Cold Knife Research Articles

A Resident's Guide to Laparoscopic Hysterectomy of Large Fibroid Uterus

Study Objective The objective is to demonstrate laparoscopic technique for hysterectomy of large, multifibroid uterus. Design N/A. Setting Patient is a 49-year-old para 2 with history of 2 prior cesarean sections and hysteroscopic myomectomy undergoing total laparoscopic hysterectomy and bilateral salpingectomy for massively enlarged fibroid uterus with heavy menses despite Mirena IUD in place and associated bulk symptoms manifested by pelvic pain, pressure, and urinary frequency. Pelvic MRI demonstrated a massively enlarged fibroid uterus measuring 204 × 87 × 141 mm in size with the largest fibroid located in the posterior lower uterine segment measuring 90 × 80 × 93 mm. Patients or Participants N/A. Interventions Preoperative medication with 3 cycles of leuprolide followed by laparoscopic hysterectomy and bilateral salpingectomy with removal of 20-week uterus via cold knife morcellation and mini-laparotomy. Measurements and Main Results At her postoperative appointment, the patient reported feeling well without vaginal bleeding and improvement in her bulk symptoms. Conclusion Hysterectomy offers definitive treatment for symptomatic fibroids in women who do not desire future fertility. Although technically challenging, large fibroid uteruses are amenable to laparoscopic resection and preoperative treatment with GnRH agonists such as leuprolide may aid in surgical optimization. The objective is to demonstrate laparoscopic technique for hysterectomy of large, multifibroid uterus. N/A. Patient is a 49-year-old para 2 with history of 2 prior cesarean sections and hysteroscopic myomectomy undergoing total laparoscopic hysterectomy and bilateral salpingectomy for massively enlarged fibroid uterus with heavy menses despite Mirena IUD in place and associated bulk symptoms manifested by pelvic pain, pressure, and urinary frequency. Pelvic MRI demonstrated a massively enlarged fibroid uterus measuring 204 × 87 × 141 mm in size with the largest fibroid located in the posterior lower uterine segment measuring 90 × 80 × 93 mm. N/A. Preoperative medication with 3 cycles of leuprolide followed by laparoscopic hysterectomy and bilateral salpingectomy with removal of 20-week uterus via cold knife morcellation and mini-laparotomy. At her postoperative appointment, the patient reported feeling well without vaginal bleeding and improvement in her bulk symptoms. Hysterectomy offers definitive treatment for symptomatic fibroids in women who do not desire future fertility. Although technically challenging, large fibroid uteruses are amenable to laparoscopic resection and preoperative treatment with GnRH agonists such as leuprolide may aid in surgical optimization.

Evaluation of Holmium Laser versus Cold Knife in Optical Internal Urethrotomy for the Management of Urethral Stricture

Abstract Background : urethral stricture is one of the most difficult urological problems to cure adequately and is know to mankind since ages as it has been documented in ancient literature of Egyptians and Greeks. Aim of the work: the aim of our study is to evaluate and compare the outcomes of Ho:YAG laser urethrotomy with the conventional cold knife technique as regards treatment outcome, efficacy and complications Patients and methods: A total of 20 male patients presented to the urology department at El Maadi military hospital and Ain shams university hospitals diagnosed as urethral stricture requiring optical internal urethrotomy were included in this study. Patients were randomized into two groups : In group A (holmium group): 10 patients underwent internal urethrotomy with Holmium laser. In group B (cold knife group) 10 patients underwent internal urethrotomy with cold knife. Results: based upon uroflowmetry, assessment of treatment effectiveness and complications were made at 3 months follow-up. Post operative fall in the peak flow rate was noted during the follow up in both groups, but was highter fall in the holmium group than the cold knife group at the end of the third month.

A Case of Elastography-Assisted Laparoscopic Fertility Preservation for Severe Deep Endometriosis Causing Ureteral Stenosis and Subtype II Adenomyosis

Adenomyosis is commonly treated by total hysterectomy. Adenomyomectomy is considered for women of reproductive age who wish to preserve their fertility. However, a high recurrence rate following adenomyomectomy has been reported because complete removal of the lesion is difficult, and uterine rupture during pregnancy remains a complication. We previously reported that laparoscopic adenomyomectomy using a cold knife prevented thermal damage to the myometrium and elastography to avoid residual lesions. Here, we report the case of a patient who underwent complete resection of a subtype II adenomyosis and resection of deep endometriosis (DE) with the closure of the pouch of Douglas. The patient was 31 years old, had severe dysmenorrhea, and had left ureteral stenosis and subtype II adenomyosis associated with the closure of the pouch of Douglas by the DE. After resection of the DE posterior wall adenomyosis, residual lesions were confirmed by laparoscopic real-time elastography. Eight weeks after surgery, postoperative transvaginal ultrasound showed that the myometrium had shrunk from 28 to 22.7 mm, and the hydronephrosis had disappeared, although a stent remained necessary. In this study, we report the complete resection of subtype II adenomyosis and DE, combined with elastography to visualize the lesions during resection.

Is Olfactory Function Affected by Endoscopic Transsphenoidal Skull Base Surgery?

Is Olfactory Function Affected by Endoscopic Transsphenoidal Skull Base Surgery?

Early Outcome of Cold Knife Ablation and Diathermy Fulguration of Posterior Urethral Valve; A Comparative Study

Background: Posterior urethral valve (PUV) is the most common obstructive anomaly of the urethra. Urethral valves have a wide range of clinical and anatomical presentations and today most patients are diagnosed in the prenatal or early neonatal period. Cold knife and diathermy fulguration are two of the technique of PUV ablation.
 Objective: To find out early outcome of posterior urethral valve ablation between cold knife and diathermy fulguration.
 Methodology: This prospective comparative interventional study was conducted in the Department of Pediatric surgery in Dhaka Shishu Hospital (DSH), Dhaka. 54 patients with PUV, admitted for valve ablation during study period were included in this study. Patients were divided in to two group. Among them, 27 were in Group-A, whose PUV ablation were done by cold knife and 27 were in Group-B whose PUV ablation were done by diathermy fulguration. Successful ablation was confirmed under endoscopic vision as well as with the demonstration of good stream following supra pubic compression, at the end of the procedure. All patients were kept with 72 hours of urethral catheterization (All silicon self retaining Foley’s catheter according to body texture ) .Post PUV ablation pt. were given discharged with prophylactic antibiotics on 4th POD.
 Results: The mean age was found 18.37±16.13 months in cold knife ablation group and 12.70±11.03 months in diathermy fulguration group. Significant number (06/22.2%) of cases were associated with residual valve in diathermy fulguration group and non signicant number (301/3.7%) cases in cold knife ablation group . Significant number (04/14.8%) of cases were associated with post PUV ablation stricture urethra also in diathermy fulguration group and no stricture was found in cold knife ablation group . Significant hematuria. was present in 2(7.4%) in cold knife ablation group and 1(3.7%) in diathermy fulguration group.
 Conclusion: This study concludes that use of cold knife in case of ablation of PUV causes less post ablation obstruction (residual valve and stricture urethra) than using diathermy fulguration and can be regarded a safe and better option for PUV treatment.

Holmium: YAG Versus Cold Knife Internal Urethrotomy in the Management of Short Urethral Strictures: A Randomized Controlled Trial.

Introduction: our study aimed to assess the safety and efficacy of Holmium: YAG laser internal urethrotomy compared to the cold knife internal urethrotomy. Methods: Eighty adult male patients presented with a urethral stricture less than 1.5 cm were included in our study; they were randomly allocated into 2 groups representing Holmium and cold knife internal urethrotomy. A careful evaluation with ascending cystourethrogram and uroflowmetry were done on all patients, and they were followed up for 1 year with uroflowmetry. Results: Each group included 40 patients sharing the same demographic data. The most common cause of a urethral stricture in both groups was iatrogenic injury. The mean operative time of the cold knife urethrotomy procedure was 10.98 ± 2.40 minutes compared to 15.43 ± 2.48 minutes in the holmium laser urethrotomy group with a highly significant difference. The results showed success rates of 90% and 80% for the holmium laser and cold knife internal urethrotomy groups respectively. The perioperative complication according to the Clavien-Dindo classification, showed no statistically significant difference in grade 1 and 2 complications. A recurrence rate with the need for redo surgery representing grade 3B complication was seen in 4 cases in the Holmium group compared to 8 cases in the cold knife group with a statistically significant difference. Conclusion: Both Holmium Laser and cold knife internal urethrotomy are an effective surgical option for the treatment of a urethral stricture less than 1.5 cm with a promising outcome after 1-year follow-up with a better success rate using the Holmium laser.

Elevated neutrophil-lymphocyte ratio can be a biomarker for predicting the development of cervical intraepithelial neoplasia.

Cervical intraepithelial neoplasia (CIN) is the abnormal growth of cells on the surface of the cervix that could potentially lead to cervical cancer. In the present study, we investigated whether measuring the neutrophil-lymphocyte ratio (NLR) can be useful for predicting the risks of developing cervical lesions.This is a retrospective analysis of 212 women who were enrolled in this study. Among them, 106 patients with histologically confirmed CIN1-3 who were treated with loop electrosurgical excision procedure or cold knife cone in the Department of Gynecology, The Affiliated Hospital of Inner Mongolia Medical University between July 30th 2016 and January 30th 2019.Among the 106 patients in the CIN group, cytology showed minor abnormality which included atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion in 42, high-grade squamous intraepithelial lesion in 62, and squamous cell carcinoma in 2 patients. We found that the NLR has no significant difference between the control group and the CIN1 group, while there were significant differences between CIN1 and CIN2, and CIN2 and CIN3 group. The median of the NLR was higher in the HPV16-persistent groups than in the HPV-negative group.In conclusion, a high NLR value independently predicts CIN and the stage of CIN. The NLR may help doctors evaluate outcomes of patients received conization and choose alternative therapies for patients with high NLR value.

Predictors of recurrence in patients with high-grade cervical intraepithelial neoplasia after cervical conization.

This study was to identify the predictors of recurrence in patients with high-grade cervical intraepithelial neoplasia (CIN) after cervical conization.Totally 415 patients with CIN ≥ II who underwent loop electrosurgical excision procedure (LEEP) or cold knife conization (CKC) were included in this retrospective study. Cox proportional hazards model was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) regarding the association between postoperative recurrence and clinicopathological data.After the mean follow-up of (21.48 ± 5.82) months, 90 (21.69%) out of 415 cases were subjected to recurrence after cervical conization. The influencing factors for postoperative recurrence included times of full-term birth, history of preterm birth, history of abortion, positive margin, cone length, width, depth, smoking, and history of complicating diseases (P < .05). Multivariate Cox model indicated the positive margin (HR = 2.144, 95% CI: 1.317–3.492, P < .05), history of preterm birth (HR = 4.515, 95% CI: 1.598–12.754, P < .05), history of complicating diseases (HR = 3.552, 95% CI: 1.952–6.462, P < .05) were independent risk factors for recurrence after cervical conization. The restricted cubic diagram showed that the cone depth >0.5 cm was a protective factor for postoperative recurrence.For the patients with high-grade CIN after cervical conization, positive margins, histories of preterm birth, and complicating diseases were associated with increased risk of recurrence, but cone depth (>0.5 cm) with lower risk of recurrence.

Abstract 91: IGCS Fellowship Program in Mozambique: the Results

Abstract Purpose: Mozambique is a country with a very high prevalence of gynecological cancer and, until 2018 had no training program in gynecologic oncology and no gynecologic oncology specialists. Through the International Gynecologic Cancer Society (IGCS) global fellowship program, three gynecologists in Mozambique were trained to become gynecologic oncologists and completed training in October 2020. Methods: The training program pairs specialists in gynecologic oncology with gynecologists in countries without a formal training program in gynecologic oncology. In Mozambique, fellows were paired with specialists from Brazil and the United States, due to a common language with Brazilians and pre-existing partnerships. Over a 2.5 year period, fellows performed self-study using an on-line curriculum, received training in clinical practice and surgery with specialist mentors who traveled to Mozambique 3-4 times/year, attended monthly tumor boards and other regular virtual meetings, and visited the mentors' hospitals in Brazil for a 3 month observership. All surgical cases were logged in REDCap. after completing all requirements, the fellows successfully completed a final exam and received a certificate of successful completion of training. Results: During the training, each fellow participated on average of 251 surgical procedures where they performed: 69 radical hysterectomies, 80 simple hysterectomies, 92 salpingo-oophorectomies, 73 pelvic lymphadenectomies, 2 para-aortic lymphadenectomies, 14 radical vulvectomies, 19 inguinal lymphadenectomies, 34 cold knife conizations and 38 loop electrosurgical excision procedures (LEEPs). At the conclusion of the fellowship, the fellows were performing these procedures independently. Conclusion: The IGCS program and international mentors supported the training of physicians in Mozambique, a country without formal gynecologic oncology training, facilitating the acquisition of the knowledge and skills to effectively care for women with gynecologic cancers. Citation Format: Ricardina Rangeiro, Dercia Changule, Siro Daud, Magda Ribeiro, Elvira Luis, Flora Mabota, Georgia Cintra, Renato Moretti-Marques, Andre Lopes, Marcelo Vieira, Mila Salcedo, Ellen Baker, Cesaltina Lorenzoni, Kathleen Schemeler. IGCS Fellowship Program in Mozambique: the Results [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 91.

Does ibuprofen, prednisolone, or amoxicillin reduce post-tonsillectomy pain in children? A prospective randomized controlled trial

ObjectiveTo evaluate whether the use of anti-inflammatory or antibiotic in the postoperative period modifies pain in children undergoing tonsillectomy. Methods225 children who underwent cold knife tonsillectomy ± adenoidectomy were randomized into five groups, receiving #1 metamizole/acetaminophen, #2 amoxicillin, #3 ibuprofen, #4 prednisolone, or #5 amoxicillin plus prednisolone. All groups received oral analgesics (metamizole/acetaminophen) to use as needed. Pain was monitored during the 7 days following surgery using the Parents’ Postoperative Pain Measurement (PPPM) and the Faces Pain Scale - Revised (FPS-R). Pain was also indirectly evaluated by the dose of analgesics administered on each day and by the time needed to return to a solid diet. ResultsAfter losses (24%), 170 individuals were submitted for analysis. Multiple comparisons demonstrated that the evolution of pain between the different groups, as matched day-per-day, was not significantly different by either PPPM or FPS-R (p > 0.05). The instances of analgesic intake were also similar in all the groups (p > 0.05), as was the return to solid food ingestion (p = 0.41). All groups presented a similar standard of clinical improvement at intervals of 2 days (p < 0.01). Independent of postoperative pain management, patients developed significant pain up to the day 4 following surgery. ConclusionThe addition of amoxicillin, ibuprofen, prednisolone, or amoxicillin and prednisolone does not modify postoperative pain in children undergoing cold-knife tonsillectomy. Special pain control should be performed on the first 4 days following tonsillectomy in children.

From modified radical mastectomy to infra-radical mastectomy: a phase I study for surgical de-escalation focusing on pathological analyses.

Despite that breast conservative therapy became the standard of care in breast cancer, modified radical mastectomy, a large mutilating surgery, is still required for an important number of patients. In order to improve the quality of life and the psychological aspects of a surgery involving the femininity of woman, we developed a new less invasive procedure called infra-radical mastectomy. It aims to save the neckline of patients by the maintenance of the peripheral skin-fatty flap that constitutes the base for implantation of the breast. This phase I study analyzed the feasibility of this procedure using outcome of anatomo-pathological analyses as primary endpoint. Between March 2015 and July 2017, all women with operable breast cancer without signs of lymph node invasion were invited to participate in the study in the 2 participating institutions. After a water-assisted dissection of the peri-glandular space, an enucleation of the breast was performed by a cold knife which represents the infra-radical mastectomy. A peri-glandular re-excision (PGR) of the skin and the fat tissue surrounding the gland was then achieved to obtain an MRM. This PGR underwent a careful pathological examination (10 samples per patient). Moreover, the tissue volume and the skin surface of the PGR were quantified. A total of 53 patients (median age: 60 years) were prospectively recruited. The pathological analysis of peri-glandular biopsies revealed none residual invasive carcinoma, 1% of biopsies contained focal ductal carcinoma in situ (DCIS) and 0.4% atypical hyperplasia corresponding to 4 and 2 patients respectively. These 4 patients with residual DCIS were preoperatively diagnosed with extensive DCIS. On average after an infra-radical mastectomy, 37% of the volume and 53% of the skin surface of a complete modified radical mastectomy were sparred. The evaluation of biopsies from peri-glandular tissue suggests that infra-radical mastectomy should be further evaluated except for patients diagnosed with extensive DCIS which must be excluded of this infra-radical approach. Additional work is needed to evaluate cosmetic outcome and impact on quality of life, the need of radiotherapy and the oncological long-term outcome.

The role of MRI in cervical cancer\u2009>\u20092\xa0cm (FIGO stage IB2-IIA1) conservatively treated with neoadjuvant chemotherapy followed by conization: a pilot study

IntroductionMRI is very accurate in selecting young women with cervical cancer for fertility-sparing surgery (FSS), in particular radical hysterectomy (RH). In order to improve obstetrical outcomes, neoadjuvant chemotherapy (NACT) followed by cold knife conization (CKC) has been proposed as alternative technique.ObjectiveTo investigate the role of MRI in evaluation of response to treatment after neoadjuvant chemotherapy (NACT), followed by CKC, in patients with cervical cancer FIGO stage IB2-IIA1 with tumor size 2 – 4 cm, desiring to preserve their fertility.Methods13 young women (23–36 years old) with cervical cancer stage IB2-IIA1 desiring to preserve their fertility were included. Tumor diameter at baseline and after treatment was detected on 1.5 T MRI. Treatment response was assessed according to Response Evaluation Criteria in Solid Tumors (RECIST 1.1) and then compared to histopathology result.ResultsMRI correctly assessed 11 out of 13 cases, according to RECIST 1.1, compared to histopathology. Among these 7 patients with partial response (PR), 2 cases of CR, 1 SD and 1 PD with persistence or enlargement of primary tumor.ConclusionOur pilot study supports the usefulness of MRI in assessment of treatment response after NACT, followed by CKC.Trial registration numberClinicalTrials.gov: NCT02323841

Elvira Geluz Ilano-Colmenar, MD (1930 – 2021)

A fighter through and through, my mother Elvie passed away at the age of 90 in St. Luke’s, Quezon City due to cancer. During her last days in the hospital, with nurses and attendings rushing back and forth her room with various equipment, she would often marvel at how medicine has advanced since her younger years. “Iba na talaga ngayon…”, she would say, followed by a pained chuckle and a faraway look in her eyes. While times have certainly changed and continue to do so, this did not hinder my mom from being the best doctor she could be.&#x0D; Born in Imus, Cavite, Elvie was the youngest daughter in a family of eight children. Her father passed when she was just a toddler, so they were raised single-handedly by her mother since then. She was known as ‘Tia Elvie’ to her nieces and nephews, whom she nurtured and cared for dearly. She finished Medicine at the University of Santo Tomas in 1954, and beauty and brains that she was, was also a candidate for Miss Medicine in that year. She then pursued her residency in Otolaryngology at King’s County Hospital, Brooklyn New York in 1960. She married the love of her life, Manolo Colmenar in 1964.&#x0D; Dr. Colmenar established her practice in St. Luke’s, where she joined the staff of the EENT Department at Cathedral Heights, Quezon City and was subsequently appointed the first Chairperson of our very own ENT-HNS Department in 1987. She worked very hard to establish an accredited residency training program, all while serving as a beacon and guide to our residents and staff. Influenced by her service, my brother Loy and I followed in her footsteps, pursuing our own careers in Dentistry and Medicine later on. She was also a source of inspiration to several of her nieces who later became established physicians in their own fields of specialty, as well as two of her grandchildren who are also pursuing Dentistry and Medicine.&#x0D; Mom was known for her 30-minute cold knife tonsillectomies, but one thing she would always emphasize was the importance of patient safety over speed. A natural peacemaker, she also served in the hospital ethics committee, where she mediated in settling cases between warring physicians, hospital staff, and patients. This value of hers would also be evident in our clan, as we would always approach her first during times of family crisis. After retirement, she continued her practice at home, mostly for free, until she could no longer do so.&#x0D; While it broke our hearts to see her go, my mom lived a beautiful and fulfilling life. She will always be remembered as a steadfast doctor, an inspiring mentor, a doting wife, mother, and grandmother, and one of the strongest and most generous women we will ever have the pleasure of knowing. May she rest in peace in the hands of our Lord.

Necessity for subsequent surgery in women of child-bearing age with positive margins after conization

Background20–25% of women with high-grade cervical intraepithelial neoplasias (HSIL) have residual lesions after conization. The state of the margin is generally considered to be a risk factor for recurrence or persistent lesions. Predictors of positive margins and residual lesions need to be identified. A design for postoperative management and avoidance of overtreatment needs to be provided, especially for women of child-bearing age.MethodsThis study was a retrospective analysis of 1309 women of child-bearing age with HSIL, who underwent cold knife conization (CKC). Age, gravidity, parity, human papillomavirus (HPV) species, cytology, transformation zone type, results of endocervical curettage (ECC), quadrant involvement, glandular involvement, and Cervical Intraepithelial Neoplasia (CIN) grade were analyzed. Among those with positive margins, 245 patients underwent secondary surgery within three months, including CKC, a loop electrosurgical excision procedure, and total hysterectomy. Risk factors for positive margins and residual lesions were assessed.ResultsThere was no significant difference in age, gravidity, parity, glandular involvement, and CIN grade between the two groups (P > 0.3). There was a significant difference in HPV species, cytology, ECC results, and quadrant involvement (P < 0.002). Multivariate analysis showed a major cytology abnormality, high-risk HPV infection, type III transformation zone, positive ECC result, and multiple quadrant involvement were independent risk factors for positive margins and residual lesions (P < 0.02). Age > 35 years was also a risk factor for residual lesions (P < 0.03).ConclusionHigh-risk women should be treated appropriately considering fertility. Patients with positive margins should be managed uniquely. Surgery for women without fertility may be appropriate. Close follow-up is necessary for women who have fertility requirements or are unwilling to undergo subsequent surgery if they have no risk factors, especially women < 35 years.

Successful urethral reconstruction with scrotal skin island flap and pudendal thigh flap for urethral stricture and urethrocutaneous fistula

Abstract Introduction: One of the complications following transurethral resection of the prostate is urethral stricture formation. There are several treatment methods for urethral obstructions, such as urethral dilation with urethral sounds, direct vision internal urethrotomy with a cold knife or laser, and urethral reconstruction. However, urethrocutaneous fistulae, periurethral and scrotal abscesses are complications that result from urethral dilation and direct vision internal urethrotomy. Patient concerns: A 66-year-old male patient complained of difficulty in voiding for 3 years accompanied by urinary frequency and incomplete emptying. He had no underlying chronic diseases. He underwent transurethral resection of the prostate, however, urinary frequency and a weak urine stream persisted for 2 weeks. Diagnoses: According to physical examination and cystoscopy, the patient was diagnosed with urethrocutaneous fistula and urethral stricture. Interventions: Initially, urethral sounding and direct vision internal urethrotomy were performed, however, complications such as urethrocutaneous fistula, periurethral and scrotal abscesses occurred. Urethral reconstruction was performed as a two staged procedure involving urethral fistulectomy, cutaneous urethrotomy, debridement and suprapubic cystostomy in the first stage followed by reconstruction using scrotal skin island and pudendal thigh flaps six months later. Outcomes: Improved voiding and no wound dehiscence were observed on postoperative day 56. After a follow-up period of 2 years, there was no evidence of urinary retention nor incomplete emptying. However, there was minimal residual paresthesia from the medial thigh to the left hemi-scrotal skin. Conclusion: Urethral reconstruction with scrotal skin island and pudendal thigh flaps can be a successful treatment method owing to abundant blood supply and less skin tension.

The treatment strategy of patients with positive margins after cervical cold knife conization-A 7-year retrospective study in China.

To explore treatment strategies for patients with positive margins after cervical cold knife conization (CKC) by estimating the risk of residual or recurrent CIN2 or worse (CIN2+). A retrospective study included 569 patients receiving CKC for CIN3 in Xiangya Hospital from January 2013 to December 2017. Demographic characteristics and test results were obtained before CKC, after CKC, at 6, 12, and 24months, then annually thereafter. The primary end point was residual/recurrent CIN2+ post-CKC. Fourteen (2.46%) patients had residual/recurrent CIN2+ with a median time of occurrence at 12months post-CKC. Taking the average age and hrHPV viral load tested by Hybrid Capture 2 (HC2) as thresholds, the risk of residual/recurrent CIN2+ was higher in women aged over 40years or with a baseline HC2 of 300 or more for the ratio of relative light units to positive cut-off values. Patients with positive margins were at higher risk of residual/recurrent CIN2+ (hazard ratio 3.66, 95% confidence interval 1.25-10.71), especially when endocervix was involved. A total of 536 (94.20%) patients received HPV testing within 6months after CKC. Patients with both positive HPV testing results and positive margins were at the highest risk of residual/recurrent CIN2+. Patients with positive endocervical margins are at high risk for residual/recurrent CIN2+, independent of the severity of margins. HPV testing within 6months after CKC may be a feasible triage strategy for these patients.

Comparative study on surgical outcome for benign vocal cord lesions by conventional method versus coblation

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Benign&lt;strong&gt; &lt;/strong&gt;vocal cord lesions are common laryngeal pathology found in routine clinical practice.microlaryngeal surgery is useful in excision for pathology. Coblation assisted microlaryngeal surgery is a new technique for the vocal cord lesions&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Current study was conducted in Government Kilpauk medical college hospital and Government Royapettah hospital from the period of 2018 to 2019 in 40 patients with benign vocal cord lesion. The objectives of current study were to assess the voice handicap Index before and after surgery, to assess the surgical benefits and ease in doing the procedure intraoperatively and to assess the postoperative recovery in conventional micro laryngeal procedure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; The overall analysis shows coblation being an evolving technique has advantages over the conventional cold knife method. Blood loss and the surgery duration was less in coblation. But the assessment tools of both voice handicap index, voice analysisand GRBASscore favours conventional micro laryngeal surgery with reduced scores and improvement in performance with statistically significant values probably due to minimal tissue handling and decrease in post op scarring in conventional micro laryngeal surgery.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The overall voice handicap index and voice analysis showed improvement post operatively in both the groups with more favoring response to conventional method with statistically significant values. In the same away the GRBAS score also favors the conventional method. Coblation being a newer technique can be employed for surgical treatment for micro-laryngeal surgery considering its advantages and less time consumption. Stroboscopy and other acoustic analysis along with long term follow up is needed.&lt;/p&gt;

Neck dissection performed from the outside with a cold knife

Neck dissection performed from the outside with a cold knife

Fertility-sparing Surgery for Patients with Cervical, Endometrial, and Ovarian Cancers

Nearly 10% of the 1.3 million women living with a gynecologic cancer are aged <50 years. For these women, although their cancer treatment can be lifesaving, it's also life-altering because traditional surgical procedures can cause infertility and, in many cases, induce surgical menopause. For appropriately selected patients, fertility-sparing options can reduce the reproductive impact of lifesaving cancer treatments. This review will highlight existing recommendations as well as innovative research for fertility-sparing treatment in the 3 major gynecologic cancers. For early-stage cervical cancers, fertility-sparing surgeries include cold knife conization, simple hysterectomy with ovarian preservation, or radical trachelectomy with placement of a permanent cerclage. In locally advanced cervical cancer, ovarian transposition before radiation therapy can help preserve ovarian function. For endometrial cancers, fertility-sparing treatment includes progestin therapy with endometrial sampling every 3 to 6 months. After cancer regression, progestin therapy can be halted to allow attempts to conceive. Hysterectomy with ovarian preservation can also be considered, allowing for fertility using assisted reproductive technology and a gestational carrier. For ovarian cancers, fertility-sparing surgery includes unilateral salpingo-oophorectomy or bilateral salpingo-oophorectomy (with lymphadenectomy and staging depending on tumor histology). With higher-risk histology or higher early-stage disease, adjuvant chemotherapy is recommended-however, this carries a 3% to 10% risk of ovarian failure. Use of oocyte or embryo cryopreservation in patients with early-stage ovarian malignancy remains an area of ongoing research. Overall, fertility-sparing management of gynecologic cancers is associated with acceptable rates of progression-free survival and overall survival and is less life-altering than more radical surgical approaches.

Evaluation of cervical length and optimal timing for pregnancy after cervical conization in patients with cervical intraepithelial neoplasia: A retrospective study.

To evaluate the change of cervical length and the best timing for pregnancy after cervical conization in patients with cervical intraepithelial neoplasia (CIN).This was a retrospective study including patients under 40 years with fertility desire treated by cervical conization for CIN. To assess the cervical length, the patients were divided into 2 groups according to different surgery procedure: loop electrosurgical excision procedure (LEEP) and cold knife conisation (CKC). Patients with cervical length < 2.5 cm in CKC group were divided into 2 groups according to whether receiving cervical cerclage. Trans-vaginal ultrasound examination was used to measure cervical length by fixed professional sonographers.In LEEP group, the cervical length preoperative was significantly longer than 3 months postoperatively (3.03 ± 0.45 cm vs 2.84 ± 0.44 cm, P = .000). In CKC group, the cervical length preoperative was significantly longer than 3 and 6 months postoperatively (2.90 ± 0.41 cm vs 2.43 ± 0.43 cm and 2.68 ± 0.41 cm, respectively, P = .000). Cervical length was significantly longer at 12 and 9 months after cerclage compared to that without cerclage. Eighteen patients got pregnant in LEEP group, among which one was pregnant at 5 months postoperatively and had premature delivery. There was 1 inevitable abortion and 1 preterm birth among 39 pregnant patients from CKC group.Patients who have fertility desire with CIN were recommended for pregnancy at 6 and 9 months after LEEP and CKC, respectively. Cerclage effectively prolonged cervical length in patents with that less than 2.5 cm to prevent cervical incompetence.