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Aghababaie Z, O'Grady G, Nisbet LA, Modesto AE, Chan CHA, Matthee A, Amirapu S, Beyder A, Farrugia G, Asirvatham SJ, Sands GB, Paskaranandavadivel N, Cheng LK, Angeli-Gordon TR. Localized bioelectrical conduction block from radiofrequency gastric ablation persists after healing: safety and feasibility in a recovery model. Am J Physiol Gastrointest Liver Physiol 2022; 323:G640-G652. [PMID: 36255716 PMCID: PMC9744642 DOI: 10.1152/ajpgi.00116.2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/27/2022] [Accepted: 10/13/2022] [Indexed: 01/31/2023]
Abstract
Gastric ablation has demonstrated potential to induce conduction blocks and correct abnormal electrical activity (i.e., ectopic slow-wave propagation) in acute, intraoperative in vivo studies. This study aimed to evaluate the safety and feasibility of gastric ablation to modulate slow-wave conduction after 2 wk of healing. Chronic in vivo experiments were performed in weaner pigs (n = 6). Animals were randomly divided into two groups: sham-ablation (n = 3, control group; no power delivery, room temperature, 5 s/point) and radiofrequency (RF) ablation (n = 3; temperature-control mode, 65°C, 5 s/point). In the initial surgery, high-resolution serosal electrical mapping (16 × 16 electrodes; 6 × 6 cm) was performed to define the baseline slow-wave activation profile. Ablation (sham/RF) was then performed in the mid-corpus, in a line around the circumferential axis of the stomach, followed by acute postablation mapping. All animals recovered from the procedure, with no sign of perforation or other complications. Two weeks later, intraoperative high-resolution mapping was repeated. High-resolution mapping showed that ablation successfully induced sustained conduction blocks in all cases in the RF-ablation group at both the acute and 2 wk time points, whereas all sham-controls had no conduction block. Histological and immunohistochemical evaluation showed that after 2 wk of healing, the lesions were in the inflammation and early proliferation phase, and interstitial cells of Cajal (ICC) were depleted and/or deformed within the ablation lesions. This safety and feasibility study demonstrates that gastric ablation can safely and effectively induce a sustained localized conduction block in the stomach without disrupting the surrounding slow-wave conduction capability.NEW & NOTEWORTHY Ablation has recently emerged as a tool for modulating gastric electrical activation and may hold interventional potential for disorders of gastric function. However, previous studies have been limited to the acute intraoperative setting. This study now presents the safety of gastric ablation after postsurgical recovery and healing. Localized electrical conduction blocks created by ablation remained after 2 wk of healing, and no perforation or other complications were observed over the postsurgical period.
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Affiliation(s)
- Zahra Aghababaie
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Gregory O'Grady
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Linley A Nisbet
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Andre E Modesto
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | | | - Ashton Matthee
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Satya Amirapu
- Histology Laboratory, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Arthur Beyder
- Division of Gastroenterology and Hepatology, and Enteric Neurosciences Program, Mayo Clinic, Rochester, Minnesota
| | - Gianrico Farrugia
- Division of Gastroenterology and Hepatology, and Enteric Neurosciences Program, Mayo Clinic, Rochester, Minnesota
| | | | - Gregory B Sands
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | | | - Leo K Cheng
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- Department of Surgery, Vanderbilt University, Nashville, Tennessee
| | - Timothy R Angeli-Gordon
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
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Hu H, Choi JDW, Edye MB, Aitken T, Kapurubandara S. Gastric Injury at Laparoscopy for Gynecologic Indications: A Systematic Review. J Minim Invasive Gynecol 2022; 29:1224-1230. [PMID: 36184063 DOI: 10.1016/j.jmig.2022.09.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/19/2022] [Accepted: 09/23/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This systematic review aims to identify causes of increased risk for and location and mechanism of gastric injury at laparoscopy for gynecologic indications and determine optimal management. DATA SOURCES A prospectively registered systematic review (PROSPERO: CRD42021237999) was undertaken and performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases searched included Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Medline, Embase, Web of Science, SCOPUS, and Google Scholar from 1960 to 2021. METHODS OF STUDY SELECTION All study types were included involving female patients of any age with gastric injury at laparoscopy for gynecologic indication. TABULATION, INTEGRATION, AND RESULTS A total of 6294 articles were screened, from which 67 studies were selected for a full-text review. Twenty-eight articles were included, which contained 42 cases drawn from 7 observational studies, 4 case series, and 17 case reports. Of these, 93% (39/42) were at the time of laparoscopic entry, with Veress entry technique used in 79% of these cases (31/39). Eighteen cases reported an entry point, with 77% (14/18) occurring at the periumbilical entry point and 11% (2/18) occurring at Palmer's point. Of the cases with reported etiology for gastric distention or displacement, 64% (9/14) were owing to anesthetic cause. The most common sites of gastric injury were on the anterior stomach wall (n = 8) and the greater curvature (n = 5). Among patients with reported management (32/42), a similar proportion were managed conservatively (11) when compared with repair through laparotomy (13) or laparoscopy (8). All injuries were detected intraoperatively with no reported short-term sequelae. CONCLUSION This systematic review of the literature reveals that gastric injury at laparoscopy for gynecologic indications is a rare complication predominantly occurring during laparoscopic entry, most commonly at the periumbilical entry point. When detected intraoperatively, conservative management, laparoscopic, or open repair in the appropriate patient has been performed with no short-term sequelae. The limitations of this review include paucity of cases, detail, and timeline of publications.
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Affiliation(s)
- Hillary Hu
- Department of Obstetrics and Gynaecology, Westmead Hospital (Drs. Hu and Kapurubandara), Sydney, New South Wales, Australia.
| | - Joseph Do Woong Choi
- Department of Surgery, Blacktown and Mount Druitt Hospitals (Drs. Choi and Edye), Sydney, New South Wales, Australia
| | - Michael B Edye
- Department of Surgery, Blacktown and Mount Druitt Hospitals (Drs. Choi and Edye), Sydney, New South Wales, Australia; Western Sydney Universit (Dr. Edye), Sydney, New South Wales, Australiay
| | - Tess Aitken
- University of Sydney Library (X Aitken), Sydney, New South Wales, Australia
| | - Supuni Kapurubandara
- Department of Obstetrics and Gynaecology, Westmead Hospital (Drs. Hu and Kapurubandara), Sydney, New South Wales, Australia; University of Sydney (Dr. Kapurubandara), Sydney, New South Wales, Australia; Sydney West Advanced Pelvic Surgery Unit (Dr. Kapurubandara), Sydney, New South Wales, Australia
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Madhok B, Nanayakkara K, Mahawar K. Safety considerations in laparoscopic surgery: A narrative review. World J Gastrointest Endosc 2022; 14:1-16. [PMID: 35116095 PMCID: PMC8788169 DOI: 10.4253/wjge.v14.i1.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/11/2021] [Accepted: 12/10/2021] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic surgery has many advantages over open surgery. At the same time, it is not without its risks. In this review, we discuss steps that could enhance the safety of laparoscopic surgery. Some of the important safety considerations are ruling out pregnancy in women of the childbearing age group; advanced discussion with the patient regarding unexpected intraoperative situations, and ensuring appropriate equipment is available. Important perioperative safety considerations include thromboprophylaxis; antibiotic prophylaxis; patient allergies; proper positioning of the patient, stack, and monitor(s); patient appropriate pneumoperitoneum; ergonomic port placement; use of lowest possible intra-abdominal pressure; use of additional five-millimetre (mm) ports as needed; safe use of energy devices and laparoscopic staplers; low threshold for a second opinion; backing out if unsafe to proceed; avoiding hand-over in the middle of the procedure; ensuring all planned procedures have been performed; inclusion of laparoscopic retrieval bags and specimens in the operating count; avoiding 10-15 mm ports for placement of drains; appropriate port closures; and use of long-acting local anaesthetic agents for analgesia. Important postoperative considerations include adequate analgesia; early ambulation; careful attention to early warning scores; and appropriate discharge advice.
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Affiliation(s)
- Brij Madhok
- Upper GI Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Derby DE22 3NE, United Kingdom
| | - Kushan Nanayakkara
- Upper GI Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Derby DE22 3NE, United Kingdom
| | - Kamal Mahawar
- Department of General Surgery, South Tyneside and Sunderland NHS Foundation Trust, Sunderland SR4 7TP, United Kingdom
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Watrowski R, Kostov S, Alkatout I. Complications in laparoscopic and robotic-assisted surgery: definitions, classifications, incidence and risk factors - an up-to-date review. Wideochir Inne Tech Maloinwazyjne 2021; 16:501-525. [PMID: 34691301 PMCID: PMC8512506 DOI: 10.5114/wiitm.2021.108800] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/30/2021] [Indexed: 11/26/2022] Open
Abstract
Almost all gynecological and general-surgical operations are - or can be - performed laparoscopically. In comparison to an abdominal approach, the minimally invasive access offers several advantages; however, laparoscopy (both conventional and robotic-assisted) can be associated with a number of approach-specific complications. Although the majority of them are related to the laparoscopic entry, adverse events may also occur due to the presence of pneumoperitoneum or the use of laparoscopic instruments. Unfortunately, a high proportion of complications (especially affecting the bowel and ureter) remain unrecognized during surgery. This narrative review provides comprehensive up-to-date information about definitions, classifications, risk factors and incidence of surgical complications in conventional and robotic-assisted laparoscopy, with a special focus on gynecology. The topic is discussed from various perspectives, e.g. in the context of stage of surgery, injured organs, involved instruments, and in relation to malpractice claims.
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Affiliation(s)
- Rafał Watrowski
- St. Josefskrankenhaus, Teaching Hospital of the University of Freiburg, Freiburg, Germany
| | - Stoyan Kostov
- Department of Gynecology, Medical University Varna, Varna, Bulgaria
| | - Ibrahim Alkatout
- Department of Gynecology and Obstetrics, Kiel School of Gynecological Endoscopy, University Hospitals Schleswig-Holstein, Kiel, Germany
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Gordts S, Gordts S, Puttemans P, Segaert I, Valkenburg M, Campo R. Systematic use of transvaginal hydrolaparoscopy as a minimally invasive procedure in the exploration of the infertile patient: results and reflections. Facts Views Vis Obgyn 2021; 13:131-140. [PMID: 34184842 PMCID: PMC8291988 DOI: 10.52054/fvvo.13.2.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background The aim of this study was to evaluate the added value of transvaginal hydrolaparoscopy (THL) in the investigation of the infertile patient. Methods A retrospective cohort study, based on records from 01/09/2006 to 30/12/2019 was undertaken in a tertiary care infertility centre. THL was performed in 2288 patients. These were patients who were referred for endoscopic exploration of the female pelvis as part of their infertility investigation. In 374 patients with clomiphene- resistant polycystic ovary syndrome (PCOS), ovarian capsule drilling was also performed. The outcome objectives of this study included the evaluation of the added diagnostic value of THL as well as the feasibility and safety of the visual inspection of the female pelvis using this technique. Results Of the 2288 procedures failed access to the pouch of Douglas occurred in in 23 patients (1%). The complication rate was 0.74%, due to bowel perforations (n= 13) and bleeding (n= 4) requiring laparoscopy. All bowel perforations were treated conservatively, with 6 days of antibiotics, and no further complications occurred. Findings were normal in 49.8% of patients. Endometriosis was diagnosed in 366 patients (15.9%); adhesions were present in 144 patients. Conclusions THL is a minimally invasive procedure, with a low complication and failure rate, providing an accurate visual exploration of the female pelvis in a one-day hospital setting. When indicated, minimally invasive surgery is possible in the early stages of endometriosis and for ovarian capsule drilling in patients with clomiphene- resistant PCOS.
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Frountzas M, Pergialiotis V, Stergios K, Doulamis I, Katafygiotis P, Lazaris AC, Schizas D, Perrea DN, Nikiteas N, Toutouzas K. Fibrin sealants as an adequate treatment alternative to traditional suturing for confined bowel lesions: A hypothesis for future experimental research. Med Hypotheses 2019; 136:109514. [PMID: 31812011 DOI: 10.1016/j.mehy.2019.109514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/26/2019] [Accepted: 11/30/2019] [Indexed: 02/07/2023]
Abstract
Bowel perforation is a rare, but serious complication of laparoscopic surgery with a mortality rate that reaches 20%. There are several risk factors that could predispose to bowel perforation, but the surgeon's experience and the difficulty of each case play the most important role. Delayed bowel injuries happen due to conduction of electrical energy through the abdominal cavity, and in the majority of cases require reoperation. Early bowel injuries are caused by thermal injury of an electrosurgical instrument or during the insertion of the laparoscopic instruments inside the peritoneal cavity. Such injuries are recognized during the operation and are usually fixed by placing sutures. TISSEEL™ is a fibrin sealant with various applications in several surgical specialties, that simulates the latter stages of the coagulation cascade, and could be used as an alternative treatment for confined bowel perforations during laparoscopy. The efficacy of fibrin sealants in closing bowel gaps has been tested in some experimental models as well as its adequacy in enhancing bowel anastomoses performed with sutures. In addition, there is scarce evidence that fibrin sealants enhance the healing process after bowel enclosure either combined to suturing or not, which is supported by an experimental pilot study, that was conducted by our study group. The present study tries to combine all the available data in order to propose an effective alternative treatment for confined bowel injuries or controversial cases, that happen during laparoscopic surgery. In that way, every surgeon could face them even without huge expertise, conversions to open surgery would diminish and the disadvantages of suturing would disappear. Future experimental studies should be designed in the terms of extensive comparison of the two methods, with the purpose of this comparison to be tested in humans in the future.
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Affiliation(s)
- Maximos Frountzas
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens Medical School, Athens, Greece.
| | - Vasilios Pergialiotis
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens Medical School, Athens, Greece; First Department of Obstetrics and Gynecology, Unit of Gynecologic Oncology, Alexandra Hospital, National and Kapodistrian University of Athens, Greece
| | - Konstantinos Stergios
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens Medical School, Athens, Greece
| | - Ilias Doulamis
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Patroklos Katafygiotis
- Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas C Lazaris
- Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, Laiko General Hospital, Athens Medical School, Athens, Greece
| | - Despina N Perrea
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens Medical School, Athens, Greece
| | - Nikolaos Nikiteas
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens Medical School, Athens, Greece; Second Department of Propaedeutic Surgery, Laiko General Hospital, School of Medicine, Athens Medical School, Athens, Greece
| | - Konstantinos Toutouzas
- First Department of Propaedeutic Surgery, Hippocration Hospital, Athens Medical School, Athens, Greece
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Tros R, van Kessel M, Oosterhuis J, Kuchenbecker W, Bongers M, Mol BW, Koks C. Transvaginal hydrolaparoscopy and laparoscopy. Reprod Biomed Online 2019; 40:105-112. [PMID: 31899124 DOI: 10.1016/j.rbmo.2019.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 10/09/2019] [Accepted: 10/17/2019] [Indexed: 11/26/2022]
Abstract
RESEARCH QUESTION To evaluate the findings of outpatient transvaginal hydrolaparoscopy (THL) in comparison with diagnostic laparoscopy combined with chromopertubation in subfertile women. DESIGN In a retrospective study in four large teaching hospitals, all subfertile women who underwent a THL and a conventional laparoscopy as part of their fertility work-up in the period between 2000 and 2011 were studied. Findings at THL were compared with findings at diagnostic and therapeutic laparoscopies. Tubal occlusion, endometriosis and adhesions were defined as abnormalities. RESULTS Out of 1119 women, 1103 women underwent THL. A complete evaluation or incomplete but diagnostic procedure could be performed in 989 (89.7%) and 28 (2.5%), respectively. An incomplete non-diagnostic procedure was performed in 11 (1.0%) women. Failure of THL occurred in 75 women (6.8%) and 40 of these women (3.6%) subsequently underwent laparoscopy. Laparoscopy was performed in a total of 126 patients with a median time interval of 7 weeks (interquartile range [IQR] 3-13 weeks). Of 64 patients who successfully underwent both THL and laparoscopy, concordant findings were found in 53 women and discordant results in 11 women, 6 of which were caused by tubal spasm. Sensitivity of THL in detecting abnormalities was 100% and specificity was 22.2%, with a likelihood ratio of 1.29. CONCLUSION THL in an outpatient setting can detect anatomical abnormalities comparable to the more invasive reference standard diagnostic laparoscopy. If THL succeeds, there is no need to add a diagnostic laparoscopy in the work-up.
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Affiliation(s)
- Rachel Tros
- Department of Obstetrics and Gynaecology, Amsterdam UMC, VU Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - Mianna van Kessel
- Department of Obstetrics and Gynaecology, Medisch Spectrum Twente, Enschede 7500 KA, the Netherlands
| | - Jur Oosterhuis
- Department of Obstetrics and Gynaecology, St. Antonius Hospital, Utrecht 3543 AZ, the Netherlands
| | - Walter Kuchenbecker
- Department of Obstetrics and Gynaecology, Isala, Zwolle 8000 GK, the Netherlands
| | - Marlies Bongers
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven 5500 MB, the Netherlands
| | - Ben Willem Mol
- Department of Obstetrics and Gynaecology, Monash University, Monash Medical Centre, 246 Clayton Road, Clayton VIC 3168, Australia
| | - Carolien Koks
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven 5500 MB, the Netherlands
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van den Beukel BAW, Stommel MWJ, van Leuven S, Strik C, IJsseldijk MA, Joosten F, van Goor H, Ten Broek RPG. A Shared Decision Approach to Chronic Abdominal Pain Based on Cine-MRI: A Prospective Cohort Study. Am J Gastroenterol 2018; 113:1229-1237. [PMID: 29946174 DOI: 10.1038/s41395-018-0158-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 05/11/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Chronic abdominal pain develops in 11-20% of patients undergoing abdominal surgery, partly owing to post-operative adhesions. In this study we evaluate results of a novel diagnostic and therapeutic approach for pain associated with adhesions. METHODS Prospective cohort study including patients with a history of abdominal surgery referred to the outpatient clinic of a tertiary referral center for the evaluation of chronic abdominal pain. Subgroups were made based on outcome of adhesion mapping with cine-MRI and shared decision making. In operatively managed cases, anti-adhesion barriers were applied after adhesiolysis. Long-term results for pain were evaluated by a questionnaire. RESULTS A total of 106 patients were recruited. Seventy-nine patients had adhesions on cine-MRI, 45 of whom underwent an operation. Response rate to follow-up questionnaire was 86.8%. In the operative group (Group 1), the number of negative laparoscopies was 3 (6%). After a median of 19 (range 6-47) months follow-up, 80.0% of patients in group 1 reported improvement of pain, compared with 42.9% in patients with adhesions on cine-MRI who declined surgery (group 2), and 26.3% in patients with no adhesions on cine-MRI (group 3), P = 0.002. Consultation of medical specialists was significantly lower in group 1 compared with groups 2 and 3 (35.7 vs. 65.2 vs. 58.8%; P = 0.023). CONCLUSION We demonstrate long-term pain relief in two-thirds of patients with chronic pain likely caused by adhesions, using cine-MRI and a shared decision-making process. Long-term improvement of pain was achieved in 80% of patients who underwent surgery with concurrent application of an anti-adhesion barrier.
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Affiliation(s)
- Barend Arend Willem van den Beukel
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands. Rijnstate Hospital Department of Radiology, Arnhem, The Netherlands. These authors jointly supervised: Harry van Goor H, Richard PG ten Broek
| | - Martijn Willem Jan Stommel
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands. Rijnstate Hospital Department of Radiology, Arnhem, The Netherlands. These authors jointly supervised: Harry van Goor H, Richard PG ten Broek
| | - Suzanne van Leuven
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands. Rijnstate Hospital Department of Radiology, Arnhem, The Netherlands. These authors jointly supervised: Harry van Goor H, Richard PG ten Broek
| | - Chema Strik
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands. Rijnstate Hospital Department of Radiology, Arnhem, The Netherlands. These authors jointly supervised: Harry van Goor H, Richard PG ten Broek
| | - Michiel Andreas IJsseldijk
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands. Rijnstate Hospital Department of Radiology, Arnhem, The Netherlands. These authors jointly supervised: Harry van Goor H, Richard PG ten Broek
| | - Frank Joosten
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands. Rijnstate Hospital Department of Radiology, Arnhem, The Netherlands. These authors jointly supervised: Harry van Goor H, Richard PG ten Broek
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands. Rijnstate Hospital Department of Radiology, Arnhem, The Netherlands. These authors jointly supervised: Harry van Goor H, Richard PG ten Broek
| | - Richard Peter Gerardus Ten Broek
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands. Rijnstate Hospital Department of Radiology, Arnhem, The Netherlands. These authors jointly supervised: Harry van Goor H, Richard PG ten Broek
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Coenders-Tros R, van Kessel M, Vernooij M, Oosterhuis G, Kuchenbecker W, Mol B, Koks C. Performance of outpatient transvaginal hydrolaparoscopy. Hum Reprod 2016; 31:2285-91. [DOI: 10.1093/humrep/dew161] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 05/20/2016] [Indexed: 01/10/2023] Open
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Yetişir F, Sarer AE, Acar HZ, Yazıcıoglu O, Basaran B. Treatment of delayed jejunal perforation after irreducible femoral hernia repair with open abdomen management and delayed abdominal closure with skin flap approximation. Int J Surg Case Rep 2015; 16:19-24. [PMID: 26408935 PMCID: PMC4643348 DOI: 10.1016/j.ijscr.2015.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 08/13/2015] [Accepted: 09/05/2015] [Indexed: 11/30/2022] Open
Abstract
Delayed bowel perforation may develop after irreducible femoral hernia surgery especially in elderly patients with comorbid disease. Open abdomen management with negative pressure therapy and delayed open abdomen closure with skin flap approximation is optimum treatment modality for hemodynamically instable patient.
Introduction We show the management of a delayed jejunal perforation, after irreducible femoral hernia operation with the help of negative pressure therapy (NPT) and delayed abdominal closure (DAC) with skin flap approximation in an elderly woman for the first time in the literature. Presentation of case A 76 year-old woman was admitted to the emergency department with irreducible femoral hernia and ileus. After examining the femoral hernia sac and noting the presence of viable intestine within the hernia sac, a femoral hernia repair with mesh was performed. At postoperative day 1 she started to defecate and oral intake was started. The patient was discharged on postoperative day 3. On postoperative day 8, she was re-admitted to the emergency department with septic shock. The patient underwent reoperation. Septic abdomen and delayed perforation from strangulated part of the jejunum were seen. A jejunostomy was opened and patient was treated with open abdomen management and delayed abdominal closure with skin flap. The ostomy was closed 4 months later. Discussion The exact mechanism of delayed presentation of small bowel perforation remains controversial. Delayed intestinal perforation has rarely been reported after blunt abdominal trauma (BAT), conductive burn injuries of the bowel with cautery, or necrosis of strangulated bowel in a hernia sac. Open abdomen (OA) management is a life-saving and challenging strategy in severe generalized peritonitis. Conclusion Delayed bowel perforation may develop after irreducible femoral hernia surgery. OA management with NPT and DAC with skin flap approximation are optimal treatment modalities for the hemodynamically instable patient.
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Affiliation(s)
- Fahri Yetişir
- Atatürk Research and Training Hospital, General Surgery Department, Turkey.
| | - A Ebru Sarer
- Atatürk Research and Training Hospital, Anesthesiology and Reanimation Department, Turkey
| | - Hasan Zafer Acar
- Lokman Hekim private Hospital, General Surgery Department, Turkey
| | - Omer Yazıcıoglu
- Atatürk Research and Training Hospital, General Surgery Department, Turkey
| | - Basar Basaran
- Atatürk Research and Training Hospital, General Surgery Department, Turkey
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Agar N, Philippe AC, Bourdel N, Rabischong B, Canis M, Le Bouedec G, Mulliez A, Dauplat J, Pomel C. [Morbidity of pelvic lymphadenectomy and para-aortic lymphadenectomy in endometrial cancer]. Bull Cancer 2015; 102:428-35. [PMID: 25956349 DOI: 10.1016/j.bulcan.2015.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 02/04/2015] [Indexed: 10/23/2022]
Abstract
The aim of this study was to evaluate the complication rate of pelvic and para-aortic lymphadenectomy in the management of endometrial cancer following the changes to the recommendations of INCa 2010. This is a retrospective study of 208 patients operated for endometrial cancer between July 2010 and March 2014 in two referral centers. Eighty lymphadenectomy were performed, 65 with hysterectomy and bilateral annexectomy and 18 lymphadenectomy were performed for restaging. Complications assessment is based on the Dindo Clavien classification. We report 17 severe complications (grade 3a and over) (P<0.001), including 14 among patients receiving lymphadenectomy. Morbidity increases with the number of lymphnodes removed and their positivity (P<0.001). The para-aortic lymphadenectomy is primarily responsible for complications (P <0.001). We describe 7 lower limbs lymphedema, 12 nerve injuries, 8 ileus, 5 venous or arterial thromboembolism, 17 blood transfusions, 13 lymphoceles including 9 infected. The rate of intraoperative complications on a first lymphadenectomy is 8% while it reached 22% for restaging. Restaging is significantly more at risk of serious complications (P=0.03) with two deaths. Twenty-four chronic disorders with impaired quality of life (2 without lymphadenectomy) are reported. They are present in 50% of restaging (P=0.033 compared to first lymphadenectomy). Lymphadenectomy is a source of severe morbidity (17.5%) with 2.5% mortality. The benefit of this surgery should probably be discussed again.
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Affiliation(s)
- Nicolas Agar
- Hôpital Estaing, département de gynécologie obstétrique, 1, rue Lucie-Aubrac, 63100 Clermont-Ferrand, France
| | - Anne-Cécile Philippe
- Centre Jean-Perrin, département de chirurgie cancérologique, 58, rue Montalembert, 63058 Clermont-Ferrand, France; Université d'Auvergne, France
| | - Nicolas Bourdel
- Hôpital Estaing, département de gynécologie obstétrique, 1, rue Lucie-Aubrac, 63100 Clermont-Ferrand, France
| | - Benoît Rabischong
- Hôpital Estaing, département de gynécologie obstétrique, 1, rue Lucie-Aubrac, 63100 Clermont-Ferrand, France; Université d'Auvergne, France
| | - Michel Canis
- Hôpital Estaing, département de gynécologie obstétrique, 1, rue Lucie-Aubrac, 63100 Clermont-Ferrand, France; Université d'Auvergne, France
| | - Guillaume Le Bouedec
- Centre Jean-Perrin, département de chirurgie cancérologique, 58, rue Montalembert, 63058 Clermont-Ferrand, France
| | - Aurélien Mulliez
- Délégation recherche clinique et innovation, 58, rue Montalembert, 63003 Clermont-Ferrand cedex, France
| | - Jacques Dauplat
- Centre Jean-Perrin, département de chirurgie cancérologique, 58, rue Montalembert, 63058 Clermont-Ferrand, France; Université d'Auvergne, France
| | - Christophe Pomel
- Centre Jean-Perrin, département de chirurgie cancérologique, 58, rue Montalembert, 63058 Clermont-Ferrand, France; Université d'Auvergne, France.
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12
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Ülker K, Anuk T, Bozkurt M, Karasu Y. Large bowel injuries during gynecological laparoscopy. World J Clin Cases 2014; 2:846-851. [PMID: 25516859 PMCID: PMC4266832 DOI: 10.12998/wjcc.v2.i12.846] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/04/2014] [Accepted: 09/17/2014] [Indexed: 02/05/2023] Open
Abstract
Laparoscopy is one of the most frequently preferred surgical options in gynecological surgery and has advantages over laparotomy, including smaller surgical scars, faster recovery, less pain and earlier return of bowel functions. Generally, it is also accepted as safe and effective and patients tolerate it well. However, it is still an intra-abdominal procedure and has the similar potential risks of laparotomy, including injury of a vital structure, bleeding and infection. Besides the well-known risks of open surgery, laparoscopy also has its own unique risks related to abdominal access methods, pneumoperitoneum created to provide adequate operative space and the energy modalities used during the procedures. Bowel, bladder or major blood vessel injuries and passage of gas into the intravascular space may result from laparoscopic surgical technique. In addition, the risks of aspiration, respiratory dysfunction and cardiovascular dysfunction increase during laparoscopy. Large bowel injuries during laparoscopy are serious complications because 50% of bowel injuries and 60% of visceral injuries are undiagnosed at the time of primary surgery. A missed or delayed diagnosis increases the risk of bowel perforation and consequently sepsis and even death. In this paper, we aim to focus on large bowel injuries that happen during gynecological laparoscopy and review their diagnostic and management options.
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13
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Cuss A, Bhatt M, Abbott J. Coming to terms with the fact that the evidence for laparoscopic entry is as good as it gets. J Minim Invasive Gynecol 2014; 22:332-41. [PMID: 25460522 DOI: 10.1016/j.jmig.2014.10.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 10/27/2014] [Accepted: 10/30/2014] [Indexed: 02/07/2023]
Abstract
Entry to the peritoneal cavity for laparoscopic surgery is associated with defined morbidity, with all entry techniques associated with substantial complications. Debate over the safest entry technique has raged over the last 2 decades, and yet, we are no closer to arriving at a scientifically valid conclusion regarding technique superiority. With hundreds of thousands of patients required to perform adequately powered studies, it is unlikely that appropriately powered comparative studies could be undertaken. This review examines the risk of complications related to laparoscopic entry, current statements from examining bodies around the world, and the medicolegal ramifications of laparoscopic entry complications. Because of the numbers required for any complications study, with regard to arriving at an evidence-based decision for laparoscopic entry, we ask: is the current literature perhaps as good as it gets?
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Affiliation(s)
- Amanda Cuss
- Royal Hospital for Women, Sydney, Australia and University of New South Wales, Sydney, Australia
| | | | - Jason Abbott
- Royal Hospital for Women, Sydney, Australia and University of New South Wales, Sydney, Australia.
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14
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El-Hossamy H, Morsi H. Recognition and Prevention of Gastric Injury During Gynecologic Laparoscopy. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2013.0116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hashem El-Hossamy
- Department of Obstetrics and Gynaecology, Dudley Hospitals NHS Foundation Trust, Dudley, West Midlands, United Kingdom
| | - Hassan Morsi
- Department of Obstetrics and Gynaecology, Dudley Hospitals NHS Foundation Trust, Dudley, West Midlands, United Kingdom
- Department of Obstetrics and Gynaecology, Russells Hall Hospital, Dudley Hospitals NHS Foundation Trust, Dudley, West Midlands, United Kingdom
- University of Birmingham, Birmingham, United Kingdom
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15
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Bhullar JS, Gayagoy J, Chaudhary S, Kolachalam RB. Delayed presentation of a bowel Bovie injury after laparoscopic ventral hernia repair. JSLS 2014; 17:495-8. [PMID: 24018096 PMCID: PMC3771778 DOI: 10.4293/108680813x13753907292070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Slow transmural tissue necrosis may occur after an electrosurgical Bovie injury and lead to eventual bowel perforation. Introduction: Bowel injury during laparoscopic surgery is a rare but serious complication. A Bovie injury to the bowel can cause delayed perforation of the viscus, thus increasing the possibility of a preventable morbidity. Patients presenting with perforation peritonitis within 24 hours and up to 2 to 3 weeks after laparoscopic Bovie injury to the bowel have been reported in the literature. Case Description: A 74-year-old woman underwent a laparoscopic ventral hernia mesh repair. Intraoperatively, a small area of superficial Bovie injury to the small bowel was repaired with Lembert sutures and tissue glue. Postoperatively, the patient recovered well, but she presented with perforation peritonitis 3 months after surgery. An exploratory laparotomy showed a jejunal perforation in the same area that was injured with cautery and repaired during the previous surgery. The patient was only using inhaled steroids for asthma on and off but had a remote history of chemotherapy and radiation for colorectal cancer. Conclusion: Bovie injury to the bowel has a hidden depth, causing a slow transmural tissue necrosis, and it might also impair local healing and eventually lead to perforation. Thus, the patient may present later than the usual period for wound healing and remodeling as previously reported. Given the disastrous consequence, it is imperative to perform a good surgical repair of even a minor Bovie injury to the bowel. This is the first report of a delayed presentation (>1 month) of a Bovie injury of the bowel.
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Affiliation(s)
- Jasneet Singh Bhullar
- Department of Surgery, Providence Hospital & Medical Centers, 16001 W 9 Mile Rd, Southfield, MI 48075, USA.
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16
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Comparison of tubal sterilization procedures performed by keyless abdominal rope-lifting surgery and conventional CO2 laparoscopy: a case controlled clinical study. ScientificWorldJournal 2013; 2013:963615. [PMID: 24453932 PMCID: PMC3886610 DOI: 10.1155/2013/963615] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 10/08/2013] [Indexed: 12/12/2022] Open
Abstract
Objective. To evaluate the safety and efficacy of Keyless Abdominal Rope-Lifting Surgery (KARS), for tubal sterilization procedures in comparison with the conventional CO2 laparoscopy. Material and Methods. During a one-year period, 71 women underwent tubal ligation surgery. Conventional laparoscopy (N = 38) and KARS (N = 33) were used for tubal sterilization. In KARS, an abdominal access pathway through a single intra-abdominal incision was used to place transabdominal sutures that elevated the abdominal wall, and the operations were performed through the intraumbilical entry without the use of trocars. In CO2 laparoscopy, following the creation of the CO2 pneumoperitoneum a 10 mm trocar and two 5 mm trocars were introduced into the abdominal cavity. Tubal sterilizations were performed following the creation of the abdominal access pathways in both groups. The groups were compared with each other. Results. All operations could be performed by KARS without conversion to CO2 laparoscopy or laparotomy. The mean operative time of the two groups was not significantly different (P > 0.05). Intra- and postoperative findings including complications, bleeding, and hospital stay time did not differ between groups (P > 0.05). Conclusion. KARS for tubal sterilization seems safe and effective in terms of cosmesis, postoperative pain, and early hospital discharge.
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17
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Mesdaghinia E, Abedzadeh-Kalahroudi M, Hedayati M, Moussavi-Bioki N. Iatrogenic gastrointestinal injuries during obstetrical and gynecological operation. ARCHIVES OF TRAUMA RESEARCH 2013; 2:81-4. [PMID: 24396799 PMCID: PMC3876555 DOI: 10.5812/atr.12088] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 05/25/2013] [Accepted: 05/29/2013] [Indexed: 12/12/2022]
Abstract
Background Gastrointestinal Injuries (GI) during gynecological operation are uncommon but proper
management of these injuries is very important. Objectives The aim of this study was to review the causes and management of gastrointestinal
injuries during gynecological and obstetrical operations. Patients and Methods In this descriptive retrospective study, 25 patients with gastrointestinal injuries
during gynecological and obstetrical operation at Shabihkhani Maternity Hospital in
Kashan city were reviewed. Demographic data such as age, gravid, parity, type of surgery
or procedure, history of laparotomy, the surgical operation, injury site, time of
diagnosis and method of treatment were extracted from medical records. Results The mean age of women was 33.2 ± 7.57 years. Fourty-four percent of the patients
had a history of abdominal scar. Thirty-two percent of all GI injuries occurred during
total abdominal hysterectomy (TAH). The small bowel was injured in 36% of cases.
Fifty-two percent of injuries were diagnosed during the operation and the mean time of
injury diagnosis was 2.8 ± 0.9 days. Conclusions All of the gynecologic surgeons must be aware of gastrointestinal injuries and should
anticipate injury to these organs especially in high-risk patients for decreasing
patient morbidity.
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Affiliation(s)
- Elaheh Mesdaghinia
- Department of Obstetrics and Gynecology, Kashan University
of Medical Sciences, Kashan, IR Iran
| | - Masoumeh Abedzadeh-Kalahroudi
- Trauma Research Center, Kashan University of Medical
Sciences, Kashan, IR Iran
- Corresponding author: Masoumeh Abedzadeh-Kalahroudi,
Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel.:
+98-3615550021, Fax: +98-3615620634, E-mail:
| | - Mehrdad Hedayati
- Deputy of Health, Kashan University of Medical Sciences,
Kashan, IR Iran
| | - Nushin Moussavi-Bioki
- Department of General Surgery, Kashan University of Medical
Sciences, Kashan, IR Iran
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18
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Whittemore JC, Mitchell A, Hyink S, Reed A. Diagnostic Accuracy of Tissue Impedance Measurement Interpretation for Correct Veress Needle Placement in Canine Cadavers. Vet Surg 2013; 42:613-22. [DOI: 10.1111/j.1532-950x.2013.01107.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 12/01/2011] [Indexed: 01/29/2023]
Affiliation(s)
- Jacqueline C. Whittemore
- Department of Small Animal Clinical Sciences at the College of Veterinary Medicine; University of Tennessee; Knoxville, Tennessee
| | - Amanda Mitchell
- Department of Small Animal Clinical Sciences at the College of Veterinary Medicine; University of Tennessee; Knoxville, Tennessee
| | - Sara Hyink
- Department of Small Animal Clinical Sciences at the College of Veterinary Medicine; University of Tennessee; Knoxville, Tennessee
| | - Ann Reed
- Office of Information Technology; University of Tennessee; Knoxville, Tennessee
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19
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Affiliation(s)
- Michael Baggish
- The Women's Center, Saint Helena Hospital, Saint Helena, CA
- Department of Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, OH (emeritus)
- Department of Obstetrics and Gynecology, University of California, San Francisco, San Francisco, CA
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20
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Ülker K, Hüseyinoğlu Ü, Kılıç N. Management of benign ovarian cysts by a novel, gasless, single-incision laparoscopic technique: keyless abdominal rope-lifting surgery (KARS). Surg Endosc 2012; 27:189-98. [PMID: 22733196 DOI: 10.1007/s00464-012-2419-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 05/25/2012] [Indexed: 01/05/2023]
Abstract
BACKGROUND To find the most efficacious method to minimize the side effects and maximize the advantages of laparoscopic surgery, this study aimed to define and document a gasless, single-incision abdominal access technique for the management of benign ovarian cysts. METHODS During a 1½ year period, 55 women underwent surgery for a benign ovarian cyst. Conventional carbon dioxide (CO(2)) laparoscopy was used for 33 of the women, and 22 of the women underwent a novel, gasless, single-incision laparoscopic surgery. An abdominal access pathway through a single intraabdominal incision was used to place transabdominal sutures that elevated the abdominal wall, and the operations were performed through the intra-umbilical entry without the use of trocars. Thus, the new technique was called keyless abdominal rope-lifting surgery (KARS). Two operative groups were compared to assess the feasibility of the new technique. RESULTS All the operations could be performed by KARS without conversion to CO(2) laparoscopy or laparotomy. However, for two patients in the conventional laparoscopy group, minilaparotomy had to be performed for tissue retrieval. Although the two techniques had many similar results, the total operative times and the abdominal access times in the KARS group were significantly longer than in the conventional laparoscopy group (p < 0.05). Simple oral analgesics were adequate for postoperative pain relief in both groups. CONCLUSIONS The KARS technique is a gasless, single-incision laparoscopic procedure that can be performed safely and effectively in terms of cosmesis, postoperative pain, and fertility preservation for the management of benign adnexal pathologies.
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Affiliation(s)
- Kahraman Ülker
- Department of Obstetrics and Gynecology, Kafkas University Medical Faculty, Kars, Turkey.
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21
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Radosa MP, Winzer H, Mothes AR, Camara O, Diebolder H, Weisheit A, Runnebaum IB. Laparoscopic myomectomy in peri- and post-menopausal women is safe, efficacious and associated with long-term patient satisfaction. Eur J Obstet Gynecol Reprod Biol 2012; 162:192-6. [DOI: 10.1016/j.ejogrb.2012.02.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 01/06/2012] [Accepted: 02/28/2012] [Indexed: 10/28/2022]
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22
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Cipullo L, Lucio C, Zullo F, Fulvio Z, Visconti F, Federica V, Palatucci V, Valeria P, Pascale R, Renato P, Marra ML, Luisa MM, Guida M, Maurizio G. Gastric injuries during gynaecologic laparoscopy. Arch Gynecol Obstet 2012; 286:1081-6. [PMID: 22639137 DOI: 10.1007/s00404-012-2389-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 05/10/2012] [Indexed: 10/28/2022]
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23
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24
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Early postoperative small bowel obstruction after laparoscopic myomectomy. Fertil Steril 2010; 94:2329.e9-12. [PMID: 20416869 DOI: 10.1016/j.fertnstert.2010.03.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 03/05/2010] [Accepted: 03/10/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To describe an early small bowel obstruction after robotic-assisted laparoscopic myomectomy with the Davinci system. DESIGN Case report. SETTING Academic medical center. PATIENT(S) Two days after a robotic-assisted laparoscopic myomectomy, a 35-year-old nulligravid African-American woman developed a small bowel obstruction due to retained myoma fragments that had implanted on and subsequently kinked loops of the small bowel. INTERVENTION(S) The patient was managed conservatively for 4 days with bowel rest and IV hydration. Due to worsening clinical symptoms and supportive radiologic findings, exploratory laparotomy was performed to lyse adhesions and remove the implanted myoma pieces. MAIN OUTCOME MEASURE(S) Clinical resolution of small bowel obstruction symptoms. RESULT(S) No bowel resection was needed for this patient. CONCLUSION(S) Prompt recognition and operative treatment of the small bowel obstruction prevented the need for intestinal resection. To reduce the risk of ectopic implantation of myoma fragments, meticulous care should be taken to remove all remnants of morcellated tissue. Immediate postoperative complications, such as bowel obstruction, and long-term complications related to recurrent myomas may then be avoided.
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25
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Van Lue SJ, Van Lue AP. Equipment and instrumentation in veterinary endoscopy. Vet Clin North Am Small Anim Pract 2009; 39:817-37. [PMID: 19683646 DOI: 10.1016/j.cvsm.2009.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Endoscopic procedures are minimally invasive in nature, and have been found to decrease the postoperative stress response and postoperative pain compared with similar procedures performed by an open approach. There is an ongoing effort to make minimally invasive surgery even less invasive through research and the development of new and improved medical devices. This article provides a general overview of the necessary equipment and instrumentation that will assist practitioners in making decisions for the incorporation of endoscopy/endoscopic surgery into their practice.
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Affiliation(s)
- Stephen J Van Lue
- Surgical Research and Innovation, LyChron, LLC, Mountain View, CA 94043, USA.
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26
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Lam A, Kaufman Y, Khong SY, Liew A, Ford S, Condous G. Dealing with complications in laparoscopy. Best Pract Res Clin Obstet Gynaecol 2009; 23:631-46. [PMID: 19539536 DOI: 10.1016/j.bpobgyn.2009.03.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Accepted: 03/16/2009] [Indexed: 11/26/2022]
Abstract
With increasing adoption of laparoscopic surgery in gynaecology, there has been a corresponding rise in the types and rates of complications reported. This article sets out to classify complications associated with laparoscopy according to the phases of the surgery; assess the incidence, the mechanisms, the presentations; and recommend methods for preventing and dealing with complications in laparoscopic surgery. Its aim is to promote a culture of risk management based on the development of strategies to improve patient safety and outcome.
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Affiliation(s)
- Alan Lam
- Centre for Advanced Reproductive Endosurgery, (CARE), Royal North Shore Hospital, University of Sydney, Sydney, Australia.
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27
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Varma R, Gupta JK. Laparoscopic entry techniques: clinical guideline, national survey, and medicolegal ramifications. Surg Endosc 2008; 22:2686-97. [DOI: 10.1007/s00464-008-9871-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 01/12/2008] [Accepted: 01/27/2008] [Indexed: 12/20/2022]
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29
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Shibahara H, Shimada K, Kikuchi K, Hirano Y, Suzuki T, Takamizawa S, Fujiwara H, Suzuki M. Major complications and outcome of diagnostic and operative transvaginal hydrolaparoscopy. J Obstet Gynaecol Res 2007; 33:705-9. [PMID: 17845334 DOI: 10.1111/j.1447-0756.2007.00636.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Transvaginal hydrolaparoscopy (THL) has recently been developed as a less invasive alternative to conventional laparoscopy. There are some reports that described the usefulness and prognostic value of diagnostic THL in infertile women. Moreover, operative THL such as ovarian drilling for unovulatory women with polycystic ovarian syndrome (PCOS) to induce ovulation has also been found to be as effective as that by conventional laparoscopy. The risk of bowel injury and sepsis by transvaginal access with culdoscopy was higher than that with laparoscopy in the previous reports. The purpose of the present study was to examine the risk of diagnostic and operative THL according to two case studies with a literature review. METHODS The authors carried out diagnostic or operative THL in 177 infertile women, aged 22-43 years. Major complications during THL and a review of the literature were analyzed. RESULTS Two cases of bowel injury were diagnosed during diagnostic THL. No complication occurred during operative THL. In total, the incidence of bowel injury was 1.1%. The injuries were diagnosed during THL and treated expectantly under strict conditions in both cases. Ten studies in the literature reported a total of 4232 procedures, including 26 bowel injuries (0.61%) and one perforation of a retroflexed uterus (0.02%). CONCLUSIONS The usefulness of THL for diagnostic and operative purposes is in no doubt. However, informed consent should be obtained and vigilance before and during THL should be maintained, although it can be done on an outpatient clinic basis.
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Affiliation(s)
- Hiroaki Shibahara
- Department of Obstetrics and Gynecology, School of Medicine, Jichi Medical University and Center for Reproductive Medicine, Jichi Medical University Hospital, Yakushiji, Shimotsuke, Tochigi, Japan.
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30
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Baggish MS. One-Hundred and Thirty Small- and Large-Bowel Injuries Associated with Gynecologic Laparoscopic Operations. J Gynecol Surg 2007. [DOI: 10.1089/gyn.2007.b-02287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Michael S. Baggish
- Department of Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, OH
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31
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Mateus J, Pezzi C, Somkuti SG. Recognition and prevention of gastric injury during gynecologic laparoscopy. Obstet Gynecol 2006; 108:804-6. [PMID: 17018509 DOI: 10.1097/01.aog.0000214680.33896.d0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Laparoscopy has become an essential tool for the gynecologist. Its use has dramatically increased, in part, because of technological advances, but also because of well-documented advantages over laparotomy in particular scenarios. Immediate recognition of a complication is essential for reducing morbidity and potential mortality. We report an inadvertent gastric injury during a diagnostic laparoscopy. CASE A 36-year-old woman sustained a gastric perforation during the insertion of an umbilical 5-mm trocar. After the injury was recognized, the patient underwent exploratory laparotomy, and primary repair of the defect was performed. The patient had an uneventful postoperative recovery. CONCLUSION Gastric injury is a rare complication of gynecologic laparoscopy. Identification of risk factors, the use of a nasogastric or orogastric tube to relieve any gastric dilatation before initiation of the procedure, and proper surgical technique may minimize such injuries.
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Affiliation(s)
- Julio Mateus
- Department of Obstetrics and Gynecology, Abington Memorial Hospital, Abington, PA 19000, USA.
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32
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Ito M, Harada T, Yamauchi N, Tsudo T, Mizuta M, Terakawa N. Small bowel perforation from a thermal burn caused by contact with the end of a laparoscope during ovarian cystectomy. J Obstet Gynaecol Res 2006; 32:434-6. [PMID: 16882271 DOI: 10.1111/j.1447-0756.2006.00423.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although laparoscopic surgery now replaces many gynecologic laparotomy procedures, serious complications unique to laparoscopy may occur, including vascular or bowel injury. In most cases of bowel injury during laparoscopy, the laparoscopic instruments that cause injury are the trocar, Veress needle, grasping forceps or scissors, electrocoagulator, or laser. We report a rare case of small bowel perforation after a thermal burn caused by contact with the end of the scope during laparoscopic ovarian cystectomy. Burns and perforations of the small bowel during laparoscopy are rare complications preventable by familiarity with the physical properties of the laparoscopic instruments.
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Affiliation(s)
- Masayuki Ito
- Department of Obstetrics and Gynecology, Masuda Red Cross Hospital, Masuda, Japan.
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33
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Nezhat C, de Fazio A, Nicholson T, Nezhat C. Intraoperative sigmoidoscopy in gynecologic surgery. J Minim Invasive Gynecol 2006; 12:391-5. [PMID: 16213423 DOI: 10.1016/j.jmig.2005.03.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2004] [Accepted: 03/28/2005] [Indexed: 12/20/2022]
Abstract
Intraoperative sigmoidoscopy is underused by the majority of practicing gynecologists and is not widely taught in obstetrics and gynecology training programs. In this report, a step-by-step approach is provided in order to perform sigmoidoscopy. Indications for use, along with various intraoperative applications, are discussed. Results from our center's experience with its use during laparoscopic treatment of adhesions, endometriosis, and associated disease of the bowel also are provided. Intraoperative sigmoidoscopy is a safe and efficacious procedure that can aid in the evaluation and treatment of pelvic pathology and facilitate identification and management of bowel injuries. It should be considered a valuable adjunct when such cases are encountered by gynecologic and pelvic surgeons.
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Affiliation(s)
- Ceana Nezhat
- Atlanta Center for Special Pelvic Surgery, Atlanta, Georgia 30342, USA.
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34
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Cartron G, Leblanc E, Ferron G, Martel P, Narducci F, Querleu D. Complications des lymphadénectomies cœlioscopiques en oncologie gynécologique : 1102 interventions chez 915 patientes. ACTA ACUST UNITED AC 2005; 33:304-14. [PMID: 15914073 DOI: 10.1016/j.gyobfe.2005.04.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2005] [Accepted: 04/08/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Evaluate complications of pelvic and para aortic laparoscopic lymphadenectomies in oncologic gynaecology to confirm the surgical approach and include it in current therapy. PATIENTS AND METHODS From December 1998 to March 2004, 915 patients underwent pelvic and/or aortic lymphadenectomies by laparoscopy. Among them, 771 were operated on at the centre Oscar-Lambret (Lille, France), whereas 144 underwent surgery at the institut Claudius-Regaud (Toulouse, France). Laparoscopic lymphadenectomies could be indicated along with other procedures in 98 early adnexal carcinomas, in 237 cervical carcinomas and 216 locally advanced cervical carcinomas. It may also be included as part of cancer therapy with (radical) hysterectomy/trachelectomy in 161 endometrial and 203 up front surgical cervical carcinomas. RESULTS A total of 1102 pelvic and aortic lymphadenectomies have been performed: 714 pelvic (694 trans peritoneal, 20 extra peritoneal) and 388 aortic lymphadenectomies (154 transperitoneal, 234 extraperitoneal). Seventeen open surgeries (1.85%) were necessary for technical reasons or complications. DISCUSSION AND CONCLUSIONS Laparoscopic lymphadenectomies are safe and accurate with no more complications than by laparotomy and no death up to now.
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Affiliation(s)
- G Cartron
- Institut Claudius-Regaud, 20-24, rue du Pont-St-Pierre, 31052 Toulouse cedex, France.
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Nezhat CH, de Fazio A, Nezhat CR. Laparoscopic repair of gastric perforation secondary to umbilical trocar insertion. J Minim Invasive Gynecol 2005; 12:171-3. [PMID: 15904625 DOI: 10.1016/j.jmig.2005.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2004] [Accepted: 10/08/2004] [Indexed: 10/25/2022]
Abstract
A postmenopausal woman was scheduled to undergo laparoscopic treatment of an 8-cm simple ovarian cyst. During abdominal entry, umbilical trocar insertion caused a gastric perforation that was diagnosed immediately and repaired laparoscopically. Following completion of the procedure, the patient was observed for 24 hours with a nasogastric tube in place and was discharged to home on the second postoperative day without further complications. The possibility of gastric distension and perforation is almost always present during laparoscopic abdominal entry. When perforation occurs, repair can be accomplished safely by laparoscopy.
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Affiliation(s)
- Ceana H Nezhat
- Center for Special Pelvic Surgery, Atlanta, Georgia 30342, USA.
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Nio M, Ishii T, Amae S, Wada M, Nishi K, Hayashi Y. An experimental study on the utility of a 3-mm ultrasonically activated trocar system. J Pediatr Surg 2004; 39:1842-4. [PMID: 15616946 DOI: 10.1016/j.jpedsurg.2004.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND/PURPOSE A prototype of a 3-mm ultrasonically activated trocar system supplied by Olympus Corporation was evaluated experimentally in terms of its utility and safety. METHODS Three piglets with an average weight of 12 kg were used. A pneumoperitoneum was created by Hasson's technique. Eleven punctures were made with a disposable conical 3-mm trocar (CT), 9 punctures with a 3-mm radially expanding trocar (ET), and 13 punctures with a 3-mm ultrasonically activated trocar (UT) under laparoscopic control. The authors recorded the time for abdominal penetration, the severity of the peritoneal tenting, the presence of elevated abdominal pressure of 5 mm Hg or more at the penetration, and the maximal force applied to the trocar to remove from the abdominal wall. RESULTS The average times for penetration were 11.8, 9.4, and 3.8 seconds with CT, ET, and UT, respectively (P < .05, CT v. UT, ET v. UT). The average maximal forces at the trocar removal were 10.52, 21.17, and 21.24 N with CT, ET, and UT, respectively (P < .05, CT v. ET, CT v. UT). Elevation of abdominal pressure of 5 mm Hg or more was recorded in CT and ET but not in UT. Peritoneal tenting was the most severe in ET and minimal in UT. No complication related to the UT system was found. CONCLUSIONS The 3-mm UT is a simple and safe device and is expected to become commercially available.
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Affiliation(s)
- Masaki Nio
- Department of Surgery, Miyagi Children's Hospital, Sendai 989-3126, Japan
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Abstract
BACKGROUND Bowel injury is a rare but serious complication of laparoscopic surgery. This review examines the incidence, location, time of diagnosis, causative instruments, management and mortality of laparoscopy-induced bowel injury. METHODS The review was carried out using the MeSH browser within PubMed. The keywords used were 'laparoscopy/adverse effects' and 'bowel perforation'. Additional articles were sourced from references within the studies found in the PubMed search. RESULTS The incidence of laparoscopy-induced gastrointestinal injury was 0.13 per cent (430 of 329 935) and of bowel perforation 0.22 per cent (66 of 29 532). The small intestine was most frequently injured (55.8 per cent), followed by the large intestine (38.6 per cent). In at least 66.8 per cent of bowel injuries the diagnosis was made during the laparoscopy or within 24 h thereafter. A trocar or Veress needle caused the most bowel injuries (41.8 per cent), followed by a coagulator or laser (25.6 per cent). In 68.9 per cent of instances of bowel injury, adhesions or a previous laparotomy were noted. Management was mainly by laparotomy (78.6 per cent). The mortality rate associated with laparoscopy-induced bowel injury was 3.6 per cent. CONCLUSION At 0.13 per cent, the incidence of laparoscopy-induced bowel injury is small and such injury is usually discovered during the operation. Nevertheless, laparoscopy-induced bowel injury is associated with a high mortality rate of 3.6 per cent.
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Affiliation(s)
- M van der Voort
- Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Nezhat C, Seidman D, Nezhat F, Nezhat C. The role of intraoperative proctosigmoidoscopy in laparoscopic pelvic surgery. ACTA ACUST UNITED AC 2004; 11:47-9. [PMID: 15104830 DOI: 10.1016/s1074-3804(05)60009-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE To report the outcome of rigid sigmoidoscopy during operative laparoscopy in patients at high risk for rectosigmoid and large bowel injury. DESIGN Prospective patient database with retrospective chart review (Canadian Task Force classification II-3). SETTING Referral practice and tertiary medical center. PATIENTS Two hundred sixty-two women with rectosigmoid endometriosis and adhesions. INTERVENTIONS Rigid sigmoidoscopy during laparoscopy. At the end of surgery, proctosigmoidoscopy was performed to evaluate intraluminal abnormality or rectosigmoid injury. The pelvis was then filled with isotonic fluid to observe laparoscopically for air leakage. MEASUREMENTS AND MAIN RESULTS Sigmoidoscopy was performed due to a lesion involving the rectum or sigmoid in 60.7%, large bowel in 11.1%, and posterior cul-de-sac in 28.2% of patients. During laparoscopy, endometriosis was found in 30.5%, adhesions in 20.2%, and both in 43.5%. Four women (1.5%) had bowel injury identified during sigmoidoscopy; all bowel injuries were treated by intracorporeal laparoscopic suturing. One incomplete repair was detected by sigmoidoscopy. In one woman (0.4%) a rectal polyp was detected. CONCLUSION Bowel injury is one of the most serious complications of laparoscopy. Early detection and prompt intraoperative management are essential to prevent a potentially catastrophic outcome. Sigmoidoscopy is a relatively easy procedure and aids during laparoscopy in the diagnosis of bowel perforation and in assessment of bowel wall invasion and potential stricture caused by endometriosis. It is a safe procedure even when performed immediately after extensive laparoscopic surgical treatment of rectosigmoid endometriosis and adhesions.
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Affiliation(s)
- Ceana Nezhat
- Center for Special Pelvic Surgery, Atlanta, Georgia, USA
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Chapron C, Cravello L, Chopin N, Kreiker G, Blanc B, Dubuisson JB. Complications during set-up procedures for laparoscopy in gynecology: open laparoscopy does not reduce the risk of major complications. Acta Obstet Gynecol Scand 2004; 82:1125-9. [PMID: 14616258 DOI: 10.1046/j.1600-0412.2003.00251.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare the risk of major complications during the set-up procedures for laparoscopy according to whether the classic technique (creation of the pneumoperitoneum followed by introduction of the optics trocar) or open laparoscopy is used. METHODS Comparison was made of two retrospective series each carried out in a department promoting one of the two techniques. The setting was a university-affiliated hospital. Two groups of patients were compared: group A, classic laparoscopy, n = 8324; group B, open laparoscopy, n = 1562. We investigated the set-up procedures of operative laparoscopy according to the rules of classic or open laparoscopy. RESULTS The risk of failure requiring conversion to laparotomy is significantly higher in the group of patients who underwent open laparoscopy [three cases (0.19%) vs. 0 case (0.0%); p = 0.004]. The risk of major complications is comparable in the two groups [group A, four cases (0.05%) vs. group B, three cases (0.19%); p = 0.08]. In the classic laparoscopy group there were four major complications: one injury to the aorta and three bowel injuries. In the open laparoscopy group there were three major complications: two bowel injuries and one postoperative occlusion. CONCLUSIONS Open laparoscopy does not reduce the risk of major complications during the set-up procedures for laparoscopy. Randomized prospective trials are indispensable for comparing the risks involved with the classic technique and those of open laparoscopy.
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Affiliation(s)
- C Chapron
- Assistance Publique des Hôpitaux de Paris, Service de Gynécologie Obstétrique II, Unité de Chirurgie, Clinique Universitaire Baudelocque, CHU Cochin Port-Royal, Paris, France.
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Shen CC, Wu MP, Lu CH, Hung YC, Lin H, Huang EY, Huang FJ, Hsu TY, Chang SY. Small Intestine Injury in Laparoscopic-Assisted Vaginal Hysterectomy. ACTA ACUST UNITED AC 2003; 10:350-5. [PMID: 14567810 DOI: 10.1016/s1074-3804(05)60260-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE To review laparoscopic-assisted vaginal hysterectomy (LAVH) cases for instances of small intestine injury. DESIGN Retrospective review (Canadian Task Force Classification II-2). SETTING Tertiary care university hospital. PATIENTS Two thousand six hundred eighty-two women. INTERVENTION LAVH. MEASUREMENTS AND MAIN RESULTS Indications for hysterectomy were myomata uteri, adenomyosis, intractable menorrhagia, endometriosis, severe pelvic adhesions, cervical intraepithelial neoplasia, endometrial polyps, and hyperplasia. Small bowel injuries occurred in five women (1.9/1000), one (20%) of which was recognized postoperatively. Thermal injuries occurred in two patients, trocar injuries in two, and a dissection wound in one. Two-layer closure was performed for three patients, and partial resection with reanastomosis for two. All patients were discharged without sequelae. CONCLUSION Small bowel injury during LAVH is not common. It may have unusual characteristics and devastating consequences if not recognized and treated promptly.
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Affiliation(s)
- Chung-Chang Shen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Shibahara H, Takamizawa S, Hirano Y, Takei Y, Fujiwara H, Tamada S, Sato I. Relationships between Chlamydia trachomatis
Antibody Titers and Tubal Pathology Assessed using Transvaginal Hydrolaparoscopy in Infertile Women. Am J Reprod Immunol 2003; 50:7-12. [PMID: 14506923 DOI: 10.1034/j.1600-0897.2003.01173.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PROBLEM Since transvaginal hydrolaparoscopy (THL) was introduced as the first-line procedure in the early stages of the exploration of the adnexal structures in infertile women, it has been shown that THL is a less traumatic and a more suitable outpatient procedure than diagnostic laparoscopy. This study was performed to investigate the relationships between Chlamydia trachomatis antibody titers and tubal pathology assessed using THL in infertile women. METHODS The C. trachomatis antibody titers (IgG and IgA) were evaluated by ELISA. The posterior of the uterus and the tubo-ovarian structures were carefully observed, and tubal passage using indigocarmine was confirmed using THL. THL was carried out in 32 infertile women having C. trachomatis antibody in their sera between May 1999 and October 2001. Unilateral salpingectomy had been performed on two of the 32 patients. RESULTS Tubal occlusion was confirmed in 20 (32.3%) of the 62 tubes, while peritubal adhesion was diagnosed in 37 (59.7%) of the 62 tubes. Using receiver operating characteristics curves, the cut-off value of C. trachomatis IgG antibody titer to predict tubal occlusion was determined to be 3.55. Tubal occlusion was observed in 16 (51.6%) of the 31 tubes in patients with the C. trachomatis IgG antibody titer of more than 3.55, which was significantly higher in four (12.9%) of the 31 tubes having the antibody titer less than 3.55 (P = 0.004). However, there was no correlation between C. trachomatis IgG antibody titer and peritubal adhesion. As for C. trachomatis IgA antibody titer, there was no correlation between antibody titer and tubal occlusion or peritubal adhesion. CONCLUSIONS These results suggest that C. trachomatis infection is significantly associated with tubal pathology. Although the cut-off value of C. trachomatis IgG antibody titer to predict the existence of tubal occlusion was shown to be 3.55, we would suggest that THL or standard laparoscopy is performed to consider appropriate treatments in patients with past C. trachomatis infection because of the high prevalence of peritubal adhesion.
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Affiliation(s)
- Hiroaki Shibahara
- Department of Obstetrics and Gynecology, Jichi Medical School, Kawachi-gun, Tochigi, Japan.
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Shen CC, Wu MP, Kung FT, Huang FJ, Hsieh CH, Lan KC, Huang EY, Hsu TY, Chang SY. Major complications associated with laparoscopic-assisted vaginal hysterectomy: ten-year experience. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 2003; 10:147-53. [PMID: 12732762 DOI: 10.1016/s1074-3804(05)60289-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE To describe our experience with major complications associated with laparoscopic-assisted vaginal hysterectomy (LAVH) and compare our results with those of the American Association of Gynecologic Laparoscopists (AAGL) membership survey and another similar study. DESIGN Retrospective study (Canadian Task Force classification II-3). SETTING University-affiliated hospital. PATIENTS Two thousand seven hundred two women. Intervention. LAVH. MEASUREMENTS AND MAIN RESULTS Demographic data and medical histories (age, parity, surgical indications, pathologic findings, major complications) were analyzed. Major complications were 11 bladder injuries, 4 ureter injuries, 11 bowel injuries, 2 vascular injuries, 2 cases of massive bleeding from the vaginal cuff or colpotomy wound with associated impending shock, 2 cases of postoperative ileus, and 2 pelvic abscesses. Our overall major complication rate was 1.3% compared with 2.7% in the AAGL 1995 membership survey (p <0.001). Similar rates of febrile morbidity (2.2% and 2.0%), bleeding requiring transfusion (0.05% and 0.06%), and bowel, ureteral, or bladder injury (1.0% and 1.0%) were noted between our study and the other 1995 study (all p >0.05). Of 34 major complications in our study, 24 occurred during hysterectomy performed by inexperienced general gynecologists and 10 by an experienced endoscopist (p = 0.005). CONCLUSION The rate of major complications associated with LAVH can be reduced when the procedure is performed by a well-trained laparoscopic surgeon compared with a less-experienced general gynecologist.
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Affiliation(s)
- Chung-Chang Shen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, 4F-4, 123-6, Ta-Pei Road, Niao Sung Hsiang, Kaohsiung, Taiwan
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Laparoscopic adhesiolysis in patients with chronic abdominal pain: a blinded randomised controlled multi-centre trial. Lancet 2003; 361:1247-51. [PMID: 12699951 DOI: 10.1016/s0140-6736(03)12979-0] [Citation(s) in RCA: 268] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Laparoscopic adhesiolysis for chronic abdominal pain is controversial and is not evidence based. We aimed to test our hypothesis that laparoscopic adhesiolysis leads to substantial pain relief and improvement in quality of life in patients with adhesions and chronic abdominal pain. METHODS Patients had diagnostic laparoscopy for chronic abdominal pain attributed to adhesions; other causes for their pain had been excluded. If adhesions were confirmed during diagnostic laparoscopy, patients were randomly assigned either to laparoscopic adhesiolysis or no treatment. Treatment allocation was concealed from patients, and assessors were unaware of patients' treatment and outcome. Pain was assessed for 1 year by visual analogue score (VAS) score (scale 0-100), pain change score, use of analgesics, and quality of life score. Analysis was by intention to treat. FINDINGS Of 116 patients enrolled for diagnostic laparoscopy, 100 were randomly allocated either laparoscopic adhesiolysis (52) or no treatment (48). Both groups reported substantial pain relief and a significantly improved quality of life, but there was no difference between the groups (mean change from baseline of VAS score at 12 months: difference 3 points, p=0.53; 95% CI -7 to 13). INTERPRETATION Although laparoscopic adhesiolysis relieves chronic abdominal pain, it is not more beneficial than diagnostic laparoscopy alone. Therefore, laparoscopic adhesiolysis cannot be recommended as a treatment for adhesions in patients with chronic abdominal pain.
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Hirano Y, Shibahara H, Takamizawa S, Suzuki I, Yamanaka S, Suzuki T, Fujiwara H, Suzuki M. Application of transvaginal hydrolaparoscopy for ovarian drilling using Nd:YAG laser in infertile women with polycystic ovary syndrome. Reprod Med Biol 2003; 2:37-40. [PMID: 29699164 PMCID: PMC5906835 DOI: 10.1046/j.1445-5781.2003.00018.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Since transvaginal hydrolaparoscopy (THL) was introduced as the first-line procedure in the early stage of the exploration of the tubo-ovarian structures in infertile women, it has been shown that THL is a less traumatic and a more suitable outpatient procedure than diagnostic laparoscopy. In the present study, a minimally invasive surgery was carried out in infertile women with polycystic ovary syndrome (PCOS) by THL. Ovarian drilling using Nd:YAG laser vaporization by THL was performed in two clomiphen citrate-resistant infertile women with PCOS. After ovarian drilling with THL, a patient recovered an ovulatory cycle. These findings suggest that ovarian drilling by THL seems to be a safe procedure in infertile women with PCOS. However, further investigations are required to evaluate the effectiveness and risks of this minimally invasive operation. (Reprod Med Biol 2003; 2: 37-40).
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Affiliation(s)
- Yuki Hirano
- Department of Obstetrics and Gynecology, Jichi Medical School, Tochigi, Japan
| | - Hiroaki Shibahara
- Department of Obstetrics and Gynecology, Jichi Medical School, Tochigi, Japan
| | - Satoru Takamizawa
- Department of Obstetrics and Gynecology, Jichi Medical School, Tochigi, Japan
| | - Izumi Suzuki
- Department of Obstetrics and Gynecology, Jichi Medical School, Tochigi, Japan
| | - Seiji Yamanaka
- Department of Obstetrics and Gynecology, Jichi Medical School, Tochigi, Japan
| | - Tatsuya Suzuki
- Department of Obstetrics and Gynecology, Jichi Medical School, Tochigi, Japan
| | - Hiroyuki Fujiwara
- Department of Obstetrics and Gynecology, Jichi Medical School, Tochigi, Japan
| | - Mitsuaki Suzuki
- Department of Obstetrics and Gynecology, Jichi Medical School, Tochigi, Japan
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Brosens I, Gordon A, Campo R, Gordts S. Bowel injury in gynecologic laparoscopy. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 2003; 10:9-13. [PMID: 12554987 DOI: 10.1016/s1074-3804(05)60227-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE To review surveys of the last decade on bowel injuries to evaluate the prevalence, causes, management, and outcomes of these events occurring during or as a result of laparoscopy. DESIGN Retrospective evaluation (Canadian Task Force classification II-2). SETTING Surveys and databases. PATIENTS None. INTERVENTION Data analysis. MEASUREMENTS AND MAIN RESULTS Combined data show that diagnostic and minor operative laparoscopy are associated with a 0.08% risk of bowel injury, and in major operative laparoscopy the risk increases to 0.33%. Injuries occurring during access and operative procedure decrease significantly with experience, but even in experienced hands injury during access cannot be avoided. Delayed diagnosis remains a major problem. Up to 15% of these injuries are not diagnosed during laparoscopy, and one of five cases of delayed diagnosis results in death. Perioperative diagnosis and immediate repair by laparoscopy or laparotomy reduce the likelihood of severe complications and consequently medicolegal actions. CONCLUSIONS Several surveys on complications of gynecologic laparoscopy tend to underestimate the risk of bowel injury. Prevention starts by awareness that such injury is an inherent risk of the technique, even in hands of experienced surgeons.
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Affiliation(s)
- Ivo Brosens
- Leuven Institute for Fertility and Embryology, Tiensevest 168, B-3000 Leuven, Belgium
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46
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Meijer D. Safety of dissection tools in laparoscopic surgery. J Laparoendosc Adv Surg Tech A 2002; 12:285-6. [PMID: 12269499 DOI: 10.1089/109264202760268096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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47
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Thomas K, Simms I. Chlamydia trachomatis in subfertile women undergoing uterine instrumentation. How we can help in the avoidance of iatrogenic pelvic inflammatory disease? Hum Reprod 2002; 17:1431-2. [PMID: 12042255 DOI: 10.1093/humrep/17.6.1431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Guidelines drawn up for patients undergoing termination of pregnancy state that there should be a protocol for either screening or treating for Chlamydia trachomatis. So far guidelines for other techniques that require instrumentation of the uterus (e.g. hysterosalpingography) remain unclear and controversial. By looking for other less invasive techniques we will be able to avoid these problems in a proportion of cases. Screening or treatment should be performed in those cases requiring uterine instrumentation.
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Affiliation(s)
- Kevin Thomas
- Department of Obstetrics and Gynaecology, University of Liverpool, Liverpool Women's Hospital, Crown Street, Liverpool L8 7SS, UK.
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48
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Affiliation(s)
- Javier F Magrina
- Division of Gynecologic Oncology, Mayo Clinic, Scottsdale, Arizona 85259, USA
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49
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Cravello L, Banet J, Agostini A, Bretelle F, Roger V, Blanc B. [Open laparoscopy: analysis of complications due to first trocar insertion]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2002; 30:286-90. [PMID: 12043503 DOI: 10.1016/s1297-9589(02)00317-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the complications of open laparoscopy during the set-up of laparoscopy in gynecologic surgery. DESIGN Retrospective study performed between February 1994 and January 2001 in a University Centre. PATIENTS AND METHODS 1,562 patients underwent open laparoscopies. Procedures were performed by 8 gynaecological surgeons. Peri- and postoperative complications were assessed and analysed. RESULTS Major injuries concerned gastrointestinal tract: 2 perforations with immediate diagnosis and one postoperative occlusion treated by delayed laparotomy (0.19%). No death occurred. No vascular injuries and no bladder complications were noted. CONCLUSION We recommend open laparoscopy because of its innocuity and easiness. Advantages concern decrease of major vascular injuries and early recognition of bowel injuries.
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Affiliation(s)
- L Cravello
- Service de gynécologie-obstétrique B, hôpital de la Conception, 147, bd Baille, 13385 Marseille, France.
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50
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Shen CC, Lu HM, Chang SY. Characteristics and management of large bowel injury in laparoscopic-assisted vaginal hysterectomy. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 2002; 9:35-9. [PMID: 11821604 DOI: 10.1016/s1074-3804(05)60102-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVE To review laparoscopic-assisted vaginal hysterectomies (LAVH) for large bowel injuries. DESIGN Retrospective review (Canadian Task Force classification II-2). SETTING University-affiliated hospital. PATIENTS Two thousand eighty-four women. INTERVENTION LAVH. MEASUREMENTS AND MAIN RESULTS Indications for hysterectomy were myomata uteri, adenomyosis, intractable menorrhagia, endometriosis, severe pelvic adhesions, cervical intraepithelial neoplasia, endometrial polyps, and hyperplasia. Large bowel injuries occurred in six women (2.9/1000), only one of which was recognized postoperatively. Colostomy was performed in four patients, simple repair in one, and laparoscopic repair in one. All these patients were discharged without sequelae. CONCLUSION In our experience, bowel injury during LAVH was not a common event.
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Affiliation(s)
- Chung-Chang Shen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, 4F-4, No 123-6, Ta-Pei Road, Naio Sung Hsiang, Kaohsiung, Taiwan
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