25301
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Li LB, Cai XJ, Mou YP, Wei Q. Reoperation of biliary tract by laparoscopy: Experiences with 39 cases. World J Gastroenterol 2008; 14:3081-4. [PMID: 18494063 PMCID: PMC2712179 DOI: 10.3748/wjg.14.3081] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the safety and feasibility of biliary tract reoperation by laparoscopy for the patients with retained or recurrent stones who failed in endoscopic sphincterotomy.
METHODS: A retrospective analysis of data obtained from attempted laparoscopic reoperation for 39 patients in a single institution was performed, examining open conversion rates, operative times, complications, and hospital stay.
RESULTS: Out of the 39 cases, 38 (97%) completed laparoscopy, 1 required conversion to open operation because of difficulty in exposing the common bile duct. The mean operative time was 135 min. The mean post-operative hospital stay was 4 d. Procedures included laparoscopic residual gallbladder resection in 3 cases, laparoscopic common bile duct exploration and primary duct closure at choledochotomy in 13 cases, and laparoscopic common bile duct exploration and choledochotomy with T tube drainage in 22 cases. Duodenal perforation occurred in 1 case during dissection and was repaired laparoscopically. Retained stones were found in 2 cases. Postoperative asymptomatic hyperamylasemia occurred in 3 cases. There were no complications due to port placement, postoperative bleeding, bile or bowel leakage and mortality. No recurrence or formation of duct stricture was observed during a mean follow-up period of 18 mo.
CONCLUSION: Laparoscopic biliary tract reoperation is safe and feasible if it is performed by experienced laparoscopic surgeons, and is an alternative choice for patients with choledocholithiasis who fail in endoscopic sphincterectomy.
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25302
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Kluivers KB, Hendriks JCM, Mol BWJ, Bongers MY, Vierhout ME, Brölmann HAM, de Vet HCW. Clinimetric properties of 3 instruments measuring postoperative recovery in a gynecologic surgical population. Surgery 2008; 144:12-21. [PMID: 18571580 DOI: 10.1016/j.surg.2008.03.027] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2007] [Accepted: 03/30/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND General, health-related quality-of-life questionnaires and recovery-specific questionnaires have been used to measure recovery in surgical patients. The aim of this study was to evaluate the clinimetric properties of 3 recovery instruments and to examine whether recovery-specific instruments are useful. METHODS The Quality of Recovery-40 (QoR-40), Recovery Index-10 (RI-10), and RAND-36 health survey were used to measure recovery in women undergoing different types of hysterectomy in the first 12 weeks after operation. Construct validity was assessed by testing predefined hypotheses. The changes observed during the postoperative period were used as indicators for responsiveness. RESULTS One hundred and sixty-one women were included. Response rate and internal consistency were found satisfactory. The highest number of hypotheses used for assessment of construct validity was confirmed in the RI-10. The RI-10 was more responsive compared with the QoR-40 and the RAND-36. CONCLUSIONS Because construct validity and responsiveness were greatest in the RI-10, we conclude that this short recovery-specific instrument is useful in studies evaluating postoperative recovery. We recommend the use of the RI-10, unless the immediate postoperative days are of interest in which the QoR-40 was valid.
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Affiliation(s)
- Kirsten B Kluivers
- Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Centre, Postbus 9101, 6500 HB Nijmegen, the Netherlands.
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25303
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Abstract
AbstractLaparoscopic surgery has developed into an important part of the gynecological surgical pallet. Its implementation into daily practice has shown to be complex, especially the advanced procedures. The difficulties of implementation is multifactorial; however, the training of laparoscopy is one of the major issues of this subject. The adequate training of residents and gynecologists is essential for its optimal and safe implementation. Concerning the advanced procedures, the question raises as to who should be able to perform these procedures and how this is established. Causes, difficulties, and limitations of the implementation of advanced laparoscopy will be discussed in this paper.
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25304
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Stepanian AA, Miklos JR, Moore RD, Mattox TF. Risk of mesh extrusion and other mesh-related complications after laparoscopic sacral colpopexy with or without concurrent laparoscopic-assisted vaginal hysterectomy: experience of 402 patients. J Minim Invasive Gynecol 2008; 15:188-96. [PMID: 18312989 DOI: 10.1016/j.jmig.2007.11.006] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Revised: 11/10/2007] [Accepted: 11/21/2007] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE To estimate the incidence of mesh-related complications including mesh erosion/extrusion rates in patients undergoing laparoscopic sacral colpopexy, with or without concurrent hysterectomy, using macroporous soft polypropylene mesh. DESIGN Historical cohort study (Canadian Task Force classification II-2). SETTING Private urogynecology clinic. PATIENTS A total of 446 consecutive patients with uterovaginal or vaginal vault prolapse underwent laparoscopic sacral colpopexy with use of macroporous soft polypropylene mesh from January 2003 through January 2007. In all, 402 consecutive patients met enrollment criteria. Two groups of patients were identified: (1) those receiving concurrent hysterectomy (n = 130); and (2) those with a history of hysterectomy (n = 272). INTERVENTIONS Patients were treated with laparoscopic sacral colpopexy with use of macroporous soft polypropylene mesh in conjunction with other laparoscopic and/or vaginal procedures. MEASUREMENTS AND MAIN RESULTS Data were collected in the form of chart reviews and patient questionnaires. Comparisons were made between groups 1 and 2. Patient demographics, history, mesh erosion/extrusion rates, and mesh-related complications were analyzed. Length of follow-up was 1 to 54 months with a median follow-up time of 12 months. No statistically significant differences existed between 2 groups in rates of mesh erosion/extrusion or other mesh-related complications. Overall vaginal mesh erosion/extrusion rate was 1.2% (95% CI 0.5%-2.7%) with an associated mesh revision rate of 1.2% (95% CI 0.5%-2.7%). Patients with concurrent hysterectomy had an erosion/extrusion rate of 2.3% (3/130) as compared with 0.7% (2/272) in patients with a history of hysterectomy, p = .18. No cases of mesh erosion through organs and tissues other than vaginal mucosa were observed. Cuff abscess occurred in 1 patient with concurrent hysterectomy, with an overall infection rate of 0.3% (95% CI 0.01%-1.2%). One more patient developed an inflammatory reaction to the mesh. Excision of exposed mesh was performed in all 5 patients with mesh extrusion. Vaginal approach to excision was uniformly used. Laparoscopic removal of the entire mesh took place in 4 patients with persistent pelvic pain, in 1 patient with cuff abscess, and in one patient with a questionable mesh reaction. An estimated 975 to 17 000 patients were required in each group to achieve power to detect a statistically significant difference in rate of mesh-related complications in this study. CONCLUSION Risk of mesh extrusion or other mesh-related complications after laparoscopic sacral colpopexy using soft macroporous Y-shaped polypropylene mesh is about 1% in our study. No significant increase in risk of mesh-related complications was observed in patients receiving concurrent hysterectomy when compared with patients who had a previous hysterectomy. The sample size of almost 2000 patients was needed to detect a statistically significant difference in rate of mesh-extrusion in this study.
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Affiliation(s)
- Assia A Stepanian
- Center for Women's Care and Reproductive Surgery, Atlanta, GA 30328, USA.
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25305
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Creus M, Fábregues F, Carmona F, del Pino M, Manau D, Balasch J. Combined laparoscopic surgery and pentoxifylline therapy for treatment of endometriosis-associated infertility: a preliminary trial. Hum Reprod 2008; 23:1910-6. [PMID: 18487215 DOI: 10.1093/humrep/den167] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Surgical treatment has modest efficacy for the treatment of infertility associated with early-stage endometriosis. Immunomodulation with pentoxifylline is considered as a new strategy potentially useful in treating endometriosis. Thus, this study investigated the usefulness of combined laparoscopic surgery and pentoxifylline therapy in the treatment of infertility associated with minimal to mild endometriosis. METHODS A prospective, randomized, controlled blind trial was conducted. Patients entered the study immediately after laparoscopic surgery and were randomly assigned to the treatment with either oral pentoxifylline (800 mg/day) (pentoxifylline group, n = 51) or an oral placebo (placebo group, n = 53). Patients were then observed for pregnancy for 6 months. RESULTS Among 98 patients finally considered in the evaluation of the results, the 6 month overall pregnancy rates were 28 and 14% in the pentoxifylline and placebo groups, respectively. Thus, an absolute difference of 14% (95% CI -2 to 30) (Chi-squared test, P = 0.1) in the cumulative probability of pregnancy in 6 months after laparoscopic surgery in patients receiving pentoxifylline versus placebo post-operatively was observed. CONCLUSION Our findings provide preliminary clinical evidence to suggest the new experimental treatment approaches, toward endometriosis, that are based on immunomodulation deserve further attention. Well-designed multicenter trials are warranted to confirm or refute our results.
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Affiliation(s)
- Montserrat Creus
- Institut Clinic of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine-University of Barcelona, Barcelona, Spain
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25306
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Wilson M, Merkur H. Hematuria at laparoscopic hysterectomy: a 9-year review at Sydney West Advanced Pelvic Surgery, Australia. J Minim Invasive Gynecol 2008; 15:146-51. [PMID: 18312982 DOI: 10.1016/j.jmig.2007.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Revised: 11/26/2007] [Accepted: 12/02/2007] [Indexed: 11/15/2022]
Abstract
The aim of this study was to estimate the prevalence and significance of hematuria during laparoscopic hysterectomy for benign uterine disease. The review assessed its incidence, risk factors, site of associated urinary tract injuries, methods of diagnosis, management strategies, and most likely intraoperative point at which hematuria occurred during laparoscopic hysterectomies. A retrospective review of 755 cases of laparoscopic-assisted and total laparoscopic hysterectomies from January 1998 through December 2006 was undertaken at Sydney West Advanced Pelvic Surgery, Sydney, Australia.
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Affiliation(s)
- Matthew Wilson
- Sydney West Advanced Pelvic Surgery Unit-working within Sydney West Area Health Services, Sydney, Australia.
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25307
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Kikuchi I, Takeuchi H, Shimanuki H, Kitade M, Kumakiri J, Kuroda K, Kobayashi Y, Takeda S. Questionnaire analysis of recovery of activities of daily living after laparoscopic surgery. J Minim Invasive Gynecol 2008; 15:16-9. [PMID: 18262138 DOI: 10.1016/j.jmig.2007.08.606] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Revised: 08/05/2007] [Accepted: 08/10/2007] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE A questionnaire survey of patients discharged after laparoscopic surgery was performed to investigate and analyze the recovery of activity of daily living (ADL) 1 month after surgery. DESIGN Retrospective study (Canadian Task Force classification II-2). SETTING University hospital. PATIENTS Two hundred ten patients who underwent laparoscopic surgery from June 1, 2003 through March 31, 2004, other than those who underwent total hysterectomy or emergency surgery. INTERVENTION Laparoscopic surgery. MEASUREMENTS AND MAIN RESULTS At discharge, all patients were given a questionnaire form with the following instructions: "Except for bathing and sport activities, you may do everything unless you feel wound pain." In principle, they were discharged on postoperative day 2. The subjects were asked to record in the questionnaire form the time when they could carry out ADL for the first time after surgery, and the time to recovery was compared among 3 major surgical procedures (myomectomy, adnexal surgery, and resection of deep infiltrating endometriosis), for blood loss level, and duration of surgery. The questionnaire form was collected at the clinical visit 1 month after surgery. The collection rate of the questionnaire was 92.4%. The mean (95% CI) of days (disease day) before the subjects could do ADL for the first time after surgery was 5.4 (4.5-6.3) for housekeeping, 5.6 (4.7-6.5) for shopping, 11.6 (10.1-13.2) for bathing, 11.8 (10.2-13.5) for bicycle riding, 12.5 (11.4-13.7) for office work, 12.8 (11.6-13.9) for light exercise, 16.0 (13.7-18.3) for physical work, and 18.1 (15.0-21.2) for sport activities. This indicates that the postoperative period for recovery tended to be longer for the activities with larger burden. The postoperative period before recovery was not significantly influenced by the surgical technique, duration of surgery or blood loss level. CONCLUSION The recovery of ADL occurred quickly after laparoscopic surgery. Most of the patients could return to their preoperative ADL within 1 month. Although the recovery status was almost constant, irrespective of the surgical technique or invasiveness level, the number of days required for recovery varied more likely because of various factors including sensitivity to pain, character, and living environment of the patients.
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Affiliation(s)
- Iwaho Kikuchi
- Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan.
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25308
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Huffaker RK, Kuehl TJ, Muir TW, Yandell PM, Pierce LM, Shull BL. Transverse cystocele repair with uterine preservation using native tissue. Int Urogynecol J 2008; 19:1275-81. [DOI: 10.1007/s00192-008-0629-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Accepted: 03/27/2008] [Indexed: 10/22/2022]
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25309
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Samuel NC, Karragianniadou E, Clark TJ. Outpatient versus day-case endometrial ablation using the NovaSure™ impedance-controlled ablative system. ACTA ACUST UNITED AC 2008. [DOI: 10.1007/s10397-008-0394-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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25310
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Muppala H, Rafi J, Najia SK. Laparoscopic insufflation through a defined surgical point in the left upper quadrant: a 3-year experience. ACTA ACUST UNITED AC 2008. [DOI: 10.1007/s10397-008-0397-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25311
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Molinas CR, De Win G, Ritter O, Keckstein J, Miserez M, Campo R. Feasibility and construct validity of a novel laparoscopic skills testing and training model. ACTA ACUST UNITED AC 2008. [DOI: 10.1007/s10397-008-0391-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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25312
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Mohammadzadeh A, Heidari M, Soltanghoraee H, Jeddi-Tehrani M, Ghaffari Novin M, Akhondi MMA, Zeraati H, Mohammadzadeh F. Retracted: Evaluation of the effect of pentoxifylline on white blood cell count in serum and peritoneal fluid in female rats with endometriosis. J Obstet Gynaecol Res 2008; 34:307-13. [DOI: 10.1111/j.1447-0756.2008.00745.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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25313
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Agostini A, Crochet P, Petrakian M, Estrade JP, Cravello L, Gamerre M. Hysteroscopic Tubal Sterilization (Essure) in Women with an Intrauterine Device. J Minim Invasive Gynecol 2008; 15:277-9. [DOI: 10.1016/j.jmig.2008.01.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2007] [Revised: 12/24/2007] [Accepted: 01/09/2008] [Indexed: 11/28/2022]
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25314
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Fambrini M, Penna C, Pieralli A, Fallani MG, Andersson KL, Lozza V, Scarselli G, Marchionni M. Carbon-dioxide Laser Vaporization of the Bartholin Gland Cyst: A Retrospective Analysis on 200 Cases. J Minim Invasive Gynecol 2008; 15:327-31. [DOI: 10.1016/j.jmig.2008.02.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Revised: 02/12/2008] [Accepted: 02/16/2008] [Indexed: 11/25/2022]
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25315
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Zakashansky K, Lerner DL. Total Laparoscopic Radical Hysterectomy for the Treatment of Cervical Cancer. J Minim Invasive Gynecol 2008; 15:387-8; author reply 388. [DOI: 10.1016/j.jmig.2008.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Accepted: 02/25/2008] [Indexed: 11/26/2022]
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25316
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Kabli N, Tulandi T. A Randomized Trial of Outpatient Hysteroscopy with and without Intrauterine Anesthesia. J Minim Invasive Gynecol 2008; 15:308-10. [DOI: 10.1016/j.jmig.2008.01.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2007] [Revised: 01/12/2008] [Accepted: 01/30/2008] [Indexed: 11/26/2022]
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25317
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Gadducci A, Tana R, Cosio S, Fanucchi A, Genazzani AR. Molecular target therapies in endometrial cancer: from the basic research to the clinic. Gynecol Endocrinol 2008; 24:239-49. [PMID: 18569027 DOI: 10.1080/09513590801953556] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Molecular targeted therapies represent an interesting field of pharmacological research in endometrial cancer. The loss of PTEN (phosphatase and tensin homolog deleted on chromosome 10) function, with consequent activation of the PI3K (phosphatidylinositol-3-kinase)-AKT (serine/threonine-specific protein kinase)-mTOR (mammalian target of rapamycin) signaling pathway, occurs in 32-83% of endometrioid-type endometrial carcinomas, thus suggesting a role for mTOR inhibition in this malignancy. Some analogues of rapamycin (CCI-799, RAD-001, AP-23573) have been developed and tested in different tumors including endometrioid-type endometrial carcinoma. For example, AP-23573 achieved a clinical benefit response in 33% of 27 heavily pretreated patients, and CCI-799 obtained a 26% partial response rate and a 63% stable disease rate in 19 patients. Overexpression of ErbB-2 (epidermal growth factor type II receptor) has been detected in 18-80% of uterine papillary serous carcinomas (UPSCs), thus providing a biological rationale for the use of trastuzumab in these aggressive tumors. UPSC often overexpresses claudin-3 and claudin-4, which represent the epithelial receptors for Clostridium perfringens enterotoxin (CPE). CPE-mediated therapy might be a novel treatment modality for UPSC resistant to chemotherapy. A better understanding of the signaling transduction pathways that are dysregulated in endometrioid-type endometrial carcinoma and UPSC will allow the development of novel molecular targeted therapies.
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Affiliation(s)
- Angiolo Gadducci
- Department of Procreative Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy.
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25318
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Mutter GL, Bergeron C, Deligdisch L, Ferenczy A, Glant M, Merino M, Williams ARW, Blithe DL. The spectrum of endometrial pathology induced by progesterone receptor modulators. Mod Pathol 2008; 21:591-8. [PMID: 18246050 DOI: 10.1038/modpathol.2008.19] [Citation(s) in RCA: 159] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Progesterone receptor modulators (PRM) are hormonally active drugs effective in the management of endometriosis and uterine leiomyomata. The endometrial effects of progestin blockade by PRMs in premenopausal women are currently being evaluated in several clinical trials, but few pathologists have had access to these materials and published information of the histological changes is scanty. Eighty-four endometrial specimens from women receiving one of four different PRMs were reviewed by a panel of seven experienced gynecologic pathologists to develop consensus observations and interpretive recommendations as part of an NIH-sponsored workshop. Although the pathologists were blinded to agent, dose, and exposure interval, the review was intended to provide an overview of the breadth of possible findings, and a venue to describe unique features. Endometrial histology included inactive and normal-appearing cycling endometrium. Overtly premalignant lesions (atypical hyperplasia or EIN) were not seen. In a subset of cases, asymmetry of stromal and epithelial growth resulted in prominent cystically dilated glands with admixed estrogen (mitotic) and progestin (secretory) epithelial effects of a type not encountered in contemporary clinical practice. The variety of endometrial appearances suggested that findings might differ by agent and dose over time according to relationships that must be specified for each agent. The constellation of changes seen in those endometria with cystically dilated glands is so novel that new terminology and diagnostic criteria are required for pathologists to recognize them. The panel has designated these changes as PRM-associated endometrial changes (PAEC). Additional follow-up studies will be needed to fully define their natural history and relationship to specific agents and administration regimens.
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Affiliation(s)
- George L Mutter
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.
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25319
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Uterine Artery Embolization Versus Occlusion for Uterine Leiomyomas: A Pilot Randomized Clinical Trial. J Minim Invasive Gynecol 2008; 15:301-7. [DOI: 10.1016/j.jmig.2008.01.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Revised: 01/24/2008] [Accepted: 01/30/2008] [Indexed: 11/17/2022]
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25320
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Payne TN, Dauterive FR. A Comparison of Total Laparoscopic Hysterectomy to Robotically Assisted Hysterectomy: Surgical Outcomes in a Community Practice. J Minim Invasive Gynecol 2008; 15:286-91. [PMID: 18439499 DOI: 10.1016/j.jmig.2008.01.008] [Citation(s) in RCA: 181] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Revised: 01/14/2008] [Accepted: 01/30/2008] [Indexed: 11/20/2022]
Affiliation(s)
- Thomas N Payne
- Ochsner Clinic Foundation, Baton Rouge, Louisiana 70809, USA.
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25321
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Total Laparoscopic Hysterectomy with Earlier Uterine Artery Ligation. J Minim Invasive Gynecol 2008; 15:355-9. [DOI: 10.1016/j.jmig.2008.01.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Revised: 01/14/2008] [Accepted: 01/30/2008] [Indexed: 11/17/2022]
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25322
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Hysteroscopic Resection of Uterine Leiomyosarcoma: A Case Report and Literature Review. J Minim Invasive Gynecol 2008; 15:380-3. [DOI: 10.1016/j.jmig.2008.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Revised: 01/31/2008] [Accepted: 02/08/2008] [Indexed: 11/24/2022]
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25323
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25324
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Chmarra MK, Dankelman J, van den Dobbelsteen JJ, Jansen FW. Force feedback and basic laparoscopic skills. Surg Endosc 2008; 22:2140-8. [DOI: 10.1007/s00464-008-9937-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Revised: 03/10/2008] [Accepted: 03/27/2008] [Indexed: 10/22/2022]
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25325
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Martel G, Poulin ÉC, Mamazza J, Boushey RP. Laparoscopy influences hiring practices within academic surgical departments. Surg Endosc 2008; 23:341-6. [DOI: 10.1007/s00464-008-9934-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Revised: 02/01/2008] [Accepted: 04/05/2008] [Indexed: 11/28/2022]
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25326
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Bajka M, Tuchschmid S, Streich M, Fink D, Székely G, Harders M. Evaluation of a new virtual-reality training simulator for hysteroscopy. Surg Endosc 2008; 23:2026-33. [DOI: 10.1007/s00464-008-9927-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2007] [Accepted: 02/18/2008] [Indexed: 01/22/2023]
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25327
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van Dongen H, Emanuel MH, Wolterbeek R, Trimbos JB, Jansen FW. Hysteroscopic morcellator for removal of intrauterine polyps and myomas: a randomized controlled pilot study among residents in training. J Minim Invasive Gynecol 2008; 15:466-71. [PMID: 18588849 DOI: 10.1016/j.jmig.2008.02.002] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2007] [Revised: 02/04/2008] [Accepted: 02/04/2008] [Indexed: 11/26/2022]
Abstract
The purpose of this randomized controlled study was to compare conventional resectoscopy and hysteroscopic morcellation among residents in training (Canadian Task Force classification I). Sixty women with an intrauterine polyp or myoma were randomized to either hysteroscopic removal by conventional resectoscopy or hysteroscopic morcellation performed by 6 residents in training for obstetrics and gynecology (10 procedures per resident). The mean operating time for resectosocpy and morcellation was 17.0 (95% confidence interval [95% CI] 14.1-17.9, standard deviation [SD] 8.4) and 10.6 (95% CI 7.3-14.0, SD 9.5) min, respectively (p = .008). Multiple linear regression analysis showed that operating time increased significantly, for both resectoscopy and morcellator, when volume of intrauterine disorder increased. The use of the hysteroscopic morcellator reduced operating time more than 8 min in comparison to conventional resectoscopy (p < .001) when correction for volume was applied. Subjective surgeon and trainer scores for convenience of technique on a visual analog scale were in favor of the morcellator. No learning curve was observed. In conclusion, the hysteroscopic morcellator for removal of intrauterine polyps and myomas offers a good alternative to conventional resectoscopy for residents in training.
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Affiliation(s)
- Heleen van Dongen
- Department of Gynaecology, Leiden University Medical Center, Leiden, The Netherlands.
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25328
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Möller C, Hoffmann J, Kirkland TA, Schwede W. Investigational developments for the treatment of progesterone-dependent diseases. Expert Opin Investig Drugs 2008; 17:469-79. [PMID: 18363513 DOI: 10.1517/13543784.17.4.469] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Clinical evidence has shown that conditions such as uterine fibroids, endometriosis and breast cancer are progesterone-dependent diseases. Therefore, progesterone receptor (PR) antagonists and selective PR modulators (SPRMs) are under development for the treatment of these conditions. However, the first PR antagonists that became available exhibit insufficient selectivity or tolerability for the chronic administration required to treat these conditions. Despite initial setbacks, development of second-generation PR antagonists with better selectivity continues forward. OBJECTIVE In this review we would like to summarise prospects for using PR antagonists for the treatment of uterine fibroids, endometriosis and breast cancer, and to give an overview of the development of new steroidal and non-steroidal PR antagonists. METHOD Available preclinical and clinical data and publications have been reviewed with the focus on scientific background and use in the three mentioned indications. RESULTS/CONCLUSION Preclinical and clinical evidence demonstrated that PR antagonists and SPRMs are effective for the treatment of progesterone-dependent diseases. Future development will demonstrate if they can become important drugs.
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Affiliation(s)
- Carsten Möller
- Bayer Schering Pharma, Global Drug Discovery, Women's Healthcare, Müllerstrasse 178, 13353 Berlin, Germany
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25329
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Nezhat C, Lavie O, Hsu S, Watson J, Barnett O, Lemyre M. Robotic-assisted laparoscopic myomectomy compared with standard laparoscopic myomectomy--a retrospective matched control study. Fertil Steril 2008; 91:556-9. [PMID: 18377901 DOI: 10.1016/j.fertnstert.2007.11.092] [Citation(s) in RCA: 165] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Revised: 11/30/2007] [Accepted: 11/30/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Compare robotic-assisted laparoscopic myomectomy (RALM) to a matched control standard laparoscopic myomectomy (LM). DESIGN A retrospective matched control study. SETTING Private practice setting. PATIENT(S) Premenopausal and postmenopausal women who underwent either robotic-assisted or standard laparoscopic myomectomy. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Retrospective chart review was performed. Cases of laparoscopic robotic-assisted myomectomies were compared with a matched control group of standard LM. Comparisons were based on Fisher's exact, Mann-Whitney, and exact chi-square tests. RESULT(S) Between January 2006 and August 2007, 15 consecutive RALMs were performed at our institution, compared with 35 matched control standard LMs. The two groups were matched by age, body mass index, parity, previous abdominopelvic surgery, size, number, and location of myomas. Mean surgical time for the RALM was 234 minutes (range 140-445) compared with 203 minutes (range 95-330) for standard LMs. Blood loss, hospitalization time, and postoperative complications were not significantly different. CONCLUSION(S) The RALM required a significant prolonged surgical time over LM. It appears that in the hands of a skilled laparoscopic surgeon, the RALM does not offer any major advantage. This technology, however, offers exciting potential applications while learning endoscopic surgery. Further studies are warranted to asses the utility of RALM for general gynecologic surgeons.
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Affiliation(s)
- Camran Nezhat
- Center for Special Minimally Invasive Surgery, Stanford University Medical Center, Palo Alto, California 94304, USA.
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25330
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Jee BC, Lee JY, Suh CS, Kim SH, Choi YM, Moon SY. Impact of GnRH agonist treatment on recurrence of ovarian endometriomas after conservative laparoscopic surgery. Fertil Steril 2008; 91:40-5. [PMID: 18377899 DOI: 10.1016/j.fertnstert.2007.11.027] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2007] [Revised: 11/12/2007] [Accepted: 11/12/2007] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To analyze the influence of postoperative GnRH agonist treatment on disease recurrence after conservative laparoscopic surgery for ovarian endometriomas according to duration of the treatment. DESIGN Retrospective cohort study. SETTING University hospital. PATIENT(S) One hundred nine consecutive premenopausal women who underwent conservative laparoscopic surgery for ovarian endometriomas (endometriosis stage III/IV) were enrolled in the study. The patients were divided into four treatment groups: expectant management (n = 37) and GnRH agonist therapy for 3 (n = 28), 4 (n = 21), and 6 months (n = 23). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) An ultrasound confirmed recurrence of ovarian endometriomas. RESULT(S) The overall crude recurrence rate was 16.5% after follow-up for an average of 20.1 months. The crude recurrence and the cumulative probabilities of disease recurrence at 24/36 months tended to be lower in patients who received a GnRH agonist for 6 months (4.3%, 5.3%/5.3%) compared with those who received it for 3 months (17.9%, 12.5%/25.0%) and 4 months (28.6%, 18.9%/39.2%) and patients with expectant management (16.2%, 22.4%/37.9%). However, the differences did not reach statistical significance. CONCLUSION(S) Treatment with GnRH agonist for six months had a beneficial impact on the recurrence rate after conservative laparoscopic surgery for ovarian endometriomas.
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Affiliation(s)
- Byung Chul Jee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, South Korea
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25331
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Hart RJ, Hickey M, Maouris P, Buckett W. Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database Syst Rev 2008:CD004992. [PMID: 18425908 DOI: 10.1002/14651858.cd004992.pub3] [Citation(s) in RCA: 145] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Endometriomata are endometriotic deposits within the ovary. The surgical management of these blood filled cysts is controversial. The laparoscopic approach to the management of endometriomata is favoured over a laparotomy approach as it offers the advantage of a shorter hospital stay, faster patient recovery and decreased hospital costs. Currently the commonest procedures for the treatment of ovarian endometriomata are either excision of the cyst capsule or drainage and electrocoagulation of the cyst wall. OBJECTIVES The objective of this review was to determine the most effective technique of treating an ovarian endometrioma; either excision of the cyst capsule or drainage and electrocoagulation of the cyst wall. The end-points assessed were the relief of pain, recurrence of the endometrioma, recurrence of symptoms and in women desiring to conceive the subsequent pregnancy rate, either spontaneous or as part of fertility treatment. SEARCH STRATEGY The reviewers searched the Cochrane Menstrual Disorders and Subfertility Group specialised register of trials (searched 3rd March 2007), the Cochrane Register of Controlled Trials (The Cochrane Library, Issue 3, 2007), MEDLINE (1966-August 2007), EMBASE (1980- March 2007) and reference lists of articles, the handsearching of relevant journals and conference proceedings and by contacting leaders in the field of endoscopic surgery throughout the world. The Cochrane Menstrual Disorders and Subfertility Group Trials Register is based on regular searches of MEDLINE, EMBASE, CINHAL and CENTRAL. SELECTION CRITERIA Randomised controlled trials of excision of the cyst capsule versus drainage and electrocoagulation of the cyst in the management of ovarian endometriomata. DATA COLLECTION AND ANALYSIS Reviewers assessed eligibility and trial quality. MAIN RESULTS No randomised studies of the management of endometriomata by laparotomy were found. Two randomised studies of the laparoscopic management of ovarian endometriomata of greater than 3cm in size, for the primary symptom of pain were included. Laparoscopic excision of the cyst wall of the endometrioma was associated with a reduced recurrence rate of the symptoms of dysmenorrhea (OR 0.15 CI 0.06-0.38), dyspareunia (OR 0.08 CI 0.01-0.51) and non-menstrual pelvic pain (OR 0.10 CI 0.02-0.56), a reduced rate of recurrence of the endometrioma (OR 0.41 CI 0.18-0.93) and with a reduced requirement for further surgery (OR 0.21 CI 0.05-0.79) than surgery to ablate the endometrioma. For those women subsequently attempting to conceive it was also associated with a subsequent increased spontaneous pregnancy rate in women who had documented prior sub-fertility (OR 5.21 CI 2.04-13.29). A further randomised study was identified that demonstrated an increased ovarian follicular response to gonadotrophin stimulation for women who had undergone excsional surgery when compared to ablative surgery (WMD 0.6 CI 0.04-1.16). There is insufficient evidence to favour excisional surgery over ablative surgery with respect to the chance of pregnancy after controlled ovarian stimulation and intra-uterine insemination (OR 1.40 CI 0.47-4.15) . AUTHORS' CONCLUSIONS There is good evidence that excisional surgery for endometriomata provides for a more favourable outcome than drainage and ablation with regard to the recurrence of the endometrioma, recurrence of pain symptoms, and in women who were previously subfertile, subsequent spontaneous pregnancy . Consequently this approach should be the favoured surgical approach. However in women who may subsequently may undergo fertility treatment insufficient evidence exists to determine the favoured surgical approach.
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Affiliation(s)
- R J Hart
- University of Western Australia, King Edward Memorial Hospital, School of Women's and Infants Health, 374 Bagot Road, Subiaco, Western Australia, Australia, WA 6008.
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25332
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Abstract
BACKGROUND Laparoscopy is a very common procedure in gynaecology. Complications associated with laparoscopy are often related to entry. The life-threatening complications include injury to the bowel, bladder, major abdominal vessels, and anterior abdominal-wall vessel. Other less serious complications can also occur, such as post-operative infection, subcutaneous emphysema and extraperitoneal insufflation. There is no clear consensus as to the optimal method of entry into the peritoneal cavity. OBJECTIVES The objective of this study was to compare the different laparoscopic entry techniques in terms of their influence on intra-operative and post-operative complications. SEARCH STRATEGY This review has drawn on the search strategy developed by the Menstrual Disorders and Subfertility Group. In addition MEDLINE and EMBASE were searched through to July, 2007. SELECTION CRITERIA Randomised controlled trials were included when one laparoscopic primary-port-entry technique was compared with another. DATA COLLECTION AND ANALYSIS Data were extracted independently by the first two authors. Differences of opinion were registered and resolved by the fourth author. Results for each study were expressed as odds ratio (Peto version) with their 95% confidence intervals. MAIN RESULTS The 17 included randomised controlled trials concerned 3,040 individuals undergoing laparoscopy. Overall there was no evidence of advantage using any single technique in terms of preventing major complications. However, there were two advantages with direct-trocar entry when compared with Veress-Needle entry, in terms of avoiding extraperitoneal insufflation (OR 0.06, 95%CI 0.02, 0.23) and failed entry (OR 0.22, 95%CI 0.08, 0.56). There was also an advantage with radially expanding access system (STEP) trocar entry when compared with standard trocar entry, in terms of trocar site bleeding (OR 0.06, 95%CI 0.01, 0.46). Finally, there was an advantage of not lifting the abdominal wall before Veress-Needle insertion when compared to lifting in terms of failed entry without an increase in the complication rate (OR 5.17, 95%CI 2.24, 11.90). However, studies were limited to small numbers, excluding many patients with previous abdominal surgery and women with a raised body mass index, who often had unusually high complication rates. AUTHORS' CONCLUSIONS On the basis of evidence investigated in this review, there appears to be no evidence of benefit in terms of safety of one technique over another. However, the included studies are small and cannot be used to confirm safety of any particular technique.
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Affiliation(s)
- G Ahmad
- Stepping Hill Hospital, Obstetric & Gynaecology, 30 Badger Road, Altrincham, Cheshire, UK, WA14 5UZ.
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25333
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Vicino M, Scioscia M, Resta L, Marzullo A, Ceci O, Selvaggi LE. Fibrotic tissue in the endometrioma capsule: surgical and physiopathologic considerations from histologic findings. Fertil Steril 2008; 91:1326-8. [PMID: 18410939 DOI: 10.1016/j.fertnstert.2008.02.157] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Revised: 02/25/2008] [Accepted: 02/25/2008] [Indexed: 11/19/2022]
Abstract
Ovarian tissue inadvertently excised along with endometriomas was associated with the presence of pericystic fibrosis and serum levels of CA-125, representing the only clinical parameter for predicting follicle loss before surgery. A consecutive series of 91 ovarian endometriotic cysts were studied, and an inverse relationship between serum CA-125 and the thickness of the fibrotic tissue of the endometrioma capsule was demonstrated.
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Affiliation(s)
- Mario Vicino
- Department of Gynaecology, Obstetrics and Neonatology, University of Medical Science of Bari, Bari, Italy
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25334
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Conservative management of patients with early endometrial carcinoma: a systematic review. Clin Transl Oncol 2008; 10:155-62. [DOI: 10.1007/s12094-008-0173-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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25335
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Varma R, Gupta JK. Laparoscopic entry techniques: clinical guideline, national survey, and medicolegal ramifications. Surg Endosc 2008; 22:2686-97. [DOI: 10.1007/s00464-008-9871-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 01/12/2008] [Accepted: 01/27/2008] [Indexed: 12/20/2022]
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25336
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Abstract
BACKGROUND Endometriosis is a common chronic disease that causes symptoms of pain and infertility. The pain syndrome can be quite incapacitating. The pain symptoms usually originate in the reproductive organs but can also involve the urinary or intestinal tracts if endometriosis implantation has occurred there. The presentation and physical appearance of endometriosis is extremely variable and can be characterized by a chronic intraperitoneal inflammatory process and adhesions. The only definitive diagnostic technique is laparoscopy. OBJECTIVE To review current literature on the treatment strategies for endometriosis. METHODS Review of Pubmed, Cochrane database and Medline for current review articles and studies regarding the current treatment strategies for endometriosis. RESULTS Initial treatment is surgical or medical. Medical therapy is often used as a first-line therapy and can also be used in conjunction with those patients who undergo surgical therapy for pain. No medical therapy has proven effective for infertility. Medical therapy consists mostly of hormonal suppressive therapy in which the medication causes a downregulation of the hypothalamus-pituitary-ovarian pathway. Non-steroidal anti-inflammatory drugs and oral contraceptives are often used as an initial approach even without a definitive diagnosis. Progestins, such as oral norethindrone and depot medroxyprogesterone, are effective while using them but have a high recurrence rate. The norgestrol intrauterine device is also quite effective at relieving pain associated with endometriosis, especially pain arising during menses as well as from lesions in the rectovaginal tissue. Gonadotropin-releasing hormone agonists induce a pseudomenopausal state and have significant side effects, such as hot flashes and genital atrophy. 'Add-back' therapy with a progestin has been shown to relieve most of these drug related symptoms. Gonadotropin-releasing hormone agonists are also very effective at relieving symptoms of pain during treatment but are also associated with a high recurrence rate. New drug therapies that are under investigation are aromatase inhibitors and immunomodulators. Furthermore, new delivery systems are being investigated that may also improve the patient response.
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Affiliation(s)
- Allison K Rodgers
- Department of Obstetrics and Gynecology, The Cleveland Clinic, Department of Obstetrics and Gynecology-A81, 9500 Euclid Avenue, Cleveland, Ohio 44159, USA
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25337
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Abstract
Uterine leiomyomas pose a significant health issue to reproductive-age women. Many women desire uterine conservation, and previously safe and efficacious therapies have been limited. Magnetic resonance-guided focused ultrasound surgery is a new noninvasive therapy that has been proven to be both safe and efficacious in the treatment of fibroids.
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25338
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Hysterectomy compared with endometrial ablation for dysfunctional uterine bleeding: a randomized controlled trial. Obstet Gynecol 2008; 111:992, author reply 992-3. [PMID: 18378762 DOI: 10.1097/aog.0b013e31816bfad2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25339
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Abstract
Natural orifice translumenal endoscopic surgery (NOTES) is a unique emerging surgical concept expanding flexible endoscopy beyond the gut wall. The methods and technology growing from this concept may minimize trauma from surgical access to the peritoneal cavity by completely eliminating body surface incisions. So far, NOTES surgeries have been reported by modifying laparoscopic surgery. The peroral transgastric route was chosen to access the peritoneal cavity in initial trials because of a potentially lower risk for surrounding organ injury using the anterior wall percutaneous endoscopic gastrostomy-style gastrotomy. This article reviews and describes techniques of transgastric access to the peritoneal cavity used in published animal studies.
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25340
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Laparoscopic radical hysterectomy with vaginectomy and reconstruction of vagina in patients with stage I of primary vaginal carcinoma. Gynecol Oncol 2008; 109:92-6. [DOI: 10.1016/j.ygyno.2007.12.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Revised: 12/08/2007] [Accepted: 12/11/2007] [Indexed: 11/19/2022]
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25341
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Sagili H, Divers M. Hysteroscopic sterilisation with Essure(R): a promising new alternative to tubal ligation? JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2008. [DOI: 10.1783/jfp.34.2.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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25342
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Vercellini P, Somigliana E, Viganò P, Abbiati A, Daguati R, Crosignani PG. Endometriosis: current and future medical therapies. Best Pract Res Clin Obstet Gynaecol 2008; 22:275-306. [DOI: 10.1016/j.bpobgyn.2007.10.001] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25343
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Are C, Brennan MF, D’Angelica M, Fong Y, Guillonneau B, Jarnagin WR, Park B, Strong VE, Touijer K, Weiser M, Abu-Rustum NR. Current Role of Therapeutic Laparoscopy and Thoracoscopy in the Management of Malignancy: A Review of Trends from a Tertiary Care Cancer Center. J Am Coll Surg 2008; 206:709-18. [DOI: 10.1016/j.jamcollsurg.2007.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2007] [Revised: 10/29/2007] [Accepted: 11/05/2007] [Indexed: 01/21/2023]
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25344
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Vascular “Pseudo Invasion” in Laparoscopic Hysterectomy Specimens: A Diagnostic Pitfall. Am J Surg Pathol 2008; 32:560-5. [DOI: 10.1097/pas.0b013e31816098f0] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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25345
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Gorlero F, Nicoletti L, Lijoi D, Ferrero S, Pullè A, Ragni N. Endometrial directed biopsy during sonohysterography using the NiGo device: prospective study in women with abnormal uterine bleeding. Fertil Steril 2008; 89:984-90. [PMID: 17612538 DOI: 10.1016/j.fertnstert.2007.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Revised: 04/17/2007] [Accepted: 04/17/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the accuracy of sonohysterography (SHG), combined with sonography-guided biopsies that are performed by using the NiGo device, in the diagnosis of endometrial pathologies in women with abnormal uterine bleeding (AUB). DESIGN Prospective study. SETTING Outpatient clinic. PATIENT(S) One hundred sixteen women with AUB (55 postmenopausal and 61 premenopausal). INTERVENTION(S) Patients underwent transvaginal sonography and SHG; when an endometrial condition needing a biopsy was diagnosed, the biopsy was performed both by using the NiGo device (ASL 1, Imperia, Italy) and by using Pipelle. MAIN OUTCOME MEASURE(S) Feasibility of SHG and endometrial biopsy by NiGo. RESULT(S) Sonohysterography was successfully performed by using the NiGo device in 87.4% of the cases (92.6% of premenopausal women and 81.5% of postmenopausal women). Seventy-eight (86.7%) women were judged to require endometrial biopsy; the NiGo device allowed obtaining an adequate biopsy for histological evaluation in 74 cases (94.9%). There was no statistically significant difference in efficacy between the NiGo and Pipelle in providing a specimen that was adequate for histological evaluation. Although no significant difference was observed in the histological diagnosis performed on the specimens obtained by the two techniques, NiGo allowed diagnosis of more focal lesions (simple hyperplasia, endometrial polyps, and myomas). CONCLUSION(S) The NiGo device allows an adequate biopsy for histological evaluation to be obtained during SHG in an outpatient setting.
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Affiliation(s)
- Franco Gorlero
- Department of Women and Children, Division of Obstetrics and Gynecology, Imperia Hospital, Imperia, Italy
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25346
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Famuyide AO, Hopkins MR, El-Nashar SA, Creedon DJ, Vasdev GM, Driscoll DJ, Connolly HM, Warnes CA. Hysteroscopic sterilization in women with severe cardiac disease: experience at a tertiary center. Mayo Clin Proc 2008; 83:431-8. [PMID: 18380988 DOI: 10.4065/83.4.431] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the feasibility and effectiveness of hysteroscopic sterilization as a minimally invasive sterilization method for women with high-risk cardiac disease. PARTICIPANTS AND METHODS In a retrospective cohort study, 18 women with high-risk cardiac conditions that strictly contraindicated pregnancy were compared with a reference cohort of 157 women without cardiac disease. All underwent microinsert hysteroscopic sterilization at Mayo Clinic from January 2003 through February 2007. End points included successful placement, fallopian tube patency determined by hysterosalpingogram 3 months after the procedure, and pregnancy status. RESULTS Women in the cardiac cohort were younger than those in the reference cohort (median age, 25 vs 39 years; P<.001), had lower parity (median, 0 vs 2; P<.001), and had a higher proportion of patients categorized as American Society of Anesthesiologists' physical status 3 (severe systemic disease) and physical status 4 (systemic disease that is a constant threat to life) (83% vs 6%; P<.001). No significant differences were noted for use of general anesthesia (17% vs 27%; P=.41), successful bilateral device placement (100% vs 95%; P>.99), postoperative pain score (median, 0 for both groups; P=.87), or length of hospitalization (median, 6 vs 6 hours; P=.63). No intraoperative complications occurred. Follow-up hysterosalpingography showed high tubal occlusion rates in both cohorts (100% cardiac; 98% reference; P>.99). No pregnancies occurred during a median follow-up period of 20 months (interquartile range, 8-33 months). CONCLUSION For women with cardiac disease and strict contraindications for pregnancy, microinsert hysteroscopic sterilization provided minimally invasive, permanent, and reliable contraception.
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Affiliation(s)
- Abimbola O Famuyide
- Department of Obstetrics and Gynecology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
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25347
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Donnez O, Jadoul P, Squifflet J, Donnez J. Laparoscopic repair of wide and deep uterine scar dehiscence after cesarean section. Fertil Steril 2008; 89:974-80. [PMID: 17624346 DOI: 10.1016/j.fertnstert.2007.04.024] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Revised: 04/17/2007] [Accepted: 04/17/2007] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To propose a new laparoscopic technique for repair of scar dehiscence after cesarean section. DESIGN The dehiscent scars were evaluated by ultrasound, hysterography, hysteroscopy, and magnetic resonance imaging. The results were correlated with those after laparoscopic repair. SETTING University hospital. PATIENT(S) Three patients underwent cesarean section and presented with symptomatic dehiscence at the level of the incision. INTERVENTION(S) Laparoscopic repair of the dehiscence, including excision of the fibrotic tissue and laparoscopic closure of the anterior uterine wall. MAIN OUTCOME MEASURE(S) Evaluation by ultrasound and magnetic resonance imaging of the sagittal depth of the scar and the thickness of the residual myometrium covering the dehiscence. RESULT(S) The defect was completely corrected by laparoscopic repair in all cases. CONCLUSION(S) Evaluation of uterine scar dehiscence after cesarean section can be performed by ultrasound and magnetic resonance imaging, and laparoscopic surgical repair may be performed with good postoperative anatomic outcomes.
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Affiliation(s)
- Olivier Donnez
- Department of Gynecology, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
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25348
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Acién P, Acién M, Sánchez-Ferrer ML. Müllerian anomalies "without a classification": from the didelphys-unicollis uterus to the bicervical uterus with or without septate vagina. Fertil Steril 2008; 91:2369-75. [PMID: 18367185 DOI: 10.1016/j.fertnstert.2008.01.079] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2007] [Revised: 01/28/2008] [Accepted: 01/28/2008] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To point out possible discrepancies in the classic hypothesis of Müllerian development and to present cases that support an alternative hypothesis. DESIGN Case reports. SETTING University hospital. PATIENT(S) Six women with uterine malformation. INTERVENTION(S) Surgical, clinical, and outpatient evaluation of the anomalies. MAIN OUTCOME MEASURE(S) Assessment of the genital anomalies according to our embryologic investigations and embryologic-clinical classification and standard classifications for Müllerian malformations. RESULT(S) We have included examples of cases presenting with didelphys uterus with normal cervix, didelphys uterus with septate cervix, and bicornuate (or didelphys) uterus with septate cervix and vagina versus septate uterus with double cervix and vagina, septate bicervical uterus with isthmic communication, and normal simplex uterus with septate cervix and vagina. CONCLUSION(S) These case reports prove that the fusion and reabsorption processes in the development of the Müllerian ducts can be affected to different degrees in the superior-convergent and inferior-divergent portions, thus resulting in atypical or transitional cases without a classification. Therefore, for a more appropriate classification of the uterine malformations, even if the same degrees of fusion, resorption, and development defects are used, a separate classification should be made for each superior and inferior uterine segment.
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Affiliation(s)
- Pedro Acién
- Service of Obstetrics and Gynecology, University Hospital of San Juan, Department/Division of Gynecology, Miguel Hernández University, Campus of San Juan, Alicante, Spain.
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25349
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Kindberg S, Stehouwer M, Hvidman L, Henriksen TB. Postpartum perineal repair performed by midwives: a randomised trial comparing two suture techniques leaving the skin unsutured. BJOG 2008; 115:472-9. [PMID: 18271883 DOI: 10.1111/j.1471-0528.2007.01637.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare a continuous suture technique with interrupted stitches using inverted knots for postpartum perineal repair of second-degree lacerations and episiotomies. DESIGN A double-blind randomised controlled trial. SETTING A Danish university hospital with more than 4800 deliveries annually. POPULATION A total of 400 healthy primiparous women with a vaginal delivery at term. METHOD Randomisation was computer-controlled. Structured interviews and systematic assessment of perineal healing were performed by research midwives blinded to treatment allocation at 24-48 hours, 10 days and 6 months postpartum. Pain was evaluated using a visual analogue scale and the McGill Pain Questionnaire. Wound healing was evaluated using the REEDA scale and by assessment of gaping wounds >0.5 cm. Analysis complied with the intention-to-treat principle. MAIN OUTCOME MEASURES The primary outcome was perineal pain 10 days after delivery. Secondary outcomes were wound healing, patient satisfaction, dyspareunia, need for resuturing, time elapsed during repair and amount of suture material used. RESULTS A total of 400 women were randomised; 5 women withdrew their consent, leaving 395 for follow up. The follow-up rate was 98% for all assessments after delivery. No difference was seen in perineal pain 10 days after delivery. No difference was seen in wound healing, patient satisfaction, dyspareunia or need for resuturing. The continuous suture technique was significantly faster (15 versus 17 minutes, P = 0.03) and less suture material was used (one versus two packets, P < 0.01). CONCLUSION Interrupted, inverted stitches for perineal repair leaving the skin unsutured appear to be equivalent to the continuous suture technique in relation to perineal pain, wound healing, patient satisfaction, dyspareunia and need for resuturing. The continuous technique, however, is faster and requires less suture material, thus leaving it the more cost-effective of the two techniques evaluated.
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Affiliation(s)
- S Kindberg
- Perinatal Epidemiology Research Unit, Aarhus University Hospital, Skejby, Aarhus, Denmark
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