Invasive Gynecologic Procedures Research Articles

Postoperative Telemedicine Use: Satisfaction and Safety After Benign Gynecologic Surgery: A Randomized Controlled Trial [ID 2683391

INTRODUCTION: Telemedicine for postoperative care can be appropriate after minimally invasive surgery, but few studies have examined this option in gynecologic surgery. The objective of this randomized controlled trial was to determine whether virtual, compared to in-person postoperative care, after minimally invasive gynecologic procedures would increase patient satisfaction without negative safety concerns. METHODS: Patients were randomized to a telemedicine or in-person visit 2 weeks postoperatively. Eligible participants included women undergoing elective, minimally invasive gynecologic surgery. All participants completed the PSQ-18 form with addendum questions at their 6-week postoperative visit. Chart review was performed to assess frequency of postoperative adverse events. The Wilcoxon rank sum and Fisher exact test were used. RESULTS: Of 51 participants enrolled, 29 were randomized to standard (in-person) visits versus 22 randomized to intervention (telehealth). There was no statistical difference in the overall satisfaction with the postoperative care received between the intervention and the standard groups (93.8% agree or strongly agree versus 95.7%; P=1). There was no increase in postoperative complications in the intervention arm of the study, with an overall complication rate of 12.5% in all cases. CONCLUSION: It is reasonable to use telemedicine as an option for postoperative care based on shared decision-making with appropriate patients. A virtual postoperative visit is a safe option for patients who may not be able to travel to the office. Future study is ongoing to confirm statistical significance.

Concurrent Minimally Invasive Gynecologic Procedures at the Time of Laparoscopic Cholecystectomy.

In this cross-sectional study including 1,722,479 women who underwent laparoscopic cholecystectomy between January 2016 and December 2019 identified in the Healthcare Cost and Utilization Project's Nationwide Ambulatory Surgery Sample, the prevalence rate of gynecologic diagnoses was 11.3 per 1,000. Among presumed elective laparoscopic cholecystectomy, the highest performance rate of concurrent gynecologic procedure per gynecologic diagnosis was laparoscopic adnexectomy among patients with benign ovarian tumor (652/1,000 diagnoses), followed by laparoscopic adnexectomy for endometrioma (386/1,000 diagnoses) and cervical conization for cervical carcinoma in situ (304/1,000 diagnoses). The measured surgical morbidity rates for patients who had concurrent gynecologic surgery and those who did not were 2.8 per 1,000 and 1.9 per 1,000, respectively (adjusted odds ratio 1.39, 95% CI 0.75-2.59). These results suggest that minimally invasive gynecologic surgeries are being performed at the time of outpatient laparoscopic cholecystectomy in the United States.

Long-term rare complications of minimally invasive gynecologic procedures during pregnancy

Long-term rare complications of minimally invasive gynecologic procedures during pregnancy

A Morphometric Study on Anatomic Characteristics of Corona Mortis in South Indian Population

Introduction: The Corona Mortis or the “crown of death” is the vascular anastomosis between the external iliac and obturator vessels in the retropubic region. If injured accidentally during laparoscopic inguinal hernia repair and certain minimally invasive gynaecological procedures such as midurethral or pubovaginal sling, can result in inadvertent haemorrhage. Recognising the anatomic characteristics of the corona mortis vessel is needed in order to prevent bleeding catastrophe. Aim: To estimate the prevalence and location of corona mortis in South Indian population and to determine the frequency of occurrence and its morphometry in males and females. Materials and Methods: This was an observational cross- sectional study conducted between December 2020 to August 2021 in the Department of Anatomy, Rajarajeswari Medical College and Hospital, Bangalore, Karnataka, India. Dissection of 55 adult cadavers (42 male and 13 female hemipelvises) was performed and corona mortis was observed on pelvic surface of superior pubic ramus, number of venous and arterial anastomosis were noted and photographed. In addition to diameter of the anastomotic vessel, the distance of corona mortis vessel from the pubic symphysis was measured using electronic digital caliper. Demographic data was expressed as frequency and percentage and continuous data as mean and standard deviation. Z test and t-test were done using statistical software Statistical Package for the Social Sciences (SPSS) version 23.0 to deduce the results. A p-value of <0.05 was considered as significant. Results: The corona mortis was observed in 35 out of 55 specimens (63.64%). It was seen in 29 male (69%) and six female hemipelvises (46%). In all the specimens, venous anastomosis was observed between the obturator vein and inferior epigastric or external iliac vein. Consequently, in the present study all the determined corona mortis were venous. The mean distance of corona mortis vessel from the pubic symphysis was 5.26±1.2 cm in males and 5.63±0.94 cm in females with p-value= 0.48, thus the distance of the anastomotic vessel remains consistent in both the sexes. Furthermore, diameter of corona mortis vessel (greater than 1 mm) was measured in both the sexes and found to be statistically not significant. Besides there was incidental finding, aberrant obturator artery was more prevalent in females in comparison to males (p-value=0.013). Conclusion: Corona mortis was present in 63.64% of the South Indian population and no statistically significant difference was found in prevalence in males and females. The distance of corona mortis vessel and the diameter of the vessel was consistent in both males and females.

Effect of Gabapentin on Sedation and Same Day Discharge in Gynecologic Laparoscopy

Study Objective To compare sedation scores, pain scores, and hospital length of stay among patients undergoing outpatient minimally invasive gynecologic procedures based on preoperative gabapentin administration. Design Retrospective cohort study. Setting Academic teaching hospital. Patients or Participants The first thirty patients meeting inclusion and exclusion criteria for each group were selected in a retrospective manner. The sample size was calculated to detect a 1-point difference in the Aldrete sedation score. Patients undergoing outpatient gynecologic laparoscopic surgery with a single surgeon between May 2020 and March 2021 were eligible for inclusion. Interventions Dosages of routine preoperative gabapentin were sequentially decreased from 600 mg to 300 mg to none. Outcomes included sedation based on the Aldrete score and Pasero Opioid-Induced Sedation Scale (POSS) and pain based on the numerical rating scale during the initial recovery period. Rates of same day discharge and hospital length of stay were also tracked. Measurements and Main Results A total of 91 unique persons were included in the analysis. There was no difference between groups for age, race, ASA score, operating time, administered morphine equivalents, or benzodiazepine administration. Comparison between the three groups did not detect significant differences in either sedation scores or pain scores. Same day discharge did differ between groups with 89% of patients receiving 0 mg discharged on the day of surgery compared to 81% and 59% of patients in the 300 mg and 600 mg groups, respectively (p-value=0.019). Hospital length of stay did not reach a statistical difference. Conclusion No differences were identified in sedation or pain scores based on preoperative administration of gabapentin. The percentage of same day discharges was inversely related to dose of preoperative gabapentin, with 0 mg having the highest rate of same day discharge. These results support current recommendations to discontinue routine administration of gabapentin in outpatient gynecologic surgery. To compare sedation scores, pain scores, and hospital length of stay among patients undergoing outpatient minimally invasive gynecologic procedures based on preoperative gabapentin administration. Retrospective cohort study. Academic teaching hospital. The first thirty patients meeting inclusion and exclusion criteria for each group were selected in a retrospective manner. The sample size was calculated to detect a 1-point difference in the Aldrete sedation score. Patients undergoing outpatient gynecologic laparoscopic surgery with a single surgeon between May 2020 and March 2021 were eligible for inclusion. Dosages of routine preoperative gabapentin were sequentially decreased from 600 mg to 300 mg to none. Outcomes included sedation based on the Aldrete score and Pasero Opioid-Induced Sedation Scale (POSS) and pain based on the numerical rating scale during the initial recovery period. Rates of same day discharge and hospital length of stay were also tracked. A total of 91 unique persons were included in the analysis. There was no difference between groups for age, race, ASA score, operating time, administered morphine equivalents, or benzodiazepine administration. Comparison between the three groups did not detect significant differences in either sedation scores or pain scores. Same day discharge did differ between groups with 89% of patients receiving 0 mg discharged on the day of surgery compared to 81% and 59% of patients in the 300 mg and 600 mg groups, respectively (p-value=0.019). Hospital length of stay did not reach a statistical difference. No differences were identified in sedation or pain scores based on preoperative administration of gabapentin. The percentage of same day discharges was inversely related to dose of preoperative gabapentin, with 0 mg having the highest rate of same day discharge. These results support current recommendations to discontinue routine administration of gabapentin in outpatient gynecologic surgery.

Characteristics of Non-Ablative Resurfacing of Soft Tissues by Repetitive Er:YAG Laser Pulse Irradiation.

Background and ObjectivesRecently, several minimally invasive gynecological, ENT and esthetic procedures have been introduced that are based on delivering “smooth” sequences of Er:YAG laser pulses to cutaneous or mucosal tissue at moderate cumulative fluences that are not only below the ablation threshold but typically also do not require local anesthesia. To explain the observed clinical results using “smooth‐resurfacing,” it has been suggested that in addition to the direct heat injury to deeper‐lying connective tissues, there is an additional mechanism based on indirect triggering of tissue regeneration through short‐exposure, intense heat shocking of epithelia. The goal of this study is to improve understanding of the complex dynamics of the exposure of tissues to a series of short Er:YAG laser pulses, during which the thermal exposure times transition from extremely short to long durations.Study Design/Materials and MethodsA physical model of laser‐tissue interaction was used to calculate the temperature evolution at the irradiated surface and deeper within the tissue, in combination with a chemical model of tissue response based on the recently introduced variable heat shock (VHS) model, which assumes that the tissue damage represents a combined effect of two limiting Arrhenius′ processes, defining cell viability at extremely long and short exposure times. Superficial tissue temperature evolution was measured during smooth‐resurfacing of cutaneous and mucosal tissue, and compared with the model. Two modalities of non‐ablative resurfacing were explored: a standard “sub‐resurfacing” modality with cumulative fluences near the ablation threshold, and the “smooth‐resurfacing” modality with fluences below the patient′s pain threshold. An exemplary skin tightening clinical situation was explored by measuring pain tolerance threshold fluences for treatments on abdominal skin with and without topical anesthesia. The obtained temperature data and pain thresholds were then used to study the influence of Er:YAG laser sequence parameters on the superficial (triggering) and deep (coagulative) tissue response.ResultsThe simulations show that for the sub‐resurfacing modality, the parameter range where no excessive damage to the tissue will occur is very narrow. On the other hand, using pain tolerance as an indicator, the smooth‐resurfacing treatments can be performed more safely and without sacrificing the treatment efficacy. Two preferred smooth‐resurfacing treatment modalities were identified. One involves using optimally long pulse sequence durations (≈1–3 seconds) with an optimal number of pulses (N ≈ 10–30), resulting in a maximal short‐exposure superficial tissue response and moderate coagulation depths. And for deeper coagulation, without significant superficial heat shocking, very long pulse sequences (>5 seconds) with a large number of delivered pulses are to be used in combination with topical anesthesia.ConclusionsA comparison of the simulations with the established smooth‐resurfacing clinical protocols in gynecology, ENT, and esthetics suggests that, through clinical experience, the clinical protocols have been optimized for the maximal superficial heat shock triggering effect. Further research is needed to gain a better understanding of the proposed role of heat shock triggering in the clinically observed regeneration of cutaneous, vaginal, and oral tissues following Er:YAG laser smooth‐resurfacing. Lasers Surg. Med. © 2021 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals LLC.

Children’s Literature and the Rise of ‘Mind Cure’: Positive Thinking and Pseudo-Science at the Fin de Siècle by Anne Stiles

Reviewed by: Children’s Literature and the Rise of ‘Mind Cure’: Positive Thinking and Pseudo-Science at the Fin de Siècle by Anne Stiles Jessica Straley STILES, ANNE. Children’s Literature and the Rise of ‘Mind Cure’: Positive Thinking and Pseudo-Science at the Fin de Siècle. Cambridge, UK: Cambridge University Press, 2021. 249 pp. $99.99 hardcover. The title of Anne Stiles’s new book—Children’s Literature and the Rise of ‘Mind Cure’—proposes a straightforward connection between two phenomena: a literary genre that flourished in the second half of the nineteenth century and a spiritual movement that gained popularity in the United States at the same time. Her introduction establishes the best-known link: Frances Hodgson Burnett’s documented interest in ‘mind cure’ and the ethos of positive thinking while she was writing The Secret Garden (1911), in which her character Colin Craven alleviates his debilitating disability merely by thinking himself well. Within only a few pages of Stiles’s thoughtful and engaging book, however, ‘children’s literature’ and ‘mind cure’ start to lose their rigid categorical edges and take on a wonderfully wide-ranging and integrative scope. ‘Mind cure’ is another term for New Thought, far less a logically coherent doctrine than a conveniently capacious coalescence of positive thinking, self-help, alternative medicine, faith healing, spiritualism, Romanticism, Transcendentalism, feminism, and utopianism. Stiles traces the intricate webs of these belief systems in familiar turn-of-the-century children’s literature and follows these threads into fictions by Henry James and Charlotte Perkins Gilman. The resulting argument goes beyond simple connection. Rather, Stiles pulls both children’s literature and ‘mind cure’ from the fringes of literary culture and religious history and deftly demonstrates their centrality to tenacious (if under-studied) theories of self-actualization. Stiles explains the rise of New Thought in the United States as a rejection of Calvinist predestination, on the one hand, and medical orthodoxy, on the other. Its proponents, including Phineas Parkhurst Quimby and Mary Baker Eddy, believed that thoughts and wishes have tangible power in the physical world and are, in some cases, more real than material bodies. Three of the authors whom Stiles discusses—Burnett, Gilman, and L. M. Montgomery—suffered from depression, insomnia, and bipolar disorder and experienced [End Page 440] the damage done by the medically-sanctioned “remedies” offered to women: combinations of indiscriminately prescribed drugs and the “rest cure” (while others endured the traumas of institutionalization and invasive gynecological procedures). Though none became exacting devotees of New Thought, positive thinking provided an alluring curative alternative and, as Stiles convincingly shows, motivated the characterizations of their child protagonists, who like Cedric Errol of Burnett’s Little Lord Fauntleroy (1886) and Anne Shirley of Montgomery’s Anne of Green Gables (1908) benefit from their insistent optimism regardless of material realities. Stiles argues that it is a mistake to assimilate these happy youngsters into the more familiar paradigm of the Romantic child, a predominantly male figure proposed by male poets and pedagogues. The child of New Thought, at least in its earliest formulations, expressed distinctly female concerns about embodiment, family bonds, and political power. New Thought’s focus on spirituality and healing, rather than institutional hierarchy, allowed women to assume leadership positions largely unattainable elsewhere. But moving into professional spheres while still bearing the burdens of Victorian motherhood was not without personal cost. Burnett, Gilman, and Eddy shared an ambivalence about motherhood that influenced both their religious outlook and literary production. Stiles reads Cedric Errol as an externalized manifestation of “the inner child” who—in the guise of androgynous youthful exuberance—can carry out his mother’s “socially unacceptable desires” for influence outside the home (35). Gilman’s Herland trilogy (1911–16) adopts New Thought’s laissez-faire parenting as a necessary arrangement for her feminist utopia “devoid of sin, sickness, and sex” (159). This critical reorientation—from the autonomous child to the relationship between child and mother—is Stiles’s most significant disruption of the scholarly adherence to the Romantic child. The child inspired by New Thought is not the product of nostalgia for lost perfection, but a beacon of hope for a communal future achieved through creative visualization...

Rethinking pharmacological venous thromboembolism prophylaxis in minimally invasive gynaecological procedures.

Rethinking pharmacological venous thromboembolism prophylaxis in minimally invasive gynaecological procedures.

The Fresh Frozen Cadaveric Study of Direct Pouch of Douglas Laparoscopic and Robotic Trocar Insertion for Vaginal Natural Orifice Transluminal Endoscopic Surgery

To determine the distances and angles that assure a safe entry into the pouch of Douglas (POD) during blind laparoscopic and robotic trocar entry. Trocars were inserted into the POD of 4 intact fresh frozen female pelves. Cadaveric dissection was performed, and the distance from the POD to the sacrum at rest and with maximal pressure to POD with the trocar was measured. In addition, the optimal angle for trocar insertion and entry was evaluated. Inova Advanced Simulation and Technology Evaluation Center. Fresh frozen cadavers with intact reproductive organs. Vaginal POD trocar insertion. Measurements were recorded from the sacrum to the POD at rest and from the sacrum to the hymen with trocar pressure. The dissection demonstrated correct trocar placement in the POD of human cadaveric specimens. The mean distances from the sacrum to the hymen, the sacrum to the POD, and the sacrum to the POD with pressure were 18.75 cm, 9.75 cm, and 7.25 cm, respectively. After the deployment of the trocar, the tip was observed to be 2 cm below the cervix in the POD. The mean trocar angle to clear the sacral promontory and the neurovascular structures without injury to the uterus was 25° to 40° from the horizontal plane and 15° to 30° from the coronal plane. A direct trocar entry into the POD has been found to be feasible in fresh frozen cadaveric specimens. This study provided valuable information for the angle of entry into the POD to facilitate vaginal and robotic trocar entry for minimally invasive gynecologic procedures.

How to Master the Complex Task of Laparoscopic Suturing and Intra-Corporeal Knot Tying Using the Novel Clock Face Logic

Video Objective The aim was to design a reproducible, easy to adopt method for teaching laparoscopic suturing and intracorporeal knot tying. The novel use of a clock face to guide the steps is proposed to simplify & accelerate skill acquisition. The technique appears far easier to conceptualize than many others and has been very positively received during laparoscopic masterclasses conducted at the Centre for Advanced Reproductive Endo-surgery in Sydney, Australia. Setting Laparoscopic suturing requires very different and more advanced skill sets compared to suturing at open procedures. Proficiency with these skills is essential for the completion of advanced minimally invasive gynecological procedures such as hysterectomy, myomectomy and sacrocolpopexy. Inadequate laparoscopic suturing skills have been identified as a key factor impeding the use and greater adoption of minimally invasive techniques for most gynecologists. Laparoscopic suturing is one of the most difficult skills in minimally invasive surgery due to multiple factors including a constrained working field, altered depth perception, the need for counterintuitive movements and also the lack of a standardized teaching technique. Interventions This video uses images and footage from a simulation laboratory to clearly illustrate the steps involved in mastering laparoscopic suturing and intracorporeal knot tying using novel clock face directions to guide the movements. Conclusion This technique has been successfully incorporated into masterclasses run at the Centre, where anecdotally participants have grasped the concepts involved in laparoscopic suturing more quickly than with previous techniques. A prospective study is planned to compare the use of the novel clock face instructional teaching to more conventional terminology. The aim was to design a reproducible, easy to adopt method for teaching laparoscopic suturing and intracorporeal knot tying. The novel use of a clock face to guide the steps is proposed to simplify & accelerate skill acquisition. The technique appears far easier to conceptualize than many others and has been very positively received during laparoscopic masterclasses conducted at the Centre for Advanced Reproductive Endo-surgery in Sydney, Australia. Laparoscopic suturing requires very different and more advanced skill sets compared to suturing at open procedures. Proficiency with these skills is essential for the completion of advanced minimally invasive gynecological procedures such as hysterectomy, myomectomy and sacrocolpopexy. Inadequate laparoscopic suturing skills have been identified as a key factor impeding the use and greater adoption of minimally invasive techniques for most gynecologists. Laparoscopic suturing is one of the most difficult skills in minimally invasive surgery due to multiple factors including a constrained working field, altered depth perception, the need for counterintuitive movements and also the lack of a standardized teaching technique. This video uses images and footage from a simulation laboratory to clearly illustrate the steps involved in mastering laparoscopic suturing and intracorporeal knot tying using novel clock face directions to guide the movements. This technique has been successfully incorporated into masterclasses run at the Centre, where anecdotally participants have grasped the concepts involved in laparoscopic suturing more quickly than with previous techniques. A prospective study is planned to compare the use of the novel clock face instructional teaching to more conventional terminology.

Laparoscopic assisted robotic myomectomy of a huge myoma; Does robotic surgery change the borders in minimally invasive gynecology?

Today, the adoption of minimal invasive gynecologic procedures is expanding their routine use in clinical practice. Until recently, a diameter of 8 cm was the recommended maximal size for laparoscopic removal of fibroids. However, robot-assisted laparoscopy improved the capacity and the feasibility of the many gynecologic procedures. Here, we report a video of robotic myomectomy of a huge myoma.

Prophylactic Antibiotic Reduces the Risk of Peritonitis after Invasive Gynecologic Procedures.

Background:Peritonitis is a serious complication after invasive procedures in patients undergoing peritoneal dialysis (PD). Most studies that have investigated peritonitis following invasive gynecologic procedures enrolled small patient populations. This study focuses on the clinical presentation, outcomes, and effects of prophylactic antibiotic use before invasive techniques.Methods:A retrospective study was conducted on patients who underwent invasive gynecologic procedures between 2005 and 2015 in a tertiary medical center. Eligible patients were identified and enrolled and their demographic data were collected. The use of prophylactic antibiotics and the outcomes of peritonitis were recorded.Results:Twenty-six gynecologic procedures were performed on 18 PD patients. Seven episodes of peritonitis occurred in 6 patients after invasive gynecologic procedures. Eleven procedures were preceded by prophylactic antibiotic treatment (6 oral cefadroxil, 1 oral cefuroxime, 1 oral clindamycin, 1 intravenous [IV] ceftriaxone, 1 IV ceftazidime, and 1 IV cefazolin). The pathogens were diverse (group B Streptococcus, group D Streptococcus, E. coli, and Enterococcus). All episodes of peritonitis were successfully treated using intraperitoneal antibiotics without recurrence, technique failure, or mortality. The odds ratio of peritonitis in the non-prophylaxis group was 20.29 (95% confidence interval 1.01 - 406.35, p = 0.0103).Conclusion:The use of prophylactic antibiotic treatment considerably reduced the risk of peritonitis after invasive gyne co logic procedures.

Peritoneal Dialysis-Associated Peritonitis.

Peritonitis is a common and severe complication in peritoneal dialysis (PD). Detailed recommendations on the prevention and treatment of PD-associated peritonitis have been published by the International Society for Peritoneal Dialysis (ISPD), but there is a substantial variation in clinical practice among dialysis units. Prophylactic antibiotics administered before PD catheter insertion, colonoscopy, or invasive gynecologic procedures, daily topical application of antibiotic cream or ointment to the catheter exit site, and prompt treatment of exit site or catheter infection are key measures to prevent PD-associated peritonitis. When a patient on PD presents with clinical features compatible with PD-associated peritonitis, empirical antibiotic therapy, with coverage of both Gram-positive and Gram-negative organisms (including Pseudomonas species), should be started once the appropriate microbiologic specimens have been obtained. Intraperitoneal is the preferred route of administration. Antifungal prophylaxis, preferably oral nystatin, should be added to prevent secondary fungal peritonitis. Once the PD effluent Gram stain or culture and sensitivity results are available, antibiotic therapy can be adjusted accordingly. A detailed description on the dosage of individual antibiotic can be found in the latest recommendations by the ISPD. The duration of antibiotics is usually 2-3 weeks, depending on the specific organisms identified. Catheter removal and temporary hemodialysis support is recommended for refractory, relapsing, or fungal peritonitis. In some patients, a new PD catheter could be inserted after complete resolution of the peritonitis. PD catheter removal should also be considered for refractory exit site or tunnel infections. After the improvement in clinical practice, there is a worldwide trend of reduction in PD-associated peritonitis rate, supporting the use of PD as a first-line dialysis modality.

Bowel and Bladder Injury Repair and Follow-up After Gynecologic Surgery.

Bowel and bladder injuries are relatively rare, but there can be serious complications of both open and minimally invasive gynecologic procedures. As with most surgical complications, timely recognition is key in minimizing serious patient morbidity and mortality. Diagnosis of such injuries requires careful attention to surgical entry and dissection techniques and employment of adjuvant diagnostic modalities. Repair of bowel and bladder may be performed robotically, laparoscopically, or using laparotomy. Repair of these injuries requires knowledge of anatomic layers and suture materials and testing to ensure that intact and safe repair has been achieved. The participation of consultants is encouraged depending on the primary surgeon's skill and expertise. Postoperative care after bowel or bladder injury requires surveillance for complications including repair site leak, abscess, and fistula formation.

Chemicals in Surgical Smoke and the Efficiency of Built-in-Filter Ports.

Background and Objectives:Surgical smoke contains various malodorous and hazardous combustion byproducts. We aimed to analyze hydrocarbons accumulated in the abdominal cavity during laparoscopic gynecologic surgery and determine the efficiency of a built-in-filter port.Methods:We prospectively followed seven patients with benign uterine pathology. Surgical smoke was generated using laparoscopic or robotic electrocautery. The smoke was collected twice for each patient using a built-in-filter port and a conventional port. The concentrations of volatile organic compounds and aldehydes were determined using gas chromatography with mass spectrometry and high-performance liquid chromatography with ultraviolet visible light detection and compared using the paired-sample Wilcoxon signed-rank test.Results:Five volatile organic compounds and five aldehydes had toxic effects or unpleasant odors. The median concentration of formaldehyde before filtration (0.870 ppm) exceeded the time-weighted average concentration (0.75 ppm) of the Occupational Safety and Health Administration. Built-in-filter ports significantly reduced the concentration of five volatile organic compounds and two aldehydes but not that of formaldehyde, acetaldehyde, and propionaldehyde. Formaldehyde concentration decreased by 50% after filtration but remained above the recommended exposure limit (0.016 ppm) of the National Institute of Occupational Safety and Health.Conclusions:Surgical smoke in minimally invasive gynecologic procedures contains several hazardous hydrocarbons including formaldehyde. Built-in-filter ports have the potential to reduce the exposure of surgical smoke to surgeons and operating room personnel; nevertheless, development of built-in-filter ports is necessary to improve the filtering efficiency for highly concentrated formaldehydes.

Enhanced Recovery after Surgery (ERAS) Outcomes in Minimally Invasive Non-hysterectomy Gynecologic Procedures

Enhanced Recovery after Surgery (ERAS) Outcomes in Minimally Invasive Non-hysterectomy Gynecologic Procedures

Contained Power Morcellation; a Multicentre Australian Experience

Objective: To determine the feasibility of contained laparoscopic power morcellation during minimally invasive gynaecological procedures using the Espiner Morcellation Containment System.

Indications for morcellation in gynecologic surgery.

Minimally invasive gynecologic procedures, in particular laparoscopic hysterectomy and myomectomy, often require tissue morcellation. Whether morcellated or not, myometrial cells can be found in the abdomen and pelvis after either laparoscopic or open myomectomy. Following morcellation, careful inspection for and removal of tissue fragments and copious irrigation and suctioning of fluid can remove residual tissue and cells without the use of containment bags. The dogma of not 'cutting-through' cancer is not correct for many surgical specialties and irrelevant with regards to leiomyosarcoma (LMS) and minimally invasive gynecologic surgery. Eliminating residual disease in the pelvis and abdomen should be the goal of myomectomy or hysterectomy. Morcellation of excised tissue is necessary for many women with symptomatic fibroids who choose to undergo laparoscopic myomectomy or hysterectomy. LMS is an uncommon disease, with a poor prognosis due to early hematogenous metastasis to lung, bone and liver. Preoperatively, it is often difficult to differentiate from benign fibroids. LMS has a high propensity for local recurrence despite performance of total hysterectomy. Efforts to remove all tissue and cells from the pelvis and abdomen should be the goal of minimally invasive surgery with morcellation.

Antecedents of Abnormally Invasive Placenta in Primiparous Women: Risk Associated With Gynecologic Procedures.

To evaluate the association between prior invasive gynecologic procedures and the risk of subsequent abnormally invasive placenta (ie, placenta accreta, increta, and percreta). We conducted a population-based data linkage study including all primiparous women who delivered in New South Wales, Australia, between 2003 and 2012. Data were obtained from linked birth and hospital admissions with a minimum lookback period of 2 years. Prior procedures invasive of the uterus were considered including gynecologic laparoscopy with instrumentation of the uterus; hysteroscopy, including operative hysteroscopy; curettage, including suction curettage and surgical termination; and endometrial ablation. Modified Poisson regression was used to determine the association between the number of prior gynecologic procedures and risk of abnormally invasive placenta. Eight hundred fifty-four cases of abnormally invasive placenta were identified among 380,775 deliveries included in the study (22.4/10,000). In total, 33,296 primiparous women had at least one prior procedure (8.7%). Among women with abnormally invasive placenta, 152 (17.8%) had undergone at least one procedure compared with 33,144 (8.7%) among women without abnormally invasive placenta (P<.01). After adjustment, the relative risk was 1.5 for one procedure (99% CI 1.1-1.9), 2.7 for two procedures (99% CI 1.7-4.4), and 5.1 for three or more procedures (99% CI 2.7-9.6). Abnormally invasive placenta was also positively associated with maternal age, socioeconomic advantage, mother being Australia-born, placenta previa, hypertension, multiple births, use of assisted reproductive technology, and female fetal sex. Women with a history of prior invasive gynecologic procedures were more likely to develop abnormally invasive placenta. These insights may be used to inform management of pregnancies in women with a history of gynecologic procedures.

573 - “Doc, I Am Perplexed”: Readability Index Analysis of Online Patient Information on Minimally Invasive Gynecological Procedures

573 - “Doc, I Am Perplexed”: Readability Index Analysis of Online Patient Information on Minimally Invasive Gynecological Procedures