Surgery For Benign Indications Research Articles

Unveiling the Accuracy of Ultrasonographic Assessment of Thyroid Volume: A Comparative Analysis of Ultrasonographic Measurements and Specimen Volumes.

In endocrine surgery, a precise ultrasonographic measurement of thyroid volume is crucial. However, there is limited comparative research between ultrasonographic and specimen volumes, which has left this issue open to debate. This study aims to assess the accuracy of recommended formulas for ultrasonographic thyroid volume measurement by comparing them to specimen volumes and analyzing the influencing variables. From the data of 120 eligible patients, different formulas, including ultrasonographic thyroid volume (US-TV) based on the ellipsoid formula, lower correction factor thyroid volume (LCF-TV), and calculated ultrasonographic (derived formula) thyroid volume (CU-TV), were used to estimate the thyroid volume based on measurements taken prior to surgery. These measurements were compared with the intraoperative specimen volume (IO-TV) derived using Archimedes' principle. According to our findings, the mean values for US-TV and LCF-TV were significantly lower, whereas CU-TV was higher than IO-TV. Deviations were more significant in patients who had surgery for benign indications or compressive symptoms and in those with suppressed thyroid-stimulating hormone levels. Although the ellipsoid formula tends to underestimate the actual thyroid volume, it remains the most accurate method for measuring ultrasonographic thyroid volume. The deviation is greater for larger volumes.

Tips and Tricks for Adapting to Single Port Robotic Surgery

Study Objective Demonstrate ways of successfully navigating inherent limitations to the robotic single port surgical modality in the context of hysterectomy. Design Demonstration of surgical technique. Setting Academic medical center. Patients or Participants Women undergoing robotic single port surgery for benign indications. Interventions Robotic single port surgery using the SP1098 da Vinci SP® Surgical System. Measurements and Main Results The primary challenges with single port surgery are optimizing visualization and instrument mobility. The camera can be moved in a traditional fashion, or be cobra-ed, in which the camera retracts and is lifted above or below the instruments to allow for optimal utilization of space. It is best to keep the instruments as extended into the pelvis as is comfortable to allow the surgeon to engage the elbows of the instruments. Obtaining traction of tissue is limited with the single port robot. Medial traction and cephalad traction along the axis of the trocar is not restricted; however, adequate lateral or anterior traction is more challenging to obtain. The single port trocar accommodates a maximum of three instruments. However, two instruments are sufficient to achieve most surgical goals. If the fourth aperture of the trocar is not in use, a laparoscopic instrument can be inserted by the bedside assistant. Unfortunately, the assistant's mobility is greatly restricted. Movement of any laparoscopic instrument is restricted to the axis of the single port trocar. Conclusion Robotic single port gynecologic surgery is achievable with minimal adjustments to surgical technique. Optimizing visualization and instrument mobility is key for successful use of this surgical modality.

Prevalence of and Preoperative Risk Factors for Unplanned Inpatient Admission Following Outpatient Gynecologic Surgery

Study Objective We aimed to identify the prevalence of unplanned inpatient admission following outpatient gynecologic surgery. Additionally, we aimed to identify factors available preoperatively that place patients at higher risk for admission. Design Retrospective cohort study. Setting Academic medical center. Patients or Participants Women (n=2,373) age 18 and older who underwent scheduled outpatient gynecologic surgery for a benign indication between November 2017 and September 2019. Interventions Gynecologic surgery performed for benign indications. Measurements and Main Results The primary outcome was inpatient admission directly following the index surgery, defined by Medicare as spending two midnights or more in the hospital. Patients who were admitted were older (median age 50 vs 42, p There were 53 (2%) admissions directly following the index surgery. In a multivariate model adjusted for age, cardiopulmonary and pain comorbidities, ASA class, and surgery performed, the following factors were significantly associated with increased odds of inpatient admission: undergoing surgery with urogynecology (aOR 4.0; 95% CI 1.7-9.6) or gynecologic oncology (aOR 3.2; 95% CI 1.3-8.1) as compared to benign gynecology and undergoing intra-abdominal surgery (aOR 10.6; 95% CI 3.2-34.9) or prolapse surgery (aOR 6.8; 95% CI 1.8-26.1) as compared to other vulvovaginal surgery. Conclusion The prevalence of inpatient admissions following outpatient gynecologic surgery for benign indications is low. Patients undergoing surgery with urogynecology or gynecologic oncology were at higher risk for admission, even when adjusted for age, major comorbidities, and surgery performed. Due to the overall low prevalence of the outcome, larger studies are needed to further clarify what places these patient groups at higher risk.

Hysterectomy with and without oophorectomy and all-cause and cause-specific mortality

Hysterectomy is one of the most commonly performed gynecologic surgeries, with an estimated 30% of women in Australia undergoing the procedure by age of 70 years. In the United States, about 45% of women undergo hysterectomy in their lifetime. Some studies have suggested that this procedure increases the risk of premature mortality. With many women making the decision to undergo hysterectomy for a benign indication each year, additional research is needed to clarify whether there are long-term health consequences of hysterectomy. This study aimed to examine the association between hysterectomy for benign indications, with or without removal of the ovaries, and cause-specific and all-cause mortality. Our cohort of 666,588 women comprised the female population of Western Australia with linked hospital and health records from 1970 to 2015. Cox regression models were used to assess the association between hysterectomy and all-cause, cardiovascular disease, cancer, and other mortality by oophorectomy type (categorized as none, unilateral, and bilateral), with no hysterectomy or oophorectomy as the reference group. We repeated these analyses using hysterectomy without oophorectomy as the reference group. We also investigated whether associations varied by age at the time of surgery, although small sample size precluded this analysis in women who underwent hysterectomy with unilateral salpingo-oophorectomy. In our main analysis, women who underwent hysterectomy or oophorectomy as part of cancer treatment were retained in the analysis and considered unexposed to that surgery. For a sensitivity analysis, we censored procedures performed for cancer. Compared with no surgery, hysterectomy without oophorectomy before 35 years was associated with an increase in all-cause mortality (hazard ratio, 1.29; 95% confidence interval, 1.19-1.40); for surgery after 35 years of age, there was an inverse association (35-44 years: hazard ratio, 0.93; 95% confidence interval, 0.89-0.97). Similarly, hysterectomy with bilateral salpingo-oophorectomy before 45 years of age was associated with increased all-cause mortality (35-44 years: hazard ratio, 1.15; 95% confidence interval, 1.04-1.27), but decreased mortality rates after 45 years of age. In our sensitivity analysis, censoring gynecologic surgeries for cancer resulted in many cancer-related deaths being excluded for women who did not have surgery for benign indications and thus increased the hazard ratios for the associations between both hysterectomy without oophorectomy and hysterectomy with bilateral salpingo-oophorectomy and risk of all-cause and cancer-specific mortality. The sensitivity analysis therefore potentially biased the results in favor of no surgery. Among women having surgery for benign indications, hysterectomy without oophorectomy performed before 35 years of age and hysterectomy with bilateral salpingo-oophorectomy performed before 45 years of age were associated with an increase in all-cause mortality. These procedures are not associated with poorer long-term survival when performed at older ages.

2462 Don't Forget the Appendix! Incidental Appendix Findings During Laparoscopic Pelvic Surgery

Study Objective Evaluate the incidence of appendectomy for grossly abnormal appearance during laparoscopic gynecologic surgery for benign indications and pathologic concordance. Design Retrospective chart review of patients who underwent an appendectomy during laparoscopic gynecologic surgery for other indications. Setting Surgeries by Advanced Gynecologic Surgery Institute (AGSI), a group of three highly skilled minimally invasive gynecologic surgeons, at three community hospitals in the Chicago area. Patients or Participants A total of 3,478 patients underwent laparoscopic surgery by AGSI between January 1, 2013 through February 28, 2018. Seventy-three patients underwent appendectomy, and fifty-six were included in final analysis. All patients were 18 years of age or older with available operative and pathology reports. Interventions IRB approval was obtained and a retrospective chart review conducted using outpatient and inpatient electronic medical records. Measurements and Main Results Patients were assessed for age, body mass index, surgical indication, procedure performed, intra-operative appendiceal findings, blood loss, pathology, intra-operative events, and postoperative complications. Intraoperatively, the most common indication for appendectomy was endometriosis or fibrosis (61.8%) of which 58.8% had confirmatory pathology and 23.5% had normal pathology. Overall, 75.0% of the specimens were positive for a pathologic process. Four (7.2%) appendiceal malignancies were found, three mucinous and one carcinoid tumor. All three patients with mucinous tumors were operated on by a general surgeon, at same time of gynecologic surgery (1) or at a later date (2). No significant sequelae occurred. Conclusion The appendix should be evaluated during gynecologic laparoscopy, as incidental findings may be identified including malignancies. It is safe for trained gynecologists to perform a laparoscopic appendectomy, but a general surgeon should be consulted intra-operatively when a suspicious mass or malignancy is noted. Future research could evaluate postoperative pain profiles, increased costs and surgical time, and incidence of appendiceal pathology in the endometriosis population.

Processing of fallopian tube, ovary, and endometrial surgical pathology specimens: A survey of U.S. laboratory practices

ObjectiveMany high-grade serous carcinomas initiate in fallopian tubes as serous tubal intraepithelial carcinoma (STIC), a microscopic lesion identified with specimen processing according to the Sectioning and Extensive Examination of the Fimbria protocol (SEE-Fim). Given that the tubal origin of these cancers was recently recognized, we conducted a survey of pathology practices to assess processing protocols that are applied to gynecologic surgical pathology specimens in clinical contexts in which finding STIC might have different implications. MethodsWe distributed a survey electronically to the American Society for Clinical Pathology list-serve to determine practice patterns and compared results between practice types by chi-square (χ2) tests for categorical variables. Free text comments were qualitatively reviewed. ResultsSurvey responses were received from 159 laboratories (72 academic, 87 non-academic), which reported diverse specimen volumes and percentage of gynecologic samples. Overall, 74.1% of laboratories reported performing SEE-Fim for risk-reducing surgical specimens (82.5% academic versus 65.7% non-academic, p < 0.05). In specimens from surgery for benign indications in which initial microscopic sections showed an unanticipated suspicious finding, 75.9% of laboratories reported using SEE-Fim to process the remainder of the specimen (94.8% academic versus 76.4% non-academic, p < 0.01), and 84.6% submitted the entire fimbriae. ConclusionsChanges in the theories of pathogenesis of high-grade serous carcinoma have led to implementation of pathology specimen processing protocols that include detailed analysis of the fallopian tubes. These results have implications for interpreting trends in cancer incidence data and considering the feasibility of developing a bank of gynecologic tissues containing STIC or early cancer precursors.

Cost-effectiveness analysis of conventional laparoscopic versus robotically assisted laparoscopic adnexal surgery for benign indications performed by gynecologic oncologists

Cost-effectiveness analysis of conventional laparoscopic versus robotically assisted laparoscopic adnexal surgery for benign indications performed by gynecologic oncologists

Investigation of Tenascin Expression in Endometriosis

Objective. To evaluate the serum and tissue levels and local expression pattern of tenascin, a high molecular weight extracellular matrix protein, in eutopic and ectopic endometrium from patients with and without endometriosis and to compare the proliferative and secretory phase differences. Materials and Methods. Thirty women with endometriosis and fifteen women without endometriosis undergoing surgery for benign indications were included in the study. Serum and tissue levels and proliferative and secretory phase expression patterns of tenascin in the ectopic and eutopic endometrium were analyzed with immunohistochemistry and immunoassays. The results were compared with Mann-Whitney U test. P values &lt;0.05 were considered as statistically significant. Results. Tenascin expression was detected in both of eutopic and ectopic endometrium of women with and without endometriosis. In immunohistochemical staining, intense staining of tenascin was observed in glandular cells of eutopic and ectopic endometrial tissue samples of both groups during secretory phase (P&lt;0.01). Eutopic and ectopic tissue levels of tenascin were higher than serum tenascin levels only secretory phase (P=0.02). There was no significant difference between groups for tissue and serum levels of tenascin during cycle phases. Conclusion. Tenascin expression showed cyclic change on eutopic and ectopic endometrium.

Prophylactic Salpingectomy Does Not Affect Short and Long Term Surgical Outcomes When Associated to Surgery for Benign Indications

Prophylactic Salpingectomy Does Not Affect Short and Long Term Surgical Outcomes When Associated to Surgery for Benign Indications

Is the Fault in Our Steroids or in Our Selves?

Is the Fault in Our Steroids or in Our Selves?

The detection of microsatellite instability in blind endometrial samples—a potential novel screening tool for endometrial cancer in women from hereditary nonpolyposis colorectal cancer families?

Microsatellite instability (MSI) is the phenotypic molecular characteristic of the majority of tumors associated with the hereditary nonpolyposis colorectal cancer syndrome (HNPCC). Women in this group have an increased risk of endometrial cancer (EC). This study aimed to determine whether MSI could be demonstrated in blind endometrial samples from women with EC, HNPCC kindreds undergoing screening for EC, and women with normal endometrium. Twenty-four women with EC, 20 women from HNPCC kindreds, and 20 women undergoing gynecological surgery for benign indications underwent blind sampling. MSI analysis was performed by conventional polymerase chain reaction using fluorescent-labeled primers and automated analysis. Twelve microsatellites were studied with MSI defined as evident when novel alleles were seen in endometrial biopsy samples compared to genomic DNA. Of the 24 EC samples obtained, sufficient DNA for analysis was extracted in 17 cases. Three cases had evidence of MSI in at least 7/12 loci. None of the endometrium from the two other study groups revealed evidence of MSI. This is the first demonstration of MSI in blind endometrial biopsies. The ability to demonstrate MSI in heterogenous endometrial samples suggests potential for the development of a novel EC screening tool for women in HNPCC kindreds.