Gynecology and Minimally Invasive Therapy-GMIT最新文献

We present the management of seven patients who were diagnosed with bladder stone associated with exposed intravesical mesh after transvaginal mesh (TVM) surgery for pelvic organ prolapse. The TVM may be exposed inside the bladder which can result in urinary stone formation. Several treatment modalities have been proposed such as laser lithotripsy, transurethral resection, and open or laparoscopic resection of exposed mesh. However, the optimal route of treatment remains inconclusive. In our series, two cases were managed by transurethral resection and one of them had recurrence. Five cases were managed by laparoscopic resection and one of them had recurrence. Two recurrent cases underwent laparoscopic resection and then no recurrence occurred. No intraoperative or postoperative complications occurred. Although there is limited evidence, we recommend laparoscopic resection for the treatment of intravesical mesh exposure. Offering transurethral resection as an initial management of intravesical mesh exposure is possible with careful discussion about the recurrence rate.

Objectives: We investigated the relationship between the degree of fibrosis and endometrial cancer (EC) by calculating the fibrosis-4 (FIB-4) score, a noninvasive marker for measuring the severity of liver fibrosis.

Materials and methods: Liver function tests, platelet (PLT) values, abdominal ultrasonography (USG), and magnetic resonance imaging (MRI) reports were analyzed retrospectively before, after, and at diagnosis in patients with EC.

Results: The study included 38 patients diagnosed with EC. The median FIB-4 score was calculated as 1.15 (minimum: 0.46-maximum: 3.72). When endometroid (type 1 EC) and nonendometroid (type 2 EC) were compared, the FIB-4 score was higher in type one patients (1.16 [0.46-3.72] and 1.01 [0.53-2.96], respectively). However, there was no significant difference between the two groups (P = 0.961). There was no significant difference between the groups in terms of aspartate aminotransferase, alanine aminotransferase, and PLT parameters before diagnosis, at the time of diagnosis, and after treatment. Gamma-glutamyl transferase (GGT) level was significantly higher in the type 1 group in the prediagnosis period (P = 0.016). In the posttreatment period, GGT was higher in the type 2 group (P = 0.020). For PLT level, there was a statistically significant difference between all three periods only in the type 1 group (P < 0.001).

Conclusion: FIB-4 score was higher in patients with type 1 EC, which is more associated with obesity and hormones. In addition, prediagnostic values of GGT and PLT were statistically significantly higher in the type 1 group. Our study needs further studies to support FIB-4 score and biochemical GGT and PLT as biochemical markers in patients with type 1 EC.

Objectives: Despite advancements in the management of advanced ovarian, fallopian tube, and peritoneal cancers, there remains a need to explore safe and effective diagnostic techniques, particularly in cases where primary debulking surgery (PDS) is challenging. This retrospective study aimed to investigate the safety and availability of diagnostic laparoscopy for patients with advanced ovarian, fallopian tube, and peritoneal cancers.

Materials and methods: We analyzed data from 36 patients who underwent diagnostic laparoscopy between September 2017 and March 2023. The surgical outcomes of diagnostic laparoscopy and initial treatment outcomes were investigated.

Results: The median patient age was 65 years (range, 39-82 years), with majority diagnosed with high-grade serous carcinoma (HGSC). Perioperative complications were observed in 11% of patients. Neoadjuvant chemotherapy (NAC) was administered to 92% of patients, with PDS performed in two cases. Of the 33 patients who received NAC, 30 (90%) underwent interval debulking surgery, and 23 (77%) achieved complete resection. Two patients (clear-cell carcinoma and mucinous carcinoma) died of cancer before or during the initial chemotherapy. The median follow-up duration for all patients was 26.9 months. Median progression-free survival (PFS) was 19.7 months, and median overall survival was 65.5 months. In multivariate analysis, non-HGSC (hazard ratio: 3.20, 95% confidence interval [CI]: 1.07-9.61, P = 0.038) and homologous recombination proficiency (hazard ratio: 7.44, 95% CI: 1.39-39.9, P = 0.019) were risk factors for PFS.

Conclusion: Diagnostic laparoscopy is useful for intraperitoneal observation and pretreatment diagnosis in advanced ovarian, fallopian tube, and peritoneal cancers. Despite tolerable perioperative complications, further research is warranted to optimize patient outcomes.

Objectives: The standard laparoscopic sacrocolpopexy (LSC) technique involves several suture fixation sites, which can prolong the operative time. This study aimed to investigate the extent to which the operative time could be shortened using devices such as tackers in sites where suture manipulation could be omitted.

Materials and methods: The study enrolled 82 patients who underwent LSC at our hospital between May 2016 and May 2022. The median operative time was 3.2 h (1.78-6.5 h). Changes in symptoms before and after surgery were measured using several questionnaires and 60-min pad weight testing among patient groups based on the device used.

Results: Among the preoperative factors, no factors were found to be significantly correlated with the operative time (≥3.2 h or <3.2 h). As intraoperative factors, significant associations were found between the number of tackers used on the posterior vaginal wall, anterior vaginal wall, and cervix (0-3 locations), whether a device was used in mesh retroperitonealization, whether the first needle used to fix the anterior longitudinal ligament was successful, whether adhesion dissection was performed, and the type of sealing device. Among these factors, the use of tackers on the posterior wall, anterior wall, and cervix and the use of a device in mesh retroperitonealization were significantly associated with the operative time.

Conclusion: The use of easy-to-operate devices appeared to contribute to a shorter operative time in LSC.

Cesarean scar pregnancy (CSP) is an ectopic that is located in the myometrium of a previous C-section of the scar. It is rare but threatening. The aim of this study was to introduce 10 cases of CSP treated with hysteroscopic resection. In the preoperative phase, the patients with beta-human chorionic gonadotropin (B-hCG) titers more than 10,000 were treated with methotrexate (MTX) to reduce B-hCG titers. Two patients did not receive MTX. All patients were treated with hysteroscopic resection except one patient, who underwent hysteroscopic resectoscopy due to a lack of reduction of B-hCG and due to unrepairable scar site of cesarean and uterine perforation eventuate hysterectomy. All patients had normal menstrual cycles as well as the negative β-hCG level after 2 months. Moreover, no recurrence was reported after 3 years. Low-invasive treatments such as hysteroscopic resection can be an important step to maintain fertility and the general health of patients.

Objectives: This study aimed to demonstrate the utility of origami crane training in enhancing laparoscopic skills.

Materials and methods: This retrospective study was conducted at our hospital and involved a single participant: a gynecologist qualified in laparoscopy. For 44 months, the surgeon made 1000 origami cranes within a dry box; the time required to fold each crane was recorded. In addition, a review was conducted on 80 total laparoscopic hysterectomies (TLHs) performed by the surgeon during that period, assessing the time taken for vaginal cuff suturing and the frequency of technical errors.

Results: The initial training time for making an origami crane was 35 min, with the fastest time achieved at 6 min and 38 s (No. 686). The learning curve demonstrated a gradual improvement over time. Among the 80 cases of TLHs, the mean time for vaginal cuff suturing was 778.3 ± 166.7 s. Moreover, the mean number of errors was 0.91 ± 1.17. A comparison between the first half of patients (first-half group) (n = 40) and the second half (second-half group) (n = 40) revealed significant differences in both the time taken (840.5 ± 188.0 s vs. 716.0 ± 115.6 s, P = 0.001) and number of errors (1.17 ± 1.46 vs. 0.65 ± 0.66, P = 0.042).

Conclusion: Origami crane training could be useful for improving laparoscopic surgical skills and bolstering surgeon motivation.

This case report presents the diagnosis and management of a 41-year-old woman who developed a vesicouterine cutaneous fistula after a cesarean section. She initially presented with pus discharge from the cesarean wound site, and later exhibited cyclical hematuria and fluid leakage from the skin incision, prompting further investigation. Diagnostic modalities, including computed tomography with contrast, confirmed the presence of a complex fistula involving the bladder, uterus, and skin. Conservative management with gonadotropin-releasing hormone therapy was attempted but discontinued due to worsening symptoms. Surgical intervention was performed successfully, leading to the resolution of symptoms. This case underscores the importance of prompt recognition and appropriate management of rare postcesarean complications, emphasizing adherence to anatomical principles.