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Quintana-Bertó R, Padilla-Iserte P, Lago V, Tauste C, Díaz-Feijoo B, Cabrera S, Oliver-Pérez R, Coronado PJ, Martín-Salamanca MB, Pantoja-Garrido M, Marcos-Sanmartin J, Cazorla E, Lorenzo C, Rodríguez-Hernández JR, Roldán-Rivas F, Gilabert-Estellés J, Muruzábal JC, Cañada A, Domingo S. Endometrial cancer: predictors and oncological safety of tumor tissue manipulation. Clin Transl Oncol 2024; 26:1098-1105. [PMID: 37668932 DOI: 10.1007/s12094-023-03310-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/11/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE The main goal of this study is to assess the impact of tumor manipulation on the presence of lympho-vascular space invasion and its influence on oncological results. METHODS We performed a retrospective multi-centric study amongst patients who had received primary surgical treatment for apparently early-stage endometrial cancer. A multivariate statistical analysis model was designed to assess the impact that tumor manipulation (with the use of uterine manipulator or preoperative hysteroscopy) has on lympho-vascular development (LVSI) in the final surgical specimen. RESULTS A total of 2852 women from 15 centers were included and divided into two groups based on the lympho-vascular status in the final surgical specimen: 2265 (79.4%) had no LVSI and 587 (20.6%) presented LVSI. The use of uterine manipulator was associated with higher chances of lympho-vascular involvement regardless of the type used: Balloon manipulator (HR: 95% CI 4.64 (2.99-7.33); p < 0.001) and No-Balloon manipulator ([HR]: 95% CI 2.54 (1.66-3.96); p < 0.001). There is no evidence of an association between the use of preoperative hysteroscopy and higher chances of lympho-vascular involvement (HR: 95% CI 0.90 (0.68-1.19); p = 0.479). CONCLUSION Whilst performing common gynecological procedures, iatrogenic distention and manipulation of the uterine cavity are produced. Our study suggests that the use of uterine manipulator increases the rate of LVSI and, therefore, leads to poorer oncological results. Conversely, preoperative hysteroscopy does not show higher rates of LVSI involvement in the final surgical specimen and can be safely used.
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Affiliation(s)
- Raquel Quintana-Bertó
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, València, Spain.
| | - Pablo Padilla-Iserte
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, València, Spain
| | - Víctor Lago
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, València, Spain
| | - Carmen Tauste
- Department of Gynecologic Oncology, Complejo Hospitalario de Navarra, Navarra, Spain
| | - Berta Díaz-Feijoo
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Silvia Cabrera
- Gynecologic Oncology Unit, Gynecology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Reyes Oliver-Pérez
- Gynecologic Oncology-Unit, Department of Obstetrics and Gynecology, University Hospital 12 de Octubre, 12 de Octubre Research Institute, Complutense University of Madrid, Madrid, Spain
| | - Pluvio J Coronado
- Women's Health Institute of the Hospital Clínico San Carlos, IdISSC, University Complutense, Madrid, Spain
| | | | - Manuel Pantoja-Garrido
- Department of Gynecology and Obstetrics, University Hospital Virgen Macarena, Sevilla, Spain
| | - Josefa Marcos-Sanmartin
- Department of Obstetrics and Gynecology, Dr. Balmis General University Hospital, Alicante, Spain
- Department of Public Health, Miguel Hernández University, Sant Joan d'Alacant, Alicante, Spain
- Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Eduardo Cazorla
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrevieja, Alicante, Spain
| | - Cristina Lorenzo
- Department of Obstetrics and Gynecology, Hospital Nuestra Señora de La Calendaria, Santa Cruz de Tenerife, Spain
| | | | - Fernando Roldán-Rivas
- Department of Obstetrics and Gynaecology, Clinico Lozano Blesa Hospital, Zaragoza, Spain
| | - Juan Gilabert-Estellés
- Department of Obstetrics and Gynecology, University General Hospital of València, València, Spain
| | - Juan Carlos Muruzábal
- Department of Gynecologic Oncology, Complejo Hospitalario de Navarra, Navarra, Spain
| | - Antonio Cañada
- Department of Biostatistics, Health Research Institute La Fe, València, Spain
| | - Santiago Domingo
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, València, Spain
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Uwais A, Al-Abadleh A, Jahameh M, Satari A, Al-Hawamdeh Q, Haddadin S. A Comparison between Total Abdominal Hysterectomy versus Total Laparoscopic Hysterectomy. Gynecol Minim Invasive Ther 2024; 13:43-47. [PMID: 38487613 PMCID: PMC10936723 DOI: 10.4103/gmit.gmit_72_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 03/17/2024] Open
Abstract
Objectives To compare the operative and postoperative outcomes of total laparoscopic hysterectomy (TLH) and total abdominal hysterectomy (TAH). Materials and Methods In this retrospective comparative study, we reviewed all hysterectomies performed in the Al-Karak Governmental Hospital in Al-Karak, Jordan, from September 2018 to July 2022. We enrolled 129 patients who underwent hysterectomy. The patients were divided into the TLH (n = 39) and TAH (n = 90) groups. Patient data were accessed through hospital records and analyzed using SPSS 25.0. Results The most common indication for TLH was uterine fibroid, and that for TAH was abnormal uterine bleeding, although the specimen weights were comparable. There was no significant between-group difference in the patient's demographics. Although the TLH group had longer operative time, the hospital stay was shorter and there were no reported cases of wound infection. The estimated blood loss was significantly lower in the TLH group than in the TAH group, but there was no difference between the two groups in terms of blood transfusion requirement and postoperative hemoglobin level. Conclusion TLH and TAH had comparable overall outcomes in the Al-Karak Governmental Hospital. However, TLH was superior to TAH in terms of blood loss, and patients with TLH recovered faster without postoperative wound infection.
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Affiliation(s)
- Ala Uwais
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mutah University, Al-Karak, Jordan
| | - Ahmed Al-Abadleh
- Department of Clinical Sciences, Faculty of Medicine, Mutah University, Al-Karak, Jordan
| | - Mohammad Jahameh
- Department of Clinical Sciences, Faculty of Medicine, Mutah University, Al-Karak, Jordan
| | - Anas Satari
- Department of Clinical Sciences, Faculty of Medicine, Mutah University, Al-Karak, Jordan
| | - Qabas Al-Hawamdeh
- Department of Clinical Sciences, Faculty of Medicine, Mutah University, Al-Karak, Jordan
| | - Sahel Haddadin
- Department of General Surgery, King Hussein Medical Hospital, Royal Medical Services, Amman, Jordan
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Zhou X, Liang D, Li Q, Zhao L, Bin Y, Ma F, Wu R, Lv Y, Li Q. The sealing effect of magnetic-sealing uterine manipulator in isolated uterus from patients with early-stage cervical cancer: a pre-clinical study. J Gynecol Oncol 2023; 34:e78. [PMID: 37477101 PMCID: PMC10627758 DOI: 10.3802/jgo.2023.34.e78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 06/11/2023] [Accepted: 06/24/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVE Traditional uterine manipulator is considered as the main reason for short survival of patients with early-stage cervical cancer during minimally invasive surgery. This study aims to assess the sealing effect of magnetic-sealing uterine manipulators (MUMs) in isolated uteruses. METHODS The study was performed on isolated uterus from patients with early-stage cervical cancer who underwent open abdominal radical hysterectomy between November 2019 to April 2021. Right-angle forceps closure tests (groups 1 and 3) were defined as control tests. One experimental MUM closure test (group 2) and 2 control tests were respectively carried out in each of the isolated uterus. DNA ploidy analysis system was used to observe exfoliated cells. Statistical analysis was performed using Wilcoxon signed-rank test to assess the sealing effect of MUM. RESULTS We identified 36 patients. No regional node metastasis was discovered and only one tumor was larger than 4.0 cm in diameter. The mean of exfoliated tumor cells in groups 1, 2, and 3 were 1, 1, and 2, respectively. There was no significant difference in the quantity of exfoliated cells between groups 1 and 3 (p=0.476), so the results of the 2 groups were merged. Subsequently, a significant difference was observed between combined right-angle forceps closure tests and MUM closure tests (p=0.022). CONCLUSION The sealing effect of MUM was better than that of right-angle forceps. MUM can effectively seal cervical cancer cells in the cup cover, avoiding the dissemination of tumor cells. TRIAL REGISTRATION Chinese Clinical Trial Register Identifier: ChiCTR1900026012.
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Affiliation(s)
- Xue Zhou
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Dongxin Liang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qing Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Department of Obstetrics and Gynecology, Northwest Women's and Children's Hospital, Xi'an, China
| | - Lanbo Zhao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yadi Bin
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Feng Ma
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Shaanxi Provincial Key Laboratory of Magnetic Medicine, Xi'an, China
| | - Rongqian Wu
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Shaanxi Provincial Key Laboratory of Magnetic Medicine, Xi'an, China
| | - Yi Lv
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Shaanxi Provincial Key Laboratory of Magnetic Medicine, Xi'an, China.
| | - Qiling Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Shaanxi Provincial Key Laboratory of Magnetic Medicine, Xi'an, China.
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Sallée C, Lacorre A, Despoux F, Mbou VB, Margueritte F, Gauthier T. Use of uterine manipulator and uterine perforation in minimally invasive endometrial cancer surgery. J Gynecol Obstet Hum Reprod 2023; 52:102621. [PMID: 37301478 DOI: 10.1016/j.jogoh.2023.102621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/02/2023] [Accepted: 06/07/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Safety of the uterine manipulator (UM) within endometrial cancer (EC) surgery is being questioned. Its use might be one of the issues for potential tumor dissemination during the procedure, especially in the case of uterine perforation (UP). No prospective data on this surgical complication, nor on the oncological consequences exist. The aim of this study was to assess the rate of UP while using UM when performing surgery for EC and the impact of UP on the choice of adjuvant treatment. METHODS We conducted a prospective single-center cohort study from November 2018 to February 2022, considering all EC cases surgically treated by a minimally invasive approach with the help of a UM. Demographic, preoperative, postoperative and adjuvant treatment corresponding to the included patients were collected and comparatively analyzed according to the absence or presence of a UP. RESULTS Of the 82 patients included in the study, 9 UPs (11%) occurred during surgery. There was no significant difference in demographics and disease characteristics at diagnosis that may have induced UP. The type of UM used or the approach (laparoscopic vs. robotic) did not influence the occurrence of UP (p = 0.44). No positive peritoneal cytology was found post hysterectomy. There was a statistically significantly higher rate of lymph-vascular space invasion within the perforation group, 67% vs. 25% in the no perforation group, p = 0.02. Two out of nine (22%) adjuvant therapies were changed because of UP. The median follow-up time for patients was 7.6 months (range 0.5-33.1 months). No recurrence was found in the UP group. CONCLUSION Our study found a uterine perforation rate of 11%. This information needs to be further integrated to consider the usefulness of MU for EC surgery.
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Affiliation(s)
- C Sallée
- Department of Gynecology and Obstetrics, CHU Limoges, 8 Avenue Dominique Larrey, Cedex, Limoges 87042, France.
| | - A Lacorre
- Department of Gynecology and Obstetrics, CHU Limoges, 8 Avenue Dominique Larrey, Cedex, Limoges 87042, France
| | - F Despoux
- Department of Gynecology and Obstetrics, CHU Limoges, 8 Avenue Dominique Larrey, Cedex, Limoges 87042, France
| | - V B Mbou
- Department of Anatomopathology, CHU Limoges, 8 avenue Dominique Larrey, Cedex, Limoges 87042, France
| | - F Margueritte
- Department of Gynecology and Obstetrics, CHI Poissy, 10 rue du Champ Gaillard, Poissy 78300, France
| | - T Gauthier
- Department of Gynecology and Obstetrics, CHU Limoges, 8 Avenue Dominique Larrey, Cedex, Limoges 87042, France
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Khalife T, Dewitt JJ, Brien AL. Pre-post pilot study: investigating the role of rectovaginal contamination in laparoscopic hysterectomy-related infectious morbidity. AJOG GLOBAL REPORTS 2023; 3:100258. [PMID: 37645644 PMCID: PMC10461244 DOI: 10.1016/j.xagr.2023.100258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Affiliation(s)
- Tarek Khalife
- Mayo Clinic Health System, 1025 Marsh St., Mankato, MN 56001
| | - Jason J. Dewitt
- Mayo Clinic Health System, 1025 Marsh St., Mankato, MN 56001
| | - Amy L. Brien
- Mayo Clinic Health System, 1025 Marsh St., Mankato, MN 56001
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Clinical Relevance of Uterine Manipulation on Oncologic Outcome in Robot-Assisted versus Open Surgery in the Management of Endometrial Cancer. J Clin Med 2023; 12:jcm12051950. [PMID: 36902743 PMCID: PMC10004409 DOI: 10.3390/jcm12051950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/10/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023] Open
Abstract
In this study, we investigated the impact of uterine manipulation on endometrial cancer survival outcomes. We analyzed patients with endometrial cancer who underwent robot-assisted staging and open staging surgery between 2010 and 2020. Either uterine manipulators or vaginal tubes were utilized in robot-assisted staging. Propensity score matching was performed to correct baseline characteristics. Progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier curve analysis. In total, 574 patients, including those undergoing robot-assisted staging with a uterine manipulator (n = 213) or vaginal tube (n = 147) and staging laparotomy (n = 214), were analyzed. Propensity score matching was performed for age, histology, and stage as covariates. Before matching, Kaplan-Meier curve analysis showed that PFS and OS were significantly different among the three groups (p < 0.001 and p = 0.009, respectively). In the propensity-matched cohorts of 147 women, the previously suggested differences in PFS and OS were not observed in patients undergoing robot-assisted staging with a uterine manipulator or vaginal tube or open surgery. In conclusion, robotic surgery using a uterine manipulator or vaginal tube did not compromise survival outcomes in endometrial cancer management.
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Urologic Complication after Laparoscopic Hysterectomy in Gynecology Oncology: A Single-Center Analysis and Narrative Review of the Literature. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121869. [PMID: 36557071 PMCID: PMC9782160 DOI: 10.3390/medicina58121869] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
Background and Objectives: Minimally invasive surgery (MIS) has recently increased its application in the treatment of gynecological malignancies. Despite technological and surgical advances, urologic complications (UC) are still the main concern in gynecology surgery. Current literature reports a wide range of urinary tract injuries, and consistent scientific evidence is still lacking or dated. This study aims to report a large single-center experience of urinary complications during laparoscopic hysterectomy for gynecologic oncologic disease. Materials and Methods: All patients who underwent laparoscopic hysterectomy for gynecologic malignancy at the Department of Medicine and Surgery of the University Hospital of Parma from 2017 to 2021 were retrospectively included. Women with endometrial cancer, cervical cancer, ovarian cancer, uterine sarcoma, or borderline ovarian tumors were included. Patients undergoing robotic surgery with incomplete anatomopathological data or patients lost during follow-up were excluded from the analysis. Intraoperative and postoperative UC were analyzed and ranked according to the Clavien-Dindo classification. Results: Two hundred-sixty patients were included in the study: 180 endometrial cancer, 18 cervical cancer, nine ovarian cancer, two uterine sarcomas, and 60 borderline ovarian tumors. Nine (3.5%) UCs were reported (five intraoperative and four postoperative complications). No anamnestic variables showed a statistical correlation with the surgical complication in the univariable analyses. C1 radical hysterectomy, a higher FIGO stage, and postoperative adjuvant treatment (p-value = 0.001, p-value = 0.046, and p-value = 0.046, respectively) were independent risk factors associated with the occurrence of UC. Conclusions: The urological complication rates in patients with oncological disease are relatively rare events in the expert hands of dedicated surgeons. Radical hysterectomy, FIGO stage, and adjuvant treatment are independent factors associated with urinary complications.
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Siegenthaler F, Johann S, Imboden S, Samartzis N, Ledermann-Liu H, Sarlos D, Eberhard M, Mueller MD. Prospective Multicenter Trial Assessing the Impact of Positive Peritoneal Cytology Conversion on Oncological Outcome in Patients with Endometrial Cancer Undergoing Minimally Invasive Surgery with the use of an Intrauterine Manipulator : Positive Peritoneal Cytology Conversion and Its Association with Oncological Outcome in Endometrial Cancer. Ann Surg Oncol 2022; 29:8320-8333. [PMID: 36057902 PMCID: PMC9640429 DOI: 10.1245/s10434-022-12356-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 07/20/2022] [Indexed: 12/16/2023]
Abstract
BACKGROUND Minimally invasive surgery is the standard approach in early-stage endometrial cancer according to evidence showing no compromise in oncological outcomes, but lower morbidity compared with open surgery. However, there are limited data available on the oncological safety of the use of intrauterine manipulators in endometrial cancer. PATIENTS AND METHODS This prospective multicenter study included patients with endometrial cancer undergoing laparoscopic staging surgery with the use of an intrauterine manipulator. We obtained three different sets of peritoneal washings: at the beginning of the surgical procedure, after the insertion of the intrauterine manipulator, and after the closure of the vaginal vault. The rate of positive peritoneal cytology conversion and its association with oncological outcomes was assessed. RESULTS A total of 124 patients were included. Peritoneal cytology was negative in 98 (group 1) and positive in 26 (group 2) patients. In group 2, 16 patients presented with positive cytology at the beginning of the surgery (group 2a) and 10 patients had positive cytology conversion during the procedure (group 2b). Recurrence rate was significantly different among the study groups, amounting to 9.2%, 25.0%, and 60.0% for groups 1, 2a, and 2b, respectively (p < 0.001). Group 1 showed the best recurrence-free and overall survival, followed by group 2a, while patients in group 2b had the worst oncological outcomes (p = 0.002 and p = 0.053, respectively). Peritoneal cytology was an independent predictor of recurrence and death on multivariable analysis. CONCLUSION A total of 8.1% of patients with endometrial cancer undergoing minimally invasive surgery with intrauterine manipulation showed positive peritoneal cytology conversion associated with significantly worse oncological outcome.
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Affiliation(s)
- Franziska Siegenthaler
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Bern, Switzerland.
| | - Silke Johann
- Department of Obstetrics and Gynecology Spitalzentrum Oberwallis, Standort Visp, Visp, Switzerland
| | - Sara Imboden
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Nicolas Samartzis
- Department of Gynecology and Obstetrics, Canton Hospital Schaffhausen, Schaffhausen, Switzerland
| | - Haiyan Ledermann-Liu
- Department of Obstetrics and Gynecology, Canton Hospital Aarau, Aarau, Switzerland
| | - Dimitri Sarlos
- Department of Obstetrics and Gynecology, Canton Hospital Aarau, Aarau, Switzerland
| | - Markus Eberhard
- Department of Gynecology and Obstetrics, Canton Hospital Schaffhausen, Schaffhausen, Switzerland
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Bern, Switzerland
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Han L, Shi G, Ruan J. A modified cup-type uterine manipulator. Asian J Surg 2022; 45:1933-1934. [PMID: 35440386 DOI: 10.1016/j.asjsur.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/07/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Ling Han
- Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China
| | - Gang Shi
- Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China
| | - Jiaying Ruan
- Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China.
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Camille S, Aymeline L, France D, Lobna O, Cyrille H, Martin K, Jean-Marc C, Frédéric G, François M, Emilie R, Tristan G. Use of uterine manipulator in endometrial cancer: A French survey from Francogyn group. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:1395-1399. [DOI: 10.1016/j.ejso.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/22/2022] [Accepted: 02/03/2022] [Indexed: 11/26/2022]
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Ultrasound Imaging of Acquired Myometrial Pseudoaneurysm: The Role of Manipulators as an Unusual Cause during Laparoscopic Surgery. Diagnostics (Basel) 2022; 12:diagnostics12010164. [PMID: 35054332 PMCID: PMC8774433 DOI: 10.3390/diagnostics12010164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/07/2022] [Accepted: 01/07/2022] [Indexed: 11/17/2022] Open
Abstract
An acquired uterine artery myometrial pseudoaneurysm can occur due to inflammation, trauma, or iatrogenic causes, such as surgical procedures, and can lead to profuse bleeding. The efficacy of uterine manipulators in gynecological surgery, particularly as a cause of a pseudoaneurysm, has been poorly discussed in the literature. In this paper, we discuss a case of a 39-year-old woman with profuse uterine bleeding that occurred seven days after operative laparoscopic surgery for endometriosis. The color Doppler ultrasound better evoked the arterial-like turbulent blood flow inside this cavity. These sonographic features were highly suggestive of uterine artery pseudoaneurysm, presumably related to a secondary trauma caused by the manipulator. The diagnosis was subsequently re-confirmed by angiography, and the patient was treated conservatively with uterine artery embolization. Ultrasound has been shown to be a valuable and safe tool for imaging pseudoaneurysm and guiding subsequent interventional procedures. Accordingly, we briefly review the most suitable manipulators used in benign gynecological surgeries to verify if the different types in use can guide the surgeon towards the correct choice according to surgical needs and thus prevent potentially dangerous trauma.
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12
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Ravlo M, Moen MH, Bukholm IRK, Lieng M, Vanky E. Ureteric injuries during hysterectomy-A Norwegian retrospective study of occurrence and claims for compensation over an 11-year period. Acta Obstet Gynecol Scand 2021; 101:68-76. [PMID: 34766333 DOI: 10.1111/aogs.14293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Ureteric injury is a rare but serious, iatrogenic complication of hysterectomy. The risk depends on indication for surgery, predisposing risk factors, and peroperative conditions. Our aims were to evaluate and learn from compensation claims to The Norwegian System of Patient Injury Compensation (NPE) for ureteric injury occurring during hysterectomies to predict risk factors, time of identification, symptoms, and consequences, and to relate these cases to injuries registered in The Norwegian Patient Registry. MATERIAL AND METHODS A retrospective study of ureteric injuries occurring during hysterectomies, reported to NPE and the Norwegian Patient Registry from 2009 through 2019. RESULTS During the study period, 53 096 hysterectomies were registered in The Norwegian Patient Registry, of which ureteric injury was documented in 643 (1.2%). More ureteric injuries were registered in large hospital trusts than in small trusts (1.3% vs. 0.7%, p < 0.05). NPE received 69 claims due to ureteric injury occurring during hysterectomy, comprising 11% of all injuries in the study period. Compensation was approved for 15%. Women who claimed compensation were younger (48.1 ± 8.9 years vs. 55.1 ± 13.6 years, p < 0.01), more likely to have had a benign diagnosis (89.9% vs. 52.1%, p < 0.01), and more likely to have had the ureteric injury recognized after discharge (58.0% vs. 33.0%, p < 0.001) compared with non-complainants. Identification of the ureters during the hysterectomy was documented in 30% of the NPE patient files. Additional information for the NPE cases included the following. The most common symptoms of unidentified injury were pain (77%), fever (12%), urinary leakage (13%), and anuria (8%). Re-operation was necessary in 77% of the cases, and 10% of the women lost one kidney. Long-term consequences after repair, such as loss of a kidney or persistent pain, were seen in 17%. No women died because of the injury. CONCLUSIONS The incidence of ureteric injury occurring during hysterectomy in Norway was 1.2%; 11% involved a claim for compensation, and 15% of these had their case approved. Most ureteric injuries were not recognized during the hysterectomy. Documentation of peroperative identification of the ureters during hysterectomy was often missing. Vigilance to pain as a postoperative symptom of peroperative unrecognized ureteric injury may result in earlier diagnosis and treatment.
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Affiliation(s)
- Merethe Ravlo
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Obstetrics and Gynecology, St. Olav's Hospital, University Hospital of Trondheim, Norway
| | - Mette Haase Moen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Marit Lieng
- Division of Gynecology and Obstetrics, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Eszter Vanky
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Obstetrics and Gynecology, St. Olav's Hospital, University Hospital of Trondheim, Norway
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13
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Yavuzcan A, Altıntaş R, Yıldız G, Başbuğ A, Baştan M, Çağlar M. Does Uterine Manipulator Type Affect Surgical Outcomes of Laparoscopic Hysterectomy? Gynecol Minim Invasive Ther 2021; 10:19-24. [PMID: 33747768 PMCID: PMC7968609 DOI: 10.4103/gmit.gmit_65_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/13/2020] [Accepted: 08/11/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives: Many surgeons use uterine manipulator (UM) during laparoscopic hysterectomy (LH). In this study, we aimed to compare the outcomes of LH operations performed by using partially reusable UM with the articulated system (artUM) and disposable (dUM) UM without articulation. Materials and Methods: A total of 99 patients underwent the LH operation. This study was carried out with 35 of those 99 Caucasian patients who met the inclusion criteria. Group 1 consisted for 7 LH operations using the articulated RUMI® II/KOH-Efficient™ (Cooper Surgical, Trumbull, CT, USA) system (artUM), while Group II consisted of 28 patients using old-type V Care®(ConMed Endosurgery, Utica, New York, USA) dUM as UM. Results: Mean operation time was found to be 157.1 ± 42.0 min. The operation time was found statistically longer in Group 1, consisted of artUM used patients (P = 0.006 and P < 0.05). No statistically significant difference was found between two groups in terms of surgical results such as, delta hemoglobin value (P = 0.483 and P < 0.05), length of hospital stay (P = 0.138 and P < 0.05), and postoperative maximum body temperature (P = 0.724 and P < 0.05). Conclusion: The UM type did not alter the surgical outcomes except the operating time in our study. According to our results, the surgical technique is a more significant variable than instruments used in LH for normal size uterus. Further prospective, large-scale studies comparing various UM systems are mandatory.
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Affiliation(s)
- Ali Yavuzcan
- Department of Obstetrics and Gynecology, School of Medicine, Duzce University, Duzce, Turkey
| | - Raşit Altıntaş
- Urology Clinic, Burdur Bucak State Hospital, Burdur, Turkey
| | - Gazi Yıldız
- Department of Obstetrics and Gynecology, Istanbul Kartal Training and Research Hospital, Istanbul, Turkey
| | - Alper Başbuğ
- Department of Obstetrics and Gynecology, School of Medicine, Duzce University, Duzce, Turkey
| | - Merve Baştan
- Department of Obstetrics and Gynecology, School of Medicine, Sakarya University, Sakarya, Turkey
| | - Mete Çağlar
- Department of Obstetrics and Gynecology, School of Medicine, Akdeniz University, Antalya, Turkey
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14
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Capozzi VA, Rosati A, Uccella S, Riemma G, Tarascio M, Torella M, De Franciscis P, Colacurci N, Cianci S. Role of uterine manipulator during laparoscopic endometrial cancer treatment. Transl Cancer Res 2020; 9:7759-7766. [PMID: 35117378 PMCID: PMC8799210 DOI: 10.21037/tcr-20-2094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/06/2020] [Indexed: 01/22/2023]
Abstract
Endometrial cancer (EC) is the most frequent gynecologic malignancy with 61,000 new cases diagnosed per year in the USA. Gynecologic Oncology Group (GOG) LAP2 randomized study demonstrated a superimposable 5-year overall survival between laparotomic and laparoscopic approaches in EC treatment. In this context the uterine manipulator (UM) represents a valuable tool in order to increase the ergonomics of surgical gesture during a laparoscopic total hysterectomy. Despite the proven safety of the minimally invasive approach in EC treatment, neither the indication whether to use or not, nor the recommendation concerning a specific type of UM are provided by international guidelines. This narrative review aims to collect all the main findings in the literature about UM use to investigate its safety in EC patients. Based on the analysis of the literature research, the main results were categorized into two manipulator-related problems: the iatrogenic LVSI, and the retrograde tumor spillage. LVSI is defined as the presence of tumor cells within an endothelium-lined space. An electronic search was performed using the following keywords: 'uterine manipulator', and 'endometrial cancer'. The electronic database search provided a total of 93 studies. Of whom, 12 case reports, 5 studies not in English language, and 65 works not fitting the review scope were excluded from the analysis. Eleven studies were considered eligible for the purpose of the study. The most recent studies have highlighted the safety of the uterine manipulator in the early-stage EC laparoscopic treatment. All types of manipulators are considered to be fairly safe but its application should be tailored according to tumor dimension and grade of myometrial infiltration.
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Affiliation(s)
| | - Andrea Rosati
- Unità Operativa Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Univeristario A. Gemelli, IRCCS, Rome, Italy
| | - Stefano Uccella
- Nuovo Ospedale degli Infermi Dipartimento di Oncologia di Biella, Ponderano, Italy
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mattia Tarascio
- Azienda Sanitaria Provinciale di Catania- via S. Maria La Grande, Catania, Italy
| | - Marco Torella
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Stefano Cianci
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
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15
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Watanabe T, Mori M, Shimizu T, Yamamoto Y, Tei E, Hirakawa H, Ohno M, Tahara K, Tomonaga K, Ogawa K, Takezoe T, Fuchimoto Y, Fujino A, Kanamori Y. Intraluminal manipulator-assisted laparoscopic surgery for Hirschsprung disease. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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