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Carson J, Warrander L, Johnstone E, van Loon R. Personalising cardiovascular network models in pregnancy: A two-tiered parameter estimation approach. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2021; 37:e3267. [PMID: 31799783 PMCID: PMC9286682 DOI: 10.1002/cnm.3267] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/07/2019] [Accepted: 09/07/2019] [Indexed: 05/26/2023]
Abstract
Uterine artery Doppler waveforms are often studied to determine whether a patient is at risk of developing pathologies such as pre-eclampsia. Many uterine waveform indices have been developed, which attempt to relate characteristics of the waveform with the physiological adaptation of the maternal cardiovascular system, and are often suggested to be an indicator of increased placenta resistance and arterial stiffness. Doppler waveforms of four patients, two of whom developed pre-eclampsia, are compared with a comprehensive closed-loop model of pregnancy. The closed-loop model has been previously validated but has been extended to include an improved parameter estimation technique that utilises systolic and diastolic blood pressure, cardiac output, heart rate, and pulse wave velocity measurements to adapt model resistances, compliances, blood volume, and the mean vessel areas in the main systemic arteries. The shape of the model-predicted uterine artery velocity waveforms showed good agreement with the characteristics observed in the patient Doppler waveforms. The personalised models obtained now allow a prediction of the uterine pressure waveforms in addition to the uterine velocity. This allows for a more detailed mechanistic analysis of the waveforms, eg, wave intensity analysis, to study existing clinical indices. The findings indicate that to accurately estimate arterial stiffness, both pulse pressure and pulse wave velocities are required. In addition, the results predict that patients who developed pre-eclampsia later in pregnancy have larger vessel areas in the main systemic arteries compared with the two patients who had normal pregnancy outcomes.
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Affiliation(s)
- Jason Carson
- Zienkiewicz Centre for Computational Engineering, College of EngineeringSwansea UniversitySwanseaUK
- Data Science Building, Swansea University Medical SchoolSwansea UniversitySwanseaUK
- HDR UK Wales and Northern IrelandHealth Data Research UKLondonUK
| | - Lynne Warrander
- Maternal and Fetal Health Research Centre, Division of Developmental Biology, Faculty of Medicine Biology and HealthUniversity of ManchesterManchesterUK
| | - Edward Johnstone
- Maternal and Fetal Health Research Centre, Division of Developmental Biology, Faculty of Medicine Biology and HealthUniversity of ManchesterManchesterUK
| | - Raoul van Loon
- Zienkiewicz Centre for Computational Engineering, College of EngineeringSwansea UniversitySwanseaUK
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Carson J, Lewis M, Rassi D, Van Loon R. A data-driven model to study utero-ovarian blood flow physiology during pregnancy. Biomech Model Mechanobiol 2019; 18:1155-1176. [PMID: 30838498 PMCID: PMC6647440 DOI: 10.1007/s10237-019-01135-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 02/20/2019] [Indexed: 12/30/2022]
Abstract
In this paper, we describe a mathematical model of the cardiovascular system in human pregnancy. An automated, closed-loop 1D-0D modelling framework was developed, and we demonstrate its efficacy in (1) reproducing measured multi-variate cardiovascular variables (pulse pressure, total peripheral resistance and cardiac output) and (2) providing automated estimates of variables that have not been measured (uterine arterial and venous blood flow, pulse wave velocity, pulsatility index). This is the first model capable of estimating volumetric blood flow to the uterus via the utero-ovarian communicating arteries. It is also the first model capable of capturing wave propagation phenomena in the utero-ovarian circulation, which are important for the accurate estimation of arterial stiffness in contemporary obstetric practice. The model will provide a basis for future studies aiming to elucidate the physiological mechanisms underlying the dynamic properties (changing shapes) of vascular flow waveforms that are observed with advancing gestation. This in turn will facilitate the development of methods for the earlier detection of pathologies that have an influence on vascular structure and behaviour.
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Affiliation(s)
- Jason Carson
- College of Engineering, Swansea University, Bay Campus, Fabian Way, Swansea, SA1 8EN UK
| | - Michael Lewis
- College of Engineering, Swansea University, Bay Campus, Fabian Way, Swansea, SA1 8EN UK
| | - Dareyoush Rassi
- College of Human and Health Sciences, Swansea University, Singleton Campus, Singleton Park, Swansea, SA2 8PP UK
| | - Raoul Van Loon
- College of Engineering, Swansea University, Bay Campus, Fabian Way, Swansea, SA1 8EN UK
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Puntambekar S, Puntambekar S, Telang M, Kulkarni P, Date S, Panse M, Sathe R, Agarkhedkar N, Warty N, Kade S, Manchekar M, Chitale M, Parekh H, Parikh K, Mehta M, Kinholkar B, Jana JS, Pare A, Kanade S, Sadre A, Hardikar S, Jathar A, Bakre T, Chate M, Tiruke R. Novel Anastomotic Technique for Uterine Transplant Using Utero-ovarian Veins for Venous Drainage and Internal Iliac Arteries for Perfusion in Two Laparoscopically Harvested Uteri. J Minim Invasive Gynecol 2018; 26:628-635. [PMID: 30599196 DOI: 10.1016/j.jmig.2018.11.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/29/2018] [Accepted: 11/05/2018] [Indexed: 12/22/2022]
Abstract
STUDY OBJECTIVE To evaluate 2 cases of uterine transplant surgery that used utero-ovarian veins as outflow channels, internal iliac arteries for perfusion, and the organ harvest surgery performed laparoscopically. DESIGN Case study (Canadian Task Force Classification III). SETTING An urban, private, tertiary care hospital. PATIENTS Two patients, ages 30 and 24years, diagnosed with absolute uterine factor infertility secondary to Mayer-Rokitansky-Küster-Hauser syndrome underwent related living donor uterine transplants; donors were their mothers with normal menses. INTERVENTIONS Retrieval of organs through minilaparotomy and laparoscopic harvest of donor internal iliac arteries and ovarian veins. MEASUREMENTS AND MAIN RESULTS Anastomosis was completed with bilateral donor internal iliac arteries to recipient internal iliac arteries in an end-to-end manner and with bilateral donor ovarian veins to recipient external iliac veins in an end-to-side manner. The lengths of utero-ovarian veins of both donors were 11 and 11cm on both sides; the lengths of the internal iliac arteries of both donors were 10 and 7.5cm on the left side and 10 and 6cm on the right side. The operative times for harvest surgery, bench surgery and transplant surgery were 2:40 and 3:20 hours, 34:32 and 33:30 min and 4:00 and 4:30 hours respectively for recipients 1 and 2. Daily postoperative uterine Doppler was completed through day 8 and then every other day and showed good intrauterine blood flow (i.e., low resistance arcuate vessel flow; resistance index < .5). Cervical biopsies on postoperative days 7 and 14 showed no evidence of rejection in either recipient. Both recipients started menstruating within 2 months of surgery. CONCLUSION By using ovarian veins as outflow channels, the challenges involved in dissection along the internal iliac vein are avoided, and harvesting the donor internal iliac artery reduces the tension on vascular anastomosis. The selection of vessels to be harvested could make the technique reproducible, although larger studies are warranted to confirm results.
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Affiliation(s)
- Shailesh Puntambekar
- Departments of General Surgery (Drs. Puntambekar, Panse, Sathe, Manchekar, Chitale, Parekh, Mehta, and Jathar).
| | - Seema Puntambekar
- Obstetrics and Gynaecology (Drs. Puntambekar, Telang, Kulkarni, Warty, Kade, Parikh, Bakre, Chate, and Tiruke)
| | - Milind Telang
- Obstetrics and Gynaecology (Drs. Puntambekar, Telang, Kulkarni, Warty, Kade, Parikh, Bakre, Chate, and Tiruke)
| | - Pankaj Kulkarni
- Obstetrics and Gynaecology (Drs. Puntambekar, Telang, Kulkarni, Warty, Kade, Parikh, Bakre, Chate, and Tiruke)
| | | | - Mangesh Panse
- Departments of General Surgery (Drs. Puntambekar, Panse, Sathe, Manchekar, Chitale, Parekh, Mehta, and Jathar)
| | - Ravindra Sathe
- Departments of General Surgery (Drs. Puntambekar, Panse, Sathe, Manchekar, Chitale, Parekh, Mehta, and Jathar)
| | | | - Neeta Warty
- Obstetrics and Gynaecology (Drs. Puntambekar, Telang, Kulkarni, Warty, Kade, Parikh, Bakre, Chate, and Tiruke)
| | - Sandesh Kade
- Obstetrics and Gynaecology (Drs. Puntambekar, Telang, Kulkarni, Warty, Kade, Parikh, Bakre, Chate, and Tiruke)
| | - Manoj Manchekar
- Departments of General Surgery (Drs. Puntambekar, Panse, Sathe, Manchekar, Chitale, Parekh, Mehta, and Jathar)
| | - Mihir Chitale
- Departments of General Surgery (Drs. Puntambekar, Panse, Sathe, Manchekar, Chitale, Parekh, Mehta, and Jathar)
| | - Hirav Parekh
- Departments of General Surgery (Drs. Puntambekar, Panse, Sathe, Manchekar, Chitale, Parekh, Mehta, and Jathar)
| | - Kajal Parikh
- Obstetrics and Gynaecology (Drs. Puntambekar, Telang, Kulkarni, Warty, Kade, Parikh, Bakre, Chate, and Tiruke)
| | - Mehul Mehta
- Departments of General Surgery (Drs. Puntambekar, Panse, Sathe, Manchekar, Chitale, Parekh, Mehta, and Jathar)
| | | | | | | | | | | | - Shirish Hardikar
- Radiology (Dr. Hardikar), Galaxy CARE Laparoscopy Institute, Pune, India
| | - Advait Jathar
- Departments of General Surgery (Drs. Puntambekar, Panse, Sathe, Manchekar, Chitale, Parekh, Mehta, and Jathar)
| | - Tejashree Bakre
- Obstetrics and Gynaecology (Drs. Puntambekar, Telang, Kulkarni, Warty, Kade, Parikh, Bakre, Chate, and Tiruke)
| | - Meenakshi Chate
- Obstetrics and Gynaecology (Drs. Puntambekar, Telang, Kulkarni, Warty, Kade, Parikh, Bakre, Chate, and Tiruke)
| | - Raviraj Tiruke
- Obstetrics and Gynaecology (Drs. Puntambekar, Telang, Kulkarni, Warty, Kade, Parikh, Bakre, Chate, and Tiruke)
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MacKoul P, Baxi R, Danilyants N, van der Does LQ, Haworth LR, Kazi N. Laparoscopic-Assisted Myomectomy with Bilateral Uterine Artery Occlusion/Ligation. J Minim Invasive Gynecol 2018; 26:856-864. [PMID: 30170179 DOI: 10.1016/j.jmig.2018.08.016] [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: 02/10/2018] [Revised: 07/31/2018] [Accepted: 08/23/2018] [Indexed: 10/28/2022]
Abstract
STUDY OBJECTIVE Conventional laparoscopic myomectomy (CLM) and robotic-assisted myomectomy (RAM) are limited in the number and size of myomas that can be removed, whereas abdominal myomectomy (AM) is associated with increased complications and morbidity. Here we evaluated the surgical outcomes of these myomectomy techniques compared with those of laparoscopic-assisted myomectomy (LAM), a hybrid approach that combines laparoscopy and minilaparotomy with bilateral uterine artery occlusion or ligation to control blood loss. DESIGN Retrospective chart review (Canadian Task Force classification II-1). SETTING Suburban community hospital. PATIENTS Women age ≥18 years with nonmalignant indications. INTERVENTION A total of 1313 consecutive CLMs, RAMs, AMs, and LAMs performed between January 2011 and December 2013. MEASUREMENTS AND MAIN RESULTS Our review included 163 CLMs (12%), 156 RAMs (12%), 686 AMs (52%), and 308 LAMs (23%). Although the average number, size, and total weight of leiomyomas removed were comparable in the LAM and AM groups (9.1, 8.13 cm, and 391 g, respectively, vs 9.0, 7.5 cm, and 424 g; p < .0001), the number and weight of myomas were significantly greater in those 2 groups compared with the CLM and RAM groups (2.9 and 217 g, respectively, and 2.9 and 269 g; p < .0001). The intraoperative complication rate was highest in the RAM group, and the postoperative complication rate was highest in the AM group, both of which were approximately 3 times greater than the rates in the LAM group. There was no statistically significant difference in postoperative complication rates between the CLM and LAM groups. CONCLUSION LAM with uterine artery occlusion/ligation is a viable approach for removing large tumor loads while minimizing blood loss and precluding the need for power morcellation.
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Affiliation(s)
- Paul MacKoul
- Center for Innovative GYN Care, Rockville, Maryland (all authors)
| | - Rupen Baxi
- Center for Innovative GYN Care, Rockville, Maryland (all authors)
| | | | | | - Leah R Haworth
- Center for Innovative GYN Care, Rockville, Maryland (all authors)
| | - Nilofar Kazi
- Center for Innovative GYN Care, Rockville, Maryland (all authors)
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Tanos V, Berry KE, Frist M, Campo R, DeWilde RL. Prevention and Management of Complications in Laparoscopic Myomectomy. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8250952. [PMID: 29693017 PMCID: PMC5859837 DOI: 10.1155/2018/8250952] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 02/04/2018] [Indexed: 11/18/2022]
Abstract
Myomectomy aims to preserve fertility, treat abnormal uterine bleeding, and alleviate pain. It should cause minimal damage to the endometrium, while being tolerable and durable, and reduce the incidence of myoma recurrence and complications including bleeding, hematoma, adhesions, and gravid uterus perforation. Training and experience are crucial to reduce complications. The surgical strategy depends on imaging information on the myomas. The position of the optical and secondary ports will determine the degree of ergonomic surgery performance, time and difficulty of myoma enucleation, and the suturing quality. Appropriate hysterotomy length relative to myoma size can decrease bleeding, coagulation, and suturing times. Bipolar coagulation of large vessels, while avoiding carbonization and myometrium gaps after suturing, may decrease the risk of myometrial hematoma. Quality surgery and the use of antiadhesive barriers may reduce the risk of postoperative adhesions. Slow rotation of the beveled morcellator and good control of the bag could reduce de novo myoma and endometriosis. Low intra-abdominal CO2 pressure may reduce the risk of benign and malignant cell dissemination. The benefits a patient gains from laparoscopic myomectomy are greater than the complication risks of laparoscopic morcellation. Recent publications on laparoscopic myomectomies demonstrate reduced hospitalization stays, postoperative pain, blood loss, and recovery compared to open surgery.
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Affiliation(s)
- V. Tanos
- University of Nicosia Medical School, Nicosia, Cyprus
- European Academy for Gynecological Surgery (Nicosia Branch), 55-57 Andrea Avraamidi St., Strovolos, 2024 Nicosia, Cyprus
- Aretaeio Hospital, Strovolos, Nicosia, Cyprus
| | - K. E. Berry
- St George's, University of London MBBS Programme at the University of Nicosia Medical School, Nicosia, Cyprus
| | - M. Frist
- St George's, University of London MBBS Programme at the University of Nicosia Medical School, Nicosia, Cyprus
| | - R. Campo
- European Society Gynaecological Endoscopy, Leuven, Belgium
- The European Academy for Gynecological Surgery, Leuven, Belgium
- Life Expert Centre, Schipvaartstraat 4, 3000 Leuven, Belgium
| | - R. L. DeWilde
- European Society Gynaecological Endoscopy, Leuven, Belgium
- Cahir Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius-Hospital Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany
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