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Bekkers IP, Henschen R, Smeets NA, van Vliet HA, Damoiseaux A, Wassen MM. Vaginal assisted NOTES hysterectomy in The Netherlands; A prospective cohort study. Eur J Obstet Gynecol Reprod Biol X 2024; 23:100323. [PMID: 39091980 PMCID: PMC11292541 DOI: 10.1016/j.eurox.2024.100323] [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: 04/11/2024] [Revised: 06/08/2024] [Accepted: 06/16/2024] [Indexed: 08/04/2024] Open
Abstract
Objectives Vaginal assisted Natural Orifice Transluminal Endoscopic Surgery (NOTES) combines the benefits of vaginal and endoscopic surgery. This study presents the results of the first vaginal assisted NOTES hysterectomies (VANH) in The Netherlands. Study design A prospective cohort study was performed in two non-academic teaching hospitals in The Netherlands. Data was collected from patients who underwent a VANH for benign indications between August 2019 and April 2023. Baseline characteristics and data of intra- and postoperative surgical outcomes were recorded and analysed. The VANHs were performed by four experienced vaginal and endoscopic gynaecological surgeons. Results A total of 200 patients underwent a VANH. Indications were dysfunctional menstrual bleeding (61 %; n = 122), abnormal cervical cytology (15.5 %; n = 31), abdominal pain (11.5 %; n = 23), post ablation/sterilization pain syndrome (3.5 %; n = 7), uterine fibroids (5.0 %; n = 10), atypical endometrial hyperplasia (2.5 %; n = 5) and Lynch or BRCA gene mutation carriers (1.0 %, n = 2). The mean surgical time was 61.4 min ( ± 22.8 min) with a mean blood loss of 88 mL ( ± 89 mL) and a mean uterine weight of 150 g ( ± 112 g). In 2.0 % (n = 4) of the cases a conversion was necessary. Same day discharge (SDD) was feasible in 80.2 % (n = 105) of the patients planned in day-care. In 2.0 % (n = 4) an intra-operative complication and in 9.0 % (n = 18) a post-operative complication occurred. Conclusion This study shows vNOTES to be a safe and feasible surgical technique and can be safely implemented with appropriate patient selection and skilled surgeons. It highlights the importance of surgeon awareness of the challenges inherent in the initial stages of the implementation of a new surgical technique when performing their first vNOTES procedures. Additional randomized clinical trials are needed to show superiority of vNOTES compared to traditional surgery.
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Affiliation(s)
- Ilse P.W. Bekkers
- Department of Obstetrics & Gynecology, Zuyderland Medical Centre Heerlen, Henri Dunantstraat 5, 6419 PC Heerlen, Limburg, the Netherlands
- GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, the Netherlands
- Maastricht University, Maastricht, the Netherlands
| | - Rebecca Henschen
- Department of Obstetrics & Gynecology, Zuyderland Medical Centre Heerlen, Henri Dunantstraat 5, 6419 PC Heerlen, Limburg, the Netherlands
- GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, the Netherlands
- Maastricht University, Maastricht, the Netherlands
| | - Nicol A.C. Smeets
- Department of Obstetrics & Gynecology, Zuyderland Medical Centre Heerlen, Henri Dunantstraat 5, 6419 PC Heerlen, Limburg, the Netherlands
| | - Huib A.A.M. van Vliet
- Department of Obstetrics & Gynecology, Catharina Hospital Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands
- Department Obstetrics and Gynecology, Universitair Ziekenhuis Gent, Corneel Heymanslaan 10, 9000 Gent, Oost-Vlaanderen, Belgium
| | - Anne Damoiseaux
- Department of Obstetrics & Gynecology, Catharina Hospital Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands
| | - Martine M.L.H. Wassen
- Department of Obstetrics & Gynecology, Zuyderland Medical Centre Heerlen, Henri Dunantstraat 5, 6419 PC Heerlen, Limburg, the Netherlands
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Seracchioli R, Maletta M, Pazzaglia E, Raffone A, Vicenti R, Scarperi S, Bergamini V, Raimondo D. Ovarian tissue biopsy for cryopreservation by vaginal natural orifice transluminal endoscopic surgery: a new approach for a minimal invasive ovarian biopsy. Fertil Steril 2024; 122:385-387. [PMID: 38604263 DOI: 10.1016/j.fertnstert.2024.04.005] [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: 01/11/2024] [Revised: 03/23/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is an emerging surgical procedure that combines the advantages of the vaginal approach with laparoscopic vision and instrumentation. Shorter hospitalization and lesser postoperative pain associated with vNOTES may be explained by the advantages of this innovative surgical approach (e.g., absence of abdominal incisions, shorter operative time, and lower insufflation pressure). Ovarian tissue cryopreservation allows to preserve reproductive and endocrine functions in young women with oncological disease at risk of premature ovarian insufficiency (POI) caused by gonadotoxic treatments. Ovarian tissue biopsy for cryopreservation consists of a large biopsy of 1 or both ovaries that is usually performed by laparoscopy. Then, the removed ovarian tissue is cryopreserved for the future transplant after cancer remission. The volume of ovarian biopsy ranges from 50% of the ovary for women at moderate risk of POI to 70%-100% of it for those at high risk. The inclusion criteria for ovarian tissue cryopreservation are women aged <35 years who cannot delay start of oncological treatments for follicle cryopreservation, with a moderate or high risk of POI and good chance of 5-year survival. Ovarian tissue cryopreservation cannot be performed if tumor treatments include uterine irradiation or for tumors at risk of ovarian metastases (as in the case of ovarian cancer, leukemia, neuroblastoma, or Burkitt lymphoma). Despite widespread adoption of vNOTES in gynecology, ovarian biopsy for cryopreservation has never been performed using this route. DESIGN Step-by-step explanation of the procedure with descriptive text and narrated video footage. SETTING Tertiary-level referral academic center. PATIENT(S) A 27-year-old patient recently diagnosed with low-grade follicular non-Hodgkin lymphoma was referred to our center for ovarian tissue cryopreservation before chemotherapy. The patient included in this study gave informed consent for publication of the video and posting of the video online including social media, the journal website, scientific literature websites (e.g., PubMed, ScienceDirect, and Scopus), and other applicable sites. Because of the nature of the study, institutional review board approval was not required. INTERVENTION(S) Access to the peritoneal cavity was created by a 3-cm posterior colpotomy. The peritoneum was then opened using cold scissors and temporarily fixed to the posterior vaginal wall. The GelPOINT Mini Advanced Access Platform (Applied Medical, Rancho Santa Margarita, CA), with 1 10-mm and 2 5-mm trocars, was used as the vNOTES port. The inner Alexis ring of the GelPOINT was inserted through the colpotomy into the pouch of Douglas. A hysterometer was placed into the uterine cavity to keep the uterus anteverted during the surgery. A pneumoperitoneum was created to a pressure of 8 mm Hg, and the operating table was tilted to a 20° Trendelenburg position. A 10-mm rigid 30° camera was inserted in the inferior and larger trocar, and both ovaries were visualized. Seventy percent of the left ovary was removed with cold scissors to minimize trauma on the surgical specimen. After removal of the GelPOINT cap, ovarian biopsy was immediately picked up by the biologist of our fertility center. The ovary was coagulated with a bipolar instrument. The hysterometer was then replaced by a uterine manipulator to perform tubal patency test, and blue dye passage through both salpinges was observed. Finally, the Alexis retractor and stich on the posterior peritoneum were removed, and the vagina was sutured using interrupted stiches. The total operative time was 25 minutes. MAIN OUTCOMES MEASURE(S) Ovarian tissue biopsy for cryopreservation by vNOTES. RESULT(S) No intraoperative and postoperative complications were reported, and the patient was discharged after 24 hours from surgery. CONCLUSION(S) Vaginal natural orifice transluminal endoscopic surgery may be a feasible alternative approach to laparoscopy for ovarian tissue cryopreservation: it allows an easy access to the ovaries and removal of different tissue volumes. Patients undergoing ovarian cryopreservation may benefit from the vNOTES approach because a rapid postoperative recovery is crucial to start chemotherapy in a short time. As for other vNOTES procedures, accurate selection of patients seems to be crucial for a successful ovarian tissue cryopreservation. We believe that the inclusion and exclusion criteria reported for other gynecologic procedures performed through vNOTES may also be valid for ovarian tissue cryopreservation by vNOTES. Women at high risk of pelvic adhesions (e.g., coexistent endometriosis, previous pelvic surgery, or inflammatory pelvic disease), those with an increased body mass index or enlarged uterus, and those with cervical, vaginal, or uterine cancer cannot be considered for this approach because all these factors are associated with failure of vNOTES. On the other hand, women with no history of surgery, endometriosis, and large myomas may benefit from the vNOTES approach, and these women represent most of patients who undergo ovarian tissue cryopreservation. Further and larger studies are needed to assess the efficacy and safety of this new approach.
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Affiliation(s)
- Renato Seracchioli
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Manuela Maletta
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
| | - Enrico Pazzaglia
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Antonio Raffone
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Rossella Vicenti
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Stefano Scarperi
- Division B, Obstetrics and Gynecology, University of Verona, Verona, Italy
| | | | - Diego Raimondo
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Comba C, Karakas S, Erdogan SV, Demir O, Şimşek E, Karasabanoglu F, Demirayak G, Ozdemir IA. Transvaginal natural orifice transluminal endoscopic surgery (VNOTES) retroperitoneal sentinel lymph node BIOPSY compared with conventional laparoscopy in patients with endometrial cancer. Surg Oncol 2024; 55:102099. [PMID: 38991626 DOI: 10.1016/j.suronc.2024.102099] [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: 04/02/2024] [Revised: 05/30/2024] [Accepted: 06/28/2024] [Indexed: 07/13/2024]
Abstract
INTRODUCTION To explore the possibility of treatment with VNOTES sentinel lymph node dissection concept in patients with endometrial cancer. METHODS Patients who underwent VNOTES sentinel lymph node biopsy with the Comba modification were compared to patients who underwent conventional laparoscopic sentinel lymph node biopsy performed by the same surgical team. A total of 38 patients who underwent sentinel lymph node biopsy + total laparoscopic hysterectomy and bilateral salpingo-oophorectomy (BSO) were compared with 19 patients who underwent VNOTES retroperitoneal sentinel lymph node biopsy + hysterectomy and BSO. Surgical steps were described. RESULTS The average operation time, perioperative blood loss, the number of sentinel lymph nodes, presence of complications, and preoperative-postoperative hemoglobin-hematocrit differences, tumor stages, grades, largest tumor diameter, depths of invasion, and histological subtypes were similar in both the VNOTES and conventional laparoscopy groups. The postoperative pain scores were lower and the hospital stay was shorter in the VNOTES group than in the conventional laparoscopy group. No disease recurrence had been detected in either group at the time of writing. CONCLUSION Compared to conventional laparoscopy, sentinel lymph node biopsy with the VNOTES technique provides similar surgical results and is more advantageous in terms of postoperative pain and hospital length of stay.
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Affiliation(s)
- Cihan Comba
- Department of Gynecologic Oncology, Istanbul Aydin University VM Medical Park Hospital, Istanbul, Turkey.
| | - Sema Karakas
- Department of Gynecologic Oncology, Bakırköy Dr Sadi Konuk Training and Research Hospital, University of Health Sciences, İstanbul, Turkey.
| | - Sakir Volkan Erdogan
- Department of Obstetrics and Gynecology, Bayrampasa Kolan Hospital, İstanbul, Turkey.
| | - Omer Demir
- Department of Obstetrics and Gynecology, Karadeniz Technical University Hospital, Trabzon, Turkey.
| | - Erkan Şimşek
- Department of Gynecologic Oncology, Bakırköy Dr Sadi Konuk Training and Research Hospital, University of Health Sciences, İstanbul, Turkey.
| | - Fatma Karasabanoglu
- Department of Obstetrics and Gynecology, Inebolu State Hospital, Kastamonu, Turkey.
| | - Gokhan Demirayak
- Department of Obstetrics and Gynecology, Memorial Sisli Hospital, İstanbul, Turkey.
| | - Isa Aykut Ozdemir
- Department of Gynecologic Oncology, Medipol University Hospital, Istanbul, Turkey.
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Dominoni M, Gritti A, Pano MR, Sandullo L, Papa R, Torella M, Gardella B. Which Is the Best Surgical Approach for Female-to-Male Sexual Reassignment? A Systematic Review of Hysterectomy and Salpingo-Oophorectomy Options from the Gynecological Perspective. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1095. [PMID: 39064524 PMCID: PMC11278962 DOI: 10.3390/medicina60071095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 06/22/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: Transgender people are defined as individuals whose gender identity does not entirely match their sex assigned at birth. Gender surgery typically represents the conclusive and irreversible step in the therapeutic process, especially for the impact on the reproductive sphere. The increased awareness of gender dysphoria and the expanding array of medical and surgical options, including minimally invasive techniques, contribute to the gradual increase in the social impact of transgender surgery. There are several surgical techniques for "gender assignment", such as vaginal, laparotomic, laparoscopic, and robotic, and the novel approach of vaginal natural orifice transluminal endoscopic surgery to perform a hysterectomy and bilateral salpingo-oophorectomy (BSO). The purpose of this review is to assess the various surgical approaches (hysterectomy and salpingo-oophorectomy) for gender reassignment in order to determine the best option in clinical practice for the female-to-male population in terms of surgical outcomes such as operative time, surgical complication, hospital discharge, postoperative pain, and bleeding. Materials and Methods: This systematic review includes studies from 2007 to 2024. Special consideration was given to articles documenting the characteristics and management of female-to-male reassignment surgery. Finally, eight papers were included in this review. Results: The literature analysis considered surgical techniques ranging from traditional surgery to innovative methods like vaginal natural orifice transluminal endoscopic surgery and robotic-assisted laparoscopic hysterectomy. Vaginal natural orifice transluminal endoscopic surgery and the robotic approach offer potential benefits such as reduced postoperative pain and shorter hospital stays. While vaginal natural orifice transluminal endoscopic surgery may encounter challenges due to narrow access and smaller vaginal dimensions, robotic single-site hysterectomy may face instrument conflict. Conclusions: The conventional laparoscopic approach remains widely used, demonstrating safety and efficacy. Overall, this review underscores the evolving landscape of surgical techniques for gender affirmation and emphasizes the necessity for personalized approaches to meet the specific needs of transgender patients.
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Affiliation(s)
- Mattia Dominoni
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; (A.G.); (M.R.P.); (B.G.)
- Department of Obstetrics and Gynecology, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
| | - Andrea Gritti
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; (A.G.); (M.R.P.); (B.G.)
- Department of Obstetrics and Gynecology, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
| | - Martina Rita Pano
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; (A.G.); (M.R.P.); (B.G.)
- Department of Obstetrics and Gynecology, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
| | - Lucia Sandullo
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 81100 Naples, Italy; (L.S.); (R.P.); (M.T.)
| | - Rossella Papa
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 81100 Naples, Italy; (L.S.); (R.P.); (M.T.)
| | - Marco Torella
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 81100 Naples, Italy; (L.S.); (R.P.); (M.T.)
| | - Barbara Gardella
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; (A.G.); (M.R.P.); (B.G.)
- Department of Obstetrics and Gynecology, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
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de Tayrac R, Cosson M. Vaginal Hysterectomy and Pelvic Organ Prolapse: History and Recent Developments. Int Urogynecol J 2024; 35:1363-1373. [PMID: 38691125 DOI: 10.1007/s00192-024-05783-7] [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: 11/13/2023] [Accepted: 03/19/2024] [Indexed: 05/03/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Vaginal hysterectomy (VH) was described as far back as 120 CE. However, it was not till the mid-1900s when reconstructive procedures were introduced to mitigate the risk of, or treat, pelvic organ prolapse in relation to VH. Furthermore, routine hysterectomy, particularly VH, has long been advocated in prolapse surgery. However, this indication is now questionable. METHODS Literature review to provide an overview of current evidence and experts' opinion regarding the relationship between VH and pelvic organ prolapse. The review presents a historical perspective on the role of VH in the management of pelvic organ prolapse, the current debate on the usefulness of the procedure in this context, a practical guide on operative techniques used during VH and the impact of recent surgical developments on its use. RESULTS Vaginal hysterectomy is a well-established technique that is still superior to laparoscopic hysterectomy for benign gynecological disease, although more surgically challenging. However, it is possible that some contemporary techniques, such as vaginal natural orifice transluminal endoscopic surgery, may overcome some of these challenges, and hence increase the number of hysterectomies performed via the vaginal route. Although patients should be counselled about uterine-sparing reconstructive surgery, vaginal hysterectomy continues to be a major surgical procedure in reconstructive pelvic floor surgery. CONCLUSIONS Therefore, it is prudent to continue to train residents in vaginal surgical skills to ensure that they continue to provide safe, cost-effective, and comprehensive patient care.
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Affiliation(s)
- Renaud de Tayrac
- Department of Obstetrics and Gynecology, Caremeau University Hospital, Nimes, France.
| | - Michel Cosson
- Department of Gynecology, Jeanne de Flandre University Hospital, Lille, France
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Major AL, Jumaniyazov K, Jabbarov R, Razzaghi M, Mayboroda I. Gynecological Laparoscopic Surgeries under Spinal Anesthesia: Benefits and Challenges. J Pers Med 2024; 14:633. [PMID: 38929854 PMCID: PMC11204947 DOI: 10.3390/jpm14060633] [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: 05/08/2024] [Revised: 05/28/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVE This prospective study investigated the feasibility of performing laparoscopic pelvic surgery under spinal anesthesia and analyzed the intraoperative side effects, like pain, nausea, and vomitus, of 915 patients. METHODS The implementation and performance of laparoscopic surgery under local anesthesia on 915 patients (out of a total of 3212 who underwent laparoscopic pelvic surgery under spinal anesthesia) were analyzed in relation to BMI (body mass index), obesity, pain during surgery, amount of intraperitoneal mmHg CO2 gas pressure, and surgical complications. RESULTS BMI > 30, intra-abdominal adhesions, increased duration of the operation, bleeding, and increased intraperitoneal CO2 pressure were statistically significant as the main causes of pain during laparoscopic surgery under spinal anesthesia. Underweight patients, on the other hand, had less pain when intra-abdominal pressure increased compared to those of normal weight. The appearance of pain, nausea, and vomitus occurred in 10.3% of patients, and these events were easy to manage and treat. They did not affect the surgeon's work or the course of the operation. CONCLUSIONS In light of these observations, we are proposing spinal anesthesia for laparoscopic surgery as the first choice in patients who have no contraindications. To the best of our knowledge, this clinical study constitutes the largest clinical observation and dataset concerning spinal anesthesia in laparoscopic pelvic surgery. TRIAL REGISTRATION ISRCTN38987, 10 December 2019.
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Affiliation(s)
- Attila L. Major
- Femina Gynecology Centre, CH-1205 Geneva, Switzerland
- Faculty of Sciences and Medicine, University of Fribourg, CH-1700 Fribourg, Switzerland
- Department of Gynecology and Obstetrics, Urgench Branch of Tashkent Medical Academy, Urgench 220100, Uzbekistan
| | - Kudrat Jumaniyazov
- Department of Gynecology and Obstetrics, Urgench Branch of Tashkent Medical Academy, Urgench 220100, Uzbekistan
| | - Ruslan Jabbarov
- Department of Anesthesiology, Urgench Branch of Tashkent Medical Academy, Urgench 220100, Uzbekistan
| | - Mehdi Razzaghi
- Department of Mathematics, Computer Science, and Digital Forensics, Bloomsburg University, Bloomsburg, PA 17815, USA
| | - Ivanna Mayboroda
- Department of Gynecology and Obstetrics, Regional Hospital of Yverdon-les-Bains, CH-1400 Yverdon, Switzerland
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Zhong F, Dai Y, Liao X, Cheng W, Liu Y, Liu Y, Yan Z, Lin Y, Gan X. Discharge within 24 h, transvaginal natural orifice transluminal endoscopic surgery- more suitable for ambulatory surgery in gynecology procedures: a retrospective study. BMC Womens Health 2024; 24:283. [PMID: 38730489 PMCID: PMC11088004 DOI: 10.1186/s12905-024-03132-w] [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: 11/06/2023] [Accepted: 05/06/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Natural orifice transluminal endoscopic surgery (NOTES) is an achievement in the field of minimally invasive surgery. However, the vantage point of vaginal natural orifice transluminal endoscopic surgery (vNOTES) in gynecologicalprocedures remains unclear. The main purpose of this study was to compare vNOTES with laparo-endoscopic single-site surgery, and to determine which procedure is more suitable for ambulatory surgery in gynecologic procedures. METHODS This retrospective observational study was conducted at the Department of Gynecology, Chengdu Women's and Children's Central Hospital. The 207 enrolled patients had accepted vNOTES and laparo-endoscopic single-site surgery in gynecology procedures from February 2021 to March 2022. Surgically relevant information regarding patients who underwent ambulatory surgery was collected, and 64 females underwent vNOTES. RESULTS Multiple outcomes were analyzed in 207 patients. The Wilcoxon Rank-Sum test showed that there were statistically significant differences between the vNOTES and laparo-endoscopic single-site surgery groups in terms of postoperative pain score (0 vs. 1 scores, p = 0.026), duration of anesthesia (90 vs. 101 min, p = 0.025), surgery time (65 vs. 80 min, p = 0.015), estimated blood loss (20 vs. 40 mL, p < 0.001), and intestinal exhaustion time (12.20 vs. 17.14 h, p < 0.001). Treatment with vNOTES resulted in convenience, both with respect to time savings and hemorrhage volume in surgery and with respect to the quality of the prognosis. CONCLUSION These comprehensive data reveal the capacity of vNOTES to increase surgical efficiency. vNOTES in gynecological procedures may demonstrate sufficient feasibility and provide a new medical strategy compared with laparo-endoscopic single-site surgery for ambulatory surgery in gynecological procedures.
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Affiliation(s)
- Fangyuan Zhong
- Department of Gynecology and Obstetrics, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Chengdu, Sichuan, 610073, China
| | - Yueyu Dai
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400042, China
| | - Xiaoyan Liao
- Department of Gynecology and Obstetrics, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Chengdu, Sichuan, 610073, China
| | - Wei Cheng
- Department of Gynecology and Obstetrics, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Chengdu, Sichuan, 610073, China
| | - Ying Liu
- Department of Gynecology and Obstetrics, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Chengdu, Sichuan, 610073, China
| | - Yan Liu
- Department of Gynecology and Obstetrics, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Chengdu, Sichuan, 610073, China
| | - Ziru Yan
- Department of Gynecology and Obstetrics, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Chengdu, Sichuan, 610073, China
| | - Yonghong Lin
- Department of Gynecology and Obstetrics, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Chengdu, Sichuan, 610073, China
| | - Xiaoqin Gan
- Department of Gynecology and Obstetrics, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Chengdu, Sichuan, 610073, China.
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Feldman MAR, Sänger IV, Santilli AL, Sarsotti CJ, Izbizky GH. Reviving forgotten techniques: Vaginal salpingectomy in public health system, a retrospective cohort study. Int J Gynaecol Obstet 2024. [PMID: 38706428 DOI: 10.1002/ijgo.15592] [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: 12/15/2023] [Revised: 02/06/2024] [Accepted: 04/23/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE To evaluate the viability of the vaginal route as an alternative to laparoscopy for patients seeking permanent surgical contraception. METHODS We conducted a retrospective cohort study in 2021, dividing patients into two groups based on their preference: vaginal and laparoscopic salpingectomy. The statistical analysis was conducted using STATA, employing standard statistical methods based on the distribution of variables. RESULTS The study included 64 patients, with 34 undergoing the vaginal approach and 30 the laparoscopic route. No statistically significant differences were observed in baseline characteristics or complications between the two groups. Both surgical methods were found to be feasible. The vaginal route demonstrated a significantly shorter mean surgical time (P < 0.001). The laparoscopic route exhibited significantly less intraoperative blood loss (P < 0.001) and fewer hospitalization hours (P = 0.008). Postoperative satisfaction and pain levels did not show statistically significant differences. CONCLUSION Vaginal salpingectomy is a feasible technique with low complication rates, making it a potential option for gynecologists to offer their patients. We propose vaginal route inclusion in the training curriculum for gynecologic surgeons during the residency program, without any subspecialty requirements.
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Affiliation(s)
| | - Ileana Verónica Sänger
- Gynecology Unit, Hospital General de Agudos José María Penna, Ciudad Autónoma de Buenos Aires (CABA), Argentina
| | - Ana Lucía Santilli
- Gynecology Unit, Hospital General de Agudos José María Penna, Ciudad Autónoma de Buenos Aires (CABA), Argentina
| | | | - Gustavo Hernán Izbizky
- Obstetrics Unit, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires (CABA), Argentina
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Lerner V, Stuart AE, Baekalandt J. Vaginal Natural Orifice Transluminal Endoscopic Surgery Hysterectomy Deconstructed: Expanding Minimally Invasive Gynecologic Surgeons' Toolbox. J Gynecol Surg 2024; 40:78-99. [PMID: 38690154 PMCID: PMC11057779 DOI: 10.1089/gyn.2023.0098] [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: 05/02/2024] Open
Abstract
Background The introduction of vaginal natural orifice transluminal endoscopic surgery (vNOTES) to the toolbox of gynecologic surgeons has the potential to reverse the trend of vaginal hysterectomy declines. Methods This review discusses nuances of the vNOTES technique applied to hysterectomy; describes vNOTES hysterectomy, step-by-step (including tips and tricks for low- and high-complexity cases for surgeons who may want to incorporate vNOTES hysterectomy into their surgical repertoires); and examines evidence and research trends in this field. Results The descriptions in the text, figures, tables, and videos all contribute to giving readers a clear understanding of vNOTES, its advantages, limitations, and research potentials. Conclusions vNOTES hysterectomy is a unique blend of vaginal, laparoscopic, and laparoendoscopic single-site surgery (LESS) techniques and is not a new procedure, but rather another tool to use in minimally invasive gynecologic surgery. (J GYNECOL SURG 40:78).
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Affiliation(s)
- Veronica Lerner
- Department of Obstetrics & Gynecology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, New York, USA
| | - Andrea E Stuart
- Department of Obstetrics and Gynaecology, Institution of Clinical Sciences, Lund University, Lund, Sweden
- Department of Obstetrics and Gynaecology, Helsingborg Hospital, Sweden
| | - Jan Baekalandt
- Department of Gynaecologic Oncology, Imelda Hospital, Bonheiden, Belgium
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Liu Y, Li X, Liu T, Xie A, Wu X, Jia Y, Liao X, Cheng W, Wang H, Zhong F, Xu L, Huang J, Xiu S, Li Z, Li Y, Xiao X, Lin Y, Gan X. Transvaginal natural orifice endoscopic surgery for tubal ectopic pregnancy: A more suitable surgical approach for enhanced recovery after surgery. Heliyon 2024; 10:e24945. [PMID: 38312673 PMCID: PMC10835374 DOI: 10.1016/j.heliyon.2024.e24945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/13/2024] [Accepted: 01/17/2024] [Indexed: 02/06/2024] Open
Abstract
Objective We aimed to determine the safety of Vaginal natural orifice transluminal endoscopic surgery (vNOTES) in terms of the Enhanced Recovery after Surgery (ERAS) concept for tubal pregnancy surgery and provide a detailed process of vNOTES for tubal pregnancy surgery, including experience and key points for surgeons performing this procedure. Methods The Longitudinal Vaginal Natural Orifice Transluminal Endoscopic Surgery Study (LovNOTESS), which was conducted in Chengdu, China. A total of 219 patients who underwent tubal ectopic pregnancy surgery between September 2021 and March 2022. The patients underwent salpingectomy or salpingostomy using transumbilical laparoendoscopic single-site surgery (LESS) or vNOTES, according to their preferences. This study prospectively collected perioperative and one-year follow-up data on tubal pregnancy outcomes after vNOTES and compared them with those after LESS. Results The vNOTES group showed a shorter surgical duration, hospitalization duration, and postoperative exhaust time and a lower analgesic medication usage rate, but it showed a higher surgical conversion rate. The vNOTES approach reduced the postoperative exhaust time by approximately 9 h (95% confidence interval [CI]: -11.93, -5.57 h, p < .001) and the risk of postoperative analgesic drug use by 77% (odds ratio, 0.23; 95% CI: 0.10, 0.61, p = .023). Conclusion vNOTES can shorten the exhaust time and duration of hospitalization, reduce postoperative pain, and avoid surface surgical scars in tubal pregnancy surgeries, consistent with the ERAS concept. However, more comprehensive preoperative evaluation of patients who choose vNOTES is required to reduce the occurrence of intraoperative conversion.Trial registration: ChiCTR2100053483.
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Affiliation(s)
- Ying Liu
- Department of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Xin Li
- Department of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Tianjiao Liu
- Department of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Aijie Xie
- Department of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Xian Wu
- Department of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Yujian Jia
- Department of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Xiaoyan Liao
- Department of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Wei Cheng
- Department of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Hui Wang
- Department of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Fangyuan Zhong
- Department of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Lijuan Xu
- Department of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Juan Huang
- Department of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Siqin Xiu
- Department of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Zhongzhi Li
- Department of Gynecology and Obstetrics, Chongqing University Fuling Hospital, Chongqing, 408099, China
| | - Yalan Li
- Psychiatry Department, Psychosomatic Medical Center, The Fourth People’s Hospital of Chengdu, Chengdu, 610036, China
| | - Xue Xiao
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Yonghong Lin
- Department of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Xiaoqin Gan
- Department of Gynecology and Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
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Chen Y, Zhou Y, Tan L, Chen S, Wu C, Liang Y, Sun N, Liu J. Comparative analysis of transvaginal natural orifice transluminal endoscopic surgery versus laparoendoscopic single-site sacrocolpopexy for pelvic organ prolapse: A propensity score matching study. Heliyon 2023; 9:e19698. [PMID: 37809779 PMCID: PMC10558931 DOI: 10.1016/j.heliyon.2023.e19698] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/26/2023] [Accepted: 08/28/2023] [Indexed: 10/10/2023] Open
Abstract
Purpose To compare the safety, feasibility, and effectiveness of transvaginal natural orifice transluminal endoscopic sacrocolpopexy (vNOTES-SC) and laparoendoscopic single-site sacrocolpopexy (LESS-SC) for pelvic organ prolapse (POP). Method Ninety-four patients with POP who underwent vNOTES-SC or LESS-SC from October 2016 to November 2018 were included. The propensity score matching method was used for 1:1 matching between the two surgery groups. After matching, the general perioperative indicators, surgical complications, and the subjective and objective therapeutic effects of the two groups 3 years post-surgery were analyzed. Results After matching, 36 patients in each group were included, exhibiting balanced and comparable baseline data and an average follow-up of 48.6 ± 7.44 months. The operation time and postoperative hospitalization days were significantly reduced in the vNOTES-SC group (P < 0.05). However, perioperative complication incidence was not significantly different between the two groups (P > 0.05). Additionally, no significant differences were detected in de novo stress urinary incontinence (16.7% vs. 13.9%), de novo overactive bladder (de novo OAB, 8.3% vs. 0.0%), urination disorder (2.8% vs. 0.0%), defecation disorder (0.0% vs. 2.8%), lumbosacral pain (0.0% vs. 2.8%), or mesh complication (2.8% vs. 5.6%) incidences between the vNOTES-SC and LESS-SC groups (P > 0.05). Prolapse recurrence was not reported in either group. The quantitative description of pelvic organ position (POP-Q), Pelvic Floor Impact Questionnaire-7 (PFIQ-7), and Patient Global Impression of Improvement scale (PGI-I) scores showed improvement after the operation, but no significant differences were observed between the two groups (P > 0.05). Conclusion The 3-year follow-up revealed that vNOTES-SC and LESS-SC had similar complications and efficacy rates. Compared with LESS-SC, vNOTES-SC resulted in shorter operation time and fewer postoperative hospitalization days (corresponding to the enhanced recovery after surgery [ERAS] concept), along with better cosmetic results without a scar. Therefore, our study findings suggest that clinicians should choose the surgery method based on the specific situation, and we recommend choosing vNOTES-SC when both surgeries are suitable.
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Affiliation(s)
- Yan Chen
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510150, China
| | - Youjun Zhou
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510150, China
| | - Liping Tan
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510150, China
| | - Shihui Chen
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510150, China
| | - Chunhua Wu
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510150, China
| | - Yanling Liang
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510150, China
| | - Nannan Sun
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510150, China
| | - Juan Liu
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510150, China
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Isono W, Tsuchiya H, Tsuchiya A, Nishii O, Fujimoto A. Obvious advantage of vaginal natural orifice transluminal endoscopic surgery hysterectomy against total laparoscopic hysterectomy in small uterus patients and the future prospects at a regional core institution: A retrospective study. Eur J Obstet Gynecol Reprod Biol X 2023; 19:100206. [PMID: 37753517 PMCID: PMC10518506 DOI: 10.1016/j.eurox.2023.100206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/15/2023] [Accepted: 06/06/2023] [Indexed: 09/28/2023] Open
Abstract
Objective Owing to the combination of benefits, including permanent visual guidance and no abdominal skin incision, vaginal natural orifice transluminal endoscopic surgery hysterectomy (vNOTES-H) is currently widely used. However, the introduction of vNOTES-H has been delayed in many Japanese regional core hospitals because of its specific device and skill requirements. Therefore, the characteristics and advantages should be explained for the widespread use of this technique. Study design We reviewed the medical records of 17 patients with vNOTES-H and 94 patients with total laparoscopic hysterectomy (TLH) from January 1, 2015 to December 31, 2022. In this analysis, to compare the results of vNOTES-H to TLH, we excluded certain patients with a relatively heavy uterus (>255 g) and the presence of abdominal adhesions. In this report, first, the characteristics of the vNOTES-H procedures using a transvaginal access platform are explained by referring to one representative patient. Second, the patient characteristics of the vNOTES-H and TLH groups, including operation time and blood loss amount, were compared. Then, to detect the influence of vNOTES-H on the difficulty of operation among all 111 patients, we performed a multivariate logistic regression analysis to assess the influence of each of 9 factors, including "vNOTES-H", "Advanced age", "High BMI", "3 parity", "Gynaecological operation history", "Adenomyoma", "Large leiomyoma", "Heavy uterus" and "Large uterus", on the two indexes, including "Short time operation" and "Massive blood loss". Results In the simple comparison between the groups with vNOTES-H and TLH, the operation time in the former group was significantly shorter than in the latter group, although other factors did not show significant differences, including blood loss amount. Moreover, in the multivariate logistic regression analysis of all 111 patients, the "vNOTES-H" factor showed a significantly high possibility of "short time operation", although no factor, including "vNOTES-H", showed a significant influence on "massive blood loss". Conclusions vNOTES-H showed advantages in terms of operation time without increasing blood loss for patients with a relatively small uterus. However, to expand the selection for vNOTES-H, we should accumulate further patients and perform more analyses.
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Affiliation(s)
- Wataru Isono
- Department of Obstetrics and Gynaecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, 5-1-1, Futago, Takatsu-Ku, Kawasaki, Kanagawa 213-8507, Japan
| | - Hiroko Tsuchiya
- Department of Obstetrics and Gynaecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, 5-1-1, Futago, Takatsu-Ku, Kawasaki, Kanagawa 213-8507, Japan
| | - Akira Tsuchiya
- Department of Obstetrics and Gynaecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, 5-1-1, Futago, Takatsu-Ku, Kawasaki, Kanagawa 213-8507, Japan
| | - Osamu Nishii
- Department of Obstetrics and Gynaecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, 5-1-1, Futago, Takatsu-Ku, Kawasaki, Kanagawa 213-8507, Japan
| | - Akihisa Fujimoto
- Department of Obstetrics and Gynaecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, 5-1-1, Futago, Takatsu-Ku, Kawasaki, Kanagawa 213-8507, Japan
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