Gynecology and Minimally Invasive Therapy-GMIT最新文献

{"title":"Evaluation of the Success of Hysteroscopic Uterine Septum Resection.","authors":"Sule Atalay Mert, Berna Dilbaz, Funda Akpinar, Elif Gulsah Diktas, Tugba Kinay, Tugba Ensari, Ozlem Moraloglu Tekin","doi":"10.4103/gmit.gmit_131_22","DOIUrl":"10.4103/gmit.gmit_131_22","url":null,"abstract":"<p><strong>Objectives: </strong>The aim is to use three-dimensional transvaginal ultrasonography (3-D TVUS) to evaluate the success of hysteroscopic metroplasty for the uterine septum and to compare the pregnancy outcomes.</p><p><strong>Materials and methods: </strong>Thirty-eight patients with uterine septum who had hysteroscopic uterine septum resection were recruited. Preoperative 3-D TVUS measurements of the septal apex to the uterine fundus (s1), septal apex to internal os distance (s2), and intercornual distance (s3) were compared with the postoperative values. The pregnancies of the patients were followed up for a year postoperative period.</p><p><strong>Results: </strong>Out of the 38 patients, thirty-five had partial uterine septum (class U2a), while 3 patients had complete uterine septum (class U2b). Eighteen (47.36%) of the patients who underwent uterine septum resection achieved pregnancy, and thirteen of these pregnancies were (72.2%) term pregnancies, and all term pregnancies resulted in a live birth. Natural conception was achieved in 77.7% (14 of 18) of the patients. Term pregnancy occurred in 68.7% (11 of 16) of the patients with a partial septum and in 66.6% (2 of 3) of the patients with a complete uterine septum. A comparison of the 3-D TVUS measurements of the uterus pre- and postoperatively showed a decrease in s1 and an increase in s2 (<i>P</i> < 0.05). The uterine cavity length of pregnant patients was found to be higher than nonpregnant patients (<i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>Reproductive results of hysteroscopic metroplasty were favorable in achieving live and term birth. three-dimensional TVUS can be preferred as a noninvasive effective method in objective evaluation of the success of the hysteroscopic surgery.</p>","PeriodicalId":45272,"journal":{"name":"Gynecology and Minimally Invasive Therapy-GMIT","volume":"12 1","pages":"230-235"},"PeriodicalIF":1.2,"publicationDate":"2023-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10683958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41877354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic Large Dermoid Cystectomy in Pregnancy.","authors":"Luay Ibrahim Abu Atileh, Nouf Moh'd Khalifeh","doi":"10.4103/gmit.gmit_89_21","DOIUrl":"10.4103/gmit.gmit_89_21","url":null,"abstract":"","PeriodicalId":45272,"journal":{"name":"Gynecology and Minimally Invasive Therapy-GMIT","volume":"12 1","pages":"249-250"},"PeriodicalIF":1.2,"publicationDate":"2023-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10683959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43185285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term Outcome of Robotic and Laparoscopic Surgery for Gynecological Malignancies: A Single-center Experience.","authors":"Corina-Elena Minciuna, Mihail Ivanov, Sanziana Aioanei, Stefan Tudor, Monica Lacatus, Catalin Vasilescu","doi":"10.4103/gmit.gmit_137_22","DOIUrl":"10.4103/gmit.gmit_137_22","url":null,"abstract":"<p><strong>Objectives: </strong>Minimally invasive surgery (MIS) has become the preferred option for many gynecologic pathologies since complication rate and postoperative recovery time have decreased considerably. Postoperative complications remain an important aspect when using the MIS approach, if they are not timely or accurately diagnosed and treated. The main aim of the study is to first assess their incidence, followed by identifying possible risk factors. Furthermore, the secondary aim is to identify if the type of MIS approach used, robotic or laparoscopic, may render some additional benefits.</p><p><strong>Materials and methods: </strong>The database of the General Surgery Department was queried between 2008 and 2019 for patients with gynecologic pathology: 2907 cases were identified. An additional selection was performed using the following filters: MIS and neoplasia. All emergency surgeries were excluded. One hundred and ninety-eight cases were obtained.</p><p><strong>Results: </strong>The majority of complications were urological (11.6%) with only 7.07% requiring a specific urological procedure. The second most common was lymphorrhea 4.5%. Dindo-Clavien classification correlates positively with the postoperative hospital stay (PHS) (<i>P</i> = 0.000), the type of surgery (<i>P</i> = 0.046), the primary tumor location (<i>P</i> = 0.011), conversion rate (<i>P</i> = 0.049), the expertise of the lead surgeon (<i>P</i> = 0.012), and the operative time (<i>P</i> = 0.002). The urological complications correlate positively with the type of surgery (<i>P</i> = 0.002), the tumor location (<i>P</i> = 0.001), early reintervention (<i>P</i> = 0.000), operative time (<i>P</i> = 0.006), postoperative hemorrhage (<i>P</i> = 0.000), pelvic abscess (<i>P</i> = 0.000), venous thrombosis (<i>P</i> = 0.011), and postoperative cardiac complications (<i>P</i> = 0.002). Laparoscopic and robotic approaches were comparatively assessed. The PHS (<i>P</i> = 0.025), the type of surgery performed (<i>P</i> = 0.000), and primary tumor location (<i>P</i> = 0.011) were statistically significantly different.</p><p><strong>Conclusion: </strong>Postoperative complications reported after MIS for gynecological malignancies show similar incidence as in the current literature, also taking into consideration those for the open approach. The robotic approach seems to be able to perform more complex surgeries with no difference in the postoperative complication rates. The expertise of the lead surgeon in gynecology correlates with lower postoperative complications. Further prospective studies are needed to confirm these results.</p>","PeriodicalId":45272,"journal":{"name":"Gynecology and Minimally Invasive Therapy-GMIT","volume":"12 1","pages":"236-242"},"PeriodicalIF":1.2,"publicationDate":"2023-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10683964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44611848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Pros and Cons of Hystero-preservation on Pelvic Reconstructive Surgery.","authors":"Chin-Chiu Chen, I-Ting Peng, Ming-Ping Wu","doi":"10.4103/gmit.gmit_21_23","DOIUrl":"10.4103/gmit.gmit_21_23","url":null,"abstract":"<p><p>In the \"boat at the dock\" theory, pelvic organ prolapse (POP) may happen when the ropes (uterine supportive ligaments) break and/or the water level drops (pelvic floor muscles). Thus, it causes the boat (uterus and other pelvic organs) to slip from normal position and protrude out of the vagina. Surgical intervention with or without hysterectomy (hystero-preservation) is the most effective treatment for POP. Both hysterectomy and hystero-preservation for POP had a high anatomic and clinical cure rate. There is an increasing trend of hystero-preservation for POP during the past decades. The choices of either hysterectomy or hystero-preservation depend on the surgical factors, psychosocial factors, self-esteem and sexuality factors, and surgeon factors. Pelvic reconstructive surgery, either hysterectomy or hystero-preservation, can be performed via different approaches, including abdominal, laparoscopic, and vaginal routes, with native tissue or with mesh. This review will elucidate their related pros and cons, with further discussion and comparison of hystero-preservation via different routes.</p>","PeriodicalId":45272,"journal":{"name":"Gynecology and Minimally Invasive Therapy-GMIT","volume":"12 1","pages":"203-210"},"PeriodicalIF":1.2,"publicationDate":"2023-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10683956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46383652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Outcomes following Vaginal Natural Orifice Transluminal Endoscopic Surgery and Laparoendoscopic Single-site Surgery in Benign Hysterectomy: A Systematic Review and Meta-analysis.","authors":"Avir Sarkar, P Sivaranjani, Rinchen Zangmo, Kallol Kumar Roy, Maninder Kaur Ghotra, Radha Rani Seelam, Shivam Pandey","doi":"10.4103/gmit.gmit_88_22","DOIUrl":"10.4103/gmit.gmit_88_22","url":null,"abstract":"<p><p>Gradually increasing interest in laparoscopic surgeries has led to the advent of various lesser invasive techniques in the form of vaginal natural orifice transluminal endoscopic surgery (vNOTES) and laparoendoscopic single-site (LESS) surgery. Very few studies have analyzed the advantages and disadvantages of vNOTES over LESS surgeries in hysterectomy. After a comprehensive search, full texts of relevant manuscripts were obtained to assess eligibility for recruitment. A comprehensive meta-analysis was subsequently performed to compare the outcomes of vNOTES and LESS in hysterectomy, and forest plots were constructed. Four articles were rendered for review (three retrospective cohort studies and one randomized controlled trial). Three studies showed lesser postoperative pain in vNOTES compared to LESS. In one study, postoperative vaginal pain was higher in vNOTES due to additional suture between uterine artery and vaginal wall. The meta-analysis concluded that vNOTES could be better alternative to LESS hysterectomies. However, further large multicentric randomized trials are required for the standardization of the surgical method.</p>","PeriodicalId":45272,"journal":{"name":"Gynecology and Minimally Invasive Therapy-GMIT","volume":"12 1","pages":"195-202"},"PeriodicalIF":1.2,"publicationDate":"2023-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10683960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48054182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Efficacy of Vaginal Misoprostol versus a Synthetic Osmotic Dilator (Dilapan-S) for Cervical Preparation before Operative Hysteroscopy: A Randomized Controlled Study.","authors":"Aiswarya K Nair, Murali Subbaiah, Dilip Kumar Maurya","doi":"10.4103/gmit.gmit_111_22","DOIUrl":"10.4103/gmit.gmit_111_22","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the need for mechanical cervical dilatation following vaginal misoprostol or synthetic osmotic dilator (Dilapan-S) usage for cervical preparation before operative hysteroscopy.</p><p><strong>Materials and methods: </strong>Fifty-five premenopausal women scheduled for operative hysteroscopic procedures with a 26 Fr resectoscope were included in this randomized, controlled clinical trial. After randomization, either 400 μg of vaginal misoprostol or intracervical synthetic osmotic dilator (Dilapan-S) was inserted 12 h before operative hysteroscopy. The need for additional mechanical cervical dilatation before insertion of the resectoscope was compared between the two groups. Initial cervical diameter before mechanical dilatation, intraoperative complications (cervical tears, creation of a false passage), and ease of dilatation were also compared between the two groups.</p><p><strong>Results: </strong>In the misoprostol group, 92% of women required additional mechanical cervical dilatation, whereas only 36% of women in the Dilapan-S group required additional dilatation (<i>P</i> < 0.05). The median initial cervical diameter achieved with Dilapan was 9 mm (Q1: 7 mm; Q3: 10 mm), and with misoprostol, it was 6 mm (Q1: 4.5 mm; Q3: 8 mm) (<i>P</i> < 0.05). There was no significant difference in other outcome parameters between the two groups.</p><p><strong>Conclusion: </strong>Synthetic osmotic dilator (Dilapan-S) is more efficacious than vaginal misoprostol at ripening the cervix before operative hysteroscopy.</p>","PeriodicalId":45272,"journal":{"name":"Gynecology and Minimally Invasive Therapy-GMIT","volume":"12 1","pages":"225-229"},"PeriodicalIF":1.2,"publicationDate":"2023-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10683957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46661811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New Surgical Approach to Treat Fibroids and Solid Tumors - Thermal and Nonthermal Ablation.","authors":"Wu-Shun Felix Wong","doi":"10.4103/gmit.gmit_18_23","DOIUrl":"10.4103/gmit.gmit_18_23","url":null,"abstract":"<p><p>There is a trend toward more minimally invasive treatment for symptomatic uterine fibroids. They are image-guided ablation surgery with focused ultrasound, microwave, and radiofrequency ablations that are becoming tested and used in some medical centers or hospitals. Nevertheless, these image-guided ablation surgeries involve thermal ablation to the fibroids, which might lead to thermal injury to the surrounding tissues, for example, nerve injury, vessel injury, and skin burn due to heat diffusion. A new technology - irreversible electroporation (IRE) - is a new paradigm for treating solid tumors. This nonthermal ablation process does not induce high temperatures when treating cancers or solid tumors. The IRE treatment may soon be used for treating fibroids or other solid tumors. In a few clinical trials, IRE is currently used in experimental studies for treating gynecological cancers. This paper will present the minimally invasive thermal ablation treatments for fibroids, introduce this new nonthermal IRE ablation in treating gynecological cancer, and propose its future uses in uterine fibroids.</p>","PeriodicalId":45272,"journal":{"name":"Gynecology and Minimally Invasive Therapy-GMIT","volume":"12 1","pages":"191-194"},"PeriodicalIF":1.2,"publicationDate":"2023-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10683962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42631392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Weight-Loss Interventions and Levonorgestrel Intrauterine System Implantation for Early-Stage Endometrial Cancer and Atypical Endometrial Hyperplasia to Reduce Perioperative Risk of Severely Obese Patients.","authors":"Roze Isono-Taniguchi,&nbsp;Hiroshi Tsubamoto,&nbsp;Kayo Inoue,&nbsp;Tomoko Ueda,&nbsp;Shinichiro Saeki,&nbsp;Yumi Takimoto,&nbsp;Yu Wakimoto,&nbsp;Hiroaki Shibahara","doi":"10.4103/gmit.gmit_98_22","DOIUrl":"10.4103/gmit.gmit_98_22","url":null,"abstract":"<p><p>Endometrial cancer (EC) and atypical endometrial hyperplasia (AEH) are associated with obesity, which increases the perioperative morbidity and surgical difficulties in laparoscopic and robotic surgery. Weight-loss interventions (WLIs) are likely to reduce morbidity; however, delayed surgery may cause cancer progression. To minimize the tumor progression, levonorgestrel intrauterine system (LNG-IUS) with minimal side effects was used until the planned surgery. During 2016 and 2021, we conducted preoperative management of WLI using LNG-IUS for seven highly obese women with a body mass index (BMI) ≥35 kg/m² who had AEH and EC with Grade 1 and no myometrial invasion on magnetic resonance imaging. In three of the seven patients, the BMI decreased by more than 5. Two patients with AEH achieved remission after LNG-IUS placement and requested conservative management. Five patients with EC underwent laparoscopic hysterectomy, without perioperative complications.</p>","PeriodicalId":45272,"journal":{"name":"Gynecology and Minimally Invasive Therapy-GMIT","volume":"12 3","pages":"175-178"},"PeriodicalIF":1.2,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2e/cf/GMIT-12-175.PMC10553596.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41147738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blunt Tipped Forceps Guided Bag Placement when Contained Power Morcellation is Performed for Laparoscopic and Robotic Surgery.","authors":"Rikiya Sano,&nbsp;Mitsuru Shiota,&nbsp;Takahito Miyake,&nbsp;Yasunari Miyagi","doi":"10.4103/gmit.gmit_27_23","DOIUrl":"10.4103/gmit.gmit_27_23","url":null,"abstract":"objectIves In the United States, uterine sarcoma was diagnosed in a 0.28% of cases by means of histology after using power morcellation in laparoscopic hysterectomy or myomectomy.[1] In addition to leiomyosarcoma, there have been reports of postoperative diagnoses including endometrial cancer, cervical cancer, low-grade endometrial stromal sarcoma, and placental site trophoblastic tumor.[2-4] Currently, the Food and Drug Administration (FDA) recommends utilizing container bags when using power morcellation.[5] In this sense, the most important procedure for reducing cell spillage is the safe placement of the bag without damage. Therefore, in this study, we introduce the blunt-tipped forceps-guided safe bag placement that we are practicing [Figure 1].","PeriodicalId":45272,"journal":{"name":"Gynecology and Minimally Invasive Therapy-GMIT","volume":"12 3","pages":"181-182"},"PeriodicalIF":1.2,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/87/75/GMIT-12-181.PMC10553603.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41146966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Morbidity of Laparoscopic Hysterectomy versus Abdominal Hysterectomy: A Retrospective Overview.","authors":"Mukta Agarwal,&nbsp;Shivangni Sinha,&nbsp;Smita Singh,&nbsp;H Haripriya,&nbsp;Ishita Roy","doi":"10.4103/gmit.gmit_30_23","DOIUrl":"10.4103/gmit.gmit_30_23","url":null,"abstract":"<p><strong>Objectives: </strong>Laparoscopic skills are not an innate behavior, nor can they be easily mimicked, and can only be acquired through hands-on training. The need for reliable training and its assessment is becoming increasingly important with the course of time.</p><p><strong>Materials and methods: </strong>A retrospective comparative study was done in a tertiary care center where all patients undergoing hysterectomy by laparoscopic and abdominal route were included in the study.</p><p><strong>Objectives: </strong>Our study aims to compare the operative and postoperative complications of laparoscopic hysterectomy with abdominal hysterectomy. The study was conducted from June 2016 to October 2022.</p><p><strong>Results: </strong>The mean operative time for uteri size lesser than 12 weeks was found significant in the total laparoscopic hysterectomy (TLH) group (75 ± 25 min) to total abdominal hysterectomy (TAH) (117 ± 28 min, <i>P</i> < 0.001). The mean blood loss in the TLH group was significant (110 ± 30 ml vs. 160 ± 116 ml, <i>P</i> < 0.002). The mean hospital stay was significantly shorter in TLH (4 ± 2.4 days vs. 7 ± 2.41 days, <i>P</i> < 0.002). The operative and postoperative complications observed were 3.1% in the TLH group and 11.7% in the TAH group.</p><p><strong>Conclusion: </strong>TLH when performed efficiently has proved to be a preferable route over other conventional hysterectomies.</p>","PeriodicalId":45272,"journal":{"name":"Gynecology and Minimally Invasive Therapy-GMIT","volume":"12 3","pages":"161-165"},"PeriodicalIF":1.2,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5d/d9/GMIT-12-161.PMC10553594.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41147737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}