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Applications of Ultrasound-Mediated Drug Delivery and Gene Therapy. Int J Mol Sci 2021; 22:ijms222111491. [PMID: 34768922 PMCID: PMC8583720 DOI: 10.3390/ijms222111491] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/11/2021] [Accepted: 10/19/2021] [Indexed: 12/14/2022] Open
Abstract
Gene therapy has continuously evolved throughout the years since its first proposal to develop more specific and effective transfection, capable of treating a myriad of health conditions. Viral vectors are some of the most common and most efficient vehicles for gene transfer. However, the safe and effective delivery of gene therapy remains a major obstacle. Ultrasound contrast agents in the form of microbubbles have provided a unique solution to fulfill the need to shield the vectors from the host immune system and the need for site specific targeted therapy. Since the discovery of the biophysical and biological effects of microbubble sonification, multiple developments have been made to enhance its applicability in targeted drug delivery. The concurrent development of viral vectors and recent research on dual vector strategies have shown promising results. This review will explore the mechanisms and recent advancements in the knowledge of ultrasound-mediated microbubbles in targeting gene and drug therapy.
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Abstract
Ultrasound is a readily available, safe and portable imaging modality that is widely applied in gynecology. However, there is limited guidance for its use intra-operatively especially with complex gynecological procedures. This narrative review examines the existing literature published on the use of intraoperative ultrasound (IOUS) in benign gynecology and in gynecological oncology. We searched for the following terms: ‘intraoperative,’ ‘ultrasonography,’ ‘gynecology’ and ‘oncology’ using Pubmed/Medline. IOUS can minimize complications and facilitate difficult benign gynecological procedures. There is also a role for its use in gynecological oncology surgery and fertility-sparing surgery. The use of IOUS in gynecological surgery is an emerging field which improves visualization in the surgical field and aids completion of minimally invasive techniques. Ultrasound (US) is a portable and safe imaging method that uses high frequency sound waves to visualize structures within the body. While most US examinations are done outside the body there is an emerging field which uses US devices within the body during surgery to aid complex procedures. This review examines the published literature on this technique in benign gynecology and in gynecological oncology. This review demonstrates the use of intraoperative US improves visualization and minimizes surgical complications.
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Santamaria X, Liu JH, Aghajanova L, Isaacson K, Movilla P, Fernandez H, Capmas P, Donnez J, Simón C. Should we consider alternative therapies to operative hysteroscopy for the treatment of Asherman syndrome? Fertil Steril 2020; 113:511-521. [PMID: 32111470 DOI: 10.1016/j.fertnstert.2020.01.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 01/20/2020] [Indexed: 12/30/2022]
Affiliation(s)
| | - James H Liu
- Department of Obstetrics and Gynecology, University Hospitals Cleveland, Cleveland, Ohio; Department of Reproductive Biology, Case Western Reserve University, Cleveland, Ohio
| | - Lusine Aghajanova
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford School of Medicine, Stanford, California
| | - Keith Isaacson
- Department of Minimally Invasive Gynecologic Surgery, Newton Wellesley Hospital, Newton, Massachusetts
| | - Peter Movilla
- Department of Minimally Invasive Gynecologic Surgery, Newton Wellesley Hospital, Newton, Massachusetts
| | - Hervé Fernandez
- Department of Gynecology and Obstetrics, AP-HP, GHU-Sud, Hospital Bicêtre, Le Kremlin Bicêtre, France; Faculty of medicine, University Paris-Sud Saclay, Le Kremlin Bicêtre, France; INSERM U1018, Centre of Research in Epidemiology and Population Health (CESP), Le Kremlin Bicêtre, France
| | - Perrine Capmas
- Department of Gynecology and Obstetrics, AP-HP, GHU-Sud, Hospital Bicêtre, Le Kremlin Bicêtre, France; Faculty of medicine, University Paris-Sud Saclay, Le Kremlin Bicêtre, France; INSERM U1018, Centre of Research in Epidemiology and Population Health (CESP), Le Kremlin Bicêtre, France
| | - Jacques Donnez
- Société de Recherche pour l'Infertilité (SRI), Brussels, Belgium
| | - Carlos Simón
- Department of Obstetrics & Gynecology, Valencia University & INCLIVA, Valencia, Spain; Department of Obstetrics & Gynecology, BIDMC Harvard University, Boston, Massachusetts; Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, Texas.
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Nishimura K, Yonezawa K, Fumoto S, Miura Y, Hagimori M, Nishida K, Kawakami S. Application of Direct Sonoporation from a Defined Surface Area of the Peritoneum: Evaluation of Transfection Characteristics in Mice. Pharmaceutics 2019; 11:pharmaceutics11050244. [PMID: 31121989 PMCID: PMC6571618 DOI: 10.3390/pharmaceutics11050244] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/14/2019] [Accepted: 05/20/2019] [Indexed: 02/07/2023] Open
Abstract
In the present study, we developed a sonoporation system, namely “direct sonoporation”, for transfecting the peritoneum from a defined surface area to avoid systematic side effects. Here, the transfection characteristics are explained because there is less information about direct sonoporation. Naked pDNA and nanobubbles were administered to diffusion cell attached to the visceral and parietal peritoneum from the liver and peritoneal wall surface, respectively. Then, ultrasound was irradiated. Direct sonoporation showed a higher transfection efficacy at the applied peritoneum site from the liver surface while other sites were not detected. Moreover, transgene expression was observed in the peritoneal mesothelial cells (PMCs) at the applied peritoneum site. No abnormality was observed in the inner part of the liver. Although transgene expression of the visceral peritoneum was tenfold higher than that of the parietal peritoneum, transgene expression was observed in the PMCs on both the applied peritoneum sites. These results suggest that direct sonoporation is a site-specific transfection method of the PMCs on the applied peritoneum site without transgene expression at other sites and show little toxicity in the inner tissues at the applied site via cavitation energy. This information is valuable for the development of an intraperitoneal sonoporation device for treatment of peritoneal diseases such as peritoneal fibrosis.
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Affiliation(s)
- Koyo Nishimura
- Department of Pharmaceutical Informatics, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki-shi, Nagasaki 852-8588, Japan.
| | - Keita Yonezawa
- Department of Pharmaceutical Informatics, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki-shi, Nagasaki 852-8588, Japan.
| | - Shintaro Fumoto
- Department of Pharmaceutics, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki-shi, Nagasaki 852-8588, Japan.
| | - Yusuke Miura
- Department of Pharmaceutical Informatics, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki-shi, Nagasaki 852-8588, Japan.
| | - Masayori Hagimori
- Department of Pharmaceutical Informatics, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki-shi, Nagasaki 852-8588, Japan.
| | - Koyo Nishida
- Department of Pharmaceutics, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki-shi, Nagasaki 852-8588, Japan.
| | - Shigeru Kawakami
- Department of Pharmaceutical Informatics, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki-shi, Nagasaki 852-8588, Japan.
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Urman B, Boza A, Ata B, Aksu S, Arslan T, Taskiran C. Intraoperative endoscopic ultrasound guidance for laparoscopic excision of invisible symptomatic deep intramural myomas. J OBSTET GYNAECOL 2017; 38:85-89. [PMID: 28764594 DOI: 10.1080/01443615.2017.1327515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aim of this study was to evaluate the feasibility of intraoperative endoscopic ultrasound guidance for excision of symptomatic deep intramural myomas that are not otherwise visible at laparoscopy. Seventeen patients with symptomatic deep intramural myomas who underwent laparoscopic myomectomy with intraoperative endoscopic ultrasound guidance were followed up and reported. All myomas were removed successfully. The endometrium was breached in one patient. All patients were relieved of their symptoms and three patients presenting with infertility conceived. There were no short- or long-term complications associated with the procedure. One patient who had multiple myomas necessitated intravenous iron treatment prior to discharge. Laparoscopic removal of small symptomatic deep intramural myomas is facilitated by the use of intraoperative endoscopic ultrasound that enables exact localisation and correct placement of the serosal incision. Impact statement What is already known on this subject: When the myoma is symptomatic, compressing the endometrium, does not show serosal protrusion and is not amenable to hysteroscopic resection, laparoscopic surgery may become challenging. What do the results of this study add: The use of intraoperative endoscopic ultrasound under these circumstances may facilitate the procedure by accurate identification of the myoma and correct placement of the serosal incision. What are the implications of these findings for clinical practice and/or further research: Intraoperative ultrasound should be more oftenly used to accurately locate deep intramural myomas to the end of making laparoscopy feasible and possibly decreasing recurrence by facilitating removal of otherwise unidentifiable disease.
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Affiliation(s)
- Bulent Urman
- a Department of Obstetrics and Gynecology , Koc University School of Medicine, Rumelifeneri Yolu , Istanbul , Turkey.,b Women's Health Centre , American Hospital , Istanbul , Turkey
| | - Aysen Boza
- b Women's Health Centre , American Hospital , Istanbul , Turkey
| | - Baris Ata
- a Department of Obstetrics and Gynecology , Koc University School of Medicine, Rumelifeneri Yolu , Istanbul , Turkey
| | - Sertan Aksu
- b Women's Health Centre , American Hospital , Istanbul , Turkey
| | - Tonguc Arslan
- b Women's Health Centre , American Hospital , Istanbul , Turkey
| | - Cagatay Taskiran
- a Department of Obstetrics and Gynecology , Koc University School of Medicine, Rumelifeneri Yolu , Istanbul , Turkey.,b Women's Health Centre , American Hospital , Istanbul , Turkey
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Vigoureux S, Fernandez H, Capmas P, Levaillant JM, Legendre G. Assessment of Abdominal Ultrasound Guidance in Hysteroscopic Metroplasty. J Minim Invasive Gynecol 2016; 23:78-83. [DOI: 10.1016/j.jmig.2015.08.882] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 08/18/2015] [Accepted: 08/19/2015] [Indexed: 11/28/2022]
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Zheng Y, Jiang Q, Lv YE, Liu F, Yang L. Role of laparoscopy as a minimally invasive procedure in treatment of ruptured uterine scar during second-trimester induction of abortion. J Obstet Gynaecol Res 2015; 42:464-6. [PMID: 26695381 DOI: 10.1111/jog.12917] [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: 03/12/2015] [Revised: 09/29/2015] [Accepted: 10/30/2015] [Indexed: 11/26/2022]
Abstract
Uterine rupture is an uncommon complication following termination of pregnancy and is usually accompanied by severe lower abdominal pain and shock caused by intra-abdominal hemorrhage. Laparotomy should be carried out promptly in order to repair the uterus or even to resect the uterus. Here we present a case of uterine rupture of a scarred uterus, which occurred during a second-trimester induced abortion. The patient was successfully treated by laparoscopy with the help of laparoscopic ultrasound. This case suggests an alternative, effective approach to the diagnosis and treatment of uterine rupture.
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Affiliation(s)
- Yanmei Zheng
- Department of Obstetrics and Gynecology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, People's Republic of China
| | - Qiaoying Jiang
- Department of Obstetrics and Gynecology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, People's Republic of China
| | - Ya-Er Lv
- Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, People's Republic of China
| | - Feng Liu
- Department of Urology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, People's Republic of China
| | - Liwei Yang
- Department of Obstetrics and Gynecology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, People's Republic of China
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Gong XH, Lu J, Liu J, Deng YY, Liu WZ, Huang X, Yang YH, Xu Q, Yu ZY. Segmentation of Uterus Using Laparoscopic Ultrasound by an Image-Based Active Contour Approach for Guiding Gynecological Diagnosis and Surgery. PLoS One 2015; 10:e0141046. [PMID: 26516767 PMCID: PMC4627783 DOI: 10.1371/journal.pone.0141046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 10/02/2015] [Indexed: 11/18/2022] Open
Abstract
In laparoscopic gynecologic surgery, ultrasound has been typically implemented to diagnose urological and gynecological conditions. We applied laparoscopic ultrasonography (using Esaote 7.5~10MHz laparoscopic transducer) on the retrospective analyses of 42 women subjects during laparoscopic extirpation and excision of gynecological tumors in our hospital from August 2011 to August 2013. The objective of our research is to develop robust segmentation technique for isolation and identification of the uterus from the ultrasound images, so as to assess, locate and guide in removing the lesions during laparoscopic operations. Our method enables segmentation of the uterus by the active contour algorithm. We evaluated 42 in-vivo laparoscopic images acquired from the 42 patients (age 39.1 ± 7.2 years old) and selected images pertaining to 4 cases of congenital uterine malformations and 2 cases of pelvic adhesions masses. These cases (n = 6) were used for our uterus segmentation experiments. Based on them, the active contour method was compared with the manual segmentation method by a medical expert using linear regression and the Bland-Altman analysis (used to measure the correlation and the agreement). Then, the Dice and Jaccard indices are computed for measuring the similarity of uterus segmented between computational and manual methods. Good correlation was achieved whereby 84%-92% results fall within the 95% confidence interval in the Student t-test) and we demonstrate that the proposed segmentation method of uterus using laparoscopic images is effective.
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Affiliation(s)
- Xue-Hao Gong
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University, Second People’s Hospital of Shenzhen, Shenzhen, China
| | - Jun Lu
- Department of Ultrasound, Second Clinical College of Jinan University, People’s Hospital of Shenzhen, Shenzhen, China
| | - Jin Liu
- Department of Obstetrics & Gynecology, First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Ying-Yuan Deng
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University, Second People’s Hospital of Shenzhen, Shenzhen, China
| | - Wei-Zong Liu
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University, Second People’s Hospital of Shenzhen, Shenzhen, China
| | - Xian Huang
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University, Second People’s Hospital of Shenzhen, Shenzhen, China
| | - Yong-Heng Yang
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University, Second People’s Hospital of Shenzhen, Shenzhen, China
| | - Qin Xu
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University, Second People’s Hospital of Shenzhen, Shenzhen, China
| | - Zhi-Ying Yu
- Department of Obstetrics & Gynecology, First Affiliated Hospital of Shenzhen University, Shenzhen, China
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Gong XH, Lu J, Liu J, Deng YY, Liu WZ, Huang X, Pirbhulal S, Yu ZY, Wu WQ. A novel ultrasound based approach for lesion segmentation and its applications in gynecological laparoscopic surgery. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2015; 38:709-20. [PMID: 26232250 DOI: 10.1007/s13246-015-0363-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 07/15/2015] [Indexed: 01/18/2023]
Abstract
Laparoscopic ultrasound (LUS) has been widely utilized as a surgical aide in general, urological, and gynecological applications. Our study summarizes the clinical applications of laparoscopic ultrasonography in laparoscopic gynecologic surgery. Retrospective analyses were performed on 42 women subjects using laparoscopic surgery during laparoscopic extirpation and excision of gynecological tumors in our hospital from August 2011 to August 2013. Specifically, the Esaote 7.5 × 10 MHz laparoscopic transducer was used to detect small residual lesions, as well as to assess, locate and guide in removing the lesions during laparoscopic operations. The findings of LUS were compared with those of preoperative trans-vaginal ultrasound, postoperative, and pathohistological examinations. In addition, a novel method for lesion segmentation was proposed in order to facilitate the laparoscopic gynecologic surgery. In our experiment, laparoscopic operation was performed using a higher frequency and more close to pelvic organs via laparoscopic access. LUS facilitates the ability of gynaecologists to find small residual lesions under laparoscopic visualization and their accurate diagnosis. LUS also helps to locate residual lesions precisely and provides guidance for the removal of residual tumor and eliminate its recurrence effectively. Our experiment provides a safer and more valuable assistance for clinical applications in laparoscopic gynecological surgery that are superior to trans-abdominal ultrasound and trans-vaginal ultrasound.
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Affiliation(s)
- Xue-Hao Gong
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University, Second People's Hospital of Shenzhen, Shenzhen, China
| | - Jun Lu
- Department of Ultrasound, Second Clinical College of Jinan University, People's Hospital of Shenzhen, Shenzhen, China
| | - Jin Liu
- Department of Obstetrics & Gynecology, First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Ying-Yuan Deng
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University, Second People's Hospital of Shenzhen, Shenzhen, China
| | - Wei-Zong Liu
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University, Second People's Hospital of Shenzhen, Shenzhen, China
| | - Xian Huang
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University, Second People's Hospital of Shenzhen, Shenzhen, China
| | - Sandeep Pirbhulal
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Zhi-Ying Yu
- Department of Obstetrics & Gynecology, First Affiliated Hospital of Shenzhen University, Shenzhen, China.
| | - Wan-Qing Wu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China.
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Matsushima T, Kaseki H, Iida S, Asakura H. Laser Hysterofiberscopic Intrauterine Surgery Guided by Laparoscopically Assisted Intra-Abdominal Sonohysterography: A Retrospective Review of 65 Patients. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2013.0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Takashi Matsushima
- Department of Obstetrics and Gynecology, Nippon Medical School Musashikosugi Hospital, Nakahara-ku, Kawasaki, Kanagawa, Japan
| | - Hisayuki Kaseki
- Department of Gynecology, Flowers & Forest Tokyo Hospital, Kita-ku, Tokyo, Japan
| | - Shinya Iida
- Department of Obstetrics and Gynecology, Nippon Medical School Musashikosugi Hospital, Nakahara-ku, Kawasaki, Kanagawa, Japan
| | - Hirobumi Asakura
- Department of Obstetrics and Gynecology, Nippon Medical School Musashikosugi Hospital, Nakahara-ku, Kawasaki, Kanagawa, Japan
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Kamel MA, El-Tawab SS, Aboel Enein L, El-Ashkar OS, El-Meniawy NA. Efficacy of Transrectal Three-Dimensional Ultrasound-Guided Hysteroscopic Metroplasty. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2013.0134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mostafa A.M. Kamel
- Department of Obstetrics and Gynecology, Shatby Maternity University Hospital, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sally S. El-Tawab
- Department of Obstetrics and Gynecology, Shatby Maternity University Hospital, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Loai Aboel Enein
- Obstetrics and Gynecology Hospital, Aim Shams University, Cairo, Egypt
| | - Osama S. El-Ashkar
- Department of Obstetrics and Gynecology, Shatby Maternity University Hospital, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Nehal A. El-Meniawy
- Department of Obstetrics and Gynecology, Shatby Maternity University Hospital, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Noyan V, Tiras MB, Oktem M, Guner H. Laparoscopic Ultrasonography in the Management of Ovarian Cysts. Gynecol Obstet Invest 2005; 60:63-6. [PMID: 15775686 DOI: 10.1159/000084477] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2004] [Accepted: 01/07/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of the study was to determine the role of laparoscopic ultrasonography in the management of ovarian cysts extirpated by means of endoscopic surgery. METHODS Laparoscopic ultrasonography was used during endoscopic surgery in 14 consecutive patients with an adnexal mass. The diagnostic accuracies of transvaginal and laparoscopic ultrasonography were compared according to the final pathological diagnosis. Estimations of the exact location of the ovarian mass by means of laparoscopic visualization and laparoscopic ultrasonography were compared. The presence of residual tumor tissue after cyst extirpation was monitored with laparoscopic ultrasonography. RESULTS Using laparoscopic ultrasound and transvaginal ultrasound the correct diagnosis was made in 12 of 14 (85.7%) and 9 of 14 (64.3%) patients, respectively (not significantly different). With laparoscopic visualization, the exact location of the ovarian tumor could be demonstrated in 57.1% (8/14) of the cases, while with laparoscopic ultrasonography precise visualization of the ovarian mass was achieved in all cases (not significantly different). Two patients were found to have residual tumor tissue in the ovary when laparoscopic ultrasonography was performed again after tumor extirpation. CONCLUSION Laparoscopic ultrasonography seems to be useful in patients with an adnexal mass managed by endoscopic surgery, in terms of evaluating the internal characteristics and predicting the histological diagnosis of the ovarian cyst, deciding on the correct placement of the incision to prevent unnecessary trauma to the ovary, and evaluation of the ovary after cyst extirpation to expose any residual tumor tissue.
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Affiliation(s)
- Volkan Noyan
- Department of Obstetrics and Gynecology, Kirikkale University School of Medicine, Kirikkale, Turkey.
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Abstract
PURPOSE OF REVIEW Gynecologists are well trained in office-based ultrasound, but are less experienced in the field of intraoperative ultrasound. Many gynecologic procedures may benefit from the use of real-time ultrasonography. The purpose of this review is to summarize the current use of intraoperative ultrasound in gynecologic procedures. RECENT FINDINGS Evaluation and assessment of the value of intraoperative ultrasound in gynecological procedures is essentially non-existent. The role of intraoperative ultrasound in gynecology is in its infancy, with anecdotal experience and literature involving predominantly case reports. Intraoperative ultrasound is helpful in laparoscopic myomectomy, particularly when the uterine contour is normal. It is also useful in defining pelvic anatomy in cases of complex reproductive procedures. Intraoperative ultrasound improves precision in characterizing ovarian lesions, particularly in the setting of endometriomas or dermoid cysts. It has been shown to decrease both operative time and complication rates in dilation and curettage procedures. Intraoperative ultrasound reduces recurrence and re-operation rates after hysteroscopy by facilitating more-complete resection of uterine myomas. Ultrasound guidance improves the efficiency of embryo transfer in in-vitro fertilization and could potentially be beneficial in other 'blind' gynecological procedures. SUMMARY Intraoperative ultrasound appears to be a safe and valuable tool for the gynecologic surgeon. Ultrasound improves visualization of anatomy, reduces complication and re-operation rates, and facilitates completion of more cases via less-invasive endoscopic approaches.
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Affiliation(s)
- Amy Criniti
- University of Washington, Department of Obstetrics & Gynecology, Division of Reproductive Endocrinology & Infertility, Seattle, WA 98195, USA
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14
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Letterie GS. Three-dimensional ultrasound-guided embryo transfer: a preliminary study. Am J Obstet Gynecol 2005; 192:1983-7; discussion 1987-8. [PMID: 15970868 DOI: 10.1016/j.ajog.2005.02.044] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Embryo transfer techniques have emerged as 1 of the most important variables during in vitro fertilization. Two-dimensional ultrasound guidance is an integral part of this procedure and a method to monitor catheter passage through the cervix into the endometrial cavity. Catheter placement may better be achieved with 3-dimensional monitoring to assess the relationship of the catheter tip to the uterine cavity. The purpose of this study was to compare the precision of catheter placement and position by 2- and 3-dimensional ultrasound. STUDY DESIGN Twenty-four patients were studied. The cervix, uterus, and endometrial cavity were prescreened in 2 dimensions at the midline in the longitudinal plane of the uterus. Embryo transfers were then performed under 2-dimensional guidance. After satisfactory catheter placement and transfer of the embryos, the catheter was held in place for 60 to 120 seconds. During this interval, an automated, single sweep of the uterus and endometrial cavity was performed for net volume acquisition. All images were stored and retrospectively reviewed. Embryo transfer catheter placement with 2-dimensional ultrasound guidance was then compared with the images obtained in 3 simultaneous planes. RESULTS Visualization of the embryo catheter tip with 2-dimensional ultrasound was achieved in all patients. These images suggested that the catheter was 2 cm from the uterine fundus and in the midline. Satisfactory 3-dimensional images for review and comparison were obtained in 21 of 24 patients. Three-dimensional ultrasound images confirmed placement and agreed with findings of 2-dimensional ultrasound images in 17 of 21 patients. In 4 patients, the catheter tip on 3-dimensional ultrasound was observed to be displaced either anteriorly or laterally from the ideal region as suggested by 2-dimensional ultrasound. In 1 case, the catheter tip on 3-dimensional ultrasound was observed to be far laterally in the region of the uterine cornua. CONCLUSION Two-dimensional ultrasound-guided embryo transfer continues to be the standard for image-guided transfers. Data of the present study suggest that the precision of catheter tip placement and consequently embryo transfer may be improved with 3-dimensional imaging. Four of 21 patients studied had catheter tip placement in a different and less-than-ideal area when studied with 3-dimensional ultrasound. Three-dimensional imaging may provide an improvement in embryo transfer technique and have a positive impact on overall pregnancy rates.
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Affiliation(s)
- Gerard S Letterie
- Center for Fertility and Reproductive Endocrinology, Virginia Mason Center, Seattle, WA, USA.
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Letterie GS, Catherino WH. A 7.5-MHz finger-grip ultrasound probe for real-time intraoperative guidance during complex reproductive surgical procedures. Am J Obstet Gynecol 2002; 187:1588-90. [PMID: 12501068 DOI: 10.1067/mob.2002.128400] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE A 7.5-MHz finger-grip probe was used to monitor intra-abdominal reproductive surgery in two groups of patients. STUDY DESIGN The first group of patients underwent transabdominal myomectomy for multiple uterine leiomyomas (n = 3) and the second group underwent uterine reconstruction and excision of obstructive uterine horn (n = 3). Intraoperative real-time imaging was accomplished by direct application of the finger-grip probe to the uterine serosa by using saline solution as a transmission media. Ultrasound imaging and surgical dissection were carried out both sequentially and simultaneously. RESULTS In the first group of patients, the finger-grip probe provided precise location of the leiomyomas and intraoperative guidance for dissection during the myomectomy. In the second group of patients, the finger probe provided images of intrauterine anatomy in one patient who had a normal-sized and normal-shaped uterus with an obstructed intracavitary horn and hematometrium. In two other patients, the obstructed uterine horn extended deep into the pelvis lateral to the vagina. Real-time imaging provided intraoperative monitoring of depth of dissection into the paravaginal space. CONCLUSION The finger-grip probe demonstrated intrauterine anatomy and enabled a more directed surgical approach, both in placement of uterine incisions for surgical reconstruction and excision of obstructed horns for mullerian abnormalities and in identification and dissection for leiomyomas.
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Affiliation(s)
- Gerard S Letterie
- Center for Fertility and Reproductive Endocrinology, Virginia Mason Medical Center, Seattle, WA 98110, USA
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