Excision Of Lesion Research Articles

Laparoscopic shaving of rectosigmoid deep infiltrating endometriosis under laparoscopic ultrasound guidance

To present laparoscopic shaving of rectosigmoid endometriosis using the novel approach of laparoscopic ultrasound guidance to enhance complete excision. The intervention performed includes excision of rectosigmoid deep infiltrating endometriosis under guidance of laparoscopic ultrasound. NA RESULTS & CONCLUSION: It is important to perform a complete pre-operative evaluation to determine the extent of disease and the necessity of a multidisciplinary approach. Intraoperative laparoscopic ultrasound can provide additional information including size and depth of lesions, which could play a role in surgical decision making. Laparoscopic ultrasound may enhance complete excision of DIE lesions and decrease the incidence of recurrence.

Venous malformation of the conjunctiva and orbit.

A 28-year-old male presented with a large conjunctival lobulated, nonpulsatile, red vascular lesion involving a large part of the temporal quadrant of the left globe. There was no proptosis or globe displacement, but the left eye abduction was limited. T2-weighted magnetic resonance imaging scan of the brain and orbit revealed an extensive contrast-enhancing lobulated lesion in the left half of the face involving the upper lip, cheek, oral cavity, extraconal space of left orbit, and nasal cavity. He underwent surgical excision of the conjunctival lesion with amniotic membrane reconstruction.

Association of endometrial polyps with STC-1 and STC-2 in infertile patients.

The present study aimed to evaluate the impact of endometrial polyps (EPs) on the endometrium of patients with unexplained infertility using stanniocalcin-1 and -2 proteins (STC), whose effects on endometrial receptivity have been reported recently. A case-control study was performed, consisting of 26 patients who underwent endometrial sampling for diagnosis and/or treatment and diagnosed with EP on biopsy and/or excision material, and 23 patients with normal endometrial findings in the pathology, for a total of 49 patients with unexplained infertility. An immunohistochemistry examination was performed on paraffin-embedded tissue samples from both groups to understand whether there was a relationship between EP and STC. Staining results of the polyp and control groups for STC-1 and STC-2 were compared, and it was investigated whether STCs were predictive for EP. In the comparison performed between the H-score evaluation results of the control and polyp groups after the immunohistochemical staining method, the staining in the polyp group was significantly higher for both STC-1 (p < 0.001) and STC-2 (p < 0.001). There was more staining with STC-1 than STC-2 in all groups (STC-1: 15.08; STC-2: 8.27; p < 0.05). In the logistic regression analysis established with STC-1, STC-2, and age, the predictive effect of STC-1 for EP was statistically significant (p = 0.040; odds ratio: 1.66; 95% confidence interval: 1.02-2.68). In EP, according to receiver operating characteristic curve analysis, area under the curve was 0.980 (likelihood ratio: 20.35; p < 0.05), and the cut-off value was 18 for STC-1. In infertile patients, since STC-1, which affects endometrial receptivity, is found to be significantly higher in polyps and has a predictive effect on polyps, in patients with unexplained infertility, routine uterine cavity evaluation and routine excision of polypoid lesions detected during this period may have a positive effect on endometrial receptivity.

Use of self‐inflating tissue expanders in equine surgery: A prospective study of 20 cases

SummaryBackgroundTissue expansion is a well‐established technique in reconstructive surgery. Self‐inflating tissue expanders (STE) have not been widely adopted by veterinary surgeons, and clinical descriptions of their use in horses are lacking.ObjectiveTo describe the indications, clinical experiences and outcomes of a series of equine cases that used a hydrogel‐based STE to assist soft tissue reconstruction.Study designProspective clinical study.MethodsCase details, surgical techniques and outcomes were recorded for horses requiring use of an STE, using a predesigned data collection sheet completed by the treating surgeon. All horses underwent two surgical procedures as part of their treatment: one to place the STE(s) and a second to remove the device(s) and perform reconstructive surgery using the expanded tissue.ResultsTwenty horses had STEs implanted at seven clinics and had sufficient follow‐up for inclusion in the study. Indications for using the expanders included the following: expansion of skin prior to excision of a neoplastic lesion (n = 13), repair of a sinocutaneous fistula (n = 2), repair of chronic scarring or a nonhealing wound (n = 2), repair of a full‐thickness ear pinna defect (n = 1) and repair of a rectovestibular injury (n = 2). The degree of tissue expansion was graded as good in 19/20 cases (95%) and provided sufficient tissue to cover the entire defect in 11/20 cases (55%). STE‐associated complications occurred in 9/20 horses (45%), but none of these complications were serious. The final clinical outcome was graded by the treating surgeon as good or excellent in 15/20 horses (75%).Main limitationsOnly one type of STE device is described, and its use was not compared with other treatments. Information regarding use of the STE at locations other than the head (n = 3) is limited.ConclusionsUse of a STE device in horses resulted in no serious complications and provided a good outcome in a variety of equine clinical cases.

Managing leukoplakia with diode laser: A report of two cases

Oral leukoplakia is the most common precancerous lesion of the oral mucosa. WHO defined it as a lesion which has a white patch or plaque on the oral mucosa that cannot be removed by scraping and cannot be classified clinically or microscopically as another disease process. Management of oral leukoplakia should begin with elimination of predisposing habit. There are currently different approaches in the management of Leukoplakia such as scalpel surgery, systemic carotenoids and antioxidants, electro cauterization, cryotherapy and Lasers. Even though on-surgical options are preferred choice of treatment, it takes time to achieve complete regression of lesion and sometimes may not achieve complete resolution. On the other hand, conventional surgical techniques are invasive and cause trauma to the patient. Excision of precancerous oral lesions using LASER offers comparative advantages over traditional scalpel excision. Laser is an acronym for Light Amplification by stimulated emission of radiation. It is surgical technique which excises the targeted tissue using emission of a monochromatic light of specific wavelength. Because of this property, laser excision of the tissue results in complete bloodless field of surgery, reduced chances of post-surgical inflammation and infections and hence better treatment compliance of the patients towards the surgery. This is one of the important goals for management of oral potentially malignant disorders. We present two case reports of homogeneous leukoplakia treated using diode lasers of wavelength 810nm with follow-up. Both cases did not report any post-operative discomfort or inflammation. The aim of this case report is to highlight the importance of laser excision with minimal complications and better treatment outcomes.

Selective surgical excision of high-risk lesions

Intraductal papilloma, flat epithelial atypia, radial scar, atypical lobular hyperplasia, and lobular carcinoma in situ have historically been referred to as high-risk lesions and managed with routine surgical excision after diagnosis on core needle biopsy. The misnomer high-risk stems from high rates of upgrade to malignancy reported in historic literature. However, recent studies have found much lower upgrade rates, <2%, than previously thought. These findings are explained by advances in imaging technology, larger-bore biopsy needles, and emphasis on radiology-pathology concordance. Concordant lesions have a low upgrade risk and can be managed with radiographic and clinical surveillance instead of surgical excision. Surgical de-escalation is feasible for many of these lesions with careful multidisciplinary review and a detailed risk–benefit discussion with patients.

Percutaneous vacuum-assisted excision (VAE) of breast lesions of uncertain malignant potential (B3 lesions): a preliminary single-centre Italian experience.

In recent years vacuum-assisted excision (VAE) has been described as an alternative treatment for some B3 lesions. This study aims to assess the effectiveness of using VAE to manage selected B3 lesions by quantifying the number of B3 lesions undergoing VAE, the malignant upgrade rate, and the complications encountered. Our department evaluated all B3 lesions diagnosed between January 2019 and October 2021 and treated them with VAE. The data were collected during the initial biopsy and final histology based on VAE image guidance, also considering initial lesions and complications. The exclusion criteria were: B3 lesion of size > 20mm, presence of a concomitant malignant lesion, lesion < 5.0mm distant from the skin, nipple or pectoral muscle, phyllodes tumours or indeterminate B3 lesions. Lesions that upgraded to malignancy underwent surgical excision, while benign lesions performed radiological follow-ups. From 416 B3 lesions diagnosed, 67 (16.1%) underwent VAE. VAE was performed under X-ray (50/67) or ultrasound guidance (17/67). Five cases (7.5%) upgraded to a malignant lesion, 2 ADH, 2 LIN and one papillary lesion that underwent surgery. No malignancy or new lesions has occurred at the site of the VAE, with an average radiological follow-up of 14.9months. VAE could be a safe and effective pathway for managing selected B3 lesions. Lesions initially subjected to CNB with ADH and LN outcome, before undergoing VAE, should perform a VAB for better tissue characterization and management.

Giant fibroadenoma of the breast treated with reduction mammoplasty and excision of lesion: A case report

Oncoplastic surgery was developed to allow for large tumor excision, immediate breast reconstruction, and optimal breast shape and symmetry. These techniques, used in past for malignant tumors, are useful for cosmetic issues caused by benign breast disease. Here, we present a case report Wise-pattern reduction mammoplasty for oncoplastic reconstruction of a giant fibroadenoma. A 29-year-old woman with 40 C size breasts presented to the clinic with the left breast enlargement from the past 7 months. Breast surgery team excised the mass with a Wise-pattern reduction technique. Immediately postoperatively, the patient showed excellent symmetry. Follow-up postoperatively showed good wound healing, preserved symmetry, and a viable, sensate nipple. Oncoplastic breast reconstruction in a reduction pattern technique after giant fibroadenoma removal provides an excellent outcome, allowing for improved symmetry.

Abstract 3346: Evaluation of a serum-based test integrating tumor tissue and gut microbiome derived metabolites for diagnosis of advanced colorectal adenoma

Abstract Background: Detection and endoscopic excision of colorectal precancerous lesions (advanced adenoma, AA) has been recognized as an effective way to prevent the occurrence of colorectal cancer (CRC) and reduce CRC induced mortality. Current DNA-based (mutations or methylations) tests exhibited compromised efficiency for AA diagnosis due to the late appearance of tumor-derived DNA biomarkers into stool or blood samples during tumorigenesis. Here, by integrating metabolic biomarkers associated with tumor tissue and colorectal neoplasia related gut microbiota, we established the serum metabolites-based test and examined its ability to detect advanced adenoma patients from normal, hyperplastic polyps and low-risk adenoma individuals. Methods: Consensus participants undergoing coloscopy were enrolled in this prospective study, and the result of colonoscope examination and histopathology from biopsied lesions were used as gold standard (ChiCTR2200058078). Serum metabolites were quantified by pseudo-targeted metabolomics based on LC-MS/MS method. By integrating abundances of these serum metabolites associated with tumor tissue and colorectal neoplasia related gut microbiota, a diagnostic model was established, and its performance for detecting advanced adenoma was validated using leave-one-out cross-validation. Results: In total, 803 participants, including 178 normal individuals, 167 patients with hyperplastic polyps, 203 patients with low-risk colorectal adenoma and 255 advanced colorectal adenoma patients, were enrolled in this study and subjected to the serum metabolites-based test. The diagnostic model achieved an AUC of 0.80 (95% CI: 0.77-0.83) for advanced adenoma, with a sensitivity of 44.7% at 88.9% specificity. Additionally, we also separately analyzed its performances for advanced adenoma with different histological subtypes, achieving a sensitivity of 37.0% for tubulous adenoma and a sensitivity of 53.3% for adenoma with villous structure, respectively. As for advanced adenoma with high-grade dysplasia, the model could achieve a sensitivity of 61.2%. In comparation, sensitivities of all current tests for advanced colorectal adenoma, either fecal or blood based, were less than 45% at a similar specificity. Conclusions: Based on integrating metabolic biomarkers associated with both tumor tissue and colorectal neoplasia related gut microbiota, we developed a novel blood-based test that can detect advanced colorectal adenoma with higher accuracy than all current fecal or blood-based tests. Citation Format: Jingyuan Xiang, Longsong Li, Xingting Guo, Xiaowei Li, Kai Lin, Liuyang Yang, Xudong Dai, Enqiang Linghu, Ningli Chai. Evaluation of a serum-based test integrating tumor tissue and gut microbiome derived metabolites for diagnosis of advanced colorectal adenoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3346.

V10-02 SINGLE-PORT TRANSVESICAL PARTIAL PROSTATECTOMY: PREOPERATIVE SURGICAL PLANNING USING A 3D PRINTED MODEL

You have accessJournal of UrologyCME1 Apr 2023V10-02 SINGLE-PORT TRANSVESICAL PARTIAL PROSTATECTOMY: PREOPERATIVE SURGICAL PLANNING USING A 3D PRINTED MODEL Ethan Ferguson, Jason Scovell, Roxana Ramos, Albert Geskin, Jay Chavali, Andres Purysko, and Jihad Kaouk Ethan FergusonEthan Ferguson More articles by this author , Jason ScovellJason Scovell More articles by this author , Roxana RamosRoxana Ramos More articles by this author , Albert GeskinAlbert Geskin More articles by this author , Jay ChavaliJay Chavali More articles by this author , Andres PuryskoAndres Purysko More articles by this author , and Jihad KaoukJihad Kaouk More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003328.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Surgical simulation using 3D printed prostate and kidney models has been developed with proposed benefits in pre-operative planning, training, and patient education. Single-port (SP) transvesical partial prostatectomy has been performed in highly selected patients with localized intermediate risk prostate cancer as an alternative to focal therapy. We sought to record our experience and outcomes of SP transvesical partial prostatectomy using a 3D printed model of the bladder and prostate. METHODS: An otherwise healthy and potent 59 year-old patient was selected with localized Gleason 3+4=7 prostate cancer, arising from a MRI-visible lesion in the left anterior prostate gland and no other positive biopsies. Segmentation of the preoperative prostate MRI was done to isolate the bladder, prostate, prostatic urethra, and DVC. Using this information, a 1:1 scale 3D printed model was created. A rehearsal procedure was performed on the model using the DaVinci SP surgical system prior to the patient’s operation. RESULTS: Transvesical access, docking, catheter insertion, partial prostate excision, and vesico-urethral reconstruction were able to be simulated using the 3D model. On the day of surgery, lesion excision was carried out with assistance of fused MRI and ultrasound images for intraoperative guidance. Pathology showed Gleason 3+4 disease. The patient achieved negative margins despite incidental focal extraprostatic extension and was discharged on the same day of the procedure. The foley catheter was removed on postoperative day 3. He was fully continent immediately following foley catheter removal and regained full potency within one week of surgery. CONCLUSIONS: A 3D printed model of the bladder and prostate can be used to simulate partial prostatectomy prior to the in-vivo operation. This has potential benefits in surgical planning and education, though challenges include simulation of patient physiology such as bleeding and the cost of materials. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e926 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ethan Ferguson More articles by this author Jason Scovell More articles by this author Roxana Ramos More articles by this author Albert Geskin More articles by this author Jay Chavali More articles by this author Andres Purysko More articles by this author Jihad Kaouk More articles by this author Expand All Advertisement PDF downloadLoading ...

Oropharyngeal Mucocele as an Unusual Cause of Recurrent Pneumonia in a Young Infant

Background: Oral mucoceles, though frequently seen as asymptomatic lesions in young adults, very little is known about their existence in infants and the complications arising out of them in this age group. Clinical Description: A 4-month-old infant presented with a history of recurrent episodes of breathing difficulty since 15 days of life, every episode being managed as aspiration pneumonia. The child presented in the fifth such episode with tachypnea tachycardia and chest indrawing. Auscultation revealed bilateral crepitations and chest X-ray showed diffuse haziness in the bilateral chest predominantly in the right middle lobe, rest of the systemic examination being normal. Oral cavity examination showed a bluish globular bulge behind the tongue with surrounding congested mucosa and thick secretions. Management and Outcome: The baby was managed with respiratory support in the form of continuous positive airway pressure, intravenous antibiotics Piperacillin-Tazobactam, amikacin and metronidazole, and anti-reflux measures of oral Domperidone. Flexible laryngoscopy showed a cystic lesion behind the tongue and contrast-enhanced computerized tomography confirmed a hypodense lesion arising from the uvula suggestive of a mucocele. Excision of the oro-pharyngeal cystic lesion was done and the histopathological examination confirmed it to be a mucocele. The baby was gradually weaned off oxygen support and proper breastfeeding was re-established. Conclusion: This case creates awareness regarding the fact that an unsuspected oral mucocele may be the cause of recurrent respiratory symptoms in an infant, thereby reiterating the importance of oral examination even in young infants.

A Diffusion Tensor Imaging-Based Prognostic Classification for Surgery of Intrinsic Lesions Involving the Motor Pathways.

The critical role of different adjuncts in improving the neurological outcome in intrinsic brain lesions affecting eloquent areas is demonstrated by their more diffuse utilization. Neurosurgeons often rely on preoperative and intraoperative diffusion tensor imaging tractography to improve the operative strategy and prognosis. We aimed to identify and validate a diffusion tensor imaging-based classification considering the relationship between the brain lesion and the corticospinal tract to predict a >50% reduction of motor evoked potentials (MEPs) during surgical excision of lesions involving the motor pathways. We included patients consecutively enrolled at our institution between April 2020 and September 2022 with 3 patterns of increasing complexity according to the relationship between the lesion and the corticospinal tract as identified on preoperative diffusion tensor imaging. Outcome measures were >50% reduction in intraoperative MEPs and neurological outcome defined as unchanged, improved, or worsened. The study included 83 patients. A statistically significant linear trend between higher rates of reduction of MEPs and higher classification grades was observed (P= 0.001), with sensitivity 0.60, specificity 0.88, accuracy 0.83, and area under the curve 0.75. Higher grades were associated with worse neurological outcomes (P= 0.02). The classification proved reliable in anticipating reduction in intraoperative MEPs and in predicting neurological outcome. Using this classification in patients undergoing surgery for lesions involving the motor pathways could help in counseling the patient, surgical planning, enhancing teamwork of operating room personnel, and improving the patient's prognosis.

A rare case of inclusion body fibromatosis

Infantile digital fibromatosis is a marked fibrous proliferation of infancy characterized by occurrence in the fingers and toes and a marked tendency for local recurrence. It accounts for 0.2% of registered soft tissue tumors. The lesion rarely exceeds 2 cm and tends to regress spontaneously. The presence of characteristic inclusion bodies in the cytoplasm of neoplastic fibroblasts distinguishes it from other fibromatosis. Current treatment recommendations include function-preserving excision and intralesional steroid injections for symptomatic lesions. Although lesions recur more than 60% of the time after excision, the ultimate prognosis is excellent.

PIGMENTED VILLONODULAR SYNOVITIS OF HIP: A RARE CASE

Pigmented villonodular synovitis (PVNS) is a rare disease that can affect any joint, bursa or tendon sheath. The hip is less frequently affected than the knee.1 We report a case of a 46 years old male presented with history of pain and limp over right hip since 6months associated with difculty in sitting cross legged and squatting to performing day today activity. There was no history of fever, weight loss, and long term drug intake. Radiological assessment showed secondary arthritis of right hip with features of avascular necrosis (AVN). The provisional diagnosis was Arthritis of right hip secondary to AVN/ Inammatory arthritis and the patient underwent uncemented right total hip replacement(THA), Intra operatively the articular erosion was noted with reddish gray abnormal synovial growth. Histological assessment showed diffuse expansive sheets of histiocytes admixed with hemosiderin laden macrophages and alveolar spaces lined by synovial cells and collagenized stroma. A short term follow up of 18months did not show any clinical recurrence. We conclude that, from our observation, complete excision of lesion combined with THA is an effective treatment for PVNS of Hip.

Time and economic cost of the routine use of marker sutures in surgical management of cutaneous skin malignancies.

Use of marker sutures in excision and direct closure of skin lesions is an unnecessary, potentially costly and time-consuming addition to a commonly performed procedure. We advocate reduction or avoidance of marker sutures in routine cases to decrease both economic cost and carbon footprint of this common surgical procedure.

Photography as the Sole Means of Proof: Medical Liability in Dermatology

Malignant melanoma is a cutaneous malignancy resulting from the uncontrolled proliferation of melanocytes and poses a challenge diagnostically because neoplastic lesions can mimic benign lesions, which are much more common in the population. Doctors, when they suspect the presence of melanoma, arrange for its removal and the performance of a histological examination to ascertain its diagnosis; in cases where the dermatoscopic examination is indicative of benignity, however, after the lesion is removed, histological examination is not always performed, a very dangerous occurrence and a harbinger of further medico-legal problems. The authors present a court litigation case of an "alleged" failure to diagnose malignant melanoma in a patient who died of brain metastases from melanoma in the absence of a certain location of the primary tumor: the physician who had removed a benign lesion a few months earlier was sued, and only thanks to the presence of photographic documentation was the health care provider able to prove his extraneousness. The aim of this paper is to formulate a proposal for a dermatological protocol to be followed in cases of excisions of benign skin lesions with a twofold purpose: on the one hand, to be able to prove, in a judicial context, the right action on the part of the sanitarians; on the other hand, to avoid the rise of so-called "defensive medicine".

Platelet-Rich Plasma and Acellular Dermal Matrix in the Surgical Treatment of Hidradenitis Suppurativa: A Comparative Retrospective Study.

(1) Introduction: Hidradenitis suppurativa (HS) is an inflammatory skin disease with recurrent, chronic, painful, and purulent skin lesions. Topical or systemic antibiotics are the most widely used treatments for the management of mild stages of the disease. In chronic cases (Hurley II/III), wide excision of lesions should be considered. During reconstructive surgery, the most problematic aspect is wound closure. Very large excisional wounds require reconstructive techniques such as skin flaps, skin grafts, or both. Surgical methods have their limitations, so reconstructive methods in HS surgery need to be continuously improved through the use of, for example, platelet-rich plasma and acellular dermal matrix; (2) Methods: The aim of this study was to evaluate the clinical outcomes and efficacy of surgical treatment of patients with HS using local skin flaps injected with PRP compared to a group of local skin flaps without platelet-rich plasma injection, an acellular dermal matrix, and split-thickness skin graft co-grafts. Sixty-one patients (29 males and 32 females) were included in the study. Most patients were characterized by Hurley grade III HS; (3) Results: The use of PRP injection in reconstructions (skin flaps) improved healing and reduced the number of complications, a notable trend in this study. A co-graft of acellular dermal matrix and split-thickness skin graft gave better therapeutic results than split-thickness skin graft alone (fewer days in hospital, fewer postoperative complications); (4) Conclusions: PRP injected into skin flaps, co-grafted acellular dermal matrix, and split-thickness skin grafts are good options for the surgical treatment of hidradenitis suppurativa.

Ocular Mycobacterium haemophilum infection originating in the cornea: a case report

BackgroundMycobacterium haemophilum is a slow-growing non-chromogenic nontuberculous Mycobacterium species that can cause skin infection or arthritis in an immunocompromised population or in children. Primary infection of the healthy adult cornea is rare. The special requirements for culture make this pathogen difficult to diagnose. The study aims to report the clinical manifestation and treatment process of corneal infection and notify the awareness of M. Haemophilus keratitis among clinicians. This is the first case report of primary M. haemophilum infection in the cornea of healthy adults reported in the literature.Case presentationA 53-year-old healthy goldminer presented with left eye redness and a history of vision loss for four months. The patient was misdiagnosed with herpes simplex keratitis until M. haemophilum was detected using high-throughput sequencing. Penetrating keratoplasty was performed, and a large number of mycobacteria were detected by Ziehl-Neelsen staining of the infected tissue. Three months later, the patient developed conjunctival and eyelid skin infections that manifested as caseous necrosis of the conjunctiva and skin nodules. After excision and debridement of the conjunctival lesions and systemic antituberculosis drug treatment for 10 months, the patient was cured.ConclusionM. haemophilum could cause primary corneal infection in healthy adults, which is an infrequent or rare infection. Owing to the need for special bacterial culture conditions, conventional culture methods do not provide positive results. High-throughput sequencing can rapidly identify the presence of bacteria, which aids in early diagnosis and timely treatment. Prompt surgical intervention is an effective treatment option for severe keratitis. Long-term systemic antimicrobial therapy is crucial.

Periurethral and Anterior Vaginal Wall Masses: Etiology, Presentation, and Treatment Outcomes

ABSTRACT Periurethral and anterior vaginal masses are relatively common with an estimated prevalence of 3% to 4% and 1%, respectively. These masses often cause diagnostic challenges due to nonspecific and overlapping symptoms. Urinary symptoms include frequency, urgency, and dysuria; vaginal discharge, urinary tract infection (UTI), dyspareunia, bleeding, postvoid dribbling, pelvic and urethral pain, and palpable mass can also present. Familiarity with differentiation of masses is important to make timely diagnoses and to expedite treatment without delays. This study aimed to describe the etiology of periurethral and anterior vaginal wall masses in a large series, as well as report the clinical presentations to determine whether the differential diagnosis can be narrowed based on presenting symptoms. The study consisted of a retrospective chart review, based on charts of patients from November 2001 to July 2021 at a tertiary referral center. Analyzed data included age, body mass index, operative findings, operative time, concomitant procedures, pathologic diagnosis, catheterization time, complications, length of stay, symptoms on follow-up, and follow-up duration. Describing the etiology of periurethral and anterior vaginal wall masses was the primary objective of the study (including underlying etiology distribution), followed by the secondary objective of describing rates of other clinical characteristics. A systematic search of literature was performed using various databases: MEDLINE (Ovid), Cochran Central Register of Controlled Trials (Wiley Online Library), EMBASE (Elsevier), and Scopus. The study included a total of 126 patients, all with at least 1 symptom exhibited. The most common presenting symptoms were palpable mass, dyspareunia, and urinary tract symptoms (dysuria, stress urinary incontinence [SUI], and UTI). There was an infection rate of 21.4% and a malignancy rate of 1.6%. Each patient underwent surgical treatment, including urethral repair, periurethral cyst excision, urethral diverticulectomy, and lesion excision. A total of 29.4% of patients reported SUI preoperatively. Postoperatively, 105 patients reported no incontinence (83.3%), 15 reported SUI (11.9%), 5 reported mixed urinary incontinence (4%), and 1 presented with overflow incontinence (0.8%). Limitations of the study include the prospective collection of data but its retrospective analysis, thereby limiting findings according to the accuracy and completeness of the medical records. In addition, there was an absence of patient-reported outcome measures when SUI or other symptoms were assessed, and the authors recognize a need for future prospective studies to include such outcome measures. This large series evaluation of periurethral and anterior vaginal wall masses is the largest of its kind, as the previous study included only 79 patients with periurethral masses, 96% of whom had definitive pathological diagnoses and surgical treatment. This study provides a broad view into the etiological spectrum underlying periurethral and anterior vaginal masses. Malignancy is rare. Infectious pathology is common and found in 21.4% of patients, whereas urethral diverticulum was the most common pathology (40% of cases). Finally, this study indicated high success rates for surgical excisions, as there were no recurrences among diverticula patients in the study. For Skene’s gland cyst excisions, a recurrence rate of less than 1% was noted.

Learning curve in ultrasound-guided vacuum-assisted excision of breast lesions for surgeons and ultrasound physicians.

The varying experience of surgeons and ultrasound physicians, and their collaboration with physicians, may affect operation time and efficiency. We evaluated the learning curve of ultrasound-guided vacuum-assisted excision (VAE) of breast lesion with collaboration between different physicians, and assessed characteristics associated with operation time. The sample population of this retrospective study was divided into two groups: 49 consecutive patient surgeries completed by skilled surgeons and novice ultrasound physicians (U group); and 30 consecutive patient surgeries completed by skilled ultrasound physicians and novice surgeons (S group). Cumulative summation graphs were used to evaluate operation time and calculate the turning point of the learning curve. Patients in the U and S groups were divided into exploration stage and proficiency stage according to the turning point, and the differences in influencing factors were compared. A total of 548 patients who underwent vacuum-assisted breast excision performed by a combination of skilled surgeons and skilled ultrasound physicians were selected as the reference group (R group). The differences among the three groups were compared. The relationship between the operation time and other factors in the different groups was analyzed using linear regression. The best learning curve of the sample population was the quadratic fitting equation, and the turning point was the 19th case in the U group and the 14th case in the S group. The total operation times in the proficiency stage were significantly shorter than those in the exploration stage in the U and S groups (P=0.012 and P=0.003, separately). Patient age, long diameter, short diameter, and depth of masses related to the operation time. Our data suggest the existence of different learning curves in ultrasound-guided vacuum-assisted excision for the collaborations of different stages surgeons and ultrasound physicians. Through the accumulation of experience, it is feasible to safely perform ultrasound-guided VAE of breast lesions.