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Spurzem GJ, Broderick RC, Cota PR, Sandler BJ, Jacobsen GR, Horgan S. Early Experience With a Novel Super-Hydrophilic Laparoscopic Scope Cleaning Device and Narrative Review of Available Cleaning Strategies. Surg Innov 2024:15533506241281316. [PMID: 39218621 DOI: 10.1177/15533506241281316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
BACKGROUND Impaired visibility is a challenge in laparoscopic surgery. Frequent scope removal increases operative time, reduces efficiency, and potentially compromises patient safety. We examine our initial experience with a novel cleaning device that applies cold plasma to the scope lens and review current available laparoscope cleaning methods. METHODS The novel device was used in a variety of laparoscopic general surgery cases from April to November 2023. Primary outcome was number of scope removals per case. Secondary outcomes were time spent cleaning and number of times the scope became smudged or dirty with blood/tissue debris (debris events). An existing device that utilizes heated anti-fogging solution was used for comparison. RESULTS 97 cases were included (31 with novel device and 66 with existing device). Scope removal rate for the novel device was lower compared to the existing device (0.87 ± 1.02 vs 0.97 ± 1.20 removals/case, P = 0.69), but not statistically significant. Average number of debris events was also lower for the novel device, but not statistically significant (0.90 ± 0.94 vs 1.0 ± 1.18 debris events/case, P = 0.69). Average total time spent cleaning per case was similar between devices (16.9 ± 24.0 vs 15.9 ± 18.7 seconds, P = 0.82). CONCLUSION This study demonstrates that a hydrophilic scope cleaning device has comparable performance to heated anti-fogging solution and may reduce scope removals and debris events. Direct comparisons between cleaning products are lacking. Surgeons are most likely to be successful with the cleaning strategy that best suits one's surgical practice.
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Affiliation(s)
- Graham J Spurzem
- Department of Surgery, Division of Minimally Invasive Surgery, University of California San Diego, San Diego, CA, USA
| | - Ryan C Broderick
- Department of Surgery, Division of Minimally Invasive Surgery, University of California San Diego, San Diego, CA, USA
| | - Patricia R Cota
- Department of Surgery, Division of Minimally Invasive Surgery, University of California San Diego, San Diego, CA, USA
| | - Bryan J Sandler
- Department of Surgery, Division of Minimally Invasive Surgery, University of California San Diego, San Diego, CA, USA
| | - Garth R Jacobsen
- Department of Surgery, Division of Minimally Invasive Surgery, University of California San Diego, San Diego, CA, USA
| | - Santiago Horgan
- Department of Surgery, Division of Minimally Invasive Surgery, University of California San Diego, San Diego, CA, USA
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2
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Subba K, Lambert E, El-Ghobashy A. Tips and tricks in gynaecological robotic surgery. Best Pract Res Clin Obstet Gynaecol 2024; 93:102453. [PMID: 38219641 DOI: 10.1016/j.bpobgyn.2023.102453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/07/2023] [Accepted: 12/21/2023] [Indexed: 01/16/2024]
Abstract
It was the dawn of a new era for robotic surgery when the Food and Drug Administration (FDA) approved da Vinci robotic surgical system for general laparoscopic procedures in 2000. The surgical practice saw a transformative breakthrough towards minimally invasive approach with the ever-increasing uptake of advanced robots proven to benefit patients and surgeons in various ways. However, these innovative machines only complement and enhance a surgeon's operating skills, and with such privilege come responsibilities and new challenges. Heavy reliance on such advanced devices while operating on humans necessitates thorough training and supervision to ensure safe and efficient applications. It is the surgeon's responsibility to direct the procedure constantly and lead other team members who assist during the surgery. In this chapter, we provide miscellaneous tips and tricks that can help beginners navigate through robotic surgery with more confidence and enthusiasm.
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Affiliation(s)
- Kamana Subba
- Obstetrics and Gynaecology, Gynaecological Oncology, UK.
| | | | - Alaa El-Ghobashy
- Department of Gynaecological Oncology, The Royal Wolverhampton NHS Trust, West Midlands, UK
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Sima RM, Crăițan AV, Pleș L, Bobircă F, Amza M, Gorecki GP, Georgescu MT, Hamoud BH. The Beginner Laparoscopists Trends in the Learning Process of Laparoscopy for Adnexal Gynecological Pathologies-The Experience of Our Center. Healthcare (Basel) 2023; 11:1752. [PMID: 37372870 DOI: 10.3390/healthcare11121752] [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: 05/19/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Laparoscopy for benign ovarian pathology is the appropriate surgical approach and it has many well-known advantages. Minimal invasive gynecological surgery increases the quality of life of the patient. The learning process of laparoscopy is difficult and requires many interventions to acquire manual skills. The objectives of the study were to assess the learning process of laparoscopy for adnexal pathology surgery performed by beginner laparoscopists. MATERIALS AND METHODS This study included three gynecological surgeons who were beginners in laparoscopy and who were named A, B, and C. We collected information about patients, diagnosis, surgical technique, and complications. RESULTS We have analyzed the data from 159 patients. The most frequent primary diagnosis was functional ovarian cyst, and the laparoscopic cystectomy was performed in 49.1% of interventions. The need to convert a laparoscopy into laparotomy was necessary in 1.3% of patients. There were no cases of reintervention, blood transfusion, or ureteral lesions. The duration of the surgical intervention varied statistically significantly according to patient's BMI and to the surgeon. After 20 laparoscopic interventions, a significant improvement was found in the time needed to perform ovarian cystectomy (operators A and B) and salpingectomy (operator C). CONCLUSIONS The process of learning laparoscopy is laborious and difficult. We found a significant decrease in operating time after a twenty laparoscopic interventions.
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Affiliation(s)
- Romina-Marina Sima
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- The "Bucur" Maternity, "Saint John" Hospital, 040294 Bucharest, Romania
| | - Anca-Violeta Crăițan
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Liana Pleș
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- The "Bucur" Maternity, "Saint John" Hospital, 040294 Bucharest, Romania
| | - Florin Bobircă
- Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Surgery Department, Dr. Ion Cantacuzino Clinical Hospital, 011437 Bucharest, Romania
| | - Mihaela Amza
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- The "Bucur" Maternity, "Saint John" Hospital, 040294 Bucharest, Romania
| | - Gabriel-Petre Gorecki
- Faculty of Medicine, Titu Maiorescu University, 040441 Bucharest, Romania
- Department of Anesthesia and Intensive Care, CF2 Clinical Hospital, 011464 Bucharest, Romania
| | - Mihai-Teodor Georgescu
- "Prof. Dr. Al. Trestioreanu" Oncology Discipline, Carol Davila University of Medicine and Pharmacy, 252 Fundeni St., 050474 Bucharest, Romania
| | - Bashar Haj Hamoud
- Department for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, KirrbergerStraße 100, Building 9, 66421 Homburg, Germany
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4
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Nabeel A, Al-Sabah SK, Ashrafian H. Effective cleaning of endoscopic lenses to achieve visual clarity for minimally invasive abdominopelvic surgery: a systematic review. Surg Endosc 2022; 36:2382-2392. [PMID: 33963440 PMCID: PMC8921162 DOI: 10.1007/s00464-021-08519-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 04/17/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To review the recently available interventions to achieve optimal visual clarity in laparoscopic abdominopelvic surgery compared to conventional cleaning alternatives. Currently, there is no consensus on the most effective method for the cleaning of endoscopic lenses used in minimally invasive abdominopelvic surgery. METHODS Literature searching for articles relevant to answering a predefined research question was performed in December 2019 and involved searching of the electronic databases of MEDLINE, the Cochrane Registry, and EMBASE. Basic search terms were derived using the PICO (population, intervention, comparator and outcomes) framework and through a scoping search of literature via MEDLINE. A manual search of Google Scholar and citation screening of eligible studies was also performed to ensure the identification and inclusion of all pertinent studies to address the research question. RESULTS Among conventional and readily available methods, the most effective approaches involved heated sterile water, heating of laparoscope lenses, and surfactant solutions, including FRED and Ultra-Stop, while evaluations of all novel devices and methods were more effective than controls, which included lens wiping systems and air and carbon dioxide flow systems. While the former surgical techniques were consistently associated with superior lens cleaning ability and/or defogging capability and subsequent optical clarity of images within the surgical field, no methods conferred any meaningful effects upon other clinically important outcomes, such as operative time, costs, complication rates and length of stay, suggesting that decision making concerning the selection of lens cleaning method/device should suit the preferences of the instrument operator and/or the responsible surgeon. CONCLUSIONS We demonstrated that a range of endoscopic lens cleaning methods and devices can be used to achieve sufficient optical clarity of the laparoscopic surgical field through either preventing lenses from fogging and/or facilitating the inter-operative cleaning of fouled lenses. Despite the various methods evaluated in this review, there were no significant differences in complication rates between the intervention and control groups.
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Affiliation(s)
- Ahmad Nabeel
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
- Department of Surgery, Jaber Al-Ahmad Al-Sabah Hospital, Kuwait City, Kuwait
| | - Salman K Al-Sabah
- Department of Surgery, Jaber Al-Ahmad Al-Sabah Hospital, Kuwait City, Kuwait
- Department of Surgery, Faculty of Medicine, Health Sciences Centre, Kuwait University, Kuwait City, Kuwait
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom.
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Scioscia M, Huscher CGS, Brusca F, Marchegiani F, Cannone R, Brasile O, Greco P, Scutiero G, Anania G, Pontrelli G. Preservation of the inferior mesenteric artery in laparoscopic nerve-sparing colorectal surgery for endometriosis. Sci Rep 2022; 12:3146. [PMID: 35210558 PMCID: PMC8873484 DOI: 10.1038/s41598-022-07237-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 01/27/2022] [Indexed: 11/18/2022] Open
Abstract
Laparoscopic rectosigmoid resection for endometriosis is usually performed with the section of the inferior mesenteric artery (IMA) distal to the left colic artery (low-tie ligation). This study was to determine outcomes in IMA-sparing surgery in endometriosis cases. A single-center retrospective study based on the analysis of clinical notes of women who underwent laparoscopic rectosigmoid segmental resection and IMA-sparing surgery for deep infiltrating endometriosis with bowel involvement between March the 1st, 2018 and February the 29th, 2020 in a referral hospital. During the study period, 1497 patients had major gynecological surgery in our referral center, of whom 253 (17%) for endometriosis. Of the 100 patients (39%) who had bowel endometriosis, 56 underwent laparoscopic nerve-sparing rectosigmoid segmental resection and IMA-sparing surgery was performed in 53 cases (95%). Short-term complications occurred in 4 cases (7%) without any case of anastomotic leak. Preservation of the IMA in colorectal surgery for endometriosis is feasible, safe and enables a tension-free anastomosis without an increase of postoperative complication rates.
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Affiliation(s)
- Marco Scioscia
- Department of Obstetrics and Gynecology, Policlinico Hospital, Abano Terme, Padua, Italy
| | - Cristiano G S Huscher
- Department of Surgical Oncology, Robotics and New Technologies, Policlinico Hospital, Abano Terme, Padua, Italy
| | - Federica Brusca
- Department of Medical Science, Section of Obstetrics and Gynecology, University of Ferrara, Azienda Ospedaliero-Universitaria S.Anna, Via Aldo Moro 8, 44124, Cona, FE, Italy
| | - Francesco Marchegiani
- First Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Rossella Cannone
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, Policlinico University of Bari, Bari, Italy
| | - Orsola Brasile
- Department of Medical Science, Section of Obstetrics and Gynecology, University of Ferrara, Azienda Ospedaliero-Universitaria S.Anna, Via Aldo Moro 8, 44124, Cona, FE, Italy
| | - Pantaleo Greco
- Department of Medical Science, Section of Obstetrics and Gynecology, University of Ferrara, Azienda Ospedaliero-Universitaria S.Anna, Via Aldo Moro 8, 44124, Cona, FE, Italy.
| | - Gennaro Scutiero
- Department of Medical Science, Section of Obstetrics and Gynecology, University of Ferrara, Azienda Ospedaliero-Universitaria S.Anna, Via Aldo Moro 8, 44124, Cona, FE, Italy
| | - Gabriele Anania
- Department of Medical Science, Section of General Surgery, University of Ferrara, Azienda Ospedaliero-Universitaria S.Anna, Cona, Ferrara, Italy
| | - Giovanni Pontrelli
- Department of Obstetrics and Gynecology, Policlinico Hospital, Abano Terme, Padua, Italy
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Hirata T, Koga K, Kai K, Katabuchi H, Kitade M, Kitawaki J, Kurihara M, Takazawa N, Tanaka T, Taniguchi F, Nakajima J, Narahara H, Harada T, Horie S, Honda R, Murono K, Yoshimura K, Osuga Y. Clinical practice guidelines for the treatment of extragenital endometriosis in Japan, 2018. J Obstet Gynaecol Res 2020; 46:2474-2487. [PMID: 33078482 PMCID: PMC7756675 DOI: 10.1111/jog.14522] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/28/2020] [Indexed: 01/31/2023]
Abstract
The aim of this publication is to disseminate the clinical practice guidelines for the treatment of intestinal, bladder/ureteral, thoracic and umbilical endometriosis, already published in Japanese, to non-Japanese speakers. For developing the original Japanese guidelines, the clinical practice guideline committee was formed by the research team for extragenital endometriosis, which is part of the research program of intractable disease of the Japanese Ministry of Health, Labor and Welfare. The clinical practice guideline committee formulated eight clinical questions for the treatment of extragenital endometriosis, which were intestinal, bladder/ureteral, thoracic and umbilical endometriosis. The committee performed a systematic review of the literature to provide responses to clinical questions and developed clinical guidelines for extragenital endometriosis, according to the process proposed by the Medical Information Network Distribution Service. The recommendation level was determined using modified Delphi methods. The clinical practice guidelines were officially approved by the Japan Society of Obstetrics and Gynecology and the Japan Society of Endometriosis. This English version was translated from the Japanese version.
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Affiliation(s)
- Tetsuya Hirata
- Department of Obstetrics and GynecologyDoai Kinen HospitalTokyoJapan
- Department of Obstetrics and GynecologyUniversity of TokyoTokyoJapan
| | - Kaori Koga
- Department of Obstetrics and GynecologyUniversity of TokyoTokyoJapan
| | - Kentaro Kai
- Department of Obstetrics and GynecologyOita UniversityOitaJapan
| | | | - Mari Kitade
- Department of Obstetrics and GynecologyJuntendo UniversityTokyoJapan
| | - Jo Kitawaki
- Department of Obstetrics and GynecologyKyoto Prefectural UniversityKyotoJapan
| | - Masatoshi Kurihara
- Pneumothorax Research Center and Division of Thoracic SurgeryNissan Tamagawa HospitalTokyoJapan
| | | | - Toshiaki Tanaka
- Department of Surgical OncologyUniversity of TokyoTokyoJapan
- Department of SurgeryInternational Catholic HospitalTokyoJapan
| | | | - Jun Nakajima
- Department of Thoracic SurgeryUniversity of TokyoTokyoJapan
| | | | - Tasuku Harada
- Department of Obstetrics and GynecologyTottori UniversityTottoriJapan
| | - Shigeo Horie
- Department of UrologyJuntendo UniversityTokyoJapan
| | - Ritsuo Honda
- Department of Obstetrics and GynecologyKumamoto UniversityKumamotoJapan
| | - Koji Murono
- Department of Surgical OncologyUniversity of TokyoTokyoJapan
| | - Kotaro Yoshimura
- Department of Plastic SurgeryJichi Medical UniversityShimotsukeJapan
| | - Yutaka Osuga
- Department of Obstetrics and GynecologyUniversity of TokyoTokyoJapan
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7
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Vigueras Smith A, Sumak R, Cabrera R, Kondo W, Ferreira H. Bowel anastomosis leakage following endometriosis surgery: an evidence based analysis of risk factors and prevention techniques. Facts Views Vis Obgyn 2020; 12:207-225. [PMID: 33123696 PMCID: PMC7580259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Deep endometriosis most commonly involves the rectosigmoid junction and its management often requires a colorectal resection. Anastomotic leakage is a severe complication after resection and affects 1-6% of the cases. OBJECTIVE To evaluate the risk factors related to anastomotic leakage following endometriosis sur-gery, its prevention techniques and the role of protective stomas. METHODS A comprehensive literature review was carried out for English-language publications in Pubmed and Google Scholar. We included all studies including the following MeSH terms and key words: Anastomotic leakage AND bowel surgery OR Endometriosis OR Colorectal surgery OR Bowel endometriosis. Two authors independently made a selection and analysed relevant abstracts according to the aim of this review. RESULTS Risk factors and preventive measures were categorised considering the patient condition, the intra- operative setting and the surgical procedure itself. Level I and II recommendations include modifiable risk factors such as the use of stapled or handsewn anastomosis; intra-operative air leak test to check the integrity of the anastomosis; systematic use of pelvic and trans-anal drainage; application of protective or ghost ileostomy in low rectal resections; vaginal closure before the bowel resection; use of oral antibiotics the day before surgery and performing partial mesorectal resection near the bowel wall. Diverting stomas may decrease the morbidity and the clinical consequences of leakage over 65% of low rectal resections but may cause significant adverse effects. CONCLUSION Evidence-based protective actions are crucial to reduce clinical consequences of anastomotic leakage and to minimise the use of protective stomas in endometriosis surgery.
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Affiliation(s)
- A Vigueras Smith
- Department of Minimally Invasive Surgery Unit of Centro Hospitalar Universitário do Porto, Porto. Portugal
| | - R Sumak
- Department of Minimally Invasive Surgery Unit of Centro Hospitalar Universitário do Porto, Porto. Portugal
| | - R Cabrera
- Department of Gynaecology and Minimally Invasive Unit, Vita Batel Hospital. Curitiba. Brazil
| | - W Kondo
- Department of Gynaecology and Minimally Invasive Unit, Vita Batel Hospital. Curitiba. Brazil
| | - H Ferreira
- Department of Minimally Invasive Surgery Unit of Centro Hospitalar Universitário do Porto, Porto. Portugal
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8
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Ip JCY, Chua TC, Wong SW, Krishnan S. Rectal disc resection improves stool frequency in patients with deep infiltrating endometriosis: A prospective study. Aust N Z J Obstet Gynaecol 2020; 60:454-458. [DOI: 10.1111/ajo.13145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 02/03/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Julian C. Y. Ip
- Department of Surgery Prince of Wales Private Hospital Sydney New South Wales Australia
- Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
| | - Terence C. Chua
- Department of Surgery Logan Hospital Metro South Health Brisbane Queensland Australia
- School of Medicine Griffith University Gold Coast Queensland Australia
| | - Shing W. Wong
- Department of Surgery Prince of Wales Private Hospital Sydney New South Wales Australia
- University of New South Wales Sydney New South Wales Australia
| | - Surya Krishnan
- Royal Hospital for Women Sydney New South Wales Australia
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9
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Holdsworth-Carson SJ, Rogers PAW. The complex relationship between body mass index and endometriosis. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2018. [DOI: 10.1177/2284026518810586] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
There is an inverse relationship between endometriosis and a women’s body mass index. To date, the precise mechanisms and aetiological basis linking body mass index with endometriosis remain unknown. Although an increased incidence of endometriosis is observed in women with low body mass indices; endometriosis is associated with conditions common to obesity (hypercholesterolemia, hypertension and coronary heart disease). In the context of endometriosis, further research is necessary in women with surgically confirmed disease to improve clinical advice and patient outcomes.
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Affiliation(s)
- Sarah J Holdsworth-Carson
- Department of Obstetrics and Gynaecology, The University of Melbourne and Gynaecology Research Centre, The Royal Women’s Hospital, Parkville, VIC, Australia
| | - Peter AW Rogers
- Department of Obstetrics and Gynaecology, The University of Melbourne and Gynaecology Research Centre, The Royal Women’s Hospital, Parkville, VIC, Australia
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10
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Dong Y, Braden B, Klinger C, Ripolles T, Dietrich CF. Ultrasound findings in extragenital endometriosis. J Ultrason 2018; 18:247-254. [PMID: 30427131 PMCID: PMC6442214 DOI: 10.15557/jou.2018.0036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
We present a report on ultrasound findings in extragenital endometriosis and a literature review accompanied by illustrations. Intestinal endometriosis should be considered in female patients of reproductive age who present with constipation, gastrointestinal bleeding, nausea, vomiting, cramp-like abdominal pain, diarrhoea and pelvic pain. Although definitive preoperative diagnosis of endometriosis is difficult, clinical suspicion and appropriate imaging might prevent extensive surgical procedures with higher morbidity. Contrast-enhanced ultrasound is an efficient non-invasive imaging method without any radiation exposure that supports the early diagnosis of intestinal endometriosis and may help assess the vascularization of endometriotic lesions within the distinct layers of the intestinal wall.
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Affiliation(s)
- Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Barbara Braden
- Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK
| | | | - Tomás Ripolles
- Department of Radiology, Dr Peset Universitary Hospital, Valencia, Spain
| | - Christoph F Dietrich
- Medizinische Klinik 2, Caritas-Krankenhaus Bad Mergentheim, Bad Mergentheim, Germany
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11
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Ianieri MM, Mautone D, Ceccaroni M. Recurrence in Deep Infiltrating Endometriosis: A Systematic Review of the Literature. J Minim Invasive Gynecol 2018; 25:786-793. [DOI: 10.1016/j.jmig.2017.12.025] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/27/2017] [Accepted: 12/13/2017] [Indexed: 11/28/2022]
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12
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Nezhat C, Li A, Falik R, Copeland D, Razavi G, Shakib A, Mihailide C, Bamford H, DiFrancesco L, Tazuke S, Ghanouni P, Rivas H, Nezhat A, Nezhat C, Nezhat F. Bowel endometriosis: diagnosis and management. Am J Obstet Gynecol 2018; 218:549-562. [PMID: 29032051 DOI: 10.1016/j.ajog.2017.09.023] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/19/2017] [Accepted: 09/27/2017] [Indexed: 12/29/2022]
Abstract
The most common location of extragenital endometriosis is the bowel. Medical treatment may not provide long-term improvement in patients who are symptomatic, and consequently most of these patients may require surgical intervention. Over the past century, surgeons have continued to debate the optimal surgical approach to treating bowel endometriosis, weighing the risks against the benefits. In this expert review we will describe how the recommended surgical approach depends largely on the location of disease, in addition to size and depth of the lesion. For lesions approximately 5-8 cm from the anal verge, we encourage conservative surgical management over resection to decrease the risk of short- and long-term complications.
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13
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Holdsworth-Carson SJ, Dior UP, Colgrave EM, Healey M, Montgomery GW, Rogers PAW, Girling JE. The association of body mass index with endometriosis and disease severity in women with pain. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2018. [DOI: 10.1177/2284026518773939] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: There is a well-established inverse relationship between body mass index and frequency of endometriosis. However, these population-based studies have relied mostly on self-reported cases of endometriosis, rather than surgically confirmed endometriosis where disease severity has been objectively assessed. The aim of the current retrospective study was to establish whether the established relationship between endometriosis and low body mass index was independent of disease severity. Methods: Women with menstrual and/or pelvic pain undergoing laparoscopy for suspected endometriosis were recruited for this retrospective study (n = 509). Women were grouped by body mass index (kg/m2) according to World Health Organization criteria: underweight (<18.5), normal (18.5–24.99), pre-obese (25–29.99) or obese (≥30). Endometriosis was scored according to the revised American Fertility Society system. Data were analysed based on body mass index and endometriosis status to identify any relationship between body mass index and disease. Results: The average body mass index of women with endometriosis was 25.0 kg/m2. The body mass index distribution of women with endometriosis differed relative to women in the general population. As expected, fewer obese women had endometriosis than in the lower body mass index categories. However, the obese women who did have endometriosis had significantly higher revised American Fertility Society scores compared to women with normal and pre-obese body mass indices. Discussion: Our results are consistent with the established finding of an inverse relationship between body mass index and endometriosis. The novel finding from this study is that obesity is associated with increased disease severity and reduced frequency of stage I endometriosis. It remains unclear what role body mass index has in the cause or effect of endometriosis; we speculate that body mass index may be useful for sub-classifying the disease.
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Affiliation(s)
- Sarah J Holdsworth-Carson
- Department of Obstetrics and Gynaecology, The University of Melbourne and Gynaecology Research Centre, The Royal Women’s Hospital, Parkville, VIC, Australia
| | - Uri P Dior
- The Royal Women’s Hospital, Parkville, VIC, Australia
| | - Eliza M Colgrave
- Department of Obstetrics and Gynaecology, The University of Melbourne and Gynaecology Research Centre, The Royal Women’s Hospital, Parkville, VIC, Australia
| | - Martin Healey
- Department of Obstetrics and Gynaecology, The University of Melbourne and Gynaecology Research Centre, The Royal Women’s Hospital, Parkville, VIC, Australia
- The Royal Women’s Hospital, Parkville, VIC, Australia
| | - Grant W Montgomery
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Peter AW Rogers
- Department of Obstetrics and Gynaecology, The University of Melbourne and Gynaecology Research Centre, The Royal Women’s Hospital, Parkville, VIC, Australia
| | - Jane E Girling
- Department of Obstetrics and Gynaecology, The University of Melbourne and Gynaecology Research Centre, The Royal Women’s Hospital, Parkville, VIC, Australia
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14
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Saguyod SJU, Kelley AS, Velarde MC, Simmen RCM. Diet and endometriosis-revisiting the linkages to inflammation. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2018. [DOI: 10.1177/2284026518769022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Endometriosis is a chronic inflammatory condition that may cause pelvic pain, dysmenorrhea, and/or infertility in women of reproductive age. While treatments may include medical or surgical management, the majority of therapeutic options are non-curative, and women may experience longstanding pain and/or disability. In general, chronic diseases are believed to result from modifiable risk factors, including diet. In this review, we discuss recent data on evidence-based associations between diet and endometriosis and the mechanistic points of action of constituent dietary factors with emphasis on inflammatory events that may contribute to the promotion or inhibition of the disease. Understanding the convergence of diet and endometriosis may lead to the development of clinical strategies to improve the quality of life for symptomatic women.
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Affiliation(s)
- Sofia Jade U Saguyod
- Institute of Biology, University of the Philippines Diliman, Quezon City, Philippines
| | - Angela S Kelley
- Department of Obstetrics and Gynecology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Michael C Velarde
- Institute of Biology, University of the Philippines Diliman, Quezon City, Philippines
| | - Rosalia CM Simmen
- Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Bertocchi E, Barugola G, Benini M, Bocus P, Rossini R, Ceccaroni M, Ruffo G. Colorectal Anastomotic Stenosis: Lessons Learned after 1643 Colorectal Resections for Deep Infiltrating Endometriosis. J Minim Invasive Gynecol 2018; 26:100-104. [PMID: 29678755 DOI: 10.1016/j.jmig.2018.03.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/12/2018] [Accepted: 03/13/2018] [Indexed: 12/12/2022]
Abstract
STUDY OBJECTIVE To evaluate the incidence, risk factors, and treatment of colorectal anastomotic stenosis in patients who undergo rectosigmoid resection for deep infiltrating endometriosis (DIE). DESIGN Retrospective analysis of a prospective database (Canadian Task Force classification III). SETTING Public medical center. PATIENTS All women who underwent laparoscopic rectosigmoid resections for DIE at our hospital between January 2002 and December 2016. INTERVENTION All patients were evaluated clinically and endoscopically at 1 month and 3 months after bowel resection. Stenosis was defined as a lack of passage through the anastomosis of a 12-mm proctoscope. Symptomatic stenosis was defined as the presence of endoscopically confirmed stricture accompanied by at least 2 of the following symptoms: constipation, need to push, tenesmus, and ribbon stools. Only patients with symptomatic stenosis were studied. Demographic data, surgical techniques, and postoperative complications were recorded prospectively. Treatments and outcomes of anastomotic symptomatic strictures were analyzed. MEASUREMENTS AND MAIN RESULTS A total of 1643 patients underwent laparoscopic rectosigmoid resection at our hospital between January 2002 and December 2016. Among these, 104 patients (6.3%) presented with symptomatic anastomotic stenosis. The median patient age was 27 years (range, 23-44 years), and the median interval between diagnosis and the onset of symptomatic stenosis was 57 days (range, 21-64 days). The only statistically significant predictors of anastomotic stenosis were the presence of ileostomy (p = .01) and previous pelvic surgery (p = .002). Treatment of choice was always conservative. Of the 104 patients in the study cohort, 90 (86.5%) underwent 3 endoscopic dilatations. No patient required reoperation. CONCLUSION The anastomotic stricture is a recognized complication in patients following intestinal resection for DIE, and protective ileostomy is the sole modifiable factor related to anastomotic stenosis. Endoscopic dilatation is a valid option to treat this complication.
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Affiliation(s)
- Elisa Bertocchi
- Department of Surgery, Sacred Heart-Don Calabria Hospital, Negrar, Verona, Italy.
| | - Giuliano Barugola
- Department of Surgery, Sacred Heart-Don Calabria Hospital, Negrar, Verona, Italy
| | - Marco Benini
- Department of Gastroenterology and Endoscopy, Sacred Heart-Don Calabria Hospital, Negrar, Verona, Italy
| | - Paolo Bocus
- Department of Gastroenterology and Endoscopy, Sacred Heart-Don Calabria Hospital, Negrar, Verona, Italy
| | - Roberto Rossini
- Department of Surgery, Sacred Heart-Don Calabria Hospital, Negrar, Verona, Italy
| | - Marcello Ceccaroni
- Department of Gynecology, Sacred Heart-Don Calabria Hospital, Negrar, Verona, Italy
| | - Giacomo Ruffo
- Department of Surgery, Sacred Heart-Don Calabria Hospital, Negrar, Verona, Italy
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16
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Young S, Burns MK, DiFrancesco L, Nezhat A, Nezhat C. Diagnostic and treatment guidelines for gastrointestinal and genitourinary endometriosis. J Turk Ger Gynecol Assoc 2017; 18:200-209. [PMID: 29278234 PMCID: PMC5776160 DOI: 10.4274/jtgga.2017.0143] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 12/03/2017] [Indexed: 01/28/2023] Open
Abstract
Endometriosis is commonly misdiagnosed, even among many experienced gynecologists. Gastrointestinal and genitourinary endometriosis is particularly difficult to diagnose, and is commonly mistaken for other pathologies, such as irritable bowel syndrome, interstitial cystitis, and even psychological disturbances. This leads to delays in diagnosis, mismanagement, and unnecessary testing. In this review, we will discuss the diagnosis and management of genitourinary and gastrointestinal endometriosis. Medical management may be tried first, but often fails in cases of urinary tract endometriosis. This is particularly important in cases of ureteral endometriosis because silent obstruction can lead to eventual kidney failure. Thus, we recommend complete surgical treatment in these cases. Bladder endometriosis may be managed more conservatively, and only if symptomatic, because these rarely lead to significant morbidity. In cases of bowel endometriosis, we recommend medical management first in all cases, and the least invasive surgical management only if medical treatment fails. This is due to the extensive nervous and vasculature supply to the lower rectum. Injury to these nerves and vessels can cause significant complications and postoperative morbidity.
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Affiliation(s)
- Stacy Young
- Camran Nezhat Institute and Center for Special Minimally Invasive and Robotic Surgery, California, USA
- Stanford University Medical Center, California, USA
| | - Megan Kennedy Burns
- Camran Nezhat Institute and Center for Special Minimally Invasive and Robotic Surgery, California, USA
- Stanford University Medical Center, California, USA
| | - Lucia DiFrancesco
- Camran Nezhat Institute and Center for Special Minimally Invasive and Robotic Surgery, California, USA
- Stanford University Medical Center, California, USA
| | - Azadeh Nezhat
- Camran Nezhat Institute and Center for Special Minimally Invasive and Robotic Surgery, California, USA
- Stanford University Medical Center, California, USA
- University of California, San Francisco, School of Medicine, San Francisco, USA
| | - Camran Nezhat
- Camran Nezhat Institute and Center for Special Minimally Invasive and Robotic Surgery, California, USA
- Stanford University Medical Center, California, USA
- University of California, San Francisco, School of Medicine, San Francisco, USA
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17
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Laparoscopic lens fogging: solving a common surgical problem in standard and robotic laparoscopes via a scientific model. Surg Endosc 2017; 32:1600-1606. [DOI: 10.1007/s00464-017-5772-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 07/17/2017] [Indexed: 11/26/2022]
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18
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Menakaya UA, Rombauts L, Johnson NP. Diagnostic laparoscopy in pre-surgical planning for higher stage endometriosis: Is it still relevant? Aust N Z J Obstet Gynaecol 2016; 56:518-522. [DOI: 10.1111/ajo.12505] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 06/13/2016] [Indexed: 01/24/2023]
Affiliation(s)
- Uche A. Menakaya
- Department of Obstetrics and Gynecology; Calvary Public Hospital; ACT Australia
- JUNIC Specialist Imaging and Women's Center; Canberra ACT Australia
| | - Luk Rombauts
- Monash University; Melbourne Vic. Australia
- Monash IVF; Melbourne Vic. Australia
- Reproductive Medicine; Monash Health; Clayton Vic. Australia
| | - Neil P. Johnson
- Robinson Research Institute; University of Adelaide; Adelaide SA Australia
- University of Auckland; Auckland New Zealand
- Repromed and Auckland Gynecology Group; Auckland New Zealand
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Soto E, Catenacci M, Bedient C, Jelovsek JE, Falcone T. Assessment of Long-Term Bowel Symptoms After Segmental Resection of Deeply Infiltrating Endometriosis: A Matched Cohort Study. J Minim Invasive Gynecol 2016; 23:753-9. [DOI: 10.1016/j.jmig.2016.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 02/27/2016] [Accepted: 03/04/2016] [Indexed: 10/22/2022]
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20
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Rossini R, Monsellato D, Bertolaccini L, Pesci A, Zamboni G, Ceccaroni M, Ruffo G. Lymph Node Involvement in Deep Infiltrating Intestinal Endometriosis: Does It Really Mean Anything? J Minim Invasive Gynecol 2016; 23:787-92. [DOI: 10.1016/j.jmig.2016.03.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 03/29/2016] [Accepted: 03/29/2016] [Indexed: 12/19/2022]
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21
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Ng A, Yang P, Wong S, Vancaillie T, Krishnan S. Medium to long-term gastrointestinal outcomes following disc resection of the rectum for treatment of endometriosis using a validated scoring questionnaire. Aust N Z J Obstet Gynaecol 2016; 56:408-13. [DOI: 10.1111/ajo.12476] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 04/09/2016] [Indexed: 01/25/2023]
Affiliation(s)
- Ada Ng
- Department of Surgery; Prince of Wales Private Hospital; Randwick New South Wales Australia
| | - Phillip Yang
- Department of Surgery; Prince of Wales Private Hospital; Randwick New South Wales Australia
- University of New South Wales; Sydney New South Wales Australia
| | - Shing Wong
- Department of Surgery; Prince of Wales Private Hospital; Randwick New South Wales Australia
- University of New South Wales; Sydney New South Wales Australia
| | - Thierry Vancaillie
- Royal Hospital for Women; Randwick New South Wales Australia
- Department of Gynaecology; Prince of Wales Private Hospital; Randwick New South Wales Australia
- University of New South Wales; Sydney New South Wales Australia
| | - Surya Krishnan
- Royal Hospital for Women; Randwick New South Wales Australia
- Department of Gynaecology; Prince of Wales Private Hospital; Randwick New South Wales Australia
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22
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[Retroperitoneal endometriosis : When a rare form of endometriosis becomes a urological disease]. Urologe A 2016; 55:756-62. [PMID: 27294488 DOI: 10.1007/s00120-016-0119-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Retroperitoneal endometriosis is a common benign disease, which requires an interdisciplinary approach. In the clinical practice diagnosis is often delayed for years after onset of the unspecific symptoms so that increased awareness is necessary for detection of the presence of the disease. OBJECTIVE This article provides a description of the disease including the symptoms and pathogenesis, an introduction to the complexity of diagnostic investigations and the current therapy recommendations. MATERIAL AND METHODS Comparison of current therapy recommendations according to the guidelines under consideration of individual studies and background research. Assessment of studies and the accompanying interpretations with the intention of presenting an introduction to the topic with therapy recommendations. RESULTS From a urological point of view retroperitoneal endometriosis is a benign disease affecting the ureters and urinary bladder. Involvement of the ureters leading to hydronephrosis caused by ureteral compression represents an absolute indication for therapy. Recurrent macrohematuria can also necessitate treatment. Treatment includes surgical excision of the focal point of endometriosis as the first line therapy. Various operative procedures and access routes are available but when possible a minimally invasive procedure should be used. A second line drug therapy is also possible. CONCLUSION Surgical excision of a clinically significant focus of endometriosis is the gold standard for therapy. This procedure should take place in a specialized center within an interdisciplinary consensus. Due to the fact that endometriosis is primarily a benign disease, medical clarification for the patient concerning the benefits and risks of therapy is absolutely necessary. An individual therapy concept under consideration of factors, such as the specific clinical relevance and psychological stress is recommended and in close cooperation with the patient.
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23
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Nezhat C, Main J, Paka C, Soliemannjad R, Parsa MA. Advanced gynecologic laparoscopy in a fast-track ambulatory surgery center. JSLS 2016; 18:JSLS-D-13-00291. [PMID: 25392631 PMCID: PMC4154421 DOI: 10.4293/jsls.2014.00291] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background/Objectives: It has been shown that major gynecologic laparoscopy is safe in hospital ambulatory settings, but there is little data to suggest the same in freestanding ambulatory surgery centers. This study evaluates the safety and efficacy of advanced gynecologic laparoscopic surgery using a fast-track model in freestanding ambulatory surgery centers and discusses our institution protocols. Methods: Retrospective, multicenter review was conducted of major gynecologic surgeries from August 1st 2010 to September 30th 2011 in 3 surgical centers with one primary surgeon. All patients were treated for symptomatic uterine leiomyomas and/or endometriosis. Primary outcome measures were unplanned admissions and discharge within 23 hours. Results: One hundred and thirty-four patients underwent major laparoscopic gynecologic surgery with a total of 160 procedures: 77 stage IV endometriosis treatment including 7 disk excisions of endometriosis from the large bowel, 3 ureteroneocystostomies and 1 partial bladder resection, 38 myomectomies, and 34 hysterectomies including 12 modified radical hysterectomies. The overall unplanned admission rate was 4.5%. One hundred and thirty-one patients (97.7%) were discharged within 24 hours after surgery. Three patients (2.2%) were transferred to the hospital postoperatively: 1 patient for observation of postoperative anemia and 2 patients for postoperative fever. Three patients (2.2%) were admitted to the hospital after discharge: 1 patient for postoperative ileus, 1 patient for postoperative fever, and 1 patient with septic pelvic thrombophlebitis. These postoperative issues all resolved without complication, and all patients had an uneventful follow-up. Conclusions: With appropriate resources and an experienced surgeon, advanced laparoscopic surgery can be safely performed in a fast-track ambulatory surgery center with a high rate of discharge within 23 hours and low unplanned readmission rate.
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Affiliation(s)
- Camran Nezhat
- Center for Special Minimally Invasive and Robotic Surgery, Stanford University Medical Center, Palo Alto, CA, USA
| | - Jillian Main
- Center for Special Minimally Invasive and Robotic Surgery, Stanford University Medical Center, Palo Alto, CA, USA
| | - Chandhana Paka
- Center for Special Minimally Invasive and Robotic Surgery, Stanford University Medical Center, Palo Alto, CA, USA
| | - Rose Soliemannjad
- Center for Special Minimally Invasive and Robotic Surgery, Stanford University Medical Center, Palo Alto, CA, USA
| | - M Ali Parsa
- Center for Special Minimally Invasive and Robotic Surgery, Stanford University Medical Center, Palo Alto, CA, USA
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24
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Incomplete Small Bowel Obstruction Due to Isolated Ileal Endometriosis: A Mimic of Tuberculosis. J Obstet Gynaecol India 2015; 66:642-644. [PMID: 27803532 DOI: 10.1007/s13224-015-0789-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 09/12/2015] [Indexed: 01/07/2023] Open
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25
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Pellegrino A, Damiani GR, Trio C, Faccioli P, Croce P, Tagliabue F, Dainese E. Robotic Shaving Technique in 25 Patients Affected by Deep Infiltrating Endometriosis of the Rectovaginal Space. J Minim Invasive Gynecol 2015; 22:1287-92. [DOI: 10.1016/j.jmig.2015.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 06/02/2015] [Accepted: 06/03/2015] [Indexed: 10/23/2022]
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26
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Al-Qahtani HH, Alfalah H, Al-Salamah RA, Elshair AA. Sigmoid colon endometriotic mass. A rare cause of complete large bowel obstruction. Saudi Med J 2015; 36:630-3. [PMID: 25935187 PMCID: PMC4436763 DOI: 10.15537/smj.2015.5.11268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 03/16/2015] [Indexed: 01/07/2023] Open
Abstract
Large bowel obstruction is a rare complication of gastrointestinal endometriosis. A 32-year-old female patient presented to the emergency department with complaints of diffuse abdominal pain and constipation for 10 days with progressive abdominal distention and vomiting. Plain abdominal x-ray showed grossly dilated large bowel up to the sigmoid colon with no gas in the rectum. Abdominal computed tomography revealed hugely dilated large bowel up to the sigmoid colon, with sigmoid soft tissue mass. Flexible sigmoidoscopy showed a non-ulcerating sigmoid mass, with complete obstruction of the sigmoid colon, which impeded the further advancement of the scope. She underwent exploratory laparotomy with provisional diagnosis of complete large bowel obstruction due to sigmoid tumor. Sigmiodectomy with end colostomy was performed. Histopathology revealed endometrial glands with stroma in muscularis properia of the sigmoid colon mass. Endometriosis should be considered in women of reproductive age presenting with symptoms of large bowel obstruction.
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Affiliation(s)
- Hamad H Al-Qahtani
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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27
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Robotic-Assisted Laparoscopy vs Conventional Laparoscopy for the Treatment of Advanced Stage Endometriosis. J Minim Invasive Gynecol 2015; 22:40-4. [DOI: 10.1016/j.jmig.2014.06.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 06/03/2014] [Accepted: 06/04/2014] [Indexed: 11/21/2022]
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Nirgianakis K, McKinnon B, Imboden S, Knabben L, Gloor B, Mueller MD. Laparoscopic management of bowel endometriosis: resection margins as a predictor of recurrence. Acta Obstet Gynecol Scand 2014; 93:1262-7. [DOI: 10.1111/aogs.12490] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 08/26/2014] [Indexed: 11/27/2022]
Affiliation(s)
| | - Brett McKinnon
- Department of Obstetrics and Gynecology; University of Berne; Berne Switzerland
| | - Sara Imboden
- Department of Obstetrics and Gynecology; University of Berne; Berne Switzerland
| | - Laura Knabben
- Department of Obstetrics and Gynecology; University of Berne; Berne Switzerland
| | - Beat Gloor
- Department of Visceral Surgery and Medicine; University of Berne; Berne Switzerland
| | - Michael D. Mueller
- Department of Obstetrics and Gynecology; University of Berne; Berne Switzerland
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29
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Cacciato Insilla A, Granai M, Gallippi G, Giusti P, Giusti S, Guadagni S, Morelli L, Campani D. Deep endometriosis with pericolic lymph node involvement: A case report and literature review. World J Gastroenterol 2014; 20:6675-6679. [PMID: 24914394 PMCID: PMC4047358 DOI: 10.3748/wjg.v20.i21.6675] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Revised: 12/11/2013] [Accepted: 02/20/2014] [Indexed: 02/06/2023] Open
Abstract
Deep infiltrating endometriosis is an often-painful disorder affecting women during their reproductive years that usually involves the structures of the pelvis and frequently the gastrointestinal tract. We present the case of a 37-year-old female patient with an endometrial growth on the sigmoid colon wall causing pain, diarrhea and the presence of blood in the feces. The histology of the removed specimen also revealed the involvement of the utero-vesical fold, the recto-vaginal septum and a pericolic lymph node, which are all quite uncommon findings. To identify the endometrial cells, we performed immunohistochemical staining for CD10 and the estrogen and progesterone receptors.
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30
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Abstract
Endometriosis is defined as the presence of endometrial-type mucosa outside the uterine cavity. Of the proposed pathogenic theories (retrograde menstruation, coelomic metaplasia and Müllerian remnants), none explain all the different types of endometriosis. According to the most convincing model, the retrograde menstruation hypothesis, endometrial fragments reaching the pelvis via transtubal retrograde flow, implant onto the peritoneum and abdominal organs, proliferate and cause chronic inflammation with formation of adhesions. The number and amount of menstrual flows together with genetic and environmental factors determines the degree of phenotypic expression of the disease. Endometriosis is estrogen-dependent, manifests during reproductive years and is associated with pain and infertility. Dysmenorrhoea, deep dyspareunia, dyschezia and dysuria are the most frequently reported symptoms. Standard diagnosis is carried out by direct visualization and histologic examination of lesions. Pain can be treated by excising peritoneal implants, deep nodules and ovarian cysts, or inducing lesion suppression by abolishing ovulation and menstruation through hormonal manipulation with progestins, oral contraceptives and gonadotropin-releasing hormone agonists. Medical therapy is symptomatic, not cytoreductive; surgery is associated with high recurrence rates. Although lesion eradication is considered a fertility-enhancing procedure, the benefit on reproductive performance is moderate. Assisted reproductive technologies constitute a valid alternative. Endometriosis is associated with a 50% increase in the risk of epithelial ovarian cancer, but preventive interventions are feasible.
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Affiliation(s)
- Paolo Vercellini
- Department of Obstetrics and Gynecology, Fondazione Cà Granda, Ospedale Maggiore Policlinico, Via Commenda 12, 20122 Milan, Italy
| | - Paola Viganò
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Via Olgettina 60, 20136 Milan, Italy
| | - Edgardo Somigliana
- Department of Obstetrics and Gynecology, Fondazione Cà Granda, Ospedale Maggiore Policlinico, Via Commenda 12, 20122 Milan, Italy
| | - Luigi Fedele
- Department of Obstetrics and Gynecology, Fondazione Cà Granda, Ospedale Maggiore Policlinico, Via Commenda 12, 20122 Milan, Italy
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31
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Belghiti J, Ballester M, Zilberman S, Thomin A, Zacharopoulou C, Bazot M, Thomassin-Naggara I, Daraï E. Role of Protective Defunctioning Stoma in Colorectal Resection for Endometriosis. J Minim Invasive Gynecol 2014; 21:472-9. [DOI: 10.1016/j.jmig.2013.12.094] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 12/03/2013] [Accepted: 12/04/2013] [Indexed: 10/25/2022]
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Abstract
PURPOSE OF REVIEW To present the outcome of laparoscopic resection for bowel endometriosis. RECENT FINDINGS In the last 12 months, numerous articles have been published to demonstrate and underline the efficiency and feasibility of the laparoscopic approach in the treatment of bowel endometriosis. SUMMARY Endometriosis is a common condition that can affect women in their reproductive age. It can have an intestinal involvement, and when it occurs rectum and rectosigmoid junction are the most frequent sites; other lesser frequent sites are the appendix, the distal ileum, and the cecum. It is widely agreed that surgical management is the primary treatment for symptomatic bowel endometriosis. Laparoscopic bowel resection has become increasingly popular because it represents a well tolerated and feasible technique.
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Kondo W, Ribeiro R, Zomer MT. Fast-track surgery in intestinal deep infiltrating endometriosis. J Minim Invasive Gynecol 2013; 21:285-90. [PMID: 24075838 DOI: 10.1016/j.jmig.2013.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 09/02/2013] [Accepted: 09/03/2013] [Indexed: 12/20/2022]
Abstract
STUDY OBJECTIVE To evaluate the length of hospital stay (LOS) and the readmission rate in patients undergoing laparoscopic surgery to treat intestinal deep infiltrating endometriosis (DIE) with application of the concepts of fast-track surgery. DESIGN Retrospective study of women undergoing laparoscopic treatment of intestinal DIE (Canadian Task Force classification II-3). SETTING Tertiary referral private hospital. INTERVENTIONS We evaluated 161 women who underwent laparoscopic surgery between January 2010 and April 2013 for complete treatment of intestinal DIE, via either conservative surgery (rectal shaving, mucosal skinning, or anterior disk resection) or radical surgery (segmental bowel resection). After surgery, all specimens were sent for pathologic examination to confirm the presence of endometriosis. MEASUREMENTS AND MAIN RESULTS Patients were divided into 2 groups according to type of surgery (conservative [n = 102] or radical [n = 59]), and LOS and readmission rate were measured in both groups. Median LOS was shorter in the conservative group compared with the segmental bowel resection group (19 vs 28 hours; p < .001). Ninety-two patients (90.2%) in the conservative surgery group were discharged to home on the first postoperative day, compared with only 38 patients (64.4%) in the segmental bowel resection group. Overall, the readmission rate was low (3.1%): 6.8% in the segmental bowel resection group and 1% in the conservative group (p = .04; odds ratio, 7.34; 95% confidence interval, 0.8-67.3); however, the need for repeat operation was similar in both groups (3.4% vs 1%; p = .28; odds ratio, 3.54; 95% confidence interval, 0.31-39.95). CONCLUSION Implementation of fast-track concepts in the laparoscopic treatment of intestinal DIE resulted in a short LOS and low readmission rate in both the segmental bowel resection and conservative surgery groups.
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Affiliation(s)
- William Kondo
- Department of Gynecology, Sugisawa Medical Center, Curitiba, Paraná, Brazil; Department of Gynecology, Vita Batel Hospital, Curitiba, Paraná, Brazil.
| | - Reitan Ribeiro
- Department of Gynecology, Vita Batel Hospital, Curitiba, Paraná, Brazil
| | - Monica Tessmann Zomer
- Department of Gynecology, Sugisawa Medical Center, Curitiba, Paraná, Brazil; Department of Gynecology, Vita Batel Hospital, Curitiba, Paraná, Brazil
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Neme RM, Schraibman V, Okazaki S, Maccapani G, Chen WJ, Domit CD, Kaufmann OG, Advincula AP. Deep infiltrating colorectal endometriosis treated with robotic-assisted rectosigmoidectomy. JSLS 2013; 17:227-34. [PMID: 23925016 PMCID: PMC3771789 DOI: 10.4293/108680813x13693422521836] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Robotic-assisted surgery for the treatment of deep infiltrating bowel endometriosis appears to be feasible, effective, and safe. Background and Objective: Deep infiltrating pelvic endometriosis with bowel involvement is one of the most aggressive forms of endometriosis. Nowadays, robotic technology and telemanipulation systems represent the latest developments in minimally invasive surgery. The aim of this study is to present our preliminary results and evaluate the feasibility of robotic-assisted laparoscopic colorectal resection for severe endometriosis. Methods: Between September 2009 and December 2011, 10 women with colorectal endometriosis underwent surgery with the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, CA, USA). We evaluated the following parameters: short-term complications, clinical outcomes and long-term follow-up, pain relief recurrence rate, and fertility outcomes. Results: Extensive ureterolysis was required in 8 women (80%). Ovarian cystectomy with removal of the cystic wall was performed in 7 women (70%). Torus resection was performed in all women, with unilateral and bilateral uterosacral ligament resection in 1 woman (10%) and 8 women (80%), respectively. In addition to segmental colorectal resection in all cases, partial vaginal resection was necessary in 2 women (20%). An appendectomy was performed in 2 patients (20%). The mean operative time with the robot was 157 minutes (range, 90–190 minutes). The mean hospital stay was 3 days. Six patients had infertility before surgery, with a mean infertility time of 2 years. After a 12-month follow-up period, 4 women (67%) conceived naturally and 2 (33%) underwent in vitro fertilization. Conclusion: We show that robotic-assisted laparoscopic surgery for the treatment of deep infiltrating bowel endometriosis is feasible, effective, and safe.
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Affiliation(s)
- Rosa Maria Neme
- Hospital das Clinicas, Universidade de São Paulo, São Paulo, Brazil.
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Changes in the size of rectovaginal endometriotic nodules infiltrating the rectum during hormonal therapies. Arch Gynecol Obstet 2012; 287:447-53. [DOI: 10.1007/s00404-012-2581-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 09/20/2012] [Indexed: 01/07/2023]
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Piromchai P, Kasemsiri P, Thanaviratananich S. Alternative agents to prevent fogging in head and neck endoscopy. CLINICAL MEDICINE INSIGHTS. EAR, NOSE AND THROAT 2011; 4:1-4. [PMID: 24179399 PMCID: PMC3783309 DOI: 10.4137/cment.s6597] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The essential factor for diagnosis and treatment of diseases in head and neck endoscopy is the visibility of the image. An anti-fogging agent can reduce this problem by minimizing surface tension to prevent the condensation of water in the form of small droplets on a surface. There is no report on the use of hibiscrub(®) or baby shampoo to reduce fogging in the literature. The objective of this study was to compare the efficacy between commercial anti-fogging agent, hibiscrub(®) and baby shampoo to reduce fogging for the use in head and neck endoscopy. METHODS The study was conducted at the Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University in August 2010. Commercial anti-fogging agent, baby shampoo and hibiscrub(®) were applied on rigid endoscope lens before putting them into a mist generator. The images were taken at baseline, 15 seconds, 30 seconds and 1 minute. The images' identifiers were removed before they were sent to two evaluators. A visual analogue scale (VAS) was used to rate the image quality from 0 to 10. RESULTS The difference in mean VAS score between anti-fogging agent, baby shampoo and hibiscrub(®) versus no agent were 5.46, 4.45 and 2.1 respectively. The commercial anti-fogging agent and baby shampoo had most protective benefit and performed significantly better than no agent (P = 0.05). CONCLUSIONS Baby shampoo is an effective agent to prevent fogging during head and neck endoscopy and compares favourably with commercial anti-fogging agent.
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Affiliation(s)
- Patorn Piromchai
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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