Pelvic pain after laparoscopic lateral suspension for pelvic organ prolapse: an unrecognized problem?

INTRODUCTION AND HYPOTHESIS

The laparoscopic lateral suspension (LLS) represents an alternative mesh procedure to avoid the dissection at the promontory. However, mesh-related complications such as chronic pelvic pain, dyspareunia, and bladder pain are emerging. The present study is aimed to present a video case report and describe a small case series of patients referred to our center for chronic pelvic pain after LLS.

METHODS

A surgical video of the management of a 50-year-old woman with chronic abdominal and pelvic pain, dyspareunia, and recurrent urinary tract infection (UTIs) after uterus sparing LLS is provided. Moreover, we performed a retrospective chart review of similar cases in our institution.

RESULTS

The featured procedure was completed without complications and was successful in obtaining symptom relief. Between 2018 and 2022 five patients underwent total or subtotal mesh removal for pain-related symptoms after LLS. At the median follow-up of 24 months, all patients were free from pain, but two (40%) required reoperation for prolapse recurrence CONCLUSIONS: Our experience suggests that LLS involves a certain risk of chronic pelvic pain, which may be challenging to manage and require surgical treatment.

Effectiveness of Video Tutorial Coaching in Improving the Knowledge of School Teachers on Child Abuse and Neglect in Puducherry

Aim

Child abuse and neglect (CAN) is a major threat to the health and well-being of children throughout the world. Apart from healthcare professionals, teachers also play an important role in recognizing and reporting child abuse as they are in a better position to observe the behavioral changes in children as they spend substantially more time at school. The aim of this study was to evaluate the effectiveness of a video tutorial program in improving the knowledge of school teachers on CAN.

Materials and results

A cross-sectional questionnaire-based study was conducted among the 79 school teachers of Puducherry. At baseline, a prevalidated questionnaire was used to assess the knowledge of the school teachers on CAN. After the intervention, the same prevalidated questionnaire was repeated. The mean knowledge score of teachers before intervention was 9.13. After video intervention knowledge score was improved to 14.46 (p < 0.05).

Conclusion

The study showed that a knowledge deficit exists among teachers regarding CAN, and the video tutorial program was found to be effective in improving the knowledge of school teachers. The government, as well as the schools should take the initiative to create awareness among teachers.

How to cite this article

Shivashankarappa PG, Pitchiah PA, Adimoulame S. Effectiveness of Video Tutorial Coaching in Improving the Knowledge of School Teachers on Child Abuse and Neglect in Puducherry. Int J Clin Pediatr Dent 2022;15(5):575-578.

[Undergraduate Pathology: Video tutorials including digital pathology make teaching more practical and the subject more attractive]

INTRODUCTION AND OBJECTIVES

Although pathology is one of the cornerstone subjects of the medical curriculum, for many students it can prove too theoretical and remote from clinical relevance. We present the results of a new distance learning project designed to make the teaching of pathology more practical and render the subject more attractive to the medical student.

MATERIALS AND METHODS

We developed a teaching programme which included digital pathology images and video tutorials of clinical cases; the students were required to arrive at a final diagnosis. An explanatory video of how biopsies are processed was also included. Twitter was used for rapid interaction with the students. A questionnaire was then completed by the participants evaluating the various aspects of the project.

RESULTS

All the students reached a correct diagnosis for the clinical cases. 89% of the participants were extremely satisfied with the project. The majority agreed that the different activities were interesting and useful for improving their understanding of pathology and thus recommended that they should be continued.

CONCLUSIONS

Our results support the inclusion of digital pathology into the curriculum together with video tutorials to enhance undergraduate pathology teaching. In the future, such distance learning could prove a useful resource in combination with conventional face-to-face lectures and tutorials.

Inability to walk and persistent thigh pain after transobturator tape procedure for stress urinary incontinence: surgical management

INTRODUCTION AND HYPOTHESIS

Groin pain after transobturator tape is often a self-limiting situation, but can occasionally persist and be associated with serious neurological sequelae. The video is aimed at presenting the surgical management of persistent groin pain and inability to walk after transobturator sling placement and subsequent partial removal.

METHODS

The featured patient is a 31-year-old woman unable to walk after transobturator sling implantation 2 years before. She reported left thigh pain immediately after surgery that was not responsive to postoperative medication. Six months later, suburethral portion excision was performed but no pain relief was obtained. She was unable to walk, and needed a wheelchair. Electromyography showed axonal injury of the left obturator nerve. After providing proper informed consent, the patient was admitted for combined transvaginal and transcutaneous transobturator tape arm removal.

RESULTS

The featured procedure was completed in 120 min and blood loss was <100 ml. No surgical complications were observed. The patient is currently doing left leg rehabilitation, has regained the ability to walk with the aid of a crutch, and the need for chronic pain control medication is greatly reduced.

CONCLUSION

This represents a valid surgical approach for the late management of this mesh-related complication.

Video-tutorial for the Movement Disorder Society criteria for progressive supranuclear palsy

BACKGROUND

The International Parkinson and Movement Disorder Society-endorsed Progressive Supranuclear Palsy Study Group published clinical diagnostic criteria for progressive supranuclear palsy in 2017, aiming to optimize early, sensitive and specific diagnosis.

OBJECTIVE

To assist physicians in the application of these criteria, we developed a video-based tutorial in which all core clinical features and clinical clues are depicted and explained.

METHODS

Patients provided written informed consent to the publication of their videos. High-quality videos along with essential descriptions were collected by the study group members. Most educational videos were selected in a structured consensus process.

RESULTS

We provide 68 videos of all core clinical features and clinical clues defined by the diagnostic criteria, along with instructive descriptions of the depicted patients, examination techniques and clinical findings.

CONCLUSIONS

This comprehensive video-based tutorial will support physicians in the application of the diagnostic criteria of progressive supranuclear palsy.

Surgical management of bladder erosion and pelvic pain after laparoscopic lateral suspension for pelvic organ prolapse

INTRODUCTION AND HYPOTHESIS

Mesh-augmented lateral suspension for prolapse repair seems to be associated with few complications. However, mesh-related complications can negatively affect the quality of life and may be challenging to manage. This video is aimed at presenting the surgical management of a case of severe pelvic pain and dyspareunia after lateral laparoscopic suspension associated with mesh erosion in the bladder.

METHODS

A 46-year-old woman was referred to our Unit for severe pelvic pain and inability to have sexual intercourses since undergoing a uterus-sparing laparoscopic lateral suspension procedure for genital prolapse 2 years before in another hospital. Moreover, she reported bladder pain and recurrent urinary tract infections. Cystoscopy showed mesh erosion in the bladder. She was admitted to laparoscopic hysterectomy plus subtotal mesh excision and bladder reconstruction (video).

RESULTS

No surgical complications were observed. The postoperative course was uneventful. At the current follow-up, the patient reported complete resolution of her symptoms.

CONCLUSION

The featured video shows laparoscopic subtotal mesh excision, concomitant hysterectomy and bladder repair for pelvic pain, dyspareunia and bladder erosion after lateral suspension. This video may be useful in providing anatomical views and surgical steps necessary for achieving successful surgical management of this mesh-related complication.

Laparoscopic bilateral cervicosacropexy: introduction to a new tunneling technique

INTRODUCTION AND HYPOTHESIS

To elevate and suspend the apical end of the vagina, the uterosacral ligaments (USL) were replaced by polyvinylidene fluoride (PVDF) structures. These PVDF structures were placed in the peritoneal folds of the USL at the pelvic wall to mimic the lateral and backward tension and to avoid rectal obstruction. A special tunneling device was used, which allowed the semi-circular placement of the structure without destroying the peritoneum.

METHODS

A 59-year-old woman with mixed urinary incontinence and apical prolapse (pelvic organ prolapse quantification system, POP-Q, stage 2) of the uterus underwent laparoscopic bilateral USL replacement. USLs were replaced by PVDF structures by performing the cervicosacropexy (CESA) technique using a semi-circular tunneling device.

RESULTS

Apical support was restored (POP-Q stage 0), and the patient was continent thereafter. The tunneling device was pulled through the peritoneal folds of the USLs toward the cervix. The new USL structures were brought to their physiological position. The new technique did not lead to any complications and did not cause any side effects during 1-year follow-up.

CONCLUSIONS

Restoration of apical prolapse and urinary continence was achieved by bilateral USL replacement using a semi-circular tunneling device that was inserted through the lateral abdominal trocar incision.

Transvaginal native-tissue repair of enterocele

INTRODUCTION AND HYPOTHESIS

Enterocele repair represents a challenge for pelvic surgeons. Surgical management implies enterocele sac removal. Subsequently, hernial port closure and adequate suspension may be achieved with Shull uterosacral ligament suspension (ULS).

METHODS

A 55-year-old woman with symptomatic stage 3 enterocele was admitted for transvaginal uterosacral ligaments suspension according to the described technique.

RESULTS

Surgical procedure was successfully achieved without complications. Final examination revealed excellent pelvic supports and preservation of vaginal length. This step-by-step video tutorial may represent an important tool to improve surgical know-how.

CONCLUSIONS

Transvaginal uterosacral ligaments suspension provides a safe and effective technique for enterocele repair without the use of prosthetic materials. Identifying uterosacral ligaments, proper suture placement, and reapproximation of pubocervical and rectovaginal fascias with closure of the hernial port are the key points to achieve surgical success.

Effect of the use of a video tutorial in addition to simulation in learning the maneuvers for shoulder dystocia

The development of video tutorials is flourishing and may make it possible to maintain knowledge learned during instruction with simulation. The aim of this study was to assess the effect of adding a video tutorial to a lecture and simulation for learning the maneuvers and protocol for the management of shoulder dystocia. Student midwives and medical students attended a lecture class including instruction about maneuvers and a presentation of an algorithm for the management of shoulder dystocia. They were randomized into two groups. The video group was reminded every two weeks to watch a short tutorial. The control group was reminded to consult the slide show. At the end of two months, they were evaluated by graders. The practice, theory, and global scores of the students in the video group were significantly higher than those of the students in the control group (14.8 vs. 10.4; 5.6 vs. 3.4; and 9.3 vs. 7.0, P<0.001). The scores for the video group improved at the second simulation session, compared with the first (14.8 vs. 9.9; 5.6 vs. 2.9; and 9.3 vs. 7, P<0.001). The addition of a video tutorial improved learning compared to a standard lecture and simulation session alone.