Uterine Sparing Research Articles

Prophylactic Uterine Artery Embolization in Placenta Accreta Spectrum—An Active Intervention to Reduce Morbidity and Promote Uterine Preservation

PurposeTo evaluate the feasibility and safety of early and proactive involvement of interventional radiology (IR) in the management of placenta accreta spectrum (PAS) by performing the cesarean operation and prophylactic uterine artery embolization in the IR angiography suite as a combined procedure. Materials and MethodsThis study evaluated the effectiveness and safety of prophylactic uterine artery embolization prior to placental separation in cases of antenatally proven or suspected abnormal placentation. Over a 5-year period, 16 consecutive patients with PAS underwent combined IR and obstetric intervention. In all cases, cesarean delivery was performed in the IR angiography suite. Vascular access was obtained prior to surgery with balloon placement into both internal iliac arteries. These balloons were inflated after delivery, followed by uterine artery embolization (14 of 16) if there was evidence of active postpartum bleeding or inability to deliver the placenta. ResultsThere was no fetal or maternal mortality and no significant IR or surgical adverse events. Mean blood loss was 1900 mL. Seven patients (44%) underwent hysterectomy. ConclusionsIn patients with PAS, cesarean section in the angiography suite preceded by prophylactic balloon placement and followed by uterine artery embolization was feasible, safe, and effective in preventing massive blood loss, with a 56% uterine sparing rate.

Invasion anomaly or neovascularization? A new surgical approach for cesarean delivery in pregnant women with invasive placenta accreta spectrum disorder accompanied by placenta previa.

The objective of study is to describe a new surgical approach to cesarean delivery in women with invasive placenta accreta spectrum (PAS) accompanied by placenta previa. Cesarean delivery was initiated with a transverse abdominal (Pfannenstiel) incision. A transverse incision was made above the vascular area in the lower uterine segment, and the fetus was delivered. The uterine fundus was removed from the abdomen and wrapped. Placental removal was started at posteriorly, continuing toward the anterior region. If dense adhesions were encountered, dissection was performed by inserting a finger between the adhesions to carefully separate them. It was recognized that two types of vessels develop to supply blood to the placenta. First, a perforating vessel emerges from adjacent tissues, entering the placental bed by perforating the uterine wall. Second, a superficial vessel runs along the uterine wall to enter the placental bed. The new emerging vessels were identified and ligated. Uterine sparing surgery was performed if the hemorrhage ceased. A cesarean hysterectomy was performed if hemorrhage did not cease. Eight cesarean deliveries were performed using this new surgical approach. Cesarean hysterectomy was performed in three patients in who want to sterilization diser and don't mind fertility preservation. Severe maternal morbidity, invasive procedures, intensive care unit admission, and relaparotomy were not required. The described new surgical approach provide surgeon to perform cesarean delivery without causing increase maternal morbidity and mortality. Although the approach is new and the study population is small, the results have acceptable rationality and applicability.

FETOMATERNAL OUT COME IN PLACENTA ACCRETA SPECTRUM (PAS)IN A TERTIARY CARE TEACHING HOSPITAL

Objective: To determine the fetomaternal out comes in placenta Accreta Spectrum (PAS) Study design: Descriptive study: Place and duration: Department of Obstetrics and Gynaecology unit-I1,FJMU /Sir Ganga Ram hospital Lahore. Patient and Methods: During this one years study a total of fifty pregnant women with placenta Accreta Spectrum(PAS) diagnosed on Doppler ultrasound , whether booked or un booked irrespective of number of caesarean scars with or without bleeding per vagina were included in the study. The number of caesarean section, treatment, complications maternal and fetal morbidity and mortality associated with PAS were described. Results: A total of 50 cases of PAS were studied over one year period. 35(70%) patients with placenta Accreta Spectrum (PAS) were unbooked.15(30%) were booked. 25 (50%) patients were the age group between 26-30 years. The average gestational age was between 32-36 weeks. In 35 (70%) type IV placenta previa was found. In 1o(20%) type III placenta previa was detected. In 5(10%) patient with placenta Accreta Spectrum (PAS)had previous once caesarean section while 45 (90% ) patients had two or more caesarean section. In 35 (70%) patients the presentation was bleeding per vagina while 15 (30%) patients were asymptomatic at presentation. In 15 (30%) patients placenta accreta was found while placenta increta and percreta were found in 35 (70%) patients.Total Caesarean hysterectomy done in 35 (70%) patients and Uterine sparing along with internal iliac artery, ligation was carried out in 10(20%). Bladder invasion which needed bladder repair was found in 5(10%) cases. 6(12%) maternal deaths were noted in this study. Mean Intraoperative blood loss was between 3 to 4 litres. Blood transfusion was needed in all 50 (100%) patients.Regarding perinatal out come Out of 50patients Intrauterine growth restriction. Prematurity and neonatal admission to ICU reported in 10(20%), 35(70%), and 15(30%) of the cases respectively. Conclusion: placents accreta spectrum (PAS) is a life threatening haemorrhagic condition associated with high rate of maternal and perinatal morbidity and mortality. Antenatal diagnosis by Doppler ultrasound, multi-disciplinary approach with involvement of senior obstetrician, anaesthetist and haematologist is pivotal to improve feto maternal out come.

Surgical Techniques for the Management of Placenta Accreta Spectrum.

The surgical management of placenta accreta spectrum (PAS) is often challenging. There are a variety of techniques and management options described in the literature ranging from uterine sparing to cesarean hysterectomy. Following the inaugural meeting of the Pan-American Society for Placenta Accreta Spectrum a multidisciplinary group collaborated to describe collective recommendations for the surgical management of PAS. In this manuscript, we outline individual components of the procedure and provide suggested direction at key points of a cesarean hysterectomy in the setting of PAS. KEY POINTS: · The surgical management of PAS requires careful planning and expertise.. · Multidisciplinary team care for pregnancies complicated by PAS can decrease morbidity and mortality.. · Careful surgical techniques can minimize risk of significant hemorrhage by avoiding pitfalls..

Lateral suspension with V-NOTES for the treatment of pelvic organ prolapse with the Salman-KetenciGencer technique.

Pelvic organ prolapse (POP) is a common morbidity and 10-20% of the patients need surgical correction. Sacrocolpopexy or sacrohysteropexy procedures are satisfactory but still difficult. Lateral suspension (LS) as a safe and simple technique has become an alternative technique recently. Vaginal natural orifice transluminal endoscopic surgery (V-NOTES) is also a new modality and LS using V-NOTES has not been performed previously and should be promising. This prospective observational pilot study was conducted with a total of 38 women with stage 3 and 4 POP according to the Pelvic Organ Prolapse Quantification grading system (POP-Q). Lateral suspension via V-NOTES was performed with the Salman-KetenciGencer technique using a mesh for POP. The preoperative and postoperative 6-month POP-Q stages together with Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) scores were recorded and compared. Comparison of the preoperative and postoperative 6-month POP-Q stages of the patients were statistically significant except for the total vaginal length (p<0.01). Compared with the preoperative total and subscale scores of PISQ-12, the postoperative values were considerably improved (p<0.001). With the Salman-KetenciGencer technique not only good anatomical but also good functional results were obtained with V-NOTES. Surgeons may focus on uterine sparing while using the Salman-KetenciGencer technique for apical prolapse owing to the higher rate of complications related to the colposuspension and better sexual results after the cervicosuspension.

Transcervical Ultrasound-Guided Targeted Radiofrequency Ablation of Localized Adenomyosis

<h3>Study Objective</h3> To review the definition, diagnosis, and procedural management options for adenomyosis with a focus on a novel procedure of transcervical ultrasound guided radiofrequency ablation. This video highlights one of the first successful examples of improved post operative symptoms and uterine volume reduction for a case using transcervical ultrasound-guided radiofrequency ablation. <h3>Design</h3> A 6-minute video reviewing the step-by-step demonstration of a single patient who underwent transcervical ultrasound-guided radiofrequency ablation of adenomyosis with six month post operative outcomes. <h3>Setting</h3> Surgery was performed in an outpatient surgical center with the patient in lithotomy position. <h3>Patients or Participants</h3> 42-year-old nulligravid female with no past medical or surgical history who presented with a chronic history of heavy menstrual bleeding, dysmenorrhea and worsening abdominal bulk symptoms desiring minimally invasive uterine sparing surgery. <h3>Interventions</h3> Transcervical ultrasound-guided targeted radiofrequency ablation of adenomyosis with a total of four ablations performed and combined time of 16 minutes and 30 seconds. <h3>Measurements and Main Results</h3> At six months post operation, the patient reported sustained resolution of dysmenorrhea and lighter menstrual periods. Six month post operative MRI was compared to pre operative MRI and noted a 43.5% decrease in uterine corpus volume and decrease in number of T2 hyperintense cystic foci within the uterus. <h3>Conclusion</h3> This video demonstrates one of the first successful examples of improved post operative symptoms and uterine volume reduction at six months with the transcervical ultrasound guided radiofrequency ablation of adenomyosis. Benefits of the procedure include its incisionless technique, improved intraoperative image monitoring because of the proximity of the ultrasound probe to pathology that can be operated by a single surgeon, fast recovery from surgery, and potentially cost-effective option for uterine sparing surgical management of adenomyosis. Since this is the first known published short term outcome data for this procedure on adenomyosis, more studies need to be conducted to demonstrate persistent safety and efficacy

Bridging the Gap: Robotic Approach to Isthmocele Dehiscence

<h3>Study Objective</h3> To describe a minimally invasive fertility preserving approach to emergent surgery in the setting of an isthmocele dehiscence. <h3>Design</h3> Narrated video of surgical technique with descriptions of key steps. <h3>Setting</h3> Uterine isthmoceles are usually asymptomatic but can cause abnormal uterine bleeding, pain, secondary infertility and have been associated with uterine rupture or cesarean scar dehiscence. There have been only a few case reports of isthmocele dehiscence following uterine instrumentation. Often in cases of acute bleeding, an abdominal hysterectomy is performed. We present the case of a 36-year-old G2P1001 patient who underwent dilation & evacuation at 14 weeks for holoprosencephaly which was complicated by post-operative hypotension and vaginal bleeding. Emergent laparoscopic exploration revealed concealed bleeding leading to hematoma formation at the site of isthmocele dehiscence. The hematoma was evacuated and the isthmocele was resected and repaired, allowing for a uterine preserving procedure. <h3>Patients or Participants</h3> One patient was included in this case report. <h3>Interventions</h3> Robotic assisted laparoscopic hematoma evacuation and isthmocele repair was performed with 5 key interventions: 1. Bladder mobilization using sharp dissection and cautery 2. Dilute vasopressin injected circumferentially around isthmocele 3. Monopolar cautery used to refresh dilated edges of isthmocele 4. Uterine sound introduced into endometrial cavity to delineate anatomy 5. Defect repair with 2-0 barbed suture in multiple layers <h3>Measurements and Main Results</h3> N/A. <h3>Conclusion</h3> In patients with a history of cesarean delivery, it is important to consider isthmocele dehiscence in the setting of post-procedural bleeding or hemodynamic instability. In cases of isthmocele dehiscence, specifically when there is concealed bleeding into the isthmocele, one could consider a uterine sparing minimally invasive approach. Hemodynamic stability of the patient, access to necessary resources, efficiency of ancillary staff, and surgeon experience are key factors for success in such surgical emergencies.

Retracted: A randomized controlled study comparing two uterine sparing techniques in conservative management of placenta accreta spectrum.

To compare the efficacy and safety of two uterine sparing techniques in conservative management of placenta accreta spectrum (PAS). This multicenter randomized controlled study was conducted from January 1, 2017 to December 31, 2020 at two university hospitals. Patients were randomly allocated into two groups; Group 1 was managed by Assar's technique and Group 2 was managed by Shehata's technique. Operative time, blood loss, operative complications (organ or vessel injury), and postoperative complications (early and late) were reported. Success of the technique, units of blood transfusion, and intensive care unit admissions were recorded. Demographic data in both groups were not significantly different. The mean gestational age at the delivery time was 36 weeks in both groups. Operative time was 120 (100-140) minutes and 75 (60-100) minutes in Assar's and Shehata's techniques, respectively (P< 0.001). Blood loss was higher in Shehata's technique than in Assar's (P< 0.001). Intensive care unit admissions were minimal in both groups. Operative complications were comparable in both groups. The success of Assar's and Shehata's techniques in uterine preservation was 85% and 95%, respectively. Both techniques were safe and successful in uterine sparing. Therefore, we recommend these techniques for conservative management of PAS. The trial was registered on UMIN-CTR and had the unique ID: UMIN000025315 on the following link: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000029120.

Radiofrequency ablation methods for uterine sparing fibroid treatment.

This article provides a clinical review of radiofrequency ablation (RFA) for the treatment of uterine leiomyomas. RFA is an effective and durable treatment for fibroids with sustained improvements in fibroid volume, bleeding, and patient reported outcomes with low reintervention rates. Although fertility data is limited, it is overall positive and may represent a uterine conserving and fertility preserving treatment modality. RFA is a safe and effective uterine preserving treatment option for symptomatic leiomyomas.

Colpocleisis techniques: an open-and-shut case for advanced pelvic organ prolapse

The purpose of this video is to demonstrate several advanced surgical techniques to improve efficiency and optimize the clinical success of the colpocleisis procedure. Pelvic organ prolapse is a common condition that affects up to 40% of the postmenopausal female population. For women with advanced pelvic organ prolapse, multiple medical comorbidities, and who no longer desire penetrative vaginal intercourse, an obliterative approach is preferred due to decreased anesthetic needs and operative time, and 95% long-term efficacy. The umbrella term of “colpocleisis” encompasses LeFort Colpocleisis, a uterine sparing procedure, colpocleisis with hysterectomy, and post-hysterectomy vaginal vault colpocleisis. Typically levator myorrhaphy and perineorrhaphy are also included to reinforce the repair. This video demonstrates several advanced surgical techniques to streamline the colpocleisis procedure. These methods include using electrosurgery to mark out the epithelium, the push-spread technique for superficial dissection, and demonstrating methods to create the lateral tunnels during LeFort colpocleisis with and without the use of a urinary catheter. Retraction with Allis clamps and rubber bands on hemostat clamps are utilized to improve visualization. Approximation of the anterior and posterior vaginal muscularis is also performed to obliterate the vaginal canal. Attention must be paid not to proceed past the level of the urethrovesical junction to avoid angulation of the urethra. An anatomic model is used to demonstrate the suture placement during levator myorrhaphy to facilitate an adequate purchase of the levator ani muscles. Ultimately the goal of colpocleisis is a vaginal opening that is one centimeter in width and three centimeters in depth. These skills enable the surgeon to maximize efficiency and surgical outcomes of obliterative procedures for advanced stage pelvic organ prolapse.

Resection of infected sacrohysteropexy mesh

The objective of this video is to demonstrate a robotic-assisted uterine sparing approach to treatment of infected mesh complicated by spondylodiscitis in the setting of a sacrohysteropexy, a rare but serious complication associated with urogynecologic surgery with an incidence of 1-2%.

Should Ultrasound-Guided High Frequency Focused Ultrasound Be Considered as an Alternative Non-Surgical Treatment of Uterine Fibroids in Non-Asiatic Countries? An Opinion Paper.

Minimally invasive interventions for myomata treatment have gained acceptance due to the possibility of preserving fertility with reduced trauma induced by laparotomy as way of entrance. There are insufficient data regarding outcomes of high intensity focused ultrasound (HIFU) in non-Asiatic women. Therefore, we revised the available evidence to present an expert opinion that could support physicians, patients and policy-makers for considering this approach in other populations. We revisited systematic reviews, randomized controlled trials and cohort studies from January 2018 to August 2021 using PubMed and Google scholar, regarding short and long term outcomes after ablation with focused ultrasound waves. In total, 33 studies, including 114,810 adult patients showed that outcomes of this approach depend on several parameters directly related with resistance to thermal ablation, especially fibroid size and vascularization. Two studies report satisfactory outcomes in Afro-American women. In accordance to the technique used, fibroid volume reduction showed to be higher in fibroids <300 cm3 after ultrasound guided HIFU than after MRI guided. Compared to myomectomy and uterine artery embolization, HIFU seems to have shorter hospital stay, higher pregnancy rates and similar adverse events rates, with skin burn being the most reported. Symptoms and quality of life improvement is similar to myomectomy but lower than embolization, however reintervention rate is higher after HIFU. Lacks evidence about long-term sarcoma risk after ablation. Available evidence shows that HIFU can be considered as a uterine sparing treatment for women of different ethnicities suffering of uterine myomatosis, especially for those wishing to preserve their fertility.

Clinical and Patient Reported Outcomes of Pre- and Postsurgical Treatment of Symptomatic Uterine Leiomyomas: A 12-Month Follow-up Review of TRUST, a Surgical Randomized Clinical Trial Comparing Laparoscopic Radiofrequency Ablation and Myomectomy

The objective of this study was to determine the efficacy, safety, and healthcare resource use of laparoscopic radiofrequency ablation (LAP-RFA) compared with myomectomy in patients with symptomatic uterine leiomyomas (ULs). This was a secondary analysis of the original postmarket randomized, multicenter, longitudinal, comparative TRUST (Treatment Results of Uterine Sparing Technologies) United States trial in patients with symptomatic ULs. After the procedure, subjects were followed over a 12-month period. Multicenter trial, including hospitals with or without an academic affiliation, surgery centers, and fertility centers performing outpatient procedures for uterine myomas. A total of 57 patients were randomized to either LAP-RFA (n=30) or myomectomy (n=27). LAP-RFA or myomectomy (laparoscopic or abdominal). The main outcome measures of this study were part of the secondary outcomes of the original TRUST trial. The primary outcome of this study was the reduction of UL symptoms and the improvement in patient-reported outcomes scores over time. Secondary outcomes included postprocedure hospitalization, length of stay, complications, reinterventions, and recovery time. There was a significant improvement in UL symptoms at 3 and 12 months after the procedure within each treatment group, and these improvements were similar between treatment groups. There was a significant reduction in UL symptoms per month between baseline and 12-months after the procedure for both LAP-RFA and myomectomy of 72% and 85%, respectively. A significant improvement was seen in all patient-reported outcomes scores over time for both groups. At 3 and 12 months after the procedure, the percentages of patients who were hospitalized in the LAP-RFA group were 74% and 49% lower than those of patients in the laparoscopic myomectomy group, respectively, with the 3-month difference being statistically significant. The length of hospital stay was significantly shorter in the LAP-RFA group compared with the myomectomy group (8.0 ± 5.7 hours vs 18.8 ± 14.6 hours; p < .05). Doctors recommended taking significantly less time off before returning to work for the patients in the LAP-RFA group compared with those in the myomectomy group (10.3 ± 5.1 days vs 14.5 ± 5.4 days; p < .05). The total number of days until back to normal activity was significantly lower in the LAP-RFA group compared with the myomectomy group (16.3 ± 15.2 days vs 26.5 ± 15.9 days; p < .05). The results from this 12-month follow-up study suggest that LAP-RFA is a safe, effective, uterine-sparing alternative to laparoscopic myomectomy in the treatment of ULs. These data points build on previously published studies showing that LAP-RFA has lower healthcare resource use overall, including lower postprocedure hospitalization rate and shorter length of stay. In clinical practice, LAP-RFA is a promising treatment approach to ULs for women.

Uterine Compression Sutures in Controlling Postpartum Haemorrhage: A Narrative Review.

Postpartum haemorrhage is still the main cause of maternal morbidity and mortality. Many treatments are available, butthey may threaten fertility potential. As a uterine sparing procedure, we aimed to review uterine compression sutures in order to betterunderstand when they should represent an appropriate option. A comprehensive search in MEDLINE and PubMed databases including the terms 'postpartum haemorrhage'and 'uterine compression sutures' was performed. Results were revised and articles reviewing or presenting case reports of uterinecompression sutures to treat postpartum haemorrhage were included. The first description of uterine compression sutures to control postpartum haemorrhage was published in 1997, by B-Lynch etal. After this publication, many others have reported successful management of postpartum haemorrhage with different suturing techniques.Most of them describe success rates above 75% and the possibility of fertility preservation, with cases of uneventful pregnancyafter uterine compression sutures already published. Complications associated with each technique are rare. Reports of use of uterine compression sutures include small series of cases or even single case reports which limits thequality of existing evidence to support one technique over another. Nevertheless, uterine compression sutures are recognized as aneffective surgical conservative strategy to control postpartum haemorrhage due to uterine atony and its use is recommended, if possible,prior to hysterectomy. Uterine compression sutures are effective, safe and simple to perform in an emergent situation and preserve fertilitypotential in cases of postpartum haemorrhage.

Uterine Sparing Laparoscopic Ablation of Uterine Fibroids: A Survey of Patient's Satisfaction and Treatment Outcomes

<h3>Study Objective</h3> The primary purpose of this study was to assess the patient's satisfaction with laparoscopic radiofrequency fibroid ablation (Lap-RFA) for the treatment of symptomatic uterine fibroids. We inquired about their quality of life, health state, and overall treatment effects. <h3>Design</h3> Survey study. <h3>Setting</h3> Community-based tertiary care medical center. <h3>Patients or Participants</h3> All patients who underwent a Lap-RFA by a single surgeon between the years of 2012 and 2020. <h3>Interventions</h3> laparoscopic radiofrequency fibroid ablation (Lap-RFA). <h3>Measurements and Main Results</h3> 48 patients underwent Lap-RFA procedure by the same provider and were mailed surveys for postoperative evaluation. Twenty patients responded, yeilding a 42% response rate. The mean age of the patients was 46 (34-60) years. The average time interval from surgery to survey response was 23 months (1-50). The Uterine fibroid Symptom and Health-Related Quality of Life (UFS-QOL) and the Health State Questionnaire scores are inversely related to outcomes. The UFS-QOL score can range from 37 to 185 with 37 being the optimal outcome. The average UFS-QOL score was found to be 72 (range 37-146). In addition, the Health state questionnaire can range from 5 to 15, and the average score was 6 (range 5-9). On a scale of 1 to 10, 10 representing optimal outcome, the average health rating was 8 (range 5-10). Using the Menorrhagia Impact Questionnaire, seven patients reported improved menses, ten had no change in symptoms, one had worsening symptoms, and two were postmenopausal. Sixteen patients reported some degree of satisfaction with the procedure, while three were dissatisfied with their overall treatment outcomes. Ninety percent of patients would recommend Lap-RFA to a friend. <h3>Conclusion</h3> Lap-RFA procedure is an effective uterine-sparing treatment for symptomatic fibroids with good patient satisfaction. The Lap-RFA procedure should be considered when counseling patients about fibroid management options.

Hysteroscopic Approach to a Morbidly Adherent Placenta in the Postpartum Period

<h3>Study Objective</h3> Morbidly adherent placenta (MAP) is associated with major maternal morbidity and mortality with risk factors most frequently related to previous uterine surgery. In rare occasions, retained products of conception (RPOC) could complicate low risk births or first trimester termination of pregnancy, resulting in abnormal bleeding patterns or infectious morbidity. We present a case of unsuspected focal (MAP) that was diagnosed two months after a cesarean delivery. Uterine Sparing treatment was accomplished by a 2-stage hysteroscopic resection without complications. <h3>Design</h3> Case Report Video. <h3>Setting</h3> Surgical Suite. <h3>Patients or Participants</h3> A 35-year-old G1 P0 woman had a cesarean delivery at 37 weeks and 4 days due to persistent fetal breech presentation and premature rupture of the membranes. The cesarean delivery was complicated by estimated blood loss of 1019mL with no mention of any precipitating factors. The patient presented with history of prolonged vaginal spotting while on Depot Provera. Office hysteroscopy and Pelvic MRI were utilized for diagnosis and evaluation. Uterine Sparing treatment was accomplished by a 2-stage hysteroscopic resection without complications. <h3>Interventions</h3> 2-stage hysteroscopic resection was performed. The first stage was approached by a mechanical morcellation device that resolved the main bulk of the RPOC. The second stage was approached with a Resectoscopic approach to the deep myometrial nodule that persisted on follow up imaging after the index procedure. <h3>Measurements and Main Results</h3> Complete resection of the RPOC and deep myometrial nodule was accomplished without complication. <h3>Conclusion</h3> Retained products of conception should be considered in the differential diagnosis of patients who present with abnormal uterine bleeding after birth. Treatment can be accomplished with hysteroscopic resection. Resectoscopic approach is more challenging and has a higher risk of uterine perforation yet has the ability to reach the deep-seated lesions. Provider's understanding of the limitations of each method and appropriate referral to an expert surgeon is key for optimal results.

The success rate and quality of life following three types of uterine sparing prolapse surgery

Introduction: Uterine prolapse has been traditionally treated with vaginal hysterectomy and cuff suspension. Recently there is renewed interest in uterine conservation during prolapse surgeries. This study was performed with aim to evaluate the success rate and quality of life in women following one of three types of uterine sparing prolapse surgery. Methods: This retrospective study was performed in Tehran Imam Khomeini Hospital in 2019. The data of 99 patients with uterine prolapse who underwent one of three types of uterine sparing surgery (Manchester, Sacrospinus Hysteropexy, Abdominal sacral Hysteropexy) during three years were reviewed and compared in terms of success rate and quality of life. 99 patients completed a valid questionnaire of quality of life after prolapse surgeries (Pelvic Floor Distress Inventory-20). The success rate after 12 months was evaluated as a primary outcome and the complications such as repeat surgery, using pessary and feeling mass were evaluated as secondary outcomes. Data were analyzed by SPSS software (version 22) and ANOVA, Kruskal-Wallis and Chi-square tests were used. P < 0.05 was considered statistically significant. Results: The success rate of sacral hysteropexy was higher than two other groups (about 94%).The highest recurrence was in sacrospinous, in the Ba point ( -2.06± 0.506) and C point (-2.1±1.084) (p<0.01). The quality of life was similar in the Manchester and sacral hysteropexy group and was higher than sacrospinous group. Early complications after sacral hysteropexy were ileus and defecatory disorder. Conclusion: All three uterine sparing prolapse surgeries had success rate of higher than 60%. All three surgical groups had a good quality of life and satisfaction 12 months after the procedure. The highest recurrence was in sacrospinous in Ba and C points. Finding mesh complications following sacral hysteropexy surgery requires long-term follow-up.

PMD2 Laparoscopic Radiofrequency Ablation VS Laparoscopic Myomectomy in the Treatment of Symptomatic Uterine Leiomyomas: A Meta-Analysis of Randomized Controlled Trials

This meta-analysis reviews the evidence from randomized controlled trials (RCTs) which compare laparoscopic radiofrequency ablation (LAP-RFA) and laparoscopic myomectomy (LM), two uterine sparing procedures for managing symptomatic uterine leiomyomas (UL).

Laparoscopic Uterine Artery Occlusion Combined with Uterine-sparing Pelvic Plexus Block and Partial Adenomyomectomy for Adenomyosis: A Video Case Report

OBJECTIVE Adenomyosis usually causes dysmenorrhea and anemia. Clinically, it is difficult to be solved by medicine and traditional surgery, and hysterectomy is always performed for radical treatment. In this article, we introduce a new method which could control the dysmenorrhea and anemia through laparoscopic uterine artery occlusion (LUAO) combined with uterine-sparing pelvic plexus block, and partial adenomyomectomy for uterus perservation.

Uterosacral Ligament Hysteropexy for Uterine Didelphys: A Case Report

Surgical approach to pelvic organ prolapse has traditionally included hysterectomy; however, in the past decade, uterine sparing prolapse surgery (hysteropexy) has become increasingly popular within female pelvic medicine and reconstructive surgery. The current literature demonstrates comparable outcomes for hysteropexy and traditional approach. As these procedures become more common, it is important to consider how to approach patients with unique anatomy such as uterine anomalies who desire uterine sparing surgery. In our case, we describe a woman aged 77 years with uterine didelphys who underwent a successful vaginal uterosacral ligament hysteropexy for stage 2 pelvic organ prolapse and was followed for 12 months postoperatively. Our case demonstrates that vaginal uterosacral ligament hysteropexy is feasible in a patient with uterine didelphys.