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Marchand GJ, Masoud AT, Ulibarri H, Arroyo A, Moir C, Blanco M, Herrera DG, Hamilton B, Ruffley K, Petersen M, Fernandez S, Azadi A. Systematic review and meta-analysis of vaginal natural orifice transluminal endoscopic surgery vs laparoscopic hysterectomy. AJOG Glob Rep 2024; 4:100320. [PMID: 38440153 PMCID: PMC10910317 DOI: 10.1016/j.xagr.2024.100320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
OBJECTIVE Because vaginal natural orifice transluminal endoscopic surgery and laparoscopic hysterectomy techniques both aim to decrease tissue injury and postoperative morbidity and mortality and to improve a patient's quality of life, we sought to evaluate the safety and effectiveness of a hysterectomy by vaginal natural orifice transluminal endoscopic surgery and compared that with conventional laparoscopic hysterectomy among women with benign gynecologic diseases. DATA SOURCES We used Scopus, Medline, ClinicalTrials.Gov, PubMed, and the Cochrane Library and searched from database inception to September 1, 2023. STUDY ELIGIBILITY CRITERIA We included all eligible articles that compared vaginal natural orifice transluminal endoscopic surgery hysterectomy with any conventional laparoscopic hysterectomy technique without robotic assistance for women with benign gynecologic pathology and that included at least 1 of our main outcomes. These outcomes included estimated blood loss (in mL), operation time (in minutes), length of hospital stay (in days), decrease in hemoglobin level (g/dL), visual analog scale pain score on postoperative day 1, opioid analgesic dose required, rate of conversion to another surgical technique, intraoperative complications, postoperative complications, and requirements for blood transfusion. We included randomized controlled trials and observational studies. Ultimately, 14 studies met our criteria. METHODS The study quality of the randomized controlled trials was assessed using the Cochrane assessment tool, and the quality of the observational studies was assessed using the ROBINS-I tool. We analyzed data using RevMan 5.4.1. Continuous outcomes were analyzed using the mean difference and 95% confidence intervals under the inverse variance analysis method. Dichotomous outcomes were analyzed using OpenMeta[Analyst] and odds ratios and 95% confidence intervals were reported. RESULTS The operative time and length of hospitalization were shorter in the vaginal natural orifice transluminal endoscopic surgery cohort. We also found lower visual analog scale pain scores, fewer postoperative complications, and fewer blood transfusions in the vaginal natural orifice transluminal endoscopic surgery group. We found no difference in the estimated blood loss, decrease in hemoglobin levels, analgesic usage, conversion rates, or intraoperative complications. CONCLUSION When evaluating the latest data, it seems that vaginal natural orifice transluminal endoscopic surgery techniques may have some advantages over conventional laparoscopic hysterectomy techniques.
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Affiliation(s)
- Greg J. Marchand
- Marchand Institute for Minimally Invasive Surgery (Drs Marchand and Masoud and Mses Ulibarri, Arroyo, Moir, Blanco, Gonzalez Herrera, Hamilton, and Ruffley), Mesa, AZ
| | - Ahmed Taher Masoud
- Marchand Institute for Minimally Invasive Surgery (Drs Marchand and Masoud and Mses Ulibarri, Arroyo, Moir, Blanco, Gonzalez Herrera, Hamilton, and Ruffley), Mesa, AZ
- Faculty of Medicine, Fayoum University (Dr Masoud), Fayoum, Egypt
| | - Hollie Ulibarri
- Marchand Institute for Minimally Invasive Surgery (Drs Marchand and Masoud and Mses Ulibarri, Arroyo, Moir, Blanco, Gonzalez Herrera, Hamilton, and Ruffley), Mesa, AZ
| | - Amanda Arroyo
- Marchand Institute for Minimally Invasive Surgery (Drs Marchand and Masoud and Mses Ulibarri, Arroyo, Moir, Blanco, Gonzalez Herrera, Hamilton, and Ruffley), Mesa, AZ
| | - Carmen Moir
- Marchand Institute for Minimally Invasive Surgery (Drs Marchand and Masoud and Mses Ulibarri, Arroyo, Moir, Blanco, Gonzalez Herrera, Hamilton, and Ruffley), Mesa, AZ
| | - Madison Blanco
- Marchand Institute for Minimally Invasive Surgery (Drs Marchand and Masoud and Mses Ulibarri, Arroyo, Moir, Blanco, Gonzalez Herrera, Hamilton, and Ruffley), Mesa, AZ
| | - Daniela Gonzalez Herrera
- Marchand Institute for Minimally Invasive Surgery (Drs Marchand and Masoud and Mses Ulibarri, Arroyo, Moir, Blanco, Gonzalez Herrera, Hamilton, and Ruffley), Mesa, AZ
| | - Brooke Hamilton
- Marchand Institute for Minimally Invasive Surgery (Drs Marchand and Masoud and Mses Ulibarri, Arroyo, Moir, Blanco, Gonzalez Herrera, Hamilton, and Ruffley), Mesa, AZ
| | - Kate Ruffley
- Marchand Institute for Minimally Invasive Surgery (Drs Marchand and Masoud and Mses Ulibarri, Arroyo, Moir, Blanco, Gonzalez Herrera, Hamilton, and Ruffley), Mesa, AZ
| | - Mary Petersen
- Midwestern University College of Osteopathic Medicine (Mses Petersen and Fernandez), Glendale, AZ
| | - Sarena Fernandez
- Midwestern University College of Osteopathic Medicine (Mses Petersen and Fernandez), Glendale, AZ
| | - Ali Azadi
- College of Medicine, University of Arizona (Dr Azadi), Phoenix, AZ
- School of Medicine, Creighton University (Dr Azadi), Phoenix, AZ
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Marchand GJ, Masoud A. Response to Dr. Somovilla del Saz's letter to the editor regarding "Risk of all-cause and cardiac-related mortality after vaccination against COVID-19: A meta-analysis of self-controlled case series studies". Hum Vaccin Immunother 2023; 19:2264599. [PMID: 37806668 DOI: 10.1080/21645515.2023.2264599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/25/2023] [Indexed: 10/10/2023] Open
Abstract
This is a response to Dr. Somovilla del Saz's letter to the editor regarding Marchand et al.'s article, "Risk of all-cause and cardiac-related mortality after vaccination against COVID-19: A meta-analysis of self-controlled case series studies." The response is on behalf of all authors clarifying misconceptions about the work.
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Affiliation(s)
- Greg J Marchand
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Ahmed Masoud
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
- Faculty of Medicine, Fayoum University, Fayoum, Egypt
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Marchand GJ, Masoud AT, Ulibarri H, Arroyo A, Coriell C, Goetz S, Moir C, Moberly A, Gonzalez D, Blanco M, Craig HR. Effect of a 20% intravenous fat emulsion therapy on pregnancy outcomes in women with RPL or RIF undergoing IVF/ICSI: a systematic review and meta-analysis. J Clin Transl Res 2023; 9:236-245. [PMID: 37564251 PMCID: PMC10411978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/10/2023] [Accepted: 06/11/2023] [Indexed: 08/12/2023] Open
Abstract
Background and Aim The aim of this study was to evaluate the efficacy a 20% intravenous fat emulsion therapy in women suffering from recurrent pregnancy loss or recurrent implantation failure (RPL/RIF) who are undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Materials and Methods We searched Cochrane Library, ISI Web of Science, MEDLINE, ClinicalTrials.gov, PubMed, and Scopus using relevant keywords during February 2020 for randomized controlled trials (RCTs) comparing the therapy versus placebo or no intervention in women suffering from RPL/RIF and undergoing IVF/ICSI. Results We included five RCTs with 840 patients. The intravenous fat emulsion therapy was significantly effective in increasing clinical pregnancy rates compared to the control group (risk ratios [RR] = 1.48, 95% confidence intervals [CI] [1.23, 1.79], P < 0.001). Furthermore, ongoing pregnancy and live birth rates were significantly higher with 20% intravenous fat emulsion therapy RR = 1.71, 95% CI [1.27, 2.32], P = 0.005 and RR = 1.85, 95% CI [1.44, 2.38], P < 0.001. Despite the statistically significant differences, the quality of evidence was only considered moderate, and this was primarily due to high risk of bias in the included RCTs. Conclusion Our review provides a moderate level of evidence that intravenous fat emulsion therapy is effective in improving reproductive outcomes among women with RPL/RIF performing IVF/ICSI techniques. Further, investigation is required to ascertain optimal dosage and timing of administration. Relevance for Patients Women suffering from RPL or RIF may wish to consider discussing with their reproductive endocrinologist the addition of a 20% fat emulsion therapy to planned IVF or ICSI cycles, which may improve outcomes.
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Affiliation(s)
- Greg J. Marchand
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, United States of America
| | - Ahmed Taher Masoud
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, United States of America
- Fayoum University Faculty of Medicine, Fayoum, Egypt
| | - Hollie Ulibarri
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, United States of America
| | - Amanda Arroyo
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, United States of America
| | - Catherine Coriell
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, United States of America
| | - Sydnee Goetz
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, United States of America
| | - Carmen Moir
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, United States of America
| | - Atley Moberly
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, United States of America
| | - Daniela Gonzalez
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, United States of America
| | - Madison Blanco
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, United States of America
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Marchand GJ, Masoud AT, Ulibarri H, Parise J, Arroyo A, Coriell C, Goetz S, Moir C, Moberly A. Effect of the decision to perform hysteroscopy on asymptomatic patients before undergoing assisted reproduction technologies-a systematic review and meta-analysis. AJOG Glob Rep 2023; 3:100178. [PMID: 36911234 PMCID: PMC9992750 DOI: 10.1016/j.xagr.2023.100178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVE Routine hysteroscopic evaluation before assisted reproductive technology treatment is a novel approach with the potential to reduce assisted reproductive technology failure even in the absence of evidence of uterine pathology. Following the publication of several relatively high-quality trials on this topic, we sought to determine if this practice is beneficial. DATA SOURCES We searched Web of Science, MEDLINE, PubMed, Scopus, Cochrane Library, and ClinicalTrials.gov from each database's inception until May 31, 2022 with our search strategy, attempting to locate all randomized controlled trials assessing the use of hysteroscopy in otherwise asymptomatic women undergoing assisted reproductive technology. STUDY ELIGIBILITY CRITERIA We included only randomized controlled trials that included at least one of our selected outcomes, and we excluded any studies with suspicion of pathology before the time of hysteroscopy, other than knowledge of the patient's infertility. We included all the aforementioned studies regardless of procedures or modifications performed as a result of hysteroscopic findings. Our initial search yielded 1802 results, which were reduced to 1421 after removal of duplicates. Ultimately, 11 studies were found to meet our criteria and were included in our quantitative synthesis. METHODS We used ReviewManager software, version 5.4.1 to analyze the data, which we imported after manually gathering from the 11 studies. Continuous and dichotomous outcomes were imported as standard deviations. Pooled analysis was described as a mean difference, relative to 95 % confidence interval in cases of continuous data. Dichotomous outcomes were analyzed using risk ratios and 95% confidence intervals. In homogeneous outcomes, we used a fixed-effects model, and in heterogeneous outcomes we used a random-effects model. RESULTS Our results showed that hysteroscopy was associated with significant improvement in the clinical pregnancy rate (risk ratio, 1.27 [1.11-1.45]; P<.001). We found no differences between the hysteroscopy group and the control group in live birth rate (risk ratio, 1.26 [0.99-1.59]; P=.06), miscarriage rate (risk ratio, 0.99 [0.81-1.19]; P=.88), fertilization rate (risk ratio, 1.01 [0.93-1.09]; P=.88), incidence of multiple gestations (risk ratio, 1.29 [0.98-1.71]; P=.07), number of embryos transferred (mean difference, 0.04 [-0.18 to 0.26]; P=.73), chemical pregnancy rate (risk ratio, 1.01 [0.86-1.17]; P=.93), and number of oocytes retrieved (mean difference, 0.44 [-0.11 to 0.98]; P=.11). CONCLUSION We observed an improvement in the clinical pregnancy rate, but no significant improvement in the live birth rate with routine hysteroscopy before assisted reproductive technology treatment. We believe this does not represent sufficient evidence to recommend routine hysteroscopy for otherwise asymptomatic patients before assisted reproductive technology treatment at this time.
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Affiliation(s)
- Greg J Marchand
- Faculty of Medicine, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ (Drs Marchand and Masoud, Mses Ulibarri, Parise, and Arroyo, Ms Coriell, and Mses Goetz, Moir, and Moberly)
| | | | - Hollie Ulibarri
- Faculty of Medicine, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ (Drs Marchand and Masoud, Mses Ulibarri, Parise, and Arroyo, Ms Coriell, and Mses Goetz, Moir, and Moberly)
| | - Julia Parise
- Faculty of Medicine, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ (Drs Marchand and Masoud, Mses Ulibarri, Parise, and Arroyo, Ms Coriell, and Mses Goetz, Moir, and Moberly)
| | - Amanda Arroyo
- Faculty of Medicine, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ (Drs Marchand and Masoud, Mses Ulibarri, Parise, and Arroyo, Ms Coriell, and Mses Goetz, Moir, and Moberly)
| | - Catherine Coriell
- Faculty of Medicine, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ (Drs Marchand and Masoud, Mses Ulibarri, Parise, and Arroyo, Ms Coriell, and Mses Goetz, Moir, and Moberly)
| | - Sydnee Goetz
- Faculty of Medicine, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ (Drs Marchand and Masoud, Mses Ulibarri, Parise, and Arroyo, Ms Coriell, and Mses Goetz, Moir, and Moberly)
| | - Carmen Moir
- Faculty of Medicine, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ (Drs Marchand and Masoud, Mses Ulibarri, Parise, and Arroyo, Ms Coriell, and Mses Goetz, Moir, and Moberly)
| | - Atley Moberly
- Faculty of Medicine, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ (Drs Marchand and Masoud, Mses Ulibarri, Parise, and Arroyo, Ms Coriell, and Mses Goetz, Moir, and Moberly)
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Marchand GJ, Masoud AT, Coriell C, Ulibarri H, Parise J, Arroyo A, Goetz S, Moir C, Moberly A, Govindan M. Treatment of Cesarean Scar Ectopic Pregnancy in China with Uterine Artery Embolization-A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11247393. [PMID: 36556010 PMCID: PMC9783593 DOI: 10.3390/jcm11247393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/28/2022] [Accepted: 12/05/2022] [Indexed: 12/15/2022] Open
Abstract
Cesarean scar ectopic pregnancy (CSP) is a rare form of ectopic pregnancy, and treatment of CSP with uterine artery embolization (UAE) is a novel approach. With increasing numbers of cesarean sections being performed annually, the incidence of this condition is likely to increase. The authors became aware of an unusually high number of published studies originating in mainland China regarding this unusual treatment and sought to perform a meta-analysis to provide comprehensive evidence on this novel practice. METHODS We performed a thorough search and included all forms of quality studies on this topic that reported UAE as a part of first-line management of CSP. We included only studies originating in China. Ultimately, 37 studies were included for qualitative and quantitative synthesis of evidence. After screening retrieved records and extracting data from eligible studies, we pooled continuous data as a mean estimate and 95% confidence interval (CI), and dichotomous data as proportion and 95% CI. RESULTS CSP patients treated with protocols including UAE had a mean time of 30 days for serum β-hCG normalization, 95% CI [26.816, 33.881]. They had a mean estimated intraprocedural blood loss of 4.19 ± 3.76 mL, a mean hospital stay of nine days, 95%CI [7.914, 9.876], and a success rate of 93.4%, 95%CI [0.918, 0.951]. The severe complication rate was 1.2%, 95%CI [0.008, 0.017]. CONCLUSION UAE, in combination with other procedures is being used effectively for the treatment of CSP in China. Protocols including UAE have a success rate of approximately 93.4%, and a severe complication rate of approximately 1.2%. This data's utility is limited by vast differences in the studied protocols and questionable feasibility outside of China.
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Affiliation(s)
- Greg J. Marchand
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ 85209, USA
- Correspondence:
| | - Ahmed Taher Masoud
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ 85209, USA
- Faculty of Medicine, Fayoum University, Fayoum 63514, Egypt
| | - Catherine Coriell
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ 85209, USA
| | - Hollie Ulibarri
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ 85209, USA
| | - Julia Parise
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ 85209, USA
| | - Amanda Arroyo
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ 85209, USA
| | - Sydnee Goetz
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ 85209, USA
| | - Carmen Moir
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ 85209, USA
| | - Atley Moberly
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ 85209, USA
| | - Malini Govindan
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ 85209, USA
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Marchand GJ, Masoud AT, King AK, Brazil GM, Ulibarri HM, Parise JE, Arroyo AL, Coriell CL, Goetz SP, Moir CJ, Govindan ML. Salpingectomy, tubal ligation and hysteroscopic occlusion for sterilization. Minerva Obstet Gynecol 2022; 74:452-461. [PMID: 35912465 DOI: 10.23736/s2724-606x.22.05134-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Sterilization of females is considered one of the most prevalent contraceptive techniques among women in the United States. There are many surgical sterilization procedures including salpingectomy, tubal ligation, and hysteroscopic occlusion of the fallopian tubes. We provide an overview of these methods from the clinical data and latest studies available on this topic. EVIDENCE ACQUISITION In order to review the latest literature on the topic, we searched electronic databases including PubMed, Web of Science, Scopus, and Cochrane library for all eligible studies from May 1st 2018 until May 1st 2022 using the following strategy: ("fallopian tube removal" OR Salpingectomy OR "fallopian tube excision" OR "tubal sterilization") AND ("tubal ligation" OR "bipolar coagulation" OR "tubal clip" OR "tubal ring" OR fimbriectomy). We reviewed every study that met our criteria and subjectively considered their results and methodology into this narrative review. EVIDENCE SYNTHESIS In addition to reviewing major guidelines in the United States, 19 recent studies met our eligibility criteria and were included in this review. We grouped the findings under the following headings: anatomical and physiological considerations, sterilization, salpingectomy, tubal ligation, and hysteroscopic tubal occlusion. CONCLUSIONS Bilateral salpingectomy and techniques of tubal ligation or occlusion continue to be effective procedures with good safety profiles. All techniques have similar surgical outcomes and long-term success rates. As salpingectomy has the advantage of reducing the risk of occurrence of ovarian cancer, this is preferential when feasible. Hysteroscopic occlusion techniques may be more minimally invasive but have the disadvantages of delayed efficacy, the need for a second invasive diagnostic procedure, and limited availability.
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Affiliation(s)
- Greg J Marchand
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA -
| | - Ahmed T Masoud
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
- Faculty of Medicine, University of Fayoum, Fayoum, Egypt
| | - Alexa K King
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Giovanna M Brazil
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Hollie M Ulibarri
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Julia E Parise
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Amanda L Arroyo
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Catherine L Coriell
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Sydnee P Goetz
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Carmen J Moir
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Malini L Govindan
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
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Marchand GJ, Masoud A, King A, Brazil G, Ulibarri H, Parise J, Arroyo A, Coriell C, Goetz S, Moir C, Christensen A, Alexander T, Govindan M. Systematic review and meta-analysis of Veress needle entry versus direct trocar entry in gynecologic surgery. BMJ Surg Interv Health Technol 2022; 4:e000121. [PMID: 35865828 PMCID: PMC9240888 DOI: 10.1136/bmjsit-2021-000121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 05/31/2022] [Indexed: 11/07/2022] Open
Abstract
Objective Although many studies have been performed, no consensus exists as to the ideal entry for laparoscopic gynecologic surgery. We sought out to compare the safety of direct trocar insertion with that of the Veress needle entry technique in gynecologic laparoscopic surgery. Design Systematic review with meta-analysis. Setting We searched Medline, ClinicalTrials.Gov, PubMed, Cochrane CENTRAL, SCOPUS, and Web of Science from their inception through 31 July 2021 for relevant studies. We included only controlled trials and ultimately seven trials were included in our meta-analysis. Participants Inclusion criteria included women undergoing gynecological laparoscopic surgery. Intervention The intervention of direct trocar insertion technique compared with Veress needle entry technique. Main outcome measures We compared five different outcomes associated with the efficacy and complications of laparoscopic entry. Results The pooled analysis showed that Veress needle entry was associated with a significant increase in the incidences of extraperitoneal insufflation (RR=0.177, 95% Cl (0.094 to 0.333), p<0.001), omental injury (RR=0.418, 95% Cl (0.195 to 0.896), p<0.001), failed entry (RR=0.173, 95% Cl (0.102 to 0.292), p<0.001), and trocar site infection (RR=0.404, 95% Cl (0.180 to 0.909), p<0.029). There was no significant difference between the two groups regarding the visceral injury (RR=0.562, 95% Cl (0.047 to 6.676), p<0.648). Conclusions When excluding all data apart from gynecologic surgery, the Veress needle entry technique may have an increased incidence of some, but not all complications of laparoscopic entry. It may also have a higher incidence of failed entry compared with direct entry techniques. Care should be taken in extrapolating these general results to specific surgeon experience levels. Trial registration number CRD42021273726
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Affiliation(s)
- Greg J Marchand
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Ahmed Masoud
- Fayoum University Faculty of Medicine, Fayoum, Egypt
| | - Alexa King
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Giovanna Brazil
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Hollie Ulibarri
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Julia Parise
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Amanda Arroyo
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Catherine Coriell
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Sydnee Goetz
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Carmen Moir
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Ashley Christensen
- Midwestern University College of Osteopathic Medicine, Glendale, California, USA
| | - Tia Alexander
- Midwestern University College of Osteopathic Medicine, Glendale, California, USA
| | - Malini Govindan
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
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Marchand GJ, Kurdi W, Sainz K, Maarouf H, Ware K, Masoud AT, King A, Ruther S, Brazil G, Cieminski K, Calteux N, Ulibarri H, Parise J, Arroyo A, Chen D, Pierson M, Rafie R, Shareef MA. Efficacy of hyoscine in pain management during hysteroscopy: a systematic review and meta-analysis. J Turk Ger Gynecol Assoc 2022; 23:51-57. [PMID: 34866373 PMCID: PMC8907440 DOI: 10.4274/jtgga.galenos.2021.2021-0057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
We conducted a systematic review and meta-analysis of relevant clinical trials from full-text, scientific journal archives to assess the efficacy of hyoscine for the management of pain during in-office hysteroscopy (OH) procedures. Cochrane CENTRAL, ClinicalTrials.Gov, MEDLINE, PubMed, SCOPUS and the Web of Science were searched for all clinical trials that matched our search criteria. A full assessment of bias was made using the Cochrane Group tool-set. The following outcomes were included: visual analogue scale (VAS) score for postoperative pain, postoperative need for analgesia, and procedure time. In the case of homogeneous data, the analysis was performed using a fixed effects system, and the random effects system was used with heterogeneous data. Inclusion criteria included only randomized clinical trials, and interventions that included patients receiving hyoscine-N-Butyl Bromide during OH, regardless of dose or mode of administration, and compared this with placebo. Three clinical trials were included. The actual mean difference (MD) of the VAS pain score showed no significant difference between hyoscine or placebo [MD: -0.28 (-1.08, 0.52), (p=0.49)]. For postoperative analgesia, the overall MD showed no significant difference between hyoscine or placebo [MD: 0.43 (0.16, 1.14), (p=0.09)]. For procedure time, the combined effect estimate failed to show any significant difference between hyoscine and placebo [MD: -0.66 (-2.77, 1.44) (p=0.54)]. Contrary to previously published data, our meta-analysis using the latest available RCTs fails to show hyoscine as being effective in reducing pain or the need for other forms of anesthesia in OH.
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Affiliation(s)
- Greg J. Marchand
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Wesam Kurdi
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Katelyn Sainz
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Hiba Maarouf
- REProVita Fertility Center, Recklinghausen, Germany
| | - Kelly Ware
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America,International University of Health Sciences School of Medicine, Basseterre, Saint Kitts and Nevis
| | - Ahmed Taher Masoud
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America,Fayoum University Faculty of Medicine, Fayoum, Egypt
| | - Alexa King
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Stacy Ruther
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Giovanna Brazil
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Kaitlynne Cieminski
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Nicolas Calteux
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Hollie Ulibarri
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Julia Parise
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Amanda Arroyo
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Diana Chen
- Midwestern University College of Osteopathic Medicine, Glendale, AZ, United States of America
| | - Maria Pierson
- Midwestern University College of Osteopathic Medicine, Glendale, AZ, United States of America
| | - Rasa Rafie
- Rocky Vista University College of Osteopathic Medicine, Parker, CO, United States of America
| | - Mohammad Abrar Shareef
- Department of Internal Medicine, Sebasticook Valley Hospital, Pittsfield, ME, United States of America
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Marchand GJ, Masoud A, King A, Ruther S, Brazil G, Ulibarri H, Parise J, Arroyo A, Coriell C, Goetz S, Christensen A, Sainz K. Effect of single- and double-layer cesarean section closure on residual myometrial thickness and isthmocele - a systematic review and meta-analysis. Turk J Obstet Gynecol 2021; 18:322-332. [PMID: 34955322 PMCID: PMC8711674 DOI: 10.4274/tjod.galenos.2021.71173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/12/2021] [Indexed: 12/01/2022] Open
Abstract
Objective To determine the incidence of isthmocele, its effect on residual myometrial thickness (RMT), and other complications of Cesarean delivery (CD) in relation to single- and double-layer CD closure. We searched PubMed, SCOPUS, Web of Science, ClinicalTrials.gov, MEDLINE and Cochrane Library for relevant clinical trials assessing the use of single- and double-layer uterine closure in patients undergoing cesarean sections from inception through to March 2021. Materials and Methods Our population was women undergoing cesarean section with uterine closure by any double-layer method, compared with those undergoing uterine closure through a single-layer method. RMT (in mm) was measured at 6 weeks, niche/isthmocele existence at 6 weeks, RMT (in mm) at 6-24 months and niche/isthmocele existence at 6-24 months. In order to present the highest quality evidence, we only included clinical trials in our analysis. To perform this review, we reported dichotomous outcomes using percent and total, while continuous outcomes were reported using mean ± standard deviations, and relative 95% confidence intervals using the inverse variance method. Results We found that the RMT in the double-layer closure group was significantly higher at six weeks [mean difference (MD)=-0.43 (-0.77, -0.09)], (p=0.01) and at 6-24 months of follow-up [MD=-1.27 (-2.28, -0.25)], (p=0.01). The incidence of isthmocele in the two groups, as well as the other investigated outcomes were similar across the different groups. Conclusion High-quality evidence shows that double-layer closure results in a higher RMT compared with a single-layer closure, despite no significant difference in isthmocele formation.
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Affiliation(s)
- Greg J Marchand
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Ahmed Masoud
- Fayoum University Faculty of Medicine, Fayoum, Egypt
| | - Alexa King
- International University of Health Sciences, Basseterre, St. Kitts
| | - Stacy Ruther
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Giovanna Brazil
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Hollie Ulibarri
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Julia Parise
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Amanda Arroyo
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Catherine Coriell
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Sydnee Goetz
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Ashley Christensen
- Midwestern University College of Osteopathic Medicine, Glendale, Arizona, USA
| | - Katelyn Sainz
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
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Marchand GJ, Coriell C, Taher A, King A, Ruther S, Brazil G, Cieminski K, Calteux N, Ulibarri H, Parise J, Arroyo A, Sainz K. Systematic review of the effect of implementing enhanced recovery after surgery on selected attributes of surgical recovery in gynecology. Turk J Obstet Gynecol 2021; 18:245-257. [PMID: 34580992 PMCID: PMC8480214 DOI: 10.4274/tjod.galenos.2021.47717] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
This study aimed to systematically review the available literature on enhanced recovery after surgery (ERAS) following gynecologic procedures performed either as an open surgery or as a minimally invasive gynecological surgery (MIGS) in terms of outcomes. This review revealed the results of published literature and assessed the benefits and diverse outcomes of ERAS implementation in patients undergoing MIGS or other gynecologic surgeries. In this review, we sought to examine the efficacy of entire ERAS protocols, faithfully performed, to determine whether they were successful in improving individual attributes of surgical recovery. Electronic databases of PubMed, Cochrane, Web of Science, Scopus, MEDLINE, and ClinicalTrials.gov were systematically searched in January 2021 for relevant studies. Data were extracted from eligible studies including LOS, change in the quality-of-life and recovery over time, postoperative complications including nausea and vomiting, opioid or anesthesia use, hospital cost, patient satisfaction, postoperative pain, and readmission rate as outcomes. Many of the included studies reported a significant reduction in the LOS as well as in readmission rates, hospital cost, and occurrence of nausea and vomiting postoperatively. Moreover, a clinically significant increase was noted in patient satisfaction in studies that have used tools that measure patient satisfaction. No studies have reported a significant increase in the overall quality of recovery using appropriately validated tools. Following ERAS implementation, patients’ postoperative rehabilitation, including postoperative discomfort, readmission rates, and satisfaction, showed a clinically significant improvement.
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Affiliation(s)
- Greg J Marchand
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Catherine Coriell
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Ahmed Taher
- Fayoum University Faculty of Medicine, Fayoum, Egypt
| | - Alexa King
- International University of Health Sciences, Basseterre, St. Kitts
| | - Stacy Ruther
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Giovanna Brazil
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | | | - Nicolas Calteux
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Hollie Ulibarri
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Julia Parise
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Amanda Arroyo
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Katelyn Sainz
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
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11
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Marchand GJ, Masoud AT, Ware K, King A, Ruther S, Brazil G, Cieminski K, Calteux N, Coriell C, Ulibarri H, Parise J, Arroyo A, Chen YC, Pierson M, Rafie R, Sainz K. A Systematic Review and Meta-Analysis of the Effect of Intraoperative Bupivacaine in Gynaecologic Surgery After 24 Hours or 9 Half-Lives. J Obstet Gynaecol Can 2021; 43:1279-1287. [PMID: 34293514 DOI: 10.1016/j.jogc.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/19/2021] [Accepted: 06/22/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To review all high quality available evidence regarding the effect of intraoperative bupivacaine 24 hours (or 8.9 half-lives) after intraoperative administration at time of gynaecologic surgery and to ascertain whether a second mechanism of action, beyond the initial prevention of sodium channel depolarization and blockade of nerve impulses, may be occurring. DATA SOURCES We searched all major databases with an algorithm designed to include all randomized trials that used any form of local bupivacaine, regardless of dose or route of administration, at the time of any gynaecologic surgery and compared its use with saline placebo. RESULTS As expected, we found that bupivacaine showed a significant improvement for all gynaecologic surgeries with respect to pain intensity at 6 hours after surgery when compared with a saline group (mean difference [MD] -1.28; 95% CI -1.96 to -0.61], P = 0.07). We also found a significant difference at 24 hours after surgery, giving evidence to the possibility of a second mechanism of action (MD -0.57; 95% CI -1.10 to -0.05], P = 0.01). Further subgroup analysis for pain levels at 24 hours showed significant decreases in pain for the laparoscopy (MD -0.74; 95% CI -0.93 to -0.54, P < 0.01) and laparotomy (MD -2.60; 95% CI -2.93 to -2.27, P < 0.01)) subgroups but not for the vaginal hysterectomy (MD 0.20; 95% CI -0.69 to 1.09, P = 0.66) or prolapse surgery (MD -0.11; 95% CI -0.41 to 0.19, P = 0.48) subgroups. There was no significant difference with respect to the length of hospital stay (MD -0.11; 95% CI -0.59 to 0.38, P = 0.67). CONCLUSION As expected, bupivacaine significantly reduced visual analog pain scores when compared with placebo at 6 hours after surgery, but also showed a significant difference at 24 hours after surgery, giving evidence of a second mechanism of action following the initial sodium channel blockade.
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Affiliation(s)
- Greg J Marchand
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona.
| | - Ahmed Taher Masoud
- Fayoum University Faculty of Medicine, Qesm Al Fayoum, Faiyum, Faiyum Governorate, Egypt
| | - Kelly Ware
- International University of the Health Sciences, Mesa, Arizona
| | - Alexa King
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | - Stacy Ruther
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | - Giovanna Brazil
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | | | - Nicolas Calteux
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | | | - Hollie Ulibarri
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | - Julia Parise
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | - Amanda Arroyo
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | - Yu-Chun Chen
- Midwestern University College of Osteopathic Medicine, Mesa, Arizona
| | - Maria Pierson
- Midwestern University College of Osteopathic Medicine, Mesa, Arizona
| | - Rasa Rafie
- Rocky Vista University College of Osteopathic Medicine, Mesa, Arizona
| | - Katelyn Sainz
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
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12
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Maarouf H, Marchand GJ, Ware K, Masoud A, King A, Ruther S, Brazil G, Ulibarri H, Parise J, Arroyo A, Sainz K, Shareef MA. Systematic review of the safety and efficacy of tramadol during office hysteroscopy. Turk J Obstet Gynecol 2021; 18:151-158. [PMID: 34083729 PMCID: PMC8191331 DOI: 10.4274/tjod.galenos.2021.55955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 05/07/2021] [Indexed: 12/01/2022] Open
Abstract
Office hysteroscopy (OH) is a common procedure in gynecology. Pain is the most frequently reported problem in OH. In this study, we aimed to investigate the role of tramadol administration in relieving pain in women undergoing OH. We searched PubMed, the Cochrane Library, ClinicalTrials.gov, MEDLINE, Scopus, and Web of Science databases for relevant clinical trials based on our search terms. We included randomized controlled trials and included all published trials in all six searched databases from their inception until February 28th 2021. We included pain as the primary outcome, and the incidence of adverse events of tramadol as secondary outcomes. We performed the analysis of continuous data using mean difference (MD) and dichotomous data using risk ratio (RR). We found that tramadol led to significantly less pain during the actual procedure [MD=-1.27, 95% confidence interval (CI): (-1.66, -0.88); p<0.001], immediately after the procedure [MD=-1.03, 95% CI: (-1.40, -0.67); p<0.001], and 30 minutes after the procedure [MD=-0.74, 95% CI: (-1.06, -0.41); p<0.001]. Regarding safety endpoints, no significant difference was noted for dizziness [RR=1.88, 95% CI: (0.79, 4.47); p=0.16] or vomiting [RR=1.80, 95% CI: (0.40, 8.18); p=0.45]. Based on the available data, we conclude that tramadol administration seems to be both effective and safe for patients undergoing office hysteroscopy.
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Affiliation(s)
- Hiba Maarouf
- REProVita Fertility Center, Recklinghausen, Germany
| | - Greg J. Marchand
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Kelly Ware
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Ahmed Masoud
- Fayoum University Faculty of Medicine, Fayoum, Egypt
| | - Alexa King
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Stacy Ruther
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Giovanna Brazil
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Hollie Ulibarri
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Julia Parise
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Amanda Arroyo
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Katelyn Sainz
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
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Marchand GJ, Carpenter A, Ware K, Vallejo J, King A, Anderson S, Ruther S, Brazil G, Cieminski K, Ulibarri H, Calteux N, Sainz K. Complete Laparoscopic Removal and Staging of a Large Ovarian Malignancy: A Case Report. Am J Case Rep 2021; 22:e930659. [PMID: 33859154 PMCID: PMC8057284 DOI: 10.12659/ajcr.930659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/08/2021] [Accepted: 02/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Advances in minimally invasive surgery are essential for the improvement of patient care, overall health care efficiency, and total cost reductions. Morcellation, the technique used in the present case, is often used to aid minimally invasive laparoscopic procedures, whereby larger tissue specimens are broken down and divided to be removed via smaller incisions. Morcellation has become controversial in the medical community owing to the risk of the procedure spreading an occult malignancy. CASE REPORT A 47-year-old woman with obesity presented with right-sided pelvic pain and suspicion of ovarian torsion. The patient experienced severe acute pain and was taken to the operating room for laparoscopy to remove the left-sided adnexal mass seen on imaging. During surgery, there was no evidence of torsion, and the mass was perfused. During removal of the entire tumor, blunt instruments were utilized for in-bag manual morcellation to avoid spillage of the contents of the bag, which were then sent for frozen section analysis, and a diagnosis of adenocarcinoma of the ovary was made. Once the tumor was removed, a board-certified gynecologic oncologist was consulted to assist with the remainder of the procedure. Following this, the ovarian cancer staging procedure was able to be completed laparoscopically. CONCLUSIONS This technique of in-bag manual morcellation using blunt instruments allows laparoscopic procedures to be performed on large tissue specimens with potential malignancies without spreading cancerous tissue, overcoming the associated risks of dissemination of malignancy. This technique is therefore more beneficial to patients.
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Affiliation(s)
- Greg J. Marchand
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, U.S.A
| | - Andrea Carpenter
- Department of Medicine, Midwestern University School of Medicine, Glendale, AZ, U.S.A
| | - Kelly Ware
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, U.S.A
- International University of Health Sciences, Basseterre, St. Kitts
| | - Jannelle Vallejo
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, U.S.A
- Washington University of Health and Science, San Pedro, Belize
| | - Alexa King
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, U.S.A
| | - Sienna Anderson
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, U.S.A
| | - Stacy Ruther
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, U.S.A
| | - Giovanna Brazil
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, U.S.A
| | - Kaitlynne Cieminski
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, U.S.A
| | - Hollie Ulibarri
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, U.S.A
| | - Nicolas Calteux
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, U.S.A
| | - Katelyn Sainz
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, U.S.A
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14
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Marchand GJ, Azadi A, Sainz K, Masoud A, Anderson S, Ruther S, Ware K, Hopewell S, Brazil G, King A, Vallejo J, Cieminski K, Galitsky A, Osipov R, Steele A, Love J. The Efficacy of Acetominophen for Total Laparoscopic Hysterectomy. JSLS 2021; 25:e2020.00104. [PMID: 34248331 PMCID: PMC8241284 DOI: 10.4293/jsls.2020.00104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Despite limited data, acetaminophen, along with other agents, is commonly included in enhanced recovery after surgery (ERAS) protocols following laparoscopic hysterectomy. We aimed to systematically review the efficacy of acetaminophen on the management of postoperative pain after laparoscopic hysterectomy. METHODS We searched PubMed, SCOPUS, Web of Science, and Cochrane Library databases for relevant clinical trials investigating the role of acetaminophen in the management of pain after laparoscopic hysterectomy. We performed the risk of bias according to Cochrane's risk of bias tool. We performed the analysis of homogeneous data under the fixed-effects model during the analysis of heterogeneous data under the random-effects model. The primary outcome was the assessment of pain score after 2, 6, 12, and 24 h. RESULTS A total of 495 patients in 13 trials were included in our meta-analysis. Acetaminophen was not superior at reducing postoperative pain scores. Further analysis at progressive temporal points revealed no further significance; effect size at after 2 h (SMD = -0.020, 95% CI (-0.216; 0.176)), 6 h (SMD = -0.115, 95% CI (-0.312; 0.083)), 12 h (SMD = -0.126, 95% CI (-0.277; 0.025)), or 24 h (SMD = 0.063, 95% CI (-0.065; 0.191)). Pooled analysis was heterogeneous (P < 0.1); therefore, we conducted a sensitivity analysis yielding homogeneous results. The drug did not reduce opioid need (MD = -0.16, 95% CI (-2.39, 2.06), P = 0.89). CONCLUSION We conclude that acetaminophen is not beneficial for reducing pain after laparoscopic hysterectomy. Other alternatives have better results. Caution should be given to the inclusion of acetaminophen in ERAS protocols designed for laparoscopic hysterectomy, especially as a single agent or to reduce opioid consumption.
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Affiliation(s)
- Greg J Marchand
- The Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | | | - Katelyn Sainz
- The Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | - Ahmed Masoud
- The Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | - Sienna Anderson
- The Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | - Stacy Ruther
- The Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | - Kelly Ware
- The Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | - Sophia Hopewell
- The Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | - Giovanna Brazil
- The Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | - Alexa King
- The Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | - Jannelle Vallejo
- The Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | | | - Anthony Galitsky
- The Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | - Robert Osipov
- The Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | - Allison Steele
- Midwestern University School of Medicine, Glendale, Arizona
| | - Jennifer Love
- Midwestern University School of Medicine, Glendale, Arizona
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Marchand GJ, Azadi A, Sainz K, Anderson S, Ruther S, Ware K, Hopewell S, Brazil G, King A, Cieminski K, Steele A, Love J. Systematic review and meta-analysis of ropivacaine use in laparoscopic hysterectomy. Turk J Obstet Gynecol 2021; 18:56-64. [PMID: 33715334 PMCID: PMC7962167 DOI: 10.4274/tjod.galenos.2021.06606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 01/10/2021] [Indexed: 12/01/2022] Open
Abstract
To assess the efficacy of all forms of ropivacaine administration for the management of pain and opioid use, specifically in patients undergoing laparoscopic hysterectomy. We searched PubMed, Cochrane CENTRAL, Web of Science, and SCOPUS for relevant clinical trials matching our eligibility criteria. Outcomes of interest included: Pain intensity (measured either by visual analog scale score or by numerical rating scale score), QoR-40 score (Overall quality of recovery tool, designed to measure physical comfort, physical independence, pain, emotional status, and need for support), and the need for opioid rescue. We performed the analysis under the fixed-effects model for homogeneous data and random-effects model for heterogeneous data. Most heterogeneous data were solved by the leave-one-out method, in cases where this was not successful, we then proceeded to conduct at least one subgroup meta-analysis in an attempt to solve heterogeneity. We assessed the risk of bias using Cochrane's risk of bias tool. A total of five clinical trials were included. Regarding the pain score, there was no significant difference between either group [standardized mean difference=-0.17, 95% confidence interval (CI): (-0.56, 0.23); p=0.41]. The analysis of the overall RoQ40 scores favored the ropivacaine group over the control group significantly [mean difference (MD)=17.68, 95% CI: (1.48, 33.87); p<0.001]. Regarding the use of opioids, the analysis revealed no significant difference between either group [MD=-2.57, 95% CI: (-6.62, 1.49); p=0.21]. Ropivacaine administration by any method does not seem to be effective in reducing pain or reducing the need for opioid use after laparoscopic hysterectomy procedures; however, the administration did show a significant improvement in the patient's "overall quality of recovery," as measured using the QoR-40 tool.
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Affiliation(s)
- Greg J Marchand
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Ali Azadi
- Star Urogynecology, Peoria, Arizona, USA
| | - Katelyn Sainz
- Washington University of Health and Science, San Pedro, Belize
| | - Sienna Anderson
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Stacy Ruther
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Kelly Ware
- International University of Health Sciences, Basseterre, St. Kitts
| | - Sophia Hopewell
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Giovanna Brazil
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Alexa King
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | | | - Allison Steele
- Midwestern University Faculty of Medicine, Glendale, Arizona, USA
| | - Jennifer Love
- Midwestern University Faculty of Medicine, Glendale, Arizona, USA
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Marchand GJ, Azadi A, Sainz K, Masoud A, Anderson S, Ruther S, Ware K, Hopewell S, Brazil G, King A, Vallejo J, Cieminski K, Galitsky A, Steele A, Love J. Systematic review, meta-analysis and statistical analysis of laparoscopic supracervical hysterectomy vs. endometrial ablation. J Turk Ger Gynecol Assoc 2021; 22:97-106. [PMID: 33663195 PMCID: PMC8187984 DOI: 10.4274/jtgga.galenos.2021.2020.0185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objective: This meta-analysis aimed to compare the effect of laparoscopic supracervical hysterectomy (LSH) with endometrial ablation (EA) in terms of general and menstrual-related quality of life in women opting for surgical treatment for abnormal uterine bleeding. Material and Methods: Sources searched included PubMed, Cochrane library, Scopus, and Web of Science for relevant clinical trials. Main outcomes of interest included: quality of life assessed using medical outcomes survey short form-36 (SF-36), (SF-12), operation time, time from operation to discharge, pain, fever, and hemoglobin level. Screening and data extraction were performed independently and the analysis was conducted using Review Manager Software v5.4.1. Results: Four clinical trials were included. Results of SF-12 score showed that there was no significant difference between the LSH and EA groups for either mental or physical component score overall mean difference (MD): -4.15 (-16.01, 7.71; p=0.49) and MD: 2.67 (-0.37, 5.71; p=0.08), respectively. Subgroup analysis of the SF-36 showed that only two components, general health and social function, were significantly improved in the LSH group (p<0.01) while the other six sub-scores did not differ between groups. The overall MD significantly favored the EA group for: operation time [MD: 72.65 (35.48, 109.82; p=0.0001)], time from operation to discharge [MD: 13.61 (3.21, 24.01; p=0.01)], hemoglobin level outcome [MD: 0.57 (0.40, 0.74); p<0.01], and pain score [standardized MD: 0.46 (0.32, 0.60; p<0.01)]. Conclusion: LSH has better outcomes for quality of life. This includes patient indicated responses to social health, general health, and superior hemoglobin levels at all measured points postoperatively. EA, however, was consistently associated with less operative time, a shorter hospital stay and is also considered by the authors to be a more minimally invasive technique which can also result in satisfying outcomes.
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Affiliation(s)
- Greg J Marchand
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Ali Azadi
- Department of Urogynecology, Star Urogynecology Advanced Pelvic Health Institute for Women, Arizona, United States of America
| | - Katelyn Sainz
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America,Washington University of Health and Science School of Medicine, San Pedro, Belize
| | - Ahmed Masoud
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Sienna Anderson
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Stacy Ruther
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Kelly Ware
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America,International University of Health Sciences School of Medicine, Basseterre, Saint Kitts and Nevis
| | - Sophia Hopewell
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Giovanna Brazil
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Alexa King
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Jannelle Vallejo
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America,Washington University of Health and Science School of Medicine, San Pedro, Belize
| | - Kaitlynne Cieminski
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Anthony Galitsky
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Allison Steele
- International University of Health Sciences School of Medicine, Basseterre, Saint Kitts and Nevis,Midwestern University School of Medicine, Arizona, United States of America
| | - Jennifer Love
- International University of Health Sciences School of Medicine, Basseterre, Saint Kitts and Nevis,Midwestern University School of Medicine, Arizona, United States of America
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Marchand GJ, Azadi A, Sainz K, Masoud A, Anderson S, Ruther S, Ware K, Hopewell S, Brazil G, King A, Vallejo J, Cieminski K, Galitsky A, Steele A, Love J. Systematic review, meta-analysis and statistical analysis of laparoscopic supracervical hysterectomy vs endometrial ablation. J Turk Ger Gynecol Assoc 2021. [DOI: 10.4274/jtgga.galenos.2019.2019.0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Marchand GJ, Azadi A, Anderson S, Ruther S, Hopewell S, Brazil G, Sainz K, Wolf H, King A, Vallejo J, Ware K, Cieminski K, Galitsky A. LESS hysterectomy through a bluntly created 11 mm incision. J Turk Ger Gynecol Assoc 2021; 22:76-79. [PMID: 33146476 PMCID: PMC7944236 DOI: 10.4274/jtgga.galenos.2020.2020.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
In the field of minimally invasive surgery, there is a constant drive to devise and execute the most minimally invasive surgeries possible. By the very nature of laparoscopy and robotic surgery, what one can accomplish with several ports of a given size will invariably be studied and attempted with fewer ports and with ports of smaller sizes. After researching the literature, we were not able to find any single port hysterectomies performed through a port size of smaller than 15 mm. We were able to perform, described here, a technique for performing laparoscopic hysterectomy through a single port of only 11 mm in diameter. We illustrate the technique in the accompanying video and believe the technique to be safe and reproducible.
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Affiliation(s)
- Greg J. Marchand
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Ali Azadi
- Department of Urogynecology, Star Urogynecology Advanced Pelvic Health Institute for Women, Arizona, United States of America
| | - Sienna Anderson
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Stacy Ruther
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Sophia Hopewell
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Giovanna Brazil
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Katelyn Sainz
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America,Washington University of Health and Science School of Medicine, San Pedro, Belize
| | - Hannah Wolf
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Alexa King
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Jannelle Vallejo
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America,Washington University of Health and Science School of Medicine, San Pedro, Belize
| | - Kelly Ware
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America,International University of Health Sciences School of Medicine, Basseterre, Saint Kitts and Nevis
| | - Kaitlynne Cieminski
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Anthony Galitsky
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
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Marchand GJ, Sainz K, Ruther S, Azadi A, Ware K, Brazil G, King A, Vallejo J, Cieminski K, Galitsky A, Ulibarri H, Calteux N, Osipov R. Two Port Laparoscopic Removal of Large Ovarian Cystadenoma. J Obstet Gynaecol Can 2021; 44:924-925.e1. [PMID: 33631322 DOI: 10.1016/j.jogc.2021.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 01/29/2021] [Accepted: 01/29/2021] [Indexed: 10/22/2022]
Abstract
An ovarian mucinous cystadenoma is a common benign tumour of the ovary that tends to reach very large sizes. Although traditional morcellation in the abdominal cavity is largely avoided in gynaecologic surgery, several authors have proposed other systems and techniques for the removal of large masses without resorting to laparotomy. We proposed an extremely minimally invasive technique to remove a large mass with a very low suspicion of malignancy, and created a video demonstration of the procedure. In this short film we illustrate our novel technique using only 2 laparoscopic ports, which maximizes both cosmesis and speed of recovery. The technique is not a completely closed system, therefore the potential for spreading an undiagnosed malignancy still exists. Accordingly, the authors do not suggest this technique for masses with a high potential for malignancy. However, in properly consented patients where there is very little suspicion for malignancy, our technique may be a reasonable option to promote fast recovery and provide excellent cosmesis.
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Affiliation(s)
- Greg J Marchand
- The Marchand Institute for Minimally Invasive Surgery, Mesa, AZ USA.
| | - Katelyn Sainz
- The Marchand Institute for Minimally Invasive Surgery, Mesa, AZ USA
| | - Stacy Ruther
- The Marchand Institute for Minimally Invasive Surgery, Mesa, AZ USA
| | - Ali Azadi
- Star Urogynecology, Advanced Pelvic Health Institute for Women, Peoria, Arizona
| | - Kelly Ware
- The Marchand Institute for Minimally Invasive Surgery, Mesa, AZ USA; International University of Health Sciences, Basseterre, St. Kitts
| | - Giovanna Brazil
- The Marchand Institute for Minimally Invasive Surgery, Mesa, AZ USA
| | - Alexa King
- The Marchand Institute for Minimally Invasive Surgery, Mesa, AZ USA
| | - Jannelle Vallejo
- The Marchand Institute for Minimally Invasive Surgery, Mesa, AZ USA; Washington University of Health and Science, San Pedro, Belize
| | | | - Anthony Galitsky
- The Marchand Institute for Minimally Invasive Surgery, Mesa, AZ USA
| | - Hollie Ulibarri
- The Marchand Institute for Minimally Invasive Surgery, Mesa, AZ USA
| | - Nicolas Calteux
- The Marchand Institute for Minimally Invasive Surgery, Mesa, AZ USA
| | - Robert Osipov
- The Marchand Institute for Minimally Invasive Surgery, Mesa, AZ USA
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Marchand GJ, Meassick K, Wolf H, Hopewell SK, Sainz K, Anderson SM, Ware K, Vallejo J, King A, Ruther S, Brazil G, Cieminski K, Calteux N. Respiratory depression in a neonate born to mother on maximum dose sertraline: a case report. J Med Case Rep 2021; 15:88. [PMID: 33602307 PMCID: PMC7893725 DOI: 10.1186/s13256-020-02640-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mood and anxiety disorders are common in women of childbearing age, especially during the peripartum period. As more women seek medical management for these conditions, there is an increasing need for studies to better examine the effects of exposure to selective serotonin reuptake inhibitors (SSRIs), and other antidepressants, on newborns at the time of delivery. CASE PRESENTATION We report the case of a term Caucasian infant born to a 17-year-old white female taking 100 mg of sertraline daily for depression and anxiety who exhibited respiratory depression and hypoxia after an uncomplicated vaginal delivery. The neonate was treated with the use of continuous positive airway pressure (CPAP) and supplemental oxygen and subsequently the symptoms resolved without complication. CONCLUSIONS We present this case with the suspicion of poor neonatal adjustment syndrome as the possible cause of the respiratory depression and hypoxia in this newborn.
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Affiliation(s)
- Greg J Marchand
- The Marchand Institute for Minimally Invasive Surgery, 10238 E. Hampton, Ste. 212, Mesa, AZ, 85209, USA.
| | - Katerina Meassick
- The Marchand Institute for Minimally Invasive Surgery, 10238 E. Hampton, Ste. 212, Mesa, AZ, 85209, USA.,Midwestern University School of Osteopathic Medicine, Glendale Arizona, 85308, USA
| | - Hannah Wolf
- The Marchand Institute for Minimally Invasive Surgery, 10238 E. Hampton, Ste. 212, Mesa, AZ, 85209, USA
| | - Sophia K Hopewell
- The Marchand Institute for Minimally Invasive Surgery, 10238 E. Hampton, Ste. 212, Mesa, AZ, 85209, USA
| | - Katelyn Sainz
- The Marchand Institute for Minimally Invasive Surgery, 10238 E. Hampton, Ste. 212, Mesa, AZ, 85209, USA
| | - Sienna M Anderson
- The Marchand Institute for Minimally Invasive Surgery, 10238 E. Hampton, Ste. 212, Mesa, AZ, 85209, USA
| | - Kelly Ware
- The Marchand Institute for Minimally Invasive Surgery, 10238 E. Hampton, Ste. 212, Mesa, AZ, 85209, USA
| | - Janelle Vallejo
- The Marchand Institute for Minimally Invasive Surgery, 10238 E. Hampton, Ste. 212, Mesa, AZ, 85209, USA
| | - Alexa King
- The Marchand Institute for Minimally Invasive Surgery, 10238 E. Hampton, Ste. 212, Mesa, AZ, 85209, USA
| | - Stacy Ruther
- The Marchand Institute for Minimally Invasive Surgery, 10238 E. Hampton, Ste. 212, Mesa, AZ, 85209, USA
| | - Giovanna Brazil
- The Marchand Institute for Minimally Invasive Surgery, 10238 E. Hampton, Ste. 212, Mesa, AZ, 85209, USA
| | - Kaitlynne Cieminski
- The Marchand Institute for Minimally Invasive Surgery, 10238 E. Hampton, Ste. 212, Mesa, AZ, 85209, USA
| | - Nicolas Calteux
- The Marchand Institute for Minimally Invasive Surgery, 10238 E. Hampton, Ste. 212, Mesa, AZ, 85209, USA
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Greer Polite F, DeAgostino-Kelly M, Marchand GJ. Combination of Laparoscopic Salpingectomy and Endometrial Ablation: A Potentially Underused Procedure. J Gynecol Surg 2021; 37:89-91. [PMID: 35153453 PMCID: PMC8828547 DOI: 10.1089/gyn.2020.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Despite the advantages of a decreased risk of epithelial-cell ovarian cancer and the extremely minimally invasive nature of the procedure, combined salpingectomy and endometrial ablation is a potentially underused procedure in the United States to treat abnormal uterine bleeding and desired sterilization. The lack of utilization of this combined procedure might be based on factors other than clinical considerations, including slow acceptance and adoption of Committee Opinions expressing the value of salpingectomy over sterilization. Committee Opinions and randomized clinical trials have demonstrated the benefit of salpingectomy for sterilization and epithelial-cancer risk reduction, and there could be an additional protection against postablation tubal sterilization syndrome. This Commentary discusses the advantages and rationale for consideration of expanding usage of the combined approach.
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Affiliation(s)
- Florencia Greer Polite
- Division of General Obstetrics and Gynecology Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mary DeAgostino-Kelly
- Division of General Obstetrics and Gynecology Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Greg J Marchand
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
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Azadi A, Bradley JA, Marchand GJ, Lorenz DJ, Doering D, Ostergard DR. Feasibility of Risk Reducing Salpingo-Oophorectomy at the Time of Abdominal Surgery for Correction of Pelvic Organ Prolapse and Urinary Incontinence. Gynecol Minim Invasive Ther 2021; 10:10-18. [PMID: 33747767 PMCID: PMC7968605 DOI: 10.4103/gmit.gmit_21_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/10/2020] [Accepted: 08/11/2020] [Indexed: 11/04/2022] Open
Abstract
Objective The objective of this study is to assess the perioperative outcomes when prophylactic bilateral salpingo-oophorectomy (BSO) is performed concomitantly with surgery to repair pelvic organ prolapse (POP) or stress urinary incontinence (SUI). Materials and Methods This is a retrospective case-control study of patients who underwent abdominal surgery for the correction of POP and/or SUI with or without concomitant BSO at a tertiary care center. The primary outcome measures were postsurgery length of hospitalization, estimated blood loss, and 30-day readmission rate. The secondary outcome measure was detection of ovarian cancer precursor lesions. Results We identified 734 patients who had surgery for POP and/or SUI. The control group contained 385 patients, and the BSO group contained 349 patients. There was no difference between the control and BSO groups in the postsurgery length of stay (LOS) (35.2 h vs. 34.1 h; P = 0.49), and all-cause 30-day readmission rate (14.2% vs. 11.6%; P = 0.3085). However, there was decreased blood loss (40.8 ml vs. 67.2 ml, P < 0.0001) in the BSO group compared to the control group. Sub-analysis of primary outcomes in postmenopausal women (age > 55) showed decreased postsurgery LOS (33.4 h vs. 37.4 h; P = 0.0208) and decreased blood loss (35.9 ml vs. 82.7 ml; P < 0.0001) in the BSO group compared to control. Conclusion Secondary to the lack of additional complications, we recommend surgeons give more consideration to finding appropriate candidates for a risk reducing BSO at time of abdominal surgery to repair POP or SUI.
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Affiliation(s)
- Ali Azadi
- Department of Obstetrics/Gynecology, University of Arizona College of Medicine, Phoenix, USA.,Star Urogynecology, Advanced Pelvic Health Institute for Women, Peoria, USA
| | - James A Bradley
- Department of Internal Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Greg J Marchand
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Douglas J Lorenz
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY, USA
| | - David Doering
- Norton Cancer Institute, Norton Healthcare, Louisville, KY, USA
| | - Donald R Ostergard
- Department of Obstetrics and Gynecology, UCLA School of Medicine, Los Angeles, CA, USA
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Marchand GJ, Meassick KS. Advanced Sexual Counseling and How to Ask Patients About "Intimate Disclosure". Int J Womens Health 2020; 12:1105-1108. [PMID: 33262661 PMCID: PMC7686469 DOI: 10.2147/ijwh.s256250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 10/29/2020] [Indexed: 11/23/2022] Open
Abstract
At the forefront of female sexual and reproductive health, OBGYNs play a pivotal role in assessing and managing sexual satisfaction and dysfunction. Satisfying sexuality often relates to a woman's ability or likelihood to relay to her partner the steps and actions required for her to reach orgasm. Female orgasms, in contrast to male orgasms, can be related to different areas of stimulation and processes (clitoral/vaginal (G-spot)/anal). Despite this knowledge, OBGYNs rarely discuss orgasm with patients or the importance and vulnerability of disclosing this information to their partners to enhance sexual satisfaction. Many women may not realize that sexual complaints are an acceptable subject to discuss at gynecologic visits, while others may feel uncomfortable in general talking about sex. But as the topic of female sexual dissatisfaction becomes less taboo thanks to social media, patients are increasingly likely to turn to their health-care providers to evaluate and treat sexual complaints. While conducting a thorough history, sexual history, physical exam and laboratory tests can help to rule out any biological, physiological or psychological causes of sexual dissatisfaction, it is only one half of the equation. Discussion of the steps and actions required for them to reach orgasm with their partners is paramount in working to achieve satisfying sexuality and orgasm. Despite the importance of satisfying sexuality in a relationship, this topic often leads to feelings of trepidation and vulnerability on behalf of the patient. Recognizing and providing acknowledgment of these feelings help patients feel listened to and validated.
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Affiliation(s)
- Greg J Marchand
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
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Marchand GJ. Misoprostol sleepover Camp - A review of the vicious cycle created by holding doses of prostaglandins during induction. Eur J Obstet Gynecol Reprod Biol 2020; 252:87-88. [PMID: 32585542 DOI: 10.1016/j.ejogrb.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/06/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Induction of labor using prostaglandins is a common and effective strategy for induction of labor. In order to improve safety associated with the administration of prostaglandins, health systems have developed protocols dictating when subsequent doses of prostaglandins must be held. Ideally, these criteria would prevent the administration of prostaglandins when they were likely to cause hyperstimulation. Unfortunately, these protocols are often "triggered" by uterine irritability that is not likely to contribute to hyperstimulation. This vicious cycle of prolonged hospitalization without medication administration to induce labor secondary to prostaglandins being held by hospital protocols has been coined "Misoprostol Sleepover Camp." METHODS We performed searches of all relevant literature and Pubmed, Medline and Google scholar. All articles that published a protocol of misoprostol usage for induction of labor were considered and reviewed. RESULTS Most published, described protocols for oral or vaginal misoprostol induction include parameters for holding doses, while very few of these protocols seem to take into consideration fetal status or maternal appreciation of the contractions. Most of the protocols reviewed out of simply used contractions in ten minutes as the absolute criteria for holding doses. CONCLUSION Initial review of the data seems to indicate that the described phenomenon seems inherent to the protocols described and unavoidable by obstetricians adhering to the protocols.
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Affiliation(s)
- Greg J Marchand
- Marchand Institute for Minimally Invasive Surgery, 10238 E. Hampton, Ste 212, Mesa, AZ, 85209, United States.
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Azadi A, Pinhasov K, Ware K, Marchand GJ, Ostergard DR. Comparison of Mechanical Characteristics of Commonly Used Vaginal Packing Materials. Surg Technol Int 2020; 36:186-190. [PMID: 32243561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Clinically, vaginal packing provides the benefit of hemostasis and is designed to prevent the formation of postoperative hematomas. Despite the common use of vaginal packing in pelvic surgery, there is limited data to indicate which material has the ideal characteristics for vaginal packing. MATERIALS AND METHODS Three packing materials were used: DeRoyal® Fluftex™ (DeRoyal Industries, Inc., Powell, Tennessee), NHP Surgi-Pak™ vaginal packing (NHP Industries, Inc., City of Industry, California), and Curad® Plain Packing Strips (Medline Industries, Inc., Northfield, Illinois). A fluid with similar viscosity to human blood, defibrinated sheep's blood (Remel Laboratories, Nenexa Kansas) was used to saturate the materials. The primary outcome was the amount of fluid absorbance of each product in both the handpacked and unpacked state. The number of drops used to saturate each material were counted and converted to mL/g. Each product was tested three times and the results were measured by counting the number of drops needed to saturate the material in each experiment. Experiment: Three materials were obtained and conducted into two different experiments to test absorbance. The packed trial consisted of 0.1g of material and was compacted in a 146mm standard Pasteur pipette (Sigma-Aldrich Corp., St. Louis, Missouri). Droplets of sheep's blood were dispensed until each material had reached its capacity, which was determined by counting the last sequential drop received onto the respective material before the first of the fluid fell from the material into the collecting container. Trials were conducted three times per material and an average of the three trials was calculated. The second experiment tested 1g of each material unpacked and folded into eight layers. Droplets of blood were placed onto the material until each material leaked, which was defined again as the first fluid to fall from the material into the collecting container that it was suspended above. The number of drops needed to produce this effect was recorded. All droplets were counted and converted to mL/g. Standard deviation was calculated for each material in both experiments and an analysis of variance (ANOVA) single factor test was done. RESULTS Three trials were conducted per material and there was a difference in absorbance between each packing material (p=0.02 packed, p=0.001 unpacked). Additionally, the plain packing strip absorbed the least amount of blood product in the packed and unpacked state compared to DeRoyal® Fluftex™ and NHP Surgi-Pak™ vaginal packing. The average absorbance of the packed materials was 7.7mL/g for DeRoyal® Fluftex™, 9.8mL/g for NHP Surgi-Pak™ vaginal packing, and 7.5mL/g for the Curad® Plain Packing Strips. There was a standard deviation of 2.08 drops for DeRoyal® Fluftex™, 3.51 drops for NHP Surgi-Pak™ vaginal packing, and 1.73 drops for Curad® Plain Packing Strips. Absorbance for DeRoyal® Fluftex™ unpacked was 8.2mL/g, NHP Surgi-Pak™ vaginal packing unpacked was 7.00mL/g, and Curad® Plain Packing Strips was 4.8mL/g. The standard deviation for the unpacked experiment was 29.02 drops for DeRoyal® Fluftex™, 13.61 drops for NHP Surgi-Pak™ vaginal packing, and 15.59 drops for Curad® Plain Packing Strips. A p-value of less than .05 in a confidence interval of 95% was determined. CONCLUSION Even though there are studies showing the clinical benefits of vaginal packing after a variety of gynecological surgeries, there is less known about the characteristics of the ideal material. Minimal foreign body reaction, decreased adherence to surgical scars, X-ray visualization, low cost, and easy availability are among the ideal characteristics of the presumed ideal material used for vaginal packing. In this study, we compared the absorbance between three commonly used materials and did not find any statistical differences. Further studies are needed to show the clinical benefits and mechanical characteristics of material used for vaginal packing. Due to the lack of a statistically significant difference in absorbance between the materials, evaluation of mechanical characteristics may be beneficial in determining an ideal vaginal packing product.
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Affiliation(s)
- Ali Azadi
- University of Arizona, Phoenix, Arizona, Star Urogynecology, Peoria, Arizona
| | | | - Kelly Ware
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | - Greg J Marchand
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona
| | - Donald R Ostergard
- Department of Obstetrics and Gynecology,UCLA School of Medicine, Los Angeles, California
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Marchand GJ. Expert Opinion: Broken Play Laparoscopy - What to do when there's no findings? Eur J Obstet Gynecol Reprod Biol 2020; 250:124-125. [PMID: 32438275 DOI: 10.1016/j.ejogrb.2020.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/12/2020] [Accepted: 03/16/2020] [Indexed: 10/24/2022]
Abstract
A short review of the uncomfortable scenario of a negative laparoscopy when expecting endometriosis, adhesive disease or other pathology. The article reviews different commonly used but rarely documented strategies for ameliorating pelvic pain in the absence of clear pathology.
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Affiliation(s)
- Greg J Marchand
- Marchand Institute for Minimally Invasive Surgery, 10238 E. Hampton, Ste 212, Mesa, AZ 85209, USA(1).
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Marchand GJ, Sainz KM. Pap Smear Ransom - Is It Ethical to Refuse to Refill a Patient's Birth Control Until They Come in for Their Annual Exam? Int J Womens Health 2020; 12:265-267. [PMID: 32308500 PMCID: PMC7153914 DOI: 10.2147/ijwh.s246220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/30/2020] [Indexed: 12/03/2022] Open
Abstract
A review of the common but questionably ethical practice of refusing to refill a patient’s birth control prescription until they are seen in office for, and presumably pay for, a yearly examination. This forced decision between making time for the appointment or risking an unintended pregnancy is comically referred to as “Pap Smear Ransom.” This short review examines the limited data to support or decry this common practice.
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Affiliation(s)
- Greg J Marchand
- The Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Katelyn M Sainz
- The Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
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Abstract
OBJECTIVE Guidelines for referring women with pelvic masses suspicious for ovarian cancer to gynecologic oncologists have been developed by the American College of Obstetrician Gynecologists (ACOG). We set out to evaluate the negative predictive value of these guidelines and to assess a modified algorithm involving minimally invasive surgery in the treatment of women with masses suspected to be benign. METHODS 257 consecutive patients with adnexal masses of 8cm to 13cm on preoperative ultrasound examination meeting Triage Criteria set forth in ACOG Committee Opinion 280. Patients meeting the selection criteria were scheduled for operative laparoscopy, washings, adnexectomy, bagging, and colpotomy. A total of 240 patients successfully completed intended treatment (93.38%), and 234 of these did not require admission (97.5%). There was a low incidence of significant complications: 97.50% of women were successfully treated as outpatients, 97.92% of surgeries lasted <136 minutes, and <97.08% had blood loss <200mL. The negative predictive value of ACOG Committee Opinion 280 Triage Criteria as a deselector for having invasive ovarian malignancy in our population was 95.57% for premenopausal and 90.91% for postmenopausal women. CONCLUSIONS Laparoscopic adnexectomy, bagging, and colpotomy is a desirable goal for patients with ovarian masses in the 8cm to 13cm range meeting selection criteria affording a minimally invasive approach with attendant benefits including outpatient treatment (97.5%), few complications, low likelihood of iatrogenic rupture of the ovarian capsule (1.25%), and low necessity for reoperation after final pathology is evaluated (6.03%). Negative predictive value of ACOG Committee Opinion 280 is confirmed in a community gynecology practice and is recommended to form the basis of a new treatment algorithm for women with adnexal masses.
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