Uterine Extraction Research Articles

Abdominal Parasitic Fibroids after Laparoscopic Surgery Using a Power Morcellation: A Novel Insight from Vietnam and a Narrative Revew of the Literature

Abstract Parasitic fibroid is a rare benign pathology that can be negotiated because of its rarity. The etiology remains unknown following prior intervention related to uterine fibroids. The assessment of this rare disease is usually based on clinical features and imaging modalities. In addition, appropriate management should be individualized where appropriate. Herein, we report an uncommon case at our center and raise proper recognition for all gynecologists. Particularly, in low-and middle-income countries such as Vietnam, where the health-care system is insufficient to follow-up the long-term postoperation. A 40-year-old woman (gravida 3, para 2) presented to the gynecologic examination room due the abdominal pain and increased size of abdominal circumference. The patient had undergone laparoscopy involving the power morcellator without a contained-bag system for myomectomy at our hospital 6 years prior. The imaging diagnostic tools showed multiple hypoechoic disseminated masses in the abdominal cavity. The laparotomy intervention and histopathological endpoints confirmed completely the diagnosis of parasitic fibroid. Although an extremely rare occurrence, parasitic fibroids should be informed to all patients after laparoscopic intervention for uterine fibroids. In addition, the diagnosis of parasitic fibroid should be warranted among the patients presenting with abdominal pain after a history of fibroid resection. The power morcellation in the contained bag, uterine extraction in hysterectomy, as well as relieving the surgical specimen of uterine fibroids should be gently performed to minimize fibroid tissue disruption.

Comparison of surgical outcomes between manual free vaginal morcellation and no vaginal morcellation for uterine extraction during total laparoscopic hysterectomy: Retrospective cohort study

Aim: We aimed to compare the surgical outcomes between manual free vaginal morcellation and no vaginal morcellation for uterine extraction during total laparoscopic hysterectomy (TLH) performed in a tertiary center. Materials and Methods: A total of 397 TLH either with or without oophorectomy, for a benign indication, surgeries performed at our tertiary hospital between March 2022 and May 2024 were analyzed in our study. Patients who underwent manual free vaginal morcellation were defined as Group I (n=85, 21.4%) and patients who did not undergo vaginal morcellation were defined as Group II (n=312, 78.6%). Demographic characteristics, laboratory values, operation characteristics and histopathological reports were accessed from the hospital database. Results: The median uterine weight of the morcellation group was greater. Median morcellation time was 9 minutes. While the median operation time of Group I was 80 minutes, it was 70 minutes for Group II. The groups were similar with regard to postoperative urinary tract, intraoperative urinary tract and intraoperative bowel injuries. Intraoperative vaginal or perineal laceration was detected at a greater rate in the morcellation group. Conclusion: For large uteruses, TLH is still the best option for suitable patients when performed by experienced surgeons. It has been revealed that manual free vaginal morcellation, performed without the need for additional incisions, is safe, low-cost and practical in total laparoscopic hysterectomies with benign indications.

Defining a Uterine Extraction Score based on a Volume/Access Ratio in Total Hysterectomy: a retrospective cohort study.

Regardless of the technique used, extraction of the uterus is a crucial step in hysterectomy. There is currently no scoring system to predict its feasibility. Our main objective was to determine a predictive score of uterine extraction feasibility to optimise surgical planning of total hysterectomy. As secondary objectives, we examined the correlation between uterine volume predicted by preoperative ultrasound and the final weight of the surgical specimen and analysed the impact of the uterine extraction modality on operative and hospitalisation times. We defined a Uterine Extraction Score (UES) based on the ratio between uterine sizes and vaginal access. This score was retrospectively applied to a cohort of 178 patients who were hysterectomised for benign conditions between January 2019 and December 2022. The UES allows identification of three groups of decreasing feasibility of vaginal extraction, symbolised by traffic light colours: green - vaginal extraction without morcellation, orange -vaginal extraction with morcellation, red - abdominal morcellation by mini-laparotomy or primary laparotomy. The results show that the UES--predicted, and the observed routes of extraction concord in 92% of cases. There is a strong correlation between estimated volume and final uterine weight. Uterine morcellation lengthens the operative time and the hospital stay. The UES seems to be a reliable tool to predict the route of uterine extraction in total hysterectomy. The development of a new scoring system empowers surgeons with decisive information to enhance perioperative outcomes.

Laparoscopic systemic restaging surgery for women with unexpected uterine malignancy

We investigated the feasibility of laparoscopic restaging surgery in patients with unexpected uterine cancer. This retrospective study included eight patients who underwent laparoscopic restaging surgery for Iran University uterine cancer after a prior hysterectomy or myomectomy. The median age of the patients and their body mass index were 55 years (range, 44-78) and 23.8 kg/m2 (range, 20.75- 31.89), respectively. The median interval between the prior hysterectomy and the restaging surgery was 21 days (range, 10-35). The median operating time and time for the return of bowel activity were 325 minutes (range, 200-475) and 35 hours (range, 18-50), respectively. The median numbers of harvested pelvic and para-aortic lymph nodes were 17.5 (range, 14-29) and 20.5 (range, 7-36), respectively. In seven of the eight patients, uterine extraction was performed with vaginal or electronic morcellation. The final International Federation of Gynecology and Obstetrics stage was IA in all patients. Intraoperative and postoperative complications did not occur in any of the patients, except for the need for transfusion. Patient 4 had synchronous primary cancer (stage IA) of the endometrium and left ovary. Two of the eight patients with clear cell carcinoma received chemotherapy, and none received radiotherapy. All patients survived without disease recurrence. Restaging surgery might be necessary for highly selective patients with unexpected uterine malignancies. This would be an alternative surgical modality for complete staging and planning tailored adjuvant treatments. However, lymphadenectomy might not be performed in patients with early uterine cancer.

Case Report of Hyperthyroidism on Molar Pregnancy

The hydatidiform mole in its partial or total form is a common cause of thyrotoxycosis during pregnancy. The structural homology of the placental hormone choriogonadotropin (hCG) and the hormone thyroid stimulating hormone (TSH) produced by the pituitary gland is the cause. The diagnosis of hyperthyroidism secondary to Gestational trophoblastic diseases is made in the face of low or undetectable TSH, high T4l compared to high hCG level and a suggestive image on pelvic ultrasound. The clinical signs relating to thyropathies are often absent. This is a resolving table after uterine extraction.

41: Laparoscopic retroperitoneal hysterectomy with uterine artery ligation in morbidly obese patients at a freestanding ambulatory surgery center

To compare the outcomes of laparoscopic retroperitoneal hysterectomy (LRH) in morbidly obese patients (BMI ≥ 40 k/m2) versus non-obese patients (BMI < 30 k/m2) and obese patients (BMI ≥ 30 and < 40 k/m2) at a freestanding ambulatory surgery center. A retrospective comparative analysis was performed of 1,679 women, age 18 years or older, non-pregnant, who underwent LRH by one of two laparoscopic gynecologic surgical specialists at a freestanding ambulatory surgery center serving the Washington, DC area, between October 2013 and January 2019. The study was deemed exempt from informed consent according to 45 CFR 46.101(b) by IntegReview IRB, an independent institutional review board. LRH performed via retroperitoneal dissection, uterine artery ligation at the origin at the anterior branch of the internal iliac artery, vaginal uterine extraction, and transvaginal cuff closure. No power morcellation used. Postoperative complications graded using the Clavien-Dindo Classification system. The only statistically significant differences in surgical outcomes were higher mean operative time and estimated blood loss (EBL) in the obese groups, however these differences were not clinically meaningful (3-4 minutes and 25-31 mL, respectively). There was no difference in intraoperative complication rates across BMI categories. The postoperative complication rates were lower in the in the morbidly obese group compared to the non-obese group. There were a total of 2 postoperative hospital transfers out of the 1,679 patients (Table 1, Figure 1). Laparoscopic retroperitoneal hysterectomy can be performed safely in a freestanding ambulatory surgery setting, with low rate of complications and hospital transfers, and no significant difference in surgical outcomes in morbidly obese patients.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Autotaxin is a novel molecular identifier of type I endometrial cancer

Endometrial cancer is the most common cancer of the female genital tract in Western Countries, with an incidence of 150.000 new cases/year. Despite high incidence, little is known about the molecular pathogenesis of this tumor. Phospholipids including lysophosphatidic acid (LPA) are involved in proliferation and dissemination of cancer. LPA is a potent bioactive phospholipid synthesized by autotaxin (ATX) through its lysophospholipase D activity. Recent evidence suggests that the ATX/LPA signaling axis plays a role in endometrial cancer. We carried out a prospective study involving two groups of patients classified in accordance to hysteroscopic-guided biopsy. Patients with histological diagnosis of endometrial cancer were enrolled into group one, whereas control patients with pelvic organ prolapse were assigned group two. Both groups underwent hysterectomy, with either open or laparoscopic surgery. After uterine extraction, a second endometrial biopsy was performed to collect tissues. Real-Time PCR was performed to evaluate ATX gene expression in collected tissues. Statistical analysis including unpaired two-way or one-way Student's t test and ANOVA was performed. We found ATX gene expression significantly higher in neoplastic endometrium compared with normal tissue (P value = 0.0002). In particular, the expression of ATX was significantly elevated in type I endometrial cancer (i.e., endometrioid histotype) compared to type II, in premenopausal women and in patients affected either by obesity (BMI > 30) or diabetes. We propose ATX as a novel potential biomarker particularly implicated in the pathobiology of type I endometrial cancer. Also, we propose ATX as a useful theranostic target in endometrial cancer.

Total Laparoscopic Hysterectomy and Bilateral Salpingo-Oophorectomy for a 6095-g Myomatous Uterus in a Patient of the Jehovah's Witness Faith

Study ObjectiveTo demonstrate techniques for addressing the unique challenges for a minimally invasive approach to hysterectomy presented by a massive myomatous uterus. DesignTechnical video of an operation demonstrating the methods used to perform hysterectomy in this setting, highlighting such aspects as port placement (Fig. 1), uterine manipulation (Fig. 2), exposure, and vascular control (Figs. 3 and 4) (Canadian Task Force classification III). SettingAcademic tertiary care hospital. InterventionA 49-year-old woman elected to proceed with laparoscopic hysterectomy after years of suffering from bleeding and bulk symptoms from a massively enlarged myomatous uterus. A computed tomography scan estimated uterine dimensions of 32 × 27 × 24 cm, for a volume of >7000 mL (Fig. 5). Her surgical history included a ventral herniorrhaphy with mesh, and her body mass index was 43 kg/m2. She was a Jehovah's Witness, and thus blood transfusion was not an acceptable option for her due to a religious prohibition. Intraoperatively, the uterus extended deep into the pararectal and paravesical spaces on the right, from the caudad below the cervix (Fig. 6) to superiorly near the liver edge (Fig. 7). Measurements and Main ResultsLaparoscopic hysterectomy was successfully completed (Table), and the patient was discharged on the day after surgery. Final pathology revealed a 6095-g uterus with benign leiomyomata. She presented 9 days after surgery with nausea and vomiting, suspicious for an incarcerated hernia at the tissue extraction site. Her symptoms were ultimately determined to be due to either ileus or small bowel obstruction, which likely could have been managed nonoperatively with bowel rest and fluids. She stayed an additional 2 days after readmission and was then discharged, with no further complications. ConclusionsThe size of the uterus was once considered a barrier to the use of laparoscopy for hysterectomy, but experience has shown that the benefits of minimally invasive surgery are particularly relevant for large myomas [1–4], given that a vaginal approach is not feasible and that other risks, such as wound complications and venous thromboembolism, would be greater with the large incision required to perform the procedure by laparotomy. This video uses a particularly challenging case to demonstrate a roadmap for addressing myomas in laparoscopic hysterectomy through exposure and vascular control. Although the presentation focused on the initial steps of the procedure and not on uterine extraction, this patient's readmission highlights potential complications associated with various methods of tissue removal for very large specimens.

476 - Robotic-Assisted Hysterectomy for Endometrial Cancer: Comparing Outcomes of Two Methods for Intact Uterine Extraction

Study Objective: The objective of this study was to compare peri-operative outcomes among patients with endometrial cancer undergoing robotic-assisted laparoscopic hysterectomy (RALH) with either vaginal extraction of the uterine specimen or RALH with uterine extraction via extended incision secondary to large uteri.

Sterility of Selected Operative Sites During Total Laparoscopic Hysterectomy

Study ObjectiveTo describe the type and quantity of bacteria found intraoperatively on the abdomen, vagina, surgical gloves, instrument tips, and uterus at distinct time points during total laparoscopic hysterectomy (TLH). DesignObservational study (Canadian Task Force classification III). SettingAcademic affiliated hospital. PatientsThirty-one women undergoing TLH for benign indications in 2016. InterventionsAfter antibiotic prophylaxis and chlorhexidine preparation, swabs were collected from the vaginal fornices and abdomen. During subsequent TLH, additional swabs were collected from the following sites: surgeon's gloves after placement of the uterine manipulator, tips of instruments used to close the vaginal cuff, uterine fundus after extraction, and surgeon's gloves after removal of the uterus. A calibrated loop was used to inoculate each specimen onto 5% blood and chocolate agars for growth of aerobes and onto Brucella blood, phenylethyl alcohol, kanamycin vancomycin, and Bacteroides bile esculin agars for growth of anaerobes. Manual colony counts were tabulated for all positive cultures and reported in colony-forming units per milliliter (CFU/mL). Measurements and Main ResultsAnaerobic growth was not seen on the instrument tips, in the vagina, or on the abdomen of any patient. Aerobic bacterial growth was not seen in the vagina of any patient. On the surgeon's gloves after uterine manipulator placement, no patients demonstrated sufficient bacterial growth to potentially cause surgical site infection (≥5000 CFU/mL). On the surgeon's gloves following uterine extraction, 1 patient demonstrated sufficient growth to potentially cause infection. None of the patients developed surgical site infections postoperatively. ConclusionCultures from multiple operative sites yielded bacterial growth, but the bacterial concentrations did not exceed the threshold for infection in 98.9% of cultures. Given absent growth from vaginal cultures and rare growth from abdominal cultures, chlorhexidine gluconate 4% is considered an appropriate surgical preparation for use in laparoscopic hysterectomy.

A new approach to supracervical hysterectomy during laparoscopic sacral colpopexy for pelvic organ prolapse: A randomized clinical trial.

Laparoscopic sacral colpopexy (LSC) for pelvic prolapse is a complex procedure, characterized by long operative times and, when combined with supracervical hysterectomy, by a high risk of spreading of unsuspected cancerous tissue. The aim of the present study was to compare, in patients who underwent hysterectomy plus LSC for severe POP, different methods for cervical incision and uterine morcellation. This is a prospective single Institution randomized double-blinded clinical trial enrolling 124 patients with severe POP from June 2014 to May 2015. Patients underwent laparoscopic supracervical hysterectomy (LSH) plus LSC for pelvic organ prolapse and were randomized in Group 1 (monopolar hook and conventional mechanical morcellator) and Group 2 (bipolar laparoscopic loop and bipolar morcellator), for supracervical incision and uterine morcellation, respectively. Our primary endpoints were the operative times and the secondary endpoints the incidence of intra- or post-operative complications. A total of 50 patients for group completed the study. Baseline characteristics were similar between the groups. Cervical cutting time (32 vs. 3.10 sec; P <0.01), morcellation (4.10 vs. 2.13 min; P <0.01) and operative time (131 vs. 118 min; P <0.05) resulted significantly lower in Group 2. No differences were found in terms of intra- or post-operative complications. Laparoscopic bipolar loop and morcellator guaranteed a faster and hemostatic tool during supracervical incision and a controlled and rotation-free uterine extraction. The significant surgical time reduction linked to these devices should be considered even more helpful and effective to perform a complex procedure represented by LSH plus LSC. Neurourol. Urodynam. 36:798-802, 2017. © 2016 Wiley Periodicals, Inc.

Vaginal Morcellation Inside Protective Pouch: A Safe Strategy for Uterine Extration in Cases of Bulky Endometrial Cancers: Operative and Oncological Safety of the Method

To evaluate the operative and oncologic outcomes of an innovative technique for organ morcellation in patients scheduled for laparoscopic treatment of uterine malignancies. Endoscopy is currently considered the standard of care for the operative treatment of endometrial cancer; however, the use of minimal invasive surgery (MIS) is restricted in patients with a bulky uterus or narrow vagina. Conventional unprotected intraperitoneal uterine fragmentation is indeed contraindicated in these cases. Consequently, oncologically safe methods to render these patients eligible for MIS are urgently needed. Prospective study of women with histologically proven endometrial cancer in which uterus removal was a realistic concern owing to both organ size and proportionality. The patients underwent laparoscopic staging, including retroperitoneal lymphadenectomy, total hysterectomy, and bilateral salpingo-oophorectomy, followed by vaginal morcellation of the uterus inside a protective pouch (LapSac). In our series of 30 cases, we achieved successful completion in all patients, without conversion to laparotomy. No surgery-related casualty or intraoperative morbidity was observed. The mean organ size was 246 g (range, 148-420 g), and the average additional operative time related to vaginal morcellation was 16 minutes (range, 9-28 minutes). Proper histopathological staging according to 2009 FIGO staging guidelines could be performed in all specimens. Two patients (6%) presented with significant postoperative complications, 1 each with vesicovaginal fistula and vaginal vault dehiscence. Fourteen patients (46%) needed adjuvant therapy. After a median follow-up of 20 months (range, 6-38 months), the 12-month and 24-month overall survival was 100% and 73.4% (95% confidence interval, 51%-96%), respectively. Four patients with positive lymph nodes died of distant metastasis. No case of pelvic or local relapse was observed. Vaginal morcellation following oncologic principles is a feasible method that permits rapid uterine extraction and potentially avoids unnecessary laparotomies. This series suggests that the technique may be oncologically safe and also can be used in cases of uterine pathology of uncertain malignancy.

Extraction Techniques for Large Uteri After Robotic or Laparoscopic Hysterectomy

After the performance of robotic or laparoscopic hysterectomy, extraction of large uteri must be performed in order to remove the uterus while preserving the benefit of small incisions. Mechanical morcellation is utilized to cut the uterus into strips allowing its removal through 15-20 mm incisions. However, as often fragments are spread in the peritoneal cavity, concern about recurrence with peritoneal leimyomatosis or upstaging of occult malignancies, as well as other limitations has lead many gynecologists to search for other alternatives for uterine extraction including vaginal or mini-lap morcellation techniques. This vide will review different methods of uterine extraction including indications and limitations. Equipment and tools needed as well as an efficient and safe technique for each method will be described.

A safe method of vaginal longitudinal morcellation of bulky uterus with endometrial cancer in a bag at laparoscopy

Total laparoscopic hysterectomy (TLH) is becoming an increasingly popular treatment in endometrial cancer. Intra-abdominal or vaginal uterus morcellation are well described and routinely practiced techniques in removing a benign bulky uterus but contraindicated in endometrial cancer. In malignancy, the uterus needs to be removed intact to avoid intraperitoneal spillage of the endometrial cancer cells, and a uterine size of 12 gestational weeks (g.w.) or larger has been considered a contraindication for the laparoscopic approach. The aim of our study was to evaluate the feasibility and safety of a sealed vaginal morcellation technique in a bag for endometrial cancer laparoscopic treatment. We prospectively scheduled 12 patients affected by endometrial cancer with uterus bigger than 12 g.w. for endometrial cancer laparoscopic treatment. After performing TLH, a sterile plastic wrapping bag was inserted by a 12 mm camera port by rolling it onto the blunt probe. The uterus was covered from the fundus to the cervix, placing the free edges of the bag down into the manipulator cup with two blunt graspers. The specimen completely covered by the bag was then pushed down under direct laparoscopic vision through colpotomy and pulled out from the vagina. The uterus was morcellated by the vaginal route. All patients underwent laparoscopic treatment with vaginal uterine morcellation. The mean uterus weight was 290.8 ± 79.7 g with a mean morcellation operative time of 12.1 min. All vaginal morcellations were completed successfully. All patients were without evidence of local or distant recurrence at the median follow-up time of 18 months. This technique allows the surgeon to morcellate a bulky uterus in cases of endometrial cancer and reduces the chance of neoplastic cell spillage during debulking at TLH. Vaginal morcellation following oncologic rules permits a rapid uterine extraction and may avoid a number of unnecessary laparotomies.

Vaginal morcellation: A new strategy for large gynecological malignant tumor extraction: A pilot study

ObjectiveEvaluate feasibility and safety of a novel technique for uterine morcellation in patients scheduled for laparoscopic treatment of gynecologic malignances. BackgroundThe laparoscopic management of uterine malignancies is progressively gaining importance and popularity over laparotomy. Nevertheless, minimal invasive surgery is of limited use when patients have enlarged uterus or narrow vagina. In these cases, conventional uterus morcellation could be a solution but should not be recommended due to risks of tumor dissemination. MethodsProspective pilot study of women with endometrial cancer in which uterus removal was a realistic concern due to both organ size and proportionality. Brief technique description: after completion of total laparoscopic hysterectomy and bilateral anexectomy, a nylon with polyurethane Lapsac® is vaginally inserted into the abdomen; the specimen is placed inside the pouch that will be closed and rotated 180° toward the vaginal vault and, posteriorly, pushed into the vaginal canal; in the transvaginal phase, the surgeon pulls the edges of the bag up to vaginal introitus and all vaginal walls will be covered; inside the pouch, the operator performs a uterus bisection–morcellation. ResultsIn our series of 8 cases, we achieved successful completion in all patients, without conversion to laparotomy. Average operative time, blood loss and length of hospitalization were favorable. One patient presented with a vesicovaginal fistula. ConclusionThe vaginal morcellation following oncologic principles is a feasible method that permits a rapid uterine extraction and may avoid a number of unnecessary laparotomies. Further studies are needed to confirm the oncological safety of the technique.

V250 ROBOTIC-ASSISTED LAPAROSCOPIC CYSTORRHAPHY FOR IATROGENIC CYSTOTOMY DURING RADICAL HYSTERECTOMY

You have accessJournal of UrologyFemale Voiding Dysfunction (Pelvic Reconstruction and Incontinence)1 Apr 2012V250 ROBOTIC-ASSISTED LAPAROSCOPIC CYSTORRHAPHY FOR IATROGENIC CYSTOTOMY DURING RADICAL HYSTERECTOMY Matthew Maurice, Justin Isariyawongse, Peter Buehner, Siobhan McGregor, Matthew Steinway, and Edward Cherullo Matthew MauriceMatthew Maurice Cleveland, OH More articles by this author , Justin IsariyawongseJustin Isariyawongse Cleveland, OH More articles by this author , Peter BuehnerPeter Buehner Cleveland, OH More articles by this author , Siobhan McGregorSiobhan McGregor Cleveland, OH More articles by this author , Matthew SteinwayMatthew Steinway Cleveland, OH More articles by this author , and Edward CherulloEdward Cherullo Cleveland, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.306AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Injury to the urinary tract is a common complication of minimally-invasive gynecologic surgery, occurring in up to 8% of cases. In the current era of robotic gynecologic surgery, proper identification and management of bladder and other concomitant urinary tract injuries while navigating one's way on and around the robot is a new challenge for the consulting urologist who may or may not be familiar with robotic-assisted surgery. METHODS The patient is a 44-year-old gravida 2, para 2 who presented to the gynecologist with history of menorrhagia, dysmenorrhea, and a left ovarian mass. She was taken to the operating room to undergo a robotic-assisted laparoscopic hysterectomy and bilateral salpingo-oophorectomy. Intra-operatively, the gynecologist noticed a small cystotomy nearing completion of the case. The colpotomy, uterine extraction, and vaginal cuff closure were completed prior to urologic involvement. Upon entering the operating room, the patient already was positioned in dorsal lithotomy with the table in steep Trendelenburg. The robot was docked head-on between the patient's legs. Port placement included a 12-mm camera port, two 8-mm robotic ports, and a 5-mm assistant port. A cystoscopic assistant was seated with arms outstretched over the patient's left leg in close proximity to the second robotic arm. Robotic-assisted laparoscopy and rigid cystoscopy were performed concurrently. RESULTS The cystotomy was successfully closed in a single layer with running 4-0 V-Loc suture by a virgin robotic surgeon. No other concomitant bladder or ureteral injuries were identified. Diagnosis and treatment were performed under dual cystoscopic and laparoscopic guidance. Total robotic time was 32 min, and total cystoscopic time was 22 min. An 18-French Foley catheter was left indwelling for 10 days post-operatively, at which time the cystogram showed no leak, and the catheter was removed without issue. There were no post-operative complications. CONCLUSIONS To our knowledge, this is the first documented case of a combined robotic-assisted laparoscopic and cystoscopic approach to cystorrhaphy for the indication of iatrogenic cystotomy. This approach is feasible – even for the novice robotic surgeon – convenient, and offers both diagnostic and technical advantages with limited morbidity and exceptional outcomes. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e101-e102 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Maurice Cleveland, OH More articles by this author Justin Isariyawongse Cleveland, OH More articles by this author Peter Buehner Cleveland, OH More articles by this author Siobhan McGregor Cleveland, OH More articles by this author Matthew Steinway Cleveland, OH More articles by this author Edward Cherullo Cleveland, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Endometrial Carcinoma: 178 Patients Treated by Laparoscopy

Study Objective: To evaluate results and complications of laparoscopic surgery in patients with cancer of endometrium.Design: Descriptive retrospective study. Patients with incomplete data during the picking up or the follow-up as well as those with other synchronic cancers were excluded.Setting: Unit of Gynecologic Oncology and Endoscopy of the Hospital 12 de Octubre. Madrid. Spain.Patients: 178 patients diagnosed of endometrial cancer during the years 2001 to 2007.Intervention: Laparoscopic total extrafascial hysterectomy with bilateral anexectomy. Pelvic lymphadenectomy. Para-aortic lymphadenectomy. Omentectomy.Measurements and Main Results: Mean age was 63 years. Mean age of menopause was 51 years. Mean value of Body Mass Index was 30. 18 patients had previous treatment with tamoxifen for breast cancer. Mean value of the pre-surgical Ca125 was 31 UI/ml. 18% of the patients had any previous abdominal surgical procedure. Distribution for stages: IA=70,2%, IB=20,8%, IIA=1,7%, IIB=1,1%, IIIA=2,2%, IIIB=0%, IIIC=3,9% and IV=0 %. 51% of tumors were high differentiated, 27% moderate and 22% poorly. 88% of them corresponded to endometrial adenocarcinomas. Lymphadenectomy was practiced to the 58% of the patients. In 48% of the cases uterus was sent to intraoperatory study. Mean pre-surgical hemoglobine was 13.4gr/dl and post-surgical 11.3gr/dl. Ten patients (7,5 %) required blood transfusion. The mean duration of the procedure was 173 minutes (range 60-360 minutes). Intraoperatory complications were: significant hemorrhage in three patients, uterine perforation in three patients and difficulty for the uterine extraction in two cases because of myomas. 3,8% of the cases were reconverted into laparotomy. Postoperative complications were: Fever, haematoma of abdominal wall, paralytic ileus and re-intervention. The mean hospitalization was 5 days (range 2-24).Conclusion: The laparoscopic approach is adequate in the treatment of the cancer of endometrium, with the same level of radicality than laparotomy, and with a fall rate of complications. Study Objective: To evaluate results and complications of laparoscopic surgery in patients with cancer of endometrium. Design: Descriptive retrospective study. Patients with incomplete data during the picking up or the follow-up as well as those with other synchronic cancers were excluded. Setting: Unit of Gynecologic Oncology and Endoscopy of the Hospital 12 de Octubre. Madrid. Spain. Patients: 178 patients diagnosed of endometrial cancer during the years 2001 to 2007. Intervention: Laparoscopic total extrafascial hysterectomy with bilateral anexectomy. Pelvic lymphadenectomy. Para-aortic lymphadenectomy. Omentectomy. Measurements and Main Results: Mean age was 63 years. Mean age of menopause was 51 years. Mean value of Body Mass Index was 30. 18 patients had previous treatment with tamoxifen for breast cancer. Mean value of the pre-surgical Ca125 was 31 UI/ml. 18% of the patients had any previous abdominal surgical procedure. Distribution for stages: IA=70,2%, IB=20,8%, IIA=1,7%, IIB=1,1%, IIIA=2,2%, IIIB=0%, IIIC=3,9% and IV=0 %. 51% of tumors were high differentiated, 27% moderate and 22% poorly. 88% of them corresponded to endometrial adenocarcinomas. Lymphadenectomy was practiced to the 58% of the patients. In 48% of the cases uterus was sent to intraoperatory study. Mean pre-surgical hemoglobine was 13.4gr/dl and post-surgical 11.3gr/dl. Ten patients (7,5 %) required blood transfusion. The mean duration of the procedure was 173 minutes (range 60-360 minutes). Intraoperatory complications were: significant hemorrhage in three patients, uterine perforation in three patients and difficulty for the uterine extraction in two cases because of myomas. 3,8% of the cases were reconverted into laparotomy. Postoperative complications were: Fever, haematoma of abdominal wall, paralytic ileus and re-intervention. The mean hospitalization was 5 days (range 2-24). Conclusion: The laparoscopic approach is adequate in the treatment of the cancer of endometrium, with the same level of radicality than laparotomy, and with a fall rate of complications.

Uterine electromyography signal feature extraction and classification

Uterine electromyography (EMG) signal has potential for early diagnosis of preterm labour clinically. But it is difficult to differentiate the EMG signal patterns leading to preterm birth. In this paper, the effort has been made to find effective algorithms for extracting the features from uterine EMG signals which can be used to classify the normal term labour from abnormal preterm labour signals. A combined algorithm has been proposed, in which the signal is firstly pre-processed to eliminate the noise and high frequency components. Then, the fractal dimension value along the signal is calculated to identify the abnormal values for distinguishing contraction patterns. Two techniques are employed: phase space reconstruction and singular value decomposition. Finally, the signals are classified using artificial neural network method. The experiment tests indicate that the method can be a choice for solving the problem described but more tests are required to draw final conclusion.

Uterine electromyography signal feature extraction and classification

Uterine electromyography signal feature extraction and classification

Hormonal replacement therapy for postovarioectomic syndrome

The forming specifies of Postovarioectomic syndrome (POES) after extirpation of uterine with both adnex in transitive age (after 45 years) in regular menstrual cycle was investigated. The high frequency of POES (78,1%), rapid appearance of early and late climacteric symptoms is found out. The role of premorbide surgical background in the domination of hard and middle degree disturbances (56%) was showed. The hormonal profile POES was investigated in dynamics HRT estradiol. The role of large estrogen doses and potentioning gestogen effect in the rapid elimination of early climacteric symptoms was shown. We carried out the comparative analysis of modern drugs HRT (Livial, Klimonorm, Klimen, Estraderm-TTS) after ovarioectomy with or without the uterine extraction.