Gynecology and Minimally Invasive Therapy-GMIT最新文献

Here, we describe two cases of retained products of conception (RPOC) that were successfully managed with hysteroscopic resection after laparoscopic temporary uterine artery ligation. Both patients were diagnosed with RPOC after early miscarriages. Case 1 was urgently admitted due to massive bleeding and underwent surgery following a blood transfusion. After laparoscopic temporary bilateral uterine artery ligation, the mass was hysteroscopically removed, and the ligation was subsequently released. The patient subsequently achieved an ongoing pregnancy. Case 2 underwent semi-emergency surgery due to intermittent bleeding. Initially, hysteroscopic surgery was planned. However, bleeding resulted in poor visualization of the operative field, and laparoscopic surgery was performed. In many previous reports of RPOC with heavy bleeding, uterine artery embolization was performed. However, there are concerns regarding the effect of a long-term reduction in uterine blood flow on fertility. Our method is not expected to decrease fertility because the ischemic effect is very short.

Objectives: This study aimed to determine the recurrence rate and related risk factors of primary fallopian tube cancer (PFTC).

Materials and methods: We conducted a retrospective study of 47 patients with histopathological diagnosis of PFTC treated at Tu Du Hospital between January 1, 2015, and July 31, 2022. The cumulative recurrence rate was estimated using the life table method, and recurrence-associated factors were determined using the Log-rank test and Cox proportional hazard model.

Results: The median follow-up period was 40 months (range, 7-96 months). Eight patients (17.0%) experienced recurrence. The cumulative recurrence rate of PFTC patients at 12 months was 4.4% (95% confidence interval [95% CI]: 1.12-16.45), at 24 months was 9.1% (95% CI: 3.52-22.5), at 36 months was 14.9% (95% CI: 6.92-30.41), at 48 months was 19.3% (95% CI: 9.35-37.24), and at 60 months was 25.7% (95% CI: 12.68-47.88). A higher recurrence rate was significantly associated with elevated pretreatment CA 125 level (<35 U/mL vs. ≥35 U/mL, hazards ratio [HR] = 36.9, 95% CI: 1.47-921.37), advanced FIGO stages (Stage I-II vs. stages III, HR = 6.61, 95% CI: 1.18-36.93), and suboptimal debulking surgery (residual disease ≤1 cm vs. residual disease >1 cm, HR = 7.52, 95% CI: 1.47-38.49).

Conclusion: The overall recurrence rate of PFTC patients in Southern Vietnam was 17.0%. Appropriate follow-up strategies for patients with high-risk factors are needed for early detection and management of recurrence.

Objectives: We performed preoperative evaluations of giant ovarian tumors in older adult patients using the comprehensive geriatric assessment (CGA) and estimation of physiologic ability and surgical stress (E-PASS) scoring systems. We report a case in which the Aron Alpha method was performed, and perioperative management was performed using enhanced recovery after surgery (ERAS).

Materials and methods: We performed preoperative evaluations using the E-PASS scoring system and CGA on older adult patients with giant ovarian tumors, followed by the minimally invasive Aron Alpha method and perioperative management using ERAS.

Results: The mean patient age was 75.8 ± 8.8 years; comorbidities included hypertension in three patients, hyperlipidemia in two, angina pectoris in one, cholecystitis in one, and lower extremity varicose veins in one. The mean tumor size was 21.0 ± 5.4 cm. The E-PASS scoring system showed a preoperative risk score of 0.7 ± 0.4, a surgical stress score of 0, and a comprehensive risk score of 0.3 ± 0.3. CGA showed that two patients had problems with activities of daily living and cognitive function. The mean duration of surgery was 89.0 ± 16.6 min, and the mean blood loss was 56.0 ± 65.4 mL. No surgery-associated complications were observed. No patients had prolonged hospitalization or a decline in activities of daily living.

Conclusion: We showed the usefulness of performing detailed preoperative evaluations using CGA and the E-PASS system, followed by the minimally invasive Aron Alpha surgical method and perioperative management using ERAS in improving surgical outcomes in older adult patients with giant ovarian tumors.

Objectives: Polycystic ovary syndrome (PCOS) is a prevalent endocrine-metabolic disorder affecting reproductive-aged women. Genetic factors play a significant role in its development. This meta-analysis assesses the associations between specific gene polymorphisms (Vitamin D receptor [VDR] and adiponectin [ADIPOQ]) and PCOS susceptibility.

Materials and methods: We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, Collecting data from published articles between 2013 to 2013. Eligible studies were selected based on inclusion and exclusion criteria, with quality assessment performed using the Newcastle-Ottawa scale. Data were extracted, and statistical analyses included odds ratios with 95% confidence intervals for gene polymorphisms. Heterogeneity was evaluated using I ² tests, and publication bias was assessed using Begg's and Egger's tests.

Results: A total of 33 articles involving 5677 cases and 5257 controls were included in the analysis. Significant associations were observed for VDR TaqI rs731236 polymorphism in the dominant and recessive models and VDR BsmI rs1544410 polymorphism in the dominant and recessive models. For ADIPOQ T45G rs2241766, a significant association was found in the heterozygous model. The results did not reveal any significant associations for ADIPOQ G276T rs1501299.

Conclusion: This meta-analysis suggests associations between specific gene polymorphisms (VDR and ADIPOQ) and PCOS susceptibility. Further research is needed to validate these findings and unravel the complex genetic factors contributing to PCOS, potentially leading to improved diagnostic and therapeutic strategies.

Postpregnancy bleeding is common after failed pregnancy, termination of pregnancy, and postnatally after both vaginal and cesarean delivery. Pelvic ultrasound (US) is usually the initial imaging modality of choice to ascertain the cause when the bleeding is heavy or prolonged. When used in combination with Doppler studies, US can help differentiate retained products of conception (RPOC) from rarer uterine vascular malformations (UVM), including true arterial vascular malformations and areas of enhanced endometrial vascularity (EMV), which may themselves be associated with any RPOC present. While the management of RPOC is well established and has evolved from an almost universal surgical approach to increasingly more medical or expectant alternatives, clinical decisions over the management of a concurrent UVM are less clear and treatment options need to be individualized depending on features of the lesion and the clinical situation with hysteroscopy featured as an important modality, especially when dealing with EMV's. In this review, we discuss the role of hysteroscopy in the treatment of enhanced myometrial vascularity with and without associated RPOC and propose a management algorithm.

Vulvar intestinal adenocarcinoma is a rare malignancy. The most significant predictor of advanced vulvar cancer is achieving complete resection, although determining the optimal treatment for this rare histologic type remains uncertain. We report the case of a 63-year-old woman with a primary vulvar tumor suspected of having rectal invasion and inguinal lymph node metastases based on preoperative magnetic resonance imaging and computed tomography scans. To achieve complete resection of stage IIIC intestinal-type vulvar adenocarcinoma, we performed a laparoscopic posterior pelvic exenteration (PPE) and radical vulvectomy, along with bilateral inguinal lymph node dissection. This case report highlights the use of a novel hybrid procedure that combines laparoscopic PPE with radical vulvectomy and bilateral inguinal lymph node dissection for vulvar adenocarcinoma of the intestinal type. Laparoscopic PPE can be considered a minimally invasive approach for vulvar tumor when complete resection is achievable with an appropriate safety margin.

A case of a 32-year-old patient who presented with vaginal bleeding 2 years after undergoing laparoscopic radical trachelectomy and vaginal cerclage was noted to have Mersilene tape erosion. Subsequent management includes the removal of displaced Mersilene tape and a repeat cerclage through a new technique of laparoscopic abdominal cerclage to avoid repeat tape erosion. The novel technique of laparoscopic abdominal cerclage to lower the incidence of preterm delivery among pregnant patients who underwent laparoscopic radical trachelectomy for early-stage cervical cancer is described.

Among various options of contraception, bilateral tubal ligation (BTL) remains the most frequently used method for women worldwide even at present. However, up to 30% of those who undergo BTL eventually change their minds and wish to conceive again for a variety of reasons, such as a change in marital status or simply wanting more children. In this case, we can either approach it surgically with tubal re-anastomosis (TA) or by in vitro fertilization (IVF)-embryo transfer. Despite the many advantages of TA which lead the American Society of Reproductive Medicine Committee Opinion to recommend it as the primary choice of treatment in posttubal ligation infertility in 2012, IVF is widely being chosen as the first-line treatment nowadays. This study will review the efficacy of TA in various aspects, including pregnancy rate, cost-effectiveness, feasibility, and accessibility, based on review of the literature and our experience. Through this study, we intend to provide a basis for gynecologists to consider TA as the first option in women who wish to conceive again after BTL in this day and age of IVF.