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Robot-assisted laparoscopic repair of cesarean scar defect: a systematic review of clinical evidence. J Robot Surg 2022; 17:745-751. [DOI: 10.1007/s11701-022-01502-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 11/21/2022] [Indexed: 11/28/2022]
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2
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Truong MD, Tholemeier LN. Role of Robotic Surgery in Benign Gynecology. Obstet Gynecol Clin North Am 2022; 49:273-286. [DOI: 10.1016/j.ogc.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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3
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An updated guide to the diagnosis and management of cesarean scar pregnancies. Curr Opin Obstet Gynecol 2021; 32:255-262. [PMID: 32618745 DOI: 10.1097/gco.0000000000000644] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW To review the current literature on the diagnosis and management of cesarean scar pregnancies RECENT FINDINGS: The incidence of cesarean scar pregnancies (CSPs) is increasing as a result of the increasing cesarean section rate, improved diagnostic capabilities, and a growing awareness. CSPs are associated with significant morbidity and early diagnosis is key. Diagnosis is best achieved with transvaginal ultrasound. Sonographic diagnostic criteria have been developed over decades and recently endorsed by the Society for Maternal-Fetal Medicine and other professional societies. The current categorization system differentiates CSPs that are endogenic or 'on the scar' from those that are exogenic or 'in the niche'. Following diagnosis, the challenge remains in determining the optimal management as multiple modalities can be considered. Studies have demonstrated the favorable outcomes with combined local and systemic methotrexate, surgical excision through multiple routes, and adjunctive therapies, such as uterine artery embolization or uterine balloons. The current evidence is insufficient to identify a single best treatment course and a combined approach to treatment is often required. SUMMARY Successful outcomes while minimizing complications can be achieved with a multidisciplinary, collaborative effort. Guidelines for cesarean scar pregnancies will continue to evolve as the published reports grow.
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Yang J, Li B, Liu J, Zeng W, Hong L. A New Modified Hysteroscopic-Laparoscopic Surgery for Cesarean Scar Pregnancy of Stable Type III. Int J Gen Med 2021; 14:2289-2295. [PMID: 34113158 PMCID: PMC8184249 DOI: 10.2147/ijgm.s308768] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/18/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To introduce a modified hysteroscopic-laparoscopic operation for cesarean scar pregnancy (CSP) of stable type III. Patients and Methods We retrospectively studied the case notes of 31 patients with stable type III cesarean scar pregnancy who underwent hysteroscopic-laparoscopic surgery in our hospital. Thirteen patients received the modified hysteroscopic-laparoscopic surgery (modified surgery group), and eighteen patients received traditional hysteroscopic-laparoscopic surgery (traditional surgery group). Results There was no significant difference in patients' age, gestational age, number of previous cesarean sections, the serum human chorionic gonadotropin (hCG) level before surgery, gestational sac diameter, myometrium thickness between the two groups. In the modified hysteroscopic-laparoscopic surgery, the mean surgical time was 50.45±24.45 mins, the mean length of stay in hospital was 4.50±0.50 days, which was significantly shorter than the traditional surgery group (84.75±33.28 mins and 5.50±0.75 days, respectively). And the intraoperative hemorrhage in the modified group was also less than that in the traditional group (40.50±12.25 mL vs 75.33±25.45mL). Whereas the time for hCG normalization, postoperative vaginal bleeding and menstrual recovery had no significant difference between the modified surgery group and the traditional surgery group. There was no recurrence of CSP in both groups. Conclusion The modified hysteroscopic-laparoscopic surgery had shorter operation time, less blood loss, and sooner recovery time after surgery compared to traditional hysteroscopic-laparoscopic surgery, which could be more beneficial to our patients and should be applied in clinics generally.
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Affiliation(s)
- Jiang Yang
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Hubei, People's Republic of China
| | - Bingshu Li
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Hubei, People's Republic of China
| | - Jin Liu
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Hubei, People's Republic of China
| | - Wanlin Zeng
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Hubei, People's Republic of China
| | - Li Hong
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Hubei, People's Republic of China
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Zhang X, Wang G, Sun Y, Ding P, Yang X, Zhao Z. The Z-plasty contributes to the coalescence of a chronic non-healing wound. Int Wound J 2021; 18:796-804. [PMID: 33733609 PMCID: PMC8613384 DOI: 10.1111/iwj.13583] [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: 02/05/2021] [Revised: 03/02/2021] [Accepted: 03/04/2021] [Indexed: 12/23/2022] Open
Abstract
This study aimed to explore the treatment effect of Z‐plasty on a non‐healing wound. A total of 72 patients diagnosed with a chronic non‐healing wound in Peking University Third Hospital from November 2009 to August 2019 were retrospectively analysed. Among them, 27 patients were treated with Z‐plasty, and 45 patients were treated with the general method. Detailed patient information was retrieved from medical records, including age, gender, body mass index (BMI), alcohol, smoking, and comorbidities (diabetes mellitus, hypertension, heart disease). Surgical parameters included operation time and intraoperative blood loss. Wound swelling, epidermal blisters, wound edge colour, and skin temperature at 1 day after surgery were assessed to evaluate the blood supply of the wound. Surgical complications included infection, haematoma, dehiscence, and non‐healing within 2 weeks postoperatively. Student t test (for continuous data) and Chi‐square test (for categorical data) were conducted to determine the statistical difference. We found no significant differences in age, gender, BMI, alcohol, smoking, and comorbidities between the two groups. Z‐plasty did not show any advantages in the surgical time, invasive blood loss, hospital days, and hospitalisation expenses. The incidence of abnormal wound edge colour with Z‐plasty was significantly lower than that with the general treatment (P < .05), and the Z‐plasty enables better healing of the patient's wound (P < .05). Z‐plasty promoted better recovery of chronic non‐healing wounds than direct suturing.
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Affiliation(s)
- Xinling Zhang
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Guanhuier Wang
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Yidan Sun
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Pengbing Ding
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Xin Yang
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Zhenmin Zhao
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
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Karakuş R, Karakuş SS, Güler B, Ünver G, Özkaya E. Myometrial thickness overlying cesarean scar pregnancy is significantly associated with isthmocele formation in the third month of the postoperative period. Turk J Obstet Gynecol 2021; 18:37-43. [PMID: 33715331 PMCID: PMC7962161 DOI: 10.4274/tjod.galenos.2021.65288] [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] [Indexed: 12/01/2022] Open
Abstract
Objective: To determine some associated factors for isthmocele formation 3 months after the treatment of cesarean scar pregnancy (CSP). Materials and Methods: This is a prospective consecutive case series of CSP managed by fertility preservation modalities at a single tertiary care center from May 2016 to March 2019 (n=95). Patients with a diagnosis of CSP were identified and followed prospectively to collect data on the patients’ demographics; detailed medical, surgical, and social history; symptoms; imaging and laboratory parameters at the time of CSP diagnosis and during treatment; treatment modalities, myometrial thickness; and outcomes in terms of isthmocele formation. Results: Mean myometrial thickness overlying scar pregnancy was significantly lower in the group with isthmocele formation, and the mean gestational age of scar pregnancy was also significantly lower in the group with isthmocele formation following treatment of scar pregnancy (p<0.05). Multivariate regression analysis was conducted to determine associations between certain variables and isthmocele development, which revealed that the gestational age of scar pregnancy and myometrial thickness were significantly associated with isthmocele formation. Conclusion: Myometrial thickness and gestational age of scar pregnancy were significantly associated with isthmocele formation 3 months after treatment.
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Affiliation(s)
- Resul Karakuş
- University of Health Sciences Turkey, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Sultan Seren Karakuş
- University of Health Sciences Turkey, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Burak Güler
- University of Health Sciences Turkey, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Gökhan Ünver
- University of Health Sciences Turkey, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Enis Özkaya
- University of Health Sciences Turkey, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
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Fei H, Jiang X, Li T, Pan Y, Guo H, Xu X, Shu S. Comparison Of Three Different Treatment Methods For Cesarean Scar Pregnancy. Ther Clin Risk Manag 2019; 15:1377-1381. [PMID: 31819464 PMCID: PMC6885563 DOI: 10.2147/tcrm.s220852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/01/2019] [Indexed: 11/23/2022] Open
Abstract
Background/Aim Cesarean scar pregnancy is a long term complication of cesarean section. There is a lot of controversy about the best treatment methods. We retrospectively summarized the clinical characteristics of patients with cesarean scar pregnancy and explored the advantages and disadvantages of fertility-preservation treatment method. Methods From January 2008 to September 2017, a total of 204 cases of cesarean scar pregnancy were retrospectively reviewed. 145 patients underwent transvaginal clearance, 33 patients underwent endoscopic surgery, and 26 patients underwent uterine artery embolism. The clinical characteristics, diagnosis, various treatment methods, and clinical outcomes were analyzed. Results There were no significant differences among the three groups in terms of patient age, number of previous cesarean sections, serum human chorionic gonadotropin, and clinical symptoms. The difference in mean gestational sac diameter (23.5±2.1mm vs 31.3±2.4mm vs 30.8± 1.9mm), surgical time (31.4±2.5min vs. 45.8±2.2min vs. 51.4±1.9min), blood loss (53.3± 5.5mL vs. 105.2±3.2mL vs. 75.6 ±3.5mL), blood transfusion (1/145 case vs.3/33 case vs. 0/26 case), discomfort (1/145 case vs.9/33 case vs. 16/26 case), hospital stay (6.1±1.1 day vs. 7.4±0.9 day vs.18.6±1.5 day), fever duration (1.0±0.5 day vs. 2.1±2.8 day vs. 5.7±3.5 day), and hospital expense (¥ 7825.9±234.9 vs. ¥ 10248.3± 312.9 vs. ¥ 18774.9±243.6) in transvaginal pregnancy tissue clearance, endoscopic surgery, and uterine artery embolism groups were significantly different. Conclusion Transvaginal clearance is an effective and relatively safe treatment option for patients with cesarean scar pregnancy.
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Affiliation(s)
- Hui Fei
- Department of Gynecology and Obstetrics, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen 518107, People's Republic of China
| | - Xuefeng Jiang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of JiNan University, Guangzhou 510630, People's Republic of China
| | - Tian Li
- Department of Gynecology and Obstetrics, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen 518107, People's Republic of China
| | - Ying Pan
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of JiNan University, Guangzhou 510630, People's Republic of China
| | - Hongling Guo
- Department of Gynecology and Obstetrics, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen 518107, People's Republic of China
| | - Xiaoyu Xu
- Department of Gynecology and Obstetrics, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen 518107, People's Republic of China
| | - Shanrong Shu
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of JiNan University, Guangzhou 510630, People's Republic of China
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Li Y, Lu L, Wang W, Sun J, Zhang X, Huang X. Retrospective study of patients with cesarean scar pregnancies treated by uterine artery chemoembolization and curettage. Int J Gynaecol Obstet 2018; 143:172-177. [PMID: 30074243 DOI: 10.1002/ijgo.12636] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 05/23/2018] [Accepted: 08/01/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the efficacy and long-term prognosis of uterine artery chemoembolization (UACE) combined with curettage for treatment of cesarean scar pregnancy (CSP). METHODS Data were retrospectively reviewed from women with CSPs treated by UACE with curettage at Women's Hospital of Zhejiang University, Hangzhou, a tertiary obstetrics and gynecologic center in China, between December 2006 and December 2016. Information on clinical characteristics and treatment outcomes was obtained from medical records and follow-up interviews. RESULTS There were 383 patients included; 379 (99.0%) women were successfully treated. Risk factors associated with intraoperative bleeding were size of gestational mass (P=0.001), presence of fetal heart beat (P=0.002), and type of CSP (P=0.002). Among 301 women with complete medical records over a mean ± SD follow-up of 49.8 ± 30.2 months, 164 (54.5%) women resumed normal menstruation and only 22 (7.3%) experienced a reduction in menstrual volume of more than one-half. Among 89 women attempting to conceive, the conception rate was 69% (61/89), the positive pregnancy rate was 80% (49/61), and 35 live neonates were delivered. CONCLUSION UACE combined with curettage was found to be an effective fertility-sparing treatment for CSP. Further, the approach did not seem to harm future reproductive ability.
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Affiliation(s)
- Yang Li
- Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lingjia Lu
- Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wenxian Wang
- Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jin Sun
- Department of Radiology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xinmei Zhang
- Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiufeng Huang
- Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Docheva N, Slutsky ED, Borella N, Mason R, Van Hook JW, Seo-Patel S. The Rising Triad of Cesarean Scar Pregnancy, Placenta Percreta, and Uterine Rupture: A Case Report and Comprehensive Review of the Literature. Case Rep Obstet Gynecol 2018; 2018:8797643. [PMID: 29984018 PMCID: PMC6011134 DOI: 10.1155/2018/8797643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 04/26/2018] [Indexed: 11/23/2022] Open
Abstract
As the rate of cesarean sections continues to rapidly rise, knowledge of diagnosis and management of cesarean scar pregnancies (CSPs) is becoming increasingly more relevant. CSPs rest on the continuum of placental abnormalities which include morbidly adherent placenta (accreta, increta, and percreta). A CSP poses a clinical challenge which may have significant fetal and maternal morbidity. At this point, no clear management guidelines and recommendations exist. Herein we describe the case of a second trimester CSP with rapid diagnosis and management in a tertiary care center. The case underscores the need for well-coordinated mobilization of resources and a multidisciplinary approach. A review of the literature is performed and deficits in universal management principles are underscored.
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Affiliation(s)
- Nikolina Docheva
- Department of Obstetrics and Gynecology, University of Toledo, Toledo, Ohio, USA
| | - Emily D. Slutsky
- Department of Obstetrics and Gynecology, University of Toledo, Toledo, Ohio, USA
| | - Nicolette Borella
- Mercyhurst University, Department of Biology, Eerie, Pennsylvania, USA
| | - Renee Mason
- Promedica Physicians Obstetrics-Gynecology, Maumee, Ohio, USA
| | - James W. Van Hook
- Department of Obstetrics and Gynecology, University of Toledo, Toledo, Ohio, USA
| | - Sonyoung Seo-Patel
- Department of Obstetrics and Gynecology, University of Toledo, Toledo, Ohio, USA
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10
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Huirne JAF, Vervoort AJMW, Leeuw RD, Brölmann HAM, Hehenkamp WJK. Technical aspects of the laparoscopic niche resection, a step-by-step tutorial. Eur J Obstet Gynecol Reprod Biol 2017; 219:106-112. [PMID: 29101836 DOI: 10.1016/j.ejogrb.2017.09.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 09/16/2017] [Accepted: 09/19/2017] [Indexed: 10/18/2022]
Abstract
The technique of a laparoscopic niche resection is described in ten steps and alternative steps for future studies are discussed.
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Affiliation(s)
- J A F Huirne
- Department of Obstetrics and Gynaecology, VU Medical Ventre, Amsterdam, The Netherlands; ICaR VU Medical Center, Institute for Cardiovascular Research, The Netherlands; Amsterdam Reproduction & Development, VU Medical Center and Amsterdam Medical Center, Amsterdam, The Netherlands.
| | - A J M W Vervoort
- Department of Obstetrics and Gynaecology, VU Medical Ventre, Amsterdam, The Netherlands
| | - R De Leeuw
- Department of Obstetrics and Gynaecology, VU Medical Ventre, Amsterdam, The Netherlands; ICaR VU Medical Center, Institute for Cardiovascular Research, The Netherlands; Amsterdam Reproduction & Development, VU Medical Center and Amsterdam Medical Center, Amsterdam, The Netherlands
| | - H A M Brölmann
- Department of Obstetrics and Gynaecology, VU Medical Ventre, Amsterdam, The Netherlands; ICaR VU Medical Center, Institute for Cardiovascular Research, The Netherlands
| | - W J K Hehenkamp
- Department of Obstetrics and Gynaecology, VU Medical Ventre, Amsterdam, The Netherlands; ICaR VU Medical Center, Institute for Cardiovascular Research, The Netherlands; Amsterdam Reproduction & Development, VU Medical Center and Amsterdam Medical Center, Amsterdam, The Netherlands
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11
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Piao D, Ramadan M, Park A, Bartels KE, Patel SG. Freehand diffuse optical spectroscopy imaging for intraoperative identification of major venous and arterial vessels underlying peritoneal fat: an in vivo demonstration in a pig model. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:1-4. [PMID: 29086545 DOI: 10.1117/1.jbo.22.10.100503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/04/2017] [Indexed: 06/07/2023]
Abstract
Inadvertent injury to important anatomic structures is a significant risk in minimally invasive surgery (MIS) that potentially requires conversion to an open procedure, which results in increased morbidity and mortality. Surgeons operating minimal-invasively currently do not have an easy-to-use, real-time device to aid in intraoperative identification of important anatomic structures that underlie tissue planes. We demonstrate freehand diffuse optical spectroscopy (DOS) imaging for intraoperatively identifying major underlying veins and arteries. An applicator probe that can be affixed to and detached from an 8-mm laparoscopic instrument has been developed. The 10-mm DOS source-detector separation renders sampling of tissue heterogeneities a few millimeters deep. DOS spectra acquired consecutively during freehand movement of the applicator probe on the tissue surface are displayed as a temporal and spectral image to assist in spatially resolved identification of the underlying structures. Open surgery identifications of the vena cava and aorta underlying peritoneal fat of ∼4 mm in thickness using the applicator probe under room light were demonstrated repeatedly in multiple pigs in vivo.
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Affiliation(s)
- Daqing Piao
- Oklahoma State University, School of Electrical and Computer Engineering, Stillwater, Oklahoma, United States
- Oklahoma State University, Department of Veterinary Clinical Sciences, Center for Veterinary Health, United States
| | - Mohammad Ramadan
- University of Oklahoma Health Sciences Center, Department of Urology, Oklahoma City, Oklahoma, United States
- Oklahoma City Veterans Affairs Health Care System, Department of Urology, Oklahoma City, Oklahoma, United States
| | - Aaron Park
- Oklahoma School of Science and Mathematics, Oklahoma City, Oklahoma, United States
| | - Kenneth E Bartels
- Oklahoma State University, Department of Veterinary Clinical Sciences, Center for Veterinary Health, United States
| | - Sanjay G Patel
- University of Oklahoma Health Sciences Center, Department of Urology, Oklahoma City, Oklahoma, United States
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Vervoort A, Vissers J, Hehenkamp W, Brölmann H, Huirne J. The effect of laparoscopic resection of large niches in the uterine caesarean scar on symptoms, ultrasound findings and quality of life: a prospective cohort study. BJOG 2017; 125:317-325. [PMID: 28703935 PMCID: PMC5811817 DOI: 10.1111/1471-0528.14822] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2017] [Indexed: 11/18/2022]
Abstract
Objective To evaluate the effectiveness of a laparoscopic niche resection on niche‐related symptoms and/or fertility‐related problems, ultrasound findings and quality of life. Design Prospective cohort study. Setting University hospital. Population Women with a large niche (residual myometrium <3 mm) and complaints of either postmenstrual spotting, dysmenorrhoea, intrauterine fluid accumulation and/or difficulties with embryo transfer due to distorted anatomy. Methods Women filled out questionnaires and a validated menstrual score chart at baseline and 6 months after the laparoscopic niche resection. At baseline and between 3 and 6 months follow up niches were evaluated by transvaginal ultrasound. Main outcome measures The primary outcome was reduction of the main problem 6 months after the intervention. Secondary outcomes were complications, menstrual characteristics, dysmenorrhoea, niche measurements, intrauterine fluid, surgical outcomes, satisfaction and quality of life. Results In all, 101 women underwent a laparoscopic niche resection. In 80 women (79.2%) the main problem was improved or resolved. Postmenstrual spotting was significantly reduced by 7 days at 6 months follow up compared with baseline. Dysmenorrhoea and discomfort related to spotting was also significantly reduced. The residual myometrium was increased significantly at follow up. The intrauterine fluid was resolved in 86.9% of the women with intrauterine fluid at baseline; 83.3% of women were (very) satisfied. The physical component of quality of life increased, the mental component did not change. Conclusions A laparoscopic niche resection reduced postmenstrual spotting, discomfort due to spotting, dysmenorrhoea and the presence of intrauterine fluid in the majority of women and increased the residual myometrium. Tweetable abstract Laparoscopic niche resection reduces niche‐related problems and enlarges the residual myometrium. Laparoscopic niche resection reduces niche‐related problems and enlarges the residual myometrium.
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Affiliation(s)
- Ajmw Vervoort
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, the Netherlands
| | - J Vissers
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, the Netherlands
| | - Wjk Hehenkamp
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, the Netherlands
| | - Ham Brölmann
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, the Netherlands
| | - Jaf Huirne
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, the Netherlands
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13
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The minimally invasive approach to the symptomatic isthmocele – what does the literature say? A step-by-step primer on laparoscopic isthmocele – excision and repair. Curr Opin Obstet Gynecol 2017; 29:257-265. [DOI: 10.1097/gco.0000000000000380] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Nikkels C, Vervoort AJMW, Mol BW, Hehenkamp WJK, Huirne JAF, Brölmann HAM. IDEAL framework in surgical innovation applied on laparoscopic niche repair. Eur J Obstet Gynecol Reprod Biol 2017; 215:247-253. [PMID: 28688331 DOI: 10.1016/j.ejogrb.2017.06.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/14/2017] [Accepted: 06/16/2017] [Indexed: 12/19/2022]
Abstract
The research objective of the current systematic literature review is to classify the laparoscopic niche repair according to the IDEAL framework of 'innovation stages' and to recommend the required research setting to facilitate safe and properly timed implementation of the technique. In doing so, we are also able to evaluate the practical applicability of the IDEAL framework. A systematic search of the available literature on laparoscopic niche repair was performed in PubMed, Embase, and the Wiley/Cochrane library. Articles were classified according to the IDEAL framework and recommendations were given on additional required research before the technique can be safely implemented. Practical applicability of the IDEAL framework was also evaluated. Introduction of laparoscopic niche repair matches Idea (1) and Development (2a), according to the stages of IDEAL framework, although most studies are retrospective and complications have not been registered structurally in a considerable number of the articles. As feasibility and safety have been more or less established and surgery has been further developed we enter stage 2b (Exploration) and need prospective trials preferably comparing the effectiveness of laparoscopic niche repair to expectant management, the current standard care. Available studies were classified with the use of the IDEAL framework, achieving an overall IDEAL stage to be 2a Development. As clinical outcomes, though poorly registered, have been substantially improved, laparoscopic niche repair needs to be carried forward by more advanced study designs.
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Affiliation(s)
- C Nikkels
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Anke J M W Vervoort
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
| | - Ben Willem Mol
- The Robinson Research Institute School of Paediatrics and Reproductive Health University of Adelaide, Adelaide, Australia
| | - Wouter J K Hehenkamp
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
| | - Judith A F Huirne
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
| | - Hans A M Brölmann
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
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15
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Kaelin Agten A, Cali G, Monteagudo A, Oviedo J, Ramos J, Timor-Tritsch I. The clinical outcome of cesarean scar pregnancies implanted "on the scar" versus "in the niche". Am J Obstet Gynecol 2017; 216:510.e1-510.e6. [PMID: 28115056 DOI: 10.1016/j.ajog.2017.01.019] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 12/20/2016] [Accepted: 01/13/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The term cesarean scar pregnancy refers to placental implantation within the scar of a previous cesarean delivery. The rising numbers of cesarean deliveries in the last decades have led to an increased incidence of cesarean scar pregnancy. Complications of cesarean scar pregnancy include morbidly adherent placenta, uterine rupture, severe hemorrhage, and preterm labor. It is suspected that cesarean scar pregnancies that are implanted within a dehiscent scar ("niche") behave differently compared with those implanted on top of a well-healed scar. To date there are no studies that have compared pregnancy outcomes between cesarean scar pregnancies implanted either "on the scar" or "in the niche." OBJECTIVES The purpose of this study was to determine the pregnancy outcome of cesarean scar pregnancy implanted either "on the scar" or "in the niche." STUDY DESIGN This was a retrospective 2-center study of 17 patients with cesarean scar pregnancy that was diagnosed from 5-9 weeks gestation (median, 8 weeks). All cesarean scar pregnancies were categorized as either implanted or "on the scar" (group A) or "in the niche" (group B), based on their first-trimester transvaginal ultrasound examination. Clinical outcomes based on gestational age at delivery, mode of delivery, blood loss at delivery, neonate weight and placental histopathologic condition were compared between the groups with the use of the Mann-Whitney U test. Myometrial thickness overlying the placenta was compared among all the patients who required hysterectomy and those who did not with the use of the Mann-Whitney U test. Myometrial thickness was also correlated with gestational age at delivery with the use of Spearman's correlation. RESULTS Group A consisted of 6 patients; group B consisted of 11 patients. Gestational age at delivery was lower in group B (median, 34 weeks; range, 20-36 weeks) than in group A (median, 38 weeks; range, 37-39 weeks; P=.001). In group A, 5 patients were delivered via cesarean delivery (with normal placenta), and 1 patient underwent a cesarean-hysterectomy for placenta accreta. In group B, 10 patients had a cesarean-hysterectomy for placenta increta/percreta, and 1 patient underwent gravid-hysterectomy for vaginal bleeding at 20 weeks gestation. Blood loss was increased, but not significantly higher in group B (median, 1200 mL; range, 600-4000 mL) than in group A (median, 700 mL; range, 600-1400 mL; P=.117). Myometrium was statistically significantly thinner in the patients group that require hysterectomy (median, 1 mm; range, 0-2 mm) than in the group that did not (median, 5 mm; range, 4-9 mm; P=.001). Myometrial thickness showed a positive correlation with the gestational age (r=0.820; P<.0005). CONCLUSION Patients with cesarean scar pregnancy implanted "on the scar" had a substantially better outcome compared with patients in whom the cesarean scar pregnancy implanted "in the niche." Myometrial thickness <2 mm in the first-trimester ultrasound examination is associated with morbidly adherent placenta at delivery.
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Affiliation(s)
- Andrea Kaelin Agten
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY.
| | - Giuseppe Cali
- Department of Obstetrics and Gynecology, ARNAS Civico, Palermo, Italy
| | - Ana Monteagudo
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY; Maternal Fetal Medicine Associates, Carnegie Hill Imaging for Women, New York, NY
| | - Johana Oviedo
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY
| | - Joanne Ramos
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY
| | - Ilan Timor-Tritsch
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY
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Panelli DM, Phillips CH, Brady PC. Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review. FERTILITY RESEARCH AND PRACTICE 2015; 1:15. [PMID: 28620520 PMCID: PMC5424401 DOI: 10.1186/s40738-015-0008-z] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/29/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Ectopic pregnancy is a potentially life-threatening condition occurring in 1-2 % of all pregnancies. The most common ectopic implantation site is the fallopian tube, though 10 % of ectopic pregnancies implant in the cervix, ovary, myometrium, interstitial portion of the fallopian tube, abdominal cavity or within a cesarean section scar. FINDINGS Diagnosis involves a combination of clinical symptoms, serology, and ultrasound. Medical management is a safe and effective option in most clinically stable patients. Patients who have failed medical management, are ineligible, or present with ruptured ectopic pregnancy or heterotopic pregnancy are most often managed with excision by laparoscopy or, less commonly, laparotomy. Management of nontubal ectopic pregnancies may involve medical or surgical treatment, or a combination, as dictated by ectopic pregnancy location and the patient's clinical stability. Following tubal ectopic pregnancy, the rate of subsequent intrauterine pregnancy is high and independent of treatment modality. CONCLUSION This review describes the incidence, risk factors, diagnosis, and management of tubal and non-tubal ectopic and heterotopic pregnancies, and reviews the existing data regarding recurrence and future fertility.
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Affiliation(s)
- Danielle M. Panelli
- Department of Obstcpetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115 USA
| | - Catherine H. Phillips
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Paula C. Brady
- Department of Obstcpetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115 USA
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Shokeir T. Methotrexate Treatment for Cesarean Scar Ectopic Pregnancy: Learning Lessons. J Minim Invasive Gynecol 2015; 22:1116. [PMID: 25989280 DOI: 10.1016/j.jmig.2015.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 04/29/2015] [Indexed: 10/23/2022]
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