Gynecology and Minimally Invasive Therapy-GMIT最新文献

Objectives: The objective is to evaluate the feasibility and safety of ArtiSential for performing minimally invasive surgeries for gynecological cancers.

Materials and methods: We conducted a prospective observational study at 10 Tertiary Institutional Hospitals in Korea between November 2021 and April 2022. Eligible patients were 18 years or older and planned to undergo minimally invasive surgery for gynecologic cancer. We collected baseline characteristics, surgical information, and postoperative outcomes. The primary endpoint was to compare the operation time required for gynecologic cancer surgery using ArtiSential with the reported operation time for surgery using conventional laparoscopic instruments or robots. The secondary endpoints were to evaluate the surgical outcomes of gynecologic cancer surgery using ArtiSential compared to conventional laparoscopic instruments or robots and collect operator feedback on equipment improvements during surgery.

Results: Forty patients were enrolled in this study, including 19 with endometrial cancer, 15 with cervical cancer, and 6 with ovarian cancer. The average operation time was 187.0 ± 49.2 min, with no complications encountered during surgery. Pelvic lymph nodes were assessed in 34 patients, with the ArtiSential device utilized in 22 (64.7%) of these patients, at an average assessment time of 40.3 ± 19.4 min. Most surgeons using the ArtiSential device reported that it performed slightly better than conventional laparoscopic instruments.

Conclusion: The use of the ArtiSential device in minimally invasive surgery has been demonstrated to be both feasible and safe for the treatment of early-stage gynecologic cancer.

Objectives: The objective of this study was to quantify the time to diagnosis of endometriosis by laparoscopy for patients of varying body mass index (BMI), as well as the safety of laparoscopy for endometriosis by BMI.

Materials and methods: We performed a retrospective cohort study of reproductive-age women receiving a primary laparoscopic diagnosis of endometriosis at an academic tertiary hospital from January 2017 to December 2020. Patients excluded were those undergoing repeat laparoscopy, with previously histologically diagnosed endometriosis, asymptomatic endometriosis, an unknown first gynecologic encounter, or an unknown initial BMI. Our primary outcome was time to surgical diagnosis of endometriosis by BMI class. Our secondary outcome was the evaluation of peri/postoperative risk of laparoscopy for endometriosis.

Results: A total of 152 patients received a primary surgical diagnosis of endometriosis, including 44% normal or underweight patients, 29% overweight patients, and 27% obese patients. Obese patients experienced a delay from gynecologic presentation to diagnostic laparoscopy (18.4 months, interquartile range [IQR] 3.1-42.8) compared to overweight patients (9.0 months, IQR 2.5-23.2) and normal and underweight patients (3.8 months, IQR 1.1-17.0) (P = 0.02). Although a higher percentage of overweight and obese patients was Hispanic and non-Hispanic Black, multiple linear regression maintained a significant relationship between time to surgery and BMI (P = 0.03). Perioperative and postoperative complications did not differ by BMI class. There were no differences in repeat laparoscopy for endometriosis within 3 years by BMI (P = 0.99).

Conclusion: BMI is independently associated with time to surgical diagnosis of endometriosis in our retrospective study. Diagnostic laparoscopy appears safe in obese patients, without significant perioperative morbidity.

Interstitial pregnancy accounts for only 2%-4% of all ectopic pregnancies, however, it is associated with higher mortality rates as compared to other ectopic pregnancies, due to the associated risk of uterine rupture, and hemorrhage. A 35-year-old gravida 4 abortion 3 woman reported at the 8^th week of gestation for antenatal care with comorbidity of protein C and protein S deficiency and recurrent pregnancy loss with for routine care. She was diagnosed as a case of interstitial pregnancy by transvaginal sonography and magnetic resonance imaging. She was subsequently managed by laparoscopic cornuostomy. Prompt recognition and definitive management are crucial in averting life-threatening hemorrhage due to this rare condition.

Objectives: Laparoscopic myomectomy (LM) is a procedure with a high rate of postoperative adhesions, which can lead to complications such as bowel obstruction and subsequent surgical problems, making anti-adhesion measures important. Various anti-adhesion materials are already on the market and have shown efficacy, but dextrin hydrogel spray (AdSpray™), an anti-adhesion material launched in 2017, has not yet been reported in the field of gynecology, although there are papers showing its usefulness in the surgical field such as repeat hepatectomy and ileostomy closure. Thereby, we investigated the postoperative status of AdSpray™ in LM.

Materials and methods: We report 24 cases in which AdSpray™ was used at Teine Keijinkai Hospital from 2018 to 2021 for LM, followed by cesarean section (CS) from 2019 to 2022. Adverse effects related to AdSpray™ and the presence of uterine adhesions in CS were examined.

Results: Adhesions were observed in 4 (16.7%) cases, none of which resulted in significant adverse effects of AdSpray™.

Conclusion: AdSpray™ was effective in preventing adhesion and may be an option as an anti-adhesion material in LM.

Vulvar lichen sclerosus (VLS) is a chronic inflammatory skin disorder affecting the vulvar region. VLS predominantly affects women, and most cases occur after menopause. Common symptoms include itching, skin-whitening, pain, discomfort, fissures, and scarring. Treatment options include topical steroids, emollients, lifestyle modifications, regular follow-up, and surgical interventions. Carbon dioxide (CO₂) laser treatment is a therapeutic option for managing lichen sclerosus. We report a case of VLS successfully treated with a fractional microablative CO₂ laser. A 72-year-old female presented with a dry vagina and vulvar itching for 6 months. She visited a local medical clinic, and oral anti-itching medication and topical anti-itching ointment were administered. However, the condition did not improve, and she felt itching. She visited our outpatient department, and a pelvic examination showed bilateral labia minor, revealing a white skin color change and a hardening sensation. The patient was diagnosed with VLS. Microablative fractional CO₂ laser therapy was subsequently administered. The treatment course comprised three laser therapy sessions (treatment day, 1 month, and 2 months after the first therapy). The vulvovaginal symptoms questionnaire-21 scores were 14, 6, and 2 for the first, second, and third courses of treatment, respectively. Vulvar itching improved significantly after laser treatment - no more steroid treatment needed. After 10 months of follow-up, the condition of the vulva was maintained well. Although the treatment protocol requires further exploration, CO₂ laser treatment could be considered for VLS if topical steroids are ineffective.

Objectives: The objective of this study was to investigate the safety and utility of hybrid uterine septal resection.

Materials and methods: This retrospective cohort trial included 16 patients who underwent hybrid uterine septal resection at Hyogo Medical University Hospital between January 2017 and September 2021. Hysteroscopic uterine septum resection was performed in 16 patients, whereas 5 patients with vaginal septal complications underwent an additional vaginal septectomy under supervision by thin laparoscopy and fluoroscopy. The main outcome measures were pregnancy success rate and procedure safety.

Results: The results showed that the median operative time was 77 (46-114) min, and no cases of intraoperative or postoperative adverse events were identified. The postoperative pregnancy rate was 100.0% (7/7) and the live birth rate was 71% (5/7) in women with recurrent pregnancy loss. Among women with infertility, the postoperative pregnancy rate was 55.5% (5/9), and the live birth rate was 20% (1/5).

Conclusion: These findings indicate that our hybrid septal resection technique reduces patient burden and ensures safe and reliable surgery, with good results in terms of postoperative complications, pregnancy, and miscarriage rates.

A few cases of spontaneous parasitic myoma have been reported. However, its cause remains unidentified. We report a case of spontaneous parasitic pedunculated subserosal myoma with pathological findings presenting with the absence of uterine smooth muscle cells in the stalk observed during robotic-assisted laparoscopic hysterectomy. A 51-year-old patient (G1P0) with no prior surgical history underwent a robotic-assisted laparoscopic hysterectomy. An approximately 3 cm-pedunculated subserosal myoma was found attached to the retroperitoneum. The stalk was sealed and separated and the myoma with retroperitoneal adipose tissue was resected. The stalk was pathologically identified to lack uterine smooth muscle cells and contain only muscular arteries and fibrous connective tissues. Thus, it might be hypothesized that after the myoma received collateral parasitic blood flow from the attached retroperitoneum, the stalk degenerated, and uterine smooth muscle cells were lost through an unknown mechanism, possibly underlying the development of spontaneous parasitic myomas.