Individual Physician Experience With Laparoscopic Supracervical Hysterectomy in a Single Outpatient Setting

The authors report the surgical experience of a single physician operating at 1 outpatient surgery center using laparoscopic supracervical hysterectomy for the treatment of 100 patients with benign gynecologic disease. Operative status was evaluated in terms of patient morbidity, length of surgery, blood loss, and duration of hospital stay. The mean operative time was 2.6 hours, and the mean anesthesia time was 3.2 hours. The mean estimated blood loss was 116.6 mL, and the mean patient hospital stay was 16.5 hours. There were no reported intraoperative or postoperative complications. Laparoscopic supracervical hysterectomy was not feasible and was converted to laparotomy and total abdominal hysterectomy in 4 patients. The authors present one of the first individual physician experiences at a single outpatient surgery center using laparoscopic supracervical hysterectomy for benign gynecologic conditions. Optimal patient postoperative stay and a minimal complication rate suggest that this procedure performed at a single outpatient surgery center is feasible.

Laparoscopic supracervical hysterectomy for benign gynecologic conditions

Recent results from metaanalyses and observational studies have suggested that total abdominal hysterectomy (TAH) is superior to laparoscopic supracervical hysterectomy (LSH) for the treatment of benign gynecologic conditions. However, because LSH is associated with fewer intraoperative complications, shorter operative time, and preserves patient anatomy and sexual function in comparison with TAH, clinicians should reconsider the benefits of LSH.

Recurrent vulvar lymphangitis cured with vulvectomy in a cervical carcinoma patient: a case report

BACKGROUND

Recurrent vulvar lymphangitis secondary to pelvic lymphadenectomy and radiation therapy can be a vexing clinical dilemma.

CASE

A 55-year-old woman was initially treated with radical hysterectomy and 1 postoperative radiotherapy for cervical carcinoma in 1984. In 1987 she developed persistent vulvar, leg, and ankle edema; chronic vulvar pain; and recurrent vulvar cellulitis, which were ultimately attributed to group B Streptococcus. Despite long-term antibiotic therapy and compression stockings, the cellulitis was intractable. In June 2006 the patient underwent a bilateral simple vulvectomy with preservation of the clitoris and insertion of bilateral subcutaneous Jackson-Pratt drains. Her postoperative culture results revealed normal vaginal flora.

CONCLUSION

The patient's wounds healed very well, and she has had no further episodes of vulvitis or lymphangitis. The management of recurrent infections involving lymphedema can be difficult and cause complicated clinical issues.

The effect of plasma glucose variability on neonatal outcome in the pregnant diabetic patient

Maternal glucose variability was studied in 154 pregnant diabetic patients hospitalized during the last month of their pregnancies. By means of several statistical analyses of the coefficient of variation for within-day plasma glucose variability, we found as follows. (1) There was a significant association between maternal glucose variability and neonatal outcome. (2) Patients with greater glucose variability had more episodes of hyperglycemia, but not hypoglycemia. (3) There was no correlation between maternal glucose variability and the birth weight of the infant. We are proposing the use of an index for glucose variability to monitor glucose control in pregnancy and predict neonatal outcome. Although absence of glucose variability will not ensure prevention of neonatal complications, there is a clear association between greater glucose variability and neonatal complications.