Gynecology and Minimally Invasive Therapy-GMIT最新文献

Cornual pregnancy (CP) is a subtype of ectopic pregnancy that is implanted in the interstitial segment of the fallopian tube which is defined as the tubal section crossing uterine muscular tissue. Widely recognized risk factors for CP are endometriosis, uterine leiomyomata, or pelvic inflammatory disease; all these diseases can cause tubal anatomic changes and consequently alter embryo physiological implant process. Many treatment options are available for this condition each one must be tailored according to patient and operating scenario. The incidence of uterine ruptures in the scarred uterus appears to be low, but the fear of it remains and therefore medical treatment might be favored over cornual wedge resection. The actual risk of uterine rupture after medical treatment is unknown. Multiple testing strategies exist to diagnose CP, but caution needs to be used to avoid a false diagnosis.

We describe a preconception hysteroscopic image of a patient with a ruptured uterus at 27 weeks' gestation. A 40-year-old gravida 2, para 1, underwent open adenomyomectomy because of infertility. Subsequently, hysteroscopy performed at our hospital revealed an endometrial deficit from the uterine fundus to the posterior wall, and an area where the endometrium was missing and composed of yellow tissue was seen. She later achieved pregnancy. Lower abdominal pain occurred on day 1 of the 27^th week of pregnancy. She suddenly went into a state of shock. Emergency laparotomy was performed, and a uterine rupture wound of approximately 10 cm in the longitudinal direction was seen in the posterior wall. A 1120-g male infant was stillborn. Total blood loss was 6450 mL. The mother was saved without hysterectomy. After adenomyomectomy, a hysteroscopy should be performed to check for endometrial defects before allowing pregnancy.

Synchronous bilateral ovarian torsion is rare that too in nonpathological ovaries. To the best of our knowledge, this is the second case of synchronous bilateral ovarian torsion of nonpathological ovaries in adolescents. A 14-year-old girl presented with pain lower abdomen, vomiting, and constipation for the last 10 days. Ultrasonography (USG) suggested bilateral ovarian torsion without any ovarian pathology. Emergency laparoscopy confirmed bilateral ovarian torsion with necrosed-looking ovaries, and detorsion was done. During follow-up period, she had intermittent mild pain abdomen, and on USG, her left ovary returned to normal size, but her right ovary had been bulky throughout without any cyst. At around 10 months, the patient presented with severe abdomen pain. This time only right ovarian torsion was there. Laparoscopic bilateral ovarian detorsion with bilateral ovarian ligament plication was done. Ovarian torsion can be bilateral, even in nonpathological ovaries. Ovarian fixation should be done in these cases to prevent recurrent torsion.

Objectives: Port placements at the mid-abdomen (mainstay of robotic surgery [Rob]) appear to be difficult compared to that at lower abdomen (mainstay of conventional laparoscopy [Con-Lap]). We hypothesized that the reason for this may be the difference in port puncture places.

Materials and methods: We examined how the differences between the place and puncture order of ports affected Con-Lap cases with ports mainly placed in the lower abdomen and Rob cases with ports mainly placed in the middle abdomen. The trocar time was measured from the time when the puncture position and skin incision were determined and initiated, respectively, to the time when the port was punctured and fixed and used as the indicator of difficulty.

Results: In the Con-Lap group analysis, the trocar time of the left lower port was longer (right lower: 77 s, middle lower: 117.5 s, and left lower: 138 s, P < 0.0001). In the Rob group analysis, the trocar time of the left most port was significantly longer (right-most: 89.0 s, right-middle: 92.5 s, left-middle: 121.0 s, and left-most: 197.0 s; P < 0.0001). In addition, the total trocar time was significantly longer in the first puncture at the right-middle port in the Rob group (right-most first: 8.4 min, right-middle first: 12.4 min, and left-middle first: 8.5 min, P = 0.0063).

Conclusion: In the mid-abdomen port placement, mainstay of Rob cases, the puncture order, and port site have a significant impact on the difficulty of the procedure. It is preferable to avoid initially puncturing the right-middle port in case of the Rob.

Endometrial osseous metaplasia (EOM) is an uncommon clinical entity with the presence of bone in the endometrium which requires clinical and therapeutic framework. It is also described by various other names such as endometrial ossification, ectopic intrauterine bone, and heterotopic intrauterine bone. Ossification could have various locations as the cervix the ovary, and the vagina. This overview highlights the attention on the actual pivotal points of EOM.

Objectives: The effects of laparoscopic surgical management in women with stage III/IV endometriosis remain controversial. The standard extent of resection for stage III/IV endometriosis with deep endometriosis to treat endometriosis-associated infertility is debatable. This study aimed to assess the postoperative pregnancy outcomes following a routine surgical intervention for stage III/IV endometriosis patients.

Materials and methods: Patients with stage III/IV endometriosis who underwent conservative laparoscopic surgery at our hospital between January 2010 and December 2018 were retrospectively analyzed. Statistical analyses were performed to determine the correlations between endometriosis features and postoperative pregnancy outcomes.

Results: Of 256 patients enrolled, 94 wished to conceive. Exclusion criteria: ≥40 years, adenomyosis, partners with infertility issues. Finally, 71 women were included. The overall postoperative pregnancy rate was 76.1% (n = 54): 49 and five from non-assisted reproductive technology (ART) and ART, respectively. The postoperative pregnancy rate in patients diagnosed with infertility presurgery (40/71) was 70.0% (n = 28): 24 (non-ART) and four (ART). The endometriosis fertility index (EFI) score was higher in the pregnant than in the nonpregnant group (P = 0.03). The EFI score and surgical score of EFI were higher in the non-ART than in the ART group (P = 0.04; P = 0.02); in the infertile group, they were higher in the pregnant than in the nonpregnant group (P = 0.018; P = 0.027).

Conclusion: Our postoperative pregnancy rate after conservative laparoscopic surgery for patients with stage III/IV endometriosis compared favorably with previous reports. EFI was a significant predictor of postoperative pregnancy. Our surgical approach to maintain a high surgical score of EFI might help treat endometriosis-associated infertility.