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Indraccolo U, Losavio E, Carone M. Applying graph theory to improve the quality of scientific evidence from textual information: Neural injuries after gynaecologic pelvic surgery for genital prolapse and urinary incontinence. Neurourol Urodyn 2023; 42:669-679. [PMID: 36648454 DOI: 10.1002/nau.25133] [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: 10/22/2022] [Revised: 12/07/2022] [Accepted: 01/06/2023] [Indexed: 01/18/2023]
Abstract
AIMS To provide the overall rate for all types of neurologic iatrogenic injuries during urogynaecologic surgery from textual data. METHODS Systematic research focused on complications of gynaecologic surgery and neurologic injuries in abstracts. Keywords concerning complications (cluster A), unspecific; neurologic issues (cluster B); surgery (generic words) (cluster C); specific gynaecologic operations (cluster D); and specific gynaecologic operations for pelvic organ prolapse and urinary incontinence (cluster E) were extracted. Associations among clusters of keywords were assessed by using multiple runs of text-mining software Semantic Brand Score (SBS, https://semanticbrandscore.com/#primary). Association scores were converted into probabilities. The rate of neurologic complications in urogynaecologic surgery was calculated ("a priori" probability) by applying Bayes' theorem. Textual estimates of neurological injuries in urogynaecologic surgery are 0.035554 (95% confidence intervals 0.019607-0.0515001; no quantitative data were found). To test if the probability calculated on textual information was the same as quantitative data reports ("a posteriori" probability), the rate of neurologic complication of all gynaecologic surgery was calculated using a meta-analytics approach and was compared with the textual analysis value. RESULTS The rate of neurologic complications in gynaecologic surgery after meta-analytic data synthesis has been 0.016489 (95% confidence intervals 0.012163-0.022320), which is equal to the textual estimate (0.016889, 95% confidence intervals 0.019607-0.051501). Therefore, 0.035554 is a reliable likelihood to observe a neurologic complication in urogynaecologic surgery. CONCLUSION Iatrogenic nerve injuries in urogynaecologic surgery are higher than whole gynaecologic surgery. Text-mining software SBS and probability conversion can provide reliable answers from overall scholars' opinions on unsolved clinical questions when better evidence is lacking.
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Affiliation(s)
- Ugo Indraccolo
- Maternal-Infantile Department, "Alto Chiascio" Hospital of Gubbio-Gualdo Tadino, Complex Operative Unit of Obstetrics and Gynecology, ASL 1 Umbria, Perugia, PG, Italy
| | - Ernesto Losavio
- IRCCS di Bari, Istituti Clinici Scientifici Maugeri, SPA SB, Pavia, Italy
| | - Mauro Carone
- IRCCS di Bari, Istituti Clinici Scientifici Maugeri, SPA SB, Pavia, Italy
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Abstract
A shortage of inpatient beds and nurses during the coronavirus disease 2019 pandemic has lent priority to safe same-day discharge after surgery. The minimally invasive nature of robotic surgery has allowed an increasing number of procedures to be done on an outpatient basis. Anesthetic management should be designed to complement the technical advantages of robotic surgery in facilitating early discharge.
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Postoperative Femoral Nerve Palsy and Meralgia Paresthetica after Gynecologic Oncologic Surgery. J Clin Med 2022; 11:jcm11216242. [DOI: 10.3390/jcm11216242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/11/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
Femoral nerve palsy and meralgia paresthetica following gynecologic cancer surgery are rare, but severe and long lasting. Here, we aimed to study their incidence, severity, possible risk factors and its time to remission. Between January 2008 and December 2017 976 gynecologic cancer patients were identified in our institutional database receiving surgery. Complete patient charts were reviewed retrospectively. Possible risk factors were analyzed by Fisher’s exact test. 441 (45.18%) out 976 were treated for Ovarian cancer. In total 23 patients were identified with a postoperative neurological leg disorder. A femoral nerve palsy was present in 15 patients (1.5%) and a meralgia paresthetica in 8 patients (0.82%). Three patients showed both disorders. Duration of surgery (p = 0.0000), positioning during surgery (p = 0.0040), femoral artery catheter (p = 0.0051), prior chemotherapy (p = 0.0007), nicotine abuse (p = 0.00456) and prior polyneuropathy (p = 0.0181) showed a significant association with a postoperative femoral nerve palsy. Nicotine abuse (p = 0.0335) and prior chemotherapy (p = 0.0151) were significant for the development of a meralgia paresthetica. Long lasting surgery, patient positioning and femoral arterial catheter placement are risk factors for a postoperative femoral nerve palsy in gynecologic cancer surgery. Polyneuropathy, nicotine abuse, and prior chemotherapy are predisposing risk factors for a femoral nerve palsy and a meralgia paresthetica. A resolution of symptoms is the rule for both disorders within different time schedules.
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Chen E, Kowalski JT. Natural history of postoperative neuropathies in gynecologic surgery. Int Urogynecol J 2022; 33:2471-2474. [PMID: 35384477 DOI: 10.1007/s00192-022-05183-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/04/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Neuropathy following pelvic surgery is an uncommon but important complication. The current literature about the natural history and treatment of these neuropathies is limited. We aim to describe the characteristics, treatments and natural history of postoperative neuropathy following benign gynecologic surgery. METHODS This retrospective case series included patients who underwent benign gynecologic surgery for ≥ 60 min in lithotomy. Patients with preexisting neurologic disease were excluded. Patient demographics, identification of postoperative neuropathy and details regarding evaluation and treatment were obtained from the medical record. Neuropathies were characterized by anatomic location and nerve/dermatome distribution. Duration of symptoms was classified as < 1 week, 1 week to 3 months or > 3 months with neuropathy symptoms grouped as resolved, persistent but improved or persistent. Data were analyzed with appropriate descriptive statistics, Pearson correlation and chi-square test. RESULTS The study included 2449 patients who had undergone benign gynecologic surgery, with 78 (3.2%) patients identified as having postoperative neuropathy. Most patients with neuropathies demonstrated either complete resolution [59 (75.6%)] or persistent but improved [13 (16.7%)] symptoms. Twenty-eight (35.9%) had symptoms of ≥ 3 months. Most neuropathies were sensory only [63 (80.8%)], and the most frequently documented nerve distribution was femoral [23 (29.5%)]. Evaluation and treatment of neuropathy most commonly included physical therapy consult [17 (21.8%)] and neurology consult [8 (10.3%)]. CONCLUSIONS The incidence of postoperative neuropathy in this large, benign gynecologic surgery population was 3.2%. Most neuropathies are sensory only and self-limited. While physical therapy was the most common treatment, most patients received no specific intervention.
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Affiliation(s)
- Edison Chen
- Carver College of Medicine, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Joseph T Kowalski
- Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, Iowa City, IA, 52245, USA.
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Hay AK, McDougall A, Hinstridge P, Rajakuldendran S, Yoong W. Prolonged brachial plexus neuropathy: a rare complication following protracted endometriosis surgery in Lloyd-Davies position. BMJ Case Rep 2021; 14:e243408. [PMID: 34844958 PMCID: PMC8634370 DOI: 10.1136/bcr-2021-243408] [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] [Accepted: 09/15/2021] [Indexed: 11/04/2022] Open
Abstract
Brachial plexus injury is a rare but potentially serious complication of laparoscopic surgery. Loss of motor and/or sensory innervation can have a significant impact on the patient's quality of life following otherwise successful surgery. A 38-year-old underwent elective laparoscopic management of severe endometriosis during which she was placed in steep head-down tilt Lloyd-Davies position for a prolonged period. On awakening from anaesthesia, the patient had no sensation or movement of her dominant right arm. A total plexus brachialis injury was suspected. As advised by a neurologist, an MRI brachial plexus, nerve conduction study and electromyography were requested. She was managed conservatively and made a gradual recovery with a degree of residual musculocutaneous nerve neuropathy. The incidence of brachial plexus injury following laparoscopy is unknown but the brachial plexus is particularly susceptible to injury as a result of patient positioning and prolonged operative time. Patient positioning in relation to applied clinical anatomy is explored and risk reduction strategies described.
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Affiliation(s)
- Anna Katrina Hay
- Obstetrics and Gynaecology, North Middlesex University Hospital NHS Trust, London, UK
| | - Anna McDougall
- Obstetrics and Gynaecology, North Middlesex University Hospital NHS Trust, London, UK
| | - Peter Hinstridge
- Obstetrics and Gynaecology, North Middlesex University Hospital NHS Trust, London, UK
| | | | - Wai Yoong
- Obstetrics and Gynaecology, North Middlesex University Hospital NHS Trust, London, UK
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Postoperative Lower Extremity Neuropathy With Boot Stirrups Compared With Candy Cane Stirrups. Obstet Gynecol 2021; 137:916-923. [PMID: 33831927 DOI: 10.1097/aog.0000000000004353] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/28/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess whether candy cane stirrup use is associated with an increased risk of lower extremity peripheral neuropathy compared with boot stirrups in women undergoing surgery requiring dorsal lithotomy positioning. METHODS This retrospective cohort study (June 2008-August 2015) included patients who underwent gynecologic surgery for benign indication lasting 60 minutes or longer in the lithotomy position. Patients with preexisting neurologic disease were excluded. Stirrup type, demographics, medical history, surgical factors, and relevant outcomes were collected from the medical record. Postoperative neuropathy was identified in clinical diagnoses or in physician documentation through the 6-week postoperative visit. Patient characteristics and outcomes were compared using Student's t test, χ2 test, or Fisher exact test. Logistic regression analysis was used to adjust for other clinical characteristics associated with the outcome at P≤.1. RESULTS The study included 2,449 patients, 1,838 (75.1%) with boot and 611 (24.9%) with candy cane stirrups. Women positioned in boot stirrups were younger (mean age 45.6 years [SD 13.5] vs 55.9 [SD 15.7] years; P<.001), heavier (mean body mass index [BMI] 31.5 [SD 8.7] vs 29.6 [SD 7.0]; P<.001), more likely to smoke (n=396 [21.5%] vs n=105 [17.2%]; P=.021), and had longer surgical duration (mean 176.5 minutes [SD 90.0] vs 145.3 [SD 63.9] minutes; P<.001), respectively. Diabetes (8.3%) did not differ between the groups (P=.122. Neuropathy occurred less often in the boot cohort (n=29, 1.6%, 95% CI 1.1-2.3%) than in the candy cane cohort (n=21, 3.4%, 95% CI 2.1-5.2%) (P=.008). After adjusting for age, BMI, smoking, anesthesia type and surgical time, only candy cane stirrup type (adjusted odds ratio [aOR] 2.87, 95% CI 1.59-5.19) and surgical time (per hour) (aOR 1.40, 95% CI 1.20-1.63) were independently associated with postoperative neuropathy. CONCLUSION Candy cane stirrups are associated with a significantly increased risk of lower extremity postoperative neuropathy compared with boot stirrups for women undergoing gynecologic surgery for benign indication.
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Furnas HJ, Canales FL, Pedreira RA, Comer C, Lin SJ, Banwell PE. The Safe Practice of Female Genital Plastic Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3660. [PMID: 34249585 PMCID: PMC8263325 DOI: 10.1097/gox.0000000000003660] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/15/2021] [Indexed: 01/11/2023]
Abstract
The purpose of this article is to guide surgeons in the safe practice of female genital plastic surgery when the number of such cases is steadily increasing. A careful review of salient things to look for in the patient's motivation, medical history, and physical examination can help the surgeon wisely choose best candidates. The anatomy is described, with particular attention given to the variations not generally described in textbooks or articles. Descriptions are included for labiaplasty, including clitoral hood reduction, majoraplasty, monsplasty, and perineoplasty with vaginoplasty. Reduction of anesthetic risks, deep venous thromboses, and pulmonary emboli are discussed, with special consideration for avoidance of nerve injury and compartment syndrome. Postoperative care of a variety of vulvovaginal procedures is discussed. Videos showing anatomic variations and surgical techniques of common female genital procedures with recommendations to reduce the complication rate are included in the article.
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Affiliation(s)
- Heather J. Furnas
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, Calif
- Plastic Surgery Associates, Santa Rosa, Calif
| | | | - Rachel A. Pedreira
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, Calif
| | - Carly Comer
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Samuel J. Lin
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
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Resectoscopic Surgery Part I: Overcoming Obstacles and Mastering the Basics. Surg Technol Int 2021. [PMID: 33942886 DOI: 10.52198/21.sti.38.gy1425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The introduction of the continuous flow gynecologic resectoscope (CFGR) in 1989 revolutionized minimally invasive gynecologic surgery (MIGS) by introducing such intrauterine procedures as hysteroscopic myomectomy, polypectomy, and endometrial ablation. However, with the subsequent introduction of global endometrial ablation (GEA) devices and hysteroscopic morcellators (HMs), the CFGR has fallen into relative disuse-a regrettable situation since it remains ideally suited for accomplishing many procedures that are otherwise not achievable with these newer technologies. Procedures which involve greater precision and control-endomyometrial resection (EMR), hysteroscopic metroplasty, the correction of isthmoceles, the resection of intramural myomas, and the management of late-onset endometrial ablation failure-are only possible with the CFGR. In addition, the CFGR permits a variety of functions that would otherwise require several different disposable platforms. Despite the benefits of the gynecologic resectoscope, there are clear impediments to its use including a scarcity of educational resources and trained experts, medico-legal concerns, institutional obstacles to organizing an operative team, and the need to develop and maintain an adequate caseload. In Part I of this three-part series, the author will review why the CFGR remains a relevant and indispensable tool for the minimally invasive gynecologic surgeon, the composition of an operating room team, and the instrumentation and skills necessary to accomplish basic resectoscopic surgery. In Part II, we will describe how ultrasound guidance can be used to assist the execution of more challenging intermediate-level cases. Finally, in Part III, we will discuss the most demanding cases for the resectoscopic surgeon-the treatment of post-ablation failures and the removal of intramural leiomyomas-which are clinical scenarios that require ultrasound guidance and well-honed resectoscopic surgical skills.
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Female pelvic medicine and reconstructive surgery challenges on behalf of the Collaborative Research in Pelvic Surgery Consortium: managing complicated cases. Int Urogynecol J 2021; 32:1373-1377. [PMID: 33580811 DOI: 10.1007/s00192-021-04702-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
This case presents the work-up and management of a patient experiencing acute kidney injury, urinary retention, and neuropathy following surgery for pelvic organ prolapse and stress urinary incontinence. Four international experts provide their evaluation of and approach to this complex case.
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10
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Abstract
LEARNING OBJECTIVES After studying this article, participants should be able to: (1) Identify the most appropriate type of anesthesia for the female genital plastic surgical patient and minimize risks of nerve injury and thromboembolic event through proper preoperative evaluation and knowledge of positioning. (2) Define the vulvovaginal anatomy, including common variants, and assess vulvovaginal tissues after childbirth and menopause. (3) Apply surgical techniques to minimize complications in female genital plastic surgery. (4) Classify the types of female genital mutilation/cutting and design methods of reconstruction after female genital mutilation/cutting. SUMMARY Female genital plastic surgery is growing in popularity and in numbers performed. This CME article covers several aspects of safety in the performance of these procedures. In choosing the best candidates, the impact of patient motivation, body mass index, parity, menopause and estrogen therapy is discussed. Under anesthesia, consideration for the risks associated with the dorsal lithotomy position and avoidance of compartment syndrome, nerve injury, deep venous thromboses, and pulmonary embolus are covered. Anatomical variations are discussed, as is the impact of childbirth on tissues and muscles. Surgical safety, avoidance of complications, and postoperative care of a variety of vulvovaginal procedures are discussed. Videos showing anatomical variations and surgical techniques of the most common female genital procedures with recommendations to reduce the complication rate are included in the article. Finally, female genital mutilation/cutting is defined, and treatment, avoidance of complications, and postoperative care are discussed.
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11
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Bommert M, Wagner JK, Sehouli J, Burges A, Schmalfeld B, Veldink H, Schrettenbrunner I, Fleisch M, Richter R, Harter P, Pietzner K. Perioperative management of positioning in gynecological cancersurgery: a national NOGGO-AGO intergroup survey. Int J Gynecol Cancer 2020; 30:1589-1594. [PMID: 32817308 DOI: 10.1136/ijgc-2020-001433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The daily clinical routine in the operating room includes patient positioning. The number of perioperative positioning-related complications is growing, along with the legal proceedings concerning this topic, and only a few guidelines exist to provide specific recommendations. The aim of this survey was to assess perioperative positioning and associated adverse events during gynecological cancer surgery in Germany. METHODS A total of 633 gynecological departments of primary, secondary, and maximum healthcare hospitals in Germany were invited to participate in this multiple-choice online questionnaire. The survey was conducted anonymously for a period of six months. The survey was divided into five different sections: descriptive information about the respondent department, pre- and postoperative management, management of positioning in the operating room based on two fictional case examples, and quality management. RESULTS The response rate of our survey was 29.1 % (184/633). Nearly half of the departments (46.7 %) reported to have had one to five patients with positioning-related complications during the prior 12 months, and 29.1 % had experienced a legal dispute due to positioning-related complications. Departments with more than 50 gynecologic-oncological surgeries per year more often reported positioning-related complications (p=0.003). Standard operating procedures exist in almost every department for laparoscopic (97 %) and open surgery (95.1 %), respectively. DISCUSSION The high number of positioning-related complications throughout all departments of different healthcare levels underlines the relevance of this issue and supports the need for a prospective European registry for further analysis. Training and education for all staff members should be routinely implemented to reduce and prevent positioning-related complications.
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Affiliation(s)
- Mareike Bommert
- Department of Gynecology and Gynecologic Oncology, Evangelische Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung Essen-Huttrop, Essen, Germany.,Young Academy of Gynecologic Oncology (JAGO), Berlin, Germany
| | - Jenny Katharina Wagner
- Young Academy of Gynecologic Oncology (JAGO), Berlin, Germany.,Department of Gynecology, Campus Mitte, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Jalid Sehouli
- Young Academy of Gynecologic Oncology (JAGO), Berlin, Germany.,Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Alexander Burges
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, University Hospital Munich Department of Gynecology and Obstetrics Grosshadern Campus, Munchen, Germany
| | - Barbara Schmalfeld
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hendrik Veldink
- Young Academy of Gynecologic Oncology (JAGO), Berlin, Germany.,Department of Obstetrics and Gynecology, Stiftung Mathias-Spital Rheine, Rheine, Germany
| | - Irmela Schrettenbrunner
- Young Academy of Gynecologic Oncology (JAGO), Berlin, Germany.,Department of Obstetrics and Gynecology, Sana Kliniken des Landkreises Cham GmbH, Cham, Germany
| | - Markus Fleisch
- Department of Obstetrics and Gynecology, Helios University Medical Center Wuppertal, Wuppertal, Germany
| | - Rolf Richter
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Evangelische Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung Essen-Huttrop, Essen, Germany
| | - Klaus Pietzner
- Young Academy of Gynecologic Oncology (JAGO), Berlin, Germany .,Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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Gupta A, Meriwether K, Tuller M, Sekula M, Gaskins J, Stewart JR, Hobson D, Cardenas-Trowers O, Francis S. Candy Cane Compared With Boot Stirrups in Vaginal Surgery: A Randomized Controlled Trial. Obstet Gynecol 2020; 136:333-341. [PMID: 32649498 DOI: 10.1097/aog.0000000000003954] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate differences in physical function at 6 weeks after vaginal surgery among women positioned in candy cane and boot stirrups. METHODS We conducted a single-masked, randomized controlled trial of women undergoing vaginal surgery with either candy cane or boot stirrup use. The primary outcome was a change in the PROMIS (Patient-Reported Outcomes Measurement Information System) physical function short form-20a from baseline to 6 weeks after surgery. To achieve 80% power to detect a moderate Cohen effect (d=0.5), we required 64 participants in each group. RESULTS From March 2018 to October 2019, 141 women were randomized, and 138 women (72 in the candy cane group and 66 in the boot stirrup group) were included in the final analysis. There were no baseline differences in participant characteristics including age, body mass index, comorbidities, or preoperative history of joint replacements. There were no between-group differences in surgery type, duration of surgery, estimated blood loss, or adverse events at 6 weeks postoperation. Participants in the candy cane group demonstrated worse physical function at 6 weeks compares with the improvement seen in those in the boot stirrup group; this was significantly different between groups (-1.9±7.9 candy cane vs 1.9±7.0 boot, P<.01). CONCLUSION Women undergoing vaginal surgery positioned in boot stirrups have significantly better physical function at 6 weeks after surgery when compared with women positioned in candy cane stirrups. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT03446950.
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Affiliation(s)
- Ankita Gupta
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, and the Department of Obstetrics & Gynecology, University of Louisville School of Medicine, and the Department of Bioinformatics & Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, Kentucky; the Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics & Gynecology, University of New Mexico, Albuquerque, New Mexico; and the Department of Obstetrics & Gynecology, Wayne State University School of Medicine, Detroit, Michigan
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13
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Abstract
BACKGROUND Candy cane stirrups are widely used for vaginal surgery because they provide sufficient operating space. When placed in the standard perpendicular alignment, however, these stirrups cause excessive flexion, abduction, and external rotation of the thigh, which may injure the femoral, lateral femoral cutaneous, sciatic, and common peroneal nerves. TECHNIQUE We corrected this deficiency by positioning the stirrups parallel to the operating table, just above and tilting slightly toward its lower break. After placing the patient in stirrups, we inserted a double-layer foam pad between her knee and the stirrup and adjusted the height of each stirrup until both thighs were flexed 90 degrees and both knees flexed 100 degrees. We then pushed the L-shaped lower stirrup toward or pulled it away from the operating table until each thigh was vertical, with minimal abduction or adduction. Finally, we rotated the curved upper stirrups medially until each leg was pointing slightly laterally. EXPERIENCE Of 1,576 vaginal cases, there were eight (0.5%) instances of postoperative sensory neuropathy, which usually involved the lateral femoral cutaneous nerve. CONCLUSION This simple modification to the candy cane stirrups allows placement of patients in dorsal lithotomy with their legs in an anatomically and neurologically neutral position.
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Slunsky P, Brunnberg M, Loderstedt S, Haake A, Brunnberg L. Effect of intraoperative positioning on postoperative neurological status in cats after perineal urethrostomy. J Feline Med Surg 2019; 21:931-937. [PMID: 30392433 PMCID: PMC11132246 DOI: 10.1177/1098612x18809188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate and quantify the changes in neurological status in cats after perineal urethrostomy performed in dorsal and ventral recumbency. METHODS This was a prospective, randomised study. Twenty male castrated cats with feline lower urinary tract disease presented for perineal urethrostomy were enrolled in this study. Surgery was performed in either dorsal recumbency (group A) or ventral recumbency (group B). Motor response of patellar tendon, gastrocnemius muscle, pelvic limb withdrawal and perineal reflexes, as well as the presence of spinal pain in the lumbosacral region, motor function of the tail and faecal continence, were examined before surgery, and 24 h and 14 days after surgery. RESULTS The animals had a mean weight of 5.07 ± 1.08 kg, with a mean age of 6.12 ± 1.85 years. Weight and age were not significantly different between groups A and B (both P = 0.897). All tested parameters of the neurological examination performed prior to surgery were considered normal in both groups (P = 1). The comparison between neurological examinations (perineal reflex and spinal pain) before and 24 h after surgery revealed a significantly decreased briskness of the perineal reflex and an increased occurrence of spinal pain 24 h after surgery (P = 0.043 and P = 0.031, respectively). However, the changes of aforementioned parameters were statistically insignificant (P = 0.249 and P = 0.141) between groups A and B. The other parameters (patellar tendon, pelvic limb withdrawal and gastrocnemius muscle reflexes, motor function of the tail and faecal continence) were statistically insignificant (P = 1) before surgery and 24 h after surgery, as well as between groups A and B 24 h after surgery. Results of all tested parameters were statistically insignificant (P = 1) before surgery and 14 days after surgery, as well as between groups A and B 14 days after surgery. CONCLUSIONS AND RELEVANCE The briskness of the perineal reflex was significantly decreased and the occurrence of spinal pain significantly increased 24 h after surgery. A parallel with a low-grade positioning-dependent nerve injury as described in human medicine may be drawn. However, no positioning method was proven to be superior to the other.
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Affiliation(s)
- Pavel Slunsky
- Small Animal Clinic, Faculty of Veterinary Medicine, Free University of Berlin, Berlin, Germany
| | - Mathias Brunnberg
- Small Animal Clinic, Faculty of Veterinary Medicine, Free University of Berlin, Berlin, Germany
| | - Shenja Loderstedt
- Small Animal Clinic, Faculty of Veterinary Medicine, Leipzig University, Leipzig, Germany
| | - Alexander Haake
- Justus Liebig University Giessen, Department of Veterinary Medicine, Giessen, Hesse, Germany
| | - Leo Brunnberg
- Small Animal Clinic, Faculty of Veterinary Medicine, Free University of Berlin, Berlin, Germany
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Alici HA, Ahiskalioglu A, Celik M, Demir U, Yayik AM. Ultrasound-guided pulsed radiofrequency to the ilio-inguinal/iliohypogastric nerves to manage chronic pain after caesarean delivery in a breast-feeding woman. Int J Obstet Anesth 2019; 40:157-159. [PMID: 31445791 DOI: 10.1016/j.ijoa.2019.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/02/2019] [Accepted: 04/05/2019] [Indexed: 11/18/2022]
Affiliation(s)
- H A Alici
- Ataturk University School of Medicine, Department of Anesthesiology and Reanimation, Erzurum, Turkey
| | - A Ahiskalioglu
- Ataturk University School of Medicine, Department of Anesthesiology and Reanimation, Erzurum, Turkey.
| | - M Celik
- Ataturk University School of Medicine, Department of Anesthesiology and Reanimation, Erzurum, Turkey
| | - U Demir
- Cankiri State Hospital, Department of Anesthesiology and Reanimation, Cankiri, Turkey
| | - A M Yayik
- Erzurum Regional and Training Hospital, Department of Anesthesiology and Reanimation, Erzurum, Turkey
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16
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Iwanaga J, Simonds E, Schumacher M, Kikuta S, Watanabe K, Tubbs RS. Revisiting the genital and femoral branches of the genitofemoral nerve: Suggestion for a more accurate terminology. Clin Anat 2019; 32:458-463. [PMID: 30592097 DOI: 10.1002/ca.23327] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 12/22/2018] [Indexed: 11/11/2022]
Abstract
The genitofemoral nerve is a branch of the lumbar plexus originating from the ventral rami of the first and second lumbar spinal nerves. During routine dissections of this nerve, we have occasionally observed that the genital branch of the genitofemoral nerve gave rise to the femoral branch, and the femoral branch of the genitofemoral nerve gave rise to the genital branch. Therefore, this study aimed to investigate the aforementioned distributions of the genitofemoral nerve in a large number of cadaveric specimens. Twenty-four sides from fourteen fresh-frozen cadavers derived from nine males and five females were used in this study. For proximal branches of the genitofemoral nerve, that is, as they first arise from the genitofemoral nerve, the terms "medial branch" and "lateral branch" were used. For the final distribution, the terms "genital branch" and "femoral branch" were used. On eight sides (33.3%) with nine branches, one or two branch(s) from either the medial or lateral branch became coursed as the femoral or genital branches (five became femoral and four became genital branches). Our study revealed that the distribution of the genitofemoral nerve is more complicated than previously described. The "medial branch" and "lateral branch" that we have used in the present study for describing the proximal branches of the genitofemoral nerve are more practical terms to describe the genitofemoral nerve. Clin. Anat. 32:458-463, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Joe Iwanaga
- Seattle Science Foundation, Seattle, Washington.,Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Japan
| | | | | | | | - Koichi Watanabe
- Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Japan
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington.,Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies
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Case report on rhabdomyolysis after minimally invasive surgery for squamous cell carcinoma of the uterine cervix and adhesions due to deep infiltrating endometriosis. Case Rep Womens Health 2018; 19:e00069. [PMID: 30094197 PMCID: PMC6071366 DOI: 10.1016/j.crwh.2018.e00069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/14/2018] [Accepted: 06/19/2018] [Indexed: 01/04/2023] Open
Abstract
Rhabdomyolysis is a rare clinical condition resulting from severe muscle damage that can cause potentially life-threatening complications. Amongst other causes, muscle compression due to patient positioning during prolonged surgery may result in extensive skeletal muscle breakdown. We report on a 39-year-old nulligravida who developed rhabdomyolysis after prolonged laparoscopic surgery for cervical cancer and adhesions due to deep infiltrating endometriosis. Minimally invasive surgical procedures offer major advantages in gynecologic cancer surgery, and preventive methods provide effective pressure reduction and play a crucial role in avoiding physical harm after surgical positioning. Nevertheless, a combination of surgical and patient-related risk factors may increase the risk of postsurgical onset of rhabdomyolysis. Immediate referral to a specialist center is necessary to ensure prevention of serious complications. Rhabdomyolysis is a rare complication in gynecologic minimally invasive surgery. Surgical and patient-related risk factors may increase the risk of postsurgical onset of rhabdomyolysis. Predisposing factors should be nonetheless be taken into account to avoid serious harm.
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18
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Corcione A, Angelini P, Bencini L, Bertellini E, Borghi F, Buccelli C, Coletta G, Esposito C, Graziano V, Guarracino F, Marchi D, Misitano P, Mori AM, Paternoster M, Pennestrì V, Perrone V, Pugliese L, Romagnoli S, Scudeller L, Corcione F. Joint consensus on abdominal robotic surgery and anesthesia from a task force of the SIAARTI and SIC. Minerva Anestesiol 2018; 84:1189-1208. [PMID: 29648413 DOI: 10.23736/s0375-9393.18.12241-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Minimally invasive surgical procedures have revolutionized the world of surgery in the past decades. While laparoscopy, the first minimally invasive surgical technique to be developed, is widely used and has been addressed by several guidelines and recommendations, the implementation of robotic-assisted surgery is still hindered by the lack of consensus documents that support healthcare professionals in the management of this novel surgical procedure. Here we summarize the available evidence and provide expert opinion aimed at improving the implementation and resolution of issues derived from robotic abdominal surgery procedures. A joint task force of Italian surgeons, anesthesiologists and clinical epidemiologists reviewed the available evidence on robotic abdominal surgery. Recommendations were graded according to the strength of evidence. Statements and recommendations are provided for general issues regarding robotic abdominal surgery, operating theatre organization, preoperative patient assessment and preparation, intraoperative management, and postoperative procedures and discharge. The consensus document provides evidence-based recommendations and expert statements aimed at improving the implementation and management of robotic abdominal surgery.
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Affiliation(s)
- Antonio Corcione
- Department of Critical Care Area, A.O. Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Pierluigi Angelini
- Department of General, Laparoscopic and Robotic Surgery, A.O. Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Lapo Bencini
- Division of Surgical Oncology and Robotics, Department of Oncology, Careggi University Hospital, Florence, Italy
| | - Elisabetta Bertellini
- Department of Anesthesia and Intensive Care, New Civile S. Agostino-Estense, Policlinico Hospital, Modena, Italy
| | - Felice Borghi
- Division of General and Surgical Oncology, Department of Surgery, S. Croce e Carle Hospital, Cuneo, Italy
| | - Claudio Buccelli
- Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giuseppe Coletta
- Division of Operating Room Management, Department of Emergency and Critical Care, S. Croce e Carle Hospital, Cuneo, Italy
| | - Clelia Esposito
- Department of Critical Care Area, A.O. Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Vincenzo Graziano
- Department of Anesthesia and Critical Care Medicine, Cardiothoracic Anesthesia and Intensive Care, Pisa University Hospital, Pisa, Italy
| | - Fabio Guarracino
- Department of Anesthesia and Critical Care Medicine, Cardiothoracic Anesthesia and Intensive Care, Pisa University Hospital, Pisa, Italy
| | - Domenico Marchi
- Department of General Surgery, New Civile S. Agostino-Estense, Policlinico Hospital, Modena, Italy
| | - Pasquale Misitano
- Unit of General and Mini-Invasive Surgery, Department of General Surgery, Misericordia Hospital, Grosseto, Italy
| | - Anna M Mori
- Department of Anesthesiology and Reanimation, IRCCS Policlinic San Matteo Foundation, Pavia, Italy
| | - Mariano Paternoster
- Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Vincenzo Pennestrì
- Department of Anesthesia and Intensive Care Medicine, Misericordia Hospital, Grosseto, Italy
| | - Vittorio Perrone
- Department of General and Transplant Surgery, Pisa University Hospital, Pisa, Italy
| | - Luigi Pugliese
- Unit of General Surgery 2, IRCCS Policlinic San Matteo, Foundation, Pavia, Italy
| | - Stefano Romagnoli
- Department of Anesthesia and Critical Care, Careggi University Hospital, Florence, Italy
| | - Luigia Scudeller
- Unit of Clinical Epidemiology, Scientific Direction, IRCCS Policlinic San Matteo Foundation, Pavia, Italy -
| | - Francesco Corcione
- Department of General, Laparoscopic and Robotic Surgery, A.O. Ospedali dei Colli, Monaldi Hospital, Naples, Italy
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Vecchio M, Santamato A, Geneovese F, Malaguarnera G, Catania VE, Latteri S. Iatrogenic nerve lesion following laparoscopic surgery. A case report. Ann Med Surg (Lond) 2018; 28:34-37. [PMID: 29744050 PMCID: PMC5938244 DOI: 10.1016/j.amsu.2018.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/14/2017] [Accepted: 02/10/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Peripheral neuropathy after surgical treatment is an under recognized potential untoward event. Pelvic surgery may be associated with nerve lesions by essentially three main mechanisms: transection, entrapment and pressure-stretching; the latter is the modality most frequently linked to patient's positioning on the operating room table. PRESENTATION OF THE CASE A 25 years old woman, after undergoing a laparoscopic gynaecologic procedure lasted >3 hours, on postoperative day one presented with numbness over her lateral right leg and dorsum of the foot, right foot drop and gait instability due to compression-stretching of the right superficial peroneal nerve. DISCUSSION Patient's diagnostic work up, treatment and outcome are reported and measures on how to prevent the occurrence of such type of lesion are outlined together with the importance of an early postoperative diagnosis in order to avoid permanent nerve damage. CONCLUSION Such lesions are sometimes so unexpected that delayed diagnosis leads to damages which are difficult or impossible to repair. Primary prevention plays a key role and it is realized by adhering to specific protocols. In the occurrence of the lesion a prompt diagnosis is highly recommendable and a comprehensive therapeutic plan is necessary to correctly address the specific pathology.
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Affiliation(s)
- Michele Vecchio
- Physical Medicine and Rehabilitation, A.O.U. Policlinico Vittorio Emanuele, University of Catania, Italy
| | - Andrea Santamato
- Department of Physical Medicine and Rehabilitation-“OORR Hospital”, University of Foggia, Italy
| | - Fortunato Geneovese
- Obstetrical Pathology Institute “S. Bambino Hospital”, A.O.U. Policlinico Vittorio Emanuele, University of Catania, Italy
- Department of General Surgery, Section of General Surgery and Oncology, University Medical School of Catania, Italy
| | | | - Vito Emanuele Catania
- Department of Medical-Surgical Sciences, and Advanced Technologies “G. F. Ingrassia”, University of Catania, Italy
| | - Saverio Latteri
- Cannizzaro Hospital, Operative Unit of General Surgery, Catania, Italy
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Takmaz O, Asoglu MR, Gungor M. Patient positioning for robot-assisted laparoscopic benign gynecologic surgery: A review. Eur J Obstet Gynecol Reprod Biol 2018; 223:8-13. [PMID: 29428480 DOI: 10.1016/j.ejogrb.2018.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/01/2018] [Accepted: 02/05/2018] [Indexed: 12/13/2022]
Abstract
Robotic surgical platforms are now in widespread use in the practice of gynecology all over the world. The introduction of robotic surgery has required some modifications of patient positioning when compared to standard laparoscopic surgery. Optimal patient positioning is likely to be the most essential step of robotic surgery as it provides the technical feasibility to have adequate access to the pelvic structures for performing the surgery. It is prudent to pay attention to preventing patient shifting in Trendelenburg position because of tendency of sliding down toward the direction of the head. Inappropriate patient positioning is associated with inadequate exposure of the operative field as well as detrimental complications that may lead to long-term side effects. These issues can be reduced with use of proper or strategic positioning technique. The purpose of this review is to highlight important points to properly position patient for robot-assisted laparoscopic benign gynecologic surgery and protect patient from position-related injuries.
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Affiliation(s)
- Ozguc Takmaz
- Acibadem Maslak Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey; Acibadem Mehmet Ali Aydinlar University, Department of Obstetrics and Gynecology, Division of Minimally Invasive Surgery, Istanbul, Turkey.
| | - Mehmet Resit Asoglu
- Acibadem Maslak Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Mete Gungor
- Acibadem Maslak Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey; Acibadem Mehmet Ali Aydinlar University, Department of Obstetrics and Gynecology, Division of Minimally Invasive Surgery, Istanbul, Turkey
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21
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Comparison of the Memory Foam Pad Versus the Bean Bag with Shoulder Braces in Preventing Patient Displacement during Gynecologic Laparoscopic Surgery. J Minim Invasive Gynecol 2018; 25:153-157. [DOI: 10.1016/j.jmig.2017.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 09/08/2017] [Accepted: 09/11/2017] [Indexed: 11/21/2022]
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22
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Treszezamsky AD, Fenske S, Moshier EL, Ascher-Walsh CJ. Neurologic injury and patient displacement in gynecologic laparoscopic surgery using a beanbag and shoulder supports. Int J Gynaecol Obstet 2017; 140:26-30. [DOI: 10.1002/ijgo.12325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/02/2017] [Accepted: 09/15/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Alejandro D. Treszezamsky
- Division of Gynecology; Department of Obstetrics and Gynecology; Icahn School of Medicine at Mt. Sinai; New York NY USA
- South Texas Urogynecology; San Antonio TX USA
| | - Suzanne Fenske
- Division of Gynecology; Department of Obstetrics and Gynecology; Icahn School of Medicine at Mt. Sinai; New York NY USA
| | - Erin L. Moshier
- Division of Biostatistics; Department of Preventive Medicine; Icahn School of Medicine at Mt. Sinai; New York NY USA
| | - Charles J. Ascher-Walsh
- Division of Gynecology; Department of Obstetrics and Gynecology; Icahn School of Medicine at Mt. Sinai; New York NY USA
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23
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Ramdhan RC, Loukas M, Tubbs RS. Anatomical complications of hysterectomy: A review. Clin Anat 2017; 30:946-952. [PMID: 28762535 DOI: 10.1002/ca.22962] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 07/26/2017] [Indexed: 01/23/2023]
Abstract
Hysterectomy is the most commonly performed gynecological procedure in the United States with three possible surgical approaches; vaginal, abdominal and laparoscopic. As with any surgical procedure, various anatomical complications can arise. These include injuries to anatomical structures such as the urinary bladder, ureter, intestines, rectum, anus, and a multitude of nervous structures. Other complications include sexual dysfunction, vaginal cuff dehiscence, and urinary incontinence. Using standard search engines, the anatomical complications of hysterectomies are reviewed. In conclusion, surgeons who perform hysterectomies or are involved with postoperative hysterectomy patients should be familiar with the possible complications of this common procedure and the steps that can be taken to help reduce the risk of those complications. Clinicians should also inform their patients of the potential complications as they can affect lifestyle and comfort. Clin. Anat. 30:946-952, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Rebecca C Ramdhan
- Department of Anatomical Sciences, St. George's University, Grenada, West Indies.,Seattle Science Foundation, Seattle, Washington
| | | | - R Shane Tubbs
- Department of Anatomical Sciences, St. George's University, Grenada, West Indies.,Seattle Science Foundation, Seattle, Washington
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24
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Zillioux JM, Krupski TL. Patient positioning during minimally invasive surgery: what is current best practice? ROBOTIC SURGERY : RESEARCH AND REVIEWS 2017; 4:69-76. [PMID: 30697565 PMCID: PMC6193419 DOI: 10.2147/rsrr.s115239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Introduction Positioning injuries are a known surgical complication and can result in significant patient morbidity. Studies have shown a small but significant number of neurovascular injuries associated with minimally invasive surgery, due to both patient and case-specific factors. We sought to review the available literature in regards to pathophysiological and practical recommendations. Methods A literature search was conducted and categorized by level of evidence, with emphasis on prospective studies. The result comprised 14 studies, which were summarized and analyzed with respect to our study objectives. Results While incidence of positioning injury has been identified in up to one-third of prospective populations, its true prevalence after surgery is likely 2%-5%. The mechanism is thought to be intraneural disruption from stretching or pressure, which results in decreased perfusion. On a larger scale, this vascular compromise can lead to ischemia and rhabdomyolysis. Prevention hinges on addressing patient modifiable factors such as body mass index, judicious positioning with appropriate devices, and intraoperative team awareness consisting of recurrent extremity checks and time management. Conclusion The risk for positioning injuries is underappreciated. Surgeons who perform minimally invasive surgery should discuss the potential for these complications with their patients, and operative teams should take steps to minimize risk factors.
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Affiliation(s)
| | - Tracey L Krupski
- Department of Urology, University of Virginia, Charlottesville, VA, USA,
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25
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[Imaging of the lumbosacral plexus : Diagnostics and treatment planning with high-resolution procedures]. Radiologe 2017; 57:195-203. [PMID: 28213852 DOI: 10.1007/s00117-017-0222-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Technical advances in magnetic resonance (MR) and ultrasound-based neurography nowadays facilitate the radiological assessment of the lumbosacral plexus. OBJECTIVE Anatomy and imaging of the lumbosacral plexus and diagnostics of the most common pathologies. MATERIAL AND METHODS Description of the clinically feasible combination of magnetic resonance imaging (MRI) and ultrasound diagnostics, case-based illustration of imaging techniques and individual advantages of MRI and ultrasound-based diagnostics for various pathologies of the lumbosacral plexus and its peripheral nerves. RESULTS High-resolution ultrasound-based neurography (HRUS) is particularly valuable for the assessment of superficial structures of the lumbosacral plexus. Depending on the examiner's experience, anatomical variations of the sciatic nerve (e. g. relevant in piriformis syndrome) as well as more subtle variations, for example as seen in neuritis, can be sonographically depicted and assessed. The use of MRI enables the diagnostic evaluation of more deeply located nerve structures, such as the pudendal and the femoral nerves. Modern MRI techniques, such as peripheral nerve tractography allow three-dimensional depiction of the spatial relationship between nerves and local tumors or traumatic alterations. This can be beneficial for further therapy planning. CONCLUSION The anatomy and pathology of the lumbosacral plexus can be reliably imaged by the meaningful combination of MRI and ultrasound-based high resolution neurography.
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27
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Nerve Injuries in Gynecologic Laparoscopy. J Minim Invasive Gynecol 2017; 24:16-27. [DOI: 10.1016/j.jmig.2016.09.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 09/02/2016] [Accepted: 09/07/2016] [Indexed: 11/30/2022]
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Abstract
Adverse events associated with hysteroscopic procedures are generally rare, but, with increasing operative complexity, it is now apparent that they are experienced more often. There exists a spectrum of complications that relate to generic components of procedures, such as patient positioning, anesthesia, and analgesia, to a number that are specific to intraluminal endoscopic surgery that largely comprise perforation and injuries to surrounding structures and blood vessels. Whereas a number of endoscopic procedures require the use of distending media, the response of premenopausal women to excessive absorption of nonionic fluids used for hysteroscopy is somewhat unique, and deserves special attention on the part the surgeon. There is also an increasing awareness of uncommon but problematic sequelae related to the use of monopolar radiofrequency uterine resectoscopes that involve thermal injury to the vulva and vagina. Furthermore, the uterus that has previously undergone hysteroscopic surgery may behave in unusual ways, at least in premenopausal women who experience menstruation or who become pregnant. Fortunately, better understanding of the mechanisms involved in these adverse events, as well as the use or development of a number of innovative devices, have collectively provided the opportunity to perform hysteroscopic and resectoscopic surgery in a manner that minimizes risk to the patient.
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30
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Sakai T, Murata H, Hara T. A case of scrotal pain associated with genitofemoral nerve injury following cystectomy. J Clin Anesth 2016; 32:150-2. [DOI: 10.1016/j.jclinane.2016.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 01/27/2016] [Accepted: 02/16/2016] [Indexed: 10/21/2022]
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Skinner B, Morgan H, Kobernik E, Kamdar N, Curran D, Marzano D, Hammoud M. The Decision to Incision Curriculum: Teaching Preoperative Skills and Achieving Level 1 Milestones. JOURNAL OF SURGICAL EDUCATION 2016; 73:735-740. [PMID: 27137663 DOI: 10.1016/j.jsurg.2016.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 02/10/2016] [Accepted: 02/29/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of a preoperative skills curriculum, and to assess and document competence in associated Obstetrics and Gynecology Level 1 Milestones. DESIGN The Decision to Incision curriculum was developed by a team of medical educators with the goal of teaching and evaluating 5 skills pertinent to Milestone 1: Preoperative consent, patient positioning, Foley catheter placement, surgical scrub, and preoperative time-out. Competence, overall skill performance, and knowledge were assessed by evaluator rating using checklists before and after the educational intervention. Differences between preintervention and postintervention skills performance and competence were assessed using Wilcoxon rank test and Fisher exact test, respectively. SETTING Clinical Simulation Center at an academic medical center. PARTICIPANTS Overall, 29 fourth year medical students matriculating into Obstetrics and Gynecology residencies. RESULTS The proportion of participants meeting Milestone competence significantly increased in all 5 skills, with competence achieved in 95.6% (95% CI: 92.1-99.0) of posttest skills assessments. Median overall performance also significantly improved for all 5 skills, with 83.6% (95% CI: 77.3-89.9) earning scores of 4 out of 5 or greater on the posttest. For knowledge testing, the proportion of correct responses significantly increased for both topics evaluated, from 45.2% to 99.7% (p < 0.0001) for positioning and from 32.8% to 83.1% (p < 0.0001) for time-out. CONCLUSIONS The decision to incision curriculum significantly improved preoperative skills, including skills that may be required on day 1 of residency. This curriculum also facilitated achievement and documentation of competence in multiple Milestones.
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Affiliation(s)
- Bethany Skinner
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan.
| | - Helen Morgan
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Emily Kobernik
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Neil Kamdar
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Diana Curran
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan
| | - David Marzano
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Maya Hammoud
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan
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Watanabe T, Sekine M, Enomoto T, Baba H. The utility of anatomic diagnosis for identifying femoral nerve palsy following gynecologic surgery. J Anesth 2015; 30:317-9. [PMID: 26661449 DOI: 10.1007/s00540-015-2113-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 11/22/2015] [Indexed: 11/24/2022]
Abstract
We describe a case in which an anatomic diagnosis was useful for diagnosing and estimating the cause of femoral nerve palsy following gynecologic surgery. A 49-year-old female received general and epidural anesthesia for radical ovarian cancer surgery. Although injection pain was noted in the left medial shin with 1 % mepivacaine administered as a test dose, the catheter was left indwelling because it improved her symptoms. The surgery, which lasted 195 min, was performed in the lithotomy position, and a self-retained retractor was used to gain a good surgical field. Postoperatively, the patient complained of difficulty in stretching her knee joint and left lower limb paresthesia that did not improve after stopping continuous epidural administration. A spinal cord injury related to epidural anesthesia was suspected because the sites of sensory impairment and epidural injection pain were the same; however, the patient had greater weakness of the quadriceps muscle than the iliopsoas, and no other muscle weakness was observed. These findings and previous reports suggest that her femoral nerve palsy was caused by compression of the inguinal ligament from the self-retaining retractor and lithotomy position. Twenty months after surgery, her muscle strength had fully recovered.
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Affiliation(s)
- Tatsunori Watanabe
- Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, Asahimachi 1-757, Chuo-ku, Niigata, 951-8510, Japan.
| | - Masayuki Sekine
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Asahimachi 1-757, Chuo-ku, Niigata, 951-8510, Japan
| | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Asahimachi 1-757, Chuo-ku, Niigata, 951-8510, Japan
| | - Hiroshi Baba
- Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, Asahimachi 1-757, Chuo-ku, Niigata, 951-8510, Japan
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Colsa Gutiérrez P, Viadero Cervera R, Morales-García D, Ingelmo Setién A. Intraoperative peripheral nerve injury in colorectal surgery. An update. Cir Esp 2015; 94:125-36. [PMID: 26008880 DOI: 10.1016/j.ciresp.2015.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 02/04/2015] [Accepted: 03/08/2015] [Indexed: 12/15/2022]
Abstract
Intraoperative peripheral nerve injury during colorectal surgery procedures is a potentially serious complication that is often underestimated. The Trendelenburg position, use of inappropriately padded armboards and excessive shoulder abduction may encourage the development of brachial plexopathy during laparoscopic procedures. In open colorectal surgery, nerve injuries are less common. It usually involves the femoral plexus associated with lithotomy position and self-retaining retractor systems. Although in most cases the recovery is mostly complete, treatment consists of physical therapy to prevent muscular atrophy, protection of hypoesthesic skin areas and analgesics for neuropathic pain. The aim of the present study is to review the incidence, prevention and management of intraoperative peripheral nerve injury.
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Affiliation(s)
- Pablo Colsa Gutiérrez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Sierrallana , Torrelavega, Cantabria, España.
| | | | - Dieter Morales-García
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - Alfredo Ingelmo Setién
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Sierrallana , Torrelavega, Cantabria, España
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Harma M, Sel G, Açıkgöz B, Harma Mİ. Successful obturator nerve repairing: Intraoperative sural nerve graft harvesting in endometrium cancer patient. Int J Surg Case Rep 2014; 5:345-6. [PMID: 24814984 PMCID: PMC4066562 DOI: 10.1016/j.ijscr.2014.03.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 03/24/2014] [Accepted: 03/28/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Intraoperative injury of obturator nerve is a rare complication of gynecologic surgeries, it has been reported especially in patients with endometriosis and genitourinary malignancies. Gynecologic patients undergoing open lymphadenectomy are at increased risk of obturator nerve injury. PRESENTATION OF CASE A 60-year-old woman with FIGO stage II Grade II endometrial adenocarcinoma underwent bilateral pelvic paraaortic lymphadenectomy. During right obturator lymph node dissection, the right obturator nerve was inadvertently transected with Harmonic scalpel sealing system. The graft was used to anastomose epyneurium of distal segment of obturator nerve to its counterpart in the proximal segment with 10–0 prolen suture. DISCUSSION In case of iatrogenic nerve transection, microsurgical end to end tension-free coaptation is advocated. In case of the obturator nerve is fixed and because of the thermal injury end to end alignment can not be achieved, nerve grafting is necessary. CONCLUSION According to our knowledge, successful immediate grafting of iatrogenically damaged obturator nerve during pelvic lymphadenectomy in our patient is the third report of such a case, but also it has a unique feature of being the first obturator nerve repairing case after dissected with tissue sealing system which causes large sealed area that does not make it possible to make end-to-end anastomosis without nerve harvesting.
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Affiliation(s)
- Müge Harma
- Department of Gynecology and Obstetrics, Bulent Ecevit University, Zonguldak, Turkey
| | - Görker Sel
- Department of Gynecology and Obstetrics, Bulent Ecevit University, Zonguldak, Turkey.
| | - Bektaş Açıkgöz
- Department of Neurosurgery, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Mehmet İbrahim Harma
- Department of Gynecology and Obstetrics, Bulent Ecevit University, Zonguldak, Turkey
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Soldatos T, Andreisek G, Thawait GK, Guggenberger R, Williams EH, Carrino JA, Chhabra A. High-resolution 3-T MR neurography of the lumbosacral plexus. Radiographics 2014; 33:967-87. [PMID: 23842967 DOI: 10.1148/rg.334115761] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The lumbosacral plexus comprises a network of nerves that provide motor and sensory innervation to most structures of the pelvis and lower extremities. It is susceptible to various traumatic, inflammatory, metabolic, and neoplastic processes that may lead to lumbrosacral plexopathy, a serious and often disabling condition whose course and prognosis largely depend on the identification and cure of the causative condition. Whereas diagnosis of lumbrosacral plexopathy has traditionally relied on patients' medical history, clinical examination, and electrodiagnostic tests, magnetic resonance (MR) neurography plays an increasingly prominent role in noninvasive characterization of the type, location, and extent of lumbrosacral plexus involvement and is developing into a useful diagnostic tool that substantially affects disease management. With use of 3-T MR imagers, improved coils, and advanced imaging sequences, which provide exquisite spatial resolution and soft-tissue contrast, MR neurography provides excellent depiction of the lumbrosacral plexus and its peripheral branches and may be used to confirm a diagnosis of lumbrosacral plexopathy with high accuracy or provide superior anatomic information should surgical intervention be necessary.
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Affiliation(s)
- Theodoros Soldatos
- Russell H. Morgan Department of Radiology and Radiological Science and Department of Plastic Surgery, Johns Hopkins Hospital, 601 N Caroline St, Baltimore, MD 21287, USA
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Kuponiyi O, Alleemudder DI, Latunde-Dada A, Eedarapalli P. Nerve injuries associated with gynaecological surgery. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/tog.12064] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Olayemi Kuponiyi
- Queen Alexandra Hospital; Southwick Hill Road Cosham Portsmouth PO6 3LY UK
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A comparison of shoulder pressure among different patient stabilization techniques. Am J Obstet Gynecol 2013; 209:478.e1-5. [PMID: 23707805 DOI: 10.1016/j.ajog.2013.05.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 05/07/2013] [Accepted: 05/20/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the pressure placed on the shoulders as a function of varying degrees of head-down tilt (the Trendelenburg position) and to compare these pressures among 3 different patient-positioning systems. STUDY DESIGN Participants were placed in the dorsal-lithotomy position with arms tucked and tilted at 5, 10, 15, 20, 25, and 30 degrees of head-down tilt. Using a manometer, we measured the pressure (centimeters of water) on the shoulders at each angle for 3 support devices: the Skytron shoulder support (Skytron, Grand Rapids, MI), the Allen shoulder support (Allen Medical Systems, Acton, MA), and the Allen Hug-u-Vac. RESULTS Among 23 participants, body mass index (mean ± SD) was 24.5 ± 4.3 kg/m(2). As the tilt angle increased, so did the shoulder pressure for all support systems. At a 30-degree Trendelenburg position, the Allen Hug-u-Vac transmitted less pressure to the shoulders than the Skytron (right and left, P < .001) and the Allen shoulder supports system (right, P < .001; left, P = .434). Each participant was asked, "Which system was most comfortable?" Seventy-four percent of the participants reported that they preferred the Hug-u-Vac (P < .001). CONCLUSION Shoulder pressure increases as tilt angle increases. Of the 3 support systems that were tested, the Allen Hug-u-Vac transmitted less pressure to the shoulders at a 30-degree Trendelenburg position than the Skytron and the Allen shoulder support systems.
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Singh L, Stevens EE. Leg Pain and Gynecologic Malignancy. Am J Hosp Palliat Care 2013; 30:594-600. [DOI: 10.1177/1049909112460422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Gynecologic malignancies affect more than 83 000 women in the United States, each year. Because the disease involves the pelvis, many patients have side effects distal to this area in their lower extremities. The differential diagnosis of leg pain can be divided into vascular, neurologic, and musculoskeletal causes. In this review article, we address numerous etiologies of leg pain, reviewing the prevalence of disease, physical examination findings, diagnostic as well as treatment modalities.
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Affiliation(s)
- Lilly Singh
- Department of Obstetrics & Gynecology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Erin E. Stevens
- Department of Obstetrics & Gynecology, SUNY Downstate Medical Center, Brooklyn, NY, USA
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Abstract
Hysterectomy is the most common gynecologic procedure performed in the United States, with more than 600,000 procedures performed each year. Complications of hysterectomy vary based on route of surgery and surgical technique. The objective of this article is to review risk factors associated with specific types of complications associated with benign hysterectomy, methods to prevent and recognize complications, and appropriate management of complications. The most common complications of hysterectomy can be categorized as infectious, venous thromboembolic, genitourinary (GU) and gastrointestinal (GI) tract injury, bleeding, nerve injury, and vaginal cuff dehiscence. Infectious complications after hysterectomy are most common, ranging from 10.5% for abdominal hysterectomy to 13.0% for vaginal hysterectomy and 9.0% for laparoscopic hysterectomy. Venous thromboembolism is less common, ranging from a clinical diagnosis rate of 1% to events detected by more sensitive laboratory methods of up to 12%. Injury to the GU tract is estimated to occur at a rate of 1-2% for all major gynecologic surgeries, with 75% of these injuries occurring during hysterectomy. Injury to the GI tract after hysterectomy is less common, with a range of 0.1-1%. Bleeding complications after hysterectomy also are rare, with a median range of estimated blood loss of 238-660.5 mL for abdominal hysterectomy, 156-568 mL for laparoscopic hysterectomy, and 215-287 mL for vaginal hysterectomy, with transfusion only being more likely after laparoscopic compared to vaginal hysterectomy (odds ratio 2.07, confidence interval 1.12-3.81). Neuropathy after hysterectomy is a rare but significant event, with a rate of 0.2-2% after major pelvic surgery. Vaginal cuff dehiscence is estimated at a rate of 0.39%, and it is more common after total laparoscopic hysterectomy (1.35%) compared with laparoscopic-assisted vaginal hysterectomy (0.28%), total abdominal hysterectomy (0.15%), and total vaginal hysterectomy (0.08%). With an emphasis on optimizing surgical technique, recognition of surgical complications, and timely management, we aim to minimize risk for women undergoing hysterectomy.
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Wilson M, Ramage L, Yoong W, Swinhoe J. Femoral neuropathy after vaginal surgery: a complication of the lithotomy position. J OBSTET GYNAECOL 2011; 31:90-1. [PMID: 21281008 DOI: 10.3109/01443615.2010.528082] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- M Wilson
- Departments of Obstetrics and Gynaecology, Whittington Hospital, UK.
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Al-Ajmi A, Rousseff RT, Khuraibet AJ. Iatrogenic femoral neuropathy: two cases and literature update. J Clin Neuromuscul Dis 2010; 12:66-75. [PMID: 21386773 DOI: 10.1097/cnd.0b013e3181f3dbe7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Iatrogenic femoral neuropathy is an uncommon surgical or obstetric complication that may be underreported. It results from compression, stretch, ischemia, or direct trauma of the nerve during hip arthroplasty, self-retaining retractor use in pelvicoabdominal surgery, lithotomy positioning for anesthesia or labor, and other more rare causes. Decreasing incidence of this complication after abdominal and gynecologic surgery but increase in its absolute numbers after hip arthroplasty has emerged over the last decade. We describe two illustrative cases related respectively to lithotomy positioning and self-retaining retractor use. The variability in clinical presentation of iatrogenic femoral nerve lesions, some new insights in their diverse pathophysiology, and in the diagnostic and treatment options are discussed with an update from the literature.
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Bradshaw AD, Advincula AP. Postoperative Neuropathy in Gynecologic Surgery. Obstet Gynecol Clin North Am 2010; 37:451-9. [DOI: 10.1016/j.ogc.2010.05.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Munro MG. Complications of Hysteroscopic and Uterine Resectoscopic Surgery. Obstet Gynecol Clin North Am 2010; 37:399-425. [DOI: 10.1016/j.ogc.2010.05.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Optimizing Patient Positioning and Understanding Radiofrequency Energy in Gynecologic Surgery. Clin Obstet Gynecol 2010; 53:511-20. [DOI: 10.1097/grf.0b013e3181ec17d3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Klauschie J, Wechter M, Jacob K, Zanagnolo V, Montero R, Magrina J, Kho R. Use of Anti-Skid Material and Patient-Positioning To Prevent Patient Shifting during Robotic-Assisted Gynecologic Procedures. J Minim Invasive Gynecol 2010; 17:504-7. [DOI: 10.1016/j.jmig.2010.03.013] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Revised: 03/04/2010] [Accepted: 03/12/2010] [Indexed: 11/26/2022]
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Baxi A, Kaushal M, Kadi P, Baxi DA. Femoral Neuropathy: A Curse of Vaginal Hysterectomy. J Gynecol Surg 2010. [DOI: 10.1089/gyn.2009.0056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Asha Baxi
- Disha Fertility and Surgical Center, Indore, India
| | | | - Pooja Kadi
- Disha Fertility and Surgical Center, Indore, India
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Lam A, Kaufman Y, Khong SY, Liew A, Ford S, Condous G. Dealing with complications in laparoscopy. Best Pract Res Clin Obstet Gynaecol 2009; 23:631-46. [PMID: 19539536 DOI: 10.1016/j.bpobgyn.2009.03.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Accepted: 03/16/2009] [Indexed: 11/26/2022]
Abstract
With increasing adoption of laparoscopic surgery in gynaecology, there has been a corresponding rise in the types and rates of complications reported. This article sets out to classify complications associated with laparoscopy according to the phases of the surgery; assess the incidence, the mechanisms, the presentations; and recommend methods for preventing and dealing with complications in laparoscopic surgery. Its aim is to promote a culture of risk management based on the development of strategies to improve patient safety and outcome.
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Affiliation(s)
- Alan Lam
- Centre for Advanced Reproductive Endosurgery, (CARE), Royal North Shore Hospital, University of Sydney, Sydney, Australia.
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