Laparoscopic Guidance Research Articles

Resumed ovarian function and pregnancy in early menopausal women by whole dimension subcortical ovarian administration of platelet-rich plasma and gonadotropins.

This study was designed to investigate if whole dimension subcortical ovarian administration of platelet-rich plasma with gonadotropin, in proximity to most ovarian follicles, is effective in restoring ovarian functions in women during early menopause. Platelet-rich plasma, prepared from 40 mL of autologous peripheral blood using the buffy coat method, was injected into extended subcortical area of bilateral ovaries along with recombinant follicle-stimulating hormone (rFSH) (Gonal-F 300IU) under laparoscopic guidance. The posttreatment ovarian folliculogenesis and serum levels of FSH, luteinizing hormone (LH), and estradiol were followed up for 6 months at weekly to monthly intervals. IVF was carried out in women resuming ovulatory functions. Twelve early menopausal women with mean age of 44.42 ± 2.84 were enrolled. After treatment, 11 women resumed their menstrual period in 37.1 ± 23.5 days. Their average serum FSH was 70.47 ± 20.92 and 26.22 ± 17.55 IU/L, luteinizing hormone was 34.81 ± 11.86 and 14.3 ± 12.8 IU/L, before and after treatment, respectively. The mid-cycle E2 was 251.1 ± 143.8 pg/mL. Ten oocyte retrievals were carried out among six participants, four of them received controlled ovarian stimulation and another two using natural ovulation cycles. Thirteen mature eggs were retrieved which were then ICSI fertilized to obtain 10 normally fertilized 2PN oocytes. Two participants had cleavage stage embryos transferred of which one achieved clinical pregnancy. Whole dimension subcortical ovarian administration of platelet-rich plasma with gonadotropin was shown to restore ovarian functions, at least temporarily, and could increase the probability of pregnancy using autologous oocytes in women with early menopause.

Laparoendoscopic resection of a tumor of the gastroesophageal junction

Atypical gastric resection has proved to be beneficial to treat submucosal tumors. The technique is more difficult when these tumors develop next to the gastroesophageal junction (GEJ). Intragastric resection combining endoscopic and laparoscopic approach was proposed to solve this limitation. There are no publications about this technique in our environment. A 42-year-old female patients with a 2-mm subepithelial tumor below the cardia evaluated by upper gastrointestinal (UGI) videoendoscopy and endoscopic ultrasound suggestive of a gastrointestinal stroma tumor (GIST) underwent resection using the combined laparo-endoscopic approach. Under laparoscopic guidance, balloon-tipped trocars were introduced in the abdominal cavity and then into the stomach using endoscopic view. The balloons were inflated to fix the gastirc wall to the abdominal wall. The lesion was resected using mechanical stapler. The combined approach is safe and efficient, and simple to perform for trained professionals, constituting a reproducible option in selected cases

Interleukin-2 receptor alpha as a biomarker for nonalcoholic fatty liver disease diagnosis.

Two recent studies in the adult and pediatric Nonalcoholic Steatohepatitis-Clinical Research Network (NASH-CRN) cohorts have shown that soluble interleukin-2 receptor alpha (IL2RA) levels increased with fibrosis severity. However, no hepatic study has been conducted in Asian morbidly obese patients who underwent bariatric surgery. In this study, we proposed IL2RA as a biomarker for nonalcoholic fatty liver disease (NAFLD) diagnosis and performed immunohistochemistry (IHC) staining of IL2RA. This prospective cohort study enrolled 123 morbidly obese patients who underwent bariatric surgery at Taipei Medical University Hospital from October 2016 to June 2018. During bariatric surgery, all patients underwent a wedge liver biopsy under laparoscopic guidance. The diagnoses of NASH and liver fibrosis were made histologically. In IHC of IL2RA, the number of lymphocytes with IL2RA immunoreactivity was counted in five high-power fields (×400, total: 1.19 mm2). Among the 123 patients, the mean age was 35.5 years, mean body mass index (BMI) was 40.6 kg/m2, 87 (70.7%) were female, 25 (20.7%) had diabetes mellitus, and 57 (46.3%; 11 with non-NAFLD and 46 with steatosis) and 66 (53.7%) were included in the non-NASH and NASH groups, respectively. The NASH group had higher IHC of IL2RA than the non-NASH group. In multivariate analysis, IHC of IL2RA (odds ratio, 1.025; 95% confidence interval, 1.006-1.045; p = 0.011) and alanine aminotransferase (ALT; odds ratio, 1.045; 95% confidence interval, 1.018-1.073; p = 0.001) were the independent factors associated with NASH. The area under the receiver operating curve of IL2RA IHC for NASH was 0.627 at the cutoff value of 82 (p = 0.0113). IL2RA is significantly associated with NASH in morbidly obese patients and would be a useful biomarker for NASH diagnosis.

Pregnancy outcomes after hysteroscopic surgery in women with cesarean scar syndrome.

Cesarean scar defect often causes postmenstrual abnormal uterine bleeding, dysmenorrhea, chronic pelvic pain, and infertility, which are collectively known as cesarean scar syndrome (CSS). Several studies have reported that hysteroscopic surgery can restore fertility in women with CSS. The study aimed to identify factors that influence subsequent pregnancy following hysteroscopic surgery. Therefore, we studied 38 women with secondary infertility due to CSS who underwent hysteroscopic surgery at Shiga University of Medical Hospital between July 2014 and July 2019. Our hysteroscopic procedure included inferior edge resection and superficial cauterization of the cesarean scar defect under laparoscopic guidance. Patients were followed up for 3 to 40 months after surgery. Surgery was successful in all cases and no complications were observed. Twenty-seven patients (71%) became pregnant (pregnant group), while 11 (29%) did not (non-pregnant group). Baseline characteristics of age, body mass index, gravidity, parity, previous cesarean section, presence of endometriosis, retroflex uterus, and preoperative residual myometrial thickness were not significantly different between the groups. However, the median residual myometrium thickness was significantly higher after surgery than before surgery in the pregnant group (1.9 [1.1-3.6] vs 4.9 [3.4-6.6] mm, P<0.0001), whereas this difference was not significant in the non-pregnant group. Of those who became pregnant, 85% conceived within 2 years of surgery. Although three pregnancies resulted in abortion and one is ongoing at the time of writing, 23 pregnancies resulted in healthy babies at 35-38 gestational weeks by scheduled cesarean sections with no obstetrical complications due to hysteroscopic surgery. The average birth weight was 3,076 g. Our findings support that hysteroscopic surgery is a safe and effective treatment for secondary infertility due to CSS. The thickness of the residual myometrium may be a key factor that influences subsequent pregnancy in women with CSS.

Laparoscopic assisted extracorporeal ovarian harvest: A novel technique to optimize ovarian tissue for cryopreservation in young females with cancer

BackgroundAdvances in pediatric cancer therapy have improved the long-term survival for many children with cancer. The awareness of quality of life aspects, specifically fertility preservation, has become a reality for many of these families and children. Ovarian tissue cryopreservation has emerged as an available fertility option for young females with cancer. Safe and effective removal of ovarian tissue in these girls is paramount. We report a laparoscopic assisted extracorporeal ovarian harvest technique that achieves this goal. Operative techniqueWe place a 5 mm port at the umbilicus and in the right lower quadrant. Under laparoscopic guidance we place a 12 mm port in the left suprapubic area. Utilizing the 12 mm port site a monofilament traction suture is placed through the left ovary. The traction suture is used to translocate the ovary to an extracorporeal position via the 12 mm port site. Ovarian tissue is then excised utilizing standard surgical technique with the scalpel. Hemostasis is obtained and the capsule is closed with a running absorbable suture. The ovary is placed back in its native position laparoscopically. ConclusionsThe use of this extracorporeal ovarian harvesting technique is a safe and effective method to optimize removal and minimize tissue injury. Utilization of this technique, may have potential benefit to the young female with cancer.

Successful laparoscopic surgery combined with selective arterial embolization for bleeding due to jejunal angiodysplasia: a case report

BackgroundAngiodysplasia of the gastrointestinal tract is a rare vascular pathology that sometimes causes massive hemorrhage. Angiodysplasias are particularly difficult to find in the small intestine for anatomical reasons, often impeding their diagnosis and treatment. Lesion localization is a major challenge in cases of small bowel bleeding requiring surgical intervention.Case presentationThe present case was a 52-year-old woman who was urgently hospitalized with repeated tarry stools. Surgical intervention was chosen after conservative treatment failed to improve her condition. The source of bleeding was suspected to be a vascular lesion discovered in the small intestine during a past double-balloon endoscopy. Abdominal contrast computed tomography revealed a jejunal hemorrhage. We chose selective arterial embolization to stabilize her hemodynamics followed by surgical intervention as her treatment plan. Several embolic and contrast agents (cyanoacrylate, indigo carmine, and Lipiodol) were combined to help identify the location of the lesion during surgery. This multi-pronged approach allowed us to localize the lesion under laparoscopic guidance with high confidence and accuracy, and to excise a 6-cm segment of the small intestine. The lesion was histologically diagnosed as angiodysplasia. No re-bleeding has been observed since the operation.ConclusionWe report our experience with a case of jejunal angiodysplasia, which was localized with selective arterial embolization using an array of embolic and contrast agents, and then excised laparoscopically. Selective arterial embolization with indigo carmine dye to treat small bowel bleeding preoperatively not only makes the surgery safer by stabilizing the patient’s hemodynamics, but is also very useful for localizing the lesion intraoperatively.

Hysteroscopic Resection of an Interstitial Ectopic Pregnancy

Study Objective We demonstrate a novel approach for treatment of an interstitial ectopic pregnancy via hysteroscopic resection under laparoscopic guidance. Design N/A Setting The patient was a 29 year old G2P0010 with an enlarging interstitial pregnancy despite treatment with methotrexate. The surgery was performed in an ambulatory center affiliated with a tertiary teaching hospital. Patients or Participants N/A Interventions We performed a resection of an interstitial ectopic pregnancy hysteroscopically with the aid of laparoscopic visualization. This surgical approach was undertaken after both hysteroscopic and laparoscopic evaluation determined its feasibility. Measurements and Main Results N/A Conclusion Interstitial ectopic pregnancies are rare, and factors such as hemodynamic stability, gestational age, and surgeon expertise must be considered in surgical planning. Hysteroscopic resection of an interstitial pregnancy under laparoscopic guidance can be employed safely in select cases. When appropriate, this technique allows treatment of an ectopic pregnancy with avoidance of more morbid, traditional treatments such as a cornuostomy or cornual wedge resection.

Resection of a Complete Uterine and Cervical Septum

Study Objective This video demonstrates a technique for the surgical correction of a complete uterine and cervical septum. Design 1. Overview of the background, clinical presentation and relevant pre-operative planning. 2. An illustration and instruction for surgical correction. 3. Discussion of the post-operative care and long-term outcomes. Setting The patient is positioned in lithotomy with their legs in yellow fin stirrups to allow for concurrent laparoscopic and hysteroscopic surgery. Patients or Participants The procedure is demonstrated using a patient's single surgery. Interventions A technique for resecting a complete uterine and cervical septum using vaginal and hysteroscopic surgery under laparoscopic guidance. The septum is delineated using a Foley catheter balloon in the contralateral uterine cavity, allowing for the incision and resection of the septum. The septum is resected from the level internal cervical os to the fundus to avoid future mechanical cervical insufficiency. Measurements and Main Results N/A Conclusion This video clearly demonstrates a technique for the hysteroscopic correction of a complete uterine and cervical septum under laparoscopic guidance. The septum is delineated by using a Foley catheter balloon in the contralateral uterine cavity to create a bulge at the level of the fibrous septum.

Successful Symptomatic Relief of a Patient with Recurrent Fibroids, Undergoing Laparoscopic Radiofrequency Fibroid Ablation

Study Objective To document, through a case report video, a successful Laparoscopic Radiofrequency Ablation (Lap RFA) treatment for multiple recurrent fibroids after myomectomy. Design Video Case Report, 7 month follow up. Setting Hospital OR, Straight Stick Laparoscopy with Laparoscopic Ultrasound and Guidance Mapping. Patients or Participants 36-year-old African American, G0 with history of open myomectomy in 2010, presented with 2-year history of urinary frequency, urgency, constipation, back pain and heavy menstrual bleeding. Ultrasound imaging showed multiple fibroids including: 4.6 cm type 5, 5.4cm type 2, 2.4cm type 2, 3.0 cm type 2, and 2.1 cm type 2. The patient was seeking a uterine sparing alternative to a repeat myomectomy. Interventions Hysteroscopy, D&C, and Laparoscopic Radiofrequency Ablation, July 2019, with six fibroids treated, and 13 minutes of total ablation time. EBL 15cc. No surgical or postoperative complications. Measurements and Main Results 6 week post op visit: patient reports soreness, that her pelvis subjectively feels lighter, and spotting/discharge for 2 weeks that resolved by 1 month. 3 month follow up: ultrasound shows a 7.3 × 7.2cm vs previous 9 × 9cm uterus, multiple fibroids, 3.9cm (from 5.4cm), 2.2cm (from 3.0cm) and 3.9cm (from 4.6cm) in their largest dimensions. 6 month follow up: ultrasound shows a 9 × 6 × 5cm uterus and persistence in fibroid sizes. 7 month follow up: patient notes subjective improvement in urinary frequency, urgency, constipation, back pain and heavy menstrual bleeding. Conclusion Laparoscopic radiofrequency ablation resulted in decreased uterine and fibroid size and provided symptomatic relief in this patient and should be considered as a safe, minimally invasive alternative to repeat myomectomy in patients desiring uterine sparing treatment for recurrent fibroids and for those with complex, multi-fibroid uterine anatomy.

Radiofrequency Ablation of an 11cm Posterior Transmural Fibroid

Study Objective To document through a case report and video, a successful Laparoscopic Radiofrequency Ablation (Lap RFA) treatment of an 11cm posterior transmural fibroid. Design Video Case Report, 8 months follow up. Setting Hospital OR, Straight Stick Laparoscopy with Laparoscopic Ultrasound and Guidance Mapping. Patients or Participants 29-year-old African American G0 with a one-year history of urinary frequency, urgency, heavy menstrual bleeding and anemia, recently requiring blood transfusion despite COCP's. Preoperative ultrasound imaging showed a 13 × 11 × 9cm uterus with an 11 × 9 × 9cm posterior intramural fibroid. Patient was seeking a minimally invasive, uterine sparing alternative to a myomectomy. Interventions Laparoscopic Radiofrequency Ablation and surgical resection of endometriosis, July 2019, with treatment of one single posterior transmural fibroid, 10 separate radiofrequency ablations, totaling 32minutes of total ablation time. EBL 30cc. No surgical or postoperative complications. Measurements and Main Results Patient reported subjective improvement in urinary frequency, urgency, heavy menstrual bleeding and anemia at 3 months and continued relief at 8 months post-op. 1. Uterus volume shrinkage by 47% by 4 months and remained at 8 months (1287cm^3 to 687cm^3). 2. Fibroid volume shrinkage by 72% by 4 months, and by 79% at 8 months (891cm^3 to 185 cm^3). Conclusion Laparoscopic Radiofrequency Ablation proved to be an effective treatment for fibroid larger than 9cm, in this case an 11 cm posterior intramural fibroid, and resulted in greater than 70% volume reduction and patient symptom relief by 4 months post-op.

The technique of fourth jejunal artery-based jejunal conduit for oesophagojejunostomy after thoracolaparoscopic oesophagogastrectomy for locally advanced Siewert type II tumour.

Background:Locally advanced long Siewert type II tumor requires total gastrectomy and D2 lymphadenectomy with distal esophagectomy and mediastinal lymphadenectomy for curative resection. In this scenario, a laparoscopic transhiatal approach is not feasible, and the conventional left thoracoabdominal approach is associated with increased morbidity.Aims and Objectives:To describe a novel technique of fourth jejunal artery based jejunal conduit for thoracoscopic esophagojejunostomy after laparoscopic esophagogastrectomy.Materials and Methods:The laparoscopic total gastrectomy with distal esophagectomy specimen is extracted through the periumbilical incision. A pedicled jejunal conduit based on the fourth jejunal artery is prepared, and the jejunal conduit is placed in the mediastinum under laparoscopic guidance. Using the thoracoscopic approach in a prone position, additional esophageal clearance and subcarinal lymphadenectomy are performed. Handsewn end to side esophagojejunostomy is performed at the level of the carina.Results:Three patients with long Siewert type II underwent this procedure after neoadjuvant chemotherapy. None of the patients had conduit related complications. All three patients had abdominal lymph node involvement and two patients had mediastinal lymph node involvement.Conclusion:Pedicled jejunal conduit based on the fourth jejunal artery is safe for intrathoracic anastomosis after minimally invasive esophagogastrectomy for locally advanced Siewert type II tumor.

FLUOROSCOPIC-GUIDED HYSTEROSCOPIC TUBAL CANNULATION RESULTS IN HIGH TECHNICAL SUCCESS, HIGH SPONTANEOUS PREGNANCY RATES, AND SIMILAR TIME TO PREGNANCY WHEN COMPARED TO LAPAROSCOPIC GUIDANCE

Tubal cannulation for proximal tubal obstruction (PTO) has historically used fluoroscopy for visualization and guidance or hysteroscopic visualization with laparoscopic guidance. This study compared women with PTO undergoing hysteroscopic tubal cannulation with fluoroscopic guidance versus laparoscopic guidance.

Feasibility and efficacy of ultrasonographic and laparoscopic guidance for microwave ablation of clinically normal canine ovaries.

To determine the optimal energy profile for and to assess the feasibility and efficacy of ultrasonographic and laparoscopic guidance for microwave ablation (MWA) of clinically normal canine ovaries. 44 extirpated ovaries from 22 healthy dogs. In the first of 2 trials, 13 dogs underwent oophorectomy by routine laparotomy. Extirpated ovaries underwent MWA at 45 W for 60 (n = 11) or 90 (12) seconds; 3 ovaries did not undergo MWA and served as histologic controls. Ovaries were histologically evaluated for cell viability. Ovaries without viable cells were categorized as completely ablated. Histologic results were used to identify the optimal MWA protocol for use in the subsequent trial. In the second trial, the ovaries of 9 dogs underwent MWA at 45 W for 90 seconds in situ. Ultrasonographic guidance for MWA was deemed unfeasible after evaluation of 1 ovary. The remaining 17 ovaries underwent MWA with laparoscopic guidance, after which routine laparoscopic oophorectomy was performed. Completeness of ablation was histologically assessed for all ovaries. 2 ovaries were excluded from the trial 1 analysis because of equivocal cell viability. Six of 11 ovaries and 10 of 10 ovaries that underwent MWA for 60 and 90 seconds, respectively, were completely ablated. In trial 2, laparoscopic-guided MWA resulted in complete ablation for 12 of 17 ovaries. Dissection of the ovarian bursa for MWA probe placement facilitated complete ablation. Laparoscopic-guided MWA at 45 W for 90 seconds was feasible, safe, and effective for complete ablation of clinically normal ovaries in dogs.

Single-Incision Percutaneous Closure of Pediatric Inguinal Hernia: A New Modification for Intracorporeal Suture Knotting.

Background Single-incision percutaneous closure (SIPC) of pediatric inguinal hernia under laparoscopic guidance is a well-developed feasible technique; however, suture knotting remains a major challenge during this technique. Most laparoscopic surgeons prefer extracorporeal subcutaneous suture knotting, which may be associated with consequent formation of stitch sinus and increased recurrence rate. On the other hand, intracorporeal suture knotting necessitates the availability of special devices or homemade instruments with a long learning curve. Therefore, the present study innovates new and simple modification allowing intracorporeal suture knotting during SIPC of pediatric inguinal hernia that does not require any special operating devices or homemade instruments. Patients and Methods. Four-hundred children suffering from inguinal hernia of congenital type, submitted to SIPC using Epidural needle (EN), under laparoscopic guidance with intracorporeal suture knotting. Results Children ages were 6 months to 10 years (the range). There were 300 boys and 100 girls, and two-hundred children suffered from left side hernia, 150 with right-side hernia, and 50 children with both left- and right-side hernia. 10 ± 2.2 minutes was the recorded operation time in one side hernia repair, while 14 ± 4.3 minutes was recorded for both side repair. Postoperative results reported recurrent hernia in one child and postoperative hydrocele in 3 children which resolved spontaneously after 3 weeks of follow-up. Conclusion Intracorporeal suture knotting during SIPC of pediatric inguinal hernia allows for the transformation of a formally extraperitoneal procedure to an intraperitoneal procedure. This new modification for intracorporeal suture knotting does not require any special operating devices or homemade instruments. It seems to be an attractive way during SIPC of pediatric inguinal hernia when intracorporeal suture knotting is considered.

Feasibility and Safety of Laparoscopic-Guided Epicardial Access for Ventricular Tachycardia Ablation.

BackgroundThe usual approach to epicardial access in patients with Chagas cardiomyopathy and megacolon is surgical access to avoid bowel injury. However, there are concerns regarding its safety in cases of Chagas cardiomyopathy with reports of prolonged mechanical ventilation and high mortality in this clinical setting. The aim of this study was to examine feasibility and complication rates for ventricular tachycardia ablation performed with laparoscopic‐guided epicardial access.Methods and ResultsThis single center study examined complication rates of the first 11 cases of ventricular tachycardia ablation in patients with Chagas cardiomyopathy, using laparoscopic guidance to access epicardial space. All 11 patients underwent epicardial VT ablation using laparoscopic‐guided epicardial access, and the complication rates were compared with historical medical reports. The main demographic features of our population were age, 63±13 years; men, 82%; and median ejection fraction, 31% (Q1=30% and Q3=46%). All patients were sent for ventricular tachycardia ablation because of medical therapy failure. The reason for laparoscopy was megacolon in 10 patients and massive liver enlargement in 1 patient. Epicardial access was achieved in all patients. Complications included 1 severe cardiogenic shock and 1 phrenic nerve paralysis. No intra‐abdominal organ injury occurred; only 1 death, which was caused by progressive heart failure, was reported more than 1 month after the procedure.ConclusionsLaparoscopic‐guided epicardial access in the setting of ventricular tachycardia ablation and enlarged intra‐abdominal organ is a simple alternative to more complex surgical access and can be performed with low complication rates.

Peritoneal insertion of shunts in children: comparison between trocar and laparoscopically guided insertion.

Ventriculo-peritoneal shunts are commonly used for treating hydrocephalus for all age groups. There are 3 main methods for shunt placement into the peritoneum: mini laparotomy, laparoscopically guided, or percutaneously with a trocar. There is limited literature comparing between these techniques in the pediatric population, and specifically-the trocar has not been compared with laparoscopy. The goal of this study is to compare trocar and laparoscopy use, with respect to safety and potential need for future shunt revisions. Data was retrospectively collected from 2 centers for children (< 18 years old) who underwent a primary insertion of a CSF shunt to the peritoneum, and had no prior abdominal surgery or significant abdominaldisease. One center used a trocar, and the other laparoscopic guidance. Demographics, surgical time, and shunt complications were analyzed. Primary endpoint was distal shunt malfunction, either technique-related or non-technique-related. Two hundred fifty-seven children (220 trocar, 37 laparoscopy) were included. The groups were similar with regard to age at surgery and etiology of hydrocephalus. Trocar use was associated with a slightly higher, although statistically insignificant, rate of technique-related distal complications (4.1% vs 0, p = 0.37). Following propensity score matching, there was no statistically significant difference in any shunt complication between both groups. Trocar use was associated with shorter surgery, and less surgical personnel. In primary shunt surgery in children, abdominal placement of the catheter using a trocar or laparoscopic guidance is safe, and associated with a low distal malfunction rate, with no statistically significant differences between both techniques.

Clinical Efficacy of Laparoscopy and Hystroscopic Dilation and Curettage Procedure in Managing Cesarean Scar Pregnancy

Objective: To evaluate the success rate of laparoscopy and hysteroscopic Dilation &amp;amp; Curettage in treating cesarean scar pregnancy.&#x0D; &#x0D; Methods: This cross-sectional study was carried on patients suspicious to CSP referred to Imam Khomeini Hospital, Ahvaz from Jun 2016 to March 2018. Gestational site was carefully evaluated by hysteroscopy and then curettage was carried out under laparoscopic guidance. The primary outcome in the study was time interval from treatment to hCG resolution. Moreover, the secondary outcomes were vaginal bleeding time and residual mass size.&#x0D; &#x0D; Results: In this study, 30 women with intrauterine CSP were evaluated. Of these, 5 had live embryos and 25 had dead fetuses. The success rate of treatment was 100%. Only one patient needed to transfusion. The mean and median duration of Bhcg resolution were 30.9 and 28 days, respectively. Moreover, The mean and median duration of vaginal bleeding were 30.9 and 28 days, respectively. The mean level of residual mass was 9.8 mm3 (ranged from 1 to 25 mm3).&#x0D; &#x0D; Conclusion: Overall, the findings of this study showed that D&amp;amp;C effectively treated CSP patients (100% success rate), reduced the time of Bhcg resolution and also reduced vaginal bleeding time.

Successful Conservative Treatment in a Rare Case of Type 2 Congenital Cervical Dysgenesis: Case Report and Systematic Literature Review

Objective: Providing a systematic review of type 2 cervical dysgenesis (CD) by taking into consideration an interesting and rare case of genital anomaly which was treated with the use of laparoscopic ultrasound guidance. Materials and Methods: A research of MEDLINE, EMBASE, Web of Sciences, Scopus, ClinicalTrial.gov, OVID and Cochrane Library was done. We analysed all types of study including case reports. We identified articles published at the time we began our review up from inception to July 2019. Results: Three hundred thirty-four articles were identified, three hundred fifteen other articles were excluded for various reasons. Overall, nineteen articles were incorporated for further assessment. Three surgical techniques were used to treat type 2 cervical dysgenesis: drilling and coring technique (CDT), utero-vaginal anastomosis (UVA) and hysterectomy (HRT) or hemi-hysterectomy (H-HRT). Recurrences (38%) were described only with CDT. Five successful pregnancies were reported with the same technique. Conclusions: Type 2 cervical dysgenesis is a rare congenital malformation. Data about recurrence and pregnancy rate are too sparse to recommend one technique rather than another. As shown in our comprehensive review, ultrasound-guided laparoscopy could represent a valid new surgical treatment approach.

Intraoperative Endoscopic Ultrasound Guided Surgical Treatment of Herlyn-Werner-Wunderlich Syndrome. Case Report and a Systematic Literature Review

Aim: Herlyn-Werner-Wunderlich (HWW) syndrome is a rare congenital anomaly characterized by uterus didelphys, obstructed hemivagina, and ipsilateral renal-ureteral agenesis, due to an embryogenesis defect. Clinically, HWW results in hematometrocolpos on the obstructed hemivagina side, which produces a mass effect with pain. The diagnosis is difficult because this syndrome is infrequent, and its clinical presentation is variable. Early detection and treatment are important to prevent further complications that could affect the reproductive performance. Ultrasound (US) is the first step when a Mullerian anomaly is suspected but MRI has a higher accuracy to manage surgery. Surgical treatment consists in vaginal septum excision. This review provides information about HWW syndrome and about its diagnosis and treatment. The main objective of this report is to illustrate the clinical presentation, the ultrasound features of a rare syndrome and the use of a laparoscopic ultrasound guidance to allow a fertility sparing treatment without complications. Material and Methods: A search of PubMed Database identified articles published from the inception to February 2019. Results: 186 articles were identified: 125 articles were excluded for any reason. Overall, 63 articles were incorporated for further assessment. Conclusions: The case reported was treated successfully by minimally invasive surgical drainage procedure supported by full time intraoperative ultrasound guidance. Only few researches described transvaginal and transabdominal probe use during surgery; this is the first case in the literature in which a laparoscopic ultrasound probe was used to guide surgeons in the excision of the vaginal septum to prevent complications and to preserve future fertility.

Comparison of Therapeutic Benefit of Bupivacaine HCl Transversus Abdominis Plane (TAP) Block as Part of an Enhanced Recovery Pathway versus Traditional Oral and Intravenous Pain Control after Minimally Invasive Colorectal Surgery: A Prospective, Randomized, Double-Blind Trial

Enhanced recovery pathways (ERPs), when combined with transversus abdominis plane (TAP) blocks, have been proven to reduce the length of stay (LOS) and improve quality outcomes. Nonopioid pain management is an essential component of this pathway, leading to a reduction in immobility, postoperative ileus, and an increase in patient satisfaction. TAP block variations have been studied in general and gynecologic surgery. This study evaluates the effectiveness of laparoscopic TAP blocks in conjunction with the benefit of an ERP. One hundred thirty-seven consecutive laparoscopic and robotic-assisted Colorectal Surgery patients received TAP blocks under laparoscopic guidance while under anesthesia, randomized to a placebo, bupivacaine TAP block, or bupivacaine TAP block with an ERP arm of the trial. Patient demographics, operative techniques, and postoperative outcomes were analyzed using statistical analysis software. Our main objective was to determine short-term benefits of TAP blocks on reducing total narcotic consumption. Secondary objectives included effects of TAP blocks on time to ambulation, time to bowel function, and LOS. To isolate the effect of the TAP blocks, no efforts were made to control nursing or patient education in patients managed without an ERP. Of 137 patients, 14 were withdrawn. All cases were elective, with the main diagnosis colon cancer or dysplastic polyps (47.1%). The median age in each group was comparable (P = 0.12), with female majority in both groups (58.5%). Most procedures were segmental colon resections (74.7%). Thirty-one patients received a placebo, 41 bupivacaine TAP, and 51 bupivacaine TAP plus ERP. In terms of primary endpoints, the bupivacaine plus ERP arm used statistically significant less IV narcotics on postoperative day 1 and in total (P = 0.001, P = 0.008). All patients ambulated on average within the first 24 hours postoperatively, with the TAP plus ERP group approximately 0.5 days sooner (P = 0.001). The TAP plus ERP group also had a return of bowel function and LOS approximately 24 hours early (P = 0.001 and P = 0.001). This study shows that a laparoscopically placed bupivacaine TAP block when used as part of an ERP can reduce LOS, postoperative narcotics, time to ambulation and bowel function, and LOS. Defined pain regimens with auxiliary staff teaching can add to the improvement in quality outcomes in laparoscopic colorectal surgery and, with the addition of the TAP block, can add to patient satisfaction and lower hospital costs.