Pub Date : 2018-12-22DOI: 10.15344/2394-4986/2018/146
H. Mikdachi, Arielle M Schreck
Robotic-assisted surgery in gynecologic procedures continues to increase in numbers with several advantages over other types of minimally invasive surgery. Obese patients undergoing robotic surgery have shorter hospital stays, less blood loss, lower conversion rates and lower postoperative complications despite the increase in surgical complexity of their cases. Obese patients have the highest need for minimally invasive surgery because they have increased perioperative morbidity and mortality rates, as well as worse surgical outcomes and complications with increasing BMI. Minimally invasive surgery reduces the risk of venous thromboembolism, wound infections, ileus and postoperative fevers in obese women. Robotic-assisted surgery offers a minimally invasive surgical approach to the obese woman who cannot have vaginal or conventional laparoscopic surgeries due to the physical limitations of her redundant vaginal sidewall tissue and thick abdominal wall. The robotic approach takes less operating time than conventional laparoscopic surgery in the super morbidly obese population, and surgeons experience less fatigue and mental stress. In this review article, we provide the benign gynecologist with recommendations for the preoperative and postoperative periods when performing robotic-assisted surgery on the obese gynecologic patient. We also offer detailed suggestions for effective patient positioning of even the most super morbidly obese patients. We also explain several techniques to enter the abdomen, the step which often challenges the surgeon the most and can lead to pre-peritoneal insufflation and sub-optimal visualization during the case.
{"title":"Robotic Surgery in the Obese Patient: Tips and Tricks for the Benign Gynecologist","authors":"H. Mikdachi, Arielle M Schreck","doi":"10.15344/2394-4986/2018/146","DOIUrl":"https://doi.org/10.15344/2394-4986/2018/146","url":null,"abstract":"Robotic-assisted surgery in gynecologic procedures continues to increase in numbers with several advantages over other types of minimally invasive surgery. Obese patients undergoing robotic surgery have shorter hospital stays, less blood loss, lower conversion rates and lower postoperative complications despite the increase in surgical complexity of their cases. Obese patients have the highest need for minimally invasive surgery because they have increased perioperative morbidity and mortality rates, as well as worse surgical outcomes and complications with increasing BMI. Minimally invasive surgery reduces the risk of venous thromboembolism, wound infections, ileus and postoperative fevers in obese women. Robotic-assisted surgery offers a minimally invasive surgical approach to the obese woman who cannot have vaginal or conventional laparoscopic surgeries due to the physical limitations of her redundant vaginal sidewall tissue and thick abdominal wall. The robotic approach takes less operating time than conventional laparoscopic surgery in the super morbidly obese population, and surgeons experience less fatigue and mental stress. In this review article, we provide the benign gynecologist with recommendations for the preoperative and postoperative periods when performing robotic-assisted surgery on the obese gynecologic patient. We also offer detailed suggestions for effective patient positioning of even the most super morbidly obese patients. We also explain several techniques to enter the abdomen, the step which often challenges the surgeon the most and can lead to pre-peritoneal insufflation and sub-optimal visualization during the case.","PeriodicalId":270619,"journal":{"name":"International Journal of Gynecology & Clinical Practices","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127752658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-19DOI: 10.15344/2394-4986/2018/144
R. Leke
Reducing Maternal Mortality Through the Prevention of Unsafe Abortion and Their Complications in Cameroon
在喀麦隆通过预防不安全堕胎及其并发症降低孕产妇死亡率
{"title":"Reducing Maternal Mortality Through the Prevention of Unsafe Abortion and Their Complications in Cameroon","authors":"R. Leke","doi":"10.15344/2394-4986/2018/144","DOIUrl":"https://doi.org/10.15344/2394-4986/2018/144","url":null,"abstract":"Reducing Maternal Mortality Through the Prevention of Unsafe Abortion and Their Complications in Cameroon","PeriodicalId":270619,"journal":{"name":"International Journal of Gynecology & Clinical Practices","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121603222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-19DOI: 10.15344/2394-4986/2018/145
E. Deligeoroglou, Vasileios Karountzos, P. Tsimaris, E. Deligeoroglou
Endometriosis is defined as the presence of endometrial stroma and glands outside the normal uterus. The prevalence of endometriosis in adolescents undergoing laparoscopy for chronic pelvic pain is reported to be between 19% and 73%. Interestingly, endometriosis has also been identified in premenarcheal girls with some breast development. Several factors have been incriminated for endometriosis, while no single theory can explain the variety of symptoms. Genetic factors seem to play a role, while lifestyle characteristics and environmental factors are likely related to the development of the disease. The main symptoms during diagnosis of endometriosis in adolescence, is chronic pelvic pain (27%-96%) and dysmenorrhea (18%-100%). Medical history and clinical examination are of great importance, while imaging exams are very helpful during evaluation of these girls, while endometriosis can only be diagnosed by visual inspection during laparoscopy, ideally confirmed by histology. Treatment options include not only medical regimens, with Non-Steroidal-Anti-Inflammatory Drugs and Combined Oral Contraceptives been the most common used, and other medications such as Danazol, Progestins, GnRH agonists with Add-Back therapy and cyproterone acetate, but also surgical treatment. Surgical management alone or in combination with postoperative hormonal suppression seems to improve future fertility options of adolescents with endometriosis.
{"title":"Endometriosis in Adolescence: Challenges and Opportunities for Managing Future Infertility","authors":"E. Deligeoroglou, Vasileios Karountzos, P. Tsimaris, E. Deligeoroglou","doi":"10.15344/2394-4986/2018/145","DOIUrl":"https://doi.org/10.15344/2394-4986/2018/145","url":null,"abstract":"Endometriosis is defined as the presence of endometrial stroma and glands outside the normal uterus. The prevalence of endometriosis in adolescents undergoing laparoscopy for chronic pelvic pain is reported to be between 19% and 73%. Interestingly, endometriosis has also been identified in premenarcheal girls with some breast development. Several factors have been incriminated for endometriosis, while no single theory can explain the variety of symptoms. Genetic factors seem to play a role, while lifestyle characteristics and environmental factors are likely related to the development of the disease. The main symptoms during diagnosis of endometriosis in adolescence, is chronic pelvic pain (27%-96%) and dysmenorrhea (18%-100%). Medical history and clinical examination are of great importance, while imaging exams are very helpful during evaluation of these girls, while endometriosis can only be diagnosed by visual inspection during laparoscopy, ideally confirmed by histology. Treatment options include not only medical regimens, with Non-Steroidal-Anti-Inflammatory Drugs and Combined Oral Contraceptives been the most common used, and other medications such as Danazol, Progestins, GnRH agonists with Add-Back therapy and cyproterone acetate, but also surgical treatment. Surgical management alone or in combination with postoperative hormonal suppression seems to improve future fertility options of adolescents with endometriosis.","PeriodicalId":270619,"journal":{"name":"International Journal of Gynecology & Clinical Practices","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122344640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-15DOI: 10.4172/2161-0932.1000488
N. Gultekin
Background: The emotional instability during pregnancy and the cultural negative feedback about normal vaginal delivery influence the tendency to cesarean section. The myth of vaginal delivery should be replaced with evidence based information which was given by professional persons. The coordinated educational program and pilates study in hospitals for pregnant women will encourage women during delivery and peurperal period. Method: This study was designed as case-control for 1292 pregnant women which visit the obstetric clinic of Mersin Sehir Hospital, Turkey. Case group have 421 and control group have 871 patients. The first goal was for defining of fear about vaginal birth, mode of delivery, satisfaction from pregnancy and delivery, lastly flashback after birth. In addition, secondary goal was determining the unnecessary visit of obstetric clinic in postpartum period, breastfeeding ratio, planning of next pregnancy and choosing of normal vaginal delivery in future birth. Result: Obviously, the midwife intervention encourages women to have happy, satisfied and successfull pregnancy, delivery and puerperium. However the effectiveness of education program shouldn’t be measured with the cesarean section ratio and the aim of education shouldn‘t be forcing of pregnant women to the normal vaginal delivery. It should be encouraged by programme. Conclusion: The statistical measurements of emotions will be represented with biases. Besides, the midwife intervention and pilates were seem to be successful programme for pregnant women to neglect the negative effects of delivery without changing of ceaserean numbers.
{"title":"Does Psychoeducation Encourage Pregnant Women and Positively Influence the Relation between Mother and Baby: A Case-Control Study","authors":"N. Gultekin","doi":"10.4172/2161-0932.1000488","DOIUrl":"https://doi.org/10.4172/2161-0932.1000488","url":null,"abstract":"Background: The emotional instability during pregnancy and the cultural negative feedback about normal vaginal delivery influence the tendency to cesarean section. The myth of vaginal delivery should be replaced with evidence based information which was given by professional persons. The coordinated educational program and pilates study in hospitals for pregnant women will encourage women during delivery and peurperal period. Method: This study was designed as case-control for 1292 pregnant women which visit the obstetric clinic of Mersin Sehir Hospital, Turkey. Case group have 421 and control group have 871 patients. The first goal was for defining of fear about vaginal birth, mode of delivery, satisfaction from pregnancy and delivery, lastly flashback after birth. In addition, secondary goal was determining the unnecessary visit of obstetric clinic in postpartum period, breastfeeding ratio, planning of next pregnancy and choosing of normal vaginal delivery in future birth. Result: Obviously, the midwife intervention encourages women to have happy, satisfied and successfull pregnancy, delivery and puerperium. However the effectiveness of education program shouldn’t be measured with the cesarean section ratio and the aim of education shouldn‘t be forcing of pregnant women to the normal vaginal delivery. It should be encouraged by programme. Conclusion: The statistical measurements of emotions will be represented with biases. Besides, the midwife intervention and pilates were seem to be successful programme for pregnant women to neglect the negative effects of delivery without changing of ceaserean numbers.","PeriodicalId":270619,"journal":{"name":"International Journal of Gynecology & Clinical Practices","volume":"79 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131814850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-15DOI: 10.15344/2394-4986/2018/142
Lori Leo
{"title":"The Personal Side of Miscarriage","authors":"Lori Leo","doi":"10.15344/2394-4986/2018/142","DOIUrl":"https://doi.org/10.15344/2394-4986/2018/142","url":null,"abstract":"","PeriodicalId":270619,"journal":{"name":"International Journal of Gynecology & Clinical Practices","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122013042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-26DOI: 10.15344/2394-4986/2018/141
R. Kuźlik
Aim: The aim of the study was to present new surgical technique of simultaneous reduction of labia minora and clitoral hood. Material and methods: 3 groups of patients (5 in each) with enlarged labia minora and clitoral hood were treated with new surgical technique. First group: 5 patients aged between 16-18 y.o., all virgins, second group: 5 women aged between 20-25 y.o., sexual active, and third group: 5 patients between 50-65 y.o., all after menopause. All patients were treated with “One cut technique” as simultaneous reduction of labia minora and clitoral hood. In all cases radiofrequency tool was used for cutting. Patients were operated under general anaesthesia. Results: The new surgical technique of simultaneous reduction of labia minora and clitoral hood was applied without significant complications. This surgery reduced labia minora in height and length, and clitoral hood in height and width. The procedure preserved natural colour and contour of this part of the vulva. Deformation of labia minora and clitoral hood with associated symptoms, like aesthetic dissatisfaction, physical and emotional disturbances were resolved postoperatively. In all cases self confidence and social openness improved. Following the procedure, body image perception also improved. Conclusions: In this group of patients, One cut technique of simultaneous reduction of labia minora and clitoral hood, was performed without significant complications. This method achieves expected good aesthetic results and improves physical and emotional selfesteem. (Z-plasty, inferior resection and superior pedicle flap reconstruction), de-epithelialized and laser labiaplasty [1-4,6-12]. All described methods apply only middle or posterior part of the labia minora. Most surgeons treat labia minora and clitoral hood as two different compartments. Author performed some of those methods and established hypothesis that we should see labia minora as an anatomical structure, which begins in the upper part of the vulva (periclitoral area) and ends as frenulum. On the other hand, you should not talk about restoring labia minora shape without touching clitoral hood. Material and Methods “One cut technique” is a simultaneous reduction of labia minora and clitoral hood. 3 groups of patients (5 in each) with enlarged labia minora and clitoral hood were treated with new surgical technique. First group: 5 patients aged between 16-18 y.o., all virgins; Second group: 5 women aged between 20-25 y.o., all sexual active, and Third group: 5 patients between 50-65 y.o., all after menopause. The most common symptoms, patients were suffering from were, persistent irritation with discomfort during physical activities or associated with rubbing while wearing close-fitting underwear, riding a bicycl or horseback riding, difficulties in maintaining hygiene, dyspareunia Introduction Since 1971 untill 2014, 38 papers about plastic surgery of the labia minora, were published [1]. First case report was made by Mar
{"title":"\"One Cut Technique\" - Simultaneous Reduction of Labia Minora and Clitoral Hood","authors":"R. Kuźlik","doi":"10.15344/2394-4986/2018/141","DOIUrl":"https://doi.org/10.15344/2394-4986/2018/141","url":null,"abstract":"Aim: The aim of the study was to present new surgical technique of simultaneous reduction of labia minora and clitoral hood. Material and methods: 3 groups of patients (5 in each) with enlarged labia minora and clitoral hood were treated with new surgical technique. First group: 5 patients aged between 16-18 y.o., all virgins, second group: 5 women aged between 20-25 y.o., sexual active, and third group: 5 patients between 50-65 y.o., all after menopause. All patients were treated with “One cut technique” as simultaneous reduction of labia minora and clitoral hood. In all cases radiofrequency tool was used for cutting. Patients were operated under general anaesthesia. Results: The new surgical technique of simultaneous reduction of labia minora and clitoral hood was applied without significant complications. This surgery reduced labia minora in height and length, and clitoral hood in height and width. The procedure preserved natural colour and contour of this part of the vulva. Deformation of labia minora and clitoral hood with associated symptoms, like aesthetic dissatisfaction, physical and emotional disturbances were resolved postoperatively. In all cases self confidence and social openness improved. Following the procedure, body image perception also improved. Conclusions: In this group of patients, One cut technique of simultaneous reduction of labia minora and clitoral hood, was performed without significant complications. This method achieves expected good aesthetic results and improves physical and emotional selfesteem. (Z-plasty, inferior resection and superior pedicle flap reconstruction), de-epithelialized and laser labiaplasty [1-4,6-12]. All described methods apply only middle or posterior part of the labia minora. Most surgeons treat labia minora and clitoral hood as two different compartments. Author performed some of those methods and established hypothesis that we should see labia minora as an anatomical structure, which begins in the upper part of the vulva (periclitoral area) and ends as frenulum. On the other hand, you should not talk about restoring labia minora shape without touching clitoral hood. Material and Methods “One cut technique” is a simultaneous reduction of labia minora and clitoral hood. 3 groups of patients (5 in each) with enlarged labia minora and clitoral hood were treated with new surgical technique. First group: 5 patients aged between 16-18 y.o., all virgins; Second group: 5 women aged between 20-25 y.o., all sexual active, and Third group: 5 patients between 50-65 y.o., all after menopause. The most common symptoms, patients were suffering from were, persistent irritation with discomfort during physical activities or associated with rubbing while wearing close-fitting underwear, riding a bicycl or horseback riding, difficulties in maintaining hygiene, dyspareunia Introduction Since 1971 untill 2014, 38 papers about plastic surgery of the labia minora, were published [1]. First case report was made by Mar","PeriodicalId":270619,"journal":{"name":"International Journal of Gynecology & Clinical Practices","volume":"12 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120872961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-08-04DOI: 10.15344/2394-4986/2018/139
G. Weaver, A. Bruegl, T. Pejovic, M. Moffitt
Background: Fanconi Anemia is a rare condition that carries an increased risk of squamous cell carcinoma of the head, neck and cervix due to mutations in DNA repair pathways. These same mutations may also be associated with intrinsic treatment resistance (FANCD2) and hypersensitivity (FANCA). Case: A 22-year-old woman with a history of anemia who presented with rapid progression to squamous cell carcinoma of the cervix. She developed aplastic anemia during chemoradiation and was subsequently diagnosed with Fanconi Anemia. Conclusion: Rare conditions such as Fanconi Anemia should be considered when the clinical course varies significantly from the norm. Consultations with hematology and genetics may elucidate other possible contributing factors. HPV vaccination remains an underutilized method for primary prevention of cervical cancer and should be promoted among eligible populations.
{"title":"Cervical Cancer at a Young Age: Considering Fanconi Anemia as Part of the Clinical Workup","authors":"G. Weaver, A. Bruegl, T. Pejovic, M. Moffitt","doi":"10.15344/2394-4986/2018/139","DOIUrl":"https://doi.org/10.15344/2394-4986/2018/139","url":null,"abstract":"Background: Fanconi Anemia is a rare condition that carries an increased risk of squamous cell carcinoma of the head, neck and cervix due to mutations in DNA repair pathways. These same mutations may also be associated with intrinsic treatment resistance (FANCD2) and hypersensitivity (FANCA). Case: A 22-year-old woman with a history of anemia who presented with rapid progression to squamous cell carcinoma of the cervix. She developed aplastic anemia during chemoradiation and was subsequently diagnosed with Fanconi Anemia. Conclusion: Rare conditions such as Fanconi Anemia should be considered when the clinical course varies significantly from the norm. Consultations with hematology and genetics may elucidate other possible contributing factors. HPV vaccination remains an underutilized method for primary prevention of cervical cancer and should be promoted among eligible populations.","PeriodicalId":270619,"journal":{"name":"International Journal of Gynecology & Clinical Practices","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116766839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-08-04DOI: 10.15344/2394-4986/2018/140
I. Sidky
Hysteroscopy can be performed using larger operative hysteroscopes (7-mm OD) under local anesthesia; in selected patients, however, with a paracervical block, the need for cervical dilatation requires a larger amount of anesthetic to be infiltrated superficially in the paracervical areas (base of the uterosacral ligaments) with 8 to 10 mL of local anesthetic. The procedures performed should be expedited and confined to minor surgical procedures.
{"title":"Role of Hysteroscopy in Infertility Assessment","authors":"I. Sidky","doi":"10.15344/2394-4986/2018/140","DOIUrl":"https://doi.org/10.15344/2394-4986/2018/140","url":null,"abstract":"Hysteroscopy can be performed using larger operative hysteroscopes (7-mm OD) under local anesthesia; in selected patients, however, with a paracervical block, the need for cervical dilatation requires a larger amount of anesthetic to be infiltrated superficially in the paracervical areas (base of the uterosacral ligaments) with 8 to 10 mL of local anesthetic. The procedures performed should be expedited and confined to minor surgical procedures.","PeriodicalId":270619,"journal":{"name":"International Journal of Gynecology & Clinical Practices","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116350207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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