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  Most popular articles (Since February 02, 2018)

 
 
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ORIGINAL ARTICLES
The evaluation of laparoscopic surgery on pregnant patients with ovarian cysts and its effects on pregnancy over the past 5 Years
Koki Kurihara, Mari Minagawa, Masamune Masuda, Mari Fukuyama, Keiko Tanigaki, Aya Yamamoto, Seiko Kato, Hiroyuki Fujita, Miho Eto
January-March 2018, 7(1):1-5
DOI:10.4103/GMIT.GMIT_12_17  PMID:30254926
Study Objective: Study Objective: In this research paper, we demonstrate how to increase the success rate of laparoscopic surgery on pregnant patients with an ovarian cyst using rectal probe, SAND balloon, and lowering the insufficient level. Design: The study design wasa retrospective study. Setting: The study was conducted at Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan. Patients: Pregnant patients with an ovarian cyst who underwent laparoscopic surgeries at our institution during the period from January 2011 to December 2016. Materials and Methods: We reviewed 14 cases of pregnant women with ovarian cysts that underwent laparoscopic surgery during the study period by observing and analyzing the patient's characteristics, hospitalization practices, surgical complications, operational procedures, and obstetric outcomes. Main Results: Three cases were emergency surgeries and 11 cases were elective surgeries. In the 14 cases, the gestational age at the time of the surgeries ranged from 6 to 20 weeks. In our studies, we found no systemic complications after the surgery and none of the cases reported any fetal malformation or any fetal growth restriction. Conclusion: In our review, laparoscopic surgery for ovarian cyst during pregnancy was very safe and successful, without any adverse effects on pregnancy outcome.
  1,337 224 -
Intraoperative and postoperative clinical evaluation of the hysteroscopic morcellator system for endometrial polypectomy: A prospective, randomized, single-blind, parallel group comparison study
Akira Tsuchiya, Yasunori Komatsu, Reiko Matsuyama, Hiroko Tsuchiya, Yuri Takemura, Osamu Nishii
January-March 2018, 7(1):16-21
DOI:10.4103/GMIT.GMIT_6_17  PMID:30254929
Objective: To evaluate the TRUCLEAR™ system (Smith and Nephew Inc., London, UK), a hysteroscopic system that morcellates and aspirates masses, in terms of the operating time, surgeon's convenience, and effect on patients compared with conventional electrosurgical resection. Methods: Patients undergoing hysteroscopic resection of endometrial polyps were randomly allocated to undergo hysteroscopic morcellation or electrosurgical resection (UMIN-CTR identifier: UMIN000019649). The primary outcome was the operating time. Secondary outcomes were the removal success, fluid deficit, convenience with the technique, insertion time, number of insertions during the operation, visibility of the operative field, recurrence of the patient's chief complaint, and adverse events. Results: Sixty-seven women were randomly allocated to the morcellation arm (n = 34) or electrosurgical resection arm (n = 33) from November 2015 to November 2016. The polyps were completely removed, and no adverse events were observed in all 67 patients. The average operating time (8.3 min vs. 12.0 min, P = 0.014), insertion time (5.0 min vs. 9.0 min, P < 0.001), and number of insertions (1.0 vs. 8.2, P < 0.001) were significantly lower in the morcellation arm than in the electrosurgical resection arm. Surgeons' subjective evaluation measured on a 10-cm visual analog scale was higher in the morcellation arm than in the electrosurgical resection arm in terms of easiness of removal (8.4 vs. 6.5, P < 0.001) and visibility of the operative field (7.8 vs. 6.4, P < 0.001). Conclusion: Surgeons gave the hysteroscopic morcellator system a better evaluation compared than electrosurgical resection, and the system shortened the operating time.
  1,192 221 1
The role of hysteroscopy in evaluating postmenopausal asymptomatic women with thickened endometrium
Giuseppe Trojano, Gianluca Raffaello Damiani, Vita Caroli Casavola, Rossella Loiacono, Antonio Malvasi, Antonio Pellegrino, Valeria Siciliano, Ettore Cicinelli, Maria Giovanna Salerno, Lorella Battini
January-March 2018, 7(1):6-9
DOI:10.4103/GMIT.GMIT_10_17  PMID:30254927
Backgrounds and Aims: This study aims to compare hysteroscopic and histological findings in asymptomatic postmenopausal patients with thickened endometrium. Materials and Methods: A retrospective study involving case records of 295 asymptomatic postmenopausal women with a thickened endometrium >5 mm diagnosed at transvaginal ultrasound (TVS). Patients (women) underwent hysteroscopy with biopsy between 2009 and 2015, and they were followed up at National Cancer Institute of Bari and at University Hospital of Pisa. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of hysteroscopy were evaluated. Results: Inclusion criteria were TVS, hysteroscopy, and endometrial biopsy. When the hysteroscopic findings were normal, a sensitivity of 100%, specificity of 98.6%, PPV of 95.2%, and NPV of 100% were achieved. For polyps and myomas, we found 100%, 98.7%, 99.5%, and 100%, respectively. In case of endometrial hyperplasia, a sensitivity of 66.7%, a specificity of 100%, a PPV of 100%, and a NPV of 98.1% were achieved. For endometrial cancer hysteroscopy, sensitivity, specificity, PPV, and NPV were 100%, 99.6%, 75%, and 100%, respectively. Conclusions: Hysteroscopy allows an accurate diagnosis in benign endometrial pathology and suspect of malignant endometrial pathology in postmenopausal women with thickened endometrium.
  1,198 208 2
The changes of surgical treatment for symptomatic uterine myomas in the past 15 Years
Weihong Yang, Ning Luo, Lishan Ma, Hong Dai, Zhongping Cheng
January-March 2018, 7(1):10-15
DOI:10.4103/GMIT.GMIT_11_17  PMID:30254928
Study Objective: The aim of this study is to elaborate the changes of the surgical approach of treatment for uterine myomas in Yangpu Hospital in the past 15 years. Design: This was retrospective cohort study. Setting: Yangpu Hospital, Tongji University School of Medicine, Shanghai, China. Materials and Methods: A total of 4113 patients with symptomatic uterine myomas underwent surgical treatments. Interventions: Eight kinds of different surgeries were involved in the study, including abdominal or laparoscopic surgery, hysterectomy, or uterus-sparing myomectomy. Measurements: The study collected patients' clinical data and reviewed surgical access and approach, complications, and the results of following up. Results: A total of 1559 cases (37.9%) underwent uterus-sparing myomectomy, 3005 cases (73.1%) performed laparoscopic surgeries. The percentage of laparoscopic surgery was significantly higher than homochronous data of laparotomy after 2003 (P < 0.001). The per year total of uterus-reserved surgery was proved to be negatively correlated with patient's age (R2 = 0.930; P < 0.001). The rate of myomas recurrence was significantly lower in the combined myomectomy and uterine artery occlusion group (4%, 34/910) than in the single myomectomy group (10.5%, 44/420) (P < 0.001). Conclusions: Retaining uterus and minimally invasive surgery were the important trends of surgical treatment for symptomatic uterine myomas. Laparoscopic uterus-sparing myomectomy may be an alternative to hysterectomy to manage to appropriate patients with uterine myomas.
  1,078 181 -
REVIEW ARTICLE
Outcome and management of uterine leiomyosarcoma treated following surgery for presumed benign disease: Review of literature
Tanitra Tantitamit, Kuan-Gen Huang, Manatsawee Manopunya, Chih-Feng Yen
April-June 2018, 7(2):47-55
DOI:10.4103/GMIT.GMIT_10_18  PMID:30254937
Uterine leiomyosarcoma (uLMS) is a rare and aggressive cancer, usually diagnosed incidentally at the time of myomectomy or hysterectomy. There have been concerns for several years about the fact that the inadvertent disruption of occult uLMS may have a negative impact on patient outcome. This study reviews the outcome and management of patients with a diagnosis of uLMS after surgery for presumed benign disease. We conducted a literature search in which 47 published English-language articles were obtained for evaluation. A total of 23 studies with outcomes data were included. It is evidenced that patients who underwent surgery with tumor disruption resulted in poorer outcomes compared with en bloc tumor, especially by power morcellation. The power morcellation was associated with an increased risk of recurrence, shorten time to recurrence, and upstage after re-exploration. Early re-exploration and surgical staging are appreciated for better prognosis and may alter postoperative treatment. We also updated on the incidence and preoperative evaluation to assess the risk of patient and give an effective counseling.
  985 230 -
ORIGINAL ARTICLES
Size, type, and location of myoma as predictors for successful laparoscopic myomectomy: A Tertiary Government Hospital experience
Mikaela Erlinda G. Martinez, Madonna Victoria C. Domingo
April-June 2018, 7(2):61-65
DOI:10.4103/GMIT.GMIT_12_18  PMID:30254939
Background: Laparoscopic myomectomy (LM) is a preferred alternative to abdominal myomectomy due to shorter hospitalization, faster recovery, and decreased intraoperative adhesions. The criteria, however, which constitute proper selection of patients for LM, are still a matter of debate. Since conversion to either laparoscopic-assisted myomectomy (LAM) or laparotomy (EL) entails longer time and increased costs compared to performing an open procedure from the outset, this research aims to evaluate size, location, and type of myoma as predictors for LM. Methodology: Inpatient medical records of all women who underwent LM from January 2014 to August 2016 were retrieved and reviewed. Demographic data, intraoperative records, and postoperative course were obtained. The association of size, type, and location of myomas to the procedure performed was analyzed. Results: There was no significant association between the size of the myoma or its location to the procedure performed. However, intramural and subserous myomas were associated with successful LM, while submucous myomas were associated with conversion to either LAM or EL (P = 0.010). Conclusion: LM is a difficult procedure that challenges even the most skilled laparoscopic surgeon. Proper patient selection lessens complications and decreases the risk of conversion. In this study, type of myoma may be a good predictor for successful LM; however, this conclusion may be limited by the small sample size. A large-scale multicentric prospective study is necessary to validate the role of the proposed predictors to prevent unplanned conversion to an open procedure and reduce cost and increase safety of LM.
  952 198 -
Laparoscopy and computed tomography imaging in advanced ovarian tumors: A roadmap for prediction of optimal cytoreductive surgery
Ahmed Samy El-Agwany
April-June 2018, 7(2):66-69
DOI:10.4103/GMIT.GMIT_1_17  PMID:30254940
Introduction: Comprehensive staging laparotomy and cytoreductive surgery followed by chemotherapy has been the standard of care in advanced ovarian cancer. Neoadjuvant chemotherapy is an alternative in inoperable advanced cases. To select patients amenable for successful cytoreduction, major determinants including CT imaging and laparoscopy could be of value. There is no general accepted model for selection and reproducibility of techniques are a major challenge due to different clinical practice and complexity of scoring systems. Some lesions as small size (<5 mm) peritoneal deposits and mesenteric affection are hard to see on CT so, complementary laparoscopy may play a role in the preoperative assessment. The aim of this study was evaluation of the role of laparoscopy in advanced ovarian tumors for prediction of optimal cytoreductive surgery in relation to CT and surgical peritoneal carcinomatosis index (PCI). Aim: Was to evaluate laparoscopic assessment in advanced ovarian tumors for prediction of optimal cytoreductive surgery in relation to CT and surgical peritoneal carcinomatosis index (PCI). Setting: Gyne-oncology specialized center, El-Shatby maternity university hospital, Alexandria Egypt. Methods: From January 2016 to December 2016, 15 patients were recruited from gyne-oncology specialized center, Alexandria, Egypt. Patients underwent a special design described later then laparoscopy using palmar point entry was done for assessing small lesions and the extent of affection in surface peritoneal, mesentery, serosa of the gut especially small intestine (terminal ileum affection, more or less than 50% affection) mainly with evaluating other sites as liver surface and diaphragm peritoneal surface affection after removal of ascites by aspiration. Findings were correlated with laparotomy and CT scan findings. Surgery was performed in the same setting which is better or with in two weeks. Results: There were two cases with upper abdominal surgeries (cholecystectomy and splenectomy) where no visualization of liver and stomach on laparoscopy but were free on CT scan and surgical evaluation. Douglas pouch was not assessed in two patients with large fixed bilateral ovarian masses on laparoscopy. Two cases with diaphragmatic affection on CT scan related to the posterior surface were not detected on laparoscopy. These findings were correlated with surgical findings as the gold standard. The pathology was ranging from low grade to high grade serous cyst adenocarcinoma. Conclusions: Laparoscopic evaluation is a useful adjunct with CT prior to performing ovarian cancer cytoreductive surgery for assessment of operability. Laparoscopy is better for evaluating extent of serosal affection in advanced tumors in cases with omental cakes on CT. A roadmap for prediction of operability in advanced ovarian cancer can be used by combing CT PCI and laparoscopic assessment.
  966 168 2
Hysteroscopic-guided removal of retained intrauterine device: Experience at an Academic Tertiary Hospital
Ma. Rosielyn D. Asto, Maria Antonia E. Habana
April-June 2018, 7(2):56-60
DOI:10.4103/GMIT.GMIT_11_18  PMID:30254938
Background: Removal of an intrauterine device can be easily done when the string is visible during speculum exam. The task becomes challenging when the string is no longer visible. Methodology: The in-patient and out-patient medical records of all patients admitted for hysteroscopic-guided intrauterine device removal from January 2013 to December 2015 from a tertiary academic government hospital were retrieved and reviewed. Demographic data, intraoperative record, and post-operative course and outcome were obtained. Prior attempts on removal were also noted. Total operative time, type of IUD removed, operative findings and any complications encountered were recorded. The size and model of the hysteroscope were also noted. Results: Nineteen patients were included, twelve were of reproductive age and seven were already in their menopausal years. Majority were multigravida. Reasons for IUD removal for most patients were spotting, desire for pregnancy, and expired date of use. All patients had prior attempts of ultrasound guided IUD removal. Majority of patients had unremarkable post-operative course and no readmissions were noted. Conclusion: Hysteroscopic-guided removal of IUD is a superior option for management when ultrasound guided removal fails. Unnecessary major operation and complications were avoided. In the three – year experience, there has been no major complications and re-admissions related to the procedure. Hysteroscopic removal of IUD was shown to be an effective option after failed ultrasound-guided removal with low risk of complications.
  926 205 1
Comparative study on surgical outcomes between laparoscopic and open cornuotomy in urban tertiary center of Malaysia
Wan Ahmad Hazim Wan Ghazali, Nurul Huda Zainal Abidin, Aisyah Munirah Muda, Habibah Abdul Hamid
January-March 2018, 7(1):22-26
DOI:10.4103/GMIT.GMIT_7_17  PMID:30254930
Study Objective: The objective of the study was to evaluate the prevalence of interstitial ectopic pregnancy and to compare the surgical outcomes of laparoscopic cornuotomy (LC) and laparotomy (open) cornuotomy (OC) of cornual ectopic pregnancy and to analyze its associated factors. Materials and Methods: A cross-sectional study was conducted involving cases of interstitial ectopic in Hospital Putrajaya, Putrajaya, Malaysia, over a 10-year period (2005–2014). Data on sociodemographic, clinical profile, perioperative, and postoperative were obtained from the electronic medical records. Measurement and Main Results: The prevalence of cornual pregnancy was 4.0% (n = 14) out of total 347 cases of all ectopic pregnancies in Putrajaya Hospital. The mean ± standard deviation age of patient in the LC group and OC group was 29.3 ± 5.9 years and 31.4 ± 7.3 years, respectively. The duration of hospitalization and mean operating time were both significantly shorter in the LC group than in the OC group (1.43 ± 0.54 versus 2.57 ± 0.79 and 61.4 ± 15.7 min versus 97.1 ± 38.2 min, respectively, P < 0.05).There were no statistically significant differences between both groups for the estimated blood loss, requirement of blood transfusion, complications, and future fertility. Conclusion: Laparoscopic cornual resection (cornuotomy) is a safe and less invasive procedure with a comparable complication rate. It has shown that it is feasibility and should be considered as initial treatment in managing those cases in trained hand surgeons.
  904 165 -
REVIEW ARTICLE
Loop electrosurgical excision procedure versus cryotherapy in the treatment of cervical intraepithelialneoplasia: A systematic review and meta-analysis of randomized controlled trials
Pietro D Alessandro, Bruno Arduino, Maria Borgo, Gabriele Saccone, Roberta Venturella, Annalisa Di Cello, Fulvio Zullo
October-December 2018, 7(4):145-151
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.
  843 182 -
CASE REPORTS
Laparoscopic management of maldescended ovary presenting with recurrent acute abdomen
Eghoihunu Ireo, Muhammad Haruna, Preeti Gandhi
April-June 2018, 7(2):74-77
DOI:10.4103/GMIT.GMIT_16_18  PMID:30254942
Ovarian maldescent is an extremely rare gynecological phenomenon, usually associated with Müllerian abnormalities. We report a 27-year-old woman, presenting with acute, right-sided abdominal pain. She has a history of subfertility and repeated admissions with chronic pelvic pain. Previous hysterosalpingogram and laparoscopy demonstrated unicornuate uterus with absent right fallopian tube and ovary. A right-sided, ectopic ovary was identified on later imaging and suspected as the cause of her symptoms. She underwent laparoscopic excision of the maldescended ovary with remnant fimbrial end and gubernaculum. She was discharged the following day as she was pain-free and remains so 11 months later. This case report prompts a gynecologist to consider diagnosis of maldescended ovary in the women with uterine abnormalities and repeated episodes of abdominal pain. This is the first case report to the best of our knowledge where surgical management of ovarian maldescent was performed via minimal access approach, thus avoiding laparotomy in this acute setting.
  906 108 -
EDITORIAL
A powerful value of hysteroscopy
Peng-Hui Wang
October-December 2018, 7(4):143-144
DOI:10.4103/GMIT.GMIT_71_18  PMID:30306031
  841 159 -
ORIGINAL ARTICLES
Utility of laparoscopic uterine myomectomy as a treatment for infertility with no obvious cause except for uterine fibroids
Satomi Kameda, Masafumi Toyoshima, Kohei Tanaka, Osamu Fujii, Shu-Ichi Iida, Nobuo Yaegashi, Takashi Murakami, Kazuhiko Hoshi
October-December 2018, 7(4):152-155
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.
  823 166 -
Efficacy of hormonal therapies for decreasing uterine volume in patients with adenomyosis
Takashi Matsushima, Shigeo Akira, Takehiko Fukami, Koichi Yoneyama, Toshiyuki Takeshita
July-September 2018, 7(3):119-123
DOI:10.4103/GMIT.GMIT_35_18  PMID:30254953
Study objective: The aim of this study is to evaluate the efficacy of hormonal therapies for inhibiting an increase in uterine volume in patients with adenomyosis. Design: This was retrospective cohort study. Setting: This study was conducted at Nippon Medical School Musashikosugi Hospital. Patients: A total of 28 women diagnosed with adenomyosis using magnetic resonance imaging. Methods: After providing informed consent, patients were treated with gonadotropin-releasing hormone agonist (GnRHa group), a low-dose estrogen and progestin combination (LEP group), or dienogest (DNG group) for ≥16 weeks. Uterine volume was assessed using the formula for an ovoid; uterine volumes before and after 16 weeks of treatment were compared. A <5% increase in uterine volume at 16 weeks was considered to reflect inhibition of uterine volume increase and efficacy of the medication. We compared the efficacy rate among the groups. Results: In the GnRHa group, a significant reduction in uterine volume was noted, from 307.4 ± 230.1 to 177.9 ± 142.1 cm3 (P < 0.001). In the LEP and the DNG groups, there was no significant change (LEP: 226.7 ± 116.6 cm3 pre-treatment and 230.5 ± 128.6 cm3 post-treatment, P = 0.85; DNG: 232.6 ± 117.8 cm3 pre-treatment and 262.1 ± 136.8 cm3 post-treatment, P = 0.37). The number of responders (efficacy rate) in the GnRHa group, LEP group, and DNG group was 25/26 (96.2%), 7/15 (46.7%), and 6/11 (54.5%), respectively. The efficacy rate of GnRHa therapy was significantly higher than that of LEP or DNG therapy (P < 0.001 and P = 0.005, respectively). Conclusion: We conclude that the efficacy of GnRHa in reducing uterine volume should be considered when prescribing hormone therapy for adenomyosis.
  817 166 -
CASE REPORTS
Endometriosis involving the sciatic nerve: A case report of isolated endometriosis of the sciatic nerve and review of the literature
Tal D Saar, Stefaan Pacquée, Dean Helmar Conrad, Mikhail Sarofim, Philippe De Rosnay, David Rosen, Greg Cario, Danny Chou
April-June 2018, 7(2):81-85
DOI:10.4103/GMIT.GMIT_24_18  PMID:30254944
Endometriosis is a common gynecological condition which affects 5–10% of women of reproductive age and up to 50% of women with pelvic pain and infertility. The most commonly affected areas are the pelvic peritoneum, ovaries and rectovaginal septum. Isolated endometriosis of the sciatic nerve is very rare. Our patient suffered from worsening right hip and buttock pain with severe exacerbation during menstruation. Several different imaging modalities (ultrasound of her pelvis and right hip, as well as X-rays and computed tomography scans of her right hip and lumbosacral spine) failed to identify any pathology. Magnetic resonance imaging scans of her pelvis revealed a 3.5 cm endometriotic lesion over the pelvic segment of her right sciatic nerve. Following a multidisciplinary discussion, the patient underwent laparoscopic excision of endometriosis. The patient recovered well from her surgery. She successfully conceived with in vitro fertilization 3 years after her surgery, following a failed course of Clomid (Clomiphene citrate) for ovulatory dysfunction.
  768 140 -
ORIGINAL ARTICLES
A randomized controlled trial comparing laparoscopic lens defogging techniques through simulation model
Vijay Palvia, Aaron J Herrera Gonzalez, Richard S Vigh, James N Anasti
October-December 2018, 7(4):156-160
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.
  749 156 -
CLINICAL IMAGES
Polypoid endometriosis of urinary bladder
Srisupa Laopakorn, Kuan-Gen Huang
April-June 2018, 7(2):86-87
DOI:10.4103/GMIT.GMIT_18_18  PMID:30254945
  755 142 -
EDITORIAL
Minimally invasive therapy for cancer: It is time to take actions for training system in minimally invasive therapy after lacc report
Chyi-Long Lee
January-March 2019, 8(1):1-3
DOI:10.4103/GMIT.GMIT_132_18  PMID:30783581
  697 180 -
ORIGINAL ARTICLES
Magnetic resonance imaging in the evaluation of cesarean scar defect
Wu Shun Felix Wong, Wing Tak Fung
July-September 2018, 7(3):104-107
DOI:10.4103/GMIT.GMIT_23_18  PMID:30254950
The incidence of Cesarean scar defect (CSD) would increase with the increasing trends of cesarean section delivery. The actual incidence of this condition is unknown, but it had been estimated by hysteroscopy, sonohysterography, or transvaginal ultrasound to be around 50% of patients with cesarean section. CSD is often asymptomatic, but it may produce common symptoms such as abnormal uterine bleeding, infertility, and pelvic pain. Adverse pregnancy outcomes with scar ectopic pregnancy, uterine rupture had been reported. The use of magnetic resonance imaging (MRI) imaging of this condition is seldom performed and reported. This paper is to analyze retrospectively the MRI finding of 158 women, so as to review the MRI findings of CSD, their appearances and measurements.
  714 158 -
Management of cesarean scar pregnancy among vietnamese women
Tuan Minh Vo, Thong Van, Long Nguyen, Quynh Tran
January-March 2019, 8(1):12-18
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.
  709 159 -
Five-year lapsed: Review of laparoscopic myomectomy versus open myomectomy in Putrajaya Hospital
Emily Christine D Silva, Aisyah Munirah Muda, Anis Iryani Safiee, Wan Ahmad Hazim Wan Ghazali
October-December 2018, 7(4):161-166
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.
  748 118 -
CASE REPORTS
Transposition of cardinal ligaments for stages II–III uterine prolapse: A minimally invasive procedure
Mohamad K Ramadan, Dominique A Badr, Walid Saheb, Georges Wehbeh
January-March 2018, 7(1):36-39
DOI:10.4103/GMIT.GMIT_5_17  PMID:30254934
Uterine and other pelvic organ prolapse (POP) are becoming more frequently encountered due to increased life expectancy among menopausal women. Traditionally, most surgical procedures included hysterectomy as an integral part of the management. POP might, however, though less commonly, affect women not willing to accept hysterectomy, especially young females who did not complete their family. For these patients, uterine prolapse could be managed by a number of uterine-sparing surgical procedures that are performed through either abdominal or vaginal route according to patient's condition, surgeon's choice, and skills. Most of these operations, however, are usually lengthy, invasive, need good experience, and sometimes special accessories and instruments. We performed anterior transposition of the cardinal ligaments on two patients with POP quantification Stages II-III uterine prolapse without amputating the cervix. Both patients were interviewed at 6, 12, and 18-month intervals and reported no undue pain or dyspareunia with complete satisfaction regarding self-assessment of gynecologic anatomy. Furthermore, examination by the lead author revealed satisfactory anatomic correction. We recommend this simple, easy, and minimally invasive vaginal procedure to fellow gynecologists for repair of mild degrees of uterine prolapse in women declining hysterectomy or amputation of the cervix.
  727 113 -
Transvaginal natural orifice transluminal endoscopic surgery hysterectomy in a woman with uterine adenomyosis and multiple severe abdominal adhesions
Pei-Chen Li, Dah-Ching Ding
April-June 2018, 7(2):70-73
DOI:10.4103/GMIT.GMIT_6_18  PMID:30254941
Natural orifice transluminal endoscopic surgery (NOTES) had been used for many gynecologic surgeries without pelvic adhesions. We report a 30-year-old female with multiple abdominal adhesions underwent NOTES hysterectomy successfully. A 30-year-old female (para 2, gravida 3, abortus 1) presented with menorrhagia and dysmenorrhea. She had multiple abdominal surgical histories. Computed tomography scan revealed multiple adhesions between the abdominal wall and small intestine. On pelvic ultrasonography, an enlarged uterus 8.3 cm × 3.5 cm with adenomyosis was visualized. Because of the extensive intra-abdominal adhesions, we decided to use a transvaginal NOTES approach to perform hysterectomy. We performed the surgery successfully without complication. Pathological examination confirmed adenomyosis of uterus. NOTES hysterectomy may be feasibly and safely performed in gynecologic patients with extensive abdominal adhesions.
  691 147 1
ORIGINAL ARTICLES
Influences of total laparoscopic hysterectomy according to body mass index (underweight, normal weight, overweight, or obese)
Akiko Otake, Megumi Horai, Eriko Tanaka, Aska Toda, Yukari Miyoshi, Rina Funada, Yoshimitsu Yamamoto, Kazusige Adachi
January-March 2019, 8(1):19-24
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.
  730 106 -
CASE REPORTS
Torsion of normal adnexa in a 31-year-old woman: A case report and literature review
Nao Wakui, Ai Miyoshi, Yuji Kamei, Takeya Hara, Akiko Fujishiro, Serika Kanao, Hirokazu Naoi, Hirohumi Otsuka, Masaaki Nagamatsu, Takeshi Yokoi
January-March 2018, 7(1):33-35
DOI:10.4103/GMIT.GMIT_4_17  PMID:30254933
It is known that a large ovarian cyst will likely cause torsion. However, normal adnexal torsion is rare and occurs in premenarchal girls in most cases. This is a case of a reproductive woman. A 31-year-old woman suffering from acute abdominal pain in the lower and right side consulted her gynecologist. The next day she had a computed tomography performed and was suspected of ovarian torsion. She did not have fever, nausea, or leukocytosis, but her abdominal pain persisted. Diagnostic laparoscopy was performed and showed torsion of the right fallopian tube, which was swollen and looked like a hydrosalpinx with a normal ovary. We did detorsion and excision of the right tube. However, pathological findings showed that the right tube was not a hydrosalpinx but was swollen due to blood stasis. We determined that this case was torsion of normal adnexa. In such cases, diagnostic laparoscopy is very effective.
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