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Douligeris A, Kathopoulis N, Zachariou E, Mortaki A, Zacharakis D, Kypriotis K, Chatzipapas I, Protopapas A. Laparoscopic versus Vaginal Uterosacral Ligament Suspension in Women with Pelvic Organ Prolapse: A Systematic Review and Meta-analysis of the Literature. J Minim Invasive Gynecol 2024:S1553-4650(24)00112-2. [PMID: 38493827 DOI: 10.1016/j.jmig.2024.03.007] [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: 09/07/2023] [Revised: 02/24/2024] [Accepted: 03/13/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE Uterosacral ligament suspension (USLS) is one of the most frequently used operations for the restoration of apical support in women with uterovaginal prolapse. However, existing studies are inconclusive as to whether and which surgical access route is superior. The aim of the present meta-analysis is tentatively to compare the efficiency and the postoperative complications of laparoscopic USLS (L-USLS) and vaginal USLS (V-USLS), highlighting that current evidence remains inconclusive regarding the superiority of either surgical access route. DATA SOURCES We performed a systematic literature review of 5 major databases (Medline, Scopus, Google Scholar Cochrane Central Register of Controlled Trials and Clinicaltrials.gov) from inception till April 2023. METHODS OF STUDY SELECTION No language restrictions were applied. All comparative studies that compared L-USLS and V-USLS for the management of women with uterovaginal prolapse were included. TABULATION, INTEGRATION, AND RESULTS Data from 6 retrospective cohort studies on 856 patients were extracted and analyzed. The methodological quality of the included studies was assessed using the risk of bias in nonrandomized studies of interventions tool and ranged between moderate to serious. The pooled results suggest that L-USLS was associated with a potentially decreased incidence of ureteral compromise (odds ratio [OR], 0.19; 95% confidence interval [CI] 0.04-0.89; p = .04) and seemingly lower objective (OR 0.47; 95% CI 0.23-0.97; p = .04) and subjective recurrence rates (OR 0.46; 95% CI 0.23-0.92; p = .03). There were no significant differences between the rates of postoperative pain from USLS sutures, postoperative pelvic hematomas, the suture exposure/granulation tissue formation, and the prolapse recurrence retreatment among the 2 groups. CONCLUSION The present meta-analysis indicates that L-USLS is possibly associated with significantly fewer ureteral compromise rates and decreased subjective and objective recurrences rates compared to V-USLS. Nevertheless, given the limitations in data quality and heterogeneity of the included studies, these findings should be interpreted with caution. Large-scale randomized studies are essential to more definitively determine the relative merits of the laparoscopic versus vaginal approach.
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Affiliation(s)
- Athanasios Douligeris
- Endoscopic Surgery Unit, 1(st) Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, "Alexandra" General Hospital, Vasilissis Sofias Avenue 80, 11528, Athens, Greece. (all authors)..
| | - Nikolaos Kathopoulis
- Endoscopic Surgery Unit, 1(st) Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, "Alexandra" General Hospital, Vasilissis Sofias Avenue 80, 11528, Athens, Greece. (all authors)
| | - Eleftherios Zachariou
- Endoscopic Surgery Unit, 1(st) Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, "Alexandra" General Hospital, Vasilissis Sofias Avenue 80, 11528, Athens, Greece. (all authors)
| | - Anastasia Mortaki
- Endoscopic Surgery Unit, 1(st) Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, "Alexandra" General Hospital, Vasilissis Sofias Avenue 80, 11528, Athens, Greece. (all authors)
| | - Dimitrios Zacharakis
- Endoscopic Surgery Unit, 1(st) Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, "Alexandra" General Hospital, Vasilissis Sofias Avenue 80, 11528, Athens, Greece. (all authors)
| | - Konstantinos Kypriotis
- Endoscopic Surgery Unit, 1(st) Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, "Alexandra" General Hospital, Vasilissis Sofias Avenue 80, 11528, Athens, Greece. (all authors)
| | - Ioannis Chatzipapas
- Endoscopic Surgery Unit, 1(st) Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, "Alexandra" General Hospital, Vasilissis Sofias Avenue 80, 11528, Athens, Greece. (all authors)
| | - Athanasios Protopapas
- Endoscopic Surgery Unit, 1(st) Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, "Alexandra" General Hospital, Vasilissis Sofias Avenue 80, 11528, Athens, Greece. (all authors)
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Grigoriadis T, Kalantzis C, Zacharakis D, Kathopoulis N, Prodromidou A, Xadzilia S, Athanasiou S. Platelet-Rich Plasma for the Treatment of Stress Urinary Incontinence-A Randomized Trial. Urogynecology (Phila) 2024; 30:42-49. [PMID: 37493287 DOI: 10.1097/spv.0000000000001378] [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] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
IMPORTANCE Urinary incontinence affects millions of women worldwide. OBJECTIVE The aim of the current study was to evaluate the efficacy and safety of periurethral platelet-rich plasma (PRP) injections in women with stress urinary incontinence (SUI). STUDY DESIGN This was a single-center, double-blind, randomized sham-controlled trial. Fifty participants with SUI and urodynamic stress incontinence were randomized in 2 equally sized groups. Women in the PRP group received 2 PRP injections at 3 levels of the urethra at 4- to 6-week intervals. Women in the sham group were injected with sodium chloride 0.9%. At baseline, participants underwent urodynamic studies and a 1-hour pad test and completed the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS), the Patient Global Impression Scale of Improvement, and the King's Health Questionnaire. At follow-up visits (1, 3, and 6 months), women underwent the 1-hour pad test and completed the King's Health Questionnaire and the ICIQ-FLUTS. Primary outcome was the subjective evaluation as indicated by the response to question 11a of the ICIQ-FLUTS questionnaire. Secondary outcomes included scores of questionnaires and urine loss assessed on the 1-hour pad test. The level of discomfort during injections and any adverse events were also evaluated. RESULTS During follow-up, the mean score of the 11a question decreased significantly in the PRP group compared with sham. Subjective cure was significantly higher in the PRP group (32% vs 4%, P < 0.001). A significant reduction of urine loss assessed on the 1-hour pad test was observed in the PRP group compared with the sham group at 6-month follow-up. No adverse events were observed. CONCLUSIONS Periurethral PRP injections were superior to sham injections in improving SUI symptoms with an excellent safety profile.
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Affiliation(s)
- Themos Grigoriadis
- From the 1st Department of Obstetrics and Gynecology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Blontzos N, Mavrogianni D, Ntzeros K, Kathopoulis N, Moustogiannis A, Philippou A, Koutsilieris M, Protopapas A. Differential Expression of Insulin Growth Factor 1 (IGF-1) Isoforms in Different Types of Endometriosis: Preliminary Results of a Single-Center Study. Biomolecules 2023; 14:7. [PMID: 38275748 PMCID: PMC10813029 DOI: 10.3390/biom14010007] [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: 11/12/2023] [Revised: 12/09/2023] [Accepted: 12/13/2023] [Indexed: 01/27/2024] Open
Abstract
Endometriosis is a benign, estrogen-dependent gynecological condition with an uncertain exact pathogenetic mechanism. The aim of this study was to evaluate the potential differential expression of Insulin Growth Factor 1 (IGF-1) isoforms in deeply infiltrating endometriotic (DIE) lesions, in ovarian endometriomas, and in the eutopic endometrium of the same endometriosis patients and to compare their expression with that in the eutopic endometrium of women without endometriosis. A total of 39 patients were included: 28 with endometriosis, of whom 15 had endometriomas only, 7 had DIE nodules only, and 6 had both DIE and endometriomas, and 11 without endometriosis served as controls. We noticed a similar pattern of expression between IGF-1Ea and IGF-1Ec, which differed from that of the IGF-1Eb isoform, possibly implying differential biological actions of different isoforms in DIE subtypes. We observed a tendency of lower expression of IGF-1Ea and IGF-1Ec in endometriomas without DIE compared to endometriomas with concurrent DIE or in DIE nodules. In conclusion, differential expression of IGF-1 isoforms may indicate that DIE with its associated ovarian lesions and simple ovarian endometriosis should be considered as two forms of the disease developing under different molecular pathways.
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Affiliation(s)
- Nikolaos Blontzos
- Endoscopic Surgery Unit, 1st Department of Obstetrics Gynecology, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece; (N.B.); (A.P.)
- Experimental Laboratory, 1st Department of Obstetrics Gynecology, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.M.); (K.N.)
| | - Despoina Mavrogianni
- Experimental Laboratory, 1st Department of Obstetrics Gynecology, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.M.); (K.N.)
| | - Konstantinos Ntzeros
- Experimental Laboratory, 1st Department of Obstetrics Gynecology, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.M.); (K.N.)
| | - Nikolaos Kathopoulis
- Endoscopic Surgery Unit, 1st Department of Obstetrics Gynecology, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece; (N.B.); (A.P.)
| | - Athanasios Moustogiannis
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece; (A.M.); (A.P.); (M.K.)
| | - Anastassios Philippou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece; (A.M.); (A.P.); (M.K.)
| | - Michael Koutsilieris
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece; (A.M.); (A.P.); (M.K.)
| | - Athanasios Protopapas
- Endoscopic Surgery Unit, 1st Department of Obstetrics Gynecology, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece; (N.B.); (A.P.)
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Prodromidou A, Zacharakis D, Athanasiou S, Kathopoulis N, Varthaliti A, Douligeris A, Michala L, Athanasiou V, Salvatore S, Grigoriadis T. CO 2 Laser versus Sham Control for the Management of Genitourinary Syndrome of Menopause: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Pers Med 2023; 13:1694. [PMID: 38138921 PMCID: PMC10744987 DOI: 10.3390/jpm13121694] [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: 10/10/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
In the context of the menopausal transition, genitourinary syndrome of menopause (GSM) refers to a range of genitourinary symptoms, from vaginal dryness to dysuria and urinary urgency. While hormonal treatments are standard, their associated side effects have driven the exploration of alternatives like vaginal CO2 laser. We aimed to evaluate the randomized controlled trials (RCTs) comparing vaginal CO2 laser treatment for GSM to sham controls. This systematic review sourced four electronic databases until June 2023. The analysis incorporated seven RCTs with 407 women. The CO2 laser and sham control were comparable for most parameters, including the female sexual function index (FSFI) and visual analogue scale (VAS) for dyspareunia, vaginal health index, pH, and patient satisfaction. However, the CO2 laser group showed significant improvement in the vaginal assessment scale for GSM symptoms. Sensitivity analyses revealed that parameters like FSFI showed significant differences in favor of CO2 laser group upon the exclusion of specific studies. In conclusion, vaginal CO2 laser therapy emerges as a promising alternative for GSM management, especially for most bothersome GSM symptoms; however, the need for further well-designed RCTs remains to validate its broad safety and efficacy.
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Affiliation(s)
- Anastasia Prodromidou
- 1st Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.Z.); (S.A.); (N.K.); (A.V.); (A.D.); (L.M.); (T.G.)
| | - Dimitrios Zacharakis
- 1st Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.Z.); (S.A.); (N.K.); (A.V.); (A.D.); (L.M.); (T.G.)
| | - Stavros Athanasiou
- 1st Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.Z.); (S.A.); (N.K.); (A.V.); (A.D.); (L.M.); (T.G.)
| | - Nikolaos Kathopoulis
- 1st Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.Z.); (S.A.); (N.K.); (A.V.); (A.D.); (L.M.); (T.G.)
| | - Antonia Varthaliti
- 1st Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.Z.); (S.A.); (N.K.); (A.V.); (A.D.); (L.M.); (T.G.)
| | - Athanasios Douligeris
- 1st Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.Z.); (S.A.); (N.K.); (A.V.); (A.D.); (L.M.); (T.G.)
| | - Lina Michala
- 1st Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.Z.); (S.A.); (N.K.); (A.V.); (A.D.); (L.M.); (T.G.)
| | | | - Stefano Salvatore
- Obstetrics and Gynaecology Department, IRRCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20125 Milan, Italy;
| | - Themos Grigoriadis
- 1st Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.Z.); (S.A.); (N.K.); (A.V.); (A.D.); (L.M.); (T.G.)
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Douligeris A, Diakosavvas M, Kathopoulis N, Kypriotis K, Mortaki A, Angelou K, Chatzipapas I, Protopapas A. Authors' Reply. J Minim Invasive Gynecol 2023; 30:1007-1008. [PMID: 37778635 DOI: 10.1016/j.jmig.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
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Douligeris A, Diakosavvas M, Kathopoulis N, Kypriotis K, Mortaki A, Angelou K, Chatzipapas I, Protopapas A. The Effect of Postoperative Gum Chewing on Gastrointestinal Function Following Laparoscopic Gynecological Surgery. A Meta-analysis of Randomized Controlled Trials. J Minim Invasive Gynecol 2023; 30:783-796. [PMID: 37422054 DOI: 10.1016/j.jmig.2023.06.015] [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: 05/02/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE To assess the effect of postoperative gum chewing on gastrointestinal function in women following laparoscopic gynecological surgery for benign indications. DATA SOURCES We screened 5 major databases (Medline, Scopus, Google Scholar, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov) from inception till February 2023. METHODS OF STUDY SELECTION No language restrictions were applied. We included randomized controlled trials comparing the postoperative bowel function between patients who chewed and patients who did not chew gum postoperatively after laparoscopic gynecological procedures for benign indications. TABULATION, INTEGRATION, AND RESULTS Data from 5 studies on 670 patients were extracted and analyzed by 3 independent reviewers. Meta-analysis was performed with RevMan 5.4 software (Copenhagen: The Nordic Cochrane Center, The Cochrane Collaboration, 2020), with mean differences (MDs), pooled risk ratios, and random-effects model. Postoperative gum chewing significantly reduced the time to first bowel sounds and the time to first passage of flatus (MD -2.58 hours 95% confidence interval (CI) -4.12 to -1.04 p = .001 and MD -3.97 hours 95% CI -6.26 to -1.68 p <.001, respectively). The time to first defecation, the time to first postoperative patients' mobilization, the length of hospital stay, and the risk of postoperative bowel obstruction showed no statistically significant difference between the 2 groups. When subgroup analysis was performed according to the type of the laparoscopic procedure, it failed to reveal a positive impact of postoperative gum chewing in both the times to first passage of flatus and first defecation following laparoscopic hysterectomies (MD -5.35 hours 95% CI -10.93 to 0.23 p = .06 and MD -15.93 hours 95% CI -40.13 to 8.28 p = .20, respectively). CONCLUSION The results of the present meta-analysis support that postoperative gum chewing following laparoscopic gynecological procedures seems to have a positive effect on the early mobilization of the gastrointestinal tract. However, these results should be interpreted with caution due to the small number of the included randomized controlled clinical trials.
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Affiliation(s)
- Athanasios Douligeris
- Endoscopic Surgery Unit, 1st Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Michail Diakosavvas
- Endoscopic Surgery Unit, 1st Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kathopoulis
- Endoscopic Surgery Unit, 1st Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Kypriotis
- Endoscopic Surgery Unit, 1st Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Mortaki
- Endoscopic Surgery Unit, 1st Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kyveli Angelou
- Endoscopic Surgery Unit, 1st Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Chatzipapas
- Endoscopic Surgery Unit, 1st Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Protopapas
- Endoscopic Surgery Unit, 1st Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Kathopoulis N, Diakosavvas M, Kypriotis K, Chatzipapas I, Domali E, Protopapas A. Laparoscopic management of a second trimester ruptured spontaneous heterotopic tubal pregnancy mimicking ovarian tumour, a case report. Facts Views Vis Obgyn 2023; 15:157-160. [PMID: 37436053 PMCID: PMC10410657 DOI: 10.52054/fvvo.15.2.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Laparoscopic surgery in the second trimester of pregnancy is a high risk and demanding operation. Especially when dealing with adnexal pathology, the surgeon should balance between the effort to establish adequate visualisation of the operating field with minimal uterine manipulation and use of energy application to avoid any potential adverse effects on the intrauterine pregnancy. OBJECTIVE The video shows laparoscopic surgery performed in the second trimester of pregnancy and highlights modifications to technique to ensure safety. Materials and Methods: We present a case report of spontaneous heterotopic tubal pregnancy that mimicked an ovarian tumour and was managed surgically with a laparoscopy in the second trimester. During surgery, a previously ruptured left tubal pregnancy (? ectopic) was the cause for a concealed hematoma in the pouch of Douglas, misdiagnosed as ovarian tumour. This is one of the few cases of heterotopic pregnancy treated by laparoscopy in the second trimester of pregnancy. RESULTS The patient was discharged the day 2 post-operatively, the intrauterine pregnancy progressed, and the patient delivered with a planned caesarean section on the 38th week. CONCLUSIONS Laparoscopic surgery, with adjustments, is a safe and effective method to manage adnexal pathology during a second trimester pregnancy.
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Ntzeros K, Mavrogianni D, Mplontzos N, Soyhan N, Kathopoulis N, Papamentzelopoulou MS, Chatzipapas I, Protopapas A. Expression of ZEB1 in different forms of endometriosis: A pilot study. Eur J Obstet Gynecol Reprod Biol 2023; 286:121-125. [PMID: 37245357 DOI: 10.1016/j.ejogrb.2023.05.022] [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: 12/27/2022] [Revised: 05/14/2023] [Accepted: 05/17/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVES Epithelial-Mesenchymal Transition (EMT), a cellular process in which epithelial cells lose epithelial characteristics while acquire mesenchymal features, is believed to contribute to migration and invasion abilities of the endometriotic cells. Studies on gene expression of the transcription factor ZEB1, a crucial transcription factor of EMT, show that there is probably a modified expression in the endometriotic lesions. The aim of the study was to compare the expression levels of ZEB1 in types of endometriotic lesions with different biological behavior such as endometriomas and deep infiltrating endometriotic nodules. STUDY DESIGN We have studied 19 patients with endometriosis and 8 patients with benign gynecological lesions without endometriosis. The endometriosis patient group included 9 women with only endometriotic cysts without deep infiltrating endometriotic lesion (DIE) and 10 women with DIE who had developed concurrent endometriotic cysts. The technique applied to investigate ZEB1 expression levels is Real-Time PCR. The results of the reaction were normalized by simultaneously investigating the expression of the house-keeping gene G6PD. RESULTS Analysis of the samples showed underexpression of ZEB1 in the eutopic endometrium of women with only endometriotic cysts when compared to normal endometrium. A tendency of higher ZEB1 expression, without reaching significant difference, was found between the endometriotic cysts and their paired eutopic endometrium. In women with DIE, no significant difference was found between their eutopic and normal endometrium. No significant difference was found between the endometriomas and DIE lesions. ZEB1 shows different expression profile in the endometriotic cysts of women with and without DIE when the cyst is compared to their paired eutopic endometrium. CONCLUSIONS It therefore appears that ZEB1 expression differs between different types of endometriosis. The expression levels of ZEB1 in the eutopic endometrium could affect the development of infiltrating lesions or not. However, the most important observation is the different ZEB1 expression profile of endometriomas between women with and without DIE. Although, they both share the same histologic characteristics, they show different ZEB1 expression indicating different pathogenetic mechanisms of endometriomas in cases with and without DIE. Therefore, future research on endometriosis should consider DIE and ovarian endometriosis as different diseases.
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Affiliation(s)
- Konstantinos Ntzeros
- Gynecological Endoscopy Unit, 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Greece; Laboratory of Reproductive Biology, 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Greece.
| | - Despoina Mavrogianni
- Laboratory of Reproductive Biology, 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Greece
| | - Nikolaos Mplontzos
- Gynecological Endoscopy Unit, 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Greece; Laboratory of Reproductive Biology, 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Greece
| | - Ntilay Soyhan
- Laboratory of Reproductive Biology, 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Greece
| | - Nikolaos Kathopoulis
- Gynecological Endoscopy Unit, 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Greece
| | - Myrto-Sotiria Papamentzelopoulou
- Laboratory of Reproductive Biology, 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Greece
| | - Ioannis Chatzipapas
- Gynecological Endoscopy Unit, 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Greece
| | - Athanasios Protopapas
- Gynecological Endoscopy Unit, 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Greece
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Prodromidou A, Dimitroulia E, Mavrogianni D, Kathopoulis N, Pappa KI, Loutradis D. The Effect of the Allelics of Ser680Asn Polymorphisms of Follicle-Stimulating Hormone Receptor Gene in IVF/ICSI Cycles: a Systematic Review and Meta-analysis. Reprod Sci 2023; 30:428-441. [PMID: 35680725 DOI: 10.1007/s43032-022-00996-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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 06/02/2022] [Indexed: 10/18/2022]
Abstract
A significant number of single-nucleotide polymorphisms (SNPs) of the follicle-stimulating hormone receptor (FSHr) can modify the response to exogenous FSH administration. A significant diversity in response to controlled ovarian stimulation (COS) in assisted reproductive technologies (ART) according to the type of allelic has been reported. We aimed to evaluate the relation between the Asn680Ser allelics and COS. A total of 4 electronic databases were searched for articles published up to August 2021. Prospective and retrospective comparative studies which reported outcomes after COS in patients who underwent genotyping for the detection of FSHr polymorphisms were considered eligible. A total of 11 studies including 4343 patients with Asn680Ser polymorphisms of the FSHr were included. Patients carrying the Asn/Asn allelic provide elevated E2 on the day of human chorionic gonadotropin (hCG) administration (1549 patients MD 262.39 pg/ml, p = 0.0007), but less transferrable embryos as compared with Ser/Ser genotype (283 patients MD - 0.11 embryos, p = 0.04). Ans/Ser versus Ser/Ser genotypes showed a higher E2 on the day of hCG administration (1799 patients, MD 207.86 pg/ml, p = 0.02). Pregnancy rates were similar in all combination of genotypes. There is currently no strong evidence suggesting that the examination of one gene in relation to genotypes can be effectively used as single tool to improve COS. However, polygenic analysis of different polymorphisms by analyzing the genetic profile of each individual could be useful. Further research is warranted to develop an algorithm that will enable simultaneous analysis of many genes, which combined with hormonal profile could promote treatment individualization.
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Affiliation(s)
- Anastasia Prodromidou
- Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens School of Medicine, Athens, Greece.
| | - Evangelia Dimitroulia
- Department of Microbiology, Medical School, Biopathology University of Athens, Athens, Greece
| | - Depy Mavrogianni
- Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Nikolaos Kathopoulis
- Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Kalliopi I Pappa
- Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Dimitrios Loutradis
- Athens Medical School, Kapodistrian University of Athens, Fertility Institute, Athens, Greece
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Kathopoulis N, Vlachos DE, Kypriotis K, Diakosavvas M, Chatzipapas I, Protopapas A. Laparoscopic Discoid Excision of Bowel Endometriosis Using Sutures for Closure. J Minim Invasive Gynecol 2023; 30:11-12. [PMID: 36403694 DOI: 10.1016/j.jmig.2022.11.007] [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: 07/25/2022] [Revised: 11/06/2022] [Accepted: 11/11/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To demonstrate the technique of discoid excision of bowel endometriosis followed by closure of the bowel defect using sutures, without the application of the transanal stapler device. DESIGN Stepwise demonstration of the technique with narrated video footage. SETTING Bowel endometriosis is a common pattern of deep endometriosis [1]. Discoid excision is 1 of the 3 surgical interventions applied to manage this pathologic entity, with shaving and segmental resection being the other 2 [2]. When discoid excision is performed, a transanal stapler device is used for bowel closure in most cases [3,4]. Only a few studies so far have reported the application of sutures for this purpose [5]. This video highlights the technique of bowel suturing after discoid excision. INTERVENTIONS This video presents the technique of bowel discoid excision with the application of sutures to close the bowel defect (Supplemental Video 1). The key surgical steps are as follows: 1. Dissection of both ureters and development of pararectal spaces. 2. Recognition and preservation of the inferior hypogastric plexus and the hypogastric nerve. 3. Detachment of the nodule from the cervix. 4. Detachment of the nodule from the bowel, beginning with deep shaving and followed by discoid excision. 5. Thorough description of the bowel closure using 2 layers of Vicryl 3-0 sutures, the first being interrupted and the second continuous. CONCLUSION The described technique of bowel closure using sutures may be a safe and effective alternative to the transanal stapler. Its advantage is that it can be performed when the pathology is located higher than 15 cm from the anal verge or the diameter of the nodule is more than 30 mm.
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Affiliation(s)
- Nikolaos Kathopoulis
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (all authors).
| | - Dimitrios-Efthimios Vlachos
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (all authors)
| | - Konstantinos Kypriotis
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (all authors)
| | - Michail Diakosavvas
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (all authors)
| | - Ioannis Chatzipapas
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (all authors)
| | - Athanasios Protopapas
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (all authors)
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Chatzipapas I, Diakosavvas M, Angelou K, Kypriotis K, Douligeris A, Kathopoulis N. Sharp expansion of the cesarean delivery uterine incision in women with previous cesarean section scars. Clin Case Rep 2022; 10:e6506. [PMID: 36285038 PMCID: PMC9587506 DOI: 10.1002/ccr3.6506] [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: 05/17/2022] [Revised: 08/30/2022] [Accepted: 10/10/2022] [Indexed: 11/09/2022] Open
Abstract
Although the blunt uterine incision expansion during a low-transverse cesarean delivery has prevailed over the sharp technique, the latter should not be completely abandoned. The sharp method with scissors should be considered when managing patients with previous cesarean sections, although more studies are required for a definite answer.
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Affiliation(s)
- Ioannis Chatzipapas
- 1st Department of Obstetrics and Gynecology, Alexandra Hospital, Faculty of MedicineNational and Kapodistrian University of AthensAthensGreece
| | - Michail Diakosavvas
- 1st Department of Obstetrics and Gynecology, Alexandra Hospital, Faculty of MedicineNational and Kapodistrian University of AthensAthensGreece
| | - Kyveli Angelou
- 1st Department of Obstetrics and Gynecology, Alexandra Hospital, Faculty of MedicineNational and Kapodistrian University of AthensAthensGreece
| | - Konstantinos Kypriotis
- 1st Department of Obstetrics and Gynecology, Alexandra Hospital, Faculty of MedicineNational and Kapodistrian University of AthensAthensGreece
| | - Athanasios Douligeris
- 1st Department of Obstetrics and Gynecology, Alexandra Hospital, Faculty of MedicineNational and Kapodistrian University of AthensAthensGreece
| | - Nikolaos Kathopoulis
- 1st Department of Obstetrics and Gynecology, Alexandra Hospital, Faculty of MedicineNational and Kapodistrian University of AthensAthensGreece
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Kathopoulis N, Prodromidou A, Zacharakis D, Chatzipapas I, Diakosavvas M, Kypriotis K, Grigoriadis T, Protopapas A. The Effect of Intravenous Tranexamic Acid on Myomectomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Pers Med 2022; 12:jpm12091492. [PMID: 36143277 PMCID: PMC9504364 DOI: 10.3390/jpm12091492] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/01/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022] Open
Abstract
Myomectomy is the preferred surgical treatment for symptomatic women with uterine myomas who wish to preserve their fertility. The procedure may be associated with significant intraoperative blood loss, which predisposes to increased transfusion rates and morbidity. The objective of our systematic review and meta-analysis is to investigate whether intravenous (IV) use of tranexamic acid (TXA) may reduce blood loss during myomectomy. Three electronic databases were screened until June 2022. The eligible studies were assessed for risk of bias. Four randomized controlled trials that reported outcomes from a total of 310 women were finally included in the meta-analysis—155 patients received intravenous TXA while the remaining 155 received placebo injection with normal saline or water for injection. Total estimated blood loss was significantly lower in patients who received TXA before myomectomy compared to control (230 patients MD −227.09 mL 95% CI −426.26, −27.91, p = 0.03). This difference in favor of TXA group remained when intraoperative and postoperative blood loss was separately analyzed. Postoperative hematocrit values and hemoglobin levels did not differ among the two groups (180 patients MD 0.67% 95% CI −0.26, 1.59, p = 0.16 and 250 patients MD 0.17 mg/dL 95% CI 0.07, 0.41, p = 0.17, respectively). The number of patients that received blood transfusion was also not different (310 patients OR 0.46 95% CI −0.14, 1.49, p = 0.19). Total operative time was significantly prolonged in control group compared to TXA (310 patients MD −16.39 min 95% CI −31.44, −1.34 p = 0.03). Our data show that the IV use of TXA may significantly reduce intraoperative blood loss in patients undergoing myomectomy and contribute to reduced operative time.
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Kathopoulis N, Rellias I, Zacharakis D, Chatzipapas I, Diakosavvas M, Kypriotis K, Grigoriadis T, Protopapas A. Benign appendiceal lesions, a case where a gynecologist should be able to perform laparoscopic appendectomy. J Minim Invasive Gynecol 2022; 29:1030-1032. [PMID: 35691548 DOI: 10.1016/j.jmig.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/28/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Nikolaos Kathopoulis
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Greece.
| | - Ioannis Rellias
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Greece
| | - Dimitrios Zacharakis
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Greece
| | - Ioannis Chatzipapas
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Greece
| | - Michail Diakosavvas
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Greece
| | - Konstantinos Kypriotis
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Greece
| | - Themos Grigoriadis
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Greece
| | - Athanasios Protopapas
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Greece
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Kathopoulis N, Kypriotis K, Diakosavvas M, Chatzipapas I, Zacharakis D, Grigoriadis T, Protopapas A. Large myoma receiving multiple collateral primary parasitic blood supply. Clin Case Rep 2022; 10:e05945. [PMID: 35702619 PMCID: PMC9178407 DOI: 10.1002/ccr3.5945] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/06/2022] [Accepted: 05/05/2022] [Indexed: 12/03/2022] Open
Abstract
We describe a rare case of a pedunculated myoma receiving multiple de‐novo developed parasitic collateral blood supply from the adjacent organs. The main feeding vessels arise from the omentum and the bladder. Primary parasitic blood supply on myomas is a rare pathological entity that make laparoscopic myomectomy a demanding operation.
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Affiliation(s)
- Nikolaos Kathopoulis
- Endoscopic Surgery Unit 1st Department of Obstetrics & Gynecology National and Kapodistrian University of Athens, “Alexandra” Hospital Athens Greece
| | - Konstantinos Kypriotis
- Endoscopic Surgery Unit 1st Department of Obstetrics & Gynecology National and Kapodistrian University of Athens, “Alexandra” Hospital Athens Greece
| | - Michail Diakosavvas
- Endoscopic Surgery Unit 1st Department of Obstetrics & Gynecology National and Kapodistrian University of Athens, “Alexandra” Hospital Athens Greece
| | - Ioannis Chatzipapas
- Endoscopic Surgery Unit 1st Department of Obstetrics & Gynecology National and Kapodistrian University of Athens, “Alexandra” Hospital Athens Greece
| | - Dimitrios Zacharakis
- Endoscopic Surgery Unit 1st Department of Obstetrics & Gynecology National and Kapodistrian University of Athens, “Alexandra” Hospital Athens Greece
| | - Themistoklis Grigoriadis
- Endoscopic Surgery Unit 1st Department of Obstetrics & Gynecology National and Kapodistrian University of Athens, “Alexandra” Hospital Athens Greece
| | - Athanasios Protopapas
- Endoscopic Surgery Unit 1st Department of Obstetrics & Gynecology National and Kapodistrian University of Athens, “Alexandra” Hospital Athens Greece
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15
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Papageorgiou D, Diakosavvas M, Angelou K, Kathopoulis N, Voros C, Zachariou E, Papadatou K, Papapanagiotou IK, Papakonstantinou K. Fertility outcomes after treatment with intraperitoneal chemotherapy. J OBSTET GYNAECOL 2022; 42:1626-1634. [PMID: 35612269 DOI: 10.1080/01443615.2022.2055453] [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: 10/18/2022]
Abstract
Intraperitoneal chemotherapy (IPC) administration has been added to the therapeutic protocols of cancers, confined to the abdominal cavity. Since, a survival benefit in patients treated with adjuvant IPC has been demonstrated, fertility questions are raised in these patients. A comprehensive search of the English literature of PubMed/MEDLINE, EmBase and Google Scholar databases was conducted, from their inception until April 2021, following the MOOSE guidelines. Twelve out of 473 studies were included in the final review and analysis. After treatment with IPC for peritoneal carcinomatosis, 19 women, who underwent fertility-sparing surgery, with 20 successful pregnancies were reported. The mean interval time between IPC and pregnancy was 38.4 months (range 9-168 months). In 16 cases, conception was spontaneous, three required in vitro fertilisation, whereas one pregnancy was achieved through intrauterine insemination. Mean disease-free survival was 76 months (range 24-177 months). Childbearing is a feasible approach in selected patients, after treatment with IPC. When future pregnancy is desirable, a multidisciplinary team of surgeons, gynaecologists, oncologists and reproductive specialists is required, to inform the patient thoroughly about the fertility preservation alternatives, without endangering patient's survival.
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Affiliation(s)
- Dimitrios Papageorgiou
- Department of Gynecology, Athens Naval and Veterans Hospital, Athens, Greece.,1st Department of Obstetrics and Gynecology, Alexandra Maternity Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Michail Diakosavvas
- 1st Department of Obstetrics and Gynecology, Alexandra Maternity Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kyveli Angelou
- 1st Department of Obstetrics and Gynecology, Alexandra Maternity Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kathopoulis
- 1st Department of Obstetrics and Gynecology, Alexandra Maternity Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalambos Voros
- 1st Department of Obstetrics and Gynecology, Alexandra Maternity Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftherios Zachariou
- 1st Department of Obstetrics and Gynecology, Alexandra Maternity Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantina Papadatou
- 1st Department of Obstetrics and Gynecology, Alexandra Maternity Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis K Papapanagiotou
- 1st Department of Obstetrics and Gynecology, Alexandra Maternity Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Protopapas A, Vlachos DE, Kathopoulis N, Grigoriadis T, Zacharakis D, Athanasiou S, Chatzipapas I. Total laparoscopic hysterectomy in patients with deep endometriosis: Different technical and postoperative considerations, in comparison with a procedure performed for other benign indications. Taiwan J Obstet Gynecol 2022; 61:216-222. [PMID: 35361379 DOI: 10.1016/j.tjog.2022.02.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Total laparoscopic hysterectomy (TLH) may be indicated in patients with deep infiltrative endometriosis (DIE) to treat severe chronic pelvic pain symptoms, recurrences, or co-existing uterine disease. This study discusses the challenges and specific operative and postoperative considerations in patients submitted to TLH and excision of DIE, in comparison with those undergoing a procedure for other benign indications. MATERIALS AND METHODS Patients undergoing TLH and excision of DIE were included (N = 18, group 1). These were matched with cases, treated with TLH for other benign indications during the same period (2010-2019), at a 2:1 ratio (N = 36, group 2). The two groups were compared with regards to their characteristics, and intraoperative and postoperative data, including operative time, estimated blood loss (EBL), hospital stays, and rates of complications. RESULTS In group 1, median DIE nodule size was 2.5 cm (range: 1.3-4.2). Simple hysterectomy was performed in 10, and a more extended procedure in 8 cases. All nodules were removed from the bowel wall using the shaving technique. Average EBL was significantly higher (p = .027), and duration of surgery and hospital stays longer (p = .003, and p = .0001, respectively), in group 1 vs. group 2. The rates of long-term (L-T) complications were higher in group 1 but not to a significant level (p = .087). Analysis within the DIE group showed that operative time was significantly related to nodule size, type of hysterectomy (p = .021), presence of adenomyosis (p = .041), uterine size ≥12weeks (p = .039), and the occurrence of L-T complications (p = .016). Increasing nodule size and an extended procedure (p = .005) increased significantly the EBL, which had also a significant effect on the risk of L-T complications (p = .006). CONCLUSIONS TLH in DIE patients is a different, complex and potentially more dangerous procedure compared with TLH for other benign indications. Thorough knowledge of retroperitoneal anatomy, a clear operative plan, and excellent laparoscopic skills are necessary for concomitant radical excision of lesions, with low rates of adverse events.
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Affiliation(s)
- Athanasios Protopapas
- 1st Department of Obstetrics & Gynecology, National and Kapodistrian University of Athens, Faculty of Medicine, Greece.
| | - Dimitrios-Euthymios Vlachos
- 1st Department of Obstetrics & Gynecology, National and Kapodistrian University of Athens, Faculty of Medicine, Greece
| | - Nikolaos Kathopoulis
- 1st Department of Obstetrics & Gynecology, National and Kapodistrian University of Athens, Faculty of Medicine, Greece
| | - Themistoklis Grigoriadis
- 1st Department of Obstetrics & Gynecology, National and Kapodistrian University of Athens, Faculty of Medicine, Greece
| | - Dimitrios Zacharakis
- 1st Department of Obstetrics & Gynecology, National and Kapodistrian University of Athens, Faculty of Medicine, Greece
| | - Stavros Athanasiou
- 1st Department of Obstetrics & Gynecology, National and Kapodistrian University of Athens, Faculty of Medicine, Greece
| | - Ioannis Chatzipapas
- 1st Department of Obstetrics & Gynecology, National and Kapodistrian University of Athens, Faculty of Medicine, Greece
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Diakosavvas M, Angelou K, Fasoulakis Z, Kathopoulis N, Zacharakis D, Blontzos N, Antsaklis P, Haidopoulos D, Daskalakis G, Rodolakis A, Theodora M. Myomectomy during pregnancy; diagnostical dilemmas: two case reports and a systematic review of the literature. J OBSTET GYNAECOL 2022; 42:757-765. [PMID: 35264054 DOI: 10.1080/01443615.2022.2036976] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Myomectomy in pregnancy, until this day, remains very controversial. We present two cases of successful antepartum myomectomies performed in the second trimester of gestation. In both cases, the initial suspected origin of these tumours was the ovaries. However, as it was shortly after confirmed, since both women underwent laparotomy, the diagnosis of these masses was uterine fibroids. Both cases resulted on the live birth of two healthy infants via caesarean section. Secondarily, we conducted a thorough review of current data of myomectomies performed during pregnancy, including the characteristics and diagnosis of the myomas of pregnant women, the surgical details and complications, along with the outcomes of these gestations. Overall, the analysis of cases published in international literature, suggests that the surgical removal of myomas during pregnancy can be considered safe, given certain indications and considerations. Our review comprises of 71 women undergoing excision of fibroids during pregnancy. Only three cases ended in a miscarriage while the remaining 68 resulted in a second or third trimester delivery. However, the data concerning the safety of the procedure are scarce and originate mostly from case reports. Thus, conclusions on the exact maternal and obstetrical complication rates cannot be drawn.
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Affiliation(s)
- Michail Diakosavvas
- 1st Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kyveli Angelou
- 1st Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Zacharias Fasoulakis
- 1st Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kathopoulis
- 1st Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Zacharakis
- 1st Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Blontzos
- 1st Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Panos Antsaklis
- 1st Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Haidopoulos
- 1st Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George Daskalakis
- 1st Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Rodolakis
- 1st Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marianna Theodora
- 1st Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Zacharakis D, Grigoriadis T, Kalantzis C, Kathopoulis N, Athanasiou S. 133 Vaginal hysterectomy with anterior and posterior repair for pelvic organ prolapse under local anesthesia. Backup technique or a future routine practice? Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.217] [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: 11/29/2022]
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Diakosavvas M, Kathopoulis N, Angelou K, Chatzipapas I, Zacharakis D, Kypriotis K, Grigoriadis T, Protopapas A. Hysteroscopic treatment of Cesarean Scar Pregnancy: A systematic review. Eur J Obstet Gynecol Reprod Biol 2022; 270:42-49. [PMID: 35016136 DOI: 10.1016/j.ejogrb.2021.12.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 08/17/2021] [Revised: 12/24/2021] [Accepted: 12/30/2021] [Indexed: 11/04/2022]
Abstract
More than 30 regimens, medical and surgical, have been described for the treatment of Cesarean Scar Pregnancies (CSPs). This study aims to collect and analyze data in the published literature regarding the hysteroscopic management of CSPs focusing on efficacy and complications. Using a protocol registered with Prospero (#CRD42021242314), the electronic databases PubMed/Medline, Scopus, Clinical-Trials.gov and the Cochrane Library were comprehensively searched, from their inception to June 2020. Medical Subject Headings terms such as caesarean ectopic, hysteroscopy and endoscopy were used for the identification of the relevant records. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to design the present systematic review. Eligible articles assessing the role of hysteroscopy in CSP were considered the studies published in peer-reviewed journals. Any studies with less than 10 cases or articles that insufficiently detailed the treatment regimen, the outcomes, and the success rate, were excluded. Selected articles were assessed for the level of evidence, based on Oxford Centre for Evidence-based Medicine guidelines. The methodologic quality, including the risk of bias, was evaluated with the employment of the Effective Public Health Practice Project Quality Assessment Tool. Ten out of 613 studies were included in the present review comprising 812 women with CSP treated by hysteroscopy. The treatment modalities were divided into three categories: (i) hysteroscopic resection of CSP, (ii) hysteroscopy after preoperative use of HIFU and (iii) preoperative use of UAE before hysteroscopic treatment. The overall success rate of hysteroscopic treatment on CSP cases was 91%, whereas the rate of hemorrhage or excessive vaginal bleeding (>500 mL) and the rate of hysterectomy were 1.66% and 0.28% respectively. According to the results of this systematic review, hysteroscopy appears to be a safe and effective procedure for CSP management. Current findings are primarily based on retrospective studies with poor methodological quality. Multicenter, well-designed studies are needed to draw definite conclusions.
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Affiliation(s)
- Michail Diakosavvas
- Endoscopic Surgery Unit, 1(st) Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, 11528 Athens, Greece.
| | - Nikolaos Kathopoulis
- Endoscopic Surgery Unit, 1(st) Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, 11528 Athens, Greece
| | - Kyveli Angelou
- Endoscopic Surgery Unit, 1(st) Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, 11528 Athens, Greece
| | - Ioannis Chatzipapas
- Endoscopic Surgery Unit, 1(st) Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, 11528 Athens, Greece
| | - Dimitrios Zacharakis
- Endoscopic Surgery Unit, 1(st) Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, 11528 Athens, Greece
| | - Konstantinos Kypriotis
- Endoscopic Surgery Unit, 1(st) Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, 11528 Athens, Greece
| | - Themos Grigoriadis
- Endoscopic Surgery Unit, 1(st) Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, 11528 Athens, Greece
| | - Athanasios Protopapas
- Endoscopic Surgery Unit, 1(st) Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, 11528 Athens, Greece
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20
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Chatzipapas I, Kathopoulis N, Kypriotis K, Samartzis K, Siemou P, Protopapas A. A simple technique for suspension and stabilization of retrieval bag and adnexa by anchoring to the abdominal wall. Clin Case Rep 2021; 9:e05056. [PMID: 34840798 PMCID: PMC8605171 DOI: 10.1002/ccr3.5056] [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: 05/07/2021] [Revised: 10/12/2021] [Accepted: 10/20/2021] [Indexed: 11/24/2022] Open
Abstract
We describe a useful technique, in laparoscopic cystectomy in-a-bag, for suspension and stabilization of endobag and adnexa using temporary sutures. It intends to create an isolated field to avoid spillage of the cyst content into the abdomen in case of rupture, thereby allowing the safe laparoscopic removal of ovarian masses.
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Affiliation(s)
- Ioannis Chatzipapas
- 1 Department of Obstetrics and GynecologyAlexandra HospitalNational and Kapodistrian University of AthensAthensGreece
| | - Nikolaos Kathopoulis
- 1 Department of Obstetrics and GynecologyAlexandra HospitalNational and Kapodistrian University of AthensAthensGreece
| | - Konstantinos Kypriotis
- 1 Department of Obstetrics and GynecologyAlexandra HospitalNational and Kapodistrian University of AthensAthensGreece
| | - Konstantinos Samartzis
- 1 Department of Obstetrics and GynecologyAlexandra HospitalNational and Kapodistrian University of AthensAthensGreece
| | | | - Athanasios Protopapas
- 1 Department of Obstetrics and GynecologyAlexandra HospitalNational and Kapodistrian University of AthensAthensGreece
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Samartzis K, Kathopoulis N, Loutradis D, Protopapas A. Do techniques of surgical management of ovarian endometrioma affect ovarian reserve? A narrative review. J OBSTET GYNAECOL 2021; 42:778-784. [PMID: 34693862 DOI: 10.1080/01443615.2021.1962817] [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: 10/20/2022]
Abstract
Endometriotic ovarian cysts are one of the more common gynecological disorders found in reproductive-aged and infertile women. The aim of this review is to summarise information regarding the effect of surgical treatment of endometrioma on ovarian reserve. In women with endometrioma ovarian reserve is decreased compared to similarly aged healthy women and surgical management techniques cause an additional reduction. Evidence suggests that laparoscopic ovarian cystectomy via stripping is the preferable surgical technique for management of endometrioma, compared with excisional/ablative techniques, in the fields of pain improvement, spontaneous pregnancy rates, and ovarian cyst recurrences. Ablation techniques, combined technique and three-step approach demonstrate a less decline in anti-Müllerian hormone postoperatively. A successful operation involves not only removal of ovarian pathology, but also maintenance of ovarian function and future reproductive potential. Patients should be counselled about the risks of surgery and the management plan should be individualised to patient's symptoms and reproductive goals.
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Affiliation(s)
- Konstantinos Samartzis
- Division of Gynecological Endoscopic Surgery, 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Nikolaos Kathopoulis
- Division of Gynecological Endoscopic Surgery, 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Dimitris Loutradis
- Division of Gynecological Endoscopic Surgery, 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Athanasios Protopapas
- Division of Gynecological Endoscopic Surgery, 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
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22
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Rountis A, Zacharakis D, Athanasiou S, Kathopoulis N, Grigoriadis T. The Role of Laparoscopic Surgery in the Treatment of Advanced Uterine Prolapse: A Systematic Review of the Literature. Cureus 2021; 13:e18281. [PMID: 34722059 PMCID: PMC8544914 DOI: 10.7759/cureus.18281] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2021] [Indexed: 11/28/2022] Open
Abstract
The aim of this review is to investigate and compare all laparoscopic techniques that can be used in the surgical repair of advanced uterine prolapse. A systematic search of the PubMed, Scopus, Cochrane CENTRAL, and Clinicaltrials.gov databases was performed for articles published up to December 2020, reporting data on the treatment of severe uterine prolapse using laparoscopic procedures. Only studies in the English language, with a patient sample of ≥20 and a follow-up time of ≥12 months were included. The final synthesis of this review consisted of six studies. The main laparoscopic procedures reported were vaginally assisted laparoscopic sacrocolpopexy, vaginally assisted laparoscopic uterine sacropexy, laparoscopic sacrocolpopexy with laparoscopic supracervical hysterectomy, laparoscopic inguinal ligament suspension with uterine preservation, and laparoscopic uterosacral ligament suspension combined with trachelectomy. All procedures involved mesh placement, except for laparoscopic uterosacral ligament suspension. All procedures reported anatomical cure rates > 90%. Vaginally assisted laparoscopic sacrocolpopexy had the largest amount of intraoperative blood loss whilst vaginally assisted laparoscopic uterine sacropexy was associated with bladder injuries intraoperatively. All vaginally assisted procedures reported cases of mesh extrusion postoperatively. Laparoscopic inguinal ligament suspension was the operation with the longest mean operative and hospitalization time. Conversions were not reported. The present study shows that minimally invasive surgery can be used efficiently as an alternative to open surgery in the treatment of severe uterine prolapse.
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Affiliation(s)
- Argirios Rountis
- Obstetrics and Gynecology Unit, First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, GRC
| | - Dimitris Zacharakis
- Urogynecology Unit, First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, GRC
| | - Stavros Athanasiou
- Urogynecology Unit, First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, GRC
| | - Nikolaos Kathopoulis
- Minimally Invasive Surgery Unit, First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, GRC
| | - Themos Grigoriadis
- Urogynecology Unit, First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, GRC
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23
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Chatzipapas I, Kathopoulis N, Samartzis K, Kypriotis K, Siemou P, Protopapas A. "Do it cheaper": A cost-effective Endobag for small specimens. Clin Case Rep 2021; 9:e04693. [PMID: 34484753 PMCID: PMC8405419 DOI: 10.1002/ccr3.4693] [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: 06/20/2021] [Revised: 06/30/2021] [Accepted: 07/11/2021] [Indexed: 11/15/2022] Open
Abstract
A simple technique that permits to reduce the cost during gynecologic laparoscopic surgery. Small specimens may be retrieved with the use of a modified urine pediatric bag.
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Affiliation(s)
- Ioannis Chatzipapas
- 1st Department of Obstetrics and GynecologyNational and Kapodistrian University of AthensAlexandra HospitalAthensGreece
| | - Nikolaos Kathopoulis
- 1st Department of Obstetrics and GynecologyNational and Kapodistrian University of AthensAlexandra HospitalAthensGreece
| | - Konstantinos Samartzis
- 1st Department of Obstetrics and GynecologyNational and Kapodistrian University of AthensAlexandra HospitalAthensGreece
| | - Konstantinos Kypriotis
- 1st Department of Obstetrics and GynecologyNational and Kapodistrian University of AthensAlexandra HospitalAthensGreece
| | | | - Athanasios Protopapas
- 1st Department of Obstetrics and GynecologyNational and Kapodistrian University of AthensAlexandra HospitalAthensGreece
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24
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Kypriotis K, Kathopoulis N, Tsiriva M, Zacharakis D, Chatzipapas I, Protopapas A. Leiomyoma originating from left round ligament presents as symptomatic inguinal hernia. Clin Case Rep 2021; 9:e04445. [PMID: 34295480 PMCID: PMC8287316 DOI: 10.1002/ccr3.4445] [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: 04/04/2021] [Revised: 05/14/2021] [Accepted: 05/22/2021] [Indexed: 11/17/2022] Open
Abstract
Leiomyomas may develop at extra-uterine locations and pose diagnostic dile mmas. This is a case of a fibroma originating from the left round ligament presenting as a symptomatic inguinal hernia.
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Affiliation(s)
- Konstantinos Kypriotis
- 1st Department of Obstetrics and GynecologyFaculty of MedicineNational and Kapodistrian University of Athens“Alexandra” HospitalAthensGreece
| | - Nikolaos Kathopoulis
- 1st Department of Obstetrics and GynecologyFaculty of MedicineNational and Kapodistrian University of Athens“Alexandra” HospitalAthensGreece
| | - Maria Tsiriva
- 1st Department of Obstetrics and GynecologyFaculty of MedicineNational and Kapodistrian University of Athens“Alexandra” HospitalAthensGreece
| | - Dimitrios Zacharakis
- 1st Department of Obstetrics and GynecologyFaculty of MedicineNational and Kapodistrian University of Athens“Alexandra” HospitalAthensGreece
| | - Ioannis Chatzipapas
- 1st Department of Obstetrics and GynecologyFaculty of MedicineNational and Kapodistrian University of Athens“Alexandra” HospitalAthensGreece
| | - Athanasios Protopapas
- 1st Department of Obstetrics and GynecologyFaculty of MedicineNational and Kapodistrian University of Athens“Alexandra” HospitalAthensGreece
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25
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Zacharakis D, Prodromidou A, Douligeris A, Hadzilia S, Kathopoulis N, Athanasiou S, Grigoriadis T. Pelvic floor reconstructive surgery under local anesthesia: A systematic review and meta-analysis. Neurourol Urodyn 2021; 40:1304-1332. [PMID: 34146436 DOI: 10.1002/nau.24691] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/18/2021] [Accepted: 04/18/2021] [Indexed: 12/29/2022]
Abstract
AIMS The decision on the appropriate type of anesthesia for pelvic floor repair depends on a variety of factors including patients' age, performance status, comorbidities, cost-effectiveness and personal preferences. We aim to review the literature on urogynecological procedures performed under local anesthesia (LA). METHODS A systematic search of four electronic databases was conducted for articles published up to May 2020. Studies reporting outcomes of women who underwent pelvic floor reconstructive surgery under LA with or without sedation, were considered eligible. RESULTS Nineteen studies (14 noncomparative and 5 comparative), including 1626 cases of urogynecological procedures under LA were recruited. Meta-analysis revealed significantly lower mean pain scores in LA group compared to general-regional anesthesia one (GA/RA) at both 4-6 h and 8-18 h postoperatively (160 patients; mean difference [MD], -1.70; 95% confidence interval [CI]: -3.12, -0.28; p = 0.02 and 160 patients; MD, -0.72; 95% CI: -1.17, 0.27; p = 0.002, respectively). Pain scores at >24 h did not differ among the two groups (160 patients; MD, -0.28; 95% CI: -0.60-0.05; p = 0.10). Intra- and postoperatively morphine use was not different among patients who received LA and GA during prolapse surgery while nausea rates were significantly lower in LA group compared to RA group 8 h postoperatively. CONCLUSIONS LA with or without sedation represents a safe and efficient alternative anesthetic technique for urogynecological procedures with improved pain scores in up to 18 h postoperatively especially in patients who underwent surgery for SUI. LA is feasible and could be offered to patients undergoing pelvic floor surgery allowing a prompt postoperative recovery.
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Affiliation(s)
- Dimitrios Zacharakis
- 1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Anastasia Prodromidou
- 1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Athanasios Douligeris
- 1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Sofia Hadzilia
- 1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Nikolaos Kathopoulis
- 1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Stavros Athanasiou
- 1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Themos Grigoriadis
- 1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
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26
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Zacharakis D, Athanasiou S, Kathopoulis N, Michala L, Pontikaki A, Angelou K, Grigoriadis T. Large pedunculated submucosal leiomyoma mimicking uterine prolapse. Clin Case Rep 2021; 9:e04319. [PMID: 34136245 PMCID: PMC8190530 DOI: 10.1002/ccr3.4319] [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: 03/26/2021] [Revised: 04/18/2021] [Accepted: 04/30/2021] [Indexed: 11/11/2022] Open
Abstract
The differential diagnosis of a sudden protrusion of a large vaginal mass includes a uterine or vaginal vault prolapse, a pedunculated uterine leiomyoma or leiomyosarcoma, a uterine stromal tumor or a giant polyp.
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Affiliation(s)
- Dimitrios Zacharakis
- Faculty of Medicine1st Department of Obstetrics and GynecologyNational and Kapodistrian University of AthensAthensGreece
| | - Stavros Athanasiou
- Faculty of Medicine1st Department of Obstetrics and GynecologyNational and Kapodistrian University of AthensAthensGreece
| | - Nikolaos Kathopoulis
- Faculty of Medicine1st Department of Obstetrics and GynecologyNational and Kapodistrian University of AthensAthensGreece
| | - Lina Michala
- Faculty of Medicine1st Department of Obstetrics and GynecologyNational and Kapodistrian University of AthensAthensGreece
| | - Artemis Pontikaki
- Faculty of Medicine1st Department of Obstetrics and GynecologyNational and Kapodistrian University of AthensAthensGreece
| | - Kyveli Angelou
- Faculty of Medicine1st Department of Obstetrics and GynecologyNational and Kapodistrian University of AthensAthensGreece
| | - Themos Grigoriadis
- Faculty of Medicine1st Department of Obstetrics and GynecologyNational and Kapodistrian University of AthensAthensGreece
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27
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Kathopoulis N, Zacharakis D, Chatzipapas I, Prodromidou A, Kypriotis K, Grigoriadis T, Protopapas A. Delayed Hysteroscopic-assisted Diagnosis of Giant Asymptomatic Hematocervix after Loop Conization. J Minim Invasive Gynecol 2021; 28:1671-1672. [PMID: 34052474 DOI: 10.1016/j.jmig.2021.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/04/2021] [Accepted: 05/23/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Nikolaos Kathopoulis
- Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Greece (all authors).
| | - Dimitrios Zacharakis
- Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Greece (all authors)
| | - Ioannis Chatzipapas
- Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Greece (all authors)
| | - Anastasia Prodromidou
- Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Greece (all authors)
| | - Konstantinos Kypriotis
- Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Greece (all authors)
| | - Themos Grigoriadis
- Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Greece (all authors)
| | - Athanasios Protopapas
- Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Greece (all authors)
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28
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Prodromidou A, Zacharakis D, Athanasiou S, Protopapas A, Michala L, Kathopoulis N, Grigoriadis T. The Emerging Role on the Use of Platelet-Rich Plasma Products in the Management of Urogynaecological Disorders. Surg Innov 2021; 29:80-87. [PMID: 33909538 DOI: 10.1177/15533506211014848] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The regenerative efficacy of platelet-derived products has been recently investigated in the treatment of pelvic floor disorders (PFDs). We aimed to synthesize the current evidence of platelet-rich plasma (PRP) products used in urogynaecological disorders including vaginal atrophy, pelvic organ prolapse (POP), urinary incontinence, vaginal fistulas and vaginal mesh exposure. Methods: A meticulous search of the currently available literature on the use of PRP for the management of PFDs was performed using 3 electronic databases. Results: PRP could be a feasible alternative modality for the management of vaginal atrophy with favourable outcomes in vaginal atrophy parameters and patients' satisfaction, especially when hormone therapy is contraindicated. In patients with POP, an increase in collagen concentration after PRP application was observed while the use of PRP resulted in improvement of stress urinary incontinence symptoms. A considerable proportion of vesicovaginal fistulas were treated after application of PRP-based injections. Conclusions: There is only limited evidence of the use of PRP for PFDs. Platelet-rich plasma appears to be a promising, easy to apply, cost-effective and feasible alternative therapeutic modality for the management of various urogynaecological disorders. Future randomized trials are needed to confirm the efficacy of PRP in the treatment of urogynaecological disorders.
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Affiliation(s)
- Anastasia Prodromidou
- 1st Department of Obstetrics & Gynecology, Medical School, 68989National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Dimitrios Zacharakis
- 1st Department of Obstetrics & Gynecology, Medical School, 68989National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Stavros Athanasiou
- 1st Department of Obstetrics & Gynecology, Medical School, 68989National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Athanasios Protopapas
- 1st Department of Obstetrics & Gynecology, Medical School, 68989National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Lina Michala
- 1st Department of Obstetrics & Gynecology, Medical School, 68989National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Nikolaos Kathopoulis
- 1st Department of Obstetrics & Gynecology, Medical School, 68989National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Themos Grigoriadis
- 1st Department of Obstetrics & Gynecology, Medical School, 68989National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
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29
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Pittokopitou S, Kathopoulis N, Protopapas A, Domali E. Herlyn-Werner-Wunderlich syndrome: Report of a delayed diagnosed case with video presentation of the operative technique of vaginal septum resection. J Obstet Gynaecol Res 2021; 47:2242-2245. [PMID: 33723897 DOI: 10.1111/jog.14743] [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: 12/16/2020] [Revised: 02/01/2021] [Accepted: 02/28/2021] [Indexed: 11/27/2022]
Abstract
Herlyn-Werner-Wunderlich (HWW) syndrome is a rare congenital anomaly of Mullerian duct development characterized by uterus didelphys with blind hemivagina and ipsilateral renal agenesis. We present a case of a 29-year-old nulliparous woman, who was referred to our hospital complaining of chronic pelvic pain, dyspareunia, and a palpable mass in her vagina. At the age of 12, she underwent surgery because of a didelphys uterus diagnosis. Subsequently, she was operated on twice for endometriomas. At our institution, clinical and imaging findings revealed an obstructed hemivagina setting the diagnosis of HWW syndrome. Some of the various syndrome types may go unnoticed for months or even years after the onset of menstruation. Early diagnosis, followed by proper surgical treatment, is the key to avoid potentially severe complications.
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Affiliation(s)
- Savia Pittokopitou
- Unit of Gynecological Ultrasound, 1st Department of Obstetrics & Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Nikolaos Kathopoulis
- Endoscopic Surgery Unit, 1st Department of Obstetrics & Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Athanasios Protopapas
- Endoscopic Surgery Unit, 1st Department of Obstetrics & Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Ekaterini Domali
- Unit of Gynecological Ultrasound, 1st Department of Obstetrics & Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
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30
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Kathopoulis N, Chatzipapas I, Valsamidis D, Samartzis K, Kipriotis K, Loutradis D, Protopapas A. Mechanical bowel preparation before gynecologic laparoscopic procedures: Is it time to abandon this practice? J Obstet Gynaecol Res 2021; 47:1487-1496. [PMID: 33559272 DOI: 10.1111/jog.14674] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/10/2020] [Revised: 12/12/2020] [Accepted: 01/11/2021] [Indexed: 11/28/2022]
Abstract
AIM To examine the influence of mechanical bowel preparation on surgical field visualization and patients' quality of life during benign gynecologic laparoscopic procedures. METHODS A single blind, randomized, controlled trial was undertaken with laparoscopic gynecologic surgical patients to one of the following three groups: liquid diet on the preoperative day; mechanical bowel preparation with oral polyethylene glycol (PEG) solution; minimal residue diet for 3 days. Primary outcomes included assessment of the condition of small and large bowel and the overall quality of the surgical field. Additional measures included assessment of patients' preoperative symptoms, tolerance of the preparation method and compliance to the protocol, postoperative symptoms and bowel function. RESULTS One hundred forty-four patients were randomized as follows: 49 to liquid diet, 47 to mechanical bowel preparation, and 48 to minimal residue diet. Most characteristics were similar across groups. The intraoperative surgical view and the condition of large and small bowel were equal or inferior at the patients who received mechanical bowel preparation compared with the other groups. The 4-point Likert scale scoring for small bowel (2.51 vs. 2.72 vs. 2.81, p = 0.04), large bowel (2.26 vs. 2.38 vs. 2.48, p = 0.32) and overall operative field quality (2.34 vs. 2.67 vs. 2.67, p = 0.03) demonstrated no advantage from the use of preoperative mechanical bowel preparation over liquid diet and minimal residue diet, respectively. Preoperative discomfort was significantly greater in the mechanical bowel preparation group. CONCLUSION Mechanical bowel preparation before gynecologic laparoscopic operations for benign pathology could be safely abandoned. CLINICAL TRIAL REGISTRATION ISRCTN registry, https://doi.org/10.1186/ISRCTN59502124 (No 59502124).
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Affiliation(s)
- Nikolaos Kathopoulis
- First Department of Obstetrics and Gynecology in Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Chatzipapas
- First Department of Obstetrics and Gynecology in Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Konstantinos Samartzis
- First Department of Obstetrics and Gynecology in Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Kipriotis
- First Department of Obstetrics and Gynecology in Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Loutradis
- First Department of Obstetrics and Gynecology in Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Protopapas
- First Department of Obstetrics and Gynecology in Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
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31
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Stavros S, Kathopoulis N, Drakakis P. A Common Tumor with an Unusual Finding: Mature Cystic Teratoma Containing a Ganglioneuroma. J Pediatr Adolesc Gynecol 2021; 34:92-93. [PMID: 32828965 DOI: 10.1016/j.jpag.2020.08.011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/31/2020] [Accepted: 08/07/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Ganglioneuromas (GNs) arise from peripheral or central areas of the autonomic nervous system, being benign lesions of neuroblastic origin. CASE A 19-year-old Greek female patient was admitted to our clinic with symptoms of periodic lower abdominal pain and irritation since some months ago. Ultrasonography revealed a mass of 72 × 68 mm originating from the left ovary giving the characteristics of a typical dermoid cyst. Laparoscopic ovarian cystectomy was done. The histological diagnosis revealed a mature cystic teratoma with a small hidden GN. SUMMARY AND CONCLUSION Histology remains the gold standard for their confirmation. The coexistence of GN within a mature cystic teratoma happens extremely rarely. This is one of the few cases reported in the literature.
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Affiliation(s)
- Sofoklis Stavros
- First Department of Obstetrics and Gynecology, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece.
| | - Nikolaos Kathopoulis
- First Department of Obstetrics and Gynecology, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece; Athens Bioclinic Hospital, Athens, Greece
| | - Peter Drakakis
- First Department of Obstetrics and Gynecology, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
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32
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Kathopoulis N, Chatzipapas I, Samartzis K, Theodora M, Lardou I, Protopapas A. Laparoscopic management of cesarean scar pregnancy: Report of two cases with video-presentation of different operative techniques and literature review. J Gynecol Obstet Hum Reprod 2021; 50:102066. [PMID: 33484933 DOI: 10.1016/j.jogoh.2021.102066] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 11/30/2022]
Abstract
Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy. We present two different techniques of laparoscopic management of CSP, with the concomitant repair of the coexisting uterine isthmocele. The first case is a combination of diagnostic hysteroscopy and laparoscopic extraction of conception products, and the second technique is a combination of laparoscopy and guided Dilation & Curettage. We also conducted a thorough review of the literature to present all cases of laparoscopic treatment of CSP, focusing on the surgical technique, the operation outcome, and the future pregnancies. Laparoscopy is a potential effective treatment of CSP.
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Affiliation(s)
- Nikolaos Kathopoulis
- Endoscopic Surgery Unit, 1st Department of Obstetrics & Gynecology, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece.
| | - Ioannis Chatzipapas
- Endoscopic Surgery Unit, 1st Department of Obstetrics & Gynecology, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Konstantinos Samartzis
- Endoscopic Surgery Unit, 1st Department of Obstetrics & Gynecology, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Marianna Theodora
- Unit of Gynecological Ultrasound, 1st Department of Obstetrics & Gynecology, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Ioanna Lardou
- Endoscopic Surgery Unit, 1st Department of Obstetrics & Gynecology, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Athanasios Protopapas
- Endoscopic Surgery Unit, 1st Department of Obstetrics & Gynecology, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
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Protopapas A, Kypriotis K, Chatzipapas I, Kathopoulis N, Sotiropoulou M, Michala L. Juvenile Cystic Adenomyoma vs Blind Uterine Horn: Challenges in the Diagnosis and Surgical Management. J Pediatr Adolesc Gynecol 2020; 33:735-738. [PMID: 32827760 DOI: 10.1016/j.jpag.2020.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/03/2020] [Accepted: 08/15/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Juvenile cystic adenomyomas (JCAs) are rare uterine lesions. Differential diagnosis might be difficult. We present the case of an adolescent who was diagnosed with JCA and was managed with laparoscopic excision. CASE A 14-year-old patient with complaint of menarche with excruciating dysmenorrhea, was diagnosed using magnetic resonance imaging with a uterine anomaly consisting of a normal right hemiuterus, and a left cystic lesion with surrounding hypotense myometrium. She was managed with laparoscopic excision of the left side, and uterine reconstruction. Histology was suggestive of JCA, associated with diffuse adenomyosis. Dysmenorrhea improved considerably after surgery. SUMMARY AND CONCLUSION Differential diagnosis between cystic uterine lesions relies on clinical, imaging, and perioperative clues that might assist in their formal classification. Doubt might still remain in some cases.
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Affiliation(s)
- Athanasios Protopapas
- Endoscopic Surgery Unit, First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece.
| | - Konstantinos Kypriotis
- Pediatric and Adolescent Gynecology Unit, First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Chatzipapas
- Endoscopic Surgery Unit, First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kathopoulis
- Endoscopic Surgery Unit, First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Lina Michala
- Pediatric and Adolescent Gynecology Unit, First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece
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Protopapas A, Kathopoulis N, Chatzipapas I, Athanasiou S, Grigoriadis T, Samartzis K, Kypriotis K, Vlachos DE, Zacharakis D, Loutradis D. Misoprostol vs vasopressin as a single hemostatic agent in laparoscopic myomectomy: Comparable, or just better than nothing? J Obstet Gynaecol Res 2020; 46:2356-2365. [PMID: 32914544 DOI: 10.1111/jog.14465] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/14/2020] [Accepted: 08/08/2020] [Indexed: 11/29/2022]
Abstract
AIM Laparoscopic myomectomy may be associated with considerable blood loss, especially in patients in whom no specific hemostatic measures are used. We conducted this retrospective comparative study to investigate whether misoprosol is an effective and safe alternative to vasopressin when used as single hemostatic agent in laparoscopic myomectomy. METHODS Two hundred cases undergoing laparoscopic myomectomy (-ies), were included. Of these, 50 pre-treated with vaginal misoprostol 400mcg 1 h before surgery (group 1), were compared with two historic consecutive groups: 100 patients treated with intraoperative intra-myometrial injection of dilute vasopressin (20 IU/100 mL normal saline) (group 2), and 50 treated without use of any hemostatic agent (group3). RESULTS Mean procedure length did not differ significantly between the three groups (127.9 vs 100.6 vs 130.8 min). Mean estimated blood loss (EBL) was 179.7 ± 200.0 mL in group 1, compared with 147.8 ± 171.8 mL in group 2 (P = 0.793) and 321.8 ± 246.0 mL in group 3, respectively (P < 0.001). EBL was lower in group 2 in most of the study's subgroups of patients stratified according to size and number of fibroids compared with group 1, with the exception of patients with ≥4 fibroids, and ≥7 cm in size. In these subgroups, misoprostol appeared more effective. Neither agent was associated with serious adverse events. CONCLUSION Vaginal misoprostol can be effective in reducing blood loss during laparoscopic myomectomy. Although rates of EBL are, in general, higher compared with those obtained with vasopressin, they are significantly reduced compared with those observed when no hemostatic agent is used. In extended procedures, vaginal misoprostol, due to its prolonged uterotonic action, may be associated with reduced blood loss compared with vasopressin.
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Affiliation(s)
- Athanasios Protopapas
- 1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Nikolaos Kathopoulis
- 1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Ioannis Chatzipapas
- 1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Stavros Athanasiou
- 1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Themistoklis Grigoriadis
- 1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Konstantinos Samartzis
- 1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Konstantinos Kypriotis
- 1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Dimitrios-Eythymios Vlachos
- 1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Dimitrios Zacharakis
- 1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Dimitrios Loutradis
- 1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
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Chatzipapas I, Kathopoulis N, Protopapas A, Loutradis D. Hysteroscopy for training residents using uterine post-hysterectomy specimens with a mobile hysteroscope. Facts Views Vis Obgyn 2020; 12:43-46. [PMID: 32696023 PMCID: PMC7363244] [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] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Training in hysteroscopy can be challenging, especially in conscious women as an office procedure. OBJECTIVE To develop a realistic hysteroscopy training model for residents using human uteri. METHODS Human uterine specimens were acquired immediately after hysterectomy, before they were sent for histological analysis and were used as a training model for hysteroscopy. RESULTS We describe this new technique, which we have used for one year in our resident training programme. Each resident performs at least 20 simulated diagnostic hysteroscopies in extirpated uteri, before performing procedures on women in the operating room. CONCLUSIONS Simulating hysteroscopy on human uterine models offers a novel and realistic way of training novices prior to conducting procedures under supervision on live patients. WHAT IS NEW This is a novel model for training and offers a much more realistic training opportunity.
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Affiliation(s)
- I Chatzipapas
- 1st Department of Obstetrics and Gynecology, University of Athens, Alexandra Hospital, Athens, Greece
| | - N Kathopoulis
- 1st Department of Obstetrics and Gynecology, University of Athens, Alexandra Hospital, Athens, Greece
| | - A Protopapas
- 1st Department of Obstetrics and Gynecology, University of Athens, Alexandra Hospital, Athens, Greece
| | - D Loutradis
- 1st Department of Obstetrics and Gynecology, University of Athens, Alexandra Hospital, Athens, Greece
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Chatzipapas I, Kathopoulis N, Protopapas A, Loutradis D. Using a Mobile Smartphone to Perform Laparoscopy. J Minim Invasive Gynecol 2018; 25:912-915. [DOI: 10.1016/j.jmig.2017.12.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 11/28/2017] [Accepted: 12/27/2017] [Indexed: 10/18/2022]
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Protopapas A, Giannoulis G, Chatzipapas I, Athanasiou S, Grigoriadis T, Kathopoulis N, Vlachos DE, Zaharakis D, Loutradis D. Vasopressin during Laparoscopic Myomectomy: Does It Really Extend Its Limits? J Minim Invasive Gynecol 2018; 26:441-449. [PMID: 29778690 DOI: 10.1016/j.jmig.2018.05.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 02/25/2018] [Revised: 05/11/2018] [Accepted: 05/11/2018] [Indexed: 12/01/2022]
Abstract
STUDY OBJECTIVE Τo investigate whether the use of vasopressin played an important role in the safe expansion of the indications of laparoscopic myomectomy in our practice. DESIGN A retrospective comparison of prospectively collected data (Canadian Task Force classification II2). SETTING A gynecologic endoscopy unit in a tertiary university hospital. PATIENTS One hundred fifty patients undergoing laparoscopic myomectomy; 50 were treated without the use of any vasoconstrictive agent (group 1), and 100 were treated with intraoperative intramyometrial injection of dilute vasopressin (20 IU/100 mL normal saline) (group 2). INTERVENTIONS Laparoscopic myomectomy. MEASUREMENTS AND MAIN RESULTS We compared the 2 groups in terms of size, number, and type of myomas; estimated blood loss (EBL); procedure length; transfusion rates; laparoconversion rates; and rates of complications. Two cases in group 1 (4%) were laparoconverted versus none (0%) in group 2. Overall, the mean EBL was 321.8 ± 246.0 mL in group 1 compared with 147.8 ± 171.8 mL in group 2, respectively (p <.001). Additionally, EBL was significantly lower in the vasopressin group in all of the study's subgroups of patients stratified according to the size and number of myomas. Procedure length did not differ significantly between the 2 groups (130.8 ± 49.5 vs 115.6 ± 49.4 minutes, p = .078). The risk factors for prolongation of the procedure included size and number of myomas independently of vasopressin. The rates of hypercapnea and subcutaneous emphysema were higher in group 1. The risk factors for hypercapnea and subcutaneous emphysema included the size and intramural position of the largest myoma. Vasopressin was not associated with serious cardiovascular adverse events. CONCLUSIONS Vasopressin is effective in reducing blood loss during laparoscopic myomectomy. Although experienced surgeons may achieve comparable operation times without vasopressin, even in the most challenging cases, blood loss may still be considerable. The occurrence of hypercapnea is higher in untreated cases and may contribute to laparoconversion.
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Affiliation(s)
- Athanasios Protopapas
- Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece.
| | - George Giannoulis
- Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Ioannis Chatzipapas
- Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Stavros Athanasiou
- Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Themistoklis Grigoriadis
- Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Nikolaos Kathopoulis
- Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Dimitrios-Efthymios Vlachos
- Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Dimitrios Zaharakis
- Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Dimitrios Loutradis
- Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
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Kathopoulis N, Valsamidis D, Stamatakis E, Athanasiou S, Grigoriadis T, Protopapas A. Deep neuromuscular blockade in gynecological laparoscopic surgery: a review. CLIN EXP OBSTET GYN 2017. [DOI: 10.12891/ceog3736.2017] [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: 11/01/2022]
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Kathopoulis N, Thomakos N, Mole I, Papaspirou I, Ntai S, Rodolakis A. Anterior pelvic exenteration for exstrophic bladder adenocarcinoma: Case report and review. Int J Surg Case Rep 2016; 25:13-5. [PMID: 27288750 PMCID: PMC4972129 DOI: 10.1016/j.ijscr.2016.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 03/27/2016] [Revised: 05/04/2016] [Accepted: 05/17/2016] [Indexed: 11/24/2022] Open
Abstract
Carcinoma of the exstrophic bladder is an extremely rare condition. We present a case of carcinoma in unreconstructed bladder exstrophy in a patient of 53 years old. Anterior pelvic exenteration is an alternative surgical intervention for this situation in postmenopausal women.
Introduction Bladder exstrophy is a very rare congenital anomaly and is associated with an increased incidence of bladder cancer. Most patients undergo reconstructive operations during childhood. Presentation of case A 53 year-old woman was diagnosed with enteric type mucinous adenocarcinoma of the unreconstructed exstrophic bladder. Preoperative examination revealed no primary site in the gastrointestinal system. The patient underwent an anterior pelvic exenteration with bilateral ureterostomy and repairing of the anterior abdominal wall defect with a mesh. Discussion Carcinoma of the exstrophic bladder is a very rare entity. An overall number of 118 cases of cancer in unreconstructed bladder have been reported in the literature since 1895 with adenocarcinomas consisting of 90–91% and squamous cell carcinomas 8.5%. Mechanical irritation on the bladder mucosa, embryologic origin and urine carcinogens are some o the theories of cancerous metaplasia. Conclusion This is the first case of bladder exstrophy cancer reported that was submitted to anterior pelvic exenteration. We propose this surgical procedure as an appropriate alternative in postmenopausal women and cancer of the unreconstructed bladder exstrophy.
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Affiliation(s)
- Nikolaos Kathopoulis
- Department of Obstetrics and Gynecology, University of Athens School of Medicine, Alexandra Hospital, Athens, Greece.
| | - Nikolaos Thomakos
- Department of Obstetrics and Gynecology, University of Athens School of Medicine, Alexandra Hospital, Athens, Greece
| | - Ioanna Mole
- Department of Obstetrics and Gynecology, University of Athens School of Medicine, Alexandra Hospital, Athens, Greece
| | | | - Sparti Ntai
- Department of Radiology, Alexandra Hospital, Athens, Greece
| | - Alexandros Rodolakis
- Department of Obstetrics and Gynecology, University of Athens School of Medicine, Alexandra Hospital, Athens, Greece
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Tranoulis A, Thomakos N, Haidopoulos D, Sotiropoulou M, Kathopoulis N, Davidovic-Grigoraki M, Papadimitriou C, Bamias A, Vlachos G, Rodolakis A. Accuracy of frozen section in the diagnosis of mucinous ovarian tumors. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.01.269] [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: 11/28/2022]
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Koliantzaki S, Sorras K, Kathopoulis N, Diamantopoulos G, Saltamavros A, Gkantaifis N, Dimitrakopoulos S. 93 COMPARISON OF METHODS OF MEASUREMENT OF BONE DENSITY AND THE ADVISORY – IMPORTANCE IN THE GYNAECOLOGICAI PRACTICE. Maturitas 2012. [DOI: 10.1016/s0378-5122(12)70204-9] [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: 10/27/2022]
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