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Numaga Y, Araki F, Azuma K, Toyama T, Sugimoto K, Shiraya T, Ueta T. Postoperative vision loss due to bilateral vitreous hemorrhage after robot-assisted laparoscopic hysterectomy: A case report. Am J Ophthalmol Case Rep 2024; 33:101985. [PMID: 38221938 PMCID: PMC10784671 DOI: 10.1016/j.ajoc.2023.101985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 12/02/2023] [Accepted: 12/20/2023] [Indexed: 01/16/2024] Open
Abstract
Purpose To report a case of bilateral vitreous hemorrhage (VH) resulting in postoperative vision loss (POVL) after robot-assisted laparoscopic hysterectomy in a 71-year-old female patient. Observations At initial presentation, best-corrected visual acuity was hand motion at 20 cm in the right eye and 20/666 in the left eye. VH in both eyes and preretinal hemorrhage in the left eye was observed. As the hemorrhage gradually resolved, a full-thickness macular hole was discovered in the right eye, for which the patient did not agree with a surgical treatment. Conclusions and importance This report describes a rare incidence of bilateral VH as a cause of POVL after non-ophthalmic surgery, which may be related to Trendelenburg positioning, CO2 pneumoperitoneum, and a long surgical duration. Given that POVL can cause severe visual impairment, consultation with ophthalmologists is crucial.
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Affiliation(s)
- Yuka Numaga
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Fumiyuki Araki
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Kunihiro Azuma
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Taku Toyama
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Koichiro Sugimoto
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Tomoyasu Shiraya
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
- Eye Center, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, 187-8510, Japan
| | - Takashi Ueta
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-8655, Japan
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Kweon S, Park J, Sim Y, Kwack JY, Kwon YS. Clinical Outcomes of Conservative Surgery for Diffuse Uterine Leiomyomatosis: Preliminary Experience of 17 Cases in a Single Center. J Clin Med 2023; 12:7638. [PMID: 38137706 PMCID: PMC10743964 DOI: 10.3390/jcm12247638] [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: 09/13/2023] [Revised: 12/05/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023] Open
Abstract
This study aimed to introduce the clinical outcomes of conservative surgery for diffuse uterine leiomyomatosis, which also included the specialized surgical technique. All patients with diffuse uterine leiomyomatosis underwent conservative surgery such as transient occlusion of the uterine arteries (TOUA) adenomyomectomy. All 17 surgeries were performed by a single surgeon between 2018 and 2021. The mean age of the 17 patients was 36.12 years old (range 29-48, SD = 5.4). Fourteen of the 17 patients received a previous myomectomy via a laparotomic (6, 35.3%), laparoscopic (6, 35.3%), or hysteroscopic (2, 11.8%) approach. The major symptom was menorrhagia (94.1%); the mean operation time was 97.06 min (70-160, SD = 22.71), and the mean estimated blood loss was 283.53 mL (20-1000, SD = 273.72). The mean hemoglobin level one day after the operation was 9.64 g/dL (7.2-13.1, SD = 1.85). The mean hospital stay was 6.47 days (6-8, SD = 0.62). The mean follow-up duration was 116.41 weeks (32-216, SD = 50.88). The recurrence rate was 5/17 (29.4%), and the recurrence-free interval was 50.6 weeks (27-87, SD = 23.71). In patients with diffuse uterine leiomyomatosis, who want fertility preservation and relief of disease-related symptoms, conservative surgery such as TOUA adenomyomectomy could be a good option to preserve the uterus. However, further studies are required to assess fertility outcomes with a long-term follow-up.
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Affiliation(s)
| | | | | | | | - Yong-Soon Kwon
- Department of Obstetrics and Gynecology, Nowon Eulji Medical Center, College of Medicine, Eulji University, Hangeulbiseok-ro 68, Seoul 01830, Republic of Korea; (S.K.); (J.P.); (Y.S.); (J.Y.K.)
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Swartz AZ, Novoa Y Arruga Novoa V, Hassoun JS, Crispens MA, Prescott LS. Robotic-assisted gynecologic surgery associated tympanic membrane perforation: A report of two cases and review of the literature. Gynecol Oncol Rep 2023; 46:101151. [PMID: 36873858 PMCID: PMC9982598 DOI: 10.1016/j.gore.2023.101151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 02/25/2023] Open
Abstract
Robotic gynecologic surgery is associated with the use of steep Trendelenburg positioning. Steep Trendelenburg is necessary to provide optimal exposure to the pelvis but is associated with an increased risk of non-surgical complications such as suboptimal ventilation, facial and laryngeal edema, increased intraocular and intracranial pressure as well as neurologic injury. Several case reports have described otorrhagia after robotic assisted surgery; however, there are limited reports on the risk of tympanic membrane perforation. To our knowledge, there are no published reports on tympanic membrane perforation in gynecologic nor gynecologic oncology surgery. We report two cases of perioperative tympanic membrane rupture and bloody otorrhagia associated with robot-assisted gynecologic surgery. In both cases otolaryngology/Ear Nose and Throat (ENT) was consulted, and the perforations resolved with conservative management.
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Affiliation(s)
- Alison Z Swartz
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - Jenine S Hassoun
- Vanderbilt University Medical Center, Department of Gynecologic Oncology, Nashville, TN, USA
| | - Marta A Crispens
- Vanderbilt University Medical Center, Department of Gynecologic Oncology, Nashville, TN, USA
| | - Lauren S Prescott
- Vanderbilt University Medical Center, Department of Gynecologic Oncology, Nashville, TN, USA
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4
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Abstract
Otorrhagia is generally associated with basilar skull fractures or diving accidents. In routine forensic medical practice, an accurate knowledge of the etiology of otorrhagia may have a key role to distinguish between traumatic and atraumatic causes and accidental, homicidal, or suicidal manners. The authors present the case of an unusual cause of atraumatic otorrhagia occurred in an elderly farmer found dead in a barn. He remained entrapped in a narrow tunnel created by some hay bales. The autopsy findings revealed only an intense polyvisceral congestion and subpleural petechiae, with no signs of traumatic injuries and no fractures of skull base or temporal pyramid. The cause of death was determined to be positional asphyxia, and the manner of death was deemed accidental. In fact, the head-down position resulted in diaphragm compression causing respiratory failure in combination with the stasis of the upper venous circle districts. Mechanical and gravitational forces related to upside-down position and increased vascular pressure also caused postmortem otorrhagia. In this case, the death scene investigation and circumstantial information allowed for reconstruction of the unique dynamics of the death. At the death scene, the position of the corpse must be accurately investigated because it can explain some cadaveric findings such as the ear bleeding or other markers of increased cephalic venous pressure like pink teeth, facial and conjunctival petechiae, or Tardieu spots. Therefore, forensic pathologists should consider that ear bleeding in dead bodies is not always the evidence of severe head blunt trauma or diving accidents, but it might be a postmortem phenomenon mostly related to body position.
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Teh RA, Hoshal S, Hoshal GL, Ozturk A, Chang J, Assadsangabi R, Ivanovic V, Bobinski M, Raslan OA. Bilateral external auditory canal masses following repair of ruptured abdominal aortic aneurysm and open decompressive exploratory laparotomy for compartment syndrome: A rare case of spontaneous bilateral otorrhagia. Radiol Case Rep 2020; 15:2660-2662. [PMID: 33101561 PMCID: PMC7575648 DOI: 10.1016/j.radcr.2020.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/01/2020] [Accepted: 10/02/2020] [Indexed: 11/28/2022] Open
Abstract
Very few cases of spontaneous otorrhagia (SO) following nonotolaryngologic surgery have ever been reported in surgical literature and none in radiographic. Of the surgical cases reported, SO occurred in the perioperative period following laparoscopic surgeries in the Trendelenburg position. We report the first case of spontaneous bilateral otorrhagia which presented as bilateral external auditory canal masses following endovascular surgery and open decompressive laparotomy in a 60-year-old male with a prior history of hypertension and smoking. We seek to inform radiologists that SO can present on neck imaging as external auditory canal masses as a complication of nonotolaryngologic surgery away from the imaged field of view.
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Affiliation(s)
- Richard Andrew Teh
- Section of Neuroradiology, Department of Radiology, University of California-Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817
| | - Steven Hoshal
- Department of Otolaryngology, Head and Neck Surgery, University of California-Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817
| | - Gillian L Hoshal
- Department of General Surgery, University of California-Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817
| | - Arzu Ozturk
- Section of Neuroradiology, Department of Radiology, University of California-Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817
| | - Jennifer Chang
- Section of Neuroradiology, Department of Radiology, University of California-Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817
| | - Reza Assadsangabi
- Section of Neuroradiology, Department of Radiology, University of California-Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817
| | - Vladimir Ivanovic
- Section of Neuroradiology, Department of Radiology, University of California-Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817
| | - Matthew Bobinski
- Section of Neuroradiology, Department of Radiology, University of California-Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817
| | - Osama A Raslan
- Section of Neuroradiology, Department of Radiology, University of California-Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817
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Niazi AK, Reese AS, Minko P, O'Donoghue D, Ayad S. Superior Vena Cava Syndrome and Otorrhagia During Cardiac Surgery. Cureus 2019; 11:e4602. [PMID: 31309025 PMCID: PMC6609288 DOI: 10.7759/cureus.4602] [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] [Indexed: 11/23/2022] Open
Abstract
Otorrhagia during cardiac surgery is rare. Otorrhagia combined with other signs of increased venous pressure in the upper body indicates the development of superior vena cava (SVC) syndrome. In this case, ear bleeding, facial engorgement, and conjunctival edema were noticed. The SVC cannula was displaced, leading to SVC syndrome. Repositioning of the cannula led to rapid recovery of the symptoms and an uneventful postoperative course. Providers should be vigilant about signs of SVC obstruction. Transparent coverings and surgical shelves should be used for constant examination of the head and neck to immediately detect changes.
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Affiliation(s)
| | | | - Paul Minko
- Anesthesiology, Cleveland Clinic Fairview Hospital, Cleveland, USA
| | - Donal O'Donoghue
- Anesthesiology, Cleveland Clinic Fairview Hospital, Cleveland, USA
| | - Sabry Ayad
- Anesthesiology, Cleveland Clinic Fairview Hospital, Cleveland, USA
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Adverse events related to Trendelenburg position during laparoscopic surgery: recommendations and review of the literature. Curr Opin Obstet Gynecol 2018; 30:272-278. [DOI: 10.1097/gco.0000000000000471] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Aloisi A, Pesce JE, Paraghamian SE, Chi DS, Rieth EF. Bilateral Otorrhagia after Robotically Assisted Gynecologic Surgery in the Setting of a Reduced Trendelenburg Position and Low-Pressure Pneumoperitoneum: A Case Report and Review of the Literature. J Minim Invasive Gynecol 2017; 24:1229-1233. [PMID: 28461176 DOI: 10.1016/j.jmig.2017.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 04/21/2017] [Accepted: 04/21/2017] [Indexed: 10/19/2022]
Abstract
Perioperative otorrhagia in association with nonotolaryngologic surgery is rare. The cause is typically attributed to the physiologic derangements associated with the Trendelenburg position and pneumoperitoneum during laparoscopic surgery. The most well-accepted etiology is an increase in arterial and venous pressures causing the rupture of subcutaneous capillaries, although the exact etiology remains unclear. We present the first reported case of bilateral spontaneous otorrhagia associated with robotically assisted laparoscopic surgery involving a reduced Trendelenburg position and low-pressure pneumoperitoneum. Perioperative hypertension, female gender, advanced age, and increased bleeding risk may contribute to the development of this rare complication.
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Affiliation(s)
- Alessia Aloisi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Julianna E Pesce
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sarah E Paraghamian
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of California Irvine Medical Center, Orange, California
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York
| | - Elizabeth F Rieth
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
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Jones WS, Klafta JM. Bilateral Bloody Otorrhagia After Robotic-Assisted Laparoscopic Prostatectomy. ACTA ACUST UNITED AC 2016; 5:91-2. [PMID: 26361383 DOI: 10.1213/xaa.0000000000000185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Bloody otorrhagia in the perioperative period is an uncommon event. We present a case of bilateral bloody otorrhagia after uncomplicated robotic-assisted laparoscopic prostatectomy in a 66-year-old man. Anesthetic management was unremarkable. No symptoms were noted by the patient. Postoperative otolaryngology evaluation revealed bilateral ear canal hematomas with intact tympanic membranes. The patient was discharged with Ciprodex ear drops on postoperative day 1. One-month otolaryngology follow-up revealed no long-term sequelae. Although the etiology is unclear, there seems to be a trend in the literature toward occurrence with laparoscopy in the Trendelenburg position.
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Affiliation(s)
- William Scott Jones
- From the Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
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10
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Bilateral Otorrhagia Discovered at the Completion of a Robotic Bilateral Salpingo-Oophorectomy. J Gynecol Surg 2016. [DOI: 10.1089/gyn.2015.0075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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España Fuente L, Fernández Diez A, Pérez Villafañe A. [Otorrhagia. A complication of laparoscopic hemicolectomy]. ACTA ACUST UNITED AC 2015; 63:112-5. [PMID: 26141570 DOI: 10.1016/j.redar.2015.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 04/04/2015] [Accepted: 04/08/2015] [Indexed: 11/19/2022]
Abstract
The fast and increasing advance in surgical technology during the last decades has led to a remarkable development in laparoscopic surgery. "Minimally invasive" surgery has become very popular in the last few years, not only in gynecological procedures but also in general surgery, orthopedics, thoracic and urological procedures. Gas inflation into the abdominal cavity and patient position provokes physiological changes, as well as complications that are not seen in open surgery. Pneumoperitoneum and the Trendelenburg position beyond 35° cause hemodynamic changes, resulting in an increase in arterial and central venous pressure. The external auditory canal vessels are directly affected by these changes, and postoperative otorrhagia after a prolonged laparoscopic surgery may be present. A case is presented of postoperative bilateral otorrhagia after laparoscopic left hemicolectomy.
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Affiliation(s)
- L España Fuente
- Servicio de Anestesiología y Reanimación, Hospital San Agustín, Avilés, Asturias, España.
| | - A Fernández Diez
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario de León, León, España
| | - A Pérez Villafañe
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario de León, León, España
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