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   Table of Contents - Current issue
Coverpage
January-March 2019
Volume 8 | Issue 1
Page Nos. 1-48

Online since Wednesday, January 23, 2019

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EDITORIAL  

Minimally invasive therapy for cancer: It is time to take actions for training system in minimally invasive therapy after lacc report p. 1
Chyi-Long Lee
DOI:10.4103/GMIT.GMIT_132_18  PMID:30783581
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REVIEW ARTICLE Top

Epidemiologic factors associated with endometriosis in East Asia p. 4
Chih-Feng Yen, Mee-Ran Kim, Chyi-Long Lee
DOI:10.4103/GMIT.GMIT_83_18  PMID:30783582
Aim: With a perplexing pathogenesis and an incidence rate of approximately 10% among women of reproductive age, endometriosis affects more women in Asia than in any other continent in the world. This paper reviews the available data on the epidemiology and risk factors associated with endometriosis in East Asia. Methods: Included studies were published between January 2000 and December 2016. Articles were required to include East Asian patients with a diagnosis of endometriosis and to study epidemiology, such as the prevalence and/or incidence, associated with inherited, environmental, and/or lifestyle factors. A total of 65 candidate articles were retrieved and 22 were included in the final review. Results: Only one study provided an estimate of prevalence (6.8%). Short menstrual cycle, family history of endometriosis, and some genetic polymorphisms are associated with the risk of developing endometriosis. Smoking, lower body mass index, and lower parity associated with increased risk of endometriosis were suggested as modifiable factors. Limitations of this study include the poor quality of data identified, and the language barriers behind the study retrieval. Conclusions: Data on the epidemiology of endometriosis in the East Asian populations are limited. The available data that examine potential genetic factors do not unveil whether such factors directly contribute to the increased risk of endometriosis. Further extensive studies on endometriosis in Asian women are required to improve the management of this disease.
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ORIGINAL ARTICLES Top

Management of cesarean scar pregnancy among vietnamese women p. 12
Tuan Minh Vo, Thong Van, Long Nguyen, Quynh Tran
DOI:10.4103/GMIT.GMIT_8_18  PMID:30783583
Objective: To demonstrate the efficacy of management for cesarean scar ectopic pregnancies up to 8 weeks' gestation using ultrasound-guided Foley balloon catheter placement combined with dilation and curettage (D and C) at TuDu Hospital. Subjects and Methods: A quasi-experimental study was conducted from March 2015 to March 2016. Patients with imaging-confirmed cesarean ectopic pregnancies were admitted to an inpatient unit at Tu Du Hospital. A Foley balloon catheter was placed inside the uterus under ultrasound guidance and was left in place for 24 h. Afterward, the patient underwent ultrasound-guided D and C. Follow-up to confirm success included serial blood draws to measure beta-human chorionic gonadotropin (β-hCG) levels until a value of 0, and routine ultrasounds to confirm absence of a gestational sac and no evidence of vascularity at the site of the cesarean section scar. Results: A total of 311 patients were enrolled over 3 months. Overall, 90.7% (95% confidence interval [CI]: 86.8%–93.9%) patients were successfully treated with this regimen. Several factors that were significantly associated with successful management included gestational age <6 weeks (odds ratio [OR] 3.1, 95% CI: 1.03%–8.76%), β-hCG level <11,000 mUI/mL before discharge from the hospital (OR 6.5, 95% CI: 1.42%–30.6%), gestational sac volume 2 weeks after treatment measuring <5 cm3 (OR 9.1, 95% CI: 1.96%–50.1%). Conclusions: This is an easily applicable method with a short follow-up period and reduction in treatment costs compared to standard treatment with methotrexate injection.
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Influences of total laparoscopic hysterectomy according to body mass index (underweight, normal weight, overweight, or obese) p. 19
Akiko Otake, Megumi Horai, Eriko Tanaka, Aska Toda, Yukari Miyoshi, Rina Funada, Yoshimitsu Yamamoto, Kazusige Adachi
DOI:10.4103/GMIT.GMIT_53_18  PMID:30783584
Study Objective: The aim of this study is to evaluate the effect of body mass index (BMI) on laparoscopic hysterectomy outcomes. Design: This was retrospective study. Setting: Minoh City Hospital, Japan. Materials and Methods: Between January 1, 2014, and June 30, 2017, 183 patients underwent total laparoscopic hysterectomy (TLH) at our institution. Intervention: Patients who underwent TLH were grouped according to BMI, as follows: underweight group (BMI <18.5 kg/m2), normal-weight group (18.5 ≤BMI <25 kg/m2), overweight group (25 ≤BMI <30 kg/m2), and obese group (BMI ≥30 kg/m2). Measurements and Main Results: Information on patients' clinical characteristics and surgical results were collected retrospectively by medical record review. The severity of complications was graded according to the Clavien–Dindo classification. We assessed clinical characteristics, surgical results, and the perioperative complications in each BMI group. Surgical results included operation time, nonsurgical operating room time estimated blood loss, uterine weight, and postoperative hospital stay. Compared with the normal-weight group, the obese group had significantly more complications (P = 0.012) and longer operation time (P = 0.04). The underweight and overweight groups did not have significantly different surgical results than the normal-weight group. Conclusion: Underweight and overweight patients had no significant differences in surgical results, compared with patients of normal weight. Obese patients had significantly longer operation times and more perioperative complications than patients with normal weight. Laparoscopic hysterectomy has burdens and risks for obese patients. Our results suggest that appropriate weight control may decrease the risk of surgery for obese patients.
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Laparoscopic versus laparotomy: Staging surgery for endometrial cancer – Malaysia's early experience p. 25
Wan Ahmad Hazim Wan Ghazali, Siti Amira Jamil, Ili Abdullah Sharin
DOI:10.4103/GMIT.GMIT_25_18  PMID:30783585
Objective: The objective of the study is to assess the efficacy of laparoscopy compared with laparotomy in extrafascial hysterectomy and lymphadenectomy for endometrial cancer. Design: This was a retrospective study of small cases over a 5-year period. Setting: This study was conducted in Putrajaya Hospital, a district hospital with consultant care level in obstetrics and gynecology. Sample: Forty women presented with confirmed cases of endometrial cancer based on histopathology result and underwent extrafascial hysterectomy with or without lymphadenectomy between January 2010 and December 2014. Materials and Methods: Patient outcomes were compared between 26 women who underwent laparoscopic total hysterectomy with or without lymphadenectomy and 14 women who underwent open laparotomy extrafascial hysterectomy with or without lymphadenectomy. Data were collected using electronic medical records. Main Outcome Measures: Postoperative outcomes, operative time, total intraoperative blood loss, number of lymph nodes harvested, and total days of postoperative stay were obtained. Results: There was a significant reduction in operative blood loss in the laparoscopic group with mean 262.50 ± 47.87 and laparotomy group with mean 381.82 ± 138.33, 95% confidence interval, P < 0.05. Postoperative hospital stay was also significantly reduced in the laparoscopic group, where the mean postoperative stay in laparoscopic group was 2.5 ± 2.0 days and laparotomy 5.0 ± 3.6 days. There was no significant difference in mean operative time (the mean operative time: 256 ± 76.40 for laparotomy and 288.75 ± 43.66 for the laparoscopic approach). More number of lymph nodes were harvested laparoscopically (29.75 ± 16.59) than laparotomy (23.0 ± 12.62); however, this was not significant. Conclusions: Laparoscopic surgery had significant lesser blood loss and it is comparable to laparotomy in the surgical management of endometrial cancer. Experienced surgeon will be able to perform hysterectomy and lymphadenectomy as equally good to laparotomy with adequate tumor excision and complete staging.
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CASE REPORTS Top

Unexpected tubal pregnancy at 13 weeks' gestation that was treated with laparoscopic surgery under massive hemoperitoneum p. 30
Mirang Kim, Kosuke Hiramatsu, Kaoru Fukui, Kyoka Amemiya
DOI:10.4103/GMIT.GMIT_40_18  PMID:30783586
An advanced second trimester tubal pregnancy is rarely encountered because almost all ecopic pregnancy are diagnosed at an early stage. Transvaginal sonography is simple and useful for diagnosing ectopic pregnancy. However, diagnosing the site of ectopic pregnancy and gestational age is sometimes difficult. We experienced a case of an unexpected 13-week tubal pregnancy that was not able to be diagnosed with an accurate pregnancy site and gestational age by transvaginal sonography before surgery. Under massive hemoperitoneum, forceps penetrated the area of pregnancy, which led to further massive bleeding. However, laparoscopic surgery was able to be performed. The findings in our case suggest the importance of examining with transabdominal sonography, especially in an emergency and in advanced tubal pregnancy. In addition, careful manipulation of forceps is required when the ectopic pregnancy mass is large.
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Surgical management of retained placental tissue with the hysteroscopic morcellation device p. 33
Man Hin Menelik Lee
DOI:10.4103/GMIT.GMIT_66_18  PMID:30783587
Conventionally, surgical management of retained placental tissue is largely performed using blind dilatation and curettage. Hysteroscopic removal using diathermy loop has been shown to be successful while increasing complete removal rates and reducing risk of uterine perforation. Our two cases demonstrated that complete removal of placental tissues can be achieved with hysteroscopic morcellation device which is known to be associated with less operative time and less operative risk compared to diathermy loop. Preoperative transamin can reduce intraoperative bleeding, while careful preparation must be made for bleeding immediately after the procedure when the hysteroscope is withdrawn and distended uterus slowly contracts.
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Recurrent massive uterine bleeding from a cesarean scar treated successfully by laparoscopic surgery p. 36
Tasuku Mariya, Mina Umemoto, Naoko Sugita, Masahiro Suzuki, Tsuyoshi Saito
DOI:10.4103/GMIT.GMIT_69_18  PMID:30783588
A cesarean scar can cause abnormal uterine bleeding including prolonged menstruation or postmenstrual spotting. Our patient showed massive uterine bleeding from a cesarean scar and needed blood transfusion for hemorrhagic shock. A cesarean section had only been performed once for delivery stop 9 years ago. Recurrent hemorrhage could not be controlled by conservative treatment, and we performed laparoscopic scar resection and repair. The abnormal uterine bleeding was successfully stopped, and the menstrual cycle was normalized after surgical treatment. We should be aware that even an uneventful cesarean section may have a risk of massive hemorrhage postoperatively as in the present case.
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An unusual presentation of ovarian fibroma originating from an autoamputated ovary p. 40
Hiroyuki Yazawa, Kaoru Takiguchi, Asami Kato, Karin Imaizumi
DOI:10.4103/GMIT.GMIT_63_18  PMID:30783589
We describe an extremely rare case of an unusually presented ovarian fibroma adherent to the sigmoid colon originating from an autoamputated ovary. A 64-year-old woman was referred to our hospital with an abnormal shadow that was approximately 4 cm in diameter in the pelvic cavity detected on abdominal X-ray imaging. Computed tomography demonstrated an irregularly shaped tumor with calcification in the pelvic cavity. Laparoscopy revealed that the tumor was adherent to the surface of the sigmoid colon with a discontinuous shell and empty cavity. The left ovary was lacking, although the left salpinx and right adnexa were in their normal locations. The tumor was carefully resected with cutting of the serosa of the sigmoid colon. The serosal defect was repaired with sutures. Postoperative histopathological diagnosis was old fibroma with calcification. To the best of our knowledge, this is the first reported case of extragonadal ovarian tumor originating from an autoamputated ovarian fibroma.
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CLINICAL IMAGE Top

A benign uterine leiomyoma with disturbing appearance p. 44
Lingna Chen, Wenchao Sun, Hao Chen, Xiaoyang Fei
DOI:10.4103/GMIT.GMIT_78_18  PMID:30783590
Herein, we described a 53-year-old woman who underwent laparoscopic uterine myomectomy. The cut surface of the leiomyoma showed a grain appearance, instead of a whorled feature. The disturbing appearance was an unexpected surprise to the surgeon. The diagnosis of benign uterine leiomyoma was established through intraoperative frozen section and was identical to the subsequent permanent pathology.
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LETTERS TO THE EDITOR Top

Single-site laparoscopic management of complicated paraovarian cyst p. 46
Saloua Ammar, Sahla Sellami, Mohamed Zouari, Hayet Zitouni, Manel Belhaj Mansour, Manar Hbaieb, Mahdi Bendhaou, Riadh Mhiri
DOI:10.4103/GMIT.GMIT_89_18  PMID:30783591
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Stratafix for the vaginal stump in laparoscopic hysterectomy p. 48
Beuy Joob, Viroj Wiwanitkit
DOI:10.4103/GMIT.GMIT_111_18  PMID:30783592
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