Complications Of Gynecologic Surgery Research Articles

The impact of virtual preoperative visits on complications of gynecologic surgery

The impact of virtual preoperative visits on complications of gynecologic surgery

Urological injuries following gynecologic surgery: clinical manifestations, diagnosis and management

Iatrogenic urinary tract injury constitutes a rare but serious complication of gynecologic surgery, occurring in 0.3% to 1.5% of all procedures. Delayed diagnosis and repair are associated with increased postoperative morbidity, mortality and a long-term negative impact on the quality of life. Intraoperative detection of urinary tract injuries allows for prompt repair, facilitates management and speeds up recovery. Bladder injuries are 3 times more common than ureteral injuries, and usually are recognized and repaired immediately with minimal complications. Undetected ureteral injuries lead to severe postoperative complications such as the formation of genitourinary fistulas, sepsis, renal loss and death. In this review we aim to describe the postoperative clinical manifestations, the diagnostic methods and therapeutic strategies for the management of urinary tract injuries, whether in the acute or delayed setting, in an effort to reduce the potential impact of subsequent complications to both patient and surgeon. Timely and effective repair of urinary tract injuries is critical to improve patient outcome, mitigate litigation risk, and allow an uneventful postoperative recovery in a careful manner.

PREVALENCE OF POSTOPERATIVE COMPLICATIONS IN GYNECOLOGIC SURGERY

The prevalence of surgical complications in gynecological surgery varies depending on the population. The time of occurrence of complications may range from the time of surgery itself to several weeks after the procedure. This study was conducted to determine the prevalence of postoperative complications after gynecologic surgeries and to identify the common complications after gynecologic surgeries. This is a cross sectional hospital based study included 200 patients underwent various types of gynecologic procedures in Al-Sadaqa Teaching Hospital in Aden, from Jan.1st to Dec. 31st, 2020. The study included patients from 13 years to 80 years (mean age: 43.7 ± 13.2 years), subjected to any type of gynecologic procedures (major or minor) during the study period. The prevalence of postoperative complications after gynecology surgery was (30.5%) with minor more than major complications (86.9% vs. 13.1). Common complications were pain at site of operation (24.6%), fever (12.3%), nausea and vomiting (19.7%), SSI (8.2%), URTI (6.6%), and hematoma (4.9%). Significant higher percentage of postoperative complications were reported in association with major surgeries than with minor surgeries (95.1% vs. 4.9%, respectively) (p<0.05). Among major gynecologic surgeries, the common postoperative complications were reported significantly in association with abdominal hysterectomy (29.3%), vaginal hysterectomy (20.7%), uterine myomectomy (17.2%) and Colporrhaphy (12.1%). Among minor gynecologic surgeries, the common postoperative complications were reported in association with dilatation and curettage for biopsy (66.7%) and Clitorial abscess drainage (33.3%). Other minor gynecologic surgeries did not show any association to postoperative complications. This study concluded that postoperative complications are common after gynecologic surgeries, so that operated women need to be fully investigated and evaluated prior to elective gynecologic surgeries.

Complications of Gynecologic Surgery: Vaginal Cuff Dehiscence after Total Laparoscopic Radical Hysterectomy

A 34-year-old woman G = 2 P = 2 completed parity was diagnosed with an abnormal PAP smear definite as AGC (Atypical Glandular Cells), seen in our center for a second opinion. The Bethesda system classifies atypical glandular cells (AGC) as glandular cells that demonstrate nuclear atypia appearing to exceed reactive or reparative changes but lacking certain features of adenocarcinoma.

The impact of surgical start time on complications in gynaecological surgery: a retrospective cohort study

The impact of surgical start time on complications in gynaecological surgery: a retrospective cohort study

Complications of Gynecologic Surgery: CO2 Massive Pneumothorax after a Total Laparoscopic Hysterectomy

A 43-year-old woman (G = 3, P = 0, C delivery = 3) underwent a total laparoscopic hysterectomy for uterine myomatosis. A Palmer point was used to insufflate the abdominal cavity (Supplemental Fig. 1), subcutaneous emphysema occurred during the procedure (Supplemental Fig. 2), and the Veress needle was redirected. An excessive retroperitoneal CO2 was visualized (Fig. 1), (Supplemental Fig. 3). The surgery went smoothly. In the recovery room, the patient was hemodynamic and respiratory unstable; intubation was necessary.

Intraoperative and Postoperative Complications in Gynaecological Surgery: A Retrospective Analysis.

Background and objectiveSurgical complications can arise either intraoperatively or postoperatively. The factors that lead to complications in gynaecological surgeries could be both patient-related or surgeon-related. In this study, we aimed to identify the frequency of intraoperative and postoperative complications in gynaecological surgeries conducted at our institution and to evaluate various risk factors that may predispose patients to these complications.Materials and methods This was a retrospective analysis of women undergoing gynaecological surgeries in the Department of Obstetrics and Gynaecology at a tertiary centre in Uttarakhand, India from February 2016 to December 2019. Demographic characteristics, comorbidities, and perioperative complications of these women were recorded.ResultsA total of 389 women undergoing gynaecological surgeries were included in the study cohort. Of note, 94 of these had perioperative complications, accounting for 24.16% of the total cases. The most common route of surgery associated with complications was open abdominal surgery (34.66%). The operating time in most surgeries ranged from two to three hours (48.93%), and the average duration of hospital stay after surgery was 10.79 + 7.91 days. Intraoperative and postoperative complication rates were 5.91% and 19.28% respectively. Of these, surgical site infections (SSIs) (10.28%) and fever (5.39%) were the most common complications observed. Independent parameters like age, parity, route of surgery, operative time, preoperative duration of hospital stay, and preoperative blood transfusion were significantly associated with perioperative complications.ConclusionsSurgical complications were more frequently seen in abdominal cases compared to other routes. Knowledge of centre-specific surgical outcome data can help in providing patients with better preoperative counselling.

Association of gabapentinoid utilization with postoperative pulmonary complications in gynecologic surgery: a retrospective cohort study

Objective To investigate gabapentinoid utilization and association with postoperative pulmonary complications after gynecologic surgery. Methods After Institutional Review Board approval, we performed this retrospective cohort study using the Premier Healthcare Database. We used ICD-10 and charge codes to identify adults who underwent elective gynecologic surgery from 2015 to 2018 and received either gabapentin or pregabalin on the day of surgery. Our primary outcome was a composite of pulmonary complications: respiratory failure, pneumonia, reintubation, pulmonary edema, and non-invasive or invasive ventilation. Secondary outcomes included mortality, intensive care unit admission, mechanical or non-invasive ventilation, hospital length of stay, re-admission within 30 days, opioid consumption and antiemetic use. Multivariable generalized linear mixed models were utilized to examine the associations between gabapentinoids and our outcome measures, adjusted for all covariates. Results Data from 253,013 patients were analyzed, with 19,121 (7.6%) receiving gabapentinoids. Gabapentinoid utilization increased from 3.9% in 2015 to 12.3% in 2018, and was associated with increased pulmonary complications (OR 1.19; 95% CI 1.03–1.38), non-invasive ventilation (odds ratio [OR] 1.53; 95% CI 1.29–1.81), duration of hospital stay (% change 1.75; 95% CI 0.92–2.59), daily antiemetic doses on day of surgery (mean difference [MD] 1.37; 95% CI 1.26–1.49) and subsequently (MD 1.61; 95% CI 1.30–1.99), and higher daily average (MD 4.59 mg; 95% CI 3.55–5.63) and total (MD 8.74 mg; 95% CI 6.83–10.62) parenteral morphine equivalents. Conclusions Gabapentinoid utilization in gynecologic surgery is increasing and is associated with postoperative pulmonary complications.

Improving the Evaluation and Management of Cystotomy in Gynecologic Surgery with a Cadaver Surgical Curriculum

Objectives: Urinary tract injuries are a known complication of gynecologic surgery, occurring in 0.18% - 0.80% of procedures and most commonly involving the bladder. Appropriate identification, evaluation, treatment, and follow-up by gynecologic surgeons are important to reduce the associated long-term morbidities. The purpose of this study was to implement a comprehensive cadaver curriculum in cystotomy repair for OBGYN residents. Methods: This was a prospective observational cohort study including 10 OBGYN residents (PGY1-3) at a single institution in 2020 (56% of the 18 eligible residents). The curriculum consisted of a one-hour didactic lecture and one-hour hands-on surgical skills training with fresh frozen cadavers. Residents were evaluated in three domains: 1) knowledge, 2) surgical skills, and 3) confidence. Knowledge, confidence, and resident satisfaction were evaluated with pre- and post-surveys. The bladder model, derived from the ACOG Simulation Working Group, was used to evaluate surgical skills at baseline and at completion of the curriculum. Results: Across all three PGY levels, statistically significant improvements were observed in knowledge, surgical skills, and confidence after didactic and cadaver education (p = 0.001, p Conclusions: Educating and training OBGYN residents to manage and repair cystotomies can be challenging given the low incidence of injury in the operating room. The cadaver surgical skills curriculum was an effective training module and remains an important component of skills training in conjunction with simulation and traditional didactic sessions.

Guideline No. 412: Laparoscopic Entry for Gynaecological Surgery.

To evaluate the benefits and risks of laparoscopic surgery and provide clinical direction on entry techniques, technologies, and their associated complications in gynaecological surgery. All patients, including pregnant women and women with obesity, undergoing laparoscopic surgery for various gynaecological indications. The laparoscopic entry techniques and technologies reviewed in formulating this guideline included the closed (Veress needle-pneumoperitoneum-trocar) technique, direct trocar insertion, open (Hasson) technique, visual entry systems, and disposable shielded and radially expanding trocars. Implementation of this guideline should optimize decision-making in the selection of entry technique for laparoscopic surgery. We searched English-language articles from September 2005 to December 2019 in PubMed/MEDLINE, Embase, Science Direct, Scopus, and Cochrane Library using the following MeSH search terms alone or in combination: laparoscopic entry, laparoscopy access, pneumoperitoneum, Veress needle, open (Hasson), direct trocar, visual entry, shielded trocars, radially expanded trocars, and laparoscopic complications. The authors rated the quality of evidence and strength of recommendations using the Canadian Task Force on Preventive Health Care approach (Appendix A). Surgeons performing laparoscopic gynaecological surgery. RECOMMENDATIONS.

Abstract C032: A novel integrin-targeted therapeutic agent for ovarian cancer

Abstract No present therapy effectively impacts overall survival of advanced ovarian cancer (OC). The current standard-of-care includes surgical debulking followed by combination intravenous (IV) or intraperitoneal (IP) chemotherapy. Although there is increasing interest in IP chemotherapy, side effects from cytotoxic agents result in a significant percentage of women discontinuing treatment. We propose to examine the efficacy of IP administration of a novel non-cytotoxic, non-immunogenic, anti-invasive peptide called vicrostatin (Mol. Wt. 7,146). We investigated the clinical translational potential of this disintegrin, which was conceived, produced and developed in our laboratory. Vicrostatin is produced recombinantly using a bacterial system in amounts sufficient for clinical trials. It has high binding affinity for a number of RGD (Arg-Gly-Asp)-integrins, including αvβ3, αvβ5, α5β1 and αIIbβ3. Vicrostatin disruption of the actin cytoskeleton, which occurs exclusively in motile cells (cancer and angiogenic endothelial cells), accounts for its mechanism of action. We showed lack of toxicity following vicrostatin introduction into rodents. We used several different experimental animal models to demonstrate the efficacy of vicrostatin in ovarian cancer. We compared saline and Oxiplex formulations for IP delivery of vicrostatin in mouse models. Oxiplex, a hydrogel composed of polyethylene oxide and carboxymethyl cellulose, stabilized by CaCl2, is impregnated with vicrostatin; incorporation of vicrostatin at 2-10 mg/ml results in its sustained release for 10-12 days. We eventually settled on a 5 mg/week (250mg/kg) dose per mouse and compared efficacies of Oxiplex versus saline in animals harboring IP xenografts (10 animals per group) of SKOV3GFP/LUC spheroids (2x106 cell equivalents); the spheroids were allowed to implant for 4 days before treatment with weekly IP injections of either 5 mg of vicrostatin in 1 ml saline, 5mg of vicrostatin in 1 ml of Oxiplex, or 1 ml of Oxiplex alone (control). After one-month animals in Oxiplex alone group showed extensive and widespread cancer cell dissemination based on bioluminescent imaging and findings at autopsy. Vicrostatin-saline and vicrostatin-Oxiplex treatments resulted in dramatically less or, in some animals, no grossly visible tumor foci and in ~95-98% reduction in bioluminescent signals. These results were reproduced in three independent experiments and suggest that both delivery modalities are similarly effective. An advantage of the Oxiplex formulation is its ability to prevent post-surgical adhesions, a frequent complication of gynecological surgery. We are presently using RNAseq technologies to investigate changes in expression of genes involved in intracellular pathways suspected to represent predictive biomarkers of ovarian cancer response to vicrostatin therapy in xenografts of SKOV3 ovarian cancer cells. The results will enhance our understanding of pathways targeted by vicrostatin and provide biomarkers of clinical responsiveness in future clinical trials. Citation Format: Franics S Markland, Steve Swenson, Radu Minea, Louis Dubeau. A novel integrin-targeted therapeutic agent for ovarian cancer [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics; 2019 Oct 26-30; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2019;18(12 Suppl):Abstract nr C032. doi:10.1158/1535-7163.TARG-19-C032

Intra-operative identification of ureters using indocyanine green for gynecological oncology procedures

It is well known that ureteral injury is a possible complication of gynecological surgery. The literature reports rates for ureteral injuries for pelvic surgery ranging from 1% to 10%[1 2][1]...

Prevalence of surgical complications in gynecological surgery at the Hospital Universitario San José in Popayán, Colombia. 2015

Introduction: Every surgery has risk of complications; prognosis depends on prompt diagnosis and timely management.Objective: To determine the prevalence of surgical complications in gynecological surgery in a tertiary care hospital and to explore associated factors.Materials and methods: Prevalence study with secondary analysis of medical records of patients who underwent scheduled gynecological surgery. The outcome variable was complications reported during a period of less than 30 days. The universe was established, and clinical, biological and sociodemographic variables were collected. To determine prevalence, the total number of complications was taken as the numerator and the total number of records was used as the denominator. To explore associated factors, odds ratio (OR) was used as a measure of association with a 95% CI.Results: 591 records were reviewed, finding a surgical management of ectopic pregnancy prevalence of 3.8% (OR=3.73, CI95%: 2.41-92.52). Obesity (OR 12.47, CI95%: 4.48-33.19) and gynecological surgery for malignancy (OR 3.73, CI95%: 1.14- 10.48) were associated with complications.Conclusion: The prevalence found in our institution was similar to what most studies have reported.

Complications of gynecologic surgery: focus on deep venous thrombosis and pulmonary embolism

Complications of gynecologic surgery: focus on deep venous thrombosis and pulmonary embolism

Laparoscopic repair of ureter damaged during laparoscopic hysterectomy: Presentation of two cases

Ureter injuries are uncommon but dreaded complications in gynecologic surgery and a frequent cause of conversion to laparotomy. Recently, a few papers reported the repair of gynecologic ureteral injuries using laparoscopy with encouraging results. In these case reports, we aimed to present two laparoscopically repaired ureter injuries during total laparoscopic hysterectomies (TLH). In the first case, the ureter was transected during the dissection of the cardinal ligament, approximately 7 to 8 cm distal to the ureterovesical junction (UVJ), and in the second case, it was damaged approximately 10 cm distal to the UVJ. Both transections were identified during surgery. The injured ureter was repaired without converting to laparotomy or additional trocar insertion. Ureteroureterostomy was performed in both cases uneventfully. Although ureteric injury is a rare complication during TLH, it can be managed by the same surgeon laparoscopically during the same procedure.

The sticky business of adhesion prevention in minimally invasive gynecologic surgery.

The negative impact of postoperative adhesions has long been recognized, but available options for prevention remain limited. Minimally invasive surgery is associated with decreased adhesion formation due to meticulous dissection with gentile tissue handling, improved hemostasis, and limiting exposure to reactive foreign material; however, there is conflicting evidence on the clinical significance of adhesion-related disease when compared to open surgery. Laparoscopic surgery does not guarantee the prevention of adhesions because longer operative times and high insufflation pressure can promote adhesion formation. Adhesion barriers have been available since the 1980s, but uptake among surgeons remains low and there is no clear evidence that they reduce clinically significant outcomes such as chronic pain or infertility. In this article, we review the ongoing magnitude of adhesion-related complications in gynecologic surgery, currently available interventions and new research toward more effective adhesion prevention. Recent literature provides updated epidemiologic data and estimates of healthcare costs associated with adhesion-related complications. There have been important advances in our understanding of normal peritoneal healing and the pathophysiology of adhesions. Adhesion barriers continue to be tested for safety and effectiveness and new agents have shown promise in clinical studies. Finally, there are many experimental studies of new materials and pharmacologic and biologic prevention agents. There is great interest in new adhesion prevention technologies, but new agents are unlikely to be available for clinical use for many years. High-quality effectiveness and outcomes-related research is still needed.

Management of Mesh and Graft Complications in Gynecologic Surgery.

This document focuses on the management of complications related to mesh used to correct stress urinary incontinence or pelvic organ prolapse. Persistent vaginal bleeding, vaginal discharge, or recurrent urinary tract infections after mesh placement should prompt an examination and possible further evaluation for exposure or erosion. A careful history and physical examination is essential in the diagnosis of mesh and graft complications. A clear understanding of the location and extent of mesh placement, as well as the patient's symptoms and therapy goals, are necessary to plan treatment approaches. It is important that a treating obstetrician-gynecologist or other gynecologic care provider who seeks to revise or remove implanted mesh be aware of the details of the index procedure. Diagnostic testing for a suspected mesh complication can include cystoscopy, proctoscopy, colonoscopy, or radiologic imaging. These tests should be pursued to answer specific questions related to management. Given the diverse nature of complications related to mesh-augmented pelvic floor surgery, there are no universal recommendations regarding minimum testing. Approaches to management of mesh-related complications in pelvic floor surgery include observation, physical therapy, medications, and surgery. Obstetrician-gynecologists should counsel women who are considering surgical revision or removal of mesh about the complex exchanges that can occur between positive and adverse pelvic floor functions across each additional procedure starting with the device implant. Detailed counseling regarding the risks and benefits of mesh revision or removal surgery is essential and can be conducted most thoroughly by a clinician who has experience performing these procedures. For women who are not symptomatic, there is no role for intervention.

Committee Opinion No. 694: Management of Mesh and Graft Complications in Gynecologic Surgery.

This document focuses on the management of complications related to mesh used to correct stress urinary incontinence or pelvic organ prolapse. Persistent vaginal bleeding, vaginal discharge, or recurrent urinary tract infections after mesh placement should prompt an examination and possible further evaluation for exposure or erosion. A careful history and physical examination is essential in the diagnosis of mesh and graft complications. A clear understanding of the location and extent of mesh placement, as well as the patient's symptoms and therapy goals, are necessary to plan treatment approaches. It is important that a treating obstetrician-gynecologist or other gynecologic care provider who seeks to revise or remove implanted mesh be aware of the details of the index procedure. Diagnostic testing for a suspected mesh complication can include cystoscopy, proctoscopy, colonoscopy, or radiologic imaging. These tests should be pursued to answer specific questions related to management. Given the diverse nature of complications related to mesh-augmented pelvic floor surgery, there are no universal recommendations regarding minimum testing. Approaches to management of mesh-related complications in pelvic floor surgery include observation, physical therapy, medications, and surgery. Obstetrician-gynecologists should counsel women who are considering surgical revision or removal of mesh about the complex exchanges that can occur between positive and adverse pelvic floor functions across each additional procedure starting with the device implant. Detailed counseling regarding the risks and benefits of mesh revision or removal surgery is essential and can be conducted most thoroughly by a clinician who has experience performing these procedures. For women who are not symptomatic, there is no role for intervention.

Committee Opinion No. 694 Summary: Management of Mesh and Graft Complications in Gynecologic Surgery.

This document focuses on the management of complications related to mesh used to correct stress urinary incontinence or pelvic organ prolapse. Persistent vaginal bleeding, vaginal discharge, or recurrent urinary tract infections after mesh placement should prompt an examination and possible further evaluation for exposure or erosion. A careful history and physical examination is essential in the diagnosis of mesh and graft complications. A clear understanding of the location and extent of mesh placement, as well as the patient's symptoms and therapy goals, are necessary to plan treatment approaches. It is important that a treating obstetrician-gynecologist or other gynecologic care provider who seeks to revise or remove implanted mesh be aware of the details of the index procedure. Diagnostic testing for a suspected mesh complication can include cystoscopy, proctoscopy, colonoscopy, or radiologic imaging. These tests should be pursued to answer specific questions related to management. Given the diverse nature of complications related to mesh-augmented pelvic floor surgery, there are no universal recommendations regarding minimum testing. Approaches to management of mesh-related complications in pelvic floor surgery include observation, physical therapy, medications, and surgery. Obstetrician-gynecologists should counsel women who are considering surgical revision or removal of mesh about the complex exchanges that can occur between positive and adverse pelvic floor functions across each additional procedure starting with the device implant. Detailed counseling regarding the risks and benefits of mesh revision or removal surgery is essential and can be conducted most thoroughly by a clinician who has experience performing these procedures. For women who are not symptomatic, there is no role for intervention.

Результати лікування травм сечоводу під час гінекологічних операцій

The injure of the ureter it is one of the most frequent complications in gynecological surgery and occurs according to the literature in the 0.5-30%. There is a great variety of methods of surgical treatment of ureteral injuries, including using modern minimally invasive technologies. But the truth borders of ureteral defeat often differ from the perceived visually, which may cause failures of surgical correction. Application of electroureterography can objectively determine the limits and in accordance defeat ureter level of resection. At the same time the literature have not marks about using of assessment electroureterography during the choose a method of correction of ureteral injury. The objective: to improve the results of treatment of ureteral injury during obstetric – gynecological surgery by improving methods of surgical correction. Patients and methods. In the basis researches are the results of clinical observations of 60 patients who performed surgical correction of ureteral injury. The main group of patients represented by 23 (38.3±12.3%) patients, whose injuries correction performed by laparoscopic and classical open access using the electroureterography. In the first control group operative treatment was subjected 21 (35±12.1%) patients who performed a similar surgery but without using electroureterography. In the second control group of 16 (26.7±11.2%) patients made ureteroscopy and installing JJ-stent, and mandatory condition was absence of ureteral wall defect. Results. The results of treatment assessed considering the subjective and objective criteria by the system of three marks as good, satisfactory and unsatisfactory. Among the 23 patients who were performed surgery using electroureterography, 20 (87±13.7%) patients had a good results. 3 (13±13.8%) patients results were evaluated as satisfactory. Bad results were not observed. 21 patients who performed laparoscopic surgery and by open access without using of electroureterography, founded that 8 (38.1±20.7%) patients had a good results. 9 (42.9±21.1%) patients results were evaluated as satisfactory, and 4 (19±16.8%) patients regarded as bad. Among the 16 patients who performed ureteroscopy with ureteral stenting, in 11 (68.8±22.7%) patients the results were evaluated as good. Five (31.2±22.7%) patients with satisfactory results correspond. Bad results were not observed, it is connected with initial mild ureteral injury in this group of patients (Grade I, classifies Organ Injury Scaling System). Conclusions. Using the electroureterography during the reconstructive operations has reduced the poor results by 19% compared to similar transactions without using this method. This explained that electroureterografy allows to objectively determine the limits of the ureteric defeat and accordingly level of his resection, and the most appropriate type of surgical treatment of trauma. In the turn, ureteral injury correction using ureteroscopy and stenting, is highly effective if used in patients with mild injuries (Grade I, classifies Organ Injury Scaling System). Key words: ureteral injury, treatment, gynecological surgery, electroureterography.