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   Table of Contents - Current issue
Coverpage
October-December 2018
Volume 7 | Issue 4
Page Nos. 143-186

Online since Wednesday, September 26, 2018

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EDITORIAL  

A powerful value of hysteroscopy p. 143
Peng-Hui Wang
DOI:10.4103/GMIT.GMIT_71_18  PMID:30306031
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REVIEW ARTICLE Top

Loop electrosurgical excision procedure versus cryotherapy in the treatment of cervical intraepithelialneoplasia: A systematic review and meta-analysis of randomized controlled trials p. 145
Pietro D Alessandro, Bruno Arduino, Maria Borgo, Gabriele Saccone, Roberta Venturella, Annalisa Di Cello, Fulvio Zullo
DOI:10.4103/GMIT.GMIT_56_18  PMID:30306032
Aim: Invasive cervical cancer is proceeded by a phase of preinvasive disease that is slow to progress and can be detected, treated, and collectively referred to as cervical intraepithelial neoplasia (CIN). Several excisional and ablative treatments for CIN have been studied, with loop electrosurgical excision procedure (LEEP) and cryotherapy being the two most commonly utilized. The objective of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to compare the compare harms and benefits of LEEP versus cryotherapy in women with CIN. Methods: Electronic databases were searched from their inception until May 2018. We included all RCTs comparing cryotherapy versus LEEP in women with CIN. We included trials evaluating both HIV-seropositive and HIV-seronegative women. The primary outcome was the persistence of the disease at 6-month follow-up. Meta-analysis was performed using the random-effects model to produce summary treatment effects in terms of relative risk (RR) with 95% confidence interval (CI). Results: Four trials, including 1035 women with CIN, were identified as relevant and included in the meta-analysis. Women who received LEEP for CIN had a significantly lower persistence at 6-month follow-up biopsy (RR: 0.87, 95% CI: 0.76–0.99) and significantly lower recurrence at 12-month follow-up biopsy (RR: 0.91, 95% CI: 0.84–0.99) compared to those who received cryotherapy. No between-group differences were found in the complications rate, but the analyses were not powered for these outcomes. Conclusions: In women with CIN, treatment with LEEP was associated with a significantly lower risk of persistence disease at 6 months and recurrence disease at 12 months compared to treatment with cryotherapy.
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ORIGINAL ARTICLES Top

Utility of laparoscopic uterine myomectomy as a treatment for infertility with no obvious cause except for uterine fibroids p. 152
Satomi Kameda, Masafumi Toyoshima, Kohei Tanaka, Osamu Fujii, Shu-Ichi Iida, Nobuo Yaegashi, Takashi Murakami, Kazuhiko Hoshi
DOI:10.4103/GMIT.GMIT_2_18  PMID:30306033
Objectives: Uterine fibroids are capable of causing infertility, but there are no definite criteria for which laparoscopic uterine myomectomy (LM) is known to be beneficial. To investigate the usefulness of LM, we examined pregnancy rates in patients with infertility with no obvious cause except for the presence of uterine fibroids. Materials and Methods: We retrospectively reviewed the clinical records at Suzuki Memorial Hospital between June 2010 and August 2014. We found 60 eligible patients (LM group, 46; non-LM group, 14). The criteria for performing LM were a maximal fibroid diameter of 40 mm or more or the presence of >4 fibroids. Results: The duration of infertility before the first visit was significantly longer in the LM group; although there was no significant difference in the mean patient age and body mass index. Pregnancy was achieved in 45.7% of patients (21/46) in the LM group and 28.6% (4/14) in the non-LM group. There were no pregnancies in patients with >10 fibroids. The postoperative pregnancy rate in the LM group was comparable to previously reported pregnancy rates. Conclusions: Our criteria for performing LM in patients with no obvious cause for infertility except for uterine fibroids seem appropriate, especially when the fibroids are large and the number of fibroids is between 4 and 9. However, our results suggest that the effectiveness of LM is low in patients with 10 or more uterine fibroids.
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A randomized controlled trial comparing laparoscopic lens defogging techniques through simulation model p. 156
Vijay Palvia, Aaron J Herrera Gonzalez, Richard S Vigh, James N Anasti
DOI:10.4103/GMIT.GMIT_39_18  PMID:30306034
Context: Current literature demonstrates a lack of comparative studies regarding effective techniques for reducing laparoscopic lens fogging. Aim: Our primary objective is to determine the efficacy of various laparoscopic defogging techniques (LDT) through a randomized controlled trial that employs a novel simulation model of the abdominopelvic cavity. Settings and Design: This study was conducted at academic community hospital. This study design was a randomized controlled trial through simulation. Subjects and Methods: A chamber was constructed that simulated the abdominopelvic cavity. We used 5 and 10 mm 0° laparoscopes. A 10 cm visual analog scale was developed to assign visual clarity (VC) scores. The 10 cm mark indicated perfect VC. We employed the following LDTs: (1) glove warming (GLOVE), (2) surfactant solution (Fog Reduction and Elimination Device [FRED]), (3) chlorhexidine solution (SOAP), (4) warm saline (SALINE), and (5) control. Three observers were blinded to the LDT used. Primary outcomes included VC scores at designated time intervals (5, 30, and 60 s) for each LDT. A minimum of 10 observations per time interval were required to achieve adequate power based on a 2.5 cm difference in VC scores. Results: For the 10 mm laparoscope, FRED, SOAP, and SALINE had a VC score at 60 s (VC60) higher than control (4.8 ± 2.2, 7.8 ± 0.8, 7.9 ± 0.7 vs. 2.4 ± 0.72, P < 0.05). Both SOAP and SALINE VC60 scores were higher than FRED (7.8 ± 0.8, 7.9 ± 0.7 vs. 4.8 ± 2.2, P < 0.05). No differences were noted in VC60 scores between control and GLOVE (2.4 ± 0.72 vs. 3.1 ± 2.2, P > 0.05) and between SOAP and SALINE (7.8 ± 0.8 vs. 7.9 ± 0.7, P > 0.05). Similar results were noted with the 5 mm laparoscope. Conclusions: Common LDTs such as SALINE and SOAP were more effective than FRED, while GLOVE was no different than control. These results demonstrate that the use of effective LDTs can potentially translate into improved patient care and operative outcomes during surgery.
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Five-year lapsed: Review of laparoscopic myomectomy versus open myomectomy in Putrajaya Hospital p. 161
Emily Christine D Silva, Aisyah Munirah Muda, Anis Iryani Safiee, Wan Ahmad Hazim Wan Ghazali
DOI:10.4103/GMIT.GMIT_38_18  PMID:30306035
Study Objective: This study aimed to investigate the morbidity of laparoscopic myomectomy (LM) versus open myomectomy (OM), including intraoperative blood loss, duration of surgery, hospital stay, and complications and to evaluate the criteria for selection of cases suitable for LM. Design: This was a retrospective study. Setting: This study was conducted at tertiary hospital. Participants: The records of 67 women who underwent LM, 22 women who underwent OM, and 14 women who had laparo-conversion from January 2010 to November 2014 were reviewed. Measurement and Main Results: Fibroids up to 10 cm were removed by LM, while most fibroids more than 10 cm were managed through OM. The number and weight of myomas are significantly associated with laparo-conversion, with a rate of 17%. Mean blood loss was significantly reduced in LM group than the OM and laparo-conversion groups. Duration of hospital stay was also significantly less in LM (2 ± 1 days) compared to both OM and laparo-conversion groups (3 ± 1 days). Most women underwent LM (88%) had no postoperative complications compared to OM (50%) and laparo-conversion (57.1%). The number of fibroids removed and duration of surgery was positively correlated with blood loss in the women who underwent myomectomy. Conclusion: LM is an ideal surgical approach for removal of fibroids which are up to 10 cm diameter and <5 in number, while OM is useful for cases with multiple (5 or more), larger fibroids (>10 cm), and deeply located fibroids. Preoperative evaluation of the size and number of myomas is necessary to avoid laparo-conversion and to reduce intraoperative and postoperative complications.
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New continuous barbed suture device with stratafix for the vaginal stump in laparoscopic hysterectomy p. 167
Shintaro Yanazume, Shinichi Togami, Mika Fukuda, Toshihiko Kawamura, Masaki Kamio, Shunichiro Ota, Hiroaki Kobayashi
DOI:10.4103/GMIT.GMIT_34_18  PMID:30306036
Aims: Closure of the vaginal stump in total laparoscopic hysterectomy (TLH) performed by interrupted suture is time-consuming and requires sufficient experience. Stratafix (SF) is a new type of antibacterial monofilament absorbable suture which has multiple small anchors on the string surface. There is no information concerning the efficacy of SF for vaginal stump suture in minimally invasive hysterectomy. Materials and Methods: We retrospectively evaluated the operative complications and SF (n = 20) advantages for the vaginal stump in TLH and compared with a cohort of patients with conventional sutures (n = 20). The differences in performance based on operators' skill levels were also considered. Results: The time taken to close vaginal stump in the SF suture group was significantly lower than the conventional group (median times: 13.1 vs. 18.0 min, respectively; P = 0.038). Closure by a less experienced operator using SF suture was reduced by 7.2 min. The junior operator median vaginal suture time was only 2.6 min longer than the senior operator median time in SF suture group (P = 0.218), whereas an 8.4 min difference was recorded in the conventional suture group (P = 0.043). Total operation times did not significantly correlate with vaginal suturing techniques (median times: 126 vs. 145 min, respectively; P = 0.718). Complications regarding the vaginal stump closure techniques including organ injury, bleeding, wound separation, and pain did not occur in both groups. Conclusions: SF suturing facilitates the vaginal stump closure in TLH without increasing the complications. SF allowed vaginal stump approximation and reduced the operative burden, especially in less experienced operators.
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CASE REPORTS Top

Successful procedure in conservative management of interstitial (cornual) ectopic pregnancy p. 172
Cepi Teguh Pramayadi, Alvin Bramantyo, Eka Rusdianto Gunardi
DOI:10.4103/GMIT.GMIT_9_18  PMID:30306037
A 35-year-old woman presented with spotting and lower abdominal pain. Follow-up sonography was suggestive of interstitial ectopic pregnancy. Laparoscopic cornuostomy was carried out. Before incision, diluted vasopressin was injected around the site of interstitial pregnancy. Removal of the conceptual tissues was conducted smoothly through a 1.5 cm incision. The overall blood loss was 50 mL. The operative time was 50 min, and there were no intraoperative complications. We successfully performed laparoscopic cornuostomy, which was followed by an unremarkable postoperative course. Laparoscopic surgery is a safe and effective minimally invasive surgical intervention for interstitial ectopic pregnancy if performed by the experienced surgeon. Local vasopressin injection is a good alternative for bleeding control in conservative laparoscopic surgery.
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Surgical planning and counseling in adolescence: A case report of a 16-year-old with an aborting pelvic mass p. 175
Jessica Suzanne Zigman, Joy Brotherton, Christina Truong, Tajnoos Yazdany
DOI:10.4103/GMIT.GMIT_19_18  PMID:30306038
This case illustrates a rare finding and successful treatment of an aborting fibroid in a virginal adolescent. Careful consideration for the exam process, specific counseling, surgical planning and approach in this case are presented.
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CLINICAL IMAGE Top

Single-phase focused ultrasound surgery for 15-leiomyoma and huge leiomyoma patients p. 178
Minh Duc Nguyen
DOI:10.4103/GMIT.GMIT_52_18  PMID:30306039
Focused ultrasound surgery is a potential noninvasive surgery for eliminating leiomyoma. In this clinical image, we introduced an alternative role of this method for cases of multiple leiomyomas and huge leiomyoma with effective outcomes.
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LETTERS TO THE EDITOR Top

Port-site hernia: An individualized approach to port closure p. 181
Latika J Chawla, Gayatri A Rao, Shweta R Raje, Sharda Arvind
DOI:10.4103/GMIT.GMIT_29_18  PMID:30306040
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A novel non invasive screening tool for triaging endometrial pathologies in abnormal uterine bleeding: Diseases of endometrium – evaluation and risk scoring p. 183
Deeksha Pandey, Sri Vidya Kummarapurugu, MG Sayyad
DOI:10.4103/GMIT.GMIT_73_18  PMID:30306041
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Hysteroscopy for pyometra – treading on treacherous grounds p. 185
Pearl S. Y. Tong, Angela Cong, Selvan Pather
DOI:10.4103/GMIT.GMIT_76_18  PMID:30306042
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AUTHOR INDEX Top

Author Index  
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TITLE INDEX Top

Title Index  
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