Gynecology and Minimally Invasive Therapy最新文献

{"title":"A Case in Which Flexible Hysterofiberscopic Observation Was Useful for Removal of the Arm of a Levonorgestrel-releasing Intrauterine System That Had Pierced the Cervical Wall","authors":"Tatsuji Hoshino, Mizuho Tani, Tatsuo Mori, Masato Kinugasa, Yoshiyuki Tsuji","doi":"10.4103/gmit.gmit_73_23","DOIUrl":"https://doi.org/10.4103/gmit.gmit_73_23","url":null,"abstract":"","PeriodicalId":505791,"journal":{"name":"Gynecology and Minimally Invasive Therapy","volume":"122 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141843579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myomectomy: Choosing the Surgical Approach – A Systematic Review","authors":"Jhanice S. Paredes, C. Lee, P. Chua","doi":"10.4103/gmit.gmit_152_23","DOIUrl":"https://doi.org/10.4103/gmit.gmit_152_23","url":null,"abstract":"\u0000 Myomectomy has evolved from open laparotomy to laparoscopy, hysteroscopy, VNOTES and robotic myomectomy. The surgical approach in doing myomectomy depends on the type and location of the myoma and the surgeon’s expertise. Minimally invasive surgery has been the preferred approach due to the benefit of shorter hospital stay, lesser postoperative pain, earlier recovery, minimal blood loss and the cosmetic appearance of the scar. The success of this procedure depends on the incision technique, enucleation, and blood loss prevention by using hemostatic techniques and suturing techniques. Performing myomectomy for a large uterine myoma is a laparoscopic challenge; however, with the use of Lee-Huang point (midpoint between umbilicus and xiphoid) as the primary insertion and camera port, one can easily navigate thru the abdominal cavity in case the uterus is huge obscuring the umbilical port. Laparoscopic Myomectomy can be safely and efficiently performed by experienced laparoscopic surgeons regardless of myoma size, number and location. Removal of large myoma specimen from the abdominal cavity through the laparoscope became a challenge after the use of power morcellator was abandoned. To overcome this problem, the large myoma is placed inside an Endo bag and its edges brought extracorporeally through the port site. The myoma is incised in a C-manner using a scalpel to reduce the size. Myoma can also be removed using in-bag power morcellation. Fertility preservation is the long-term aim of doing myomectomy instead of hysterectomy in the management of leiomyoma aside from alleviating symptoms of abnormal uterine bleeding, urinary frequency and abdominal pain.","PeriodicalId":505791,"journal":{"name":"Gynecology and Minimally Invasive Therapy","volume":"3 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141849320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Various Laparoscopic Techniques in Pelvic Organ Prolapse Surgery","authors":"Antonette Ramos Pesebre, Masayoshi Nomura, Divina Yumul Soliza, Purim Ruanphoo, Moeko Kuriyama, Tomoka Obuchi, M. Nagae, S. Tokiwa, Kojiro Nishio, Tokumasa Hayashi","doi":"10.4103/gmit.gmit_113_23","DOIUrl":"https://doi.org/10.4103/gmit.gmit_113_23","url":null,"abstract":"\u0000 In the past, transvaginal surgery, native tissue restoration, or obliterative methods have been used in the majority of pelvic organ prolapse (POP) surgeries. Since laparoscopy has gained popularity, other procedures have been created to provide additional POP repair alternatives. Laparoscopic technique offers many advantages compared to open or transvaginal surgery when it comes to anatomical and surgical outcomes, recurrence rates, and patient’s acceptance. Furthermore, we encouraged incorporating different laparoscopic techniques into urogynecology training to attract young gynecologists. Based on our own clinical and surgical experience, we present various laparoscopic techniques for treating POP. We think that by giving patients a variety of surgical alternatives, we can treat them all more effectively.","PeriodicalId":505791,"journal":{"name":"Gynecology and Minimally Invasive Therapy","volume":"66 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141842931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improvement in Quality of Life after Laparoscopic or Robotic-assisted Sacrocolpopexy with a Single Anterior Mesh in Patients with Pelvic Organ Prolapse: A Retrospective Analysis from a Single Institution","authors":"R. Kinouchi, Kanako Yoshida, T. Kawakita, Toshiyuki Yasui, T. Iwasa, Takeshi Kato","doi":"10.4103/gmit.gmit_19_23","DOIUrl":"https://doi.org/10.4103/gmit.gmit_19_23","url":null,"abstract":"\u0000 \u0000 \u0000 Pelvic organ prolapse (POP) is a significant health-care problem for older women. We have treated POP surgically using laparoscopic sacrocolpopexy (LSC) or robotic-assisted sacrocolpopexy (RSC). The original LSC and RSC procedures were done with anterior and posterior meshes; however, the use of the single mesh procedure is increasing because of its simplicity and safety. There have been few reports about the change in quality of life (QOL) using the single mesh procedure. Therefore, the present study aimed to retrospectively evaluate the change in QOL by LSC and RSC using a single anterior mesh for women without posterior compartment prolapse.\u0000 \u0000 \u0000 \u0000 We performed LSC or RSC using a single anterior mesh in 52 patients who had POP without posterior vaginal wall prolapse between August 2018 and October 2022. We assessed the QOL before and after surgery using prolapse-QOL (P-QOL) questionnaires.\u0000 \u0000 \u0000 \u0000 All patients who received LSC or RSC with a single anterior mesh left the hospital as scheduled without severe perioperative complications. There were no instances of wound infection or vaginal mesh extrusion. The recovery rate of questionnaires was 63.5% (33/52). All QOL score domains improved significantly, and there were no questionnaire parameters that worsened.\u0000 \u0000 \u0000 \u0000 LSC or RSC using only a single anterior mesh improves P-QOL with a low incidence of surgical complications for POP patients who did not have posterior vaginal wall prolapse. LSC or RSC with a single anterior mesh may be a prospective new procedure for POP.\u0000","PeriodicalId":505791,"journal":{"name":"Gynecology and Minimally Invasive Therapy","volume":"17 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141843183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trocar-site Herniation after Laparoscopic Myomectomy via Culdotomy Extraction","authors":"Ihsan Baglı","doi":"10.4103/gmit.gmit_157_23","DOIUrl":"https://doi.org/10.4103/gmit.gmit_157_23","url":null,"abstract":"\u0000 Trocar-site hernia is a rare and life-threatening complication of laparoscopic abdominal surgery; 5-mm trocar-site bowel herniation is rarer than ≥ 10-mm trocar-site herniation. We present a 41-year-old female patient on the postoperative 6th day with laparoscopic myomectomy admitted to our emergency department with severe vomiting and nausea. At the end of the evaluations, she was diagnosed with 5-mm trocar-site small bowel herniation. A herniated small bowel segment was rescued through the laparotomy. After full recovery, the patient was discharged on the 3rd day of hospitalization. Although there is no consensus on the closure of small fascia incisions (<10 mm) routinely, we suggest that all fascia incisions should be assessed in patients at risk to prevent trocar-site hernias. According to our investigation for trocar-site hernia in the literature, laparoscopic myomectomy may be considered a risk factor.","PeriodicalId":505791,"journal":{"name":"Gynecology and Minimally Invasive Therapy","volume":"5 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141848821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating High-intensity Focused Ultrasound with Chemotherapy for the Treatment of Invasive Hydatidiform Mole in Reproductive-age Women","authors":"Yongmiao Pan, Kaiqing Lin, Ying Hu, Xiaohong Song, L. Xu, Z. Zhou, Di Xie, Yuan Xue","doi":"10.4103/gmit.gmit_86_23","DOIUrl":"https://doi.org/10.4103/gmit.gmit_86_23","url":null,"abstract":"\u0000 Invasive hydatidiform mole, a form of gestational trophoblastic neoplasm in reproductive-age women, poses a significant threat to life due to its associated signs and symptoms. This case report details the management of a 24-year-old Chinese woman with no prior pregnancy history, who presented at our hospital 23 days postcurettage, experiencing persistent vaginal bleeding for 3 days. While two rounds of chemotherapy effectively reduced human chorionic gonadotropin levels, a subsequent magnetic resonance imaging (MRI) revealed suspicious growth lesions in the uterus. High-intensity focused ultrasound (HIFU) treatment was administered under ultrasound guidance, resulting in notable grayscale changes to optimize the efficacy of chemotherapy and restrict lesion progression. Subsequent ultrasound and MRI assessments during follow-up demonstrated a transparent texture in the muscle layer at the lesion site. This case suggests that the combination of chemotherapy and HIFU, guided by ultrasound, may represent a promising therapeutic approach for managing invasive hydatidiform mole.","PeriodicalId":505791,"journal":{"name":"Gynecology and Minimally Invasive Therapy","volume":"5 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141849015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthesia-free In-office Hysteroscopic Morcellation for Endometrial Polyps: A Prospective Study","authors":"Daiki Hiratsuka, Akira Tsuchiya, A. Fujimoto, Osamu Nishii","doi":"10.4103/gmit.gmit_64_23","DOIUrl":"https://doi.org/10.4103/gmit.gmit_64_23","url":null,"abstract":"\u0000 \u0000 \u0000 The objective of the study was to evaluate the feasibility and quality of anesthesia-free in-office hysteroscopic morcellation for the treatment of endometrial polyps.\u0000 \u0000 \u0000 \u0000 A prospective, single-center, open-label, single-arm clinical trial was conducted to evaluate the efficacy of hysteroscopic morcellation for endometrial polyps or retained products of conception. All surgical procedures were performed using the TruClear™ 5C system in the office setting without anesthesia. The primary endpoint was the success rate of surgery, defined as the completion of the operation. The secondary endpoints were operating time, fluid deficit, adverse events, pain evaluated by Visual Analog Scale (VAS) scores, and recurrence rate.\u0000 \u0000 \u0000 \u0000 Ninety-five patients underwent hysteroscopic morcellation without anesthesia and received the treatment. The success rate of surgery was 100% (95/95), and the mean operating time was 7.3 min. Adverse events occurred in only 2.1% (2/95), with vasovagal reflex. The mean VAS scores during the procedure ranged from 2.4 to 3.1, and the recurrence rate after 6 months was 2.1% (1/47), with a pregnancy rate of 33% (11/33). When comparing nulliparous and parous patients, the success rate and the operating time were equivalent, and the mean VAS scores during the procedure were both within tolerable levels but significantly higher in nulliparous patients (3.3–4.5 vs. 1.6–1.9, P < 0.001).\u0000 \u0000 \u0000 \u0000 This study demonstrated that anesthesia-free in-office hysteroscopic morcellation for endometrial polyps can be safely performed with feasible quality and only tolerable pain. This less-invasive procedure is expected to become more widespread in future.\u0000","PeriodicalId":505791,"journal":{"name":"Gynecology and Minimally Invasive Therapy","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141849987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Easy Standardized Technique for Dissection of the Anterior Leaf of the Vesicouterine Ligament","authors":"K. Chikazawa, K. Imai, T. Kuwata, Ryo Konno","doi":"10.4103/gmit.gmit_154_23","DOIUrl":"https://doi.org/10.4103/gmit.gmit_154_23","url":null,"abstract":"","PeriodicalId":505791,"journal":{"name":"Gynecology and Minimally Invasive Therapy","volume":"616 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141852271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation between Pelvic Diameter and Different Surgical Procedures for Exogenous Cervical Leiomyoma","authors":"Lifang Xue, Liying Wang, Xu Mu, Xiaoyan Xie, Kaiwu Lin, Liangzhi Cai","doi":"10.4103/gmit.gmit_15_23","DOIUrl":"https://doi.org/10.4103/gmit.gmit_15_23","url":null,"abstract":"\u0000 \u0000 \u0000 The objective of the study was to investigate the clinical value of pelvic diameter in the evaluation of surgical difficulty and selection of the best surgical plan for exogenous cervical leiomyomas.\u0000 \u0000 \u0000 \u0000 Sixty-five patients with exogenous cervical leiomyomas admitted to our hospital from 2012 to 2021 were enrolled. All patients underwent pelvic magnetic resonance imaging examination before surgery and received surgical treatment within 1 week. Relevant clinical data were collected. According to the surgical approach, they were divided into two groups: the laparoscopic group and the laparotomy group. The clinical significance of the pelvic diameter line in the surgical selection of exogenous cervical leiomyomas was discussed by retrospective analysis of the correlation between the pelvic diameter line and the collected clinical indicators.\u0000 \u0000 \u0000 \u0000 There was no significant difference in tumor location and pelvic diameter between the two groups (P > 0.05). However, there was a significant difference in tumor diameter and the ratio of tumor diameter line to pelvic diameter line (P < 0.05). In addition, the laparoscopic group underwent more myomectomy than hysterectomy and lost more blood during operation (P < 0.05).The postoperative index showed that patients in the laparotomy group had a higher proportion of full of cellular leiomyoma, higher postoperative temperature, and longer postoperative exhaust time (P < 0.05).\u0000 \u0000 \u0000 \u0000 The ratio of the tumor diameter line to the pelvic diameter line is correlated with the surgical plan selection of exogenous cervical leiomyomas, which may be used to evaluate the surgical difficulty of these patients and the selection of the suitable surgical plan.\u0000","PeriodicalId":505791,"journal":{"name":"Gynecology and Minimally Invasive Therapy","volume":"83 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141838600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Four-handed Technique for Total Laparoscopic Hysterectomy: An Italian Experience","authors":"Pierpaolo Nicolì, Anna Biffi, G. D. Boca, Amerigo Vitagliano, E. Silvestris, Vera Loizzi, E. Naro, Ettore Cicinelli, G. R. Damiani","doi":"10.4103/gmit.gmit_50_23","DOIUrl":"https://doi.org/10.4103/gmit.gmit_50_23","url":null,"abstract":"\u0000 \u0000 \u0000 In our previous article, we proposed the novel four-handed technique (FHT) for total laparoscopic hysterectomy (TLH), which, according to us, is more helpful compared to the traditional TLH route. The objectives of the study were to analyze the FHT-TLH feasibility and efficiency by comparing some surgical outcomes recorded from 750 FHT-TLH performed in our hospital to literature data about the traditional TLH route and to underline the great opportunity this novel technique offers to the young specialists and residents to be more confident with gynecological laparoscopy.\u0000 \u0000 \u0000 \u0000 This was a retrospective analysis carried out by collecting data regarding patient characteristics and surgical outcomes (operative time, blood loss, surgical complications, use of analgesics, and length of hospitalization) from 750 hospital records of women who underwent FHT-TLH (with or without adnexectomy) due to benign or malignant pathology from January 2015 to December 2021 at our hospital.\u0000 \u0000 \u0000 \u0000 We performed a total of 750 FHT-TLH, with or without adnexectomy. The mean skin-to-skin operative time for a FHT-TLH was 50 min, and the mean blood loss was 150 mL. No visceral damage was caused during surgeries. Only two patients underwent exploratory laparotomy with total abdominal hysterectomy due to the inability to proceed laparoscopically. Nonsteroidal anti-inflammatory drugs were administered only twice a day as analgesics, with advantage. The mean length of stay in the hospital after the procedure was 1.5 days, with discharge on the evening of the 1st day after surgery. No major postoperative complications occurred. The only minor postoperative complication described, in just three patients, was cellulitis of the vaginal vault.\u0000 \u0000 \u0000 \u0000 Our FHT-TLH experience represents an alternative to the traditional TLH route, which allows to apply a minimally invasive approach with some advantages for patients compared to the traditional TLH route, such as early recovery and reduced operating time, blood loss, use of analgesics, and hospital stay. Moreover, it allows young specialists and residents to be more confident with gynecological laparoscopy, particularly when operating as the first assistant, to improve their laparoscopic surgical skills faster than the traditional TLH route allows them.\u0000","PeriodicalId":505791,"journal":{"name":"Gynecology and Minimally Invasive Therapy","volume":"116 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141843824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}