Hysteroscopic view with targeted biopsy in the assessment of endometrial carcinoma. What is the rate of underestimatated diagnosis? The results of a multicenter Italian trial
AbstractObjectiveIn the last two decades, many reports demonstrated the unreliability of endometrial biopsy pathology showing an AH (atypical hyperplasia) to exclude a synchronous EEC (endometrioid endometrial carcinoma), with an underestimation of EEC in up to 50% of women. Hysteroscopy is now considered the standard diagnostic tool for endometrial pathology. However, a recent meta-analysis showed that hysteroscopically guided biopsy provides a high rate of failure with respect to dilatation and curettage (D&C) and endometrial resection, in underestimating AH instead of concurrent EC. The aim of this study was to asse...
Source: Gynecological Surgery - July 19, 2020 Category: OBGYN Source Type: research
An evaluation of a Myomscore in the preoperative assessment of uterus myomatosus: a new diagnostic standard? The experience at the Mathilden Hospital in Herford, Germany
(Source: Gynecological Surgery)
Source: Gynecological Surgery - July 6, 2020 Category: OBGYN Source Type: research
Extending cervicoplastic surgery: an alternative technique to overcome the limitation of office hysteroscopy
AbstractOur objective is to show a feasible approach to the hysteroscopic procedures when the cervical canal has a diameter smaller than the lesion. Our study is designed as a case series and illustration of the surgical hysteroscopic technique. A group of patients (n = 37) underwent office hysteroscopy in Regional Reference Center for Hysteroscopy Service at Palagi Hospital, Florence, Italy, to see and treat an endometrial polyp with unfavorable cervical conditions between January 2019 and December 2019. An office hysteroscopy in outpatient setting with vaginoscopic approach was performed in women with unfavorable cervica...
Source: Gynecological Surgery - July 1, 2020 Category: OBGYN Source Type: research
Laparoscopic-assisted myomectomy with uterine artery occlusion at a freestanding ambulatory surgery center: a case series
ConclusionLaparoscopic-assisted myomectomy can be performed safely in a freestanding ambulatory surgery setting, including morbidly obese patients. This is especially important in the age of COVID-19, as elective surgeries have been postponed due to the 2020 pandemic, which may lead to a dramatic and permanent shift of outpatient surgery from the hospital to the ASC setting. (Source: Gynecological Surgery)
Source: Gynecological Surgery - June 16, 2020 Category: OBGYN Source Type: research
Endometrial stromal sarcoma presented as endometrial polyp: a rare case
We report a case of low-grade endometrial stromal sarcoma in a 39-year-old woman, whose ultrasound examination suggested a large endometrial polyp. Polypectomy followed by laparoscopic total hysterectomy with bilateral salpingo-oophorectomy was performed. The final histological examinat ion showed no residual disease, implying that the tumor was totally resected during hysteroscopy. This case report highlights that endometrial stromal sarcoma is to be included in the differential diagnosis of endometrial polyp though rare. (Source: Gynecological Surgery)
Source: Gynecological Surgery - June 1, 2020 Category: OBGYN Source Type: research
Hysteroscopic treatment of retained placental tissue: a case report
AbstractRetained placenta tissue is a rare condition, and its diagnosis and surgical treatment are often challenging. Conventionally, the surgical management of such cases is largely performed using blind dilation and curettage. Our case demonstrates that the successful complete removal of retained placental tissues can be achieved with operative hysteroscopy with minimal use of electrosurgery in order to minimize the short- and long-term complications. This was achieved using the loop of the bipolar resectoscope as a curette performing cold dissection. (Source: Gynecological Surgery)
Source: Gynecological Surgery - June 1, 2020 Category: OBGYN Source Type: research
Is fibroid location associated with hemorrhage and complication rates following laparoscopic myomectomy?
ConclusionThe incidence of hemorrhage or complication does not seem to vary depending on the fibroid location. However, the sample size was limited; observed values suggest that fibroid location does not affect hemorrhage and complication rates. (Source: Gynecological Surgery)
Source: Gynecological Surgery - May 26, 2020 Category: OBGYN Source Type: research
Laparoscopy in the coronavirus disease 2019 (COVID-19) era
AbstractThe novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that emerged in China at the end of 2019 has become a pandemic infection that has now involved 200 countries with 465,915 confirmed cases and 21,031 confirmed deaths. Unfortunately, many data have shown that the high number of undocumented infections could have a major role in the rapid diffusion of the disease. In most of the nations involved, non-urgent, non-cancer procedures have been stopped to reallocate medical and paramedical staff to face the emergency. Moreover, concerns have been raised that minimally invasive surgery could be a proced...
Source: Gynecological Surgery - May 14, 2020 Category: OBGYN Source Type: research
Preclinical evaluation of a new robot-assisted surgical system for use in gynecology minimal access surgery
AbstractRobot-assisted laparoscopy has been developed to overcome some of the important limitations of conventional laparoscopy. In particular, the provision of stable magnified three-dimensional vision, tremor filtering, motion scaling, and articulated instruments with robot-assisted surgery has the potential to enable more surgeons to perform more complex surgery compared with conventional laparoscopy. The aim of this study was to evaluate the utility of a new robot-assisted surgical system (Versius, CMR Surgical, Cambridge, UK) for gynecologic procedures in a preclinical setting. Cadaveric sessions were conducted to eva...
Source: Gynecological Surgery - April 14, 2020 Category: OBGYN Source Type: research
Laparoscopic hysterectomy versus total abdominal hysterectomy: a retrospective study at a tertiary hospital
AbstractObjectiveTo compare laparoscopic hysterectomy (LH) with total abdominal hysterectomy (TAH) regarding different outcome measures at our tertiary hospital.Study designThis retrospective comparative cross-sectional study was conducted at the Department of Obstetrics and Gynecology Department, Women ’s Hospital, Hamad Medical Corporation, Doha, Qatar. It included 44 patients who had LH (group 1) and 95 patients who had TAH (group 2) during the period from January 2009 through June 2014.ResultsThree patients were converted from LH to TAH and were excluded from the final analysis. The size of the uterus was smaller...
Source: Gynecological Surgery - April 10, 2020 Category: OBGYN Source Type: research
The role of diagnostic hysteroscopy in diagnosis of incomplete uterine septum in patients with recurrent pregnancy loss in the era of transvaginal 3D ultrasound scan
AbstractPurposeTo determine the accuracy of transvaginal 3D ultrasound scan (TV 3D US) in detecting partial septate uterus (PSU) in patients with recurrent pregnancy loss (RPL).MethodsThis retrospective study included 113 patients with an initial diagnosis of unexplained RPL, who were subsequently found to have PSU on diagnostic hysteroscopy and who had TV 3D US prior to surgery. The diagnosis of PSU was made at the time of a diagnostic hysteroscopy based on ESHRE-ESGE classification of M üllerian anomalies. Based on hysteroscopic findings, patients were divided into two groups: those with PSU and a central point of i...
Source: Gynecological Surgery - December 11, 2019 Category: OBGYN Source Type: research
Laparoscopic lateral suspension: a single-site and single-surgeon experience
ConclusionsLLS might be a valid alternative to the laparoscopic sacrocolpopexy in women with prolapse in the anterior compartment and apical descent. Younger women with higher parity and higher degree of prolapse in the middle compartment had a higher recurrence rate after LLS. (Source: Gynecological Surgery)
Source: Gynecological Surgery - December 10, 2019 Category: OBGYN Source Type: research
Medical management of deeply infiltrating endometriosis - 7 year experience in a tertiary endometriosis centre in London
ConclusionsMedical treatments are generally safe, well tolerated and inexpensive. More than half (52.6%) of women were successfully managed with medical therapy to control their symptoms. This study supports the growing evidence supporting hormonal therapies in the management of deeply infiltrating endometriosis. The findings may be used to counsel women on the likely success rate of medical management. (Source: Gynecological Surgery)
Source: Gynecological Surgery - December 3, 2019 Category: OBGYN Source Type: research
The utility of fibrinogen level as a predictor of complications after laparoscopic gynecologic surgery: a prospective observational study
ConclusionsOur findings demonstrated that fibrinogen increase can enable the early detection of postoperative complications after laparoscopic gynecological surgery. Further prospective and multi-center studies are warranted to confirm these results. (Source: Gynecological Surgery)
Source: Gynecological Surgery - November 1, 2019 Category: OBGYN Source Type: research
Effectiveness of ovarian suspension in preventing postoperative ovarian adhesions in patients with severe pelvic endometriosis —a case-control study
AbstractBackgroundEndometriosis can exert obvious negative effects on women ’s quality of life.Excisional surgery is among the most effective treatments for severe pelvic endometriosis. The prevalence of severe pelvic adhesions following a laparoscopic examination of severe endometriosis varies between 50 and 100%. Temporary intraoperative ovarian suspension is a method for the reduction of adhesions is in the treatment of severe pelvic endometriosis. Given the importance and the prevalence of endometriosis and its complications, we conducted the present study to determine more effective adhesion-reducing methods wit...
Source: Gynecological Surgery - October 29, 2019 Category: OBGYN Source Type: research
Comparison of laparoscopy-assisted vaginal hysterectomy as endoscopic single-station surgery and conventional laparoscopic hysterectomy —surgical effects on safety and quality of life
ConclusionLESS hysterectomy is a reliable and safe option in gynecologic surgery. Compared to conventional laparoscopic hysterectomy, LESS surgery demonstrated comparable surgical properties in regard to blood loss, duration of surgery, and intra-/postoperative complications. Notably, patients undergoing LESS hysterectomy experienced some less pain postoperatively. (Source: Gynecological Surgery)
Source: Gynecological Surgery - August 16, 2019 Category: OBGYN Source Type: research
Correction to: Comparing self-assessment of laparoscopic technical skills with expert opinion for gynecological surgeons in an operative setting
In the publication of this article , the contributing author Wesam Aleyadeh was missing. This has now been updated in this correction. (Source: Gynecological Surgery)
Source: Gynecological Surgery - May 27, 2019 Category: OBGYN Source Type: research
Prediction of unsuccessful endometrial ablation: a retrospective study
ConclusionWe propose two multivariate models to predict the chance of failure and surgical re-intervention within 2 years after EA. Due to the permanent character of EA, the increasing number of post-operative failure and re-interventions, these prediction models could be useful for both the doctor and patient and may contribute to the shared decision-making. (Source: Gynecological Surgery)
Source: Gynecological Surgery - May 1, 2019 Category: OBGYN Source Type: research
Implementing robotic assisted myomectomy in surgical practice – a retrospective cohort study
AbstractBackgroundTo compare surgical outcomes of patients with leiomyomas after robotic-assisted laparoscopic myomectomy (RALM), laparoscopic myomectomy (LsM), or laparotomic myomectomy (LtM) and to construct a useful algorithm for the best modus operandi for uterine leiomyomas.MethodsDesign: A retrospective chart review. Data included patient (age and BMI) and fibroid characteristics (number, measurements of the primary fibroid, type, and location), operating time, blood loss, hospitalization length, complications during and after surgery, and complications during posttreatment pregnancies. Comparisons were based on chi-...
Source: Gynecological Surgery - April 1, 2019 Category: OBGYN Source Type: research
A value-based evaluation of minimally invasive hysterectomy approaches
AbstractBackgroundWith surgical care contributing to the rising healthcare costs around the globe, quantifying the value of surgical modalities is critical to pushing healthcare systems in the direction of greater sustainability. The purpose of this study was to assess and compare the value of minimally invasive hysterectomy approaches, as defined by operative outcomes and patient satisfaction relative to direct hospital costs.MethodsSequential mixed methods; retrospective chart review of all women (N = 2689) ≥ 18 years old who underwent hysterectomy for benign conditions from 2011 through 20...
Source: Gynecological Surgery - March 18, 2019 Category: OBGYN Source Type: research
Gasless laparoendoscopic single-site surgery with intraoperative autologous blood transfusion for management of ectopic pregnancy with significant hemoperitoneum: a retrospective observational study
ConclusionGasless LESS surgery with intraoperative autologous blood transfusion is a feasible minimally invasive surgical option with avoidance to use homologous blood for management of selected cases of ectopic pregnancy even with significant hemoperitoneum. (Source: Gynecological Surgery)
Source: Gynecological Surgery - March 5, 2019 Category: OBGYN Source Type: research
Symptomatic endometriosis developing several years after menopause in the absence of increased circulating estrogen concentrations: a systematic review and seven case reports
ConclusionsSymptomatic and clinically progressive endometriosis after menopause in the absence of increased systemic estrogen concentrations or exogenous estrogen intake starts more than 10 years after menopause in the majority of women. This observation suggests that a genetic and/or epigenetic incident caused estrogen-independent progression, increased sensitivity to estrogens or increased local production of estrogens. This observation is important for understanding the pathophys iology of endometriosis, for the management of postmenopausal endometriosis, and for individualization of medical therapy of endometri...
Source: Gynecological Surgery - February 15, 2019 Category: OBGYN Source Type: research
The diagnosis and management of interstitial ectopic pregnancies: a review
The objective of this article is to review the published literature on the diagnosis and management of interstitial pregnancies (IPs). IPs account for 2 –6% of all ectopic pregnancies and have the potential to cause life-threatening haemorrhage resulting in a 2–5% mortality rate. There is little consensus on the best practice for diagnosing and managing interstitial pregnancies. By reviewing the published data, we set out to determine what the b est evidence-based practice for the management of interstitial ectopic pregnancies is, what protocols can be used and whether this improves post-operative outcomes and ...
Source: Gynecological Surgery - February 4, 2019 Category: OBGYN Source Type: research
Pelvic exenteration in gynecologic cancer: complications and oncological outcome
ConclusionsPE provides about a 40% 4-year survival chance in a selected group of patients. The early-complications rate and 30-day mortality were acceptable. Nevertheless, the medium-late complication grades II –V were 65, 48, 18 and 9%, respectively. We must focus on identifying those patients who could potentially benefit most from PE. (Source: Gynecological Surgery)
Source: Gynecological Surgery - January 28, 2019 Category: OBGYN Source Type: research
Didactic lectures versus simulation training: a randomised pilot evaluation of its impact on surgical skill
ConclusionsThis study clearly demonstrates that exposure to simulation training is superior compared to didactic lecture-based teaching for the acquisition of surgical skills. (Source: Gynecological Surgery)
Source: Gynecological Surgery - December 18, 2018 Category: OBGYN Source Type: research
Safety and efficacy of non-absorbable mesh in contemporary gynaecological surgery
AbstractMesh-augmented pelvic floor surgery evolved to address the limitations of native tissue repair in reconstructive surgery. The development of the synthetic mid-urethral tape signalled a revolution in the treatment of stress urinary incontinence, whilst the use of mesh in abdominal apical prolapse repair may confer benefits over native tissue alternatives. However, these procedures can be associated with mesh-specific complications, underlining the need for shared decision-making between physicians and patients prior to mesh surgery.Transvaginal non-absorbable mesh implants for pelvic organ prolapse are associated wi...
Source: Gynecological Surgery - November 23, 2018 Category: OBGYN Source Type: research
Elective uterine artery embolization prior to laparoscopic resection of interstitial pregnancy: two cases and literature review
ConclusionWe report on the use of elective UAE prior to laparoscopic resection of IP, because of signs of strong vascularization on ultrasound. This strategy coincided with a nearly bloodless operation. Literature review suggests that this is one of the effective methods to reduce blood loss intra-operatively. (Source: Gynecological Surgery)
Source: Gynecological Surgery - November 14, 2018 Category: OBGYN Source Type: research
Total laparoscopic hysterectomy for benign disease: outcomes and literature analysis
ConclusionsTotal laparoscopic hysterectomy is a procedure with a low incidence of complications. Our data compare favorably with the data of the other listed studies. (Source: Gynecological Surgery)
Source: Gynecological Surgery - November 14, 2018 Category: OBGYN Source Type: research
A PET-positive rapidly growing mass of the abdominal wall after cesarean section with an unexpected diagnosis of vernix caseosa granuloma: a case report
ConclusionsThe present case provides information on an abdominal wall foreign body granuloma arisen from meconium and vernix caseosa after cesarean section, which presented an atypical clinical picture, mimicking a desmoid, thus requiring a careful diagnostic and treatment approach. (Source: Gynecological Surgery)
Source: Gynecological Surgery - October 10, 2018 Category: OBGYN Source Type: research
Comparing self-assessment of laparoscopic technical skills with expert opinion for gynecological surgeons in an operative setting
ConclusionSelf-assessment of surgical laparoscopic skills is higher than expert evaluation of these technical skills. Quality assurance measures need to be revisited and restructured through more frequent assessments using peer and expert assessment alongside self-assessment. Gynecologists also need to undergo proper assessment prior to starting independently performing procedures that require new skills. (Source: Gynecological Surgery)
Source: Gynecological Surgery - September 26, 2018 Category: OBGYN Source Type: research
Laparoscopic-guided transversus abdominis plane block versus trocar site local anesthetic infiltration in gynecologic laparoscopy
ConclusionLaparoscopic-guided transversus abdominis plane block is more effective in reduction of both pain scores in the early postoperative period and the cumulative narcotics consumption than trocar site local anesthetic infiltration in gynecologic laparoscopy.Trial registrationClinical Trials.govNCT02973451 (Source: Gynecological Surgery)
Source: Gynecological Surgery - September 17, 2018 Category: OBGYN Source Type: research
Feasibility of sentinel lymph node fluorescence detection during robotic laparoendoscopic single-site surgery in early endometrial cancer: a prospective case series
ConclusionsThe present study demonstrates the feasibility and applicability of robotic single-site approach with SLN fluorescence detection for the staging of low-risk endometrial cancer. (Source: Gynecological Surgery)
Source: Gynecological Surgery - August 22, 2018 Category: OBGYN Source Type: research
Chronic pelvic pain and the role of exploratory laparoscopy as diagnostic and therapeutic tool: a retrospective observational study
AbstractBackgroundForty percent of exploratory laparoscopies are performed for chronic pelvic pain (CPP). However, a final diagnosis is still unreported in 35% of the patients. We decided to evaluate the identification of pathological lesions and the improvement of painful symptoms in patients with CPP and normal physical examination and imaging and who are scheduled for exploratory laparoscopy. The prospective study was designed in a tertiary referral center for endometriosis. Forty-eight patients complaining of CPP and scheduled for exploratory laparoscopy were included. Pelvic pain intensity was assessed using the visua...
Source: Gynecological Surgery - July 20, 2018 Category: OBGYN Source Type: research
Fertility outcome after treatment of retained products of conception: a systematic review
ConclusionThere is insufficient evidence on how different treatment options for RPOC affect future reproductive outcomes. Results from ongoing RCTs are needed to guide clinicians towards choosing the best treatment. (Source: Gynecological Surgery)
Source: Gynecological Surgery - July 16, 2018 Category: OBGYN Source Type: research
Laparoscopic sacrocolpopexy is as safe in septuagenarians or elder as in younger women
AbstractBackgroundData concerning laparoscopic sacrocolpopexy (LSCP) in elder women are scarce. We compared intra-operative and early-postoperative complications associated with laparoscopic colpo-, cervico-, or hysteropexy in women under and above 70 years.MethodsRetrospective assessment by an independent investigator of a prospective cohort of 571 consecutive women undergoing LSCP in a tertiary unit over an 18-year period. Data included were patient demographics, operative variables, intra-operative, and early ( ≤ 3 months) postoperative complications. Complications were graded according to the Clavi...
Source: Gynecological Surgery - June 5, 2018 Category: OBGYN Source Type: research
Correction to: Prevalence and predictors of burnout among obstetrics and gynecology residents in Canada
Following the publication of this article , the authors have removed the “Maslach Burnout Inventory, Forms: General Survey, Human Services Survey& Educators Survey ” from the supplementary materials of the article  due to copyright restrictions. (Source: Gynecological Surgery)
Source: Gynecological Surgery - May 22, 2018 Category: OBGYN Source Type: research
Fetoscopic endoluminal tracheal occlusion and reestablishment of fetal airways for congenital diaphragmatic hernia
ConclusionFor left-sided severe and moderate CDH, the procedure is considered investigational and is currently being evaluated in a global randomized clinical trial (https://www.totaltrial.eu/). The procedure can be clinically offered to fetuses with severe right-sided CDH. (Source: Gynecological Surgery)
Source: Gynecological Surgery - May 8, 2018 Category: OBGYN Source Type: research
Surgical outcomes of laparoscopic hysterectomy with concomitant endometriosis without bowel or bladder dissection: a cohort analysis to define a case-mix variable
AbstractBackgroundPelvic endometriosis is often mentioned as one of the variables influencing surgical outcomes of laparoscopic hysterectomy (LH). However, its additional surgical risks have not been well established. The aim of this study was to analyze to what extent concomitant endometriosis influences surgical outcomes of LH and to determine if it should be considered as case-mix variable.ResultsA total of 2655 LH ’s were analyzed, of which 397 (15.0%) with concomitant endometriosis. For blood loss and operative time, no measurable association was found for stages I (n = 106) and II (n =&thin...
Source: Gynecological Surgery - March 16, 2018 Category: OBGYN Source Type: research
Implementation of laparoscopic hysterectomy for endometrial cancer over the past decade
ConclusionsImplementation of laparoscopic hysterectomy for early-stage EC increased from 11 to 85% in 10 years. Implementation of TLH was often preceded by LAVH and was faster in teaching hospitals. (Source: Gynecological Surgery)
Source: Gynecological Surgery - February 27, 2018 Category: OBGYN Source Type: research
Feasibility and safety of total laparoscopic hysterectomy for huge uteri without the use of uterine manipulator: description of emblematic cases
ConclusionsAlthough we believe in the great usefulness of the uterine manipulator in performing TLH for huge uteri, in the present paper, we demonstrate the feasibility and safety of such complex surgery also when the use of this tool is not possible due to unfavorable anatomical condition. (Source: Gynecological Surgery)
Source: Gynecological Surgery - February 26, 2018 Category: OBGYN Source Type: research