25401
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Ohlinger R, Paepke S, Jacobs VR, Hahn M, Grunwald S. Stellenwert der Duktoskopie in der Mammadiagnostik. GYNAKOLOGE 2006. [DOI: 10.1007/s00129-006-1847-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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25402
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Roman JD. Patient selection and surgical technique may reduce major complications of laparoscopic-assisted vaginal hysterectomy. J Minim Invasive Gynecol 2006; 13:306-10. [PMID: 16825071 DOI: 10.1016/j.jmig.2006.04.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2006] [Revised: 03/30/2006] [Accepted: 04/03/2006] [Indexed: 01/27/2023]
Abstract
STUDY OBJECTIVE To study the clinical outcome of patients who underwent laparoscopic-assisted vaginal hysterectomy especially with regard to early postoperative complications. DESIGN Retrospective study (Canadian Task Force classification II-3). SETTING Private hospital in Hamilton, New Zealand. PATIENTS Four hundred eighteen women. INTERVENTION Laparoscopic-assisted vaginal hysterectomy. MEASUREMENTS AND MAIN RESULTS Primary indication for surgery, operating time, hospital stay, and major complications were analyzed. Major complications were defined as life-threatening injuries, unintended major surgical procedures, and conversions to laparotomy that occurred under duress (eg, intraoperative hemorrhage). Complications were reported up to 6 weeks of postoperative time. The total early postoperative complication rate was 11.24%. No patient had damage to the bowel, ureter, or bladder. There were no deaths. Major complications were three cases of partial vault dehiscence and one case of partial small bowel obstruction. The operation was performed successfully in 412 cases. Six patients needed laparotomy. CONCLUSIONS This retrospective study shows that laparoscopic-assisted vaginal hysterectomy is a safe surgical procedure. The possible reasons for the low complication rate reported are the surgical technique of ureteral dissection, the use of suitable instruments to expose the vaginal fornices, a consistent team approach, and the selection of patients.
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25403
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Simsek M, Sadik S, Taskin O, Guler H, Onoglu A, Akar M, Kursun S, Tinar S. Role of laparoscopic uterine artery coagulation in management of symptomatic myomas: A prospective study using ultrasound and magnetic resonance imaging. J Minim Invasive Gynecol 2006; 13:315-9. [PMID: 16825073 DOI: 10.1016/j.jmig.2006.03.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2005] [Revised: 02/15/2006] [Accepted: 03/08/2006] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE The aim of this study was to evaluate the efficacy of laparoscopic uterine artery coagulation (LUC) in symptomatic myomatous patients. DESIGN Prospective study (Canadian Task Force classification II). SETTING Tertiary care center PATIENTS Twenty-one women with myomatous uteri. INTERVENTIONS Laparoscopic uterine artery coagulation. MEASUREMENTS AND MAIN RESULTS Laparoscopic uterine artery coagulation for myoma was performed by three-puncture laparoscopy, and the difference in uterine and/or myoma volume was determined every 3 months for 12 months clinically and using ultrasonographic and MRI calculations of uterine volume. In addition, pre and postprocedure uterine Doppler indices were determined. Main outcome measures were symptomatic improvement after LUC and reduction in volume calculated by ultrasonography and magnetic resonance imaging (MRI). All treated women reported less bleeding after treatment. At 12 months, a 57% reduction in bleeding was seen in these patients. The mean postoperative pictorial blood loss assessment was significantly lower at 12 months: 303 +/- 30.4 mL (95% CI 284-328) baseline versus 173.5 +/- 17.8 mL (95% CI 164-184) after treatment, p < .05. Postoperative pain was documented in all the patients with a visual analog scale, with a mean of 1.6 cm recorded. The mean reduction in uterine volume (pre- to post-LUC) was 195 +/- 24.3 cm3 (range 89-438). The mean operating time was 52.1 +/- 7.2 minutes (95% CI 49.8-55.4), and the mean estimated blood loss was 65.2 +/- 11.8 dL (95% CI 59.6-70.8). Mean hospitalization time was 32.3 +/- 6.6 hours (95% CI 29.2-35.4). The complication rates were low with the procedure (fever, infection). No patient required hysterectomy due to complications. Ninety percent of the women were satisfied with the procedure. CONCLUSION Laparoscopic uterine artery coagulation is effective in the management of symptomatic myomas, reducing bleeding and the volume of both uterus and myomas as documented by ultrasonography and MRI. Laparoscopic uterine artery coagulation is a cost-effective and low-morbidity option compared with conventional approaches such as myomectomy or hysterectomy. If the patient's predominant complaint is the feeling of a mass and/or bleeding, alternative treatment options should be explored. The results of this study are encouraging, but more research is needed to validate the cost-effectiveness and long-term results.
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Affiliation(s)
- Mehmet Simsek
- Department of Obstetrics and Gynecology, Akdeniz University School of Medicine, Antalya and SSK Tepecik, Izmir, Turkey
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25404
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Ghezzi F, Cromi A, Bergamini V, Uccella S, Beretta P, Franchi M, Bolis P. Laparoscopic management of endometrial cancer in nonobese and obese women: A consecutive series. J Minim Invasive Gynecol 2006; 13:269-75. [PMID: 16825065 DOI: 10.1016/j.jmig.2006.02.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Revised: 02/10/2006] [Accepted: 02/14/2006] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE To assess the technical feasibility and surgical outcome of a 5 mm-ports technique in a consecutive series of women with endometrial cancer laparoscopically managed. DESIGN Prospective collaborative cohort study (Canadian Task Force classification II-2). SETTING Two gynecologic oncology units of university hospitals. PATIENTS A series of consecutive patients undergoing laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy for the treatment of endometrial cancer. INTERVENTIONS A 10-mm zero-degree umbilical operative laparoscope and three 5-mm suprapubic trocars were used. The lymph nodes were removed with the use of a specimen bag through the umbilical port. Intraoperative and postoperative details and complications were prospectively collected. MEASUREMENTS AND MAIN RESULTS A total of 101 patients were enrolled. Twenty-two (21.8%) had a body mass index (BMI) of 30 kg/m2 or higher, and nine (8.9%) were severely obese (BMI > or =35 kg/m2). One hundred procedures (99%) were carried out entirely with only three 5-mm ancillary trocars. In one patient, a 5-mm trocar was replaced with a 10-mm trocar because of a lesion of the external iliac vein requiring the placement of vascular clips. One procedure needed to be converted to laparotomy. Intraoperative complications occurred in three patients (one bladder injury and one iliac vein injury, both managed laparoscopically, and one subcutaneous emphysema). Postoperative complications occurred in 10 (10%) patients. The only complication requiring a subsequent intervention was a symptomatic pelvic lymphocyst. No difference was found in surgical outcomes between obese women and those of ideal BMI. CONCLUSION The use of only 5-mm ancillary trocars for the laparoscopic treatment of endometrial cancer can further minimize surgical invasiveness without compromising surgical efficacy and safety in patients with high BMI as well as for women with ideal BMI.
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Affiliation(s)
- Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
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25405
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Palomba S, Nelaj E, Zullo F. Visceral fat amount as predictive factor for early laparotomic conversion in obese patients with endometrial cancer. Gynecol Oncol 2006; 102:128-9. [PMID: 16545440 DOI: 10.1016/j.ygyno.2006.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2005] [Accepted: 02/02/2006] [Indexed: 11/23/2022]
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25406
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Hovsepian DM, Ratts VS, Rodriguez M, Huang JS, Aubuchon MG, Pilgram TK. A Prospective Comparison of the Impact of Uterine Artery Embolization, Myomectomy, and Hysterectomy on Ovarian Function. J Vasc Interv Radiol 2006; 17:1111-5. [PMID: 16868163 DOI: 10.1097/01.rvi.0000228338.11178.c8] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To prospectively compare uterine artery embolization (UAE) versus myomectomy and hysterectomy with regard to ovarian function as measured by postprocedure follicle-stimulating hormone (FSH) levels and symptoms. MATERIALS AND METHODS Fifty-five patients were prospectively enrolled in the study: 33 patients who underwent UAE, seven who underwent myomectomy, and 15 who underwent hysterectomy. Patients had serum FSH and estradiol levels measured on the third day of the menstrual cycle before their procedure and at regular follow-up visits for as long as 6 months. At these intervals, patients were also surveyed regarding menopausal symptoms. RESULTS Although a mild transient increase in mean FSH level after UAE was noted at 3 months, there were no statistically significant differences among the three groups in mean FSH levels at 1 month, 3 months, or 6 months of follow-up. Menopausal symptoms arose in the UAE and hysterectomy groups, but there was no statistically significant difference or permanent effect in either group. CONCLUSION There is no significant difference in impact on ovarian function after UAE, hysterectomy, or myomectomy at follow-up for a maximum of 6 months.
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Affiliation(s)
- David M Hovsepian
- Mallinckrodt Institute of Radiology, Washington University, 510 South Kingshighway Boulevard, St. Louis, MO 63110, USA.
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25407
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Bibliography. Current world literature. Minimally invasive gynecologic procedures. Curr Opin Obstet Gynecol 2006; 18:464-7. [PMID: 16794430 DOI: 10.1097/01.gco.0000233944.74672.e0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25408
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Naumann G, Kolbl H. Operative Therapie bei Genitaldeszensus der Frau: Pro und Kontra der Verwendung von Mesh-Materialien. ACTA ACUST UNITED AC 2006; 46:96-104. [PMID: 16778448 DOI: 10.1159/000092631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The development of different mesh materials has led to an improvement of the individual surgical correction of genital prolapse. Macroporous monofilamentous synthetic meshes seem to be the optimal material in case of recurrent prolapse or of severe insufficiency of the pelvic floor. The use of biological meshes shows a markedly better tolerance with fewer infections or erosions despite the lack of evidence-based information on their long-term efficacy and safety. The surgical correction of genital prolapse has to carefully consider all risks and benefits in order to improve quality of life. In this respect, mesh materials can be particularly advantageous in the recurrent situation.
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Affiliation(s)
- Gert Naumann
- Klinik und Poliklinik für Geburtshilfe und Frauenkrankheiten, Johannes-Gutenberg-Universität, Mainz, Deutschland.
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25409
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Wu Y, Guo SW. Inhibition of proliferation of endometrial stromal cells by trichostatin A, RU486, CDB-2914, N-acetylcysteine, and ICI 182780. Gynecol Obstet Invest 2006; 62:193-205. [PMID: 16778450 DOI: 10.1159/000093975] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND All current major medications in treating endometriosis are effective in treating pain, most likely through suppression of proliferation of the implants, yet their effectiveness is relatively short term and they all have many undesirable, and sometimes severe, side effects. There is pressing need for novel, more effective medications in treating endometriosis with less and/or milder side effects. METHODS Using a recently established immortalized endometrial stromal cell line, we carried out cell proliferation assays for cells treated with trichostatin A (TSA), RU486, CDB-2914, and N-acetylcysteine, and ICI 182780. Gene expression levels for PR-A, PR-B, AR, Fas and FasL were measured. Protein expression levels for ERalpha, ERbeta, and AR were also measured. RESULTS Cell proliferation assay results for NAC, H2O2, CDB, and RU486 were nearly identical or similar to what have been reported based on primary cell cultures or in vivo studies. TSA, CDB, RU486 and NAC all had various antiproliferative effects. TSA had a more potent and longer lasting antiproliferative effect than CDB and NAC, even in the presence of an oxidant, H2O2. Its antiproliferative effect was concentration-dependent. ICI did not have a significant antiproliferative effect. PR-A, PR-B, AR, and FasL expression were all increased as compared with untreated cells. CONCLUSIONS The cell line appears to be an adequate model for stromal components of endometriotic implants. That ICI has no inhibitory effect on endometrial proliferation may explain why a phase II clinical trial on its use to treat endometriosis did not advance to later stages. The upregulation of PR-B and AR may be responsible for antiproliferative effects induced by TSA, a histone deacetylase inhibitor (HDACI). HDACIs may be promising therapeutics in treating endometriosis due to their antiproliferative effects as well as the potential to restore gene dysregulation through chromatin remodeling.
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Affiliation(s)
- Yan Wu
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226-0509, USA
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25410
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Purnichescu V, Cheret-Benoist A, Von Theobald P, Mayaud A, Herlicoviez M, Dreyfus M. Prise en charge cœlioscopique des masses latéro-utérines pendant la grossesse. ACTA ACUST UNITED AC 2006; 35:388-95. [PMID: 16940907 DOI: 10.1016/s0368-2315(06)76410-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine the feasibility, safety and limiting factors of laparoscopic management of pelvic mass in pregnancy. MATERIAL and methods. During a 10-year period, 21 laparoscopic procedures were performed in patients with pelvic masses in pregnancy after exclusion of appendicitis and ectopic pregnancy. Laparoscopic surgery was done during the first trimester of pregnancy in 8 cases, the second trimester in 12 cases and the third trimester in one case. All the procedures were performed with general anesthesia and the laparoscopic cystectomies were performed with the intraperitoneal technique. RESULTS The indications were: persistent or sonographically abnormal ovarian cyst (12 cases), torsion of ovarian cyst (5 cases), and symptomatic pelvic mass (4 cases: 2 painful cysts and 2 infarction of fibroma). One borderline tumor were discovered. The laparoscopic procedure could not be performed in two cases due to difficulty of access to the lesion. No patient encountered complications during the intra- and post-operative periods. The mean hospital stay was 4.5 days. The outcome of the pregnancy was normal in all cases. CONCLUSION Laparoscopic management of pelvic masses in pregnancy by an experienced team, is a safe and effective procedure.
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Affiliation(s)
- V Purnichescu
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Centre Hospitalier Universitaire de Caen, avenue Georges-Clemenceau, 14033 Caen Cedex
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25411
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Sener A, Chew BH, Duvdevani M, Brock GB, Vilos GA, Pautler SE. Combined transurethral and laparoscopic partial cystectomy and robot-assisted bladder repair for the treatment of bladder endometrioma. J Minim Invasive Gynecol 2006; 13:245-8. [PMID: 16698535 DOI: 10.1016/j.jmig.2006.01.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2005] [Revised: 01/16/2006] [Accepted: 01/22/2006] [Indexed: 11/25/2022]
Abstract
A 40-year-old nulliparous woman with a 7-year history of progressive abdominal discomfort and lower urinary tract symptoms was diagnosed with a deeply infiltrating 4-cm bladder endometrioma. After failing conservative therapy, she was treated with simultaneous transurethral and laparoscopic partial cystectomy and robot-assisted bladder reconstruction. She remained symptom free at last follow-up.
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Affiliation(s)
- Alp Sener
- Department of Surgery, Division of Urology, University of Western Ontario, London, Ontario, Canada
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25412
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Gadducci A, Cosio S, Genazzani AR. Old and new perspectives in the pharmacological treatment of advanced or recurrent endometrial cancer: Hormonal therapy, chemotherapy and molecularly targeted therapies. Crit Rev Oncol Hematol 2006; 58:242-56. [PMID: 16436330 DOI: 10.1016/j.critrevonc.2005.11.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2005] [Revised: 10/30/2005] [Accepted: 11/17/2005] [Indexed: 12/20/2022] Open
Abstract
Hormonal therapy and chemotherapy play a major role in the management of advanced or recurrent endometrial cancer. Progesterone therapy obtains overall response rates ranging from 11% to 25% in patients with endometrioid-type tumours, and oral medroxyprogesterone acetate 200mg daily appears to be a reasonable therapeutic option for those lesions that are well differentiated and/or have a high progesterone receptor (PgR) content. However, the activity of progestins is often compromised by the down-regulation of PgR within the target tissues, and therefore therapeutic strategies designed to enhance PgR expression are warranted. Little data are currently available about the new aromatase inhibitors and selective estrogen receptor modulators. As for chemotherapy, the combination of doxorubicin [DOX]+cisplatin [CDDP] achieves overall response rates ranging from 34% to 60%, and the addition of paclitaxel (TAX) seems to improve response rates, progression-free survival and overall survival, but to worsen toxicity profile. A phase III study is currently comparing TAX+DOX+CDDP versus the less toxic combination of TAX+carboplatin. Chemotherapy is active against both endometrioid-type carcinoma and uterine serous papillary carcinoma. However, this latter endometrial malignancy is less chemosensitive than the histologically similar high-grade serous ovarian carcinoma. Interesting fields of research are represented by investigational agents directed against specific intracellular signal transduction pathways involved in the proliferation, invasiveness and metastatic spread of endometrial cancer. Mammalian target of the rapamycin (mTOR) inhibitors, epidermal growth factor receptor inhibitors (gefitinib, erlotinib, lapatinib, the monoclonal antibody cetuximab), imatinib, the monoclonal antibody trastuzumab, and the Clostridium perfrigens enterotoxin are currently under evaluation as molecularly targeted therapies for endometrial cancer. Further investigations addressed to better understand the signal transduction pathways that are disregulated in endometrial carcinogenesis could identify novel biological targets suitable for tailored therapies.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Carcinoma, Endometrioid/drug therapy
- Carcinoma, Endometrioid/metabolism
- Clinical Trials, Phase III as Topic
- Cystadenocarcinoma, Papillary/drug therapy
- Cystadenocarcinoma, Papillary/metabolism
- Drug Design
- Endometrial Neoplasms/drug therapy
- Endometrial Neoplasms/metabolism
- Female
- Gene Expression Regulation, Neoplastic/drug effects
- Humans
- Neoplasm Proteins/agonists
- Neoplasm Proteins/antagonists & inhibitors
- Neoplasm Proteins/metabolism
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/metabolism
- Neoplasms, Hormone-Dependent/drug therapy
- Neoplasms, Hormone-Dependent/metabolism
- Signal Transduction/drug effects
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Affiliation(s)
- Angiolo Gadducci
- Department of Procreative Medicine, Division of Gynecology and Obstetrics, University of Pisa, Via Roma 56, Pisa 56127, Italy.
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25413
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Abstract
PURPOSE OF REVIEW In the past decade, laparoscopic procedures have become increasingly popular owing to decreased morbidity and convalescence compared with open procedures. The purpose of this review is to evaluate recent literature on laparoscopic surgery in pregnancy and make recommendations for anesthesia based on understanding of physiology of carbon dioxide pneumoperitoneum. RECENT FINDINGS Increasing numbers of successful cases of laparoscopic surgery are being reported. For reasons unknown, the results obtained in sheep studies do not match the observations in humans. Maternal respiratory acidosis, a common finding in sheep studies during CO2 pneumoperitoneum has not been observed in pregnant women undergoing laparoscopic surgery. A recent finding of persisting fetal sheep hypoxia beyond the duration of CO2 pneumoperitoneum calls for further investigation to determine if this finding is limited to sheep akin to sheep maternal respiratory acidosis. SUMMARY Present evidence suggests laparoscopic surgery in pregnancy is a safe option. Left uterine displacement, maintaining end-tidal carbon dioxide between 32-34 mmHg and maternal blood pressures within 20% of baseline, and limiting abdominal insufflation pressure of carbon dioxide to 12-15 mmHg are essential hallmarks of anesthesia procedure. Although no apparent long time consequences have been reported, further studies are necessary to confirm the validity of sheep fetal hypoxia studies.
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Affiliation(s)
- Nollag O'Rourke
- Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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25414
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25415
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Connor VF. Contrast infusion sonography to assess microinsert placement and tubal occlusion after Essure®. Fertil Steril 2006; 85:1791-3. [PMID: 16650420 DOI: 10.1016/j.fertnstert.2005.10.075] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2005] [Revised: 10/28/2005] [Accepted: 10/28/2005] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To develop a technique for contrast infusion sonography and assess the possible use in determining microinsert placement and tubal status after Essure sterilization. DESIGN Techniques and instrumentation. SETTING Healthy women in an academic multispecialty group. PATIENT(S) Ten women desiring permanent sterilization who have recently undergone Essure hysteroscopic sterilization. INTERVENTION(S) Contrast infusion sonography, an adaptation of hysterosalpingo contrast sonography, performed at 3-23 weeks after Essure placement. MAIN OUTCOME MEASURE(S) To determine how readily tubal status and microinsert location could be assessed with this adaptation of hysterosalpingo contrast sonography. RESULT(S) All microinserts were readily identified and tubal status was assessed by identification or absence of real-time contrast agent flow. CONCLUSION(S) This technique is very promising and could represent a convenient alternative to hysterosalpingogram (HSG) 3 months after Essure placement.
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Affiliation(s)
- Viviane F Connor
- Department of Gynecology, Cleveland Clinic Florida, Weston, Florida 33331, USA.
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25416
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Vilos GA. The ABCs of a safer laparoscopic entry. J Minim Invasive Gynecol 2006; 13:249-51. [PMID: 16698536 DOI: 10.1016/j.jmig.2005.12.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2005] [Accepted: 12/27/2005] [Indexed: 11/17/2022]
Abstract
It is well known that at least 50% of laparoscopic complications occur during the initial entry into the abdomen regardless of the method used. There is evidence that most gynecologists practice the "classic" or closed laparoscopic entry. There is no evidence that the closed entry is more or less dangerous than the other existing methods of entry. Entry-related complications have been minimized by the following three steps: low initial Veres intraperitoneal pressure indicating correct placement of the Veres needle; transient high-pressure pneumoperitoneum before primary trocar/cannula insertion; and visual entry with the Ternamian cannula. Following the above steps, no entry complications have been encountered by the author in more than 3000 consecutive laparoscopies.
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Affiliation(s)
- George A Vilos
- Department of Obstetrics and Gynecology, St. Joseph's Health Care, The University of Western Ontario, London, Ontario, Canada.
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25417
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Bojahr B, Raatz D, Schonleber G, Abri C, Ohlinger R. Perioperative complication rate in 1706 patients after a standardized laparoscopic supracervical hysterectomy technique. J Minim Invasive Gynecol 2006; 13:183-9. [PMID: 16698522 DOI: 10.1016/j.jmig.2006.01.010] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2005] [Revised: 01/12/2006] [Accepted: 01/16/2006] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE The aim of the study was to determine perioperative morbidity and complication rate after a standardized technique of laparoscopic supracervical hysterectomy (LASH). DESIGN Retrospective analysis of consecutive patients (Canadian Task Force classification II-3). SETTING Private hospital. PATIENTS Seventeen hundred and six consecutive patients with symptomatic uterine myomata, dysfunctional uterine bleeding, dysmenorrhea, or chronic pelvic pain. INTERVENTION Laparoscopic supracervical hysterectomy using a unipolar hook for dissection of the body of the uterus followed by electric morcellation. MEASUREMENTS AND MAIN RESULTS The main indications for LASH were uterine myomata with dysfunctional uterine bleeding (31.1%) or without (45.4%) and therapy-resistant dysfunctional uterine bleeding (21%). The mean uterine weight was 226.4 +/- 193.9 g (95% CI 217.1-235.6), the mean duration of surgery was 91.4 +/- 33.3 minutes (95% CI 89.9-93.0), and the mean duration of hospital stay was 2.15 +/- 0.63 days (95% CI 2.12-2.18). Nine hundred two (52.9%) of the patients had a history of at least one laparotomy. In 14 patients (0.82%), a conversion to laparotomy was necessary. Of these, 11 were due to the size and immobility of the uterus, one was due to severe adhesions, and two because of intraoperative complications. In total, five (0.3%) intraoperative and 20 (1.2%) postoperative complications occurred. The mean weight of the uterus in the five patients with intraoperative complications (three bladder injuries, one ureter injury, and one severe intraoperative bleed) was 818.4 +/- 911.9 g (95% CI -313.9-1950.7). In two patients who suffered trauma to the bladder, there was a history of cesarean sections (two and three, respectively). The most common postoperative complications were bleeding from the cervix and pain caused by adhesions or postoperative infection. CONCLUSION Laparoscopic supracervical hysterectomy is a minimally invasive surgical method that should be regarded as an alternative to all other methods of total hysterectomy in benign conditions of the uterus (uterine myomata, dysfunctional uterine bleeding, uterine adenomyosis) as it is associated with a low perioperative morbidity and a rapid period of convalescence. Of special significance is that LASH can be performed on nulliparous patients, patients who have not previously had vaginal delivery, and patients who have had previous abdominal surgery.
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Affiliation(s)
- Bernd Bojahr
- Clinic for Minimally Invasive Surgery, Minimally Invasive Center, Berlin, Germany.
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25418
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Abstract
PURPOSE OF REVIEW All Pubmed-listed articles generated by the search terms 'pelvic' and 'pain' from the year 2004 (plus or minus 6 months) were examined for relevance to pain management therapeutics. An emphasis was given to clinical studies related to chronic pain disorders. RECENT FINDINGS Use of the descriptive diagnosis 'pelvic pain', traditionally limited to gynecological pains, has now been generalized to include male populations with similar symptom complexes arising from organs of reproduction and other pelvic organ systems such as the gastrointestinal tract and urological structures. Clinical studies have sought to refine or test existing 'standard' therapies for current pain groupings, and have frequently obtained frustrating results because many therapies appear to be effective in only a subset of patients. Notably, the same therapeutics appear to be effective in similar subsets of patients with other protean disorders. SUMMARY A commonality of symptoms suggests a commonality of pathophysiology, although this has not proved to be globally true. The success of therapeutic options appears to depend upon a stratification of previous pain groupings into overlapping subsets each with their effective treatment. Current studies are still defining these subsets and finding monotherapies to be inadequate for whole populations.
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Affiliation(s)
- Timothy J Ness
- Department of Anesthesiology, University of Alabama at Birmingham, BMR#2-202, 901 19th Street S, Birmingham, Alabama 35205, USA.
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25419
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Menada Valenzano M, Lijoi D, Mistrangelo E, Costantini S, Ragni N. Vaginal Ultrasonographic and Hysterosonographic Evaluation of the Low Transverse Incision after Caesarean Section: Correlation with Gynaecological Symptoms. Gynecol Obstet Invest 2006; 61:216-22. [PMID: 16479140 DOI: 10.1159/000091497] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2005] [Accepted: 01/02/2006] [Indexed: 11/19/2022]
Abstract
AIM We investigated whether there is a correlation between morphological changes of the lower uterine segment after caesarean section (CS), visualized by means of either a transvaginal sonography (TVS) or a sonohysterography (SHG), and the frequency of abnormal uterine bleedings reported by the women. METHODS By means of a random selection of our population, anamnesis, medical records, and TVS and SHG images of the lower uterine segment were collected in 217 women (116 with previous CS and 101 with previous vaginal birth), and an observational case-control study was performed. RESULTS The uterine incision was identified in almost all women after CS (102/116) using TVS. It was observed that abnormal uterine bleeding was significantly more frequent in the CS group in comparison with the group of women who delivered vaginally. A correlation between the presence of abnormal uterine bleeding and the presence of significant sonographic findings in the lower uterine transverse incision in the women after CS was found. In the CS group, TVS findings were confirmed by those obtained by SHG, and, with this technique, a triangular anechoic area at the presumed site of incision (the niche) was identified in 69 of the 116 women (59.5%). CONCLUSIONS In this study, we found a correlation between abnormal uterine bleeding and sonographic findings in women after CS. This correlation appears to be more significant in women who had CS 5-10 years ago. A significant difference exists between the CS group and the group of women who delivered vaginally for both frequency of abnormal uterine bleeding and sonographic findings.
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Affiliation(s)
- Mario Menada Valenzano
- Department of Obstetrics and Gynaecology, University of Genova, San Martino Hospital, Genova, Italy
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25420
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25421
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Gustilo-Ashby AM, Jelovsek JE, Barber MD, Yoo EH, Paraiso MFR, Walters MD. The incidence of ureteral obstruction and the value of intraoperative cystoscopy during vaginal surgery for pelvic organ prolapse. Am J Obstet Gynecol 2006; 194:1478-85. [PMID: 16647931 DOI: 10.1016/j.ajog.2006.01.064] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2005] [Revised: 11/19/2005] [Accepted: 01/13/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of the study was to determine the incidence of ureteral obstruction during vaginal surgery for pelvic organ prolapse and the accuracy and efficacy of intraoperative cystoscopy. STUDY DESIGN The study was a retrospective review of 700 consecutive patients who underwent vaginal surgery for anterior and/or apical pelvic organ prolapse with universal intraoperative cystoscopy. RESULTS Thirty-seven patients (5.3%) had no spillage of dye from 1 or both ureters intraoperatively. The false-positive and negative cystoscopy rates were 0.4% and 0.3%, respectively. Thus, the true incidence of intraoperative ureteral obstruction was 5.1%. Intraoperative cystoscopy was accurate in 99.3% of cases, with a sensitivity and specificity of 94.4% and 99.5%, respectively. Suture removal relieved ureteral obstruction in 88% of cases. Six subjects (0.9%) had true ureteral injuries. CONCLUSION Vaginal surgery for anterior and/or apical pelvic organ prolapse is associated with an intraoperative ureteral obstruction rate of 5.1%. Intraoperative cystoscopy accurately detects ureteral obstruction and allows for relief of obstruction in the majority of cases.
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Affiliation(s)
- A Marcus Gustilo-Ashby
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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25422
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Lieng M, Istre O, Busund B, Qvigstad E. Severe complications caused by retained tissue in laparoscopic supracervical hysterectomy. J Minim Invasive Gynecol 2006; 13:231-3. [PMID: 16698531 DOI: 10.1016/j.jmig.2006.01.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2005] [Revised: 01/10/2006] [Accepted: 01/15/2006] [Indexed: 11/18/2022]
Abstract
In our department, laparoscopic supracervical hysterectomy has gradually replaced hysterectomy by laparotomy in patients with a benign condition and no history of cervical dysplasia. During the last year, we experienced serious complications in two patients because of inadequate removal of the tissue in the morcellator procedure. These cases are presented and discussed in this case report.
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Affiliation(s)
- Marit Lieng
- Department of Gynecology and Obstetrics, Endoscopic Unit, Ullevaal University Hospital, Oslo, Norway.
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25423
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Stanford EJ, Mattox TF, Parsons JK, McMurphy C. Prevalence of benign microscopic hematuria among women with interstitial cystitis: Implications for evaluation of genitourinary malignancy. Urology 2006; 67:946-9. [PMID: 16635517 DOI: 10.1016/j.urology.2005.11.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2005] [Revised: 10/05/2005] [Accepted: 11/03/2005] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the prevalence of benign microscopic hematuria among a cohort of women with clinical interstitial cystitis (IC). METHODS A total of 100 women were prospectively assessed for microscopic hematuria with postvoid sterile catheterization. The evaluation for all patients included urine culture, potassium sensitivity test (PST), cystoscopy with hydrodistension under general anesthesia, and symptom assessment with the Pelvic Pain and Urgency/Frequency (PUF) questionnaire. RESULTS The mean age +/- SD was 37 +/- 15 years, with no difference noted in those with or without microscopic hematuria (P = 0.71). Microscopic hematuria was present in 24 (24%) of the 100 women. No patient had gross hematuria, positive urine culture, or cystoscopic findings suspicious for malignancy. The mean PUF score was 17 +/- 6. The PST was positive in 92 (92%) of 100 women, and 8 patients had only cystoscopic findings diagnostic of IC. The likelihood of a positive PST or positive cystoscopic findings among patients with microscopic hematuria was similar to that of patients without microscopic hematuria. The PST results correlated with the cystoscopic findings (P < 0.001). Of 36 patients with positive cystoscopic findings, 28 (78%) had a positive PST, and 28 (30%) of 92 with a positive PST had positive cystoscopy findings. CONCLUSIONS In this cohort of women with IC, the prevalence of benign microscopic hematuria was 24%. These data suggest that in women at low risk of genitourinary malignancy who have clinical IC, microscopic hematuria may be an incidental finding.
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Affiliation(s)
- E J Stanford
- Center for Advanced Pelvic Surgery, Urogynecology, and Obstetrics/Gynecology, St. Mary's/Good Samaritan Hospital, Centralia, Illinois 62801, USA.
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25424
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Belval CC, Barranger E, Dubernard G, Touboul E, Houry S, Daraï E. Peritoneal carcinomatosis after laparoscopic radical hysterectomy for early-stage cervical adenocarcinoma. Gynecol Oncol 2006; 102:580-2. [PMID: 16624387 DOI: 10.1016/j.ygyno.2006.02.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2005] [Revised: 02/28/2006] [Accepted: 02/28/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND The risk of wound metastasis after laparoscopic management of early-stage cervical cancer is well known, but there are few data on peritoneal carcinomatosis of cervical adenocarcinoma. CASE We report the first case of peritoneal carcinomatosis occurring in a woman with FIGO stage Ib1 cervical adenocarcinoma who underwent laparoscopic type III radical hysterectomy and bilateral pelvic lymphadenectomy (sentinel node procedure) followed by vaginal brachytherapy. A peritoneal recurrence was diagnosed 16 months after surgery and was treated with chemotherapy and laparotomy. CONCLUSION Laparoscopy for cervical adenocarcinoma may carry a risk of peritoneal dissemination.
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Affiliation(s)
- Camille Challan Belval
- Service de Gynécologie-Obstétrique, Hôpital Tenon, Faculté Saint-Antoine, Assistance Publique des Hôpitaux de Paris, CancerEst, Université Pierre et Marie Curie-Paris6, 4 rue de la Chine, 75020 Paris, France
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25425
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Paul PG, Koshy AK. Multiple peritoneal parasitic myomas after laparoscopic myomectomy and morcellation. Fertil Steril 2006; 85:492-3. [PMID: 16595233 DOI: 10.1016/j.fertnstert.2005.10.017] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2005] [Revised: 10/14/2005] [Accepted: 10/14/2005] [Indexed: 11/23/2022]
Abstract
We describe multiple parasitic myomas visualized on laparoscopy in a woman who had a previous laparoscopic myomectomy. Location of the myomas suggests morcellation as a contributing factor.
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Affiliation(s)
- P G Paul
- Center for Advanced Endoscopy and Infertility Treatment, Paul's Hospital, Cochin, Kerala, India
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25426
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Vilos GA, Vilos AG, Abu-Rafea B, Pron G, Kozak R, Garvin G. Administration of goserelin acetate after uterine artery embolization does not change the reduction rate and volume of uterine myomas. Fertil Steril 2006; 85:1478-83. [PMID: 16579996 DOI: 10.1016/j.fertnstert.2005.10.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2005] [Revised: 10/06/2005] [Accepted: 10/06/2005] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine if goserelin immediately after uterine artery embolization (UAE) affected myoma reduction. DESIGN Randomized pilot study (level 1). SETTING Teaching hospital. PATIENT(S) Twenty-six women. INTERVENTION(S) All patients underwent UAE, and then 12 patients received 10.8 mg of goserelin 24 hours later. The treatment group was 5 years older: 43 versus 37.7 years. Uterine and myoma volumes were measured by ultrasound 2 weeks before UAE and at 3, 6, and 12 months. MAIN OUTCOME MEASURE(S) Uterine and fibroid volumes. RESULT(S) Pretreatment uterine volume was 477 versus 556 cm3, and dominant fibroid volume was 257 versus 225 cm3 in the control versus goserelin groups. Analysis of variance measurements indicated that the change over time did not significantly differ between the two groups. By 12 months, the control group had a mean uterine volume reduction of 58%, while the goserelin group had a reduction of 45%. Dominant fibroid changes over time did not differ between the two groups. At 12 months, the mean fibroid volume had decreased by 86% and 58% in the control and goserelin groups, respectively. CONCLUSION(S) The addition of goserelin therapy to UAE did not alter the reduction rate or volume of uterine myomas.
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Affiliation(s)
- George A Vilos
- Department of Obstetrics and Gynecology, St. Joseph's Health Care, University of Western Ontario, London, Ontario, Canada
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25427
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Abstract
PURPOSE OF REVIEW The increasing rates of primary caesarean section are likely to contribute to a rise in the incidence of uterine rupture in developed countries. Uterine rupture continues to be an important cause of maternal death in less and least developed countries. Recent publications adressing the diagnosis, aetiology and management of primary caesarian section are reviewed. RECENT FINDINGS Uterine rupture is commonly associated with vaginal birth after caesarean section, although the absolute risk varies according to previous obstetric history, gestational age, and induction of labour. Quantification of risk for a range of circumstances allows informed counselling of pregnant women. Imaging techniques may improve the early detection of uterine dehiscence but in the acute setting abnormal fetal heart rate patterns provide early diagnostic information. The scale of the problem in less and least developed countries is sobering and maternal mortality can be determined by the ability to access basic obstetric care. SUMMARY Uterine rupture remains one of the most frightening complications in obstetric care. The risk of its occurrence is likely to increase for many parous women, placing the emphasis on counselling and early prediction and prevention wherever possible.
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Affiliation(s)
- Deirdre J Murphy
- Division of Maternal and Child Health Sciences, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
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25428
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DeBattista C, Belanoff J. The use of mifepristone in the treatment of neuropsychiatric disorders. Trends Endocrinol Metab 2006; 17:117-21. [PMID: 16530421 DOI: 10.1016/j.tem.2006.02.006] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2005] [Revised: 02/17/2006] [Accepted: 02/24/2006] [Indexed: 12/30/2022]
Abstract
Mifepristone is a potent glucocorticoid and progesterone receptor antagonist. The pathophysiology of a number of neuropsychiatric disorders implicates abnormalities in glucocorticoid function. These include mood disorders such as psychotic major depression and bipolar depression. In addition, cognitive disorders such as Alzheimer's disease might also be partially mediated by abnormalities in the hypothalamic-pituitary-adrenal axis. Preliminary studies suggest that mifepristone might have a role in the treatment of a number of neuropsychiatric disorders.
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Affiliation(s)
- Charles DeBattista
- Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA.
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25429
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Kehoe SM, Abu-Rustum NR. Transperitoneal laparoscopic pelvic and paraaortic lymphadenectomy in gynecologic cancers. Curr Treat Options Oncol 2006; 7:93-101. [PMID: 16455020 DOI: 10.1007/s11864-006-0044-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Laparoscopy, a minimally invasive surgery, may benefit select patients more than traditional abdominal approaches. The benefits of this procedure include low morbidity, shorter length of hospital stay, less blood loss, no significant increase in complications, and a shorter postoperative recovery period; this allows patients to begin adjuvant therapy more quickly. Laparoscopy has been used in gynecologic oncology since the early 1990s and has continued to grow and develop. Complex gynecologic oncology procedures can be performed with a low rate of complication and a low rate of conversion to laparotomy. The literature supports the fact that laparoscopy can be performed with short-term benefit with no increase in morbidity. Although the data are limited and emerging, the risk of cancer recurrence does not appear to increase because of this minimal access approach. Currently, advanced laparoscopic techniques are used to evaluate and treat cervical, endometrial, and ovarian malignancies. Specifically, transperitoneal laparoscopic lymphadenectomy including pelvic and paraaortic nodes is a feasible and efficacious procedure in the management of certain gynecologic malignancies.
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Affiliation(s)
- Siobhan M Kehoe
- Memorial Sloan-Kettering Cancer Center, Gynecology Service, Department of Surgery, 1275 York Avenue, New York, NY 10021, USA
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25430
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Vilos GA, Newton DW, Odell RC, Abu-Rafea B, Vilos AG. Characterization and mitigation of stray radiofrequency currents during monopolar resectoscopic electrosurgery. J Minim Invasive Gynecol 2006; 13:134-40. [PMID: 16527716 DOI: 10.1016/j.jmig.2005.12.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2005] [Revised: 11/23/2005] [Accepted: 12/01/2005] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE To determine patterns and range of stray radiofrequency (RF) currents flowing through the working element of monopolar resectoscopes during routine endometrial rollerball ablation or resection; and to determine whether straightforward modifications of the uterine resectoscope and the application of RF monitoring could provide a safe pathway for such currents. DESIGN Prospective in vivo measurements (Canadian Task Force classification II-1). SETTING University-affiliated teaching hospital. PATIENTS Twelve women undergoing resectoscopic surgery. INTERVENTIONS During routine resectoscopic surgery using 1.5% glycine irrigant solution, three modified 26F Storz resectoscope working elements (model 27070E) were adapted to be continuously monitored with an Encision AEM device for excessive capacitive coupling and other stray currents from insulation failure. Active electrodes used were 3 mm and 5 mm rollberballs and 8 mm-diameter cutting loops powered by ERBE or Valleylab generators at 120 W. Active and working element currents were monitored by Pearson current transformers followed by root-mean-squared detectors based on the Analog Devices AD-637 integrated circuit. Data were recorded using a Fluke 199C oscilloscope, then serially transferred to a notebook computer and analyzed using Flukeview, Excel, and Minitab software. RESULTS Typical values of working element currents ranged from 0.10 to 0.20 A. Active electrode currents were typically in the range of 0.50 to 1.10 A. Frequently, the working element current exceeded the typical values and ranged up to 0.60 A. These current surges produced a heat factor (I(2)t) of 0.45 A(2).sec in a 10-second period. CONCLUSIONS During resectoscopic electrosurgery, baseline, most likely capacitive coupled, currents were always present. In addition, high values of working element currents occurred frequently, and they surged up to 0.60 A for significant periods of time. Without the modification of the resectoscopic device, these currents have the capability of flowing through the patient's genital tract and causing burns. Since monopolar electrosurgery remains an integral part of most hysteroscopic procedures, active electrode monitoring may offer a solution in protecting the patient and the surgeon from stray electrosurgical burns.
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Affiliation(s)
- George A Vilos
- Department of Obstetrics and Gynecology, St. Joseph's Health Care, University of Western Ontario, London, Ontario, Canada
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25431
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Takeuchi H, Kitade M, Kikuchi I, Shimanuki H, Kumakiri J, Kitano T, Kinoshita K. Laparoscopic adenomyomectomy and hysteroplasty: A novel method. J Minim Invasive Gynecol 2006; 13:150-4. [PMID: 16527719 DOI: 10.1016/j.jmig.2005.12.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2005] [Revised: 12/13/2005] [Accepted: 12/19/2005] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE To evaluate a novel method of laparoscopic adenomyomectomy. DESIGN Prospective study (Canadian Task Force classification II-3). SETTING University-affiliated hospital. PATIENTS Fourteen women with adenomyosis. INTERVENTION Laparoscopic adenomyomectomy and hysteroplasty. After local injection by diluted vasopressin solution, a transverse incision was made in the adenomyotic tissue down to the endometrium, and the adenomyotic tissue was surgically removed with a monopolar needle. The normal muscle layer on the serosal membrane side was left as an upper and lower serosal flap. The flaps were overlapped and sutured to counteract the lost muscle layer to reconstruct the uterus. MEASUREMENTS AND MAIN OUTCOME: The changes of symptoms were evaluated before and after the operation. The visual analog scale of dysmenorrhea was significantly decreased, and hypermenorrhea was improved after the surgery. Postoperative pregnancy was achieved in 2 patients, and vaginal delivery was performed in the first case. CONCLUSION For specific cases, laparoscopic adenomyomectomy may be a suitable method to relieve symptoms with minimally invasive surgery while conserving the uteri.
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Affiliation(s)
- Hiroyuki Takeuchi
- Department of Obstetrics and Gynecology, Department of Pathology, Juntendo University School of Medicine, Tokyo, Japan.
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25432
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Takeda A, Manabe S, Mitsui T, Nakamura H. Spontaneous ectopic pregnancy occurring in the isthmic portion of the remnant tube after ipsilateral adnexectomy: Report of two cases. J Obstet Gynaecol Res 2006; 32:190-4. [PMID: 16594923 DOI: 10.1111/j.1447-0756.2006.00385.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Two cases of spontaneous ectopic pregnancy occurring in the isthmic portion of the remnant tube after previous ipsilateral adnexectomy are presented. Laparoscopic observation and postoperative histopathological examination suggested intrauterine transmigration of the fertilized egg as the etiology. Laparoscopic excision of the remnant tube was performed and the postoperative course was uneventful in both cases. Attention should be paid to this unusual type of ectopic pregnancy while examining patients with previous history of adnexal surgery.
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Affiliation(s)
- Akihiro Takeda
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan.
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25433
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Kueck AS, Gossner G, Burke WM, Reynolds RK. Laparoscopic technology for the treatment of endometrial cancer. Int J Gynaecol Obstet 2006; 93:176-81. [PMID: 16563396 DOI: 10.1016/j.ijgo.2006.02.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2006] [Revised: 02/15/2006] [Accepted: 02/15/2006] [Indexed: 01/02/2023]
Affiliation(s)
- A S Kueck
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Michigan, Women's Hospital, Ann Arbor, USA
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25434
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Abstract
Since the introduction of uterine artery embolization as a minimally invasive treatment option for uterine fibroids, there has been a great deal of effort made toward developing other options for these patients. These options approach the problem differently, either with direct targeting of individual fibroids, organ-wide targeting of multiple fibroids, and systemic therapy to address the problem of fibroids using a hormonal approach. This review will focus on the different techniques and different philosophies that have been applied to the treatment of fibroids during the past decade.
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Affiliation(s)
- Gary Siskin
- Department of Radiology, Albany Medical Center, Albany, NY 12208, USA.
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25435
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Glaser V. An Interview with John Erian, M.B.B.Ch., F.R.C.O.G. J Gynecol Surg 2006. [DOI: 10.1089/gyn.2006.22.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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25436
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Abstract
Diagnosis of fallopian tube pathology has been performed with X-rays, ultrasound, magnetic resonance imaging, and even nuclear medicine exams. However, fallopian tube interventions are almost exclusively the domain of fluoroscopy. Fallopian tube interventions can be divided into two categories: embolization and recanalization. The former has only recently been described using imaging guidance while the latter has been accepted as a safe and effective procedure since the early 1990s. This article will highlight the technique and results associated with fallopian tube embolization.
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Affiliation(s)
- Hugh McSwain
- Department of Neurointerventional Radiology, University of California, San Francisco, CA 94143, USA.
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25437
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Abstract
Recent years have brought dramatic advances in the clinician's ability to offer effective pharmacotherapy to patients who have interstitial cystitis. Medical treatments have been developed and applied to reduce the interstitial cystitis symptoms of pelvic pain and urinary urgency/frequency, and to address underlying causes of the disorder. In addition, advances in the understanding of the natural history of interstitial cystitis have revealed that it is insidiously progressive and the classical definition--rare, severe and difficult to treat--is in fact the relatively uncommon, advanced stage of a disorder that affects most individuals in a mild-to-moderate and readily treatable form. This recognition has led to the identification of large numbers of previously unsuspected cases of interstitial cystitis, and the successful treatment of many individuals in the early stages of interstitial cystitis when it is far more responsive to therapy. A heparinoid-based multimodal medical regimen can effectively control symptoms and address disease pathophysiology in the majority of cases. Intravesical therapeutic solutions are new and promising adjunctive therapies that can offer immediate symptom relief during symptom flares, and for patients who are just beginning medical therapy.
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Affiliation(s)
- C Lowell Parsons
- Division of Urology (8897), University of California San Diego Medical Center, San Diego, CA 92103-8897, USA.
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25438
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Marana R, Muzii L, Ferrari S, Catalano GF, Zannoni G, Marana E. Management of adnexal cystic masses with unexpected intracystic vegetations detected during laparoscopy. J Minim Invasive Gynecol 2006; 12:502-7. [PMID: 16337577 DOI: 10.1016/j.jmig.2005.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2005] [Accepted: 07/14/2005] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE To evaluate a prospective series of consecutive patients with unexpected intracystic vegetations detected during operative laparoscopy for adnexal masses. DESIGN Prospective series of consecutive patients (Canadian Task Force classification: II-2). SETTING Tertiary care university hospitals. PATIENTS Consecutive patients found during surgery to have unexpected intracystic vegetations and treated by operative laparoscopy, out of a total series of 667 patients under 40 years of age with ultrasonographic evidence of an adnexal cystic mass without thick septa, internal wall papillarities, or solid components. INTERVENTIONS Operative laparoscopy and follow-up. MEASUREMENTS AND MAIN RESULTS Thirty-five (5.2%) of 667 patients were found at surgery to have unexpected intracystic vegetations. A frozen section was sent for pathologic analysis in all 35 patients. Frozen section diagnosis was benign in 32 patients and borderline in 3 patients. Final pathology diagnosis was borderline ovarian tumor in five of the 35 patients (14.3%), and benign in 30 patients (85.7%). No case of invasive carcinoma was diagnosed either at frozen section or at final pathology examination. The patients with borderline tumors are alive with no evidence of disease after a mean follow-up of 60 months. CONCLUSIONS In the present series, with accurate preoperative selection, the rate of adnexal cysts with unexpected intracystic vegetations was 5%, of which 14% were borderline tumors. The laparoscopic management of these adnexal masses did not adversely affect the prognosis.
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Affiliation(s)
- Riccardo Marana
- Department of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Italy.
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25439
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Grund D, Köhler C, Schneider A, Marnitz S. [Role of Laparoscopy in the Treatment of Endometrial Carcinoma]. ACTA ACUST UNITED AC 2006; 46:13-24. [PMID: 16452816 DOI: 10.1159/000089973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In the treatment of endometrial carcinoma of stages I and II, laparoscopic or laparoscopically assisted vaginal hysterectomy with bilateral adnexectomy is oncologically equivalent to abdominal hysterectomy. As the pelvic and para-aortal laparoscopic lymph node dissection can now be safely carried out, it is possible to decide definitely for or against adjuvant percutaneous irradiation. The removal of metastatic lymph nodes seems to improve survival significantly.
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Affiliation(s)
- Dorothee Grund
- Klinik für Gynäkologie, Charité Universitätsmedizin Berlin, Berlin , Deutschland
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25440
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25441
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Lenglet Y, Roman H, Rabishong B, Bourdel N, Bonnin M, Bolandard F, Duband P, Pouly JL, Mage G, Canis M. [Laparoscopic management of ovarian cysts during pregnancy]. ACTA ACUST UNITED AC 2006; 34:101-6. [PMID: 16442326 DOI: 10.1016/j.gyobfe.2005.11.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2005] [Accepted: 11/21/2005] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the results of laparoscopic surgery in the management of ovarian cysts in pregnant patients. PATIENTS AND METHODS Retrospective study including 26 pregnant patients who underwent the laparoscopic management of ovarian cysts. The indications for surgery were persistent adnexal mass, abnormal ovarian cysts revealed by ultrasound examination, suspicion of cyst complications. The technique used, the immediate postoperative results and obstetrical outcomes were studied. RESULTS Twelve patients were operated during the first trimester of pregnancy, 13 in the second, and one in the third trimester. A 12 mmHg CO2 pneumoperitoneum was created, using a Veress needle in 22 cases, and an open technique in 4 cases. Trocar sites were decided according to the uterine size and to the cyst situation. A cystectomy was performed in 11 cases, an adnexectomy in 7 cases, an oophorectomy in one case, a cyst aspiration with a biopsy of the cyst wall in 6 cases and an ovarian torsion removal in one case. A conversion to laparotomy was necessary in 3 cases. There were no immediate postoperative complications and obstetrical outcomes were good in all cases. DISCUSSION AND CONCLUSION In pregnant patients, laparoscopic management of adnexal masses appears to be safe for both mother and child.
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Affiliation(s)
- Y Lenglet
- Service de Gynécologie, Obstétrique et Médecine de la Reproduction, Polyclinique Hôtel-Dieu, CHU de Clermont-Ferrand, 11, boulevard Léon-Malfreyt, 63058 Clermont-Ferrand cedex 01, France.
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25442
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Al Sarakbi W, Worku D, Escobar PF, Mokbel K. Breast papillomas: current management with a focus on a new diagnostic and therapeutic modality. INTERNATIONAL SEMINARS IN SURGICAL ONCOLOGY 2006; 3:1. [PMID: 16417642 PMCID: PMC1395317 DOI: 10.1186/1477-7800-3-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2005] [Accepted: 01/17/2006] [Indexed: 11/23/2022]
Abstract
Breast papilloma is a term that describes an intraductal papillary configuration of the mammary epithelium on macroscopic or microscopic examination. It includes solitary intraductal papillomas, multiple papillomas, papillomatosis, and juvenile papillomatosis (JP). Recent advances in mammary ductoscopy (MD) have raised new possibilities in the diagnosis and treatment of breast papillomas. This technique represents an important diagnostic adjunct in patients with pathological nipple discharge (PND) by allowing direct visualisation and biopsy of intraductal lesions and guiding duct excision surgery. Treatment of breast papillomas often entails surgical duct excision for symptomatic relief and histopathological examination. Recently, more conservative approach has been adapted. MD-assisted microdochectomy should be considered the procedure of choice for a papilloma-related single duct discharge. Furthermore, there is increasing evidence that MD has the potential to reduce the number of duct excision procedures and minimise the extent of surgical resection. Imaging-guided vacuum-assisted core biopsy can be diagnostic and therapeutic for papillomas seen on mammography and/or ultrasound. Patients with multiple papillomas do have an increased risk of developing cancer and should be kept under annual review with regular mammography (preferably digital mammography) if treated conservatively. Magnetic resonance (MR) can be also used in surveillance in view of its high sensitivity. Because the risk is small, long term and affects both breasts, long-term follow-up is more appropriate than prophylactic mastectomy. Patients who prove to have solitary duct papilloma have insufficient increase in the risk of subsequent malignancy to justify routine follow-up.
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Affiliation(s)
- W Al Sarakbi
- The Breast Care Centre, St. George's & The Princess Grace Hospitals, London, UK
| | - D Worku
- The Breast Care Centre, St. George's & The Princess Grace Hospitals, London, UK
| | - PF Escobar
- The Cleveland Clinic Foundation, OH 44195, USA
| | - K Mokbel
- The Breast Care Centre, St. George's & The Princess Grace Hospitals, London, UK
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Gil-Moreno A, Díaz-Feijoo B, Morchón S, Xercavins J. Analysis of survival after laparoscopic-assisted vaginal hysterectomy compared with the conventional abdominal approach for early-stage endometrial carcinoma: A review of the literature. J Minim Invasive Gynecol 2006; 13:26-35. [PMID: 16431320 DOI: 10.1016/j.jmig.2005.08.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2005] [Revised: 08/12/2005] [Accepted: 08/24/2005] [Indexed: 01/02/2023]
Abstract
STUDY OBJECTIVE To assess potential differences in perioperative features and survival between laparoscopic-assisted vaginal hysterectomy and conventional transabdominal hysterectomy in stage I endometrial cancer. DESIGN Retrospective, nonrandomized clinical study (Canadian Task Force classification II-2). SETTING Acute-care, teaching hospital. PATIENTS A total of 370 patients undergoing hysterectomy and bilateral salpingo-oophorectomy with surgical staging for primary treatment for clinical stage I endometrial cancer from January 1995 through June 2001. INTERVENTION Clinical outcomes and survival in patients treated with laparoscopic-assisted vaginal hysterectomy (n = 55) and hysterectomy using the conventional abdominal approach (n = 315) were compared. MEASUREMENTS AND MAIN RESULTS Baseline characteristics and histopathologic variables were similar in both groups. A total of 91.4% of patients underwent pelvic lymphadenectomy and 49.7% paraaortic lymphadenectomy. The median follow-up was 38.1 months. Blood loss, blood transfusions required, and length of stay were significantly lower in the laparoscopic group, but surgical time was significantly longer. The mean number of pelvic and aortic nodes recovered was higher in the laparoscopic group (p < .001). Differences in overall and recurrence-free survival rates were not observed. CONCLUSION Surgical staging of early-stage endometrial cancer by laparoscopic-assisted vaginal hysterectomy is feasible, with lower perioperative morbidity and shorter hospital stay compared with transabdominal hysterectomy. Prognosis and survival were not affected by the laparoscopic vaginal approach to hysterectomy.
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Affiliation(s)
- Antonio Gil-Moreno
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Materno-infantil Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
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Munro MG. Management of leiomyomas: is there a panacea in Pandora’s box? Fertil Steril 2006; 85:40-3; discussion 48-50. [PMID: 16412724 DOI: 10.1016/j.fertnstert.2005.07.1298] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2005] [Revised: 07/15/2005] [Accepted: 07/15/2005] [Indexed: 11/18/2022]
Abstract
New procedures and medications continue to be developed for the treatment of women with uterine leiomyomas; however, most are not adequately evaluated, and none is applicable in all circumstances. Appropriate management of uterine leiomyomas should be individualized, considering the related symptoms, as well as the number, size, and location of the tumors and the patient's desire regarding uterine conservation.
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Affiliation(s)
- Malcolm G Munro
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, California 90027, USA.
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25445
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Colomb S, Bonnin M, Bolandard F, Lenglet Y, Duband P, Roman H, Canis M, Bazin JE. Prise en charge anesthésique de la femme enceinte pour cœliochirurgie gynécologique non obstétricale à la maternité de Clermont-Ferrand. ACTA ACUST UNITED AC 2006; 25:11-6. [PMID: 16256295 DOI: 10.1016/j.annfar.2005.08.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2005] [Accepted: 08/23/2005] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the anaesthetic management intended for pregnant women in the field of non obstetric and gynaecologic laparoscopic surgery. STUDY DESIGN Retrospective and monocentric investigation. PATIENTS AND METHODS Analysis of the anaesthetic and obstetric files from 27 pregnant women operated on in the establishment, between January 2001 and July 2004. RESULTS 27 female patients involved in the study. The mean pregnancy term was 15 weeks when laparoscopic surgery was performed, though a single patient was at 30 weeks. The average duration of the surgery was 61 minutes, of which 28 minutes were dedicated to pneumoperitoneum. Twenty-four patients underwent general anaesthesia, the three others underwent locoregional anaesthesia. During the perioperative period no surgical, anaesthetic or obstetric complications were observed. CONCLUSION Laparoscopic surgery during pregnancy requires double skilled management, both in anaesthesiology and obstetrics. On haemodynamics and breathing, pneumoperitoneum does not induce any additional effects when compared to operations without pregnancy. Except with delivery cases, anaesthetic support in laparoscopic surgery intended for pregnant women eventually does not generate any specific problems, but requires the same rigorous management as the one usually following surgery for pregnant patients.
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Affiliation(s)
- S Colomb
- Département d'anesthésie-réanimation, polyclinique, Hôtel-Dieu, CHU de Clermont-Ferrand, 63001 Clermont-Ferrand, France
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25446
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Loto OM, Adesoji RO, Adebayo OJ. Minilaparotomy and chromopertubation as an alternative to laparoscopy. Int J Gynaecol Obstet 2005; 92:161-2. [PMID: 16364327 DOI: 10.1016/j.ijgo.2005.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2005] [Revised: 10/07/2005] [Accepted: 10/15/2005] [Indexed: 11/17/2022]
Affiliation(s)
- O M Loto
- Department of Obstetrics and Gynecology, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria.
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25447
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25448
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2005. [DOI: 10.1002/pds.1034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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25449
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Current World Literature. Curr Opin Obstet Gynecol 2005. [DOI: 10.1097/01.gco.0000194327.87451.dd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25450
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Wenger JM, Spinosa JP, Roche B, Dubuisson JB. An Efficient and Safe Procedure for Laparoscopic Supracervical Hysterectomy. J Gynecol Surg 2005. [DOI: 10.1089/gyn.2005.21.155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jean-Marie Wenger
- Department of Gynecology, Nouvelle Clinique Vert-Pré, Geneva, Switzerland
- Department of Obstetrics and Gynecology, University Hospital of Geneva, Switzerland
| | - J.-Pierre Spinosa
- Department of Obstetrics and Gynecology, University Hospital of Geneva, Switzerland
| | - Bruno Roche
- Proctology Unit, University Hospital of Geneva, Switzerland
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