Gynecological Surgery最新文献

{"title":"Laparoscopic management of spontaneous vaginal vault dehiscence and bowel evisceration 17 years following total abdominal hysterectomy.","authors":"Georgina Baines, Simon R Jackson, Natalia Price","doi":"10.1186/s10397-017-1004-6","DOIUrl":"https://doi.org/10.1186/s10397-017-1004-6","url":null,"abstract":"","PeriodicalId":46311,"journal":{"name":"Gynecological Surgery","volume":"14 1","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s10397-017-1004-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34955175","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 effect of music in gynaecological office procedures on pain, anxiety and satisfaction: a randomized controlled trial.","authors":"N Mak,&nbsp;I M A Reinders,&nbsp;S A Slockers,&nbsp;E H M N Westen,&nbsp;J W M Maas,&nbsp;M Y Bongers","doi":"10.1186/s10397-017-1016-2","DOIUrl":"https://doi.org/10.1186/s10397-017-1016-2","url":null,"abstract":"<p><strong>Background: </strong>Pain can interfere with office procedures in gynaecology. The aim of this study is to measure the positive effect of music in gynaecological office procedures.</p><p><strong>Methods: </strong>A randomized controlled trial was performed between October 2014 and January 2016. Women scheduled for an office hysteroscopy or colposcopy were eligible for randomization in the music group or control group. Stratification for hysteroscopy and colposcopy took place. The primary outcome is patients' level of pain during the procedure measured by the visual analogue scale (VAS). Secondary outcomes include patients' level of pain after the procedure, anxiety and satisfaction of patient and doctor.</p><p><strong>Results: </strong>No positive effect of music on patients' perception of pain during the procedure was measured, neither for the hysteroscopy group (57 mm vs. 52 mm) nor for the colposcopy group (32 mm vs. 32 mm). Secondary outcomes were also similar for both groups.</p><p><strong>Conclusions: </strong>This study showed no positive effect of music on patients' level of pain, anxiety or satisfaction of patient or doctor for office hysteroscopy and colposcopy. We believe a multimodal approach has to be used to decrease patient distress in terms of pain and anxiety, with or without music.</p><p><strong>Trial registration: </strong>Dutch Trial Register, NTR4924.</p>","PeriodicalId":46311,"journal":{"name":"Gynecological Surgery","volume":"14 1","pages":"14"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s10397-017-1016-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35390479","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":"Role of blue dye for sentinel lymph node detection in early endometrial cancer.","authors":"Stefano Restaino,&nbsp;Carlo Ronsini,&nbsp;Angelo Finelli,&nbsp;Emanuele Perrone,&nbsp;Giovanni Scambia,&nbsp;Francesco Fanfani","doi":"10.1186/s10397-017-1026-0","DOIUrl":"https://doi.org/10.1186/s10397-017-1026-0","url":null,"abstract":"<p><strong>Background: </strong>Sentinel Lymphonode analysis has become a barely new and innovative way to treat early stages of endometrial cancer (Ballester et al., Lancet Oncol 469-476, 2011; Buda et al., Ann Surg Oncol 2975-81, 2016). Indocyanine green cervical injection is considered gold standard for mapping nodes' drainage. Blue dye is used as a valid alternative in many centers, due to the lower cost of execution. The objective of this video is to prove that methylene blue dye's cervical injection is a valid and \"low-cost\" method to obtain mapping of lymphatic drainage in patient with early endometrial cancer.</p><p><strong>Methods: </strong>Fifty-four-year old women, with a recent diagnosis of endometrial cancer IA G2, we performed a radical Hysterectomy type A. We diluted in equal proportions the blue dye and saline and injected 1 cl in depth and 1 cl on the surface of the cervix, at 3 o'clock and 9 o'clock. After 20 min, it was shown with precision the lymphatic drainage until the first lymph node station from both sides.</p><p><strong>Results: </strong>One external iliac lymph node and one obturator were resected on the left side and one external iliac on the right side. On histological analysis, none of the lymph nodes had any location of metastasis, neither micro-metastasis. Myometrial infiltration was 8/19 mm.</p><p><strong>Conclusions: </strong>Blue dye cervical injection is a \"low-cost\", safe, and satisfactory procedure to point out Sentinel Lymph Node of uterus drainage. Other tracers, such as indocyanine green, are widely used in gynecological oncology, but with a higher cost of the product and the needing of a dedicated optical filter to be shown on human view.</p>","PeriodicalId":46311,"journal":{"name":"Gynecological Surgery","volume":"14 1","pages":"23"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s10397-017-1026-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35622849","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":"An original and effective technique to improve exposure in open surgery.","authors":"E Nohuz,&nbsp;G Chêne","doi":"10.1186/s10397-017-1013-5","DOIUrl":"https://doi.org/10.1186/s10397-017-1013-5","url":null,"abstract":"<p><strong>Background: </strong>Exposure, especially when the organs are enlarged, remains one of the most important issue in open surgery. Considering this constraint appears critical in the progress of the surgical procedure. We highlight our technique which affords optimal exposure and improves manipulation and extraction of enlarged organs.</p><p><strong>Results: </strong>This original and effective technique is derived from an obstetrical device used to perform an assisted vaginal delivery. It improves exposure, reduces tissue manipulation, and enhances removal of the surgical specimen during hysterectomies and myomectomies. It can be similarly helpful sometimes to grasp and remove (by mini laparotomy) enlarged adnexa during laparoscopic procedures. Moreover, this trick appears particularly suited in case of obese patients.</p><p><strong>Conclusion: </strong>This new technique procures a real benefit for both the patient and the surgeon in terms of ergonomics and safety.</p>","PeriodicalId":46311,"journal":{"name":"Gynecological Surgery","volume":"14 1","pages":"10"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s10397-017-1013-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35182627","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":"Effects of salpingectomy during abdominal hysterectomy on ovarian reserve: a randomized controlled trial.","authors":"Afsaneh Tehranian,&nbsp;Roghayeh Hassani Zangbar,&nbsp;Faezeh Aghajani,&nbsp;Mahdi Sepidarkish,&nbsp;Saeedeh Rafiei,&nbsp;Tayebe Esfidani","doi":"10.1186/s10397-017-1019-z","DOIUrl":"https://doi.org/10.1186/s10397-017-1019-z","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to investigate the effect of salpingectomy on ovarian function by measuring AMH.</p><p><strong>Methods: </strong>This study was a balanced, single-center, double-blind, randomized, controlled trial in Ruin Tan Arash Hospital, Tehran, between May 2013 and November 2014. A total of 30 patients undergoing elective abdominal hysterectomy were randomized into two groups, 15 with salpingectomy and 15 without salpingectomy. The primary objective of this study was to compare mean difference of anti-Mullerian hormone (AMH) between two groups. The secondary outcomes measured were follicle-stimulating hormone (FSH), operative time, and blood loss.</p><p><strong>Results: </strong>Serum AMH levels decreased at 3 months after hysterectomy in all patients (pre AMH 1.32 ± (0.91); post AMH 1.05 ± (0.88), <i>P</i> < 0.001), the salpingectomy group (pre AMH 1.44 ± (0.94); post AMH 1.13 ± (0.86), <i>P</i> < 0.001), and no salpingectomy group (pre AMH 1.2 ± (0.9); post AMH 0.97 ± (0.92), <i>P</i> < 0.001). The rate of decline of AMH levels after surgery did not differ between the two groups (25% (17-33%) vs. 26% (15-36%), <i>P</i> = 0.23) among the women with salpingectomy versus without salpingectomy, respectively. There was no difference in the mean operative time (mean difference 0.33, 95% CI - 22.21 to 22.86, <i>P</i> < 0.92), mean blood loss (mean difference - 0.66, 95% CI - 15.8 to 14.46, <i>P</i> < 0.97), and post FSH (mean difference 0.34, 95% CI - 1.2 to 1.88, <i>P</i> < 0.65) between both groups.</p><p><strong>Conclusions: </strong>Salpingectomy with abdominal hysterectomy is a safe treatment that does not have a deleterious effect on ovarian reserve.</p><p><strong>Trial registration: </strong>Iranian Registry of Clinical Trials, IRCT2014123118866N4 (www.IRCT.ir).</p>","PeriodicalId":46311,"journal":{"name":"Gynecological Surgery","volume":"14 1","pages":"17"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s10397-017-1019-z","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35390482","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":"Essure® present controversies and 5 years' learned lessons: a retrospective study with short- and long-term follow-up.","authors":"Sara Câmara,&nbsp;Filipa de Castro Coelho,&nbsp;Cláudia Freitas,&nbsp;Lilia Remesso","doi":"10.1186/s10397-017-1023-3","DOIUrl":"https://doi.org/10.1186/s10397-017-1023-3","url":null,"abstract":"<p><strong>Background: </strong>The risk-benefit of contraception with Essure® is being readdressed due to an increase of reports of adverse effects with this device. Our aim was to proceed to an internal quality evaluation and to identify opportunities for protocol improvement. We proceeded to a one-center, retrospective consecutive case series of women admitted for Essure® placement, from 1 January 2012 until 31 December 2016 (5 years).</p><p><strong>Results: </strong>In a total of 274 women, technical difficulties were mainly unilateral, with no acute or short-term severe complications. The procedure was brief (median 3.2 min, IQR 2.5-5.2) and moderately painful (median of 4 in a 0-10 scale; IQR 3-5). At 3 months, the failure rate was 2%, with no pregnancies. Second surgery indication (< 1%) resumed to a case of nickel hypersensitivity. At 1 year, pregnancy rate was 1%. Ninety-eight percent of the patients would recommend the method.</p><p><strong>Conclusions: </strong>We identified high patient satisfaction and low failure rates, both at short and long term. Investigation about whether some women still have patent tubes at the 3-month follow-up could lead to protocol improvement. It is important that clinicians look for second causes for adverse effects related to Essure® and avoid the erroneous indication for implant removal. Long follow-up allowed for both internal quality evaluation and clarification of misconception; it could possibly also have contributed to patient satisfaction.</p>","PeriodicalId":46311,"journal":{"name":"Gynecological Surgery","volume":"14 1","pages":"20"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s10397-017-1023-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35522514","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":"Face and content validity of the virtual reality simulator 'ScanTrainer®'.","authors":"Amal Alsalamah,&nbsp;Rudi Campo,&nbsp;Vasilios Tanos,&nbsp;Gregoris Grimbizis,&nbsp;Yves Van Belle,&nbsp;Kerenza Hood,&nbsp;Neil Pugh,&nbsp;Nazar Amso","doi":"10.1186/s10397-017-1020-6","DOIUrl":"https://doi.org/10.1186/s10397-017-1020-6","url":null,"abstract":"<p><strong>Background: </strong>Ultrasonography is a first-line imaging in the investigation of women's irregular bleeding and other gynaecological pathologies, e.g. ovarian cysts and early pregnancy problems. However, teaching ultrasound, especially transvaginal scanning, remains a challenge for health professionals. New technology such as simulation may potentially facilitate and expedite the process of learning ultrasound. Simulation may prove to be realistic, very close to real patient scanning experience for the sonographer and objectively able to assist the development of basic skills such as image manipulation, hand-eye coordination and examination technique.</p><p><strong>Objective: </strong>The aim of this study was to determine the face and content validity of a virtual reality simulator (ScanTrainer®, MedaPhor plc, Cardiff, Wales, UK) as reflective of real transvaginal ultrasound (TVUS) scanning.</p><p><strong>Method: </strong>A questionnaire with 14 simulator-related statements was distributed to a number of participants with differing levels of sonography experience in order to determine the level of agreement between the use of the simulator in training and real practice.</p><p><strong>Results: </strong>There were 36 participants: novices (<i>n</i> = 25) and experts (<i>n</i> = 11) who rated the simulator. Median scores of face validity statements between experts and non-experts using a 10-point visual analogue scale (VAS) ratings ranged between 7.5 and 9.0 (<i>p</i> > 0.05) indicated a high level of agreement. Experts' median scores of content validity statements ranged from 8.4 to 9.0.</p><p><strong>Conclusions: </strong>The findings confirm that the simulator has the feel and look of real-time scanning with high face validity. Similarly, its tutorial structures and learning steps confirm the content validity.</p>","PeriodicalId":46311,"journal":{"name":"Gynecological Surgery","volume":"14 1","pages":"18"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s10397-017-1020-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35555521","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":"Pushing the boundaries of laparoscopic myomectomy: a comparative analysis of peri-operative outcomes in 323 women undergoing laparoscopic myomectomy in a tertiary referral centre.","authors":"Rebecca Mallick,&nbsp;Funlayo Odejinmi","doi":"10.1186/s10397-017-1025-1","DOIUrl":"https://doi.org/10.1186/s10397-017-1025-1","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to analyse the demographic data and peri-operative outcomes of women undergoing a laparoscopic myomectomy and assess what factors, if any, precluded using the laparoscopic approach.</p><p><strong>Methods: </strong>A single surgeon observational study of 323 patients undergoing a laparoscopic myomectomy was undertaken. Data was collected prospectively over a 12-year period and analysed using SPSS. Surgical outcomes included operating time, estimated blood loss, conversion to laparotomy, intraoperative and postoperative complications and duration of inpatient stay.</p><p><strong>Results: </strong>A total of 323 patients underwent a laparoscopic myomectomy over the 12-year period. The majority of fibroids removed were intramural (49%) and subserosal (33%). The mean size of fibroids removed was 7.66 ± 2.83 (7.34-7.99) cm, and the mean number was 4 ± 3.62 (3.6-4.39), with the greatest being 22 removed from a single patient. Average blood loss was 279.14 ± 221.10 (254.59-303.69) ml with mean duration of surgery and inpatient stay recorded as 112.92 ± 43.21 (107.94-117.91) min and 1.88 ± 0.95 (1.77-1.99) days, respectively. No major intraoperative complications were noted, and the conversion to laparotomy rate was 0.62%. All histology following morcellation was benign. Over the 12-year period despite increasingly large and more numerous fibroids being tackled, increasing experience resulted in a simultaneous reduction in overall blood loss, operating time and duration of inpatient stay.</p><p><strong>Conclusions: </strong>Laparoscopic myomectomy is a safe and efficacious procedure that should be considered the gold standard surgical treatment option for fibroids. With experience, the procedure can be undertaken with minimal complications, a low risk of conversion to laparotomy and early discharge from hospital, even in cases of large and multiple fibroids that historically would have required the open approach. This allows even the most complex of cases to now benefit for the advantages of the minimal access approach.</p>","PeriodicalId":46311,"journal":{"name":"Gynecological Surgery","volume":"14 1","pages":"22"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s10397-017-1025-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35612092","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 role of the multidisciplinary team in the management of deep infiltrating endometriosis.","authors":"Lilian Ugwumadu,&nbsp;Rima Chakrabarti,&nbsp;Elaine Williams-Brown,&nbsp;John Rendle,&nbsp;Ian Swift,&nbsp;Babbin John,&nbsp;Heather Allen-Coward,&nbsp;Emmanuel Ofuasia","doi":"10.1186/s10397-017-1018-0","DOIUrl":"https://doi.org/10.1186/s10397-017-1018-0","url":null,"abstract":"<p><p>The multidisciplinary team (MDT) is considered good practice in the management of chronic conditions and is now a well-established part of clinical care in the NHS. There has been a recent drive to have MDTs in the management of women with severe endometriosis requiring complex surgery as a result of recommendations from the European Society for Human Reproduction and Embryology (ESHRE) and British Society for Gynaecological Endoscopy (BSGE). The multidisciplinary approach to the management of patients with endometriosis leads to better results in patient outcomes; however, there are potentially a number of barriers to its implementation and maintenance. This paper aims to review the potential benefits, disadvantages and barriers of the multidisciplinary team in the management of severe endometriosis.</p>","PeriodicalId":46311,"journal":{"name":"Gynecological Surgery","volume":"14 1","pages":"15"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s10397-017-1018-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35390480","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":"Treating symptomatic uterine fibroids with myomectomy: current practice and views of UK consultants.","authors":"R Fusun Sirkeci,&nbsp;Anna Maria Belli,&nbsp;Isaac T Manyonda","doi":"10.1186/s10397-017-1014-4","DOIUrl":"https://doi.org/10.1186/s10397-017-1014-4","url":null,"abstract":"<p><strong>Background: </strong>The demand for uterus-sparing treatments is increasing as more women postpone childbirth to their 30-40s, when fibroids are more symptomatic. With an increasing choice of treatment options and changing care-provider profiles, now is an opportune time to survey current practices and opinions. Using a 25-stem questionnaire, a web-based survey was used to capture the practices and opinions of UK consultant gynecologists on the treatment of symptomatic fibroids, including the types of procedure most frequently used, methods used to reduce blood loss, and awareness and acceptability of treatment options, and to assess the impact of gender and experience of the treating gynecologist.</p><p><strong>Results: </strong>The response rate was 22%. Laparascopic myomectomy is used least frequently, with 80% of the respondents using GnRHa preoperatively to minimize blood loss and correct anemia, while vasopressin is most frequently used to reduce intraoperative blood loss. Female consultants operate significantly less frequently than males. Those with more than 10 years consultant experience are more likely to perform an open myomectomy compared to those with less than 10 years experience.</p><p><strong>Conclusions: </strong>Compared to a similar survey performed 10 years ago, surgical methods remain to be the most common treatments, but use of less invasive treatments such as UAE has increased. Consultants' attitudes appear to be responding to the patient demand for less radical treatments. However, it is yet to be seen if the changing consultant demographics will keep up with this demand. The low response rate warrants cautious interpretation of the results, but they provide an interesting snapshot of current views and practices.</p>","PeriodicalId":46311,"journal":{"name":"Gynecological Surgery","volume":"14 1","pages":"11"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s10397-017-1014-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35390535","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}