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Alves Firmeza M, de Vasconcelos Oliveira NM, Mendes Alves F, Teixeira Moreira Vasconcelos C, Ananias Vasconcelos Neto J. Urinary symptoms and sexual function after hysterectomy secondary to cervical cancer: A prospective, cohort study. Eur J Obstet Gynecol Reprod Biol 2024; 296:208-214. [PMID: 38461785 DOI: 10.1016/j.ejogrb.2024.02.042] [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: 02/08/2023] [Revised: 11/19/2023] [Accepted: 02/22/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The estimated worldwide incidence of cervical cancer (CC) is half a million cases per year. Surgical treatment is the mainstay approach for this condition. OBJECTIVES To assess the effects of hysterectomy due to cervical cancer in urinary symptoms and sexual function and the disorder related impact on the quality of patients life. STUDY DESIGN A cohort study was performed in Fortaleza/CE (Brazil) with 71 patients; of these, 31 were diagnosed with cervical cancer (G-CCU) and 40 with gynecological benign disease (G-PB). Sexual function (FSFI questionnaire), quality of life (SF-36 questionnaire) and urinary symptoms (KHQ instrument) were investigated in both groups at baseline (T0), one month (T1) and four months after surgery (T2). RESULTS Both groups presented at baseline, similar urinary symptoms (p > 0.05), but this frequency doubled for the G-CCU group at T1 and remained unchanged at T2 (p = 0.012). G-PB's frequency of symptoms remained the same for 4 months after surgery. At baseline G-PB had higher risk for sexual dysfunction than G-CCU (82.5 % versus 54.8 %, p = 0.011). However for G-CCU, an increase of this percentage was perceived at T2.Women from the G-CCU group presented worse general and specific quality of life results. CONCLUSION Women underwent to hysterectomy due to cervical cancer presented higher percentages of urinary symptoms, higher risk for sexual dysfunction and worse general and specific quality of life scores.
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Affiliation(s)
- Mariana Alves Firmeza
- Nursing Department, Federal University of Ceará, St Alexandre Baraúna, n.1115 - 1° floor, room 3 - Rodolfo Teófilo district, city of Fortaleza, state of Ceará, 60430-160, Brazil
| | - Natália Maria de Vasconcelos Oliveira
- Woman's Health Department, Federal University of Ceará, 1608 Prof. Costa Mendes St - 2° floor - Rodolfo Teófilo district, city of Fortaleza, state of Ceará 60416-200, Brazil.
| | - Flávio Mendes Alves
- Woman's Health Department, Federal University of Ceará, 1608 Prof. Costa Mendes St - 2° floor - Rodolfo Teófilo district, city of Fortaleza, state of Ceará 60416-200, Brazil.
| | - Camila Teixeira Moreira Vasconcelos
- Nursing Department, Federal University of Ceará, St Alexandre Baraúna, n.1115 - 1° floor, room 3 - Rodolfo Teófilo district, city of Fortaleza, state of Ceará, 60430-160, Brazil.
| | - José Ananias Vasconcelos Neto
- Woman's Health Department, Federal University of Ceará, 1608 Prof. Costa Mendes St - 2° floor - Rodolfo Teófilo district, city of Fortaleza, state of Ceará 60416-200, Brazil.
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Amikam U, Hochberg A, Abramov S, Lavie A, Yogev Y, Hiersch L. Risk factors for maternal complications following uterine rupture: a 12-year single-center experience. Arch Gynecol Obstet 2024; 309:1863-1871. [PMID: 37149828 DOI: 10.1007/s00404-023-07061-1] [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: 04/08/2023] [Accepted: 04/25/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE To determine maternal outcomes and risk factors for composite maternal morbidity following uterine rupture during pregnancy. METHODS A retrospective cohort study including all women diagnosed with uterine rupture during pregnancy, between 2011 and 2023, at a single-center. Patients with partial uterine rupture or dehiscence were excluded. We compared women who had composite maternal morbidity following uterine rupture to those without. Composite maternal morbidity was defined as any of the following: maternal death; hysterectomy; severe postpartum hemorrhage; disseminated intravascular coagulation; injury to adjacent organs; admission to the intensive care unit; or the need for relaparotomy. The primary outcome was risk factors associated with composite maternal morbidity following uterine rupture. The secondary outcome was the incidence of maternal and neonatal complications following uterine rupture. RESULTS During the study period, 147,037 women delivered. Of them, 120 were diagnosed with uterine rupture. Among these, 44 (36.7%) had composite maternal morbidity. There were no cases of maternal death and two cases of neonatal death (1.7%); packed cell transfusion was the major contributor to maternal morbidity [occurring in 36 patients (30%)]. Patients with composite maternal morbidity, compared to those without, were characterized by: increased maternal age (34.7 vs. 32.8 years, p = 0.03); lower gestational age at delivery (35 + 5 vs. 38 + 1 weeks, p = 0.01); a higher rate of unscarred uteri (22.7% vs. 2.6%, p < 0.01); and rupture occurring outside the lower uterine segment (52.3% vs. 10.5%, p < 0.01). CONCLUSION Uterine rupture entails increased risk for several adverse maternal outcomes, though possibly more favorable than previously described. Numerous risk factors for composite maternal morbidity following rupture exist and should be carefully assessed in these patients.
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Affiliation(s)
- Uri Amikam
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Sourasky Medical Center, 6 Weizmann St., Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Alyssa Hochberg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tiqva, Israel
| | - Shani Abramov
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Sourasky Medical Center, 6 Weizmann St., Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Lavie
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Sourasky Medical Center, 6 Weizmann St., Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yariv Yogev
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Sourasky Medical Center, 6 Weizmann St., Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liran Hiersch
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Sourasky Medical Center, 6 Weizmann St., Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Krentel H, Naem A, Moawad G, De Wilde RL. Robotic-assisted total hysterectomy with transilluminating uterine manipulator - The guiding green light of the firefly mode. Asian J Surg 2024:S1015-9584(24)00682-1. [PMID: 38643055 DOI: 10.1016/j.asjsur.2024.03.205] [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: 02/16/2024] [Accepted: 03/22/2024] [Indexed: 04/22/2024] Open
Affiliation(s)
- Harald Krentel
- Department of Obstetrics, Gynecology, Gynecologic Oncology, and Senology, Bethesda Hospital Duisburg, 47053, Duisburg, Germany.
| | - Antoine Naem
- Department of Obstetrics, Gynecology, Gynecologic Oncology, and Senology, Bethesda Hospital Duisburg, 47053, Duisburg, Germany; Faculty of Mathematics and Computer Science, University of Bremen, 28359, Bremen, Germany.
| | - Gaby Moawad
- Department of Obstetrics and Gynecology, George Washington University, Washington, DC, 20037, USA; The Center for Endometriosis and Advanced Pelvic Surgery, Washington, DC, 22101, USA.
| | - Rudy Leon De Wilde
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius-Hospital Oldenburg, Medical Campus University of Oldenburg, 26121, Oldenburg, Germany.
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Valdez-Martínez E, Márquez-González H, Bedolla M. [Non-therapeutic hysterectomy in Mexican young females with intellectual disability: a problematized reality]. GAC MED MEX 2024. [PMID: 38588533 DOI: 10.24875/gmm.23000460] [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: 11/22/2023] [Accepted: 02/12/2024] [Indexed: 04/10/2024] Open
Abstract
Background Non-therapeutic hysterectomy in girls and adolescents with intellectual disability (ID) is an acceptable practice, even when there is a lack of prescriptive ethical reason. Objectives To determine the magnitude of the practice of hysterectomy in girls and adolescents with ID, and explore the emic factors associated with this procedure. Material and methods Multicenter, intersectoral study with a mixed methods design. Results The quantitative results showed that 50 of 234 reported hysterectomies corresponded to females with ID. Average age at the time of surgery was 15 ± 2.9 years. Prophylactic abdominal hysterectomy was the most common procedure, and the justifications for it were "fertility control", "menstrual hygiene management", and "risk of sexual abuse". A qualitative analysis of 15 focus groups revealed that parents' main concern was how to manage their daughters' index disease and reproductive health; they perceived menstruation positively; they expressed their fear of dying and leaving them without support, and emphasized fertility control; none of them approved hysterectomy. Conclusions The bodies that define health policies need to create a new philosophy that avoids the reductionist approach of current biomedical model, which separates (in the health-disease process) our interdependence with other humans.
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Affiliation(s)
- Edith Valdez-Martínez
- Unidad de Investigación Médica en Epidemiología Clínica, Coordinación de Investigación en Salud, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Horacio Márquez-González
- Servicio de Investigación Clínica, Hospital Infantil de México "Federico Gómez", Ciudad de México, México
| | - Miguel Bedolla
- Investigador independiente, San Antonio, Texas, Estados Unidos
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Milman T, Maeda A, Swift BE, Bouchard-Fortier G. Predictors and outcomes of same day discharge after minimally invasive hysterectomy in gynecologic oncology within the National Surgical Quality Improvement Program database. Int J Gynecol Cancer 2024; 34:602-609. [PMID: 38097349 DOI: 10.1136/ijgc-2023-004970] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE To assess trends over time of same day discharge after minimally invasive hysterectomy in oncology, identify perioperative factors influencing same day discharge, and evaluate 30 day postoperative morbidity. METHODS A retrospective cohort of elective minimally invasive hysterectomies performed for gynecologic oncologic indications between January 2013 and December 2021 was identified using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Clinical and surgical characteristics, length of stay, and 30 day postoperative complications were captured. Clinical and surgical factors affecting same day discharge rate and impact of same day discharge on postoperative outcomes were evaluated using χ2 tests and logistic regression. RESULTS Patients undergoing minimally invasive hysterectomy (n=32 823) had a same day discharge rate of 34.5% over the 9 year period, increasing from 15.5% in 2013 to 55.1% in 2021. The rate of patients discharged on postoperative day 1 decreased from 76.4% to 41.4% over this period. On multivariable analysis, same day discharge decreased with: age 70-79 years (odds ratio (OR) 0.80) and ≥80 years (OR 0.42); body mass index 40-49.9 kg/m2 (OR 0.89) and ≥50 kg/m2 (OR 0.67); patient comorbidities, including hypertension (OR 0.85), chronic steroid use (OR 0.74), bleeding disorder (OR 0.54), anemia (OR 0.89), and hypoalbuminemia (OR 0.76); and surgical time >90th percentile (OR 0.40) (all p<0.05). Lymphadenectomy did not impact the same day discharge rate (unadjusted OR 1.03, p=0.22). Same day discharge had no effect on 30 day postoperative composite morbidity (OR 0.91, p=0.20), and was associated with fewer readmissions (OR 0.75, p=0.005). Age 70-79 years (OR 1.07, p=0.435) and age ≥80 years (OR 1.11, p=0.504) did not increase postoperative morbidity. However, body mass index categories 40-49.9 kg/m2 (OR 1.28, 95% CI 1.08 to 1.51) and ≥50 kg/m2 (OR 1.60, 95% CI 1.27 to 2.01) were associated with greater 30 day composite morbidity. CONCLUSION In this study, same day discharge following minimally invasive hysterectomy for oncologic indications was safe, and rates are rising among all age and body mass index categories. Quality improvement initiatives are needed at oncology centers to promote early discharge after minimally invasive gynecologic oncology surgery.
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Affiliation(s)
- Tal Milman
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Azusa Maeda
- Division of Gynecologic Oncology, Princess Margaret Cancer Centre/University Health Network/Sinai Health System, Toronto, Ontario, Canada
| | - Brenna E Swift
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
- Division of Gynecologic Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Geneviève Bouchard-Fortier
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
- Division of Gynecologic Oncology, Princess Margaret Cancer Centre/University Health Network/Sinai Health System, Toronto, Ontario, Canada
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Amal C, Fadwa A, Aicha G, Boufetal H, Mahdaoui S, Samouh N. Uterine smooth muscle tumor of uncertain malignant potential (STUMP) ABOUT a CASE. Int J Surg Case Rep 2024; 117:109556. [PMID: 38518473 PMCID: PMC10972788 DOI: 10.1016/j.ijscr.2024.109556] [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: 02/19/2024] [Revised: 03/12/2024] [Accepted: 03/16/2024] [Indexed: 03/24/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Uterine smooth muscle tumor of uncertain malignant potential (STUMP) is rare tumor, and regarded as sub-classification in uterine smooth muscle tumors between benign and malignant criteria. They represent a heterogeneous group of rare tumors. PRESENTATION OF CASE We report a case of a STUMP tumor in a fifty-three-year-old patient who underwent surgery for a hysterectomy. DISCUSSION STUMP often presents with nonspecific clinical manifestation the only confirmatory examination is anatomopathological and may be supported by immunohistochemistry, hysterectomy is currently considered the gold standard of treatment. CONCLUSION Uterine STUMP tumor represents a therapeutic dilemma. A multidisciplinary approach is mandatory.
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Affiliation(s)
- Cherkaoui Amal
- Obstetrics and Gynecology Department, University Hospital Ibn Rochd, Morocco; Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco.
| | - Atfi Fadwa
- Obstetrics and Gynecology Department, University Hospital Ibn Rochd, Morocco; Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco
| | - Gotni Aicha
- Obstetrics and Gynecology Department, University Hospital Ibn Rochd, Morocco; Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco
| | - Houssine Boufetal
- Obstetrics and Gynecology Department, University Hospital Ibn Rochd, Morocco; Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco
| | - Sakher Mahdaoui
- Obstetrics and Gynecology Department, University Hospital Ibn Rochd, Morocco; Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco
| | - Naima Samouh
- Obstetrics and Gynecology Department, University Hospital Ibn Rochd, Morocco; Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco
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Pla-Juher H, Pardo M, Izquierdo ÀJ, Darder E, Carbó A, Munté E, Torres-Esquius S, Balmaña J, Lázaro C, Brunet JM, Barretina-Ginesta MP. Risk of endometrial cancer after RRSO in BRCA 1/2 carriers: a multicentre cohort study. Clin Transl Oncol 2024; 26:1033-1037. [PMID: 37682500 PMCID: PMC10981602 DOI: 10.1007/s12094-023-03312-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/20/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE To know the risk of endometrial cancer (EC) in a population of women with BRCA 1/2 pathogenic or likely pathogenic variants after risk-reducing salpingo-oophorectomy (RRSO). METHODS The study cohort included data from 857 women with BRCA mutations who underwent RRSO visited four hospitals in Catalonia, Spain, from January 1, 1999 to April 30, 2019. Standardized incidence ratio (SIR) of EC was calculated in these patients using data from a regional population-based cancer registry. RESULTS After RRSO, eight cases of EC were identified. Four in BRCA 1 carriers and four in BRCA2 carriers. The expected number of cases of EC was 3.67 cases, with a SIR of 2.18 and a 95% CI (0.93-3.95). CONCLUSIONS In our cohort, the risk of EC in BRCA1/2 carriers after RRSO is not greater than expected. Hysterectomy is not routinely recommended for these patients.
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Affiliation(s)
- Helena Pla-Juher
- Medical Oncology, Catalan Institute of Oncology, Hospital Universitari Dr. Josep Trueta, Avinguda de França s/n, 17707, Girona, Spain.
- Precision Oncology Group (OncoGIR-Pro), Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain.
- Department of Epidemiology and Cancer Register, Girona, Spain.
| | - Marta Pardo
- Precision Oncology Group (OncoGIR-Pro), Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
| | - Àngel J Izquierdo
- Precision Oncology Group (OncoGIR-Pro), Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
- Hereditary Cancer Program, Catalan Institute of Oncology, IDIBGI, Girona, Spain
- Department of Epidemiology and Cancer Register, Girona, Spain
| | - Esther Darder
- Hereditary Cancer Program, Catalan Institute of Oncology, IDIBGI, Girona, Spain
- Department of Epidemiology and Cancer Register, Girona, Spain
| | - Anna Carbó
- Medical Oncology, Catalan Institute of Oncology, Hospital Universitari Dr. Josep Trueta, Avinguda de França s/n, 17707, Girona, Spain
- Precision Oncology Group (OncoGIR-Pro), Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
- Department of Epidemiology and Cancer Register, Girona, Spain
| | - Elisabet Munté
- Hereditary Cancer Program, Catalan Institute of Oncology, IDIBELL, L'Hospitalet, Barcelona, Spain
| | | | - Judith Balmaña
- Department of Medical Oncology, Vall d'Hebrón Hospital, Barcelona, Spain
| | - Concepción Lázaro
- Hereditary Cancer Program, Catalan Institute of Oncology, IDIBELL, L'Hospitalet, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto Salud Carlos III, Madrid, Spain
| | - Joan M Brunet
- Medical Oncology, Catalan Institute of Oncology, Hospital Universitari Dr. Josep Trueta, Avinguda de França s/n, 17707, Girona, Spain
- Precision Oncology Group (OncoGIR-Pro), Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
- Hereditary Cancer Program, Catalan Institute of Oncology, IDIBGI, Girona, Spain
- Department of Epidemiology and Cancer Register, Girona, Spain
| | - Maria-Pilar Barretina-Ginesta
- Medical Oncology, Catalan Institute of Oncology, Hospital Universitari Dr. Josep Trueta, Avinguda de França s/n, 17707, Girona, Spain
- Precision Oncology Group (OncoGIR-Pro), Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
- Department of Epidemiology and Cancer Register, Girona, Spain
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Hafermann J, Silas U, Saunders R. Efficacy and safety of V-Loc ™ barbed sutures versus conventional suture techniques in gynecological surgery: a systematic review and meta-analysis. Arch Gynecol Obstet 2024; 309:1249-1265. [PMID: 38127141 PMCID: PMC10894094 DOI: 10.1007/s00404-023-07291-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/06/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE One of the most challenging tasks in laparoscopic gynecological surgeries is suturing. Knotless barbed sutures are intended to enable faster suturing and hemostasis. We carried out a meta-analysis to compare the efficacy and safety of V-Loc™ barbed sutures (VBS) with conventional sutures (CS) in gynecological surgeries. METHODS We systematically searched PubMed and EMBASE for studies published between 2010 and September 2021 comparing VBS to CS for OB/GYN procedures. All comparative studies were included. Primary analysis and subgroup analyses for the different surgery and suturing types were performed. Primary outcomes were operation time and suture time; secondary outcomes included post-operative complications, surgical site infections, estimated blood loss, length of stay, granulation tissue formation, and surgical difficulty. Results were calculated as weighted mean difference (WMD) or risk ratio (RR) and 95% confidence intervals (CI) with a random effects model, and a sensitivity analysis for study quality, study size, and outlier results was performed. PROSPERO registration: CRD42022363187. RESULTS In total, 25 studies involving 4452 women undergoing hysterectomy, myomectomy, or excision of endometrioma. VBS were associated with a reduction in operation time (WMD - 17.08 min; 95% CI - 21.57, - 12.59), suture time (WMD - 5.39 min; 95% CI - 7.06, - 3.71), surgical site infection (RR 0.26; 95% CI 0.09, 0.78), estimated blood loss (WMD - 44.91 ml; 95% CI - 66.01, - 23.81), granulation tissue formation (RR 0.48; 95% CI 0.25, 0.89), and surgical difficulty (WMD - 1.98 VAS score; 95% CI - 2.83, - 1.13). No difference between VBS and CS was found regarding total postoperative complications or length of stay. Many of the outcomes showed high heterogeneity, likely due to the inclusion of different surgery types and comparators. Most results were shown to be robust in the sensitivity analysis except for the reduction in granulation tissue formation. CONCLUSION This meta-analysis indicates that V-Loc™ barbed sutures are safe and effective in gynecological surgeries as they reduce operation time, suture time, blood loss, infections, and surgical difficulty without increasing post-operative complications or length of stay compared to conventional sutures.
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Affiliation(s)
- Juliane Hafermann
- Coreva Scientific GmbH & Co KG, Im Muehlenbruch 1, 53639, Koenigswinter, Germany.
| | - Ubong Silas
- Coreva Scientific GmbH & Co KG, Im Muehlenbruch 1, 53639, Koenigswinter, Germany
| | - Rhodri Saunders
- Coreva Scientific GmbH & Co KG, Im Muehlenbruch 1, 53639, Koenigswinter, Germany
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Tai TS, Tsai CF, Yang HY. Thyroid cancer risk in women after hysterectomy: A nationwide cohort study. Maturitas 2024; 185:107980. [PMID: 38555761 DOI: 10.1016/j.maturitas.2024.107980] [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: 12/12/2023] [Revised: 03/11/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVES Hysterectomy is commonly performed for benign uterine pathologies but there is some controversy over whether it is associated with an increased risk of thyroid cancer. This study examines the associations of hysterectomy with ovarian conservation or with bilateral salpingo-oophorectomy and thyroid cancer incidence in Taiwan. METHODS We analyzed data from a nationwide health insurance claims database and identified 29,577 women aged ≥30 years who underwent hysterectomy with ovarian conservation or hysterectomy with bilateral salpingo-oophorectomy between 2000 and 2016. Propensity score-matching analyses were performed at ratios of 1:1 for the hysterectomy and no-hysterectomy groups, to reduce selection bias. We monitored thyroid cancer occurrence in both groups until 2017. Cox regression was used to calculate hazard ratios with 95 % confidence intervals and determine thyroid cancer risk in women who underwent hysterectomy. RESULTS The study comprised 29,577 patients who underwent any hysterectomy and 29,577 participants who did not. The mean follow-up period was 10.03 ± 4.92 years. Patients who underwent hysterectomy had higher thyroid cancer incidence (4.72 per 10,000 person-years) than those who did not (3.06 per 10,000 person-years) and a greater risk of any thyroid cancer (adjusted hazard ratio = 1.40; 95 % confidence interval = 1.08-1.82). However, there was no association between hysterectomy with bilateral salpingo-oophorectomy and thyroid cancer incidence (p > 0.05). CONCLUSIONS Our findings suggest that women who undergo hysterectomy are at a higher risk of developing thyroid cancer than those who do not.
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Affiliation(s)
- Tsai-Sung Tai
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City 60002, Taiwan
| | - Ching-Fang Tsai
- Clinical Data Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City 60002, Taiwan
| | - Hsin-Yi Yang
- Clinical Data Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City 60002, Taiwan.
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Santillan-Gomez A. Single-port robotic-assisted transvaginal hysterectomy (vNOTES) in a hostile abdomen. Int J Gynecol Cancer 2024:ijgc-2023-004650. [PMID: 38531536 DOI: 10.1136/ijgc-2023-004650] [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] [Indexed: 03/28/2024] Open
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Obeidat RA, Alshwayyat S, Alshwayyat TA, Rjoop A, Sharqiah QM. Presentation and treatment of two cases of malignant struma ovarii. BMC Womens Health 2024; 24:158. [PMID: 38443937 PMCID: PMC10913386 DOI: 10.1186/s12905-024-03002-5] [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: 12/15/2023] [Accepted: 02/27/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Malignant Struma Ovarii (MSO) is a rare type of germ cell tumour which is diagnosed postoperatively on surgical pathology specimens by the presence of differentiated thyroid cancer in mature cystic teratomas in the ovaries. Treatment and follow-up procedures are not clearly established due to the paucity of MSO cases. CASE 1: A 44-year-old multiparous female presented with an irregular period. Ultrasound showed a left ovarian lesion mostly a dermoid cyst, however, CT showed a 3.8 × 2.7 × 4 cm complex cystic lesion with thick septation and enhancing soft tissue component. Laparoscopic left salpingo-oophorectomy was performed and histopathology showed a follicular variant of papillary thyroid carcinoma arising in a mature cystic teratoma. Peritoneal cytology was positive for malignancy. A thyroid function test was normal before surgery. Total thyroidectomy was performed followed by radioactive (RAI) iodine therapy. Later, a total laparoscopic hysterectomy and right salpingo-oophorectomy were performed. There is no evidence of recurrent disease during the 26-months follow-up. CASE 2: A 46-year-old single female presented with left lower abdominal pain that had persisted for 2 months. Imaging revealed an 8 × 9 × 9.5 cm left ovarian mass. Laparoscopic left salpingo-oophorectomy was performed and histopathology showed mature cystic teratoma with small papillary thyroid cancer. CT showed no evidence of metastatic disease. Later, the patient had a total thyroidectomy followed by radioactive (RAI) iodine therapy. She was started on thyroxine and later had total abdominal hysterectomy and right salpingo-oophorectomy. CONCLUSION MSO is a very rare tumour. Preoperative diagnosis is very difficult because of the nonspecific symptoms and the lack of specific features in imaging studies. Also, there is no consensus on the optimal treatment of women with MSO. Our two cases add to the limited number of MSO cases.
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Affiliation(s)
- Rawan A Obeidat
- Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, P. O. Box: 3030, Irbid, 22110, Jordan.
| | - Sakhr Alshwayyat
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | | | - Anwar Rjoop
- Department of Pathology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Qosay Mahmoud Sharqiah
- Department of Pathology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Zhu X, Ye L, Fu Y, You B, Lu W. Radical Hysterectomy With Preoperative Conization in Early-Stage Cervical Cancer: A Systematic Review and Pairwise and Network Meta-Analysis. J Minim Invasive Gynecol 2024; 31:193-199. [PMID: 38016630 DOI: 10.1016/j.jmig.2023.11.019] [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: 08/10/2023] [Revised: 11/07/2023] [Accepted: 11/22/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE The investigation of the role of preoperative conization in cervical cancer aiming to explore its potential clinical significance. DATA SOURCES Cochrane Library, Embase, PubMed, and Web of Science, up to April 28, 2023. METHODS OF STUDY SELECTION (1) Observational cohort studies, (2) studies comparing radical hysterectomy with preoperative conization (CO) vs radical hysterectomy without preoperative conization (NCO) in patients with early-stage cervical cancer, and (3) studies comparing disease-free survival outcomes. TABULATION, INTEGRATION, AND RESULTS Two reviewers independently extracted the data and assessed the quality of the studies. The meta-analysis used combined hazard ratios along with their corresponding 95% confidence intervals to compare CO and NCO. We conducted a Bayesian network meta-analysis using Markov chain Monte Carlo methods to compare minimally invasive CO, open CO, minimally invasive NCO, and open NCO. Our study included 15 retrospective trials, 10 of which were used to traditional pairwise meta-analysis and 8 for network meta-analysis. The NCO group exhibited a notably higher probability of cancer recurrence than the CO group (hazard ratio, 0.52; 95% confidence interval, 0.41-0.65). In the network meta-analysis, minimally invasive NCO showed the worst survival outcome. CONCLUSION Preoperative conization seems to be a protective factor in decreasing recurrence risk, assisting clinicians in predicting survival outcomes for patients with early-stage cervical cancer. It may potentially aid in selecting suitable candidates for minimally invasive surgery in clinical practice.
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Affiliation(s)
- Xinbin Zhu
- Department of Gynecologic Oncology (Zhu, You, and Dr. Lu), Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Lele Ye
- Women's Reproductive Health Laboratory of Zhejiang Province (Drs. Ye and Lu), Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Yunfeng Fu
- Medical Centre for Cervical Diseases (Dr. Fu), Women's Hospital School of Medicine Zhejiang University, Hangzhou, China; Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology (Drs. Fu and Lu), Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Bingbing You
- Department of Gynecologic Oncology (Zhu, You, and Dr. Lu), Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Weiguo Lu
- Department of Gynecologic Oncology (Zhu, You, and Dr. Lu), Women's Hospital School of Medicine Zhejiang University, Hangzhou, China; Women's Reproductive Health Laboratory of Zhejiang Province (Drs. Ye and Lu), Women's Hospital School of Medicine Zhejiang University, Hangzhou, China; Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology (Drs. Fu and Lu), Women's Hospital School of Medicine Zhejiang University, Hangzhou, China.
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Ntafam CN, Sanusi-Musa I, Harris RD. Intramural ectopic pregnancy: An individual patient data systematic review. Eur J Obstet Gynecol Reprod Biol X 2024; 21:100272. [PMID: 38269031 PMCID: PMC10805919 DOI: 10.1016/j.eurox.2023.100272] [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: 08/11/2023] [Revised: 12/12/2023] [Accepted: 12/16/2023] [Indexed: 01/26/2024] Open
Abstract
Intramural pregnancies (IMP) are very rare and represent about 1% of ectopic pregnancies (EPs). Despite a few reported cases, there is limited awareness & knowledge among sonographers and physicians. Moreover, no established diagnostic or treatment protocol exists for such a condition. This study identifies and synthesizes what is known about IMP, including etiology and pathophysiology, common clinical presentations, imaging features, laparoscopic and hysteroscopic findings, and management. PUBMED and Google Scholar were queried to identify eligible studies. All articles on IMP in human subjects available in English and French languages were included. Other types of ectopic pregnancies, including cesarean scar and cervical ectopic pregnancies, were excluded. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines and a narrative synthesis approach were used to systematically review the medical literature. 82 cases distributed around 27 countries with an average maternal age of 32.07 years and gestational age of 9.27 weeks were eventually selected for this study. History of curettage was the most common risk factor reported in 30 (36.58%) patients, followed by history of salpingectomy, assisted reproduction with embryo transfer, and previous cesarean delivery, in 10(12.19%), 10(12.19%), and 9(10.97%) patients respectively. Ultrasound was performed in 80(97.56%) cases. Of the 66 reported ultrasound findings, 29 were diagnostic or suggestive of IMP. MRI, laparoscopy (both diagnostic & surgical) and diagnostic hysteroscopy were carried out on 18(21.95%), 36(43.9%) and 22(26.83%) patients respectively. Histopathologic examination mainly performed after surgery was the gold standard for confirming the diagnosis. Management involved conservative (3.65%) approach, medical treatment with methotrexate or potassium chloride (23.17%), and surgical interventions. The latter includes laparoscopic surgery (25.61%), laparotomic surgery (23.17%), and hysterectomy (13.41%). IMP is a rare but potentially lethal clinical entity. A significant proportion of patients are asymptomatic and have no known risk factors. Correlation between clinical history and imaging findings is vital to establish a prompt diagnosis and reduce the risk of a catastrophic outcome.
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Affiliation(s)
- Carnot N. Ntafam
- Detroit Medical Center Sinai-Grace Hospital, Detroit, MI 48235, USA
| | | | - Robert D. Harris
- Drexel University College of Medicine, Allegheny Health Network, Pittsburg, PA 15237, USA
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Kim H. Anatomic variation of a duplicated uterine artery. Anat Sci Int 2024; 99:221-224. [PMID: 38091200 DOI: 10.1007/s12565-023-00752-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 11/09/2023] [Indexed: 03/01/2024]
Abstract
During the anatomical dissection of the pelvis, a duplication of the uterine artery was identified unilaterally on the left side in a 59-year-old Korean female cadaver. The first uterine artery was found to arise directly from the anterior division of the internal iliac artery and supply the upper uterine body and tube. The second uterine artery shared a common stem with the superior and inferior vesical arteries, supplying the lower uterine body. The external diameter of each uterine artery at its origin on the left side was smaller than that of the right uterine artery. One vaginal artery was identified to arise from the left internal pudendal artery. Embryologically, a duplicated uterine artery could imply the presence of two primordial arteries separately supplying the cranial and caudal parts of the Müllerian duct during the early fetal period. This case of variational anatomy is noteworthy: clinicians could elucidate it and successfully perform uterine artery embolization or hysterectomy with minimal complications.
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Affiliation(s)
- Hankyu Kim
- Department of Anatomy, College of Medicine, The Soonchunhyang University of Korea, Soonchunhyang 6-Gil, Dongnam-Gu, Cheonan-Si, Chungcheongnam-Do, 31151, Republic of Korea.
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15
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Radtke S, Arms R, Son MA, Sanchez S, Singh V, Bencomo M, Mccall E, Rodriguez S, Olivas-Cardiel K. Reducing patient's perception of postoperative vaginal bleeding after laparoscopic hysterectomy via independent closure of the vaginal cuff angles (RCT). Eur J Obstet Gynecol Reprod Biol 2024; 294:111-116. [PMID: 38237308 DOI: 10.1016/j.ejogrb.2024.01.019] [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: 11/30/2023] [Revised: 01/06/2024] [Accepted: 01/12/2024] [Indexed: 02/21/2024]
Abstract
STUDY OBJECTIVE Determine if independently suturing the vaginal cuff angles in addition to running barbed suture has an effect on patients' perception of postoperative bleeding after laparoscopic hysterectomy. DESIGN Randomized controlled trial. SETTING University-based medical center. PATIENTS Females ages 18-60 undergoing laparoscopic hysterectomy. INTERVENTIONS Patients were randomly assigned to either cuff closure via single layer of barbed suture (control) vs adding figure-of-eight stitches at each angle (intervention). A survey was given between 10 and 25 days after surgery inquiring about bleeding and dyspareunia. A second survey was given between postoperative days 90-114. Chart review was performed to record emergency room visits, complications, infections, and reoperations during the first 90 postoperative days. RESULTS n = 117 patients were analyzed. 62 (control) and 55 (intervention). Groups were similar in terms of age (42.92 v 44.29p =.35), BMI (33.79 v 34.06p =.85), diabetes (5.26 % (3/55) v 15.09 % (8/53) p =.08) p =.97). Bleeding was decreased in intervention arm (24.19 % (15/62) v 9.09 % (5/55) p =.03). Median (IQR) pelvic pain score was similar (2.0 (0-5.0) v 2.0 (0-4.0) p =.26). Median total operative time (IQR) (129 min (102, 166) v 139 min (120, 163) p =.39) and median EBL (IQR) (50 mL (30-75) vs 50 mL (20-75) p =.43) were similar. Cuff closure in seconds (IQR) was higher in intervention group (373 sec (323, 518) v 571 sec (520, 715) p <.01). 8/60 control patients visited the ED (13.33 %) v 7/54 (12.96 %) p =.95. Readmissions (1.67 % (1/60) v 1.85 % (1/55) p = 1), re-operations (0 % (0/60) v 1.85 % (1/55) p =.47) and postoperative infections (5.0 % (3/60) v 1.85 % (1/54) p =.62) were similar. Secondary survey showed no significant difference in bleeding (15.38 % (4/26) v 4.35 % (1/23) p =.35) and SF-36 results were similar. CONCLUSION Independently suturing the vaginal cuff angles reduces patients' perception of vaginal bleeding in the early postoperative period. Incidence of complications, reoperations, and long-term quality of life are similar.
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Affiliation(s)
- Steven Radtke
- Texas Tech University Health Sciences Center El Paso, USA.
| | - Richard Arms
- Texas Tech University Health Sciences Center El Paso, USA
| | - Mary Ann Son
- Texas Tech University Health Sciences Center El Paso, USA
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Padilla-Iserte P, Domingo S. Correspondence on 'Intrauterine manipulator use during laparoscopic hysterectomy for endometrial cancer: association for pathological factors and oncologic outcomes' by Yoshida et al. Int J Gynecol Cancer 2024:ijgc-2024-005345. [PMID: 38395447 DOI: 10.1136/ijgc-2024-005345] [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] [Indexed: 02/25/2024] Open
Affiliation(s)
- Pablo Padilla-Iserte
- Department of Gynecologic Oncolgy, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Santiago Domingo
- Department of Gynecologic Oncolgy, La Fe University and Polytechnic Hospital, Valencia, Spain
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Chang SH, Huang KG, Yang LY, Pan YB, Lai CH, Chou HH. Comparison of outcomes of laparotomic and minimally invasive radical hysterectomy in women with early-stage cervical cancer. J Gynecol Oncol 2024:35.e60. [PMID: 38425140 DOI: 10.3802/jgo.2024.35.e60] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/03/2024] [Accepted: 02/11/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE This study compared the outcomes of laparotomic radical hysterectomy (LRH) and minimally invasive radical hysterectomy (MISRH) in patients with early-stage cervical cancer. METHODS The clinical data of patients with early-stage cervical cancer who underwent LRH or MISRH (laparoscopic/robotic) at Chang Gung Memorial Hospital, Linkou Branch, from 2002 to 2017 were retrospectively reviewed. The surgical safety (operation time, blood loss, blood transfusion rate, length of postoperative stay, and perioperative complications), overall survival (OS), disease-free survival (DFS), and recurrence pattern were analyzed. Propensity score matching (PSM) at a 3:1 ratio was performed to balance prognostic variables. RESULTS Of the 760 patients (entire cohort), 614 underwent LRH and 146 underwent MISRH. After PSM, 394 and 140 patients were included in the LRH and MISRH groups, respectively. The 5-year OS rate was significantly lower in the MISRH group than in the LRH group (85.6% vs. 93.2%, p=0.043), and the 5-year DFS rate (p=0.21) did not differ significantly. After PSM, the 5-year OS rates did not differ significantly between the MISRH and LRH groups (87.1% vs. 92.1%, p=0.393). The MISRH group had a significantly shorter operation time (p<0.001), lower intraoperative blood loss (p<0.001), lower blood transfusion rate (p<0.001), and shorter postoperative stay (p<0.001) but a significantly higher rate of intraoperative bladder injury (p<0.001) than the LRH group. CONCLUSION After PSM, MISRH is associated with nonsignificantly lower OS but a significantly higher risk of intraoperative urological complications than LRH.
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Affiliation(s)
- Shu-Han Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Kuan-Gen Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Lan-Yan Yang
- Division of Clinical Trial, Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Bin Pan
- Clinical Trial Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hung-Hsueh Chou
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- School of Medicine, National Tsing Hua University, Hsinchu, Taiwan.
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Latifah HM, Khan MA, Nadreen F, Latifah A, Asaad A, Baradwan S. The da Vinci robotic surgery system for the management of endometrial cancer: a single-center experience. J Robot Surg 2024; 18:89. [PMID: 38386227 DOI: 10.1007/s11701-024-01845-6] [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: 12/03/2023] [Accepted: 01/21/2024] [Indexed: 02/23/2024]
Abstract
The aim of this study was to report our single-center experience of the da Vinci robotic surgery system in the management of endometrial cancer (EC) patients during 2019-2023. We descriptively summarized the preoperative, intraoperative, and postoperative outcomes. Moreover, we conducted subgroup analyses based on obesity (BMI ≥ 30 kg/m2) and the intraoperative use of indocyanine green dye (ICG). Overall, 100 patients were analyzed. Eighty-five patients (85%) were obese. The mean operative time and estimated blood loss (EBL) were 240.84 ± 70.08 min (range: 110-720) and 104.2 ± 80.3 ml (range: 20-500), respectively. The mean number of retrieved pelvic LNs was 3.01 ± 3.06 (range: 0-15). The use of ICG was employed in 58 (58%). Only a single patient (1%) underwent conversion to laparotomy. Besides, only three (3%) patients experienced vaginal laceration intraoperatively, respectively. The mean hospital stay was 1.34 ± 0.69 days (range: 1-5). No patient experienced postoperative complications. Most tumors had endometrioid histology (82%), grade-1 tumor (49%), and stage-1A disease (67%). At 3-year follow-up, only two patients (2%) developed recurrence. Patients who received the ICG had significantly lower operative time (225.86 vs. 261.52 min, p = 0.011), estimated blood loss (90 vs. 123.81 ml, p = 0.037), and hospital stay (1.12 vs. 1.64 days, p < 0.001) compared with patients who did not receive it. However, there was no significant difference between both groups regarding the number of retrieved pelvic LNs. Obesity had no significant impact on the rates of intraoperative complications, postoperative complications, and 3-year recurrence incidence. In conclusion, robotic surgery was technically feasible and safe. The use of ICG was statistically linked to favorable outcomes, in terms of decreased operative time, EBL, and hospital stay. Obesity did not impact the perioperative surgical outcomes.
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Affiliation(s)
- Hassan M Latifah
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Mahmoud Anis Khan
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Farah Nadreen
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | | | - Alanoud Asaad
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Saeed Baradwan
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
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He Z, He Y, Xie C. Surgical techniques and experience sharing of transumbilical single-port laparoscopic hysterectomy in difficult conditions. Asian J Surg 2024:S1015-9584(24)00342-7. [PMID: 38378409 DOI: 10.1016/j.asjsur.2024.02.084] [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: 01/01/2024] [Accepted: 02/02/2024] [Indexed: 02/22/2024] Open
Affiliation(s)
- Zuoxi He
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province, PR China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, Sichuan Province, PR China
| | - Yuedong He
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province, PR China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, Sichuan Province, PR China
| | - Chuan Xie
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province, PR China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, Sichuan Province, PR China.
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Singh SK, Chauhan K, Tripathi V. Key drivers of hysterectomy among women of reproductive age in three states in India: comparative evidence from NFHS-4 and NFHS-5. BMC Womens Health 2024; 24:107. [PMID: 38336664 PMCID: PMC10854047 DOI: 10.1186/s12905-024-02886-7] [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: 06/14/2023] [Accepted: 01/04/2024] [Indexed: 02/12/2024] Open
Abstract
PURPOSE According to the 4th and 5th rounds of National Family Health Survey (NFHS), there is high prevalence of hysterectomies in the three states of Andhra Pradesh Telangana and Bihar. The three said states have more than double the number of hysterectomies taking place than the national average. Our purpose is to analyse whether these rates are increasing, decreasing or have stabilized and their reasons thereof. Such an analyses will help the policy makers in recommending good clinical practices within their states. MATERIAL AND METHODS We used data from NFHS-4 (2015-16) and NFHS-5 (2019-2021) rounds. We calculated the differences in predicted probabilities for various factors, performed a Fairlie Decomposition analyses to quantify the positive and negative contributors in the prevalence of hysterectomy across the three states over two time points, and assessed the association of various socio-demographic characteristics to hysterectomy through a multilevel logistic regression model. RESULTS AND CONCLUSION The results show that out of a total of 80,976 eligible respondents from the states under study, 5826 respondents self-reported that they had a hysterectomy done. It was found that older age, living in rural areas, belonging to other backward classes and higher wealth quintile, and higher parity positively contributed to the increased prevalence of hysterectomies in the three states. Higher educational attainment and previous use of family planning methods acted as protective factors. Characteristics at the household level had the highest intra-class correlation value in the prevalence of hysterectomy among women, followed by the Primary Sampling Unit and District levels, indicating high clustering in the prevalence of hysterectomy at the household level in all three states. Heavy menstrual bleeding/pain was the leading cause of hysterectomies in all three states, followed by fibroids/cysts in Andhra Pradesh and Telangana and Uterine disorder/ prolapse in Bihar. Over 80% of hysterectomies took place in the private hospitals. RECOMMENDATIONS The study recommends better, more efficient and accountable hysterectomy surveillance to ensure more sustainable woman's reproductive health services in India. Government should adopt and implement standard regulatory guidelines to prevent provider-driven avoidable hysterectomies. Moreover, we recommend informing primary care professionals about the long-term health effects of hysterectomy and promoting alternate therapies for treating uterine fibroids and heavy bleeding.
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Affiliation(s)
- Shri Kant Singh
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Kirti Chauhan
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, Maharashtra, India.
- Department of Biostatistics and Demography, International Institute for Population Sciences, Mumbai, Maharashtra, India.
| | - Vrijesh Tripathi
- Department of Mathematics and Statistics, The University of the West Indies, St. Augustine, Trinidad and Tobago
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Qian X, Ren D, Gu L, Ye C. Incidence and risk factors of stress urinary incontinence after laparoscopic hysterectomy. BMC Womens Health 2024; 24:105. [PMID: 38331777 PMCID: PMC10851496 DOI: 10.1186/s12905-024-02942-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 01/30/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVE To observe the long-term effects of total hysterectomy on urinary function, evaluate the effects of preoperative nutritional status, urinary occult infection, and surgical factors on the induction of postoperative stress urinary incontinence (SUI), and explore the incidence and risk factors of SUI. STUDY DESIGN From January 2017 to December 2017, 164 patients with benign non-prolapsing diseases who underwent a laparoscopic total hysterectomy in the First People's Hospital of Taicang were selected as the analysis objects. The International Incontinence Standard Questionnaire for Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and Pelvic Floor Impact Questionnaire-short version 20 (PFDI-20) were used for telephone follow-up to subjectively assess the urinary function of patients, collect their medical records, and statistically analyze the number of postoperative SUI cases. Logistic multivariate analysis was used to analyze the influencing factors of postoperative female SUI, presented as adjusted odds ratios with 95% confidence intervals. RESULTS Only 97 out of 164 patients completed the ICIQ-FLUTS and PFDI-20 questionnaires. Among these participants, 28 patients (28.86%) were diagnosed with SUI (study group), while 69 patients (71.13%) were classified as women without SUI (control group). The age, menopause, parity ≥ 2 times, Body mass index (BMI) ≥ 28 kg/m2, neonatal weight ≥ 4000 g, history of chronic cough, preoperative hemoglobin ≤ 100 g/L, preoperative urine bacteria ≥ 100u/L, preoperative uterine volume ≥ 90 cm3, intraoperative blood loss, and operation time of the study group were compared with those of the control group. The differences were statistically significant (P < 0.05). Further Logistic multivariate analysis showed that menopause, preoperative hemoglobin ≤ 100 g/L, preoperative urine bacteria ≥ 100u/L, uterine volume ≥ 90 cm3, history of chronic cough, BMI ≥ 28 kg/m2 were risk factors for postoperative SUI in patients undergoing hysterectomy (P < 0.05). CONCLUSIONS Hysterectomy for benign non-prolapse diseases has a long-term potential impact on the urinary system of patients, and the risk of postoperative SUI increases. The main risk factors of SUI are parity, menopausal status, obesity, preoperative nutritional status, and occult infection of the urinary system.
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Affiliation(s)
- XiaoHong Qian
- Department of Gynecology, Taicang Affiliated Hospital of Soochow University (The First People's Hospital of Taicang), Taicang, Jiangsu Province, 215400, China
| | - DongFang Ren
- Department of Gynecology, Taicang Affiliated Hospital of Soochow University (The First People's Hospital of Taicang), Taicang, Jiangsu Province, 215400, China
| | - liJuan Gu
- Department of Obstetrics, Taicang Affiliated Hospital of Soochow University (The First People's Hospital of Taicang), Taicang, Jiangsu Province, 215400, China
| | - Cong Ye
- Department of Gynecology, Taicang Affiliated Hospital of Soochow University (The First People's Hospital of Taicang), Taicang, Jiangsu Province, 215400, China.
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Darlet G, Margueritte F, Drioueche H, Fauconnier A. Laparoscopic Modified Radical Hysterectomy for Severe Endometriosis: A Single-center Case Series. J Minim Invasive Gynecol 2024:S1553-4650(24)00046-3. [PMID: 38325580 DOI: 10.1016/j.jmig.2024.01.022] [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: 09/05/2023] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/09/2024]
Abstract
STUDY OBJECTIVE The main objective is to describe the feasibility and report a single-center experience of a standardized laparoscopic modified radical hysterectomy technique among patients with severe endometriosis and pouch of Douglas obliteration. DESIGN A single-center case series of laparoscopic modified radical hysterectomy performed at the Poissy Hospital between December 2012 and May 2021. SETTINGS Single-center, gynecology unit (level III) with a focus on endometriosis. PATIENTS Patients with severe endometriosis (stage 4 American Fertility Society) and pouch of Douglas obliteration. MEASUREMENTS AND MAIN RESULTS Fifty-two patients with severe endometriosis underwent the surgical procedure. Of these patients, 23.1% underwent a rectal shaving (n = 12), 1.9% a discoid resection (n = 1), and 17.3% a rectal resection (n = 9), including a protective ileostomy in 1 case. Ureterolysis was performed on 82.7% of patients (n = 43). The average hospital stay was 3.3 days. Seven patients required intermittent self-catheterization (13.5%). Minor complications (Clavien-Dindo grade 1 and 2) occurred in 25.9% of the patients and severe complications in 3.8% of them (Clavien-Dindo grade 3, no grade 4). Two patients (3.8%) were reoperated: one for a postoperative occipital alopecia (balding) and the other for vaginal dehiscence with evisceration. Approximately 50 patients (96.2%) had a complete resection of endometriosis. The median follow-up was 14 months (interquartile range, 6-23 mo) with 94.3% of them improved (much and very much) and 3.8% minimally improved. CONCLUSION In our experience, laparoscopic modified radical hysterectomy is a reliable procedure with a low rate of severe complications. This technique needs to be assessed by other surgeons and others centers across the country and abroad, to determine the likelihood of it succeeding.
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Affiliation(s)
- Gael Darlet
- CHI Poissy-St-Germain, service de gynécologie & obstétrique, Poissy, France (Drs. Darlet and Margueritte, Drioueche, and Dr. Fauconnier).
| | - François Margueritte
- CHI Poissy-St-Germain, service de gynécologie & obstétrique, Poissy, France (Drs. Darlet and Margueritte, Drioueche, and Dr. Fauconnier); Université Paris-Saclay, UVSQ, Unité de recherche Risques cliniques et sécurité en santé des femmes et en santé périnatale, Montigny-le-Bretonneux, France (Drs. Margueritte and Fauconnier)
| | - Hocine Drioueche
- CHI Poissy-St-Germain, service de gynécologie & obstétrique, Poissy, France (Drs. Darlet and Margueritte, Drioueche, and Dr. Fauconnier)
| | - Arnaud Fauconnier
- CHI Poissy-St-Germain, service de gynécologie & obstétrique, Poissy, France (Drs. Darlet and Margueritte, Drioueche, and Dr. Fauconnier); Université Paris-Saclay, UVSQ, Unité de recherche Risques cliniques et sécurité en santé des femmes et en santé périnatale, Montigny-le-Bretonneux, France (Drs. Margueritte and Fauconnier)
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Lin J, Liu L, Wang L, Ma N, Zhang K, Xie N, Yu H, Deng S, Sun Y. The management of uterine tumor resembling an ovarian sex cord tumor (UTROSCT): case series and literature review. World J Surg Oncol 2024; 22:42. [PMID: 38310233 PMCID: PMC10837875 DOI: 10.1186/s12957-024-03319-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/23/2024] [Indexed: 02/05/2024] Open
Abstract
AIMS To present a case series of 11 rare uterine tumors resembling ovarian sex cord tumors (UTROSCTs), and review the literature on this topic to offer up-to-date treatment management for UTROSCTs. METHOD Eight cases from Fujian Cancer Hospital between January 2017 and May 2023 and three patients from Fujian Union Hospital between October 2012 and October 2020 were retrospectively reviewed. All cases were pathologically confirmed as UTROSCTs by two senior and experienced pathologists. Clinical behaviors, medical data, histopathological features, therapy approaches, and survival outcomes were discussed. RESULTS The median age at initial diagnosis was 53 years (29-70 years). 3 (27.3%) patients were under 40. Seven cases presented with abnormal vaginal bleeding, one with menstrual disorder, one with abnormal vaginal secretion, and two patients were accidentally found by physical examination without any symptoms. Three patients were initially misdiagnosed with endometrial cancer by MRI. Curettage was performed in all cases. Nine of them were well diagnosed by routine curettage, except for two samples, which were identified after surgery. Immunohistochemical biomarkers, such as CD99, Desmin, WT-1, CK, Vimentin, SMA, α-Inhibin, Ki67, CD56, ER, PR, and CR, tend to be positive in UTRO SCs patients. Six patients underwent hysterectomy with bilateral salpingo-oophorectomy. Two cases received a radical hysterectomy with bilateral salpingo-oophorectomy, retroperitoneal lymph node dissection, and omentum dissection. Three UTROSCTs were under observation after mass resection. The median PFS was 24 months (range 1-125 months). CONCLUSION UTROSCT is a rare mesenchymal tumor with low malignant potential. Treatment modalities should be carefully considered to balance the therapy outcomes and patient needs. Surgery conservative management might be suitable for young women with fertility desires.
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Affiliation(s)
- Jie Lin
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, China
| | - Linying Liu
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, China
| | - Linghua Wang
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, China
| | - Ning Ma
- Department of Radiology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, China
| | - Kailin Zhang
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ning Xie
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, China
| | - Haijuan Yu
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, China
| | - Sufang Deng
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, China
| | - Yang Sun
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, China.
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Hurni Y, Fung H, Simonson C, Serio MD, Lachat R, Bodenmann P, Seidler S, Huber D. Impact of Uterine Weight and Shape on vNOTES Hysterectomy: Analysis of 238 Consecutive Cases. J Minim Invasive Gynecol 2024; 31:115-122. [PMID: 37981263 DOI: 10.1016/j.jmig.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/08/2023] [Accepted: 11/14/2023] [Indexed: 11/21/2023]
Abstract
STUDY OBJECTIVE To compare the perioperative outcomes of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomies for different uterine weights and shapes. DESIGN Observational study. SETTING Swiss teaching hospital. PATIENTS Women who underwent vNOTES hysterectomy for benign conditions between May 2020 and July 2023 (N = 238). Patients were divided into 4 subgroups depending on uterus weight and shape. Uteri weighting <280 g were classified as type 0. Uteri weighting ≥280 g were categorized as type 1 (no vascular pedicle displacement), type 2 (cranial displacement of adnexal vascular pedicles), and type 3 (displacement of uterine arteries). INTERVENTIONS All women underwent vNOTES hysterectomies. We compared perioperative outcomes for the 4 subgroups. MEASUREMENT AND MAIN RESULTS We classified 168 patients (70.6%) as uterus type 0, 33 patients (13.9%) as type 1, 24 patients (10.1%) as type 2, and 13 patients (5.4%) as type 3. Mean uterine weight was 135.8 ± 59.5 g in type 0, 398.0 ± 167.3 g in type 1, 603.5 ± 217.9 g in type 2, and 661.7 ± 281.6 g in type 3. Operative time in type 0 (65.1 ± 30.9 minutes) and type 1 (65.1 ± 24.0 minutes) was shorter than in type 2 (102.3 ± 60.0 minutes) and type 3 (115.2 ± 40.3 minutes). Blood losses were more significant in type 2 (158.5 ± 212.0 mL) and type 3 (158.5 ± 110.7 mL) than in type 0 (85.6 ± 113.5 mL). No difference in the rate of total complications among groups was observed (8.3%, 3.0%, 12.5%, and 15.4% in types 0, 1, 2, and 3, respectively). CONCLUSION The displacement of the vascular pedicles seems associated with longer operative time and more blood loss and could represent a marker for technical difficulty in vNOTES hysterectomy. However, it does not influence the perioperative complication rate.
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Affiliation(s)
- Yannick Hurni
- Department of Gynecology and Obstetrics, Valais Hospital, Sion, Switzerland (Drs. Hurni, Simonson, Di Serio, Lachat, Bodenmann, Seidler, and Huber).
| | - Helen Fung
- Faculty of Medicine, University of Geneva, Geneva, Switzerland (Ms. Fung)
| | - Colin Simonson
- Department of Gynecology and Obstetrics, Valais Hospital, Sion, Switzerland (Drs. Hurni, Simonson, Di Serio, Lachat, Bodenmann, Seidler, and Huber)
| | - Marcello Di Serio
- Department of Gynecology and Obstetrics, Valais Hospital, Sion, Switzerland (Drs. Hurni, Simonson, Di Serio, Lachat, Bodenmann, Seidler, and Huber)
| | - Régine Lachat
- Department of Gynecology and Obstetrics, Valais Hospital, Sion, Switzerland (Drs. Hurni, Simonson, Di Serio, Lachat, Bodenmann, Seidler, and Huber)
| | - Pauline Bodenmann
- Department of Gynecology and Obstetrics, Valais Hospital, Sion, Switzerland (Drs. Hurni, Simonson, Di Serio, Lachat, Bodenmann, Seidler, and Huber)
| | - Stéphanie Seidler
- Department of Gynecology and Obstetrics, Valais Hospital, Sion, Switzerland (Drs. Hurni, Simonson, Di Serio, Lachat, Bodenmann, Seidler, and Huber)
| | - Daniela Huber
- Department of Gynecology and Obstetrics, Valais Hospital, Sion, Switzerland (Drs. Hurni, Simonson, Di Serio, Lachat, Bodenmann, Seidler, and Huber); Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland (Dr. Huber)
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Kurup M, Bidarahalli S, Jayaram S. Robotic Surgery in Gynaecology: A Retrospective Evaluation of an Experience at a Single Centre. J Obstet Gynaecol India 2024; 74:53-59. [PMID: 38434133 PMCID: PMC10902232 DOI: 10.1007/s13224-023-01852-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: 02/27/2023] [Accepted: 09/01/2023] [Indexed: 03/05/2024] Open
Abstract
Objective The aim of this research was to assess the role of robotics and its outcome in gynaecology both in benign and malignant cases in a single centre and provide a critical evaluation of possible advantages of robot assisted surgeries from surgeons' point of view. Design A single centre, retrospective observational study. Population All women who underwent robotic gynaecological surgeries between 2015 and 2022. Methods The Da Vinci Si™ robotic system was used for these surgeries performed by all surgeons at our quaternary care centre, and data were acquired retrospectively through electronic medical records. Descriptive statistical analysis of data was done. Main outcome measures included operative time, estimated blood loss, hospital stay, complications and conversion rates in all cases. Age was analysed as a demographic data. Outcome A total of 211 robotic cases were performed including 172 hysterectomies, 20 myomectomies and 19 cases for other gynaecological indications. The mean operating time or hysterectomy and myomectomy was 113 and 129 min, respectively, and haemoglobin drop was 1.34 and 1.2 g/dl, respectively. No conversions to laparotomy were observed in either of the groups. The surgeries for 19 benign gynaecological conditions included ovarian cystectomy, cesarean scar repair and chronic cornual ectopic. Conclusion Robotic surgical system helps accomplish several procedures with exceptional laparoscopic skills. Robotic surgery is safe in all types of gynaecological procedures and is a promising alternative for comprehensive gynaecologic surgical care.
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Affiliation(s)
- Mayadevi Kurup
- Department of Obstetrics and Gynaecology, Aster Medcity, Kochi, Kerala India
| | - Suguna Bidarahalli
- Department of Obstetrics and Gynaecology, Aster Medcity, Kochi, Kerala India
- Bangalore, India
| | - Surya Jayaram
- Department of Obstetrics and Gynaecology, Medical Trust Hospital, Kochi, Kerala India
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Whiteside JL, Tumin D, Hildebrand JP, Harris A. Determinants of Surgical Approach for Benign Outpatient Hysterectomy. J Minim Invasive Gynecol 2024; 31:123-130.e2. [PMID: 37984517 DOI: 10.1016/j.jmig.2023.11.009] [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: 07/07/2023] [Revised: 10/11/2023] [Accepted: 11/15/2023] [Indexed: 11/22/2023]
Abstract
STUDY OBJECTIVE Identify determinants of the surgical approach to a benign, outpatient, minimally invasive hysterectomy. DESIGN A cross-sectional sample of patients undergoing outpatient hysterectomy between the 4th quarter of 2015 and the 4th quarter of 2022, excluding those with a diagnosis of gynecologic malignancy, was obtained from the Vizient Clinical Data Base. The primary outcome was surgical approach to hysterectomy that was analyzed using mixed-effects regression, including a surgeon-level random effects to capture unobserved surgeon-level differences influencing variation in surgical approach. SETTING The Vizient Clinical Data Base includes patient encounter data from >50 healthcare systems and >400 community hospitals and represents approximately 97% of academic medical centers in the United States. PATIENTS Women >18 years undergoing an outpatient benign hysterectomy. INTERVENTION Surgical approach to hysterectomy. MEASUREMENT AND MAIN RESULT The final sample included 411 208 cases performed by 6089 surgeons. Among observed variables, patient diagnosis, surgeon specialty, and insurance type were strongly associated with choice of approach. However, after controlling for patient, hospital, and observable surgeon characteristics, unobserved surgeon-level differences still accounted for 72% of the variance in the use of transvaginal hysterectomy (95% confidence interval, 71-73) and 85% of the variance in the use of robot-assisted total hysterectomy (95% confidence interval, 84-86). CONCLUSION The strongest determinant of surgical approach to a benign outpatient hysterectomy in the United States was not patient- or hospital-level variability, but unexplained differences across individual surgeons. This has implications in how surgeons are trained and incentivized to deliver high-value surgical care.
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Affiliation(s)
- James L Whiteside
- Department of Obstetrics and Gynecology (Drs. Whiteside and Hildebrand), East Carolina University, Brody School of Medicine, Greenville, NC.
| | - Dmitry Tumin
- Department of Pediatrics (Dr. Tumin), East Carolina University, Brody School of Medicine, Greenville, NC
| | - Jason P Hildebrand
- Department of Obstetrics and Gynecology (Drs. Whiteside and Hildebrand), East Carolina University, Brody School of Medicine, Greenville, NC
| | - Alyssa Harris
- Vizient Inc., Center for Advanced Analytics and Informatics, Chicago, IL (Ms. Harris)
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Hossaini D, Wahdat MM, Aklaqi A, Haidary M. A rare case report of orchiopexy and hysterectomy in an Afghan boy with persistent Müllerian duct syndrome. Int J Surg Case Rep 2024; 115:109235. [PMID: 38217920 PMCID: PMC10821579 DOI: 10.1016/j.ijscr.2024.109235] [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: 11/14/2023] [Revised: 01/02/2024] [Accepted: 01/05/2024] [Indexed: 01/15/2024] Open
Abstract
INTRODUCTION Persistent Müllerian duct syndrome (PMDS), a rare genetic aberration, is characterized by the presence of Müllerian duct (MD) features in males. PMDS is usually caused by a defect in the Müllerian inhibitory system and is discovered during surgical interventions. CASE REPORT We present the case of a 14-year-old Afghan boy with severe abdominal pain who was initially diagnosed with bilateral undescended testicles and abdominal complex cysts. He was supposed to undergo a cystectomy and orchiopexy surgery. During the surgical intervention, an unexpected finding was made whereby fibrotic-like ovaries, fallopian tubes, and a segment of the uterus were identified, ultimately leading to the diagnosis of PMDS. The MD was carefully removed, and the testicles were delicately repositioned during an orchiopexy procedure. DISCUSSION In our case, the patient exhibited bilateral undescended testicles along with fibrotic-like ovaries, fallopian tubes, and a portion of the uterus, representing the presence of the female type of PMDS. To safeguard fertility, orchidopexy is recommended for pediatric patients. Conversely, in the older age group, orchidectomy is advised as a precautionary measure against the heightened susceptibility to testicular carcinoma. CONCLUSION PMDS can be associated with an undescended testicle and abdominal pain. Hence, it is crucial to thoroughly evaluate patients who have undescended testes for the presence of PMDS, and surgeons must maintain a heightened sense of awareness for PMDS while exploring individuals who present with bilateral undescended testes, as exemplified in our case.
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Affiliation(s)
- Dawood Hossaini
- Department of Biology and Microbiology, School of Medical Laboratory Technology, Khatam Al- Nabieen University, Kabul, Afghanistan.
| | | | - Ali Aklaqi
- Faculty of Medicine, Khatam -Al Nabieen University, Kabul, Afghanistan
| | - Murtaza Haidary
- Medical Research and Technology Center, Khatam Al Nabieen University, Kabul, Afghanistan.
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O'Connor RM, Scott ME, Rimel BJ. Vaginal Cuff Dehiscence in Transgender Patients After Minimally Invasive Hysterectomy. J Minim Invasive Gynecol 2024; 31:138-146. [PMID: 37925016 DOI: 10.1016/j.jmig.2023.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/21/2023] [Accepted: 10/26/2023] [Indexed: 11/06/2023]
Abstract
STUDY OBJECTIVE To compare rates of vaginal cuff dehiscence (VCD) in transgender patients with cisgender patients after minimally invasive hysterectomy (MIH). DESIGN We performed a single-surgeon, retrospective cohort analysis comparing the rates of VCD in patients undergoing MIH for gender affirmation with other indications (benign, malignant, prophylactic) with our study surgeon between January, 2015, and December, 2021. SETTING Major, urban, academic tertiary care hospital in the United States. PATIENTS 166 patients met inclusion criteria with 49 of those patients undergoing MIH (29.5%) for gender affirmation. Of the remaining 117 patients, 92 (78.6%) underwent MIH for cancer, 15 (12.8%) for prophylaxis, and 10 (8.5%) for benign indications. INTERVENTIONS Not applicable. MEASUREMENTS We assessed included patients for baseline demographics, presence of risk factors for VCD, details of index hysterectomy, and details of cuff dehiscence events. MAIN RESULTS Transgender patients tended to be younger at the time of surgery, but demographics were otherwise similar between both groups. Most transgender patients (n = 36, 73.5%) had both ovaries removed at the time of hysterectomy, 100% were on testosterone therapy pre- and postoperatively, and none used supplementary estrogen. Three of the 49 transgender patients (6.1%) experienced postoperative dehiscence of the vaginal cuff compared with 2 of the 117 cisgender patients (1.7%). This failed to reach statistical significance; however, our descriptive analysis showed that all cases of dehiscence in the cisgender group had identifiable precipitating factors (i.e., trauma). By comparison, all cases of dehiscence in the transgender group were spontaneous with few identifiable risk factors. CONCLUSION Transgender patients undergoing MIH may be at increased risk of VCD, although the rarity of this surgical complication precluded determination of statistical significance in our data set. We propose testosterone exposure as a possible risk factor for VCD, although we cannot exclude other factors, such as young age, as drivers of VCD in this population. Future studies of biospecimens are needed to evaluate for cellular differences in these patients.
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Affiliation(s)
- Reed M O'Connor
- Department of Obstetrics and Gynecology (Dr. O'Connor), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Marla E Scott
- Division of Gynecologic Oncology (Drs. Scott and Rimel)
| | - B J Rimel
- Division of Gynecologic Oncology (Drs. Scott and Rimel).
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Jin S, Li S, Fang P, Pan C, Huang S. Association of hysterectomy with nonalcoholic fatty liver disease among US women. Lipids Health Dis 2024; 23:34. [PMID: 38297360 PMCID: PMC10829175 DOI: 10.1186/s12944-024-02020-4] [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: 10/26/2023] [Accepted: 01/16/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND A postmenopausal rise in the rates of nonalcoholic fatty liver disease (NAFLD) has been reported in women. This study thus sought to further probe the association of hysterectomy with NAFLD. METHODS The data utilized in this investigation were attained from the 2017-March 2020 cycle of the National Health and Nutrition Examination Survey (NHANES), reflecting a strategic utilization of comprehensive health and nutrition information in the US population, to conduct a cross-sectional examination of the relationship between self-reported hysterectomy and NAFLD. Subjects included in this study were women aged 20 years or older. The multivariable logistic regression methodologies were utilized to determine the pertinent odds ratios (ORs) and their associated 95% confidence intervals (CIs). RESULTS Of the 2,868 subjects enrolled in this study (mean age: 51.3 years, 95%CI: 50.0-52.6 years), 22.1% (95%CI: 19.7-24.7%) reported having undergone a hysterectomy, while 31.1% (95%CI: 28.1-34.1%) exhibited elastographic evidence of NAFLD, and 3.8% (95%CI: 2.6-5.6%) exhibited clinically significant fibrosis (CSF). Relative to women with no history of hysterectomy, those that had undergone hysterectomy exhibited a higher odd of NAFLD (OR:1.66, 95%CI: 1.24-2.21) in a multivariable model fully adjusted for age, ethnicity, body mass index, female hormone use, oophorectomy, diabetes, hyperlipidemia, and smoking status. Subgroup analyses revealed a stronger association among women who were not obese (OR:2.23, 95%CI:1.61-3.11), women who were not affected by diabetes (OR:1.76, 95%CI: 1.25-2.46), and without hyperlipidemia (OR: 1.87, 95%CI: 1.10-3.16). No significant association of hysterectomy with NAFLD encompassing CSF was identified. CONCLUSIONS The results of the present nationally representative analysis suggested an association between hysterectomy and increased NAFLD prevalence among US women. Knowledge of this relationship may better aid clinical efforts to screen for and manage NAFLD.
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Affiliation(s)
- Shuanghong Jin
- Department of Infectious Disease, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan West Road, Wenzhou, 325027, China
| | - Shaoxun Li
- Department of Infectious Disease, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan West Road, Wenzhou, 325027, China
| | - Peipei Fang
- Department of Infectious Disease, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan West Road, Wenzhou, 325027, China
| | - Chenwei Pan
- Department of Infectious Disease, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan West Road, Wenzhou, 325027, China
| | - Shanshan Huang
- Department of Infectious Disease, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan West Road, Wenzhou, 325027, China.
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Leite S, Chen YS, Walker A, Riccio K, Taylor N, Zighelboim I, Graul A. Role of sentinel lymph node evaluation during hysterectomy for preoperative pathology diagnosis of endometrial intraepithelial neoplasia in a community hospital setting. Gynecol Oncol 2024; 184:83-88. [PMID: 38301310 DOI: 10.1016/j.ygyno.2024.01.026] [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: 10/17/2023] [Revised: 01/09/2024] [Accepted: 01/14/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE To determine the utility of sentinel lymph node (SLN) evaluation during hysterectomy for endometrial intraepithelial neoplasia (EIN) in a community hospital setting and identify descriptive trends among pathology reports from those diagnosed with endometrial cancer (EC). METHODS We reviewed patients who underwent hysterectomy from January 2015 to July 2022 for a pathologically confirmed diagnosis of EIN obtained by endometrial biopsy (EMB) or dilation and curettage. Data was obtained via detailed chart review. Statistical testing was utilized for between-group comparisons and multivariate logistic regression modeling. RESULTS Of the 177 patients with EIN who underwent hysterectomy during the study period, 105 (59.3%) had a final diagnosis of EC. At least stage IB disease was found in 29 of these patients who then underwent adjuvant therapy. Pathology report descriptors suspicious for cancer and initial specimen type obtained by EMB were independently and significantly associated with increased odds of EC diagnosis (aOR 8.192, p < 0.001;3.746, p < 0.001, respectively). Operative times were not increased by performance of SLN sampling while frozen specimen evaluation added an average of 28 min to procedure length. Short-term surgical outcomes were also similar between groups. CONCLUSION Patients treated for EIN at community-based institutions might be more likely to upstage preoperative EIN diagnoses and have an increased risk of later stage disease than previous research suggests. Given no surgical time or short-term outcome differences, SLN evaluation should be more strongly considered in this practice setting, especially for patients diagnosed by EMB or with pathology reports indicating suspicion for EC.
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Affiliation(s)
- Samantha Leite
- Department of Obstetrics and Gynecology, St. Luke's University Health Network, 801 Ostrum St., Bethlehem, PA 18015, United States of America.
| | - Yiting Stefanie Chen
- Division of Gynecologic Oncology, St. Luke's University Health Network, 701 Ostrum St. Suite 502, Bethlehem, PA 18015, United States of America
| | - Allison Walker
- Division of Gynecologic Oncology, St. Luke's University Health Network, 701 Ostrum St. Suite 502, Bethlehem, PA 18015, United States of America
| | - Kelly Riccio
- Lewis Katz School of Medicine at Temple University, St. Luke's University Health Network, 3500 N Broad St., Philadelphia, PA 19140, United States of America
| | - Nicholas Taylor
- Division of Gynecologic Oncology, St. Luke's University Health Network, 701 Ostrum St. Suite 502, Bethlehem, PA 18015, United States of America
| | - Israel Zighelboim
- Division of Gynecologic Oncology, St. Luke's University Health Network, 701 Ostrum St. Suite 502, Bethlehem, PA 18015, United States of America
| | - Ashley Graul
- Division of Gynecologic Oncology, St. Luke's University Health Network, 701 Ostrum St. Suite 502, Bethlehem, PA 18015, United States of America
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Chikazawa K, Muro S, Yamaguchi K, Imai K, Kuwata T, Konno R, Akita K. Denonvilliers' fascia as a potential nerve-course marker for the female urinary bladder. Gynecol Oncol 2024; 184:1-7. [PMID: 38271772 DOI: 10.1016/j.ygyno.2024.01.025] [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: 11/19/2023] [Revised: 01/04/2024] [Accepted: 01/14/2024] [Indexed: 01/27/2024]
Abstract
OBJECTIVES This study investigated the relationship between Denonvilliers' fascia (DF) and the pelvic plexus branches in women and explored the possibility of using the DF as a positional marker in nerve-sparing radical hysterectomy (RH). METHODS This study included eight female cadavers. The DF, its lateral border, and the pelvic autonomic nerves running lateral to the DF were dissected and examined. The pelvis was cut into two along the mid-sagittal line. The uterine artery, deep uterine veins, vesical veins, and nerve branches to the pelvic organs were carefully dissected. RESULTS The nerves ran sagitally, while the DF ran perpendicularly to them. The rectovaginal ligament was continuous with the DF, forming a single structure. The DF attached perpendicularly and seamlessly to the pelvic plexus. The pelvic plexus branches were classified into a ventral part branching to the bladder, uterus, and upper vagina and a dorsal part branching to the lower vagina and rectum as well as into four courses. Nerves were attached to the rectovaginal ligament and ran on its surface to the bladder ventral to the DF. The uterine branches split from the common trunk of these nerves. The most dorsal branch to the bladder primarily had a common trunk with the uterine branch, which is the most important and should be preserved in nerve-sparing Okabayashi RH. CONCLUSION The DF can be used as a marker for nerve course, particularly in one of the bladder branches running directly superior to the DF, which can be preserved in nerve-sparing Okabayashi RH.
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Affiliation(s)
- Kenro Chikazawa
- Department of Obstetrics and Gynecology, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama 330-8503, Japan; Department of Clinical Anatomy, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo City, Tokyo 113-8510, Japan.
| | - Satoru Muro
- Department of Clinical Anatomy, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo City, Tokyo 113-8510, Japan.
| | - Kumiko Yamaguchi
- Department of Clinical Anatomy, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo City, Tokyo 113-8510, Japan.
| | - Ken Imai
- Department of Obstetrics and Gynecology, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama 330-8503, Japan
| | - Tomoyuki Kuwata
- Department of Obstetrics and Gynecology, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama 330-8503, Japan.
| | - Ryo Konno
- Department of Obstetrics and Gynecology, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama 330-8503, Japan
| | - Keiichi Akita
- Department of Clinical Anatomy, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo City, Tokyo 113-8510, Japan.
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Fusegi A, Kanao H, Kamata M, Nishino S, Abe A, Omi M, Nomura H. Clinical implications of the superficial uterine vein pattern for the dissection of the anterior layer of the vesicouterine ligament in radical hysterectomy. J Gynecol Oncol 2024; 35:35.e50. [PMID: 38282260 DOI: 10.3802/jgo.2024.35.e50] [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: 09/03/2023] [Revised: 12/06/2023] [Accepted: 12/31/2023] [Indexed: 01/30/2024] Open
Abstract
OBJECTIVE To describe anatomic patterns of the superficial uterine vein (sUV) and assess their association with aspects of the dissection procedure of the anterior layer of the vesicouterine ligament (aVUL) by retrospectively reviewing surgical videos. METHODS We analyzed patients who underwent laparoscopic radical hysterectomy for early-stage cervical cancer from 2014 to 2019. The primary endpoint was the time required for aVUL dissection. Multiple linear regression analyses were performed to identify factors influencing the time required for aVUL dissection. RESULTS Fifty-three Japanese patients were included. Two sUV configurations were observed: type 1 (the vein ran ventral to the ureter along the uterine artery) and type 2 (the vein did not run along the usual ventral course; it ran dorsal to the ureter or was absent). Approximately 30% of the sUVs were type 2. The total time for dissection of both sides of the aVUL was significantly shorter for type 2 sUVs than for type 1 sUVs. The number of hemostatic interventions during dissection of each side of the aVUL was significantly lower for type 2 sUVs than for type 1 sUVs. In the multivariate analysis, the sUV configuration was the factor significantly influencing the duration of aVUL dissection on each side (right side: β=-143.4; left side, β=-160.4). CONCLUSION We demonstrated that the sUV had 2 types of courses, ventral and others, and its course affected the time required for dissection and the number of hemostatic interventions. Our results provide information supportive of improved radical hysterectomy outcomes.
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Affiliation(s)
- Atsushi Fusegi
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hiroyuki Kanao
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.
| | - Mayumi Kamata
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shogo Nishino
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akiko Abe
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Makiko Omi
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hidetaka Nomura
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
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Turan A, Karabayır HB, Kaya İG. Examining the changes in women's lives after the hysterectomy operation: Experiences of women from Turkey. Arch Womens Ment Health 2024:10.1007/s00737-024-01419-3. [PMID: 38183419 DOI: 10.1007/s00737-024-01419-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 01/02/2024] [Indexed: 01/08/2024]
Abstract
PURPOSE The aim of the study is to examine what kind of changes the operation has brought about in the social and psychological life of women. METHODS The study was a hermeneutic-phenomenological research conducted using qualitative research methods. It took place between May and July 2023 at a university hospital located in Istanbul, Turkey. Following ethical approval, the study included a total of 24 women who had undergone a 'total abdominal hysterectomy, bilateral salpingo-oophorectomy.' These participants were selected using a combination of maximum diversity sampling and random sampling methods. Data collection was carried out using a semi-structured interview form. The interviews were conducted using face-to-face interview techniques and in-depth interview methods. Qualitative data analysis involved using the coding paradigm of Grounded Theory and Straus and Corbin's coding framework. For the analysis of quantitative data, SPSS version 28.0 was employed, while qualitative data were analyzed using MaxQDA Analytics Pro 2022. RESULTS The study found that the participants had a mean age of 47 ± 7.53, and the majority, 66.7%, had not reached menopause before the operation. The qualitative analysis of the semi-structured interviews revealed five main themes, which were identified as follows: 'hysterectomy experiences', 'the impact of hysterectomy on sexual life', 'the significance attributed to the uterus', 'the significance attributed to femininity', and 'self-efficacy after hysterectomy'. CONCLUSIONS The study revealed that women experienced changes in self-perception, body image, a sense of organ loss, and developed negative attitudes towards menopause following a hysterectomy. Additionally, there was a noticeable connection between the meanings attributed to the uterus and femininity, which was often influenced by cultural and social factors. In light of these findings, it is recommended that women receive counseling from healthcare professionals before undergoing a hysterectomy. This guidance can help women better understand and cope with the physical, emotional, and cultural aspects of the procedure.
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Affiliation(s)
- Ayşenur Turan
- Department of Midwifery, Faculty of Health Sciences, Istanbul Medipol University, Istanbul, Turkey.
| | - Hilal Başak Karabayır
- Department of Midwifery, Faculty of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
| | - İffet Güler Kaya
- Department of Midwifery, Faculty of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
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Hwang JH, Kim B. Comparison of survival outcomes between robotic and laparoscopic radical hysterectomies for early-stage cervical cancer: a systemic review and meta-analysis. J Gynecol Oncol 2024; 35:e9. [PMID: 37857564 PMCID: PMC10792214 DOI: 10.3802/jgo.2024.35.e9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/08/2023] [Accepted: 09/04/2023] [Indexed: 10/21/2023] Open
Abstract
OBJECTIVE Survival outcomes of robotic radical hysterectomy (RRH) remain controversial. Therefore, we performed a meta-analysis to evaluate survival outcomes between RRH) and laparoscopic radical hysterectomy (LRH) in patients with early-stage cervical cancer. METHODS Studies comparing between RRH and LRH published up to November 2022 were systemically searched in the PubMed, Cochrane Library, Web of Science, ScienceDirect, and Google Scholar databases. Manual searches of related articles and relevant bibliographies of the published studies were also performed. Two researchers independently extracted data. Studies with information on recurrence and death after minimally invasive radical hysterectomy were also included. The extracted data were analyzed using the Stata MP software package version 17.0. RESULTS Twenty eligible clinical trials were included in the meta-analysis. When all studies were pooled, the odds ratios of RRH for recurrence and death were 1.19 (95% confidence interval [CI]=0.91-1.55; p=0.613; I²=0.0%) and 0.96 (95% CI=0.65-1.42; p=0.558; I²=0.0%), respectively. In a subgroup analysis, the quality of study methodology, study size, country where the study was conducted, and publication year were not associated with survival outcomes between RRH and LRH. CONCLUSION This meta-analysis demonstrates that the survival outcomes are comparable between RRH and LRH. TRIAL REGISTRATION International Prospective Register of Systematic Reviews Identifier: CRD42023387916.
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Affiliation(s)
- Jong Ha Hwang
- Department of Obstetrics and Gynecology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea.
| | - Bitnarae Kim
- Department of Obstetrics and Gynecology, Dongwon Cancer Specialized Care Hospital, Goyang, Korea
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Kim JH, Choi HY, Park YH, Kim SH, Chae HD, Lee SR. A new knotless parametrial tissue ligation technique for safe total laparoscopic hysterectomy. Obstet Gynecol Sci 2024; 67:120-131. [PMID: 38104531 DOI: 10.5468/ogs.23179] [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: 07/14/2023] [Accepted: 11/02/2023] [Indexed: 12/19/2023] Open
Abstract
OBJECTIVE Parametrial tissue ligation during total laparoscopic hysterectomy (TLH) is important in large uteri with large vessels. METHODS A retrospective study was performed at Asan Medical Center for comparing TLH performed with a new knotless parametrial tissue ligation method and conventional laparoscopic-assisted vaginal hysterectomy (LAVH) from March 2019 to August 2021. For TLH, after anterior colpotomy, the parametrial tissue was ligated by anchoring the suture and making a loop in one direction three times using 1-0 V-LocTM 180 (Covidien, Mansfield, MA, USA) suture. Subsequently, the cranial part of the loop was cut using an endoscopic device. RESULTS A total of 119 and 178 patients were included in the TLH and LAVH groups, respectively. The maximal diameter of the uterus was larger in the TLH group (106.29±27.16 cm) than in the LAVH group (99.00±18.92 cm, P=0.01). The change in hemoglobin (Hb) level was greater in the LAVH group than in the TLH group (P<0.001). The weight of the removed uterus was greater in the TLH group than in the LAVH group (431.95±394.97 vs. 354.94±209.52 g; P=0.03). However, when the uterine weight was >1,000 g, the operative times and change in Hb levels were similar between the two groups. In both groups, no ureteral complications occurred during or after surgery. CONCLUSION Knotless parametrial tissue ligation using 1-0 V-LocTM 180 suture in TLH can be safely applied, even in cases with large uteri, without increased risks of ureteral injury or uterine bleeding.
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Affiliation(s)
- Ju Hee Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hea Yeon Choi
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Hee Park
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Hoon Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Dong Chae
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sa Ra Lee
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Carlson S, Brando A, McGregor AE, Sutaria T, Hurtado E, Padilla PF, Arnolds K. Comparison of Postoperative Complications Between Laparoscopic Myomectomy and Total Laparoscopic Hysterectomy. J Minim Invasive Gynecol 2024; 31:43-48. [PMID: 37820828 DOI: 10.1016/j.jmig.2023.10.005] [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: 07/05/2023] [Revised: 09/24/2023] [Accepted: 10/06/2023] [Indexed: 10/13/2023]
Abstract
STUDY OBJECTIVE To compare postoperative complications of laparoscopic myomectomy (LM) with total laparoscopic hysterectomy (TLH). A secondary outcome examined whether complications differ by age. DESIGN A retrospective cohort study. SETTING A multicenter academic healthcare system. PATIENTS Individuals > 18 years old undergoing LM from 2011 to 2021 or TLH for benign indications from 2020 to 2021. INTERVENTIONS LM or TLH. MEASUREMENTS AND MAIN RESULTS There were 1178 patients in the LM group and 1304 in the TLH group. Patients who underwent LM were younger, more often premenopausal, nonsmokers, with lower body mass index, lower preoperative hemoglobin, larger uterine size, and lower American Society of Anesthesiologists class. LM had longer operative times (154.1 ± 74.5 vs 145.9 ± 70.5 min, p <.0001), higher use of intraoperative hemostatic agents (25% vs 9.1%, p <.0001), and higher estimated blood loss (222.7 ± 313.0 vs 87.4 ± 145.9 mL, p <.0001) than TLH. Postoperatively, LM was associated with fewer surgical site infections (3.1% vs 5.8%, p <.0001), readmissions within 30 days (2.0% vs 5.6%, p <.0001), or emergency department visits within 90 days (10.9% vs 14.4%, p = .008). LM were more likely to be admitted 24 hours postoperatively (5.9% vs 3.4%, p = .0023) or receive a blood transfusion within 30 days (4.0% vs 1.0%, p <.0001). Variables associated with increased risk of postoperative complications were tobacco use, American Society of Anesthesiologists class > 3, preoperative anemia, estimated blood loss ≥ 150 mL, and specimen weight > 250 g. Logistic regression demonstrated that operative time ≥185 minutes was most strongly associated with 24-hour admission postoperatively (odds ratio [OR] = 12.95; 95% confidence interval [CI], 3.71-45.27). In individuals ≤ 37 years of age, the LM group was less likely than the TLH group to experience surgical site infection (OR, 0.30; 95% CI, 0.14-0.62) or present to the emergency department (OR, 0.40; 95% CI, 0.26-0.63). CONCLUSION In this large cohort of patients, both LM and TLH had low rates of postoperative complications, but the complications differed for each approach. In appropriate surgical candidates, either approach may be offered based upon patients' goals.
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Affiliation(s)
- Sonia Carlson
- Section of Minimally Invasive Gynecologic Surgery, Department of Gynecology (Drs. Carlson, McGregor, Sutaria, Hurtado, Frazzini Padilla, and Arnolds), Cleveland Clinic Florida, Weston, FL.
| | | | - Ali E McGregor
- Section of Minimally Invasive Gynecologic Surgery, Department of Gynecology (Drs. Carlson, McGregor, Sutaria, Hurtado, Frazzini Padilla, and Arnolds), Cleveland Clinic Florida, Weston, FL
| | - Tarangi Sutaria
- Section of Minimally Invasive Gynecologic Surgery, Department of Gynecology (Drs. Carlson, McGregor, Sutaria, Hurtado, Frazzini Padilla, and Arnolds), Cleveland Clinic Florida, Weston, FL
| | - Eric Hurtado
- Section of Minimally Invasive Gynecologic Surgery, Department of Gynecology (Drs. Carlson, McGregor, Sutaria, Hurtado, Frazzini Padilla, and Arnolds), Cleveland Clinic Florida, Weston, FL
| | - Pamela Frazzini Padilla
- Section of Minimally Invasive Gynecologic Surgery, Department of Gynecology (Drs. Carlson, McGregor, Sutaria, Hurtado, Frazzini Padilla, and Arnolds), Cleveland Clinic Florida, Weston, FL
| | - Katrin Arnolds
- Section of Minimally Invasive Gynecologic Surgery, Department of Gynecology (Drs. Carlson, McGregor, Sutaria, Hurtado, Frazzini Padilla, and Arnolds), Cleveland Clinic Florida, Weston, FL
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Glass Clark S, Bretschneider CE, Bradley MS, Rhodes S, Shoag J, Sheyn D. Risk of postoperative mesh exposure following sacrocolpopexy with supracervical versus total concomitant laparoscopic hysterectomy. Int Urogynecol J 2024; 35:207-213. [PMID: 38060029 DOI: 10.1007/s00192-023-05658-3] [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: 07/10/2023] [Accepted: 09/14/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The primary objective was to compare rates of mesh exposure in women undergoing minimally invasive sacrocolpopexy with concurrent supracervical vs total hysterectomy. We hypothesized there would be a lower risk of mesh exposure for supracervical hysterectomy. METHODS This was a retrospective cohort study using the Premier Healthcare Database. Women undergoing sacrocolpopexy with supracervical or total hysterectomy between 2010 and 2018 were identified using Current Procedural (CPT) codes. Complications were identified using CPT and diagnosis codes; reoperations were identified using CPT codes. Mesh exposures were measured over a 2-year period. A multivariable logistic regression was performed with a priori defined predictors of mesh exposure. RESULTS This study includes 17,111 women who underwent minimally invasive sacrocolpopexy with concomitant supracervical or total hysterectomy (6708 (39%) vs 10,403 (61%)). Women who underwent supracervical hysterectomy were older (age 60 ± 11 vs 53 ± 13, p < 0.01) and less likely to be obese (4% vs 7%, p < 0.01). Postoperative mesh exposures within 2 years were similar (supracervical n = 47, 0.7% vs total n = 65, 0.62%, p = 0.61). On logistic regression, obesity significantly reduced the odds of mesh exposure (OR 0.2, 95% CI 0.01, 0.8); concomitant slings increased odds (OR 1.91, 95% CI 1.28, 2.83). Supracervical hysterectomy was associated with higher rates of port site hernias (1.3% vs 0.65%, p < 0.01), but lower surgical site infections within 3 months (0.81% vs 1.2%, p = 0.03). Reoperation for recurrent prolapse within 24 months was similar (supracervical n = 94, 1.4% vs total n = 150, 1.4%, p = 0.88). CONCLUSIONS Postoperative mesh exposure rates do not significantly differ based on type of concomitant hysterectomy in this dataset.
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Affiliation(s)
- Stephanie Glass Clark
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, UPMC Magee-Womens Hospital, Pittsburgh, PA, USA.
| | - C Emi Bretschneider
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Megan S Bradley
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, UPMC Magee-Womens Hospital, Pittsburgh, PA, USA
| | - Stephen Rhodes
- Urology Institute, University Hospitals, Cleveland, OH, USA
| | - Jonathan Shoag
- Division of Urologic Oncology, Urology Institute, University Hospitals, Cleveland, OH, USA
| | - David Sheyn
- Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals, Cleveland, OH, USA
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Maharjan M, Shrestha P, Ghimire S. A rare case of morbidly adherent placenta in a young Primigravida with RH negative pregnancy managed with peripartum subtotal hysterectomy. Int J Surg Case Rep 2024; 114:109121. [PMID: 38061086 PMCID: PMC10755056 DOI: 10.1016/j.ijscr.2023.109121] [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: 11/04/2023] [Revised: 11/21/2023] [Accepted: 12/02/2023] [Indexed: 01/01/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Postpartum hemorrhage (PPH) can be defined as excessive bleeding (>500 ml) from the genital tract after the delivery of baby upto 6 weeks. PPH accounts for major cause of maternal mortality rate. Prevention and early intervention can prevent this complication of delivery. However condition like placenta accreta leads to retention of placenta and makes PPH inevitable. CASE SUMMARY We present the case of massive postpartum hemorrhage secondary to Placenta accreta in young primigravida with RH negative pregnancy. Clinical findings and investigations were not significant during her admission. She delivered the baby via vaginal route but placenta was not expelled till 30 min. Due to failed manual removal of placenta patient was shifted to OT.Manual vacuum aspiration was done in OT setting and chunks of placenta along with blood clots were obtained.Uterine balloon tamponade was inserted. Due to persistent PV bleeding subtotal hysterectomy was carried out in line for placenta accreta. DISCUSSION Placenta accreta being one of the life threatening obstetric condition, it should be diagnosed as early as possible and need prompt management so as to prevent maternal mortality. Due to increasing number of cesarean delivery the cases of placenta accreta has been rising but rarely in some cases can it present in young primigravida with Rh negative pregnancy. CONCLUSION In the cases of morbidly adherent placenta it is necessary for obstetrician to early identify such conditions and timely intervene to save the mother's life. Moreover Rh negative could be a hidden risk factor.
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Affiliation(s)
- Meenu Maharjan
- Department of gynaecology and obstetrics, KIST medical college and teaching hospital, Gwarko, Lalitpur, Nepal
| | - Pratima Shrestha
- Department of gynaecology and obstetrics, KIST medical college and teaching hospital, Gwarko, Lalitpur, Nepal
| | - Sagun Ghimire
- Department of surgery, KIST medical college and Teaching Hospital, Gwarko, Lalitpur, Nepal.
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Komatsu H, Wada I, Harada T, Taniguchi F. First report of robotic-assisted total hysterectomy using the Hugo™ RAS system. Updates Surg 2024; 76:315-318. [PMID: 38070071 DOI: 10.1007/s13304-023-01710-5] [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: 07/26/2023] [Accepted: 11/18/2023] [Indexed: 01/24/2024]
Abstract
This study describes the first reported treatment of a benign gynecological disease with the Medtronic's Hugo™ RAS System, the first robot-assisted device used in the field of gynecology in Japan. Patients who underwent robot-assisted total laparoscopic hysterectomy with the Hugo™ RAS System at the Tottori University Hospital between March 2023 and June 2023 were included in this study. In the first case, the patient was in her 40 s and had uterine fibroids. We describe our experience and compare the device with the conventional da Vinci surgical system. We discuss the key features of the Hugo system (including the independent arms, open console, and pistol-shaped handle), the convenience of robotic surgery, the potential to improve quality of life, and how this technology could revolutionize the field of surgery.
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Affiliation(s)
- Hiroaki Komatsu
- Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Tottori University, Y36-1 Nishicho, Yonago, Tottori, 683-8503, Japan.
| | - Ikumi Wada
- Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Tottori University, Y36-1 Nishicho, Yonago, Tottori, 683-8503, Japan
| | - Tasuku Harada
- Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Tottori University, Y36-1 Nishicho, Yonago, Tottori, 683-8503, Japan
| | - Fuminori Taniguchi
- Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Tottori University, Y36-1 Nishicho, Yonago, Tottori, 683-8503, Japan
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Uwais A, Al-Abadleh A, Jahameh M, Satari A, Al-Hawamdeh Q, Haddadin S. A Comparison between Total Abdominal Hysterectomy versus Total Laparoscopic Hysterectomy. Gynecol Minim Invasive Ther 2024; 13:43-47. [PMID: 38487613 PMCID: PMC10936723 DOI: 10.4103/gmit.gmit_72_23] [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: 06/06/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 03/17/2024] Open
Abstract
Objectives To compare the operative and postoperative outcomes of total laparoscopic hysterectomy (TLH) and total abdominal hysterectomy (TAH). Materials and Methods In this retrospective comparative study, we reviewed all hysterectomies performed in the Al-Karak Governmental Hospital in Al-Karak, Jordan, from September 2018 to July 2022. We enrolled 129 patients who underwent hysterectomy. The patients were divided into the TLH (n = 39) and TAH (n = 90) groups. Patient data were accessed through hospital records and analyzed using SPSS 25.0. Results The most common indication for TLH was uterine fibroid, and that for TAH was abnormal uterine bleeding, although the specimen weights were comparable. There was no significant between-group difference in the patient's demographics. Although the TLH group had longer operative time, the hospital stay was shorter and there were no reported cases of wound infection. The estimated blood loss was significantly lower in the TLH group than in the TAH group, but there was no difference between the two groups in terms of blood transfusion requirement and postoperative hemoglobin level. Conclusion TLH and TAH had comparable overall outcomes in the Al-Karak Governmental Hospital. However, TLH was superior to TAH in terms of blood loss, and patients with TLH recovered faster without postoperative wound infection.
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Affiliation(s)
- Ala Uwais
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mutah University, Al-Karak, Jordan
| | - Ahmed Al-Abadleh
- Department of Clinical Sciences, Faculty of Medicine, Mutah University, Al-Karak, Jordan
| | - Mohammad Jahameh
- Department of Clinical Sciences, Faculty of Medicine, Mutah University, Al-Karak, Jordan
| | - Anas Satari
- Department of Clinical Sciences, Faculty of Medicine, Mutah University, Al-Karak, Jordan
| | - Qabas Al-Hawamdeh
- Department of Clinical Sciences, Faculty of Medicine, Mutah University, Al-Karak, Jordan
| | - Sahel Haddadin
- Department of General Surgery, King Hussein Medical Hospital, Royal Medical Services, Amman, Jordan
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Haji-Noor ZM, Mathias JG, Beltran TG, Anderson LG, Wood ME, Howard AG, Hinton SP, Doll KM, Robinson WR. The Carolina hysterectomy cohort (CHC): a novel case series of reproductive-aged hysterectomy patients across 10 hospitals in the US south. BMC Womens Health 2023; 23:674. [PMID: 38114962 PMCID: PMC10729499 DOI: 10.1186/s12905-023-02837-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/09/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Hysterectomy is a common surgery among reproductive-aged U.S. patients, with rates highest among Black patients in the South. There is limited insight on causes of these racial differences. In the U.S., electronic medical records (EMR) data can offer richer detail on factors driving surgical decision-making among reproductive-aged populations than insurance claims-based data. Our objective in this cohort profile paper is to describe the Carolina Hysterectomy Cohort (CHC), a large EMR-based case-series of premenopausal hysterectomy patients in the U.S. South, supplemented with census and surgeon licensing data. To demonstrate one strength of the data, we evaluate whether patient and surgeon characteristics differ by insurance payor type. METHODS We used structured and abstracted EMR data to identify and characterize patients aged 18-44 years who received hysterectomies for non-cancerous conditions between 10/02/2014-12/31/2017 in a large health care system comprised of 10 hospitals in North Carolina. We used Chi-squared and Kruskal Wallis tests to compare whether patients' socio-demographic and relevant clinical characteristics, and surgeon characteristics differed by patient insurance payor (public, private, uninsured). RESULTS Of 1857 patients (including 55% non-Hispanic White, 30% non-Hispanic Black, 9% Hispanic), 75% were privately-insured, 17% were publicly-insured, and 7% were uninsured. Menorrhagia was more prevalent among the publicly-insured (74% vs 68% overall). Fibroids were more prevalent among the privately-insured (62%) and the uninsured (68%). Most privately insured patients were treated at non-academic hospitals (65%) whereas most publicly insured and uninsured patients were treated at academic centers (66 and 86%, respectively). Publicly insured and uninsured patients had higher median bleeding (public: 7.0, uninsured: 9.0, private: 5.0) and pain (public: 6.0, uninsured: 6.0, private: 3.0) symptom scores than the privately insured. There were no statistical differences in surgeon characteristics by payor groups. CONCLUSION This novel study design, a large EMR-based case series of hysterectomies linked to physician licensing data and manually abstracted data from unstructured clinical notes, enabled identification and characterization of a diverse reproductive-aged patient population more comprehensively than claims data would allow. In subsequent phases of this research, the CHC will leverage these rich clinical data to investigate multilevel drivers of hysterectomy in an ethnoracially, economically, and clinically diverse series of hysterectomy patients.
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Affiliation(s)
- Zakiya M Haji-Noor
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joacy G Mathias
- Division of Women's Community and Population Health and Department of Obstetrics Gynecology, Duke University School of Medicine, Durham, North, Carolina, USA
| | - Theo Gabriel Beltran
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lauren G Anderson
- Division of Women's Community and Population Health and Department of Obstetrics Gynecology, Duke University School of Medicine, Durham, North, Carolina, USA
| | - Mollie E Wood
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Annie Green Howard
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sharon Peacock Hinton
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kemi M Doll
- Department of Obstetrics & Gynecology, University of Washington School of Medicine, Seattle, WA, USA
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA
| | - Whitney R Robinson
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Division of Women's Community and Population Health and Department of Obstetrics Gynecology, Duke University School of Medicine, Durham, North, Carolina, USA.
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Chikazawa K, Imai K, Kuwata T, Konno R. Improved bladder function in radical hysterectomy without worsening oncologic outcome: resection of the posterior layer of the vesicouterine ligament with the procedure limited to the vesical veins. J Gynecol Oncol 2023; 35:35.e28. [PMID: 38156721 DOI: 10.3802/jgo.2024.35.e28] [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: 06/17/2023] [Revised: 10/02/2023] [Accepted: 11/26/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE The classic Okabayashi nerve-sparing radical hysterectomy involves complete resection of the posterior leaf of the vesicouterine ligament, whereas in the simplified nerve-sparing radical hysterectomy, only the vesical veins and some connective tissue of the posterior layer of the vesicouterine ligament are resected. This study aimed to compare bladder function and cervical carcinoma relapse-free survival between these two techniques. METHODS We conducted a retrospective, historical control study. All female patients aged >20 years who were diagnosed with cervical cancer stage IB1-IIB and underwent radical hysterectomy with pelvic lymphadenectomy between 2009 and 2022 were enrolled. Patients who had a history of other cancers and those who were treated with non-surgical approaches or non-radical hysterectomy were excluded. The primary outcome was relapse-free survival during the follow-up period. RESULTS A total of 114 patients who underwent curative-intent radical hysterectomy were included in this study. The median follow-up duration was 60 months. No significant difference was observed in relapse-free survival between the two surgical procedures. The simplified nerve-sparing radical hysterectomy was superior in terms of both motor and sensory bladder function outcomes. CONCLUSION Resection of the posterior layer of the vesicouterine ligament, with the procedure limited to the vesical veins, is an effective and safe method for radical hysterectomy. It may be more useful for preserving the bladder function, without leading to unfavorable oncologic outcomes.
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Affiliation(s)
- Kenro Chikazawa
- Department of Obstetrics and Gynecology, Jichi Medical University, Saitama Medical Center, Saitama, Japan.
| | - Ken Imai
- Department of Obstetrics and Gynecology, Jichi Medical University, Saitama Medical Center, Saitama, Japan
| | - Tomoyuki Kuwata
- Department of Obstetrics and Gynecology, Jichi Medical University, Saitama Medical Center, Saitama, Japan
| | - Ryo Konno
- Department of Obstetrics and Gynecology, Jichi Medical University, Saitama Medical Center, Saitama, Japan
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Dequirez PL, Rosenblum N, Brucker BM. Routine uterine preservation during sacrocolpopexy for apical prolapse-Cons. Prog Urol 2023; 33:1041-1043. [PMID: 37661490 DOI: 10.1016/j.purol.2023.08.021] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 09/05/2023]
Affiliation(s)
- P-L Dequirez
- Division of Female Pelvic Medicine and Reconstructive Surgery and Neuro-urology, Department of Urology, NYU Langone Health, New York, New York City, United States.
| | - N Rosenblum
- Division of Female Pelvic Medicine and Reconstructive Surgery and Neuro-urology, Department of Urology, NYU Langone Health, New York, New York City, United States.
| | - B M Brucker
- Division of Female Pelvic Medicine and Reconstructive Surgery and Neuro-urology, Department of Urology, NYU Langone Health, New York, New York City, United States.
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Sinha J, Pokhriyal AS, Asthana V, Nautiyal R. Dexmedetomidine vs Dexamethasone as an Adjuvant to Levobupivacaine in Ultrasound-Guided Transversus Abdominis Plane Block for Postoperative Analgesia in Patients Undergoing Total Abdominal Hysterectomies. Anesth Pain Med 2023; 13:e142059. [PMID: 38666229 PMCID: PMC11041814 DOI: 10.5812/aapm-142059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 04/28/2024] Open
Abstract
Background In the postoperative period, open total abdominal hysterectomy (TAH) surgeries induce considerable pain. Multimodal strategies are being used to alleviate pain. Objectives This study aimed to examine the efficacy and safety of dexamethasone and dexmedetomidine as an adjuvant to levobupivacaine in ultrasound-guided transversus abdominis plane (TAP) blocks for postoperative pain in TAH patients. Methods A total of 72 patients with ASA grade I and grade II were randomly and equally assigned to two groups. After the completion of surgery with a subarachnoid block (SAB), patients in group 1 received a mixture of 20 mL of 0.25% levobupivacaine and 4 mg of dexamethasone on each side of the TAP block. Patients in group 2 received a mixture of 20 mL of 0.25% levobupivacaine and dexmedetomidine, with a total dose of 1 µg/kg body weight evenly distributed bilaterally in the TAP block. Patients were evaluated for pain using the Visual Analog Scale (VAS), total tramadol consumption as rescue analgesia, time to first rescue analgesia, any adverse effects, and patient satisfaction. Results When comparing VAS scores for pain assessment, we observed that the mean VAS score was initially comparable between the two groups for the first hour. However, at 6, 9, and 12 h, VAS scores were significantly lower in group 2. The mean total tramadol consumption was higher in group 1 than in group 2 (213.33 ± 44.08 vs 161.11 ± 37.93 mg, P-value 0.027). The time to the first rescue analgesia after the TAP block in the postoperative period was significantly longer in group 2 (47.5 ± 62.76 vs 77.22 ± 56.14 min, P-value 0.002). No significant side effects were noted, and a greater proportion of patients in group 2 expressed satisfaction with their overall pain treatment. Conclusions The addition of dexmedetomidine to levobupivacaine is superior to the addition of dexamethasone, as it prolongs the duration of the block in the dexmedetomidine group. However, the use of dexamethasone as an adjuvant is a good alternative option, particularly due to its lower cost and reduced incidence of adverse effects such as postoperative nausea and vomiting.
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Affiliation(s)
- Jyoti Sinha
- Department of Anesthesiology, Himalayan Institute of Medical Sciences, Jollygrant, Dehradun
| | | | - Veena Asthana
- Department of Anesthesiology, Himalayan Institute of Medical Sciences, Jollygrant, Dehradun
| | - Ruchira Nautiyal
- Department of Gynecology, Himalayan Institute of Medical Sciences, Jollygrant, Dehradun
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Yuk JS, Cho IC, Lee JH. The Risk of Stress Urinary Incontinence After Hysterectomy for Uterine Fibroids. Int Neurourol J 2023; 27:252-259. [PMID: 38171325 PMCID: PMC10762370 DOI: 10.5213/inj.2346192.096] [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: 08/09/2023] [Accepted: 10/10/2023] [Indexed: 01/05/2024] Open
Abstract
PURPOSE We evaluated the relationship between previous hysterectomy for uterine fibroids and subsequent stress urinary incontinence (SUI). METHODS This study analyzed national health insurance data. The hysterectomy group (aged 40 to 59) comprised patients who underwent hysterectomy for uterine fibroids between January 1, 2011 and December 31, 2014, and the control group (aged 40 to 59) comprised patients who visited a medical facility for a checkup during the same time span. One-to-one propensity score matching was performed to balance confounders. SUI was defined as the need for SUI surgery accompanied by a diagnosis code for SUI. RESULTS After matching, 81,373 cases (hysterectomy group) and 81,373 controls (nonhysterectomy group) were enrolled. The mean follow-up period was 7.9 years for the cases and 7.8 years for the controls. The incidence of anti-incontinence surgery was slightly but significantly higher in the cases than in the controls (2.0% vs. 1.7%, P<0.001). Compared to the control group, abdominal hysterectomy significantly increased the likelihood of anti-incontinence surgery both before (hazard ratio [HR], 1.235; 95% confidence interval [CI], 1.116-1.365) and after adjusting for confounders (HR, 1.215; 95% CI, 1.097-1.347). In contrast, laparoscopic hysterectomy, laparoscopic hysterectomy with adnexal surgery, and abdominal hysterectomy with adnexal surgery were not associated with an increased rate of anti-incontinence surgery. The significant association between abdominal hysterectomy and an elevated rate of anti-incontinence surgery persisted even after stratifying patients by age group. CONCLUSION Prior abdominal hysterectomy without adnexal surgery was associated with an increased incidence of subsequent anti-urinary incontinence surgery.
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Affiliation(s)
- Jin-Sung Yuk
- Department of Obstetrics and Gynecology, Inje University Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Korea
| | - In-Chang Cho
- Department of Urology, National Police Hospital, Seoul, Korea
| | - Jun Ho Lee
- Department of Urology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
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Lenfant L, Canlorbe G, Belghiti J, Kreaden US, Hebert AE, Nikpayam M, Uzan C, Azaïs H. Robotic-assisted benign hysterectomy compared with laparoscopic, vaginal, and open surgery: a systematic review and meta-analysis. J Robot Surg 2023; 17:2647-2662. [PMID: 37856058 PMCID: PMC10678826 DOI: 10.1007/s11701-023-01724-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 07/06/2023] [Accepted: 09/17/2023] [Indexed: 10/20/2023]
Abstract
The potential benefits and limitations of benign hysterectomy surgical approaches are still debated. We aimed at evaluating any differences with a systematic review and meta-analysis. PubMed, MEDLINE, and EMBASE databases were last searched on 6/2/2021 to identify English randomized controlled trials (RCTs), prospective cohort and retrospective independent database studies published between Jan 1, 2010 and Dec 31, 2020 reporting perioperative outcomes following robotic hysterectomy versus laparoscopic, open, or vaginal approach (PROSPERO #CRD42022352718). Twenty-four articles were included that reported on 110,306 robotic, 262,715 laparoscopic, 189,237 vaginal, and 554,407 open patients. The robotic approach was associated with a shorter hospital stay (p < 0.00001), less blood loss (p = 0.009), and fewer complications (OR: 0.42 [0.27, 0.66], p = 0.0001) when compared to the open approach. The main benefit compared to the laparoscopic and vaginal approaches was a shorter hospital (R/L WMD: - 0.144 [- 0.21, - 0.08], p < 0.0001; R/V WMD: - 0.39 [- 0.70, - 0.08], p = 0.01). Other benefits seen were sensitive to the inclusion of database studies. Study type differences in outcomes, a lack of RCTs for robotic vs. open comparisons, learning curve issues, and limited robotic vs. vaginal publications are limitations. While the robotic approach was mainly comparable to the laparoscopic approach, this meta-analysis confirms the classic benefits of minimally invasive surgery when comparing robotic hysterectomy to open surgery. We also reported the advantages of robotic surgery over vaginal surgery in a patient population with a higher incidence of large uterus and prior surgery.
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Affiliation(s)
- Louis Lenfant
- Department of Urology, Academic Hospital Pitié-Salpêtrière, APHP, Sorbonne Université, 75013, Paris, France
- Department of Surgery and Oncological Gynecology, Pitié-Salpétrière University Hospital, Assistance Publique des Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Geoffroy Canlorbe
- Department of Surgery and Oncological Gynecology, Pitié-Salpétrière University Hospital, Assistance Publique des Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Jérémie Belghiti
- Department of Surgery and Oncological Gynecology, Pitié-Salpétrière University Hospital, Assistance Publique des Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Usha Seshadri Kreaden
- Biostatistics & Global Evidence Management, Intuitive Surgical Inc, Sunnyvale, CA, USA
| | - April E Hebert
- Biostatistics & Global Evidence Management, Intuitive Surgical Inc, Sunnyvale, CA, USA
| | - Marianne Nikpayam
- Department of Surgery and Oncological Gynecology, Pitié-Salpétrière University Hospital, Assistance Publique des Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Catherine Uzan
- Department of Surgery and Oncological Gynecology, Pitié-Salpétrière University Hospital, Assistance Publique des Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Henri Azaïs
- Department of Surgery and Oncological Gynecology, Pitié-Salpétrière University Hospital, Assistance Publique des Hôpitaux de Paris, Sorbonne University, Paris, France.
- Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP, Centre, Université de Paris Cité, Paris, France.
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Shafiei SB, Shadpour S, Mohler JL, Sasangohar F, Gutierrez C, Seilanian Toussi M, Shafqat A. Surgical skill level classification model development using EEG and eye-gaze data and machine learning algorithms. J Robot Surg 2023; 17:2963-2971. [PMID: 37864129 PMCID: PMC10678814 DOI: 10.1007/s11701-023-01722-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/19/2023] [Indexed: 10/22/2023]
Abstract
The aim of this study was to develop machine learning classification models using electroencephalogram (EEG) and eye-gaze features to predict the level of surgical expertise in robot-assisted surgery (RAS). EEG and eye-gaze data were recorded from 11 participants who performed cystectomy, hysterectomy, and nephrectomy using the da Vinci robot. Skill level was evaluated by an expert RAS surgeon using the modified Global Evaluative Assessment of Robotic Skills (GEARS) tool, and data from three subtasks were extracted to classify skill levels using three classification models-multinomial logistic regression (MLR), random forest (RF), and gradient boosting (GB). The GB algorithm was used with a combination of EEG and eye-gaze data to classify skill levels, and differences between the models were tested using two-sample t tests. The GB model using EEG features showed the best performance for blunt dissection (83% accuracy), retraction (85% accuracy), and burn dissection (81% accuracy). The combination of EEG and eye-gaze features using the GB algorithm improved the accuracy of skill level classification to 88% for blunt dissection, 93% for retraction, and 86% for burn dissection. The implementation of objective skill classification models in clinical settings may enhance the RAS surgical training process by providing objective feedback about performance to surgeons and their teachers.
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Affiliation(s)
- Somayeh B Shafiei
- Intelligent Cancer Care Laboratory, Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA.
| | - Saeed Shadpour
- Department of Animal Biosciences, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - James L Mohler
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Farzan Sasangohar
- Mike and Sugar Barnes Faculty Fellow II, Wm Michael Barnes and Department of Industrial and Systems Engineering at Texas A&M University, College Station, TX, 77843, USA
| | - Camille Gutierrez
- Obstetrics and Gynecology Residency Program, Sisters of Charity Health System, Buffalo, NY, 14214, USA
| | - Mehdi Seilanian Toussi
- Intelligent Cancer Care Laboratory, Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Ambreen Shafqat
- Intelligent Cancer Care Laboratory, Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
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Hidayah GN, Harzif AK, Noviani A, Tantry HP, Santoso BI, Situmorang H. Selecting the best surgical approach in various cases of prolapsed pedunculated submucosal fibroids: A case series. Int J Surg Case Rep 2023; 113:109029. [PMID: 37988992 PMCID: PMC10696232 DOI: 10.1016/j.ijscr.2023.109029] [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: 08/31/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION The pedunculated fibroid is classically managed through vaginal myomectomy. However, vaginal myomectomy cannot be safely and easily performed in all cases. We reviewed three cases of prolapsed pedunculated submucosal fibroids, each with a specific surgical difficulty. PRESENTATION OF CASES The first case had a prolapsed pedunculated uterine fibroid in pregnancy and underwent fibroid extirpation during an emergency cesarean section through the lower uterine segment incision. The second case was a nulliparous woman with recurrent abnormal uterine bleeding due to a giant prolapsed pedunculated uterine fibroid who underwent laparotomy fibroid extirpation through posterior colpotomy, preserving the uterus. The third case had a prolapsed pedunculated uterine fibroid in perimenopause with multiple fibroids and underwent fibroid stalk excision through an isthmic incision to facilitate a safe laparotomy hysterectomy procedure. DISCUSSION Vaginal removal has become the standard surgical method for prolapsed pedunculated submucous fibroids. However, some possible consequences of vaginal myomectomy include severe stalk bleeding, infection, and uterus inversion induced by excessive traction. Therefore, specific approaches are needed in some circumstances. CONCLUSION Customised surgical approaches provided safe and efficient access to the prolapsed pedunculated fibroid stalk during myomectomy or hysterectomy.
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Affiliation(s)
- Gita Nurul Hidayah
- Urogynecology, Reconstructive Pelvic and Aesthetic Surgery Division, Obstetrics and Gynaecology (O & G) Department, dr. Cipto Mangunkusumo Hospital Jakarta-Faculty of Medicine Universitas Indonesia (FMUI), Indonesia.
| | - Achmad Kemal Harzif
- Immunology & Reproductive Endocrinology Division, O & G Department, dr Cipto Mangunkusumo Hospital-FMUI, Indonesia
| | - Astri Noviani
- O & G Department, dr Cipto Mangunkusumo Hospital-FMUI, Indonesia
| | | | - Budi Iman Santoso
- Urogynecology, Reconstructive Pelvic and Aesthetic Surgery Division, Obstetrics and Gynaecology (O & G) Department, dr. Cipto Mangunkusumo Hospital Jakarta-Faculty of Medicine Universitas Indonesia (FMUI), Indonesia
| | - Herbert Situmorang
- Reproductive Health Division, O & G Department, dr Cipto Mangunkusumo Hospital-FMUI, Indonesia
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Ahdi Derav B, Narimani M, Abolghasemi A, Eskandari Delfan S, Akbari R, Ghaemi M, Deldar Pesikhani M. Effectiveness of Group Cognitive-Behavioral Therapy for Managing Anxiety and Depression in Women Following Hysterectomy for Uterine Cancer. Asian Pac J Cancer Prev 2023; 24:4237-4242. [PMID: 38156859 PMCID: PMC10909076 DOI: 10.31557/apjcp.2023.24.12.4237] [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: 08/07/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE Hysterectomy as well as uterine cancer could be associated with a long-term risk of mental disorders. The purpose of this study is to investigate the effectiveness of group cognitive-behavioral therapy (GCBT) in reducing anxiety and depression in women who have undergone hysterectomy for uterine cancer. METHOD This experimental, pretest-post-test study was conducted in an academic hospital. 26 women with uterine cancer who underwent hysterectomy were recruited and randomly divided into two equal groups as the experimental and control groups. The experimental group was treated by GCBT for eight 1-hour sessions (by a senior psychology expert) every week until 8 weeks. Otherwise, no intervention was performed for the control group. The anxiety and depression scores of all participants were assessed and compared before and after the therapy sessions by Beck Anxiety (BAI) and Beck Depression-second version (BDI-II) questionnaires. RESULTS The mean±SD age of the participants was 33.6±4.1. Our result found significant different after GCBT in both anxiety (p=0.000) and depression (p=0.000) scores in the experimental group. However, no differences between pre and post-test scores in the control group were observed. Compared to the control group the rate of depression (p=0.000) and anxiety (p=0.000) in the case group was significantly decreased after therapy. CONCLUSION GCBT is effective in reducing anxiety and depression in women after hysterectomy. The use of GCBT in oncology centers along with medical treatments to reduce mental distress, improve mental health, and accelerate the recovery process of patients with uterine cancer and other cancers seems necessary.
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Affiliation(s)
- Bahareh Ahdi Derav
- Faculty of Educational Sciences and Psychology, Mohaghegh Ardabili University, Ardabil, Iran.
| | - Mohammad Narimani
- Faculty of Educational Sciences and Psychology, Mohaghegh Ardabili University, Ardabil, Iran.
| | | | - Sina Eskandari Delfan
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Razieh Akbari
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Marjan Ghaemi
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Maryam Deldar Pesikhani
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Bouko-Levy E, Vialaret C, Sallée C, Marquet P, Margueritte F, Dion L, Lavoue V, Gauthier T. Estimation of the prevalence of uterine infertility and its different causes in France according to data from a literature review. J Gynecol Obstet Hum Reprod 2023; 52:102684. [PMID: 37866776 DOI: 10.1016/j.jogoh.2023.102684] [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: 07/07/2023] [Accepted: 10/20/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Uterine infertility (UI) is defined as the complete absence of a uterus (absolute uterine infertility or AUI) or the presence of a non functional uterus (non-absolute uterine infertility or NAUI). The exact prevalence of uterine infertility is currently unknown. Our aim was to assess the number of French women concerned by Uterine Infertility according to a recent literature review. MATERIALS AND METHODS We have previously conducted a systematic review of the literature on UI and its various causes in the world. Based on these study and demographic data of 2022 from INSEE (Institut National de la Statistique et des Études Économiques), we attempted to estimate the number of women under 40 years of age in France affected by potential UI using direct standardization. RESULTS AND DISCUSSION Based on the estimation from INSEE data, approximately 2066 women of childbearing age would have MRKH syndrome in France, 380 the Androgen Insensitivity Syndrome and 3700 had an haemostasis hysterectomy in France. We did not find data on the prevalence of hysterectomies before the age of 40 in France. For the following pathologies: uterine malformations, radiation uterus, synechiae, myomas and adenomyosis there was a huge amount of missing data, which does not allow us to estimate the number of potentially infertile patients. CONCLUSION Prevalence of UI is poorly known. UI probably concerns several thousand patients in France. The creation of a UI registry would make enable to assess the number of patients potentially eligible for adoption, uterus transplantation or even surrogacy.
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Affiliation(s)
- E Bouko-Levy
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, Limoges 87000, France
| | - C Vialaret
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, Limoges 87000, France
| | - C Sallée
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, Limoges 87000, France
| | - P Marquet
- Pharmacology and Transplantation, INSERM U1248, Université de Limoges, 2 Rue du Pr Descottes, Limoges 87000, France
| | - F Margueritte
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, Limoges 87000, France
| | - L Dion
- Department of Obstetrics and Gynecology, Hopital Universitaire de Rennes, Rennes 35000, France
| | - V Lavoue
- Department of Obstetrics and Gynecology, Hopital Universitaire de Rennes, Rennes 35000, France
| | - T Gauthier
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, Limoges 87000, France; Pharmacology and Transplantation, INSERM U1248, Université de Limoges, 2 Rue du Pr Descottes, Limoges 87000, France.
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