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King NR, Lin E, Yeh C, Wong JMK, Friedman J, Traylor J, Tsai S, Chaudhari A, Milad MP. Laparoscopic Major Vascular Injuries in Gynecologic Surgery for Benign Indications: A Systematic Review. Obstet Gynecol 2021; 137:434-442. [PMID: 33543898 DOI: 10.1097/aog.0000000000004280] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/19/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify the incidence, location, etiology, and mortality of major vascular injuries in gynecologic laparoscopy for benign indications. DATA SOURCES A systematic review of PubMed, EMBASE, Cochrane Library, ClinicalTrials.gov, and MEDLINE was conducted. METHODS OF STUDY SELECTION One thousand ninety-seven studies were screened for inclusion with 147 full-text articles reviewed. Sixty-six studies published between 1978 and 2016 met inclusion criteria, representing 197,062 surgeries. Articles that were included reported the incidence of major vascular injuries during gynecologic laparoscopy for benign indications. Exclusion criteria included surgery for gynecologic malignancy, duplicated data, case series and reports, manuscripts not in English, and studies published only as abstracts. TABULATION, INTEGRATION, AND RESULTS Injuries to the aorta, inferior vena cava, iliac (common, external, or internal), and inferior epigastric vessels were recorded, as were injuries denoted as major but not otherwise specified. A total of 179 major vascular injuries were reported with an incidence of 0.09% (95% CI 0.08-0.10). The inferior epigastric vessels were the most commonly injured vessel (0.04%, 95% CI 0.03-0.05), comprising 48% (95% CI 40-55) of all injuries. The majority of injuries occurred during abdominal entry (82%, 95% CI 76-89), and the remainder occurred during surgical dissection (18%, 95% CI 11-24). Most injuries were recognized intraoperatively (93%, 95% CI 87-100), and approximately half (55%, 95% CI 46-63) required laparotomy for repair. Only two of the 179 major vascular injuries resulted in death, for an overall mortality rate from vascular injuries of 0.001% (95% CI 0.000-0.004). CONCLUSION The incidence of major vascular injury during gynecologic laparoscopy found in this review is very low, and the vast majority of injuries did not result in death. Laparoscopy remains a safe surgical technique in relation to vascular injuries when performed for benign gynecologic disease.
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Affiliation(s)
- Nathan R King
- Department of Obstetrics and Gynecology and the Division of Biostatistics, Department of Preventive Medicine, Northwestern Feinberg School of Medicine, Chicago, Illinois; and the Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Chen CW, Chang HC, Huang TF, Liao CC, Huang RL, Lai HC. Transition from multiport to single-site surgery: A single institution experience in robotic supracervical hysterectomy for benign gynecological diseases. Taiwan J Obstet Gynecol 2020; 58:514-519. [PMID: 31307743 DOI: 10.1016/j.tjog.2019.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To share our experience of transition from multiport to single-site robotic surgery for benign gynecological conditions as well as to assess the selection criteria of candidates for robotic single-site supracervical hysterectomy (RSSH). MATERIALS AND METHODS A retrospective review was conducted on patients undergoing robotic supracervical hysterectomy by a single surgeon in a single institute between June 2014 and December 2017. Patients who underwent additional procedures along with supracervical hysterectomy and who had unexpectant corpus malignancy proved pathologically were excluded from comparisons between patients undergoing RSSH and robotic multiport supracervical hysterectomy (RMSH). RESULTS Between June 2014 and December 2017, we accomplished 26 RSSH and 57 RMSH. There were no conversions, intraoperative complications, and readmissions within 30 days after surgery. In the RSSH group, the mean uterine weight was 264.6 ± 140.9 g with mean docking time of 15.8 ± 5.5 min, mean console time of 61.1 ± 35.6 min and mean operative time of 140.3 ± 34.4 min. In comparison to the RMSH group, the percentage of overweight/obese patients was lower (p = 0.018) and the uterine size was smaller (p < 0.001) with adenomyosis diagnosed more frequently (p = 0.002) in the RSSH group. While the operative time in the RSSH group was significantly shorter (p = 0.002), the RSSH group took longer time in docking (p < 0.001) and comparable time in console (p = 0.254). In view of chronological change, docking time and console time in the RMSH group remained steady, whereas steep decreases were observed in the RSSH group. The intraoperative blood loss and hemoglobin drop were comparable. The length of hospital stay was significantly shorter in the RSSH group (p = 0.005). CONCLUSION Transition from multiport to single-site surgery can be smooth for a surgical team experienced in the conventional multiport robotic system. RSSH is safe and feasible in properly selected patients.
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Affiliation(s)
- Chien-Wen Chen
- Department of Obstetrics and Gynecology, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan
| | - Heng-Cheng Chang
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tzu-Fei Huang
- Department of Obstetrics and Gynecology, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan
| | - Chi-Chun Liao
- Department of Obstetrics and Gynecology, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan
| | - Rui-Lan Huang
- Department of Obstetrics and Gynecology, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hung-Cheng Lai
- Department of Obstetrics and Gynecology, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Yang W, Luo N, Ma L, Dai H, Cheng Z. The Changes of Surgical Treatment for Symptomatic Uterine Myomas in the Past 15 Years. Gynecol Minim Invasive Ther 2018; 7:10-15. [PMID: 30254928 PMCID: PMC6135150 DOI: 10.4103/gmit.gmit_11_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Study Objective: The aim of this study is to elaborate the changes of the surgical approach of treatment for uterine myomas in Yangpu Hospital in the past 15 years. Design: This was retrospective cohort study. Setting: Yangpu Hospital, Tongji University School of Medicine, Shanghai, China. Materials and Methods: A total of 4113 patients with symptomatic uterine myomas underwent surgical treatments. Interventions: Eight kinds of different surgeries were involved in the study, including abdominal or laparoscopic surgery, hysterectomy, or uterus-sparing myomectomy. Measurements: The study collected patients' clinical data and reviewed surgical access and approach, complications, and the results of following up. Results: A total of 1559 cases (37.9%) underwent uterus-sparing myomectomy, 3005 cases (73.1%) performed laparoscopic surgeries. The percentage of laparoscopic surgery was significantly higher than homochronous data of laparotomy after 2003 (P < 0.001). The per year total of uterus-reserved surgery was proved to be negatively correlated with patient's age (R2 = 0.930; P < 0.001). The rate of myomas recurrence was significantly lower in the combined myomectomy and uterine artery occlusion group (4%, 34/910) than in the single myomectomy group (10.5%, 44/420) (P < 0.001). Conclusions: Retaining uterus and minimally invasive surgery were the important trends of surgical treatment for symptomatic uterine myomas. Laparoscopic uterus-sparing myomectomy may be an alternative to hysterectomy to manage to appropriate patients with uterine myomas.
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Affiliation(s)
- Weihong Yang
- Department of Gynecology and Obstetrics, Tenth People's Hospital, Tongji University School of Medicine, Shanghai, P.R.China.,Department of Gynecology, Gynecologic Minimally Invasive Surgery Research Center, Tongji University School of Medicine, Shanghai, P.R.China
| | - Ning Luo
- Department of Gynecology and Obstetrics, Tenth People's Hospital, Tongji University School of Medicine, Shanghai, P.R.China.,Department of Gynecology, Gynecologic Minimally Invasive Surgery Research Center, Tongji University School of Medicine, Shanghai, P.R.China
| | - Lishan Ma
- Department of Gynecology, Gynecologic Minimally Invasive Surgery Research Center, Tongji University School of Medicine, Shanghai, P.R.China.,Department of Obstetrics and Gynecology, Yangpu Hospital, Tongji University School of Medicine, Shanghai, P.R.China
| | - Hong Dai
- Department of Gynecology, Gynecologic Minimally Invasive Surgery Research Center, Tongji University School of Medicine, Shanghai, P.R.China.,Department of Obstetrics and Gynecology, Yangpu Hospital, Tongji University School of Medicine, Shanghai, P.R.China
| | - Zhongping Cheng
- Department of Gynecology and Obstetrics, Tenth People's Hospital, Tongji University School of Medicine, Shanghai, P.R.China.,Department of Gynecology, Gynecologic Minimally Invasive Surgery Research Center, Tongji University School of Medicine, Shanghai, P.R.China
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Mahar KM, Enslin MB, Gress A, Amrine-Madsen H, Cooper M. Single- and Multiple-Day Dosing Studies to Investigate High-Dose Pharmacokinetics of Epelsiban and Its Metabolite, GSK2395448, in Healthy Female Volunteers. Clin Pharmacol Drug Dev 2017; 7:33-43. [PMID: 28556598 DOI: 10.1002/cpdd.363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 04/06/2017] [Indexed: 01/11/2023]
Abstract
Open-label single- and double-blind repeat-dose studies in healthy female volunteers were conducted to investigate the pharmacokinetics (PK) and safety/tolerability of epelsiban total daily doses ranging from 600 to 900 mg. In 1 study (n = 12), epelsiban was dosed at 300 or 450 mg twice daily (every 12 hours) for a single day. In the repeat-dose double-blind study, epelsiban and placebo were administered to 31 subjects as 200 mg 3 times daily, 300 mg 3 times daily (TID), or 450 mg twice daily (BID) for 14 days. After both single and 14 daily repeat doses, the PK profiles for epelsiban and its metabolite, GSK2395448, remained linear at all administered doses. The exposures at a given total daily dose were also similar between BID and TID dosing regimens. Exposure (AUC0-τ ), based on dosing intervals, for both epelsiban and GSK2395448 was similar. However, compared with morning dosing, Cmax was lower after evening dosing, possibly because of a food effect. The highest accumulation of epelsiban and GSK2395448 exposures (AUC0-τ ) was approximately 34% for each after repeat dosing, consistent with the short half-life. At total daily doses of 600 and 900 mg, epelsiban was generally well tolerated, and there were no significant safety concerns identified.
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Affiliation(s)
- Kelly M Mahar
- Clinical Pharmacology Modeling and Simulation, GlaxoSmithKline, King of Prussia, PA, USA
| | - Mary Beth Enslin
- Virtual Proof of Concept Group, GlaxoSmithKline, King of Prussia, PA, USA
| | - Angie Gress
- Virtual Proof of Concept Group, GlaxoSmithKline, King of Prussia, PA, USA
| | | | - Melisa Cooper
- Virtual Proof of Concept Group, GlaxoSmithKline, King of Prussia, PA, USA
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Ala-Nissilä S, Haarala M, Järvenpää T, Mäkinen J. Long-term follow-up of the outcome of supracervical versus total abdominal hysterectomy. Int Urogynecol J 2016; 28:299-306. [PMID: 27640066 DOI: 10.1007/s00192-016-3143-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 08/28/2016] [Indexed: 02/03/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Hysterectomy for benign indications can be performed either as a supracervical or a total procedure. It is controversial whether removing the cervix is beneficial or not. This study aimed at comparing long-term outcomes after supracervical (n = 107) and total (n = 105) abdominal hysterectomy. METHODS Two prospective questionnaire-based studies were conducted among the original 212 patients operated on between February 1978 and May 1979 at Turku University Hospital, Finland. In the first study in 1997, a nonvalidated questionnaire was mailed to 193 patients to inquire about any postoperative symptoms. In the second study in 2011, a validated questionnaire and an invitation to a follow-up visit were sent to 153 women. During the visit, pelvic support was assessed using the Pelvic Organ Prolapse Quantification system. Additionally, hospital records were reviewed to identify any gynecological operations at both evaluation times. RESULTS In the first evaluation, the response rate was 94 %, and in the second, the rate was 62 %. Objective evaluation was possible in 75 women in 2011, 37 in the supracervical group and 38 in the total hysterectomy group. There were no significant differences in the rates of subjective urinary and sexual symptoms or subsequent operations for urinary incontinence and genital prolapse between women in the supracervical group and women in the total hysterectomy group. Four patients in the supracervical group required a re-operation: three for a prolapsed cervical stump and one for a cervical abscess. CONCLUSIONS Supracervical and total hysterectomies resulted in similar postoperative outcomes regarding subjective symptoms and subsequent gynecological operations during a follow-up of 33 years. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov ( www.clinicaltrials.gov ): NCT02166749.
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Affiliation(s)
- Seija Ala-Nissilä
- Department of Obstetrics and Gynecology, Turku University Hospital, FI-20520, Turku, Finland.
| | - Mervi Haarala
- Department of Obstetrics and Gynecology, Turku University Hospital, Vakka-Suomi Hospital, Uusikaupunki, Finland
| | - Tuija Järvenpää
- Department of Obstetrics and Gynecology, Turku University Hospital, Vakka-Suomi Hospital, Uusikaupunki, Finland
| | - Juha Mäkinen
- Department of Obstetrics and Gynecology, Turku University Hospital, FI-20520, Turku, Finland
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Krentel H, De Wilde R. Complications in Laparoscopic Supracervical Hysterectomy(LASH), especially the morcellation related. Best Pract Res Clin Obstet Gynaecol 2016; 35:44-50. [DOI: 10.1016/j.bpobgyn.2015.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 11/05/2015] [Indexed: 01/17/2023]
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Campagna G, Morciano A, Rossitto C, Panico G, Naldini A, Ercoli A, Cervigni M, Scambia G. A new approach to supracervical hysterectomy during laparoscopic sacral colpopexy for pelvic organ prolapse: A randomized clinical trial. Neurourol Urodyn 2016; 36:798-802. [DOI: 10.1002/nau.23030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 04/16/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Giuseppe Campagna
- Department of Obstetrics and Gynecology; Catholic University of the Sacred Heart; Roma Italy
| | - Andrea Morciano
- Department of Obstetrics and Gynecology; Catholic University of the Sacred Heart; Roma Italy
| | - Cristiano Rossitto
- Department of Obstetrics and Gynecology; Catholic University of the Sacred Heart; Roma Italy
| | - Giovanni Panico
- Department of Obstetrics and Gynecology; Catholic University of the Sacred Heart; Roma Italy
| | - Angelica Naldini
- Department of Obstetrics and Gynecology; Catholic University of the Sacred Heart; Roma Italy
| | - Alfredo Ercoli
- Department of Obstetrics and Gynecology; Catholic University of the Sacred Heart; Roma Italy
- Department of Obstetrics and Gynecology; University of Eastern Piedmont; Novara Italy
| | - Mauro Cervigni
- Department of Obstetrics and Gynecology; Catholic University of the Sacred Heart; Roma Italy
| | - Giovanni Scambia
- Department of Obstetrics and Gynecology; Catholic University of the Sacred Heart; Roma Italy
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Driessen SRC, Sandberg EM, la Chapelle CF, Twijnstra ARH, Rhemrev JPT, Jansen FW. Case-Mix Variables and Predictors for Outcomes of Laparoscopic Hysterectomy: A Systematic Review. J Minim Invasive Gynecol 2015; 23:317-30. [PMID: 26611613 DOI: 10.1016/j.jmig.2015.11.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 11/10/2015] [Accepted: 11/12/2015] [Indexed: 12/14/2022]
Abstract
The assessment of surgical quality is complex, and an adequate case-mix correction is missing in currently applied quality indicators. The purpose of this study is to give an overview of all studies mentioning statistically significant associations between patient characteristics and surgical outcomes for laparoscopic hysterectomy (LH). Additionally, we identified a set of potential case-mix characteristics for LH. This systematic review was conducted according to the Meta-Analysis of Observational Studies in Epidemiology guidelines. We searched PubMed and EMBASE from January 1, 2000 to August 1, 2015. All articles describing statistically significant associations between patient characteristics and adverse outcomes of LH for benign indications were included. Primary outcomes were blood loss, operative time, conversion, and complications. The methodologic quality of the included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. The included articles were summed per predictor and surgical outcome. Three sets of case-mix characteristics were determined, stratified by different levels of evidence. Eighty-five of 1549 identified studies were considered eligible. Uterine weight and body mass index (BMI) were the most mentioned predictors (described, respectively, 83 and 45 times) in high quality studies. For longer operative time and higher blood loss, uterine weight ≥ 250 to 300 g and ≥500 g and BMI ≥ 30 kg/m(2) dominated as predictors. Previous operations, adhesions, and higher age were also considered as predictors for longer operative time. For complications and conversions, the patient characteristics varied widely, and uterine weight, BMI, previous operations, adhesions, and age predominated. Studies of high methodologic quality indicated uterine weight and BMI as relevant case-mix characteristics for all surgical outcomes. For future development of quality indicators of LH and to compare surgical outcomes adequately, a case-mix correction is suggested for at least uterine weight and BMI. A potential case-mix correction for adhesions and previous operations can be considered. For both surgeons and patients it is valuable to be aware of potential factors predicting adverse outcomes and to anticipate this. Finally, to benchmark clinical outcomes at an international level, it is of the utmost importance to introduce uniform outcome definitions.
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Affiliation(s)
- Sara R C Driessen
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Evelien M Sandberg
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Claire F la Chapelle
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Andries R H Twijnstra
- Department of Obstetrics and Gynecology, Bronovo Hospital, The Hague, The Netherlands
| | - Johann P T Rhemrev
- Department of Obstetrics and Gynecology, Bronovo Hospital, The Hague, The Netherlands
| | - Frank Willem Jansen
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands; Department BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands.
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Unexpected Leiomyosarcoma 4 Years after Laparoscopic Removal of the Uterus Using Morcellation. Case Rep Obstet Gynecol 2015; 2015:723606. [PMID: 26491585 PMCID: PMC4602326 DOI: 10.1155/2015/723606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 09/14/2015] [Accepted: 09/16/2015] [Indexed: 11/17/2022] Open
Abstract
Background. Laparoscopic hysterectomies are increasingly popular; a morcellation device is often used. Although there are some clear benefits, morcellation of tissue does have potential risks. Case Presentation. In this case report we present a 55-year-old woman with an abdominal tumour 4 years after a laparoscopic hysterectomy using a morcellation device. Postoperative histological analysis, compromised by morcellated tissue, showed benign myoma. Because of the benign tumour no follow-up was performed. The patient presented now with an abdominal tumour, and she was scheduled for surgical removal of the tumour. During abdominal surgery the tumour appeared malignant and biopsies were taken. Histological analysis showed leiomyosarcoma, and the patient was referred to a third care centre for further treatment. The patient recovered quickly after abdominal removal of the tumour; however, after 7 months the patient had complaints and a CT scan showed a large intra-abdominal tumour with possible lung metastasis. The patient received palliative chemotherapy and died after 10 months. Conclusion. This case shows that although unexpected after a hysterectomy, a leiomyosarcoma has to be considered in case of a suspect tumour in the lower abdomen.
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Berner E, Qvigstad E, Myrvold AK, Lieng M. Pain reduction after total laparoscopic hysterectomy and laparoscopic supracervical hysterectomy among women with dysmenorrhoea: a randomised controlled trial. BJOG 2015; 122:1102-11. [DOI: 10.1111/1471-0528.13362] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2014] [Indexed: 11/28/2022]
Affiliation(s)
- E Berner
- Department of Gynaecology; Oslo University Hospital; Oslo Norway
| | - E Qvigstad
- Department of Gynaecology; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - AK Myrvold
- Department of Pathology; Oslo University Hospital; Oslo Norway
| | - M Lieng
- Department of Gynaecology; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
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Wu CJ, Tseng CW, Wu MP. Laparoscopic subtotal hysterectomy in the era of minimally invasive surgery. Gynecol Minim Invasive Ther 2015. [DOI: 10.1016/j.gmit.2014.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Urinary Tract Injuries in Laparoscopic Hysterectomy: A Systematic Review. J Minim Invasive Gynecol 2014; 21:558-66. [DOI: 10.1016/j.jmig.2014.01.006] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 12/28/2013] [Accepted: 01/06/2014] [Indexed: 11/23/2022]
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Sharon A. Gynecare Morcellex Sigma®. J Obstet Gynaecol India 2014; 64:226-7. [DOI: 10.1007/s13224-014-0568-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Pelvic Pain and Patient Satisfaction After Laparoscopic Supracervical Hysterectomy: Prospective Trial. J Minim Invasive Gynecol 2014; 21:406-11. [DOI: 10.1016/j.jmig.2013.10.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 10/22/2013] [Accepted: 10/23/2013] [Indexed: 11/18/2022]
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Binsaleh S. Specimen processing during laparoscopic renal surgery: a review of techniques and technologies. Clinics (Sao Paulo) 2014; 69:862-6. [PMID: 25628000 PMCID: PMC4286670 DOI: 10.6061/clinics/2014(12)12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 10/01/2014] [Indexed: 12/03/2022] Open
Abstract
Laparoscopic surgery has well-defined benefits for patients and has become accepted over time as a standard access strategy for the management of benign and malignant urologic diseases. Unlike in open surgery, the surgeon is often faced with the additional challenges of specimen retrieval and extraction at the end of laparoscopic extirpative procedures. This final step often requires significant laparoscopic skill to entrap and safely extract the laparoscopic specimens. Failure to apply safe exit steps at the end of a laparoscopic procedure may lead to significant morbidity. The aim of this review is to explore the different techniques and technologies available for laparoscopic kidney retrieval, entrapment and safe extraction.
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Affiliation(s)
- Saleh Binsaleh
- Division of Urology, Department of Surgery, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
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Brucker S, Rothmund R, Krämer B, Neis F, Schönfisch B, Zubke W, Taran FA, Wallwiener M. Cervical Detachment Using Monopolar SupraLoop™ Electrode versus Monopolar Needle in Laparoscopic Supracervical Hysterectomy (LSH): An Interventional, Comparative Cohort Study. Geburtshilfe Frauenheilkd 2013; 73:1121-1127. [PMID: 24771898 DOI: 10.1055/s-0033-1350975] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 09/12/2013] [Accepted: 10/07/2013] [Indexed: 10/25/2022] Open
Abstract
Objective: Currently available monopolar loop electrodes are difficult to handle in laparoscopic supracervical hysterectomy (LSH) and are entirely disposable devices, generating additional operating costs. The aim of this interventional study was the comparison of the efficiency and safety of cervical detachment with a newly developed monopolar loop electrode (SupraLoop™) with a conventional method of cervical detachment in LSH. Material and Methods: Our study sample included 1598 patients; 1070 patients that underwent LSH with cervical detachment using the monopolar SupraLoop™ (study group) and 528 patients that underwent LSH with cervical detachment using the monopolar needle (control group). We also assessed cervical detachment time and total device application and cutting time in a subgroup of 49 patients (23 patients from the study group and 26 patients from the control group). Results: Total operation time for LSH was significantly shorter among SupraLoop™ patients (93 ± 41 minutes) when compared to patients in whom cervical detachment was performed with the needle (105 ± 44 minutes) (p < 0.001). Cervical detachment time and total device application including cutting time was significantly shorter for the SupraLoop™ group (SupraLoop vs. needle; 0.12 ± 0.21 min vs. 5.1 ± 4.4 min [p < 0.001]; 2.3 ± 1.8 min vs. 5.4 ± 2.4 min [p < 0.001]). There were no major or minor complications directly related to the use of the SupraLoop™ device, whereas two intraoperative complications were directly related to the application of the monopolar needle. Conclusion: The newly developed monopolar loop electrode (SupraLoop™) is both an effective and safe instrument for cervical detachment in laparoscopic supracervical hysterectomy, and performed better than the needle, offering a significantly shorter operating time and less complications for the hysterectomy compared to the conventional method.
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Affiliation(s)
- S Brucker
- Women's Clinic, University Tübingen, Tübingen
| | - R Rothmund
- Women's Clinic, University Tübingen, Tübingen
| | - B Krämer
- Women's Clinic, University Tübingen, Tübingen
| | - F Neis
- Women's Clinic, University Tübingen, Tübingen
| | | | - W Zubke
- Women's Clinic, University Tübingen, Tübingen
| | - F A Taran
- Women's Clinic, University Tübingen, Tübingen
| | - M Wallwiener
- Women's Clinic Heidelberg, University Heidelberg, Heidelberg
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Nesbitt-Hawes EM, Maley PE, Won HR, Law KS, Zhang CS, Lyons SD, Ledger W, Abbott JA. Laparoscopic Subtotal Hysterectomy: Evidence and Techniques. J Minim Invasive Gynecol 2013; 20:424-34. [DOI: 10.1016/j.jmig.2013.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 01/15/2013] [Accepted: 01/17/2013] [Indexed: 10/27/2022]
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Berner E, Qvigstad E, Langebrekke A, Lieng M. Laparoscopic Supracervical Hysterectomy Performed With and Without Excision of the Endocervix: A Randomized Controlled Trial. J Minim Invasive Gynecol 2013; 20:368-75. [DOI: 10.1016/j.jmig.2013.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 01/14/2013] [Accepted: 01/16/2013] [Indexed: 10/27/2022]
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Unexpected malignancies after laparoscopic-assisted supracervical hysterectomies (LASH): an analysis of 1,584 LASH cases. Arch Gynecol Obstet 2012; 287:455-62. [PMID: 23053310 DOI: 10.1007/s00404-012-2559-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 09/06/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The objective of this research was to identify the rate of unexpected malignancies after laparoscopic-assisted supracervical hysterectomies (LASH) and describe the therapy regime. METHODS The research is based on a retrospective chart analysis of patients undergoing a simple hysterectomy in the gynecological endoscopy department of a general hospital in Germany. RESULTS 2,577 simple hysterectomies conducted between March 2005 and March 2010 were sub-classified in different types of hysterectomies (vaginal-, abdominal-, total-, abdominal supracervical hysterectomy, LAVH, and LASH). This study focuses on the LASH sub-group of 1,584 patients and does not make any comparisons to other operative approaches. Out of the 1,584 patients, 87.8 % (n = 1,391) received preoperative screening to exclude dysplasia or malignancy based on the policy of the German Association for gynecology and obstetrics (DGGG). The screening includes cytology (Pap-smear) and preoperative ultrasound of the uterus or dilatation and curettage (d&c). Unexpected malignancies were found in 0.25 % (n = 4) of the patients pre-screened according to DGGG protocol. Out of the four malign patients, two had endometrial cancer. Two patients had leiomyosarcoma. CONCLUSION The study shows that there is a small probability of unexpected malignancies even in correctly pre-screened patients for LASH procedures. Yet in the short-term (28-52 months), malign patients remain recurrence free after treatment. LASH is therefore a good procedure for assumed benign disease.
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Comparative analysis of different laparoscopic hysterectomy procedures. Arch Gynecol Obstet 2011; 285:1353-61. [PMID: 22124531 DOI: 10.1007/s00404-011-2140-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Accepted: 11/04/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE To compare the antecedent gynecological characteristics, indications for, and complications associated with, the different laparoscopic approaches to hysterectomy, in women with benign gynecological conditions. METHODS A retrospective cohort study of 957 patients who underwent laparoscopic supracervical (LSH), total (TLH), and assisted vaginal (LAVH) hysterectomies between January 2003 and December 2009. RESULTS Among 957 LH, 799 (83.5%) were LSH, 62 (6.4%) TLH, and 96 (10.1%) LAVH. Demographic characteristics were not different among the groups. Antecedent gynecologic conditions that were associated with the type of laparoscopic hysterectomy (LH) performed were: postmenopausal bleeding [LAVH vs. LSH, odds ratio (OR) 2.20; 95% confidence interval (CI) 1.04-4.65], previous pelvic surgery (TLH vs. LSH, OR 1.92; CI 1.05-3.52), previous cesarean delivery (LAVH vs. LSH, OR 0.39; CI 0.21-0.76), and prior hysteroscopy (LAVH vs. LSH, OR 0.29; CI 0.16-0.50). Preoperative diagnoses that were associated with the choice of LH were: menometrorrhagia (LAVH vs. LSH, OR 0.23; CI 0.14-0.38; TLH vs. LSH, OR 0.50; CI 0.26-0.98), uterine fibroids (LAVH vs. LSH, OR 0.25; CI 0.15-0.41), endometrial hyperplasia (TLH vs. LSH, OR 5.5; CI 2.04-14.84), and cervical dysplasia (TLH vs. LSH, OR 17.1; CI 6.83-42.79; LAVH vs. LSH, OR 8.05; CI 3.05-22.06). Estimated blood loss, operating time, and length of hospital stay were significantly reduced with LSH. CONCLUSION Antecedent gynecological history and the indications for surgery were associated with the type of LH performed in our institution. LSH was the most common approach and was associated with significantly less morbidity.
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Vonk Noordegraaf A, Huirne JAF, Brölmann HAM, van Mechelen W, Anema JR. Multidisciplinary convalescence recommendations after gynaecological surgery: a modified Delphi method among experts. BJOG 2011; 118:1557-67. [PMID: 21895950 DOI: 10.1111/j.1471-0528.2011.03091.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To generate structured detailed uniform convalescence recommendations after gynaecological surgery by a modified Delphi method amongst experts and a representative group of physicians. DESIGN Modified Delphi study. SETTING Expert physicians recruited by their respective medical boards and employed at different hospitals, doctor's surgeries and healthcare services. POPULATION Twelve experts (five gynaecologists, two general practitioners [GPs] and five occupational physicians [OPs]) and a representative sample of 63 medical doctors. METHODS Multidisciplinary detailed recommendations for graded resumption of relevant activities after uncomplicated hysterectomy (laparoscopic supracervical, total laparoscopic/laparoscopic-assisted, vaginal and abdominal hysterectomies) and laparoscopic adnexal surgery were developed. Recommendations were based on a literature review and a modified Delphi procedure among 12 experts, recruited in collaboration with the participating medical boards of gynaecologists, GPs and OPs. MAIN OUTCOME MEASURES A multidisciplinary consensus of at least 67% on the relevant detailed convalescence recommendations in relation to hysterectomy and laparoscopic adnexal surgery. RESULTS Out of initially 65 activities, the expert panel judged 38 activities relevant for convalescence recommendations. Consensus for all activities was achieved after four Delphi rounds and two group discussions. The recommendations were judged as feasible by a representative sample of 26 gynaecologists, 19 GPs and 18 OPs. CONCLUSIONS Consensus between gynaecologists, GPs and OPs was achieved on all relevant convalescence recommendations regarding hysterectomy (abdominal, vaginal and laparoscopic) and laparoscopic adnexal surgery.
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Affiliation(s)
- A Vonk Noordegraaf
- Department of Obstetrics and Gynaecology, AMC UMCG UWV VUmc, Amsterdam, the Netherlands
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Erian J, Lee C, Watkinson S, Alsheikh Ali A, Chaudhari L, Hill N. Laparoscopic subtotal hysterectomy in a case of uterine didelphys. Arch Gynecol Obstet 2011; 285:139-41. [PMID: 21479807 DOI: 10.1007/s00404-011-1893-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 02/24/2011] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Major congenital uterine anomalies present a management dilemma in women who are symptomatic and not responsive to medical therapy. This case report discusses the role of laparoscopic subtotal hysterectomy in a woman with uterine didelphys, who presented with a long-standing history of menorrhagia, which had not responded to medical treatment. MATERIALS AND METHODS This case report represents the role of laparoscopic subtotal hysterectomy in a woman with uterine didelphys, who presented with a long-standing history of menorrhagia, which had not responded to medical treatment with tranexamic acid and mefenamic acid, or cyclical norethisterone. Transvaginal ultrasound examination, performed as part of the routine investigation into the cause of her symptoms, was suggestive of a congenital uterine anomaly. Uterine didelphys was the suspected classification, and at the time of hysteroscopic examination, a double cervix with two separate uterine corpora was noted. An intravenous uretero-pyelogram confirmed an anatomically normal urinary tract. In view of the diagnosis and severity of symptoms, neither the Mirena intrauterine system, nor endometrial ablative techniques were considered appropriate treatments. Surgical options, including hysterectomy by the abdominal and laparoscopic routes, were discussed. She was counselled as to the potential difficulty of laparoscopic surgery, but she elected to proceed to laparoscopic subtotal hysterectomy. The procedure was performed as a Day-case and went uneventfully. CONCLUSION Day-case laparoscopic subtotal hysterectomy may be considered as a potential treatment option in symptomatic women with major congenital uterine anomaly, in whom fertility potential is no longer an issue. Accurate pre-operative assessment of the upper urinary tract is considered essential.
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Affiliation(s)
- John Erian
- Department of Obstetrics and Gynaecology, Princess Royal University Hospital, Farnborough Common, Orpington, Kent, BR6 8ND, UK
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Kopeika J, Edmonds SE, Mehra G, Hefni MA. Does hydrothermal ablation avoid hysterectomy? Long-term follow-up. Am J Obstet Gynecol 2011; 204:207.e1-8. [PMID: 21144493 DOI: 10.1016/j.ajog.2010.10.908] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 07/08/2010] [Accepted: 10/13/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We sought to assess the long-term success rate of the HydroThermAblator system (HTA). STUDY DESIGN We conducted a retrospective cohort study of 376 patients who underwent HTA at our hospital during an 8-year period, following case note review and distribution of a validated menorrhagia questionnaire. RESULTS The mean age of patients was 43 years. Operative complications included 3 women (0.8%) who experienced intraoperative burns. Of the 248 (66%) returned questionnaires, satisfaction rates were high at 77%. The amenorrhea rate was 38%, with a further 37% of women reporting a substantial decrease in their blood loss. In all, 29 (11%) women underwent subsequent hysterectomy for persistent menorrhagia or dysmenorrhea. Younger women had a significantly higher chance of proceeding to subsequent (P < .05) hysterectomy. CONCLUSION This study confirms the long-term patient satisfaction with HTA and that the overall probability of proceeding to subsequent hysterectomy over 8 years was only 11%.
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Hill N, Gupta A, Zakaryan A, Morey R. The success of 6-hour hospital discharge on patients having vaginal repair operations using a new conscious sedation technique. J OBSTET GYNAECOL 2011; 31:149-51. [DOI: 10.3109/01443615.2010.542513] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Schmidt T, Eren Y, Breidenbach M, Fehr D, Volkmer A, Fleisch M, Rein DT. Modifications of Laparoscopic Supracervical Hysterectomy Technique Significantly Reduce Postoperative Spotting. J Minim Invasive Gynecol 2011; 18:81-4. [DOI: 10.1016/j.jmig.2010.09.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 09/23/2010] [Accepted: 09/30/2010] [Indexed: 11/25/2022]
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Hwang JH, Lee JK, Lee NW, Lee KW. Vaginal Cuff Closure: A Comparison between the Vaginal Route and Laparoscopic Suture in Patients Undergoing Total Laparoscopic Hysterectomy. Gynecol Obstet Invest 2011; 71:163-9. [DOI: 10.1159/000316052] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Accepted: 05/31/2010] [Indexed: 11/19/2022]
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Past, Present, and Future of Hysterectomy. J Minim Invasive Gynecol 2010; 17:421-35. [DOI: 10.1016/j.jmig.2010.03.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Revised: 03/03/2010] [Accepted: 03/07/2010] [Indexed: 11/18/2022]
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Martínez-Zamora MA, Castelo-Branco C, Balasch J, Carmona F. Comparison of a New Reusable Gynecologic Laparoscopic Electric Morcellator with a Disposable Morcellator: a Preliminary Trial. J Minim Invasive Gynecol 2009; 16:595-8. [DOI: 10.1016/j.jmig.2009.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2009] [Revised: 04/30/2009] [Accepted: 05/13/2009] [Indexed: 11/17/2022]
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Author response to: Efficacy of laparoscopic subtotal hysterectomy in the management of menorrhagia: 400 consecutive cases. BJOG 2008. [DOI: 10.1111/j.1471-0528.2008.01874.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Efficacy of laparoscopic subtotal hysterectomy in the management of menorrhagia: 400 consecutive cases. BJOG 2008; 115:1581-2; author reply 1582-3. [DOI: 10.1111/j.1471-0528.2008.01875.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Efficacy of laparoscopic subtotal hysterectomy in the management of menorrhagia: 400 consecutive cases. BJOG 2008; 115:1582; author reply 1582-3. [DOI: 10.1111/j.1471-0528.2008.01876.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Efficacy of laparoscopic subtotal hysterectomy in the management of menorrhagia: 400 consecutive cases. BJOG 2008; 115:1583-4; author reply 1584. [DOI: 10.1111/j.1471-0528.2008.01873.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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