Obesity and older age as protective factors for vaginal cuff dehiscence following total hysterectomy
This study aims to identify factors associated with dehiscence following varying routes of total hysterectomy. This is a retrospective, matched, case-control study of women who underwent a total hysterectomy at a large, urban, university-based teaching hospital from January 2000 to December 2011. Women who underwent a total hysterectomy and had a dehiscence (n = 31) were matched by surgical mode to the next five total hysterectomies (n = 155). Summary statistics and conditional logistic regression were performed to compare cases to controls. Obese women (BMI ≥ 30) were 70 % less likely than normal weight wom...
Source: Gynecological Surgery - January 30, 2015 Category: OBGYN Source Type: research
Complete plastic lining of the abdominal cavity during laparoscopic electromechanical morcellation—a promising technique
Abstract
The risk of intraperitoneal fragment dissemination of uterine tissue, especially the dissemination of unexpected leiomyosarcoma during electromechanical morcellation, has been increasingly debated during the last year. An improved technique for contained morcellation of uterine tissue inside an insufflated plastic bag during laparoscopy is presented. Twenty-one consecutive contained morcellations were carried out during the summer of 2014, at one institution. Five laparoscopic myomectomies and 16 hysterectomies were performed. Standard laparoscopic equipment was used and a transparent plastic bag...
Source: Gynecological Surgery - January 26, 2015 Category: OBGYN Source Type: research
Myoma morcellation and leiomyosarcoma panic
(Source: Gynecological Surgery)
Source: Gynecological Surgery - January 15, 2015 Category: OBGYN Source Type: research
Ovarian endometrioma in the adolescent: a plea for early-stage diagnosis and full surgical treatment
Abstract
The incidence and severity of endometriosis in adolescent are comparable with the incidence in adult women. The mean delay between the onset of symptoms and the final diagnosis varies between 6.4 and 11.7 years. The longer the diagnosis is delayed, the more the endometriosis can progress to a more severe stage certainly in the group of patients with pelvic pain. The evolution of endometriosis and its progressivity are not predictable, and the severity of the disease is not directly related to the degree of pain. Endometriotic cysts have a detrimental effect on the ovarian reserve by the evolutio...
Source: Gynecological Surgery - January 13, 2015 Category: OBGYN Source Type: research
A mixture of 86% of CO 2 , 10% of N 2 O, and 4% of oxygen permits laparoscopy under local anesthesia: a pilot study
Abstract
The aim of this study is to verify that 10 % of N2O in CO2 sufficiently reduces pain to permit laparoscopy under local anesthesia. In nine patients undergoing laparoscopy under local anesthesia for tubal sterilization, a mixture of 86 % of CO2, 10 % of N2O, and 4 % of oxygen (the Gas Mixture) was used for the pneumoperitoneum. For CO2, N2O, and for the Gas Mixture, the pain when blowing over the tongue tip and the pH changes of saline and Hartmann’s solution were estimated. In all nine patients, discomfort was minimal and the intervention was well tolerated, similar to 100 % N2O. Tongue ti...
Source: Gynecological Surgery - December 13, 2014 Category: OBGYN Source Type: research
Discharge less than 6 hours after robot-assisted total laparoscopic hysterectomy—is it feasible?
This study tested the feasibility of a fast track programme based on robot-assisted laparoscopic hysterectomy in which patients were discharged from a day care unit within 6 h after the operation. We enrolled 22 patients. Preoperatively, all patients were carefully informed. All patients except two could be discharged on the same day. Pain during the first 24 h was not a problem. No readmissions occurred within the first 30 days after the surgery. This small series of robot-assisted laparoscopic hysterectomy demonstrates that the postoperative hospital stay could be reduced and that this procedure could be carried out i...
Source: Gynecological Surgery - December 12, 2014 Category: OBGYN Source Type: research
The trainees’ pain with laparoscopic surgery: what do trainees really know about theatre set-up and how this impacts their health
Abstract
Although it is clear that laparoscopic surgery is beneficial to the patient, such surgery brings with it unique challenges and possible injury to the surgeon. Firstly, we sought to investigate the prevalence of musculoskeletal distress experienced by trainees. Secondly, we sought to ascertain if the trainees had received appropriate instruction to optimise their operative environment during laparoscopic surgery. An anonymised questionnaire survey was distributed to all 89 trainees in obstetrics and gynaecology within Northern Ireland. Forty-four (83 %) trainees reported to having received formal...
Source: Gynecological Surgery - December 4, 2014 Category: OBGYN Source Type: research
Transcervical, intrauterine ultrasound-guided radiofrequency ablation of uterine fibroids with the VizAblate® System: three- and six-month endpoint results from the FAST-EU study
Abstract
This was a prospective, longitudinal, multicenter, single-arm controlled trial, using independent core laboratory validation of MRI results, to establish the effectiveness and confirm the safety of the VizAblate® System in the treatment of symptomatic uterine fibroids. The VizAblate System is a transcervical device that ablates fibroids with radiofrequency energy, guided by a built-in intrauterine ultrasound probe. Fifty consecutive women with symptomatic uterine fibroids received treatment with the VizAblate System. Patients had a minimum Menstrual Pictogram score of 120, no desire for fertilit...
Source: Gynecological Surgery - November 27, 2014 Category: OBGYN Source Type: research
Tubo-ovarian abscess secondary to actinomycosis: unexpected presentation and its treatment
Abstract
This is a case of an ovarian actinomycosis diagnosed as a complex ovarian cyst by ultrasound in asymptomatic patient. The ovarian tumour markers were within normal. The tube and ovary were removed laparoscopically. She received 2 weeks of daily IV 1 g of ceftriaxone, followed by 6 months of oral amoxicillin. CT scan did not show evidence of actinomycosis elsewhere. She did not give any history of intrauterine contraceptive use. (Source: Gynecological Surgery)
Source: Gynecological Surgery - November 14, 2014 Category: OBGYN Source Type: research
Should medical students be given laparoscopic training?
Abstract
Undergraduate medical education does not usually involve training in laparoscopic skills despite the fact that minimal access surgery has become the norm in the developed world. We designed a study to evaluate the attitude of surgeons and medical students to formal teaching of these skills. Two surveys were sent; one to fourth year medical students at the University of Bristol and another to specialist laparoscopic surgeons. Student questions centred on whether they would find training in basic laparoscopic skills useful, whilst surgeons were asked whether it would be acceptable for medical stude...
Source: Gynecological Surgery - November 9, 2014 Category: OBGYN Source Type: research
Hysteroscopy findings and its correlation with latent endometrial tuberculosis in infertility
Abstract
In India, 5 to 18 % of females attending infertility clinics are diagnosed to be suffering from genital tuberculosis. The present study was conducted to find out the prevalence of endometrial tuberculosis in infertility and its correlation with hysteroscopic changes. Patients attending infertility clinic with history of more than 2 years of unexplained infertility, failure to conceive in spite of successful ovulation induction in anovulatory infertility, and secondary infertility with a history of unexplained abortion or ectopic pregnancy were included in the study. In all the 105 cases, hyster...
Source: Gynecological Surgery - November 6, 2014 Category: OBGYN Source Type: research
First baby born out of a transplanted uterus
(Source: Gynecological Surgery)
Source: Gynecological Surgery - November 1, 2014 Category: OBGYN Source Type: research
Hysterosalpingo-foam sonography (HyFoSy) using two different balloon catheters: a randomized trial
Abstract
The purposes of this study were to evaluate and compare the technical feasibility and the patients’ pain during hysterosalpingo-foam sonography (HyFoSy) using two different 2-mm balloon catheters. Randomized trial in 46 consecutive women referred for tubal patency testing by HyFoSy at the Leuven University Hospital. Six women refused to participate. Forty women were randomized and blinded as to the catheter used. The patients underwent first a transvaginal ultrasound examination to assess the uterus and the ovaries and to exclude the hydrosalpinx, and subsequently, a HyFoSy was performed using ...
Source: Gynecological Surgery - October 27, 2014 Category: OBGYN Source Type: research
Comparison of dynamic MRI vaginal anatomical changes after vaginal mesh surgery and laparoscopic sacropexy
Abstract
The aim of this study is to evaluate anatomical differences in vaginal length and axis between transvaginal mesh surgery (TVM) and laparoscopic sacropexy (LSC) by pelvic magnetic resonance imaging (MRI). Twenty-seven women with stage II or more symptomatic pelvic organ prolapse were involved in this study. Thirteen patients had undergone TVM, and fourteen had LSC. Preoperative and at 1 year postoperative clinical examination and dynamic MRI were performed. The angle between the vaginal axis and horizontal line or pubococcygeal line and the position of the Douglas pouch were evaluated on MRI. In ...
Source: Gynecological Surgery - October 25, 2014 Category: OBGYN Source Type: research
Tailor-made proficiency curves in laparoscopic hysterectomy: enhancing patient safety using CUSUM analysis
The objective of this study is to develop a risk-adjusted real-time quality control system in laparoscopic hysterectomy with respect to blood loss, operative time and adverse events in order to signal derailing surgical performance in a timely fashion. Based on prior research, uterus weight, body mass index, number of surgeons, prior abdominal surgery, and type of laparoscopic hysterectomy were identified as significant covariates predicting successful surgical outcome. Cumulative sum (CUSUM) analysis, a model based on dichotomous input (success or “failure”), was selected as a predictive tool for performance analysis....
Source: Gynecological Surgery - October 22, 2014 Category: OBGYN Source Type: research
