Ovarian Vessels Research Articles

UNILATERAL OVARIAN TORSION IN FIVE GECKOS: CLINICAL AND ULTRASOUND FINDINGS.

Few cases of antemortem ovarian torsion and diagnosis have been described in reptiles. This case series reports clinical and ultrasound findings in five adult (aged 1-6 yr) female geckos (three leopard geckos [Eublepharis macularius], one crested gecko [Correlophus ciliatus], and one gargoyle gecko [Rhacodactylus auriculatus]) diagnosed with unilateral ovarian torsion between 2019 and 2023. All animals presented with acute weakness associated with coelomic distension, and one suffered from chronic diarrhea and cachexia. Coelomic ultrasound examination (12-MHz linear probe) revealed signs of bilateral follicular stasis and oophoritis in all cases (heterogenic follicles ≤1.3 cm diameter) associated with a large anechoic periovarian rim and a hyperechoic chord, consistent with twisted ovarian vessels. Blood supply to ovarian structures was not detected using a Doppler flow, and a unilateral ovarian torsion was diagnosed in all geckos. A bilateral ovariectomy was performed under general anesthesia in all five animals. The mass of the excised ovaries varied between 7 to 15 g (12.7-22.2% of body weight). One gecko died 1 d postsurgery; the four remaining animals were healthy 6 mon postsurgery. Gekkonids are unique among reptiles in that they undergo a monoautochronic ovulation (only one follicle is recruited by each ovary during each ovarian cycle); the presence of multiple vitellogenic follicles on each ovary facilitates the diagnosis of follicular stasis. This condition was present in all five geckos and was suspected to have led to ovarian torsion. This case series emphasizes the value of ultrasound examination for antemortem diagnosis of reproductive disorders in reptiles.

Feasibility of the “cuff-sleeve” suture method in improving the uterine blood supply after radical trachelectomy: A retrospective analysis

ObjectiveTo explore the feasibility of the “cuff-sleeve” suture method in improving the uterine blood supply after radical trachelectomy (RT). Study designPatients in the “cuff-sleeve” (n = 25) and traditional group (n = 10) underwent computed tomography angiography (CTA) to evaluate the residual uterine blood supply pattern after the surgery, and the preoperative group patients (n = 20) underwent CTA before the procedure. ResultsThe uteri of the 20 patients in the preoperative group were all supplied by bilateral uterine arteries of average diameter, 2.25 ± 0.35 mm. The uterine artery-supplying, hybrid supplying, and ovarian artery-supplying patterns accounted for 40 %, 36 %, and 24 % in the “cuff-sleeve” group and 20 %, 50 %, and 30 %, respectively, in the traditional group. The average diameter of the uterine arteries among the uterine artery-supplying pattern in the “cuff-sleeve” group (1.98 ± 0.36 mm) was more extensive than that in the traditional group (1.73 ± 0.15 mm) (p = 0.049). As also, the ovarian artery diameter of the hybrid supplying pattern in the “cuff-sleeve” group (1.65 ± 0.25 mm) was significantly larger than that in the traditional group (1.50 ± 0.35 mm) (p = 0.010). Additionally, while the pregnancy rate in the “cuff-sleeve” group (50.0 %) was higher than that in the traditional group (25.0 %), this difference was not statistically significant. ConclusionsThe “cuff-sleeve” suture method was associated with increased diameter of the uterine and ovarian vessels and may be a feasible method to improve the uterine blood supply and pregnancy rate after radical trachelectomy. It still warrants further evaluation for both fertility and oncologic outcomes.

Serous surface papillary borderline ovarian tumors: correlation of sonographic features with clinic pathological findings.

Serous surface papillary borderline ovarian tumor (SSPBOT) is a distinct subtype of serous borderline ovarian tumor characterized by solid tissue deposition confined to the ovarian surface. Because SSPBOT is rare, there are few published reports on the ultrasonographic features of this condition. In this retrospective study, we investigated 12 cases of SSPBOT. Ultrasound imaging of SSPBOT showed grossly normal ovaries that were encased partially or wholly by tumor deposits that were confined to the surface, with clear demarcation between normal ovarian tissue and surrounding tumors. Color Doppler imaging demonstrated the 'fireworks sign' in all cases of SSPBOT, corresponding to an intratumoral vascular bundle originating from the ovarian vessels and supplying hierarchical branching blood flow to the surrounding tumor. No patient with ovarian high-grade serous carcinoma showed these morphological and Doppler features. In our series, the fireworks sign appeared to be a characteristic feature of SSPBOT that could facilitate correct identification of this tumor. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Retroplacental hematoma: A case report

Background: Retroperitoneal hematomas during pregnancy arising from ovarian vessels are rare. Thiscondition is usually associated with hemorrhagic shock and can lead to serious maternal-fetal morbidityor mortality. Carrying a pregnancy to term when the condition is diagnosed in early pregnancy istherefore not guaranteed.Case presentation: A 39-year-old para 4+1 presented at 26 weeks of gestation with a 2-day history ofright lower abdominal pain after a fall on her farm two weeks before admission. She was anemic, andabdominal ultrasound revealed a hypoechoic mass in the right lower quadrant of the abdomen, which,upon explorative laparotomy, turned out to be a large nonexpanding zone III retroperitoneal hematoma.Conservative management without opening the hematoma was performed, and she was serially imagedto assess the etiology and to rule out any further bleeding. The patient carried the pregnancy to term anddelivered vaginally. Postpartum exploration of the abdomen during tubal ligation revealed resolution ofthe hematoma.Discussion: Retroperitoneal hematomas can occur spontaneously or can be caused by blunt orpenetrating trauma. Patients mostly present with abdominal pain, hypovolemia, or anemia. Fordescriptive purposes, the retroperitoneum is divided into three zones: central, perirenal, and pelvic. Forspontaneous or blunt trauma hematomas in the pelvic zone, conservative management without openingthe hematoma is advised.Conclusion: Retroperitoneal hematoma should be a differential diagnosis in a patient presenting with anacute abdomen during pregnancy. Although associated with morbidity and mortality during pregnancy,patients with this condition can still carry their pregnancy to term and deliver normally.

Gross and Histopathological Changes in Layers Experimentally Infected with Escherichia coli (APEC serotype O1KI)

Background: Avian pathogenic Escherichia coli (APEC) induces colibacillosis, an acute and systemic disease, resulting in substantial economic losses in the poultry sector. Aim: This study determined the gross and microscopic changes associated with Escherichia coli (E. coli) (APEC serotype O1KI) infection in layer chickens. Methods: A total of 10 layer chickens (20 weeks old) were acquired and assigned, at random, into two groups (infected and control) of 5 layers each. Each bird in the infected group was challenged with 0.5 ml of bacterial aliquot containing 109 colony-forming units (CFU) of the bacteria, administered intra-tracheally. The birds from both groups were humanely sacrificed on tenth day post-infection and subjected to post-mortem examination for gross and microscopic changes. Results: Gross lesions observed in the infected chickens included congested lungs, enlarged liver and kidney, hyperaemic intestine, congested ovarian follicles and yellowish fibrinous material in the infected group. While microscopic lesions observed were congested ovarian blood vessels, mononuclear cellular infiltration and generalised necrosis of the liver, kidney, and heart. Conclusion: This study revealed various lesions of congested lungs, enlarged liver, hyperaemic intestine, enlarged kidney, and congested ovarian follicles, yellowish fibrinous material, congested blood vessels of the oviduct that were typical of the natural infection and may be attributable to colisepticaemia.

Improvement of Inflammation and Abnormal Vascularization by TSP1 Treatment Combined with ADSCs Transplantation in Mice with Induced Polycystic Ovary Syndrome.

Polycystic ovary syndrome (PCOS) is a common gynecological endocrine disease with a certain degree of chronic inflammation and abnormal ovarian angiogenesis in reproductive women. Mesenchymal stem cells (MSCs) have potent immunomodulatory properties to regulate ovarian function, while thrombospondin 1 (TSP1) improves the abnormal formation of ovarian vessels. The present study investigated the efficacy of the combined use of adipose-derived mesenchymal stem cells (ADSCs) and TSP1 in PCOS mice. The PCOS model is established using dehydroepiandrosterone (DHEA) by subcutaneous injection. Ovarian apoptosis is assessed using terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL). Real-time quantitative PCR (RT-PCR) and western blotting are used to detect the expression of inflammatory factors and the levels of angiogenesis-related factors in ovarian tissues. Inflammatory cells count and ovarian angiogenesis are evaluated by immunofluorescence staining. This research shows that TSP1 and ADSCs treatment can significantly reduce the inflammatory state of PCOS mice, relieve the degree of ovarian cell apoptosis, optimize the ovarian histological manifestations, and restore the levels of related hormones. The proportion of CD31-positive cells in PCOS mice returned to near-normal levels. The synergistic use of ADSCs and TSP1 therapy can exert a more impressive effect by inhibiting the ovarian inflammatory response and regulating the balance of angiogenesis than the single application in PCOS mice.

ACTH impairs the migratory and secretory profile of mononuclear cells during proestrus in cattle

The aim was to evaluate the effect of ACTH on the mechanisms involved in peripheral blood mononuclear cells (PBMCs) infiltration into the ovary during dairy cattle proestrus. Regarding this, proper expression pattern of adhesion molecules must take place both in PBMCs and in endothelial cells. Argentinian Holstein cows (n = 12) were treated with 100 IU of ACTH every 12 h for 4 days before ovulation when ovariectomy was performed (day 18). Blood samples were taken on day 15 (0 h) and immediately before (72 h) and after (74 h) the last ACTH administration. In PBMCs, flow cytometry was performed to analyze CD44, CD11b and CD62-L expression along with gene expression of chemokines' receptors. Interleukin (IL)-4 and tumor necrosis factor-α (TNF-α) production was analyzed by flow cytometry after exposing PBMCs to autologous follicular fluid. In ovarian blood vessels, expression of the vascular endothelium cell adhesion-1 (VCAM-1) and the platelet endothelial cell adhesion molecule-1 was evaluated by immunohistochemistry. In T-lymphocytes, the expression of CD44 and CD11b was lower at 72 h in ACTH-treated cows (P < 0.05). In monocytes, the expression of CD11b and CD62-L was lower at 72 h in ACTH-treated cows (P < 0.05). Also, the percentage of IL-4+ cells was higher in ACTH-treated cows, meanwhile, the percentage TNF-α+ cells was lower in ACTH-treated cows (P < 0.05). Finally, in the vessels associated with the preovulatory follicle VCAM-1 immunoexpression was lower in ACTH-treated cows (P < 0.05). Here, we present novel insights into the effect of stress during the preovulatory period on the inflammatory pathway necessary for ovulation.

Pre-Operative Evaluation of Color Doppler Ultrasonography to Predict Malignancy in Ovarian Masses at Ain-Shams University

Background Ovarian cancer is the second most common gynecologic malignancy in developed countries and the third most common gynecologic malignancy in developing countries. This cancer is characterized by high malignancy, difficult early detection, low survival rate, and high fatality rate. Transvaginal ultrasonography is the first choice for imaging to differentiate between a benign and a malignant adnexal mass. Aim of the Work The aim of the study is to determine predictive value of pre-operative resistance index (RI) of color Doppler of ovarian vessels in identifying potential ovarian malignancy at Ain Shams maternity hospital between May 2015 and May 2020. Methods this retrospective observational study, was done on total 379 patients who underwent laparotomy for adnexal masses at Ain Shams University hospitals over five years period between May 2015 and May 2020 with inclusion and exclusion criteria. Medical records of the study population were revised to assess demographic data, ultrasound criteria and histopathological result Results Thin wall and clear content are negatively correlated with ovarian malignancy and these correlators statistically significant. While presence of papillae and septation are positively correlated with ovarian malignancy and these findings were statistically highly significant. Masses proved to be ovarian malignancy were mostly unilateral, more than 5 cm size, thick wall, with turbid content, solid consistency, unilocular with papillae and septation. RI in our study was lower in malignant lesions ranging between (0.22–0.60) and the Mean±SD of resistance index values in the ovarian cancer (0.48±0.07). Resistance index at cut off value ≤0.54 had high specificity and negative predictive value but moderate sensitivity and positive predictive value in diagnosing ovarian malignancy. Conclusion As evident from the current study, thick wall, turbid content, solid consistency, papillae and septations were significantly most frequent in ovarian cancer. Resistance index was significantly highest in ovarian malignancy. In current study RI was lower in malignant lesions. From the results of current study we can conclude that the pre-operative resistance index (RI) of color Doppler of ovarian vessels had significant high diagnostic performance in predicting ovarian cancer. Resistance index at cut off value≤0.54 in diagnosis of ovarian cancer has sensitivity (85.2%), specificity (91.6%), accuracy (90.2%), positive predictive value (73.4%) and negative predictive value (95.8%).

Emilin2 fosters vascular stability by promoting pericyte recruitment

Angiogenesis, the formation of the new blood vessels from pre-existing vasculature, is an essential process occurring under both normal and pathological conditions, such as inflammation and cancer. This complex process is regulated by several cytokines, growth factors and extracellular matrix components modulating endothelial cell and pericyte function. In this study, we discovered that the extracellular matrix glycoprotein Elastin Microfibril Interfacer 2 (Emilin2) plays a prominent role in pericyte physiology. This work was originally prompted by the observations that tumor-associated vessels from Emilin2−/− mice display less pericyte coverage, impaired vascular perfusion, and reduced drug efficacy, suggesting that Emilin2 could promote vessel maturation and stabilization affecting pericyte recruitment. We found that Emilin2 affects different mechanisms engaged in pericyte recruitment and vascular stabilization. First, human primary endothelial cells challenged with recombinant Emilin2 synthesized and released ∼ 2.1 and 1.2 folds more PDGF-BB and HB-EGF, two cytokines known to promote pericyte recruitment. We also discovered that Emilin2, by directly engaging α5β1 and α6β1 integrins, highly expressed in pericytes, served as an adhesion substrate and haptotactic stimulus for pericytes. Moreover, Emilin2 evoked increased NCadherin expression via the sphingosine-1-phosphate receptor, leading to enhanced vascular stability by fostering interconnection between endothelial cells and pericytes. Finally, restoring pericyte coverage in melanoma and ovarian tumor vessels developed in Emilin2−/− mice improved drug delivery to the tumors. Collectively, our results implicate Emilin2 as a prominent regulator of pericyte function and suggest that Emilin2 expression could represent a promising maker to predict the clinical outcome of patients with melanoma, ovarian, and potentially other forms of cancer.

Beneficial effects of metformin on mice female fertility after a high-fat diet intake

Female fertility is highly dependent on energy balance. High fat diet (HFD) intake entails a risk of infertility and ovulatory disorders. Considering the increase in the prevalence of overweight and obesity over the last decades, it is crucial to understand the mechanisms involved in overweight-associated infertility. In this study, we evaluated the reproductive performance of female mice fed with a HFD and the effects of metformin administration on ovarian function in these mice. We hypothesized that one of the mechanisms involved in subfertility due to a HFD intake is the alteration of ovarian blood vessel formation. We found that mice fed with HFD had altered estrous cycles and steroidogenesis, increased ovarian fibrosis, fewer pups per litter and require more time to achieve pregnancy. HFD-fed mice also presented dysregulated ovarian angiogenesis and an increase in nuclear DNA damage in ovarian cells. Ovulation rates were lower in these animals, as evidenced both in natural mating and after ovulation induction with gonadotropins. Metformin ameliorated ovarian angiogenesis, improved steroidogenesis, fibrosis, and ovulation, decreased the time to pregnancy and increased litter sizes in HFD-fed mice. We conclude that ovarian angiogenesis is one of the mechanisms detrimentally affected by HFD intake. Since metformin could improve ovarian microvasculature, it may be an interesting strategy to study in women to shed light on new targets for patients with metabolic disturbances.

Loss of p16 does not protect against premature ovarian insufficiency caused by alkylating agents

BackgroundChemical agents such as alkylating agents (AAs) that are commonly used for the treatment of cancer cause great damage to the ovaries, thereby significantly increasing the risk of premature ovarian insufficiency (POI). However, the exact molecules underlying AA-induced POI remain largely obscure. Upregulation of the p16 gene may contribute to the progression of POI. As yet, no in vivo data from p16-deficient (KO) mice are available to demonstrate a critical role of p16 in POI. In the present study, we employed p16 KO mice to investigate whether loss of p16 could protect against POI caused by AAs.MethodsWT mice and their p16 KO littermates received a single dose of BUL + CTX to establish an AA-induced POI mouse model. One month later, oestrous cycles were monitored. Three months later, some of the mice were sacrificed to collect sera for measurements of hormone levels and ovaries for measurements of follicle counts, the proliferation and apoptosis of granulosa cells, ovarian stromal fibrosis and vessels. The remaining mice were mated with fertile males for the fertility test.ResultsOur results showed that treatment with BUL + CTX significantly disrupted the oestrous cycles, increased the levels of FSH and LH while decreasing the levels of E2 and AMH, decreased the counts of primordial follicles and growing follicles while increasing the counts of atretic follicles, reduced the vascularized area in the ovarian stroma, and decreased fertility. All of these results were comparable between WT and p16 KO mice treated with BUL + CTX. In addition, ovarian fibrosis was not increased significantly in WT and p16 KO mice treated with BUL + CTX. Growing follicles with normal appearance had normally proliferating granulosa cells (without apparent apoptosis).ConclusionWe concluded that genetic ablation of the p16 gene did not attenuate ovarian damage or help preserve the fertility of mice challenged by AAs. This study demonstrated for the first time that p16 is dispensable for AA-induced POI. Our preliminary findings suggest that targeting p16 alone may not preserve the ovarian reserve and fertility of females treated with AAs.

Comparison of different modified operations in the reduced uteroplacental perfusion pressure rat model of preeclampsia

IntroductionAnimal models are indispensable tools in studying the mechanisms underlying the diseases. Rat models with reduced uterine perfusion pressure (RUPP) were able to mimic the pathophysiological traits of placental ischemia and hypoxia in preeclampsia (PE). However, ischemic injury can lead to a cascade of damage to lower limb ischemia in RUPP. Therefore, the aim of our study was to compare three modified surgical procedures of reducing uteroplacental perfusion pressure, and to provide a reference for the recognition of different PE phenotypes in the future. Material and methodsTo establish a specific uteroplacental malperfusion model of PE in rats, we bilaterally ligated uterine vessels (UU), ovarian vessels distal to ovarian branches (OO), or both (sRUPP) at 13.5 days post coitum. 21 Sprague-Dawley rats in total were used and were divided into four groups: Sham (n = 4), UU (n = 6), OO (n = 5) and sRUPP (n = 8). ResultsThe results showed that the OO and sRUPP groups could successfully mimic the phenotypes of PE while UU group not. Then, autophagy, apoptosis, and synthesis of unsaturated fatty acids were increased in both the OO and sRUPP groups compared with the Sham group, while inflammation were not statistically different. ConclusionsThe OO and sRUPP groups could successfully establish the rat model of PE while the UU group not. Notably, between the OO and sRUPP groups, the OO group has a higher fetal survival rate and might be more suitable for studying fetal-related questions, while the sRUPP group has a heavier phenotypic profile and is more suitable for studying maternal phenotypes related to PE.

Evaluation of tubal patency and its impact on ovarian blood flow and function: a comparison of hysterosalpingography and HyCoSy

Objective: To investigate Hysterosalpingo Contrast Sonography (HyCoSy) as a safe, effective, easy, and cheaper approach to measure tubal patency than hysterosalpingography (HSG) and to correlate better ovarian function, endometrial and ovarian blood flow, and conception rates in infertile women. Methodology: This cross-sectional study included 40 infertile women between 22 and 42 years age; 20 of them had HSG on day 6 or 7 of cycle and 20 HyCoSy with normal saline and 100 mg hydrocortisone. All underwent the protocol of 75 iu gonal F sc on days 2 and 3, with clomiphene 50 mg twice daily from days 2 to 7 or letrizole 2.5 twice daily from days 3 to 8 (around day 14). Evaluated criteria: resistance index (RI) and perfusion index (PI) of ovarian vessels by Doppler ultrasound, number and size of follicles for both groups, endometrial thickness, endometrial pattern, zones of blood flow to endometrium. Then HCG to promote ovulation and progesterone to support luteal phase. Results: HSG group mean age was 29.7 6 HYCOSY group age was 29 6 years. 82.1% of HSG females and 90.1% of HyCoSy females had 2nd infertility. Females undergoing HSG had 42.9% I zone and 65.6% IV zone. Females undergoing HSG and HyCoSy had 1 follicle, respectively. 68.8% of HyCoSy females were pregnant. HSG and HyCoSy had different RI, thickness. HyCoSy was thicker and had less RI than HSG. HSG and HyCoSy had similar numbers and sizes of follicles. Conclusion: HyCoSy was a safe, effective, easy, and cheaper way to evaluate tubal patency than HSG, less RI and increase endometrium thickness.

Toxic Effects of Cadmium on the Female Reproductive Organs a Review

Abstract Cadmium (Cd) is a common environmental pollutant present in soil and associated with many modern industrial processes. Cadmium may adversely influence the health of experimental animals and humans and exert significant effects on the reproductive tract morphology and physiology. During embryonic development, cadmium suppresses the normal growth and development of the ovaries, and in adults it disrupts the morphology and function of the ovaries and uterus. The exposure to cadmium has adverse effects on the oocyte meiotic maturation affecting the structure of ovarian tissue. The distribution of follicles and corpus luteum in the ovarian tissues has been shown to be disrupted, affecting the normal growth and development of the follicles. In the ovarian cortex, the number of follicles at different stages of maturation decreased, and the number of atretic follicles increased. In the medulla, oedema and ovarian haemorrhage and necrosis appears at higher doses. Granulosa cells exposed to cadmium exhibited morphological alterations. Oocyte development was inhibited and the amount of oocyte apoptosis was higher. Cadmium exposure also caused changes in the structure of the ovarian blood vessels with reduction in the vascular area. Cadmium effects included increased uterine weight, hyperplasia and hypertrophy of the endometrial lining. Exposure to cadmium had specific effects on gonadal steroidogenesis by suppressing steroid biosynthesis of the ovarian granulosa cells and luteal cells. Progesterone, follicle stimulating hormone, and luteinizing hormone decreased significantly after CdCl2 administration. Cadmium can suppress the female’s ovulation process and cause temporary infertility.

Calcium chloride diluted in ethanol 95% as female sterilizing agent: effect of transcutaneous delivery in rats

BackgroundDifferent fertility control methods are investigated as a tool for population control of free-roaming animals. Chemical castration using calcium chloride has been widely studied over the years in males, but there are few studies related to its use in females. Therefore, we aimed to evaluate the local effects, as a potential chemosterilant, of two concentrations of calcium chloride diluted in 95% ethanol when administered by transcutaneous ultrasound-guided intraovarian injection in rats. In this study, 30 female Wistar rats were randomly divided into three treatment groups, which consisted of transcutaneous ultrasound-guided intraovarian injection of: 0.9% sodium chloride solution (GC); 10% calcium chloride diluted in 95% ethanol (G10); 20% calcium chloride diluted in 95% ethanol (G20). The animals were subdivided into two evaluation times, 15 days (n = 5 of each group) and 30 days (n = 5 of each group) after the intraovarian injection. The ovarian diameter was measured using ultrasound image prior and immediately after the injection and after the treatment period. Furthermore, animals’ clinical evaluation, estrous cycles assessment, macroscopic examination of the abdominal cavity and histological evaluation of the ovaries were performed.ResultsOvarian ultrasound measurement revealed changes (p < 0.05) between ovarian diameters before and immediately after the injection in all treatments. Three animals in G20 had a small focal skin lesion at the injection site that evolved to total healing. Extended and abnormal estrous cycles were observed in G10 and G20. At gross examination, adhesions and ovarian cysts were noticed in both groups, G10 and G20. Also, the histopathology analysis revealed changes in ovarian architecture and vessel congestion in G10 and G20, but ovarian tissue damage was greater in the ovaries treated with the highest concentration (G20).ConclusionsThe results indicate that 20% calcium chloride diluted in 95% ethanol may be a potential agent for inducing sterilization in females and was possible to be minimally invasively delivered.

Robotic-Assisted Resection of Pelvic Arteriovenous Malformation Utilising Intraoperative Video Angiography with Indocyanine Green

<h3>Study Objective</h3> Surgical resection of pelvic arteriovenous malformations (AVM) can be challenging, and pre-operative imaging may not clearly identify feeding vessels. We describe a case of pelvic AVM in a young woman and demonstrate the robotic surgical resection utilising video angiography with indocyanine green (ICG). <h3>Design</h3> Case report and surgical video. <h3>Setting</h3> Four-arm robotic assisted laparoscopy. <h3>Patients or Participants</h3> A nullipara with pelvic AVM. <h3>Interventions</h3> Robotic-assisted resection of pelvic AVM guided by intraoperative ICG angiography. <h3>Measurements and Main Results</h3> A 22-year-old woman presented with progressively worsening left pelvic pain. Pelvic ultrasound demonstrated a 7cm left adnexal vascular mass and magnetic resonance angiogram confirmed a left pelvic AVM. The patient was counselled regarding the risks of embolization versus surgery and decided on the latter. Using a robotic surgical system, the left pelvic side wall was opened at the pelvic brim and careful dissection of the retroperitoneal alveolar tissue was performed. 3mL of a 2.5mg/mL solution of ICG was injected peripherally, followed by 10mL bolus of normal saline. Using the near infra-red imaging of the robotic system, the ICG demonstrates small efferent vessels arising from the left ovarian vessels and a large vein communicating with the left external iliac vein. Vascular clips were applied to the aberrant vein prior to ligation. The AVM was carefully dissected away from the surrounding tissues, with use of bipolar diathermy for coagulation of smaller vessels. A further dose of ICG was injected after resection to ensure haemostasis and to confirm the perfusion of remaining organs. Mesosalpinx and pelvic side wall peritoneum were closed with 2-0 barbed suture. The patient was discharged the following day with complete resolution of left pelvic pain and normal pelvic ultrasound scan 6 weeks later. <h3>Conclusion</h3> Robotic surgical resection of pelvic AVM is enhanced with guidance from intraoperative ICG video angiography to ensure haemostasis and complete excision.

COMPARATIVE CHARACTERISTICS OF METHODS OF LIGATION OF OVARIAN VESSELS IN OVARIOGYSTEROECTOMY IN BITCHES

The dog is the most common type of pet. These are companion animals, shepherd dogs, and service animals, that is, they can perform many different functions, improving and simplifying human life. In turn, owners should closely monitor the health of their pet, including the reproductive system. Sterilization of female small domestic animals, including bitches, is an urgent issue of controlling their numbers, as well as preventing pathologies of their reproductive system. Currently, there are several basic techniques for performing ovariohysterectomy in bitches, namely, the ligation of ovarian vessels, their electrocoagulation using a bipolar electrocoagulator, by applying vascular clips. The purpose of this work was to comparatively characterize the methods of ligation of ovarian vessels in female ovariohysterectomy and to search for the most effective, with the least complications and cheaper method of vascular ligation in ovariohysterectomy of service females. Endoscopic sterilization of females is carried out by LigaSure electrofusion (the technology of "soldering" blood vessels with electrosurgical instruments), so this method seems to be relevant when performing laparotomic ovariohysterectomy in bitches. In the course of the research, it was found that the ligation of ovarian vessels using the Ligash electrocoagulator is less traumatic, simpler, and the time of the surgical operation is reduced. During this manipulation, the contact of the surgeon's hands with the abdominal organs of the animal is minimized, which eliminates the occurrence of postoperative infections, tissue injury and pain after sterilization. This technique is carried out without the use of suture material, so there is no risk of complications in the form of its rejection or the development of an adhesive process.

A Comparison Between the Effect of Low-Level Laser Therapy and Clomiphene on Rats’ Ovarian Tissue Blood Vessels Under In Vivo Conditions

Background: Studying the prevalence of infertility as a common disease and its treatment have recently become an important issue. These treatments include drugs and surgery; and lasers have also been used complementarily. However, they affect the ovarian blood vessels number. Accordingly, the present study was conducted to investigate the photo-bio stimulation effect on near-infrared and red laser as of low-level lasers on the blood vessels in ovarian tissue, compared with the clomiphene’s effect. Methods: Twenty-eight female rats were randomly divided into four groups: Control (CT), Clomiphene Drug (D), Red Laser (RL) and Near-Infrared Laser (NIRL). Afterwards, the laser groups received irradiation (5 J/cm2 dose) and the rats in group D received clomiphene (1µg/kg). After the experiment, the animals were anesthetized and their ovaries were removed. Henceforth, the laser’s effect was investigated and compared with that of clomiphene. Results: The number of the blood vessels increased in NIRL (71.96%) and RL (67.070%) groups, compared with CT. It was also increased in NIRL (59.81%) and RL (14%) compared to D group. In addition, it increased in NIRL (53.27%) compared with RL. This increase was significant in the NIRL group indicating that NIRL increases ovarian activity to produce blood vessels that can be certainly used in future studies for finding a cure for ovarian negligence to produce more blood vessels and treat diseases caused by it. Conclusion: The results convinced us to introduce laser as a new method to increase the ovarian activation by increasing the blood vessels in a future study. Although the mechanism of low-level lasers action is not well known, it has been proved to be more effective than clomiphene.

Conservative surgical repair in cervical atresia associated with partial or complete absence of the vagina

To describe the surgical technique of laparoscopically assisted uterovaginal/vestibular anastomosis in patients with cervical atresia associated with partial or complete absence of the vagina. Surgical video article. Local institutional review board approval and written permission from the patients were obtained. Tertiary referral center. The surgical video presents surgical correction in 3 different patients with cervical agenesis. The first patient, aged 14 years, had a normoconformed uterus and total absence of the vagina. The second patient, aged 12 years, demonstrated a left unicornuate uterus and partial absence of the vagina. The third patient, aged 13 years, displayed a right unicornuate uterus and total absence of the vagina. Laparoscopic time and perineal time. During laparoscopy, the entire abdominopelvic cavity was assessed to evaluate the uterine morphology and size to exclude anomalies such as hematometra. The adnexa and adhesions were evaluated and any endometrial flare-ups were treated appropriately. A laparoscopic ultrasound probe was used to evaluate the size and location of the endometrial cavity. In cases with total absence of vaginas, an H-shaped incision in the hymenal dimple allowed a larger area of available tissue for the anastomosis. A tunnel was then created by blunt finger dissection between the bladder and rectum. Simultaneously, the uterus was pushed caudally by an assistant while the operator grasped it from below using an internal probe. A circular myometrial incision at the uterine caudal body allowed to reach the endometrial cavity and open it. The edges of the uterine cavity were then anastomized with the edges of the hymenal incision. In cases with partial absence of vaginas, the creation of the tunnel between the vagina and rectum was not necessary and the open uterus was anastomosed with the margins of the vaginal dome, engraved on the guide of a metal dilator. All patients received broad-spectrum antibiotics (i.e., cephalosporins of the last available generation) on the day before surgery and on the day of surgery. Intraoperative anatomic and ultrasound data, neovaginal length, and recovery of menstrual function 180 days after surgery. The surgical procedure was successful in all cases. No major complications were recorded, and in particular, no bladder or rectal injuries occurred. No stenosis of the neocervix was recorded. The main hospital stay of the patients was 3.5 ± 1.5 days. In each case, the neovagina developed gradually over time after surgery because of the upward traction action exerted by the uterus through its natural ligament apparatus (cardinal ligaments and ovarian vessels). This fact eliminated the requirement for the use of a mold after surgery. At the 15-week follow-up, vaginoscopy was performed, with mucus observed at the site of uterovaginal anastomosis in all cases. None of the patients developed infection after surgery because of the avoidance of molds or pessaries and the natural mucus production. Six months after surgery, the length of the neovagina was >4 cm in all 3 cases. Laparoscopic-assisted uterovaginal/vestibular anastomosis may be considered the treatment of choice for patients with cervical atresia associated with partial or complete absence of the vagina.

Ability to Perform Laparoscopic Intra- and Extracorporeal Suture Ligations in a Live Canine Ovariectomy Model after Simulation Training.

Veterinary resident training in minimally invasive surgery is currently inconsistent and depends on innate psychomotor skills. Simulation training has been shown to effectively increase basic skills, but demonstration of simulation training effects on advanced skills in the operating room is sparse. We aimed to determine if simulation-trained novice surgeons were able to perform laparoscopic suture ligation in live dogs. Three novice laparoscopic surgeons underwent a 12-session simulation training program with subsequent laparoscopic skills testing to demonstrate competency. The median skills scores of trainees and of one experienced surgeon were 417 and 472, respectively. Eighteen healthy client-owned (shelter) dogs were operated on by four surgeons: one experienced American College of Veterinary Surgeons (ACVS) diplomate, two novice ACVS residents, and one novice ACVS diplomate. Laparoscopic ovariectomy was performed with suture ligation of the ovarian pedicles. Successful surgery was defined as no evidence of ovarian vessel bleeding after transection of the pedicles. Simulation-trained novices performed successful suture-ligated ovariectomies in 11/13 dogs (85%), and the experienced surgeon in 5/5 (100%) dogs. Median total ligation time was 30 minutes (range: 17-57), which was not different among surgeons (p = .118). Median total surgery time was 105 minutes (range: 69-156) for novices and 89 minutes (range: 65-99) for the experienced surgeon (p = .038). Extensive simulation training including suturing may contribute toward surgery residents being able to perform complex laparoscopic procedures. These results need to be confirmed in larger numbers of trainees.