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Speed OE, Farsi S, Rickels K, Patel VA, Bareiss A, Dornhoffer J, Saadi RA. Auditory brainstem implants: an analysis of adverse events in the MAUDE database. Neurochirurgie 2024; 70:101570. [PMID: 38810538 DOI: 10.1016/j.neuchi.2024.101570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVE Auditory Brainstem Implants (ABI) are used to restore hearing in patients lacking appropriate cochlear anatomy and/or cochlear nerve. The objective of this study was to examine the Manufacture and User Facility Device Experience (MAUDE) database to analyze adverse events. STUDY DESIGN This is a study of a multi-institutional database maintained by the US FDA. SETTING A database analysis was performed via collaboration of multiple clinicians at tertiary referral centers. METHODS The MAUDE database was queried for Medical Device Reports (MDRs) relating to ABIs. MDRs were identified using the advanced search term "Implant, Auditory Brainstem" and reviewing all reports with the basic search term "Brainstem Implant". All collected reports were individually reviewed. RESULTS A total of 265 individual patient reports were reviewed, of which 55 reports met inclusion criteria. Reports regarding audiologic outcome included failure to provide hearing benefit (n = 27), implant failure/device malfunction (n = 10), and device non-use (n = 6). Postoperative complications included local skin infection (n = 3), CSF leak (n = 3), elevated ICP (n = 1), surgical site dehiscence (n = 1), swelling (n = 1), seroma formation requiring drainage (n = 1), and meningitis (n = 2). Two patients had dislodged magnets during 1.5 Tesla MRI acquisition. There were 35 instances of full explantation of the device and 1 partial removal; 13 patients had a new device implanted following explantation. CONCLUSIONS Poor hearing results, device failure, and non-use were commonly reported causes for explanation in this analysis. This information can aid physicians in counseling patients and family members and managing device expectations.
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Affiliation(s)
- Olivia E Speed
- University of Arkansas for Medical Sciences - Little Rock, AR, USA
| | - Soroush Farsi
- University of Arkansas for Medical Sciences - Little Rock, AR, USA
| | - Kaersti Rickels
- University of Arkansas for Medical Sciences - Little Rock, AR, USA
| | - Vijay A Patel
- Department of Otolaryngology - Head and Neck Surgery, University of California San Diego, La Jolla, CA, USA; Division of Pediatric Otolaryngology, Rady Children's Hospital - San Diego, San Diego, CA, USA
| | - Anna Bareiss
- University of Arkansas for Medical Sciences - Little Rock, AR, USA
| | - John Dornhoffer
- University of Arkansas for Medical Sciences - Little Rock, AR, USA; Arkansas Children's Hospital - Little Rock, AR, USA
| | - Robert A Saadi
- University of Arkansas for Medical Sciences - Little Rock, AR, USA; Arkansas Children's Hospital - Little Rock, AR, USA.
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Li X, Feng Y, Gong Y, Chen Y. Assessing the Reproducibility of Research Based on the Food and Drug Administration Manufacturer and User Facility Device Experience Data. J Patient Saf 2024; 20:e45-e58. [PMID: 38470959 DOI: 10.1097/pts.0000000000001220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
OBJECTIVE This article aims to assess the reproducibility of Manufacturer and User Facility Device Experience (MAUDE) data-driven studies by analyzing the data queries used in their research processes. METHODS Studies using MAUDE data were sourced from PubMed by searching for "MAUDE" or "Manufacturer and User Facility Device Experience" in titles or abstracts. We manually chose articles with executable queries. The reproducibility of each query was assessed by replicating it in the MAUDE Application Programming Interface. The reproducibility of a query is determined by a reproducibility coefficient that ranges from 0.95 to 1.05. This coefficient is calculated by comparing the number of medical device reports (MDRs) returned by the reproduced queries to the number of reported MDRs in the original studies. We also computed the reproducibility ratio, which is the fraction of reproducible queries in subgroups divided by the query complexity, the device category, and the presence of a data processing flow. RESULTS As of August 8, 2022, we identified 523 articles from which 336 contained queries, and 60 of these were executable. Among these, 14 queries were reproducible. Queries using a single field like product code, product class, or brand name showed higher reproducibility (50%, 33.3%, 31.3%) compared with other fields (8.3%, P = 0.037). Single-category device queries exhibited a higher reproducibility ratio than multicategory ones, but without statistical significance (27.1% versus 8.3%, P = 0.321). Studies including a data processing flow had a higher reproducibility ratio than those without, although this difference was not statistically significant (42.9% versus 17.4%, P = 0.107). CONCLUSIONS Our findings indicate that the reproducibility of queries in MAUDE data-driven studies is limited. Enhancing this requires the development of more effective MAUDE data query strategies and improved application programming interfaces.
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Affiliation(s)
- Xinyu Li
- From the Department of Computer Science, Vanderbilt University, Nashville, Tennessee
| | - Yubo Feng
- From the Department of Computer Science, Vanderbilt University, Nashville, Tennessee
| | - Yang Gong
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas
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Kakinuma T, Kaneko A, Kakinuma K, Matsuda Y, Yanagida K, Takeshima N, Ohwada M. Effectiveness of treating menorrhagia using microwave endometrial ablation at a frequency of 2.45 GHz. World J Clin Cases 2023; 11:5653-5659. [PMID: 37727709 PMCID: PMC10505997 DOI: 10.12998/wjcc.v11.i24.5653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/17/2023] [Accepted: 08/03/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Microwave endometrial ablation (MEA) is a minimally invasive treatment for menorrhagia. It has been covered by the national insurance in Japan since April 2012, and its demand has been increasing as the importance of women's health has advanced in society. AIM To examine the efficacy of MEA as a treatment option for menorrhagia. METHODS In this study, we retrospectively analyzed 76 patients who underwent MEA between January 2016 and March 2020 in our department. MEA was performed in the lithotomy position, under general anesthesia, and with transabdominal ultrasound guidance, including the entire endometrial circumference while confirming endometrial coagulation. The Microtaze AFM-712 and the Sounding Applicator CSA-40CBL-1006200C were used for MEA, and the endometrium was ablated using a Microtaze output of 70 W and coagulation energization time of 50 s per cycle. The visual analog scale (VAS) was used to evaluate menorrhagia, menstrual pain, and treatment satisfaction. Additionally, the hemoglobin (Hb) levels before and after MEA and associated complications were investigated. RESULTS The average age of the patients was 44.8 ± 4.0 years. While 14 patients had functional menorrhagia, 62 had organic menorrhagia, of whom 14 had endometrial polyps, 40 had uterine fibroids, and 8 had adenomyosis. The VAS score before MEA and 3 and 6 mo after the procedure were 10, 1.3 ± 1.3, and 1.3 ± 1.3, respectively, for menorrhagia and 10, 1.3 ± 1.8, and 1.3 ± 1.8, respectively, for menstrual pain, both showing improvements (P < 0.001). The MEA Hb level significantly improved from 9.2 ± 4.2 g/dL before MEA to 13.4 ± 1.2 g/dL after MEA (P = 0.003). Treatment satisfaction was high, with a VAS score of 9.6 ± 0.7. Endometritis was observed in one patient after surgery and was treated with antibiotics. CONCLUSION MEA is a safe and effective treatment for menorrhagia.
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Affiliation(s)
- Toshiyuki Kakinuma
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Nasushiobara 329-2763, Japan
| | - Ayaka Kaneko
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Nasushiobara 329-2763, Japan
| | - Kaoru Kakinuma
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Nasushiobara 329-2763, Japan
| | - Yoshio Matsuda
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Nasushiobara 329-2763, Japan
| | - Kaoru Yanagida
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Nasushiobara 329-2763, Japan
| | - Nobuhiro Takeshima
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Nasushiobara 329-2763, Japan
| | - Michitaka Ohwada
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Nasushiobara 329-2763, Japan
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Samala M, Pasupula SS, Mudigonda S, Tadikonda RR. Endometrial ablation techniques in treating menorrhagia. Minerva Obstet Gynecol 2023; 75:279-287. [PMID: 35912462 DOI: 10.23736/s2724-606x.22.05101-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Menorrhagia is a frequent gynecological problem that is clinically described as excessive blood loss of 80 mL per menstrual cycle. It has the potential to lower their quality of life and to induce anemia. Medical therapy has typically been the first line of treatment; however, it is frequently ineffectual. Hysterectomy, on the other hand, is clearly 100 percent effective in stopping bleeding, but it is more expensive and can cause serious problems. So, the endometrial ablation is preferred when the endometrial layer is destroyed or removed during the procedure. To "ablate" (remove) the endometrial lining, a variety of procedures has been devised. The gold standard resectoscopic procedures (laser, transcervical endometrial resection, and rollerball) require hysteroscopic visualization of the uterus and while safe, necessitate expert surgeons. Several innovative procedures have lately been developed, the majority of which may be conducted blindly and take less time. Many nonresectoscopic procedures are still in the process of being developed, refined, and investigated. This article discusses the various techniques and procedures used in endometrial ablation, the importance of the physician using endometrial thinning agents because success rates are higher when thinning agents are used, and the importance of women understanding the complications mainly related to pregnancy. Women should be helped to make informed management decisions by discussing the risks and benefits of each treatment with their consultant. Since there are many treatment options available, with no one option being superior in all respects, patient preference and treatment preferences should be considered when deciding on management.
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Tan S, Yu X, Cheng Z, Zhang J, Yu J, Liu F, Gao Y, Linghu R, Han Z, Liang P. Cause Analysis and Diagnosis and Treatment of Intestinal Fistulas After Ultrasound-Guided Microwave Ablation of Abdominopelvic Lesions. Front Surg 2021; 8:675585. [PMID: 34869548 PMCID: PMC8639506 DOI: 10.3389/fsurg.2021.675585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To determine the cause and high-risk factors for the development of intestinal fistulas (IFs) after ultrasound-guided microwave ablation (MA) of abdominopelvic lesions, and to identify effective prophylactic and therapeutic actions. Methods: Clinical data were collected from patients with an IF after ultrasound-guided MA of abdominopelvic lesions in our hospital from January 1, 2010 to December 31, 2018. The cause, diagnosis, and treatment of IFs in these patients were analyzed. Results: Among 8,969 patients who underwent ultrasound-guided MA of abdominopelvic lesions, eight patients developed IF after MA, Seven patients were discharged after being cured and one died. Conclusion: Abdominopelvic lesions are close to the intestines, so histories of surgery, radiotherapy, and abdominopelvic infection are high-risk factors for IF development after MA of these lesions. Surgical treatment should be provided as soon as an IF is identified.
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Affiliation(s)
- Shuilian Tan
- Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xiaoling Yu
- Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhigang Cheng
- Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jing Zhang
- Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yuanjin Gao
- Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Runze Linghu
- Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhiyu Han
- Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
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Correa J, Aribo C, Stuparich M, Nahas S, Cheung C, Behbehani S. Malfunction Events in the US FDA MAUDE Database: How Does Robotic Gynecologic Surgery Compare with Other Specialties? J Minim Invasive Gynecol 2021; 29:300-307.e1. [PMID: 34464761 DOI: 10.1016/j.jmig.2021.08.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 12/01/2022]
Abstract
STUDY OBJECTIVE To review malfunction events (MEs) related to the use of the da Vinci robot reported to the United States Food and Drug Administration Manufacturer and User Facility Device Experience in the last 10 years and compare gynecologic surgery with other surgical specialties. DESIGN A retrospective review. SETTING Manufacturer and User Facility Device Experience database. PATIENTS Reports from 2010 to 2020 with keywords "Davinci" and "Intuitive". INTERVENTIONS Report review. MEASUREMENTS AND MAIN RESULTS There were 679 reports included in the final analysis. Most MEs occurred intraoperatively (81.7%) and were related to robotic instrument malfunction (84.5%), and 30% required an instrument switch to complete the procedure. Conversion to open and laparoscopic surgery was required in 3.1% and 1.3% of MEs, respectively. Injury to the patient occurred in 15.6% of MEs. Of the reported injuries to patients, 6.6% were related to robotic malfunction, 49.2% to instrument malfunction, and 18% to surgeon or staff misuse of the robotic system, and 15.6% were complications inherent to the procedure, not related to the robotic system. Of all the reported MEs, 4.4% were related to robot malfunction, 1.5% to console malfunction, 73.3% to Intuitive accessory malfunction, 11.2% to other accessory malfunction, 4% to surgeon or staff misuse of robotic system, and 3% to complications inherent to the procedure. Comparison between gynecologic surgery and other surgical specialties showed that 14.4% of issues were solved intraoperatively in gynecologic surgery vs 13.7% in other specialties (p = .185). The procedure was completed robotically in 85.2% in gynecologic surgery vs 84% in other specialties, laparoscopically 4.6% vs 3.7%, and open in 10.2% vs 12.4%, respectively (p = .883). In gynecologic surgery, reported MEs were made by patients in 14.8% vs 4.8% in other specialties, manufacturer in 78.4% vs 74.2%, and operating room staff in 2.3% vs 16.1%, respectively (p = .007). Injury to patient was similar in gynecologic surgery compared with other specialties (35.1% vs 23.4%, p = .122). Gynecologic and other specialty MEs did not state the need for procedure rescheduling (0% vs 0%). CONCLUSION Most reported robotic MEs occurred intraoperatively, were related to robotic instrument malfunctions, and required an instrument switch. Most surgeries are completed robotically, but conversion to either an open or laparoscopic approach was reported in 4.4%. Of the 114 reported injuries, 47.4% were Clavien-Dindo grade III+. There were no differences noted in patient injury between gynecologic surgery and other specialties.
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Affiliation(s)
- Jasmine Correa
- Department of Obstetrics and Gynecology (Drs. Correa, Aribo, Stuparich, Nahas, and Behbehani), University of California, Riverside, California
| | - Chade Aribo
- Department of Obstetrics and Gynecology (Drs. Correa, Aribo, Stuparich, Nahas, and Behbehani), University of California, Riverside, California
| | - Mallory Stuparich
- Department of Obstetrics and Gynecology (Drs. Correa, Aribo, Stuparich, Nahas, and Behbehani), University of California, Riverside, California
| | - Samar Nahas
- Department of Obstetrics and Gynecology (Drs. Correa, Aribo, Stuparich, Nahas, and Behbehani), University of California, Riverside, California
| | - Cecilia Cheung
- Riverside School of Medicine, and Department of Psychology (Dr. Cheung), University of California, Riverside, California
| | - Sadikah Behbehani
- Department of Obstetrics and Gynecology (Drs. Correa, Aribo, Stuparich, Nahas, and Behbehani), University of California, Riverside, California.
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Hur K, Ge M, Kim J, Ference EH. Adverse Events Associated with Balloon Sinuplasty: A MAUDE Database Analysis. Otolaryngol Head Neck Surg 2019; 162:137-141. [DOI: 10.1177/0194599819884902] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Objective Balloon sinuplasty utilization has increased significantly since its introduction over a decade ago. However, the most common associated complications are still unknown. The objective of this study was to analyze adverse events related to balloon sinuplasty. Study Design Retrospective cross-sectional analysis. Setting Food and Drug Administration’s MAUDE database (Manufacturer and User Facility Device Experience; 2008-2018). Subjects and Methods The MAUDE database was searched for all reports on adverse events involving balloon sinuplasty devices from the 3 leading manufacturers: Acclarent, Entellus, and Medtronic. Reported events were reviewed and categorized. Results During the study period, there were 211 adverse events from 208 reports divided into the following categories: patient related (n = 102, 48.3%), device related (n = 101, 47.9%), and packaging related (n = 8, 3.8%). Four periprocedural deaths were reported but were not clearly associated with technical complications. The most common device-related complications were guide catheter malfunction (39.6%), balloon malfunction (38.6%), and imprecise navigation (17.8%). The most common patient-related complications were cerebrospinal fluid leak (36.3%), eye swelling (29.4%), and epistaxis (11.8%). A lateral canthotomy was performed in 30.0% of eye-swelling complications. Sixty percent of eye complications occurred during balloon dilation of the maxillary sinus. The years 2014 (n = 48) and 2012 (n = 32) had the highest number of adverse events reported as compared with all other years. Conclusion The most common adverse events associated with balloon sinuplasty include balloon malfunction, guide catheter malfunction, cerebrospinal fluid leak, and significant eye swelling. Health care providers should discuss these possible complications when consenting patients for balloon sinuplasty.
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Affiliation(s)
- Kevin Hur
- Caruso Department of Otolaryngology–Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of Otolaryngology–Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Marshall Ge
- Caruso Department of Otolaryngology–Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jeehong Kim
- Caruso Department of Otolaryngology–Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Elisabeth H. Ference
- Caruso Department of Otolaryngology–Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Rajwani A, Papillon-Smith J, Murji A. Bowel Perforation after Global Endometrial Ablation. J Minim Invasive Gynecol 2018; 25:1130-1131. [PMID: 29432904 DOI: 10.1016/j.jmig.2018.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/30/2018] [Accepted: 02/02/2018] [Indexed: 10/18/2022]
Affiliation(s)
- Alykhan Rajwani
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jessica Papillon-Smith
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ally Murji
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
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Endometrial Ablation. J Minim Invasive Gynecol 2017; 25:299-307. [PMID: 28888699 DOI: 10.1016/j.jmig.2017.08.656] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/25/2017] [Accepted: 08/29/2017] [Indexed: 11/23/2022]
Abstract
The destruction of the endometrium in women with heavy menstrual bleeding has been used for well over a century, and the various techniques of delivering forms of thermal energy have been modified over the years to ensure a safe and effective treatment approach. Today, 6 nonresectoscopic devices are approved for use in the United States in addition to resectoscopic techniques that rely on the skillful use of the operative hysteroscope. Regardless of the technique used, endometrial ablation uniformly reduces menstrual blood loss, improves general and menstrual-related quality of life, and prevents hysterectomy in 4 of 5 women who undergo the procedure. When patients are appropriately selected, outcomes are optimized, and risks of serious complications are minimized. This article reviews the literature with singular reference to nonresectoscopic endometrial ablation procedures including historical background, appropriate patient selection, clinical outcomes data, complications, and special or unique considerations.
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A Primer to the Structure, Content and Linkage of the FDA's Manufacturer and User Facility Device Experience (MAUDE) Files. EGEMS 2017; 5:12. [PMID: 29930960 PMCID: PMC5994953 DOI: 10.5334/egems.221] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Introduction and Background: The US Food and Drug Administration (FDA)’s Manufacturer and User Facility Device Experience (MAUDE) database is a publicly available resource providing over 4 million records relating to medical device safety. Using downloadable MAUDE files avoids limitations of the online MAUDE search interface. However, naive file usage can result in errors, while independent discovery of the nuances required to correctly work with the database can be time-consuming. Practical information is provided to shorten this learning curve and obtain accurate results when using the MAUDE database files. MAUDE File Descriptions: The MAUDE database consists of 135 fields in four primary (Master Event, Device, Patient, Text) and two supplemental (Device Problems and Problem Code Descriptions) file types. When combined, these six files provide a detailed account of an adverse event or product problem report. Website instructions for joining the files are incomplete. Comprehensive details are provided to enable precise file linking. Lessons Learned: MAUDE files have irregularities that must be understood to download and work with the data efficiently. Accurate results depend upon combining the files correctly and understanding the difference between report and event denominators. Appreciating data availability can facilitate successful MAUDE investigations. Conclusion: The MAUDE database can provide key insights about medical device safety. Detailed information is provided about the structure, content and interrelationships of the MAUDE database files to enable investigators to use this valuable resource more quickly and accurately.
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Coelho DH, Tampio AJ. The Utility of the MAUDE Database for Osseointegrated Auditory Implants. Ann Otol Rhinol Laryngol 2016; 126:61-66. [PMID: 27913723 DOI: 10.1177/0003489416674962] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the utility of Manufacturer and User Friendly Device Experience (MAUDE) database in studying osseointegrated auditory implant (OAI)-related complications. METHODS The MAUDE database was searched for all reports involving OAIs (ie, Baha, Ponto, Sophono). Complications were classified into 1 or more of 6 categories-implant, abutment, processor, skin, surgery, and other. Subcategories were generated to prevent overgeneralization. Other variables recorded included date of report, number of complications per report, manufacturer, and time from complication to report. RESULTS Over the study period, there were 269 complications listed from 238 reports divided into the following categories: implant related (n = 145), abutment related (n = 16), processor related (n = 13), skin and soft tissue related (n = 79), surgery related (n = 11), and other (n = 5). No demographic data were available. There were no discernible trends from the data, and when compared to published literature, MAUDE data appear to under- or misrepresent complications. CONCLUSION The MAUDE database is limited in its design and given fairly disparate reporting quality may not be ideally suited for quantifying risks of OAIs. These findings suggest the necessity for a substantially improved central registry for otologic implants and highlight the need for further research to investigate the root causes of their associated complication.
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Affiliation(s)
- Daniel H Coelho
- Department of oyolaryngology-head & neck surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Alex J Tampio
- Department of oyolaryngology-head & neck surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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Kumar V, Chodankar R, Gupta JK. Endometrial ablation for heavy menstrual bleeding. ACTA ACUST UNITED AC 2016; 12:45-52. [PMID: 26756668 DOI: 10.2217/whe.15.86] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Endometrial ablation can be described as one of the great gynecological success stories. It has changed the management of heavy menstrual bleeding dramatically. The development of newer (second generation) endometrial ablative techniques has enabled clinicians to set up comprehensive 'one stop clinics' based on an outpatient service to treat heavy menstrual bleeding effectively without the need for general anesthetic or conscious sedation. This article describes the rationale and evidence for use of different endometrial auto-ablative systems along with relevant technical and clinical aspects. It also addresses the essentials of a successful approach to outpatient endometrial ablation along with discussion on risks, complications and contraindications of the procedure.
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Affiliation(s)
- Vinod Kumar
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rohan Chodankar
- Heatherwood & Wexham Park Hospitals NHS Foundation Trust, Slough, UK
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Closon F, Tulandi T. Future research and developments in hysteroscopy. Best Pract Res Clin Obstet Gynaecol 2015; 29:994-1000. [DOI: 10.1016/j.bpobgyn.2015.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 03/18/2015] [Indexed: 10/23/2022]
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Bongers M. Hysteroscopy and heavy menstrual bleeding (to cover TCRE and second-generation endometrial ablation). Best Pract Res Clin Obstet Gynaecol 2015; 29:930-9. [DOI: 10.1016/j.bpobgyn.2015.03.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 03/18/2015] [Indexed: 11/24/2022]
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Complications of hysteroscopy and how to avoid them. Best Pract Res Clin Obstet Gynaecol 2015; 29:982-93. [DOI: 10.1016/j.bpobgyn.2015.03.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 03/18/2015] [Indexed: 11/21/2022]
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Manoucheri E, Fuchs-Weizman N, Cohen SL, Wang KC, Einarsson J. MAUDE: analysis of robotic-assisted gynecologic surgery. J Minim Invasive Gynecol 2014; 21:592-5. [PMID: 24486535 DOI: 10.1016/j.jmig.2013.12.122] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 12/27/2013] [Accepted: 12/31/2013] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVE To evaluate the adverse events encountered during robotic gynecologic surgery, as reported to the FDA MAUDE database from January 2006 to December 2012. DESIGN Database search (Canadian Task Force classification III). INTERVENTION A search of the FDA MAUDE database was performed by brand name "da Vinci" and manufacturer "Intuitive Surgical." Reports reflecting gynecologic procedures either by description or procedure name were included. A record of reports was kept to ensure that no duplicates were added. The date and type of event (operator-related error, technical system failure, or surgical injuries attributed to use of the robot) and the clinical outcome were recorded. MEASUREMENTS AND MAIN RESULTS Twenty-six percent of reported events (n = 73) resulted in injury, and 8.5% (n = 24) resulted in death. Of note, although adnexal procedures were performed in <3% of the cohort, they accounted for 20% of the fatalities. Twenty-one percent of injuries were attributed to operator-related error, and 14% to technical system failure; 65% were not directly related to use of the robot. Fifteen deaths were reported during planned hysterectomy. Four of those were due to injury to a major blood vessel (iliac artery in 3, and aorta in 1), although a detailed description of how the injury occurred was absent from the event description. CONCLUSION It is important to continue to evaluate the occurrence of injuries during robot-assisted surgery in an effort to identify unique challenges associated with this advanced technology.
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Affiliation(s)
- Elmira Manoucheri
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Noga Fuchs-Weizman
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sarah L Cohen
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Karen C Wang
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jon Einarsson
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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Abstract
Global endometrial ablation techniques are a relatively new surgical technology for the treatment of heavy menstrual bleeding that can now be used even in an outpatient clinic setting. A comparison of global ablation versus earlier ablation technologies notes no significant differences in success rates and some improvement in patient satisfaction. The advantages of the newer global endometrial ablation systems include less operative time, improved recovery time, and decreased anesthetic risk. Ablation procedures performed in an outpatient surgical or clinic setting provide advantages both of potential cost savings for patients and the health care system and improved patient convenience.
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Affiliation(s)
- Sarah Woods
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, 853 Jefferson Avenue, Rm E102, Memphis, TN 38163, USA
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Minimally Invasive Endometrial Ablation Device Complications and Use Outside of the Manufacturersʼ Instructions. Obstet Gynecol 2012; 120:865-70. [DOI: 10.1097/aog.0b013e31826af4fe] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Abnormal uterine bleeding is one of the most common presenting complaints encountered in a gynecologist's office or primary care setting. The availability of diagnostic tools, such as ultrasound, endometrial sampling, and diagnostic hysteroscopy has made it possible to promptly diagnose and treat an increasing number of menstrual disorders in an office setting. The incorporation of newer medical therapies: antifibrinolytic drugs, shorter hormone-free interval oral contraceptive pills, and levonorgestrel inserts along with office minimally invasive treatments operative hysteroscopy and endometrial ablations have proven to be powerful therapeutic arsenals to provide short-term relief of abnormal uterine bleeding, and potentially, avoiding or delaying the hysterectomy.
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Kaunitz AM, Inki P. The levonorgestrel-releasing intrauterine system in heavy menstrual bleeding: a benefit-risk review. Drugs 2012; 72:193-215. [PMID: 22268392 DOI: 10.2165/11598960-000000000-00000] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Heavy menstrual bleeding (HMB) is a common problem in women of reproductive age and can cause irritation, inconvenience, self-consciousness and fear of social embarrassment. Our objective was to review and appraise literature identified from the MEDLINE and EMBASE databases to evaluate the clinical evidence and provide an update on the risks and benefits of using the levonorgestrel-releasing intrauterine system (LNG-IUS) in the treatment of HMB. The LNG-IUS consistently reduces menstrual blood loss (MBL) in women with HMB, including those with underlying uterine pathology or bleeding disorders. The available data suggest that it reduces MBL to a greater extent than other medical therapies, including combined oral contraceptives, oral progestogens (both short- or long-cycle regimens), tranexamic acid and oral mefenamic acid. In addition, the LNG-IUS and endometrial ablation appear to reduce MBL to a similar extent. The adverse effects reported with the LNG-IUS in women with HMB are similar to those typically observed in women using the system for contraception. Uterine perforations were not reported in any of the studies reviewed, but expulsion rates may be higher than in the general population of LNG-IUS users. Overall, the LNG-IUS has a positive effect on most quality-of-life domains, at least comparable to those achieved with hysterectomy or endometrial ablation, and is consistently a cost-effective option across a variety of countries and settings. In conclusion, the LNG-IUS is an effective treatment option for women with HMB, including those with underlying organic pathology or bleeding disorders.
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Affiliation(s)
- Andrew M Kaunitz
- Department of Obstetrics and Gynecology, University of Florida College of Medicine-Jacksonville, FL 32209, USA.
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Asgari Z, Moini A, Samiee H, Tehranian A, Mozafar-Jalali S, Sabet S. Endometrial ablation with the NovaSure system in Iran. Int J Gynaecol Obstet 2011; 114:73-5. [PMID: 21507403 DOI: 10.1016/j.ijgo.2010.12.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 12/11/2010] [Accepted: 03/22/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the rate of response to treatment with the NovaSure endometrial ablation device among Iranian women with menorrhagia. METHODS Twenty 35-50-year-old women with menorrhagia who were referred to Arash Hospital, Tehran, Iran, in 2008 were enrolled. They underwent endometrial ablation via the NovaSure system and were followed-up for 2 years. RESULTS The incidence of amenorrhea was 30.0% at the end of the 2-year follow-up period. Hypomenorrhea was reported by 40.0% of women. The mean number of days of bleeding per month decreased significantly, from 30.0 ± 6.4 days before treatment to 3.1 ± 2.6 days after 2 years (P < 0.001). The severity of bleeding decreased significantly within 2 years after treatment (P < 0.001). In total, 85.0% of women were satisfied and 90.0% had responded to treatment-as defined by amenorrhea, hypomenorrhea, or return to normal menstruation. CONCLUSION The NovaSure system is effective and should be considered by gynecologists for the treatment of menorrhagia.
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Affiliation(s)
- Zahra Asgari
- Department of Gynecology, Arash Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Iliodromiti S, Murage A. Multiple bowel perforations requiring extensive bowel resection and hysterectomy after microwave endometrial ablation. J Minim Invasive Gynecol 2011; 18:118-20. [PMID: 21195964 DOI: 10.1016/j.jmig.2010.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 07/23/2010] [Accepted: 07/29/2010] [Indexed: 11/28/2022]
Abstract
Heavy menstrual bleeding, or menorrhagia, is a primary cause of morbidity in women. Herein, we present the case of a 41-year-old woman who underwent day-surgery endometrial microwave ablation because of dysfunctional uterine bleeding. She had undergone previous laparoscopic sterilization, and had no other risk factors except for a retroverted uterus. The procedure was performed without any documented difficulties. The patient was readmitted the following day with clinical signs of acute abdomen. Emergency laparotomy revealed a large perforation on the anterior uterine wall, full-thickness burns in the distal ileum, and multiple ischemic areas in the ileum, cecum, and ascending colon secondary to microwave burns. A right hemicolectomy was required, with extended ileal resection and subtotal hysterectomy with ovarian conservation. Although microwave endometrial therapy seems to offer many advantages, in particular in terms of efficiency and technique, complications occur, and extensive safety measures must be implemented to prevent adverse effects such as occurred in this patient.
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Genital tract burns: a complication of MenoTreat thermal balloon ablation. Eur J Obstet Gynecol Reprod Biol 2010; 152:228-9. [DOI: 10.1016/j.ejogrb.2010.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2008] [Revised: 12/08/2009] [Accepted: 06/25/2010] [Indexed: 11/23/2022]
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Practical Tips for Office Hysteroscopy and Second-Generation “Global” Endometrial Ablation. J Minim Invasive Gynecol 2009; 16:384-99. [DOI: 10.1016/j.jmig.2009.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Revised: 03/23/2009] [Accepted: 04/03/2009] [Indexed: 11/19/2022]
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Kaunitz AM, Meredith S, Inki P, Kubba A, Sanchez-Ramos L. Levonorgestrel-releasing intrauterine system and endometrial ablation in heavy menstrual bleeding: a systematic review and meta-analysis. Obstet Gynecol 2009; 113:1104-1116. [PMID: 19384127 DOI: 10.1097/aog.0b013e3181a1d3ce] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the effects of the levonorgestrel intrauterine system and endometrial ablation in reducing heavy menstrual bleeding. DATA SOURCES Medline and EMBASE were searched online using Ovid up to January 2009, as well as the reference lists of published articles, to identify randomized controlled trials comparing the levonorgestrel intrauterine system with endometrial ablation in the treatment of heavy menstrual bleeding. METHODS OF STUDY SELECTION This systematic review and meta-analysis was restricted to randomized controlled trials in which menstrual blood loss was reported using pictorial blood loss assessment chart scores. TABULATION, INTEGRATION, AND RESULTS Six randomized controlled trials that included 390 women (levonorgestrel intrauterine system, n=196; endometrial ablation, n=194) were retrieved. Three studies pertained to first-generation endometrial ablation (manual hysteroscopy) and three to second-generation endometrial ablation (thermal balloon). Study characteristics and quality were recorded for each study. Data on the effect of treatment on pictorial blood loss assessment chart scores were abstracted, integrated with meta-analysis techniques, and presented as weighted mean differences. Both treatment modalities were associated with similar reductions in menstrual blood loss after 6 months (weighted mean difference, -31.96 pictorial blood loss assessment chart score [95% confidence interval (CI), -65.96 to 2.04]), 12 months (weighted mean difference, 7.45 pictorial blood loss assessment chart score [95% CI, -12.37 to 27.26]), and 24 months (weighted mean difference, -26.70 pictorial blood loss assessment chart score [95% CI, -78.54 to 25.15]). In addition, both treatments were generally associated with similar improvements in quality of life in five studies that reported this as an outcome. No major complications occurred with either treatment modality in these small trials. CONCLUSION Based on the meta-analysis of six randomized clinical trials, the efficacy of the levonorgestrel intrauterine system in the management of heavy menstrual bleeding appears to have similar therapeutic effects to that of endometrial ablation up to 2 years after treatment.
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Affiliation(s)
- Andrew M Kaunitz
- From the Department of Obstetrics and Gynecology, University of Florida College of Medicine-Jacksonville, Florida; Bayer Schering Pharma AG, Berlin, Germany; and Department of Obstetrics and Gynaecology, Guys, Kings & St Thomas' School of Medicine, London, United Kingdom
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Löning M, Soergel P, Hillemanns P. Fluorescence diagnosis and photodynamic therapy in intra-abdominal gynecologic diseases and breast cancer – A review. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.mla.2008.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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