Gynecology and Minimally Invasive Therapy-GMIT最新文献

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.

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.

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.

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.

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.