie München, Munich, Germany
| | - Thomas K Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Ulm, Ulm, Germany
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182
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Qin C, Lee P, Luo L. The Comparison between Three-dimensional enhanced Conventional Pelvic Ultrasound and Magnetic Resonance Imaging in the Evaluation of Obstructive Müllerian Anomalies and its Concordance with Surgical Diagnosis. J Pediatr Adolesc Gynecol 2024:S1083-3188(24)00255-9. [PMID: 39098548 DOI: 10.1016/j.jpag.2024.07.004] [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: 12/28/2023] [Revised: 07/22/2024] [Accepted: 07/26/2024] [Indexed: 08/06/2024]
Abstract
OBJECTIVES This study aimed to assess the practical application of conventional two-dimensional (2D) pelvic ultrasound in conjunction with three-dimensional (3D) ultrasound for evaluating obstructive Müllerian abnormalities. DESIGN Respective study in tertiary referral hospital METHOD: Computerized stored data was used to collect surgical confirmed obstructive Müllerian anomalies cases between December 2022 and October 2023 with presurgical imagings being evaluated. Acute presentation with abdominal pain and clinical suspicion of obstructive Müllerian abnormality were required for inclusion. All study participants underwent pelvic ultrasound prior to the definitive surgery, with or without a repeat MRI if one was performed previous to admission. Those situations where both MRI and ultrasound were not conducted were excluded, such as the transverse vaginal septum, imperforate hymen, iatrogenic cervical injury or Müllerian malformation alone without obstructive outflow anomalies like didelphys, bicornuate, or septate uterus. MAIN OUTCOMES MEASURES The concordance between the surgically confirmed diagnosis and the pelvic ultrasound was reported in 27 of 29 women (93.1%). In contrast, only 24 of 29 cases were correctly diagnosed with MRI in this study (82.8%). This pilot study presents a comparison of two techniques, with a specific focus on obstructive Müllerian anomalies. The use of pelvic ultrasound not only assisted in our surgical practice but also significantly improved patient-doctor counseling. CONCLUSION In managing obstructive Müllerian abnormalities, 3D-enhanced conventional pelvic ultrasound was found effective in diagnosis and was comparable to MRI.
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Affiliation(s)
- Chenglu Qin
- Department of Obstetric and Gynaecology, Luohu Hospital, Shenzhen, 518001, China.
| | - Pohching Lee
- Department of Obstetric and Gynaecology, Luohu Hospital, Shenzhen, 518001, China
| | - Licong Luo
- Department of Radiology, Luohu Hospital, Shenzhen, 518001, China
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183
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Gong P, Shen J. An unexpected complication after removing bladder foreign body: a case report. Front Surg 2024; 11:1405129. [PMID: 39157291 PMCID: PMC11327006 DOI: 10.3389/fsurg.2024.1405129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 07/16/2024] [Indexed: 08/20/2024] Open
Abstract
Background Bladder foreign bodies commonly arise as urgent issues in urology. These foreign bodies are typically extracted through cystoscopy or cystotomy. In general, these surgical approaches rarely lead to serious complications. Methods A 34-year-old woman presented with a one-year history of frequent urination, urgency, and urodynia. Abdominal computed tomography (CT) scan revealed the presence of an intrauterine device (IUD) [a medium-sized (20 mm × 22 mm) circular IUD] near the posterior bladder wall. The object was successfully removed via cystoscopy. Two months later, the patient exhibited food residues in her urine. Enterography demonstrated a large amount of contrast agent had entered the bladder from the small intestine. We repaired the bladder with catheter for 2 weeks, removed the segment of small intestine with fistula, and anastomosed the intestine canal. Results Post-operation urine tests yielded negative results, and the patient resumed a normal diet. Conclusions Evaluating the location between foreign body and bladder wall, which is based on medical history, CT scan, and cystoscopy examination, is essential for doctors before they remove the foreign body by cystoscopy or laparoscopy. It is necessary to check for leakage by applying radiopaque fluids under fluoroscopy after removing the foreign body, which migrates from other abdominal organs. If there is damage in the bladder or other organs, laparoscopic surgery or open surgery should be performed immediately.
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Affiliation(s)
- Pengfeng Gong
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Jie Shen
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
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184
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Seraji S, Ali A, Demirel E, Akerman M, Nezhat C, Nezhat FR. Association between Ovarian Endometriomas and Stage of Endometriosis. J Clin Med 2024; 13:4530. [PMID: 39124796 PMCID: PMC11313643 DOI: 10.3390/jcm13154530] [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] [Revised: 07/03/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024] Open
Abstract
Objectives: To determine the association between ovarian endometriomas and stage of endometriosis. Methods: A total of 222 women aged 18-55 years old, who underwent minimally invasive surgery between January 2016 and December 2021 for treatment of endometriosis were included in the study. Patients underwent laparoscopic and/or robotic treatment of endometriosis by a single surgeon (FRN) and were staged using the ASRM revised classification of endometriosis. Pre-operative imaging studies, and operative and pathology reports were reviewed for the presence of endometriomas and the final stage of endometriosis. Using univariate analyses for categorical variables and the two-sample t-test or Mann-Whitney test for continuous data, association between endometriomas, stage of endometriosis, type of endometrioma, and other patient parameters such as age, gravidity, parity, laterality of endometriomas, prior medical treatment, and indication for surgery was analyzed. Results: Of the 222 patients included in the study, 86 patients had endometrioma(s) and were found to have stage III-IV disease. All 36 patients with bilateral endometriomas and 70% of patients with unilateral endometriomas had stage IV disease. Conclusions: The presence of ovarian endometrioma(s) indicates a higher stage of disease, correlating most often with stage IV endometriosis. Understanding the association between endometriomas and anticipated stage of disease can aid in appropriate pre-operative planning and patient counseling.
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Affiliation(s)
- Shadi Seraji
- Department of Minimally Invasive Gynecologic Surgery, NYU Langone Hospital Long Island, Mineola, NY 11501, USA (M.A.)
| | - Aliyah Ali
- Department of Minimally Invasive Gynecologic Surgery, NYU Langone Hospital Long Island, Mineola, NY 11501, USA (M.A.)
| | - Esra Demirel
- Department of Minimally Invasive Gynecologic Surgery, NYU Langone Hospital Long Island, Mineola, NY 11501, USA (M.A.)
| | - Meredith Akerman
- Department of Minimally Invasive Gynecologic Surgery, NYU Langone Hospital Long Island, Mineola, NY 11501, USA (M.A.)
| | - Camran Nezhat
- Center for Special Minimally Invasive and Robotic Surgery, Camran Nezhat Institute, Woodside, CA 94061, USA;
- Stanford University Medical Center, Palo Alto, CA 94305, USA
- University of California San Francisco Medical Center, San Francisco, CA 94143, USA
| | - Farr R. Nezhat
- Department of Minimally Invasive Gynecologic Surgery, NYU Langone Hospital Long Island, Mineola, NY 11501, USA (M.A.)
- Nezhat Surgery for Gynecology/Oncology, Valley Stream, NY 11581, USA
- Department of Obstetrics and Gynecology, New York Presbyterian/Weill Cornell Medical Center, New York, NY 10065, USA
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185
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Chen M, Yang X, Zhang B, Fu J, Lan Y, Chi Y. Diagnosis and treatment of Robert's uterus combined with transverse uterine septum: a case report and review of the literature. Front Med (Lausanne) 2024; 11:1434957. [PMID: 39156687 PMCID: PMC11327016 DOI: 10.3389/fmed.2024.1434957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 07/03/2024] [Indexed: 08/20/2024] Open
Abstract
Background Robert's uterus combined with transverse uterine septum is a rare uterine malformation. Only one case has been reported to date, and it is challenging to diagnose and treat. Case presentation Here we report the case of a 19-year-old female had undergone multiple treatments at a previous hospital for primary amenorrhea and periodic lower abdominal pain, with the cause remaining unclear. Ultrasonography and magnetic resonance imaging conducted at our hospital displayed the presence of uterine dysplasia with an incomplete septum. Following a multidisciplinary discussion, a preliminary diagnosis of Robert's uterus combined with transverse uterine septum was made. Following this, laparoscopic exploration and ultrasound-guided hysteroscopic metroplasty were performed. The patient experienced periodic menstruation postoperatively and did not manifest periodic lower abdominal pain. Conclusion Robert's uterus combined with transverse uterine septum is a very rare uterine malformation, with hysteroscopic metroplasty being the preferred surgical option. Nevertheless, preoperative diagnosis is extremely difficult, and there are also many difficulties in the surgical process. This case outlines the diagnostic and treatment process of a patient with Robert's uterus and transverse uterine septum. It is of great significance to fill the gap in clinical diagnosis and treatment of this special uterine malformation.
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Affiliation(s)
- Mingqian Chen
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University (Chongqing Health Center for Women and Children), Chongqing, China
| | - Xiaoyu Yang
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University (Chongqing Health Center for Women and Children), Chongqing, China
| | - Bin Zhang
- Department of Ultrasound, Women and Children's Hospital of Chongqing Medical University (Chongqing Health Center for Women and Children), Chongqing, China
| | - Jialiang Fu
- Department of Radiology, Women and Children's Hospital of Chongqing Medical University (Chongqing Health Center for Women and Children), Chongqing, China
| | - Yi Lan
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University (Chongqing Health Center for Women and Children), Chongqing, China
| | - Yugang Chi
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University (Chongqing Health Center for Women and Children), Chongqing, China
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186
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Leaf MC, Musselman K, Wang KC. Cutting-edge care: unleashing artificial intelligence's potential in gynecologic surgery. Curr Opin Obstet Gynecol 2024; 36:255-259. [PMID: 38869434 DOI: 10.1097/gco.0000000000000971] [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: 06/14/2024]
Abstract
PURPOSE OF REVIEW Artificial intelligence (AI) is now integrated in our daily life. It has also been incorporated in medicine with algorithms to diagnose, recommend treatment options, and estimate prognosis. RECENT FINDINGS AI in surgery differs from virtual AI used for clinical application. Physical AI in the form of computer vision and augmented reality is used to improve surgeon's skills, performance, and patient outcomes. SUMMARY Several applications of AI and augmented reality are utilized in gynecologic surgery. AI's potential use can be found in all phases of surgery: preoperatively, intra-operatively, and postoperatively. Its current benefits are for improving accuracy, surgeon's precision, and reducing complications.
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Affiliation(s)
- Marie-Claire Leaf
- Gynecology and Obstetrics, Division of Minimally Invasive Gynecologic Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
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187
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Olig E, Ranieri G, Louie M. Ergonomic considerations for unique surgeon populations. Curr Opin Obstet Gynecol 2024; 36:260-265. [PMID: 38837696 DOI: 10.1097/gco.0000000000000968] [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: 06/07/2024]
Abstract
PURPOSE OF REVIEW Surgeons are rapidly diversifying as a population, introducing new ergonomic challenges. This review describes the challenges that are experienced by special populations of surgeons including small-handed surgeons, pregnant surgeons, and trainees, and evidence-based solutions to overcome them. RECENT FINDINGS Small-handed and female surgeons report more musculoskeletal complaints compared with their male counterparts. Pregnant surgeons frequently report development or worsening of musculoskeletal disorders such as carpal tunnel syndrome and low back pain. Trainees also report high rates of musculoskeletal complaints with minimal autonomy to alter their environment. Limited objective data exists regarding the ideal instruments currently available for special populations. Several small, randomized studies have proposed exercise regimens targeting the upper extremities and pregnancy-related pain syndromes with improvements in symptoms. Various methods of ergonomic education have been studied in trainees with improvements in operating room posture and performance. SUMMARY Limited objective data is available to recommend specific surgical instruments for high-risk surgeon populations. Beneficial exercise regimens have been described for musculoskeletal disorders commonly plaguing surgeons but have yet to be studied explicitly in small-handed or pregnant surgeons and trainees.
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Affiliation(s)
- Emily Olig
- Department of Medical and Surgical Gynecology, Mayo Clinic, Phoenix, Arizona, USA
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Lim LM, Erfani H, Furey KB, Matsuo K, Guo XM. Risks and benefits of sentinel lymph node evaluation in the management of endometrial intraepithelial neoplasia. Expert Rev Anticancer Ther 2024; 24:745-753. [PMID: 38907661 DOI: 10.1080/14737140.2024.2372329] [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: 03/31/2024] [Accepted: 06/21/2024] [Indexed: 06/24/2024]
Abstract
INTRODUCTION Endometroid intraepithelial neoplasia (EIN) is a premalignant lesion to endometrial cancer. Increasing number of gynecologic oncologists are performing sentinel lymph node (SLN) evaluation during hysterectomy for EIN to ensure complete staging if there is cancer on the final specimen. However, there are no clear guidelines and the benefits and risks to performing SLN evaluation for EIN patients are unclear. AREAS COVERED This narrative review examines the advantages and disadvantages of SLN evaluation for EIN patients and provides an algorithm to assist clinicians in selectively applying the procedure for maximal patient benefit. Relevant articles up to March 2024 were obtained from a PubMed search on SLN use with endometrial pathology. EXPERT OPINION Sentinel lymph node evaluation for patients with EIN is safe, feasible, and particularly important for the approximately 10% of patients with high-risk endometrial carcinoma on final pathology. However, as most diagnosed carcinomas are low-risk, SLN evaluation would have limited oncologic benefit. While SLN assessment may overtreat most patients with EIN, a significant minority of patients will be improperly staged. We propose an algorithm highlighting the importance of maximal preoperative endometrial sampling and stratifying patients via risk factors to selectively identify those who would benefit most from SLN evaluation.
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Affiliation(s)
- Lauren M Lim
- Reno School of Medicine, University of Nevada, Reno, NV, USA
| | - Hadi Erfani
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Katelyn B Furey
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - X Mona Guo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
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Etrusco A, Laganà AS, Chiantera V, Gerli S, Carugno J, Sorrentino F, Riemma G, Vitagliano A, Favilli A. Efficacy, safety, and feasibility of the treatment of intrauterine pathologies with the mini-resectoscope: A systematic review. Int J Gynaecol Obstet 2024; 166:527-537. [PMID: 38317479 DOI: 10.1002/ijgo.15393] [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: 06/03/2023] [Revised: 11/30/2023] [Accepted: 01/09/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Hysteroscopy represents the gold standard for the diagnosis and treatment of intrauterine pathologies. The advent of the mini-resectoscope heralded a new era in intrauterine surgery, both in inpatient and outpatient settings. OBJECTIVES To evaluate the effectiveness, safety, and feasibility of the mini-resectoscope for the treatment of intrauterine pathologies. SEARCH STRATEGY Electronic databases were searched for English-language trials describing surgical procedures for uterine pathologies performed with a mini-resectoscope until 30 April 2023. SELECTION CRITERIA Retrospective or prospective original studies reporting the treatment of uterine pathologies with mini-resectoscope were deemed eligible for the inclusion. DATA COLLECTION AND ANALYSIS Data about study features, characteristics of included populations, surgical procedures, complications, and results/outcomes were collected. RESULTS Seven papers that met the inclusion criteria were included in this systematic review. Quantitative analysis was not possible due to data heterogeneity. A descriptive synthesis of the results was provided accordingly to the pathology hysteroscopically removed/corrected: polyps and myomas, uterine septum, intrauterine synechiae, and isthmocele. CONCLUSIONS The mini-resectoscope is poised to play a leading role in hysteroscopic surgery for many pathologies, both in inpatient and outpatient settings. Since some applications of the mini-resectoscope have not yet been thoroughly investigated, future studies should address current knowledge gaps, designing high-quality comparative trials on specific applications.
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Affiliation(s)
- Andrea Etrusco
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Antonio Simone Laganà
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Vito Chiantera
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
- Unit of Gynecologic Oncology, National Cancer Institute - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Sandro Gerli
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Jose Carugno
- Department of Obstetrics, Gynecology and Reproductive Sciences, Minimally Invasive Gynecology Division, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Felice Sorrentino
- Department of Medical and Surgical Science, Institute of Obstetrics and Gynaecology, University of Foggia, Foggia, Italy
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Amerigo Vitagliano
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari, Bari, Italy
| | - Alessandro Favilli
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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Schwartz B, Weerasooriya N, Mercier R, Gould S, Saul D, Berman L. Factors Associated With Isolated Fallopian Tube Torsion in Pediatric Patients. J Pediatr Surg 2024; 59:1538-1544. [PMID: 38649311 DOI: 10.1016/j.jpedsurg.2024.03.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 03/13/2024] [Accepted: 03/26/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Isolated fallopian tube torsion (IFTT) is a rare form of adnexal torsion that is more difficult to diagnose, which may lead to delays in treatment. Our objectives were to identify clinical and radiologic factors associated with surgically-confirmed IFTT and compare them with those of patients without torsion and with adnexal torsion (AT) in a large pediatric population. METHODS We conducted a retrospective chart review of all patients who underwent surgery for suspected adnexal torsion from 2016 to 2019. Torsion was determined intraoperatively, with IFFT defined as those with only tubal but no ovarian torsion and AT defined as those with ovarian torsion, with or without involvement of the ipsilateral fallopian tube. Clinical and radiologic variables were compared between patients with IFTT and those without torsion and with AT using descriptive statistics. A previously-described composite score to predict torsion based on the presence of vomiting and adnexal volume (VVCS) was calculated for each patient. RESULTS Of 291 patients who underwent surgery for suspected torsion, 168 had confirmed torsion: 33 (19.6%) IFTT and 135 (80.4%) AT. Patients with IFTT were more likely to be younger (12.8 vs. 14.2 years, P = 0.02), premenarchal (29.0% vs. 10.7%, P = 0.009), experience nausea (90.6% vs. 70.9%, P = 0.02) and vomiting (81.3% vs. 32.8%, P < 0.001), have a paratubal cyst on imaging (18.8% vs. 2.5%, P = 0.003), and have larger adnexal volume (143.3 vs. 64.9 ml, P < 0.001) than those without torsion. Higher BMI (26.6 vs. 22.9 kg/m2, P = 0.03), a paratubal cyst on imaging (18.8% vs. 1.5%, P < 0.001), presence of arterial (65.5% vs. 44.1%, P = 0.04) and venous Doppler flow (79.3% vs. 55.9%, P = 0.02), and radiologic impression indicating lack of torsion (37.9% vs. 16.8%, P = 0.04) were more common in IFTT than AT. The accuracy of the VVCS in predicting torsion for the IFFT group was 83.9%. CONCLUSIONS IFTT has a similar clinical presentation to AT but with a higher likelihood of a paratubal cyst and preserved Doppler flow on imaging. IFTT should be strongly considered in patients who present with pain, nausea, and vomiting and have an adnexal mass separate from the ovary on imaging, regardless of Doppler flow. LEVEL OF EVIDENCE Level II. TYPE OF STUDY Prognosis study.
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Affiliation(s)
- Beth Schwartz
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA; Division of Adolescent Medicine and Pediatric Gynecology, Nemours Children's Health, Wilmington, DE, USA.
| | - Nimali Weerasooriya
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rebecca Mercier
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sharon Gould
- Division of Radiology, Nemours Children's Health, Wilmington, DE, USA
| | - David Saul
- Division of Radiology, Nemours Children's Health, Wilmington, DE, USA
| | - Loren Berman
- Department of Surgery, Nemours Children's Health, Wilmington, DE, USA
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191
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Violette CJ, Aberle LS, Anderson ZS, Komatsu EJ, Song BB, Mandelbaum RS, Matsuzaki S, Ouzounian JG, Matsuo K. Pregnancy with endometriosis: Assessment of national-level trends, characteristics, and maternal morbidity at delivery. Eur J Obstet Gynecol Reprod Biol 2024; 299:1-11. [PMID: 38815411 DOI: 10.1016/j.ejogrb.2024.05.011] [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: 02/27/2024] [Revised: 05/01/2024] [Accepted: 05/11/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE To examine pregnancy characteristics and maternal morbidity at delivery among pregnant patients with a diagnosis of endometriosis. STUDY DESIGN This cross-sectional study queried the Healthcare Cost and Utilization Project's National Inpatient Sample. Study population was 17,796,365 hospital deliveries from 2016 to 2020, excluded adenomyosis and uterine myoma. The exposure was endometriosis diagnosis. Main outcome measures were clinical and pregnancy characteristics and severe maternal morbidity at delivery related to endometriosis, assessed with multivariable regression model. RESULTS Endometriosis was diagnosed in 17,590 patients. The prevalence of endometriosis increased by 24 % from one in 1,191 patients in 2016 to one in 853 patients in 2020 (adjusted-odds ratio [aOR] 1.24, 95% confidence interval [CI] 1.19-1.30). Clinical and pregnancy characteristics that had greater than two-fold association to endometriosis included polycystic ovary syndrome, placenta previa, cesarean delivery, maternal age of ≥30 years, prior pregnancy loss, and anxiety disorder. Pregnant patients with endometriosis were more likely to have the diagnosis of measured severe maternal morbidity during the index hospitalization for delivery (47.8 vs 17.3 per 1,000 deliveries, aOR 1.91, 95%CI 1.78-2.06); these associations were more prominent following vaginal (aOR 2.82, 95%CI 2.41-3.30) compared to cesarean (aOR 1.85, 95%CI 1.71-2.00) deliveries. Among the individual morbidity indicators, endometriosis was most strongly associated with thromboembolism (aOR 5.05, 95%CI 3.70-6.91), followed by sepsis (aOR 2.39, 95%CI 1.85-3.09) and hysterectomy (aOR 2.18, 95%CI 1.85-2.56). When stratified for endometriosis anatomical site, odds of thromboembolism was increased in endometriosis at distant site (aOR 9.10, 95%CI 3.76-22.02) and adnexa (aOR 7.37, 95%CI 4.43-12.28); odds of sepsis was most increased in endometriosis at multi-classifier locations (aOR 7.33, 95%CI 2.93-18.31) followed by pelvic peritoneum (aOR 5.54, 95%CI 2.95-10.40); and odds of hysterectomy exceeded three-fold in endometriosis at adnexa (aOR 3.00, 95%CI 2.30-3.90), distant site (aOR 5.36, 95%CI 3.48-8.24), and multi-classifier location (aOR 4.46, 95%CI 2.11-9.41). CONCLUSION The results of this nationwide analysis suggest that pregnancy with endometriosis is uncommon but gradually increasing over time in the United States. The data also suggest that endometriosis during pregnancy is associated with increased risk of severe maternal morbidity at delivery, especially for thromboembolism, sepsis, and hysterectomy. These morbidity risks differed by the anatomical location of endometriosis.
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Affiliation(s)
- Caroline J Violette
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Laurel S Aberle
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Zachary S Anderson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Emi J Komatsu
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Bonnie B Song
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Rachel S Mandelbaum
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Shinya Matsuzaki
- Department of Gynecology, Osaka International Cancer Institute, Osaka, Japan
| | - Joseph G Ouzounian
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
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Taritsa IC, Lee D, Foppiani J, Escobar MJ, Alvarez AH, Schuster KA, Lin SJ, Lee BT. Three-Dimensional Printing in Surgical Education: An Updated Systematic Review of the Literature. J Surg Res 2024; 300:425-431. [PMID: 38861866 DOI: 10.1016/j.jss.2024.04.077] [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: 12/12/2023] [Revised: 03/19/2024] [Accepted: 04/28/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION Three-dimensional printing (3DP) is being integrated into surgical practice at a significant pace, from preprocedural planning to procedure simulation. 3DP is especially useful in surgical education, where printed models are highly accurate and customizable. The aim of this study was to evaluate how 3DP is being integrated most recently into surgical residency training. METHODS We performed a structured literature search of the OVID/MEDLINE, EMBASE, and PUBMED databases following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Articles published from 2016 to 2023 that met predefined inclusion and exclusion criteria were included. Data extracted included surgical subspecialty using 3DP, application of 3DP, and any reported satisfaction measures of trainees. A thorough analysis of pooled data was performed to evaluate satisfaction rates among studies. RESULTS A total of 85 studies were included. The median number of participants was 18 (interquartile range 10-27). Fourteen surgical disciplines were represented, with ear, nose, and throat/otolaryngology having the highest recorded utilization of 3DP models among residents and medical students (22.0%), followed by neurosurgery (14.0%) and urology (12.0%). 3DP models were created most frequently to model soft tissue (35.3%), bone (24.7%), vessel (14.1%), mixed (16.4%), or whole organs (6.66%) (Fig.1). Feedback from trainees was overwhelmingly positive regarding the fidelity of the models and their support for integration into their training programs. Among trainees, the combined satisfaction rate with their use in the curriculum was 95% (95% confidence interval, 0.92-0.97), and the satisfaction rate with the model fidelity was 90% (95% confidence interval, 0.86-0.94). CONCLUSIONS There is wide variation in the surgical specialties utilizing 3DP models in training. These models are effective in increasing trainee comfort with both common and rare scenarios and are associated with a high degree of resident support and satisfaction. Plastic surgery programs may benefit from the integration of this technology, potentially strengthening future surgical curricula. Objective evaluations of their pedagogic effects on residents are areas of future research.
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Affiliation(s)
- Iulianna C Taritsa
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Daniela Lee
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jose Foppiani
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Maria Jose Escobar
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Angelica Hernandez Alvarez
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Kirsten A Schuster
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Samuel J Lin
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
| | - Bernard T Lee
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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193
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Zhang J, Shi C, Sun J, Niu J. Analysis of factors affecting the prognosis of patients with intrauterine adhesions after transcervical resection of adhesions. Fertil Steril 2024; 122:365-372. [PMID: 38518992 DOI: 10.1016/j.fertnstert.2024.03.016] [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: 08/28/2023] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVES To study the factors affecting the prognosis of patients with intrauterine adhesions (IUAs) after transcervical resection of adhesions (TCRA), analyze the reproductive outcome, and guide prognostic improvements. DESIGN Prospective study. PATIENTS Our study included 292 patients diagnosed with IUAs who underwent follow-up office hysteroscopy at Shenyang Women's and Children's Hospital between June 2018 and June 2022. INTERVENTIONS Patients were divided into case (52 patients whose hysteroscopy results indicated the presence of IUAs) and nocase (240 patients whose uterine cavity had returned to normal shape without obvious adhesion) groups on the basis of the results of a 2-month follow-up hysteroscopy following TCRA. Clinical data were collected and compared with various influencing factors, and the combined effect of these factors was assessed using multifactorial logistic regression analysis. A nomogram prediction model was constructed and internally validated on the basis of multifactorial analysis. MAIN OUTCOME MEASURES Intrauterine re-adhesion was observed at a 2-month follow-up after TCRA. RESULTS Postoperative re-adhesion occurred in 52 of 292 patients with IUAs. Multifactorial binary logistic regression analysis showed that IUA barrier gel reapplication 5 days after TCRA was a protective factor. In contrast, the preoperative American Fertility Society scores demonstrated that severe IUAs and chronic endometritis were risk factors. The results of the multifactorial analysis were used to build a nomogram model, and the area under the curve value of the nomogram model for predicting postoperative recurrence was 0.914 (95% confidence interval: 0.864-0.956). The bootstrap method was subsequently used to resample 1,000 times for internal validation. The results showed that the internal validation C-index was 0.9135, and the calibration and ideal curves were well-matched. CONCLUSION The prognosis of patients with IUAs after TCRA is related to the severity of preoperative IUAs, presence of chronic endometritis, and IUA barrier gel reapplication 5 days after TCRA. Therefore, clinicians should monitor patients using targeted data to reduce recurrence risk after TCRA and improve the prognosis of patients with IUAs.
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Affiliation(s)
- Jiantong Zhang
- Department of Obstetrics and Gynecology, Shenyang Women's and Children's Hospital, Shenyang, Liaoning, People's Republic of China
| | - Cong Shi
- Department of Obstetrics and Gynecology, Shenyang Women's and Children's Hospital, Shenyang, Liaoning, People's Republic of China
| | - Jianhua Sun
- Department of Obstetrics and Gynecology, Shenyang Women's and Children's Hospital, Shenyang, Liaoning, People's Republic of China
| | - Jumin Niu
- Department of Obstetrics and Gynecology, Shenyang Women's and Children's Hospital, Shenyang, Liaoning, People's Republic of China.
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194
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Kobylianskii A, Thiel P, McGrattan M, Barbe MF, Lemos N. Key Anatomical Concepts, Landmarks, and Proposed Terminology for Nerve-Sparing Gynecologic Surgery: A Narrative Review. J Minim Invasive Gynecol 2024; 31:641-652. [PMID: 38761917 DOI: 10.1016/j.jmig.2024.05.013] [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: 02/01/2024] [Revised: 03/27/2024] [Accepted: 05/08/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE To synthesize the terminology utilized in nerve-sparing surgical literature and propose standardized and nonconflicting terms to allow for consistent vocabulary. DESIGN We performed a literature search on PubMed using the search terms "pelvis" and "nerve-sparing." Nongynecologic surgery and animal studies were excluded. A narrative review was performed, focusing on nerves, fasciae, ligaments, and retroperitoneal spaces. Terms from included papers were discussed by all authors, who are surgeons versed in nerve-sparing procedures and one anatomist, and recommendations were made regarding the most appropriate terms based on the frequency of occurrence in the literature and the possibility of overlapping names with other structures. RESULTS 224 articles were identified, with 81 included in the full-text review. Overall, 48% of articles focused on cervical cancer and 26% on deeply infiltrating endometriosis. Findings were synthesized both narratively and visually. Inconsistencies in pelvic anatomical nomenclature were prevalent across publications. The structure with the most varied terminology was the rectal branch of the inferior hypogastric plexus with 14 names. A standardized terminology for pelvic autonomic nerve structures, fasciae, ligaments, and retroperitoneal spaces was proposed to avoid conflicting terms. CONCLUSION Surgeons and anatomists should use consistent terminology to facilitate increased uptake of nerve-sparing techniques in gynecologic surgery through a better understanding of surgical technique description. We have proposed a standardized terminology believed to facilitate this goal.
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Affiliation(s)
- Anna Kobylianskii
- Department of Obstetrics and Gynecology, Mount Sinai Hospital (Drs. Kobylianskii, Thiel, McGrattan, Lemos), Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto (Drs. Kobylianskii, Thiel, McGrattan, Lemos), Toronto, Ontario, Canada; Department of Gynecology, Women's College Hospital (Drs. Kobylianskii, Thiel, McGrattan, Lemos), Toronto, Ontario, Canada
| | - Peter Thiel
- Department of Obstetrics and Gynecology, Mount Sinai Hospital (Drs. Kobylianskii, Thiel, McGrattan, Lemos), Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto (Drs. Kobylianskii, Thiel, McGrattan, Lemos), Toronto, Ontario, Canada; Department of Gynecology, Women's College Hospital (Drs. Kobylianskii, Thiel, McGrattan, Lemos), Toronto, Ontario, Canada
| | - Meghan McGrattan
- Department of Obstetrics and Gynecology, Mount Sinai Hospital (Drs. Kobylianskii, Thiel, McGrattan, Lemos), Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto (Drs. Kobylianskii, Thiel, McGrattan, Lemos), Toronto, Ontario, Canada; Department of Gynecology, Women's College Hospital (Drs. Kobylianskii, Thiel, McGrattan, Lemos), Toronto, Ontario, Canada
| | - Mary F Barbe
- Department of Aging & Cardiovascular Discovery Center, Lewis Katz School of Medicine of Temple University (Dr. Barbe), Philadelphia, Pennsylvania
| | - Nucelio Lemos
- Department of Obstetrics and Gynecology, Mount Sinai Hospital (Drs. Kobylianskii, Thiel, McGrattan, Lemos), Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto (Drs. Kobylianskii, Thiel, McGrattan, Lemos), Toronto, Ontario, Canada; Department of Gynecology, Women's College Hospital (Drs. Kobylianskii, Thiel, McGrattan, Lemos), Toronto, Ontario, Canada; Department of Gynecology, Federal University of Sao Paolo (Dr. Lemos), Sao Paolo, Brazil; Department of Neuropelveology and Advanced Pelvic Surgery, Institute for Care and Rehabilitation in Neuropelveology and Gynecology (INCREASING) (Dr. Lemos), Sao Paolo, Brazil.
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195
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Liu M, Liang Y, Zheng X, Mo N, Jin E. Study on the value of MRI in locating the internal OS of the cervix and influencing factors. Sci Rep 2024; 14:17784. [PMID: 39090384 PMCID: PMC11294610 DOI: 10.1038/s41598-024-68735-7] [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: 12/10/2023] [Accepted: 07/26/2024] [Indexed: 08/04/2024] Open
Abstract
The position of the internal os of the cervix reported in the literature was inconsistent on MRI images. Additionally, the practical impactful data influencing the internal os located by MRI is limited. We aimed to confirm the position of the internal os of the cervix on MRI images, and the influencing factors locating the the internal os by MRI. A single-center retrospective study was conducted. Data from 175 patients who underwent total hysterectomy for stage I endometrial cancer were collected. The internal os of the cervix is positioned as the starting point for measuring the length of the cervix on MRI images. On dynamic contrast-enhanced MRI (DCE-MRI), the section formed by the enhancement difference between the uterus and cervix, and on T2-weighted imaging(T2WI), the section formed by the physiological curvature of the uterus and the low signal intensity of the cervical stroma were used as starting points. The results showed no statistically significant difference compared with the removed uterus specimens (p = 0.208, p = 0.571, p = 0.804). A history of cesarean section(p < 0.001), irregular vaginal bleeding for more than three months(p < 0.001), cervical adenomyosis(p = 0.043), and premenopause(p = 0.001) were not conducive to locating the internal os of the cervix by MRI. Our findings provide valuable information and confirm the position of the internal os of the cervix on MRI images, and the several important infuencing factors. We hope that some patients will benefit from our study.
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Affiliation(s)
- Mingming Liu
- Department of Radiology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No.59 Yong'an Road, Xicheng District, Beijing, China
| | - Yuting Liang
- Department of Radiology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Xingzheng Zheng
- Beijing Maternal and Child Health Care Hospital, Beijing, China
- Department of Pathology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Na Mo
- Beijing Maternal and Child Health Care Hospital, Beijing, China
- Department of Pathology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Erhu Jin
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No.59 Yong'an Road, Xicheng District, Beijing, China.
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196
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Kailasam A, Jatoi A, Reynolds E, Cliby W, Langstraat C. Understanding the patient experience in nonsurgical management of endometrial cancer and complex atypical hyperplasia due to obesity: A qualitative analysis. Gynecol Oncol Rep 2024; 54:101425. [PMID: 38854684 PMCID: PMC11157205 DOI: 10.1016/j.gore.2024.101425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/15/2024] [Accepted: 05/19/2024] [Indexed: 06/11/2024] Open
Abstract
Objectives Patients with class 3 obesity (BMI ≥ 40) and significant medical comorbidities with complex atypical hyperplasia (CAH) and early-stage endometrial cancer (EC) present challenges in standard surgical management. Progestin therapy is an alternative used for patient-centered reasons, including the desire for uterine preservation or because surgery is not a safe option. Our objective was to gain insights into the patient experience when undergoing this treatment approach. Methods We identified and recruited patients who received oral or IUD progesterone in the last 5 years for EC or CAH. We conducted semi-structured phone interviews regarding patients' experience with non-surgical management as well as decision-making factors to start progesterone and weight loss. Interviews were audio-recorded and transcriptions were analyzed for common themes. Results A total of 20 interviews were performed. We enrolled nine patients with CAH, eight with grade 1 EC, and three with grade 2 EC. The majority of patients (18/20) were managed with IUD. We identified the following 5 common themes support in diagnostic workup and long-term outcomes, autonomy in care, thoroughness in counseling, emotional impact of diagnosis, and perception of obesity as a defining identity. Conclusion The themes identified in the present study highlight the challenges and the stigma these patients face. It also demonstrates areas of opportunity in their counseling and care, which will help to build a more effective therapeutic relationship and ultimately lead to greater adherence in care.
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Affiliation(s)
- Aparna Kailasam
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Aminah Jatoi
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Evelyn Reynolds
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - William Cliby
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Carrie Langstraat
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
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197
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Geng D, Liu M, Wu D, Yue B. The relationship between serum levels of epidermal growth factor and β-human chorionic gonadotropin and the type and prognosis of ectopic pregnancy. Arch Gynecol Obstet 2024; 310:1179-1187. [PMID: 38683393 DOI: 10.1007/s00404-024-07523-0] [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: 01/09/2024] [Accepted: 04/17/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE This work aimed to explore the relationship between epidermal growth factor (EGF) and β-human chorionic gonadotropin (β-HCG) and ectopic pregnancy types and impact on prognosis. METHODS Twenty women with normal pregnancies (NPs) were recruited as control group, and twenty women each with tubal pregnancy (TP) and cervical pregnancy (CP) were recruited. Blood samples were collected to detect EGF and β-HCG. Data on length of hospital stay and incidence of complications were collected. The differences in serum EGF and β-HCG levels were compared among groups and within various types of ectopic pregnancy using analysis of variance and Pearson correlation analysis. RESULTS Serum EGF and β-HCG were notably lower in TP and CP group vs. controls (P < 0.05). In subgroup analysis within the types of ectopic pregnancy, serum EGF levels were drastically higher in TP group vs. CP group (P < 0.05). Serum EGF levels were negatively correlated with pregnancy outcomes and incidence of complications (P < 0.05). In patients with TP and CP, serum EGF and β-HCG recovery time and hospital stay differed drastically (P < 0.05). Serum EGF and β-HCG levels showed optimal cutoff values identified at 2.65 μg/L and 11,745.35 IU/L, respectively. The corresponding area under the curve (AUC) values were 0.885 and 0.841. CONCLUSION Elevated levels of EGF may be associated with the occurrence of ectopic pregnancy and may impact the type of ectopic pregnancy, pregnancy outcomes, and the incidence of complications. Further clinical research is warranted to investigate these findings.
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Affiliation(s)
- Dandan Geng
- Department of Gynecology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, No 39, 12 Qiao Road, Jinniu District, Chengdu, 610075, Sichuan, China.
- Department of Traditional Chinese Medicine, The Forth Hospital of Shijiazhuang, Shijiazhuang, 050000, China.
| | - Manfang Liu
- Department of Traditional Chinese Medicine, The Forth Hospital of Shijiazhuang, Shijiazhuang, 050000, China
| | - Dongyan Wu
- Department of Gynecology, The Forth Hospital of Shijiazhuang, Shijiazhuang, 050000, China
| | - Benming Yue
- Department of Gynecology, The Forth Hospital of Shijiazhuang, Shijiazhuang, 050000, China
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Hargreaves C, Wax JR. Violence in the healthcare workplace. Curr Opin Obstet Gynecol 2024; 36:234-238. [PMID: 38837222 DOI: 10.1097/gco.0000000000000961] [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: 06/07/2024]
Abstract
PURPOSE OF REVIEW Healthcare workers experience a disproportionate frequency of workplace violence. Identifying commonalities among incidents of workplace violence provides an opportunity for change to prevent and mitigate future violence. RECENT FINDINGS Despite a continued decline in overall workplace violence, the rate of violence in the healthcare sector is steadily rising. While healthcare workers make up 13% of the workforce, they experience 60% of all workplace assaults. Environmental, structural, and staffing issues may all contribute to the increased rates of workplace violence affecting healthcare workers. SUMMARY Comprehensive proactive workplace violence prevention programs can significantly reduce the frequency of violence and the negative impact on employees and institutions. Analyzing the factors that contribute to violence in the healthcare workplace provides the potential to mitigate these risks and reduce episodes of violence.
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Affiliation(s)
| | - Joseph R Wax
- Division of Maternal Fetal Medicine, Maine Medical Center, Portland, Maine, USA
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199
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Crouzat A, Gauci PA. Treatment of uterine artery (pseudo)aneurysm during pregnancy: A case report and review of the literature. Eur J Obstet Gynecol Reprod Biol 2024; 299:240-247. [PMID: 38905967 DOI: 10.1016/j.ejogrb.2024.05.046] [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: 03/04/2024] [Revised: 05/07/2024] [Accepted: 05/31/2024] [Indexed: 06/23/2024]
Abstract
PURPOSE To describe the management of uterine artery (pseudo)aneurysm, ruptured or unruptured, during pregnancy. METHODS After reporting a case about this rare pathology, a review of the literature was performed. The search was applied to PubMed databases. RESULTS A total of eighteen articles met the inclusion criteria. Eighteen patients were reported. Eight (44.4 %) patients didn't have prior medical or surgical history. Fifteen (83.3 %) beneficed interventional radiology method during pregnancy including two cases (13.3 %) with repeated embolization because of recanalization of the (pseudo)aneurysm. Nine patients (50 %) beneficed a planned cesarean between 34 and 39 weeks of gestation. One (15.8 %) patient was diagnosed with fetal death before treatment of the uterine artery (pseudo)aneurysm. CONCLUSION The decision to proceed to the treatment of the (pseudo)aneurysm must consider several factors, associated or not with a good fetal vitality and a hemodynamically stable patient. Embolization appears to be the method of choice. Mode of delivery and term remain not clear and contraindication of expulsive efforts in case of a uterine artery (pseudo)aneurysm merit further investigations.
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Affiliation(s)
- Améline Crouzat
- Department of Obstetrics and Gynecology, Reproduction and Fetal Medicine, CHU de Nice, University of Côte d'Azur, Hôpital Archet 2, 151 Route de Saint-Antoine, CS 23079 06200 Nice, France
| | - Pierre-Alexis Gauci
- Université Côte d'Azur - Centre Hospitalier Universitaire de Nice, UMR2CA, France, Hôpital Archet 2, 151 Route de Saint-Antoine, CS 23079 06200 Nice, France.
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Braungart S, Lane S, Becker CM, Alexander N. Ovarian Tissue Collection for Fertility Preservation in Children: The Need for Standardised Surgical Practice Guidance. J Pediatr Surg 2024; 59:1569-1574. [PMID: 38480030 DOI: 10.1016/j.jpedsurg.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 02/12/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Chemotherapy, pelvic radiotherapy (including total body irradiation) and novel compounds used to treat children and teenagers with benign or malignant diseases can lead to impaired fertility. For prepubertal female patients at high risk of treatment-related infertility, upfront storage of ovarian tissue is increasingly being recognised as standard of care. No surgical guidelines exist to ensure best practice technique. We reviewed current UK practice to assess surgical management. METHODS A ten-item, anonymous multiple-choice survey was distributed to the lead surgeons in all paediatric centres in England/Wales undertaking ovarian procurement for cryopreservation. RESULTS There are currently 18 centres in England and Wales that provide ovarian procurement for cryopreservation. Responses were received from 100% of the invited paediatric surgical oncology centres in England and Wales. 39.3% of participants stated that in their centre <10 cases of ovarian harvest are performed annually. In 32.1% of centres >20 cases are undertaken per year. In 64% of centres surgery is performed by a paediatric surgeon with interest in oncology or fertility preservation. The majority of cases were performed by a Consultant or Senior Registrar (89%). Regarding the surgical technique, 82% of respondents stated they gain access to the abdominal cavity using standard 3-port laparoscopy, 7% use single-port laparoscopy. Most frequently used energy devices for ovary/ovarian tissue resection were Ligasure™ (44%) and Harmonic Scalpel™ (18.5%). 96% of respondents perform a total oophorectomy, 1 respondent stated they perform a hemi-oophorectomy. 53% stated they place the ovary into a retrieval bag only if the ovary was too big for easy removal via the camera port, 28.5% always place it in a retrieval bag. Most surgeons use the umbilical port site for retrieval (82%). CONCLUSION This national survey shows significant heterogeneity in the surgical management of ovarian procurement for cryopreservation. To ensure best outcomes, research into the various surgical methods is necessary to provide data for a standardised best practice approach. LEVEL OF EVIDENCE This is a level II evidence study. In itself, it is a national survey of specialists, which was undertaken in a prospective manner.
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Affiliation(s)
- Sarah Braungart
- Department of Paediatric Surgery, Royal Hospital for Children Glasgow, UK; Department of Paediatric Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - Sheila Lane
- Department of Paediatric Haematology and Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Christian M Becker
- Nuffield Department of Women's & Reproductive Health, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Nicholas Alexander
- Department of Paediatric Surgery, St Mary's Hospital, Imperial College London, London, UK
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