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Nguyen K, McCormack L, Deans R, Nesbitt-Hawes E, Knapman B, Li F, Lim C, Abbott JA. A Prospective Study of Bladder Function Following Endometriosis Surgery With Up to Eight years Follow-up. J Minim Invasive Gynecol 2024; 31:205-212.e4. [PMID: 38042477 DOI: 10.1016/j.jmig.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/18/2023] [Accepted: 11/27/2023] [Indexed: 12/04/2023]
Abstract
STUDY OBJECTIVE To assess long-term urinary function for women having laparoscopic surgery for endometriosis. DESIGN Institutional Review Board-approved nested cohort study within a larger randomized controlled trial assessing urinary function following any benign laparoscopy for gynecological presentations. SETTING Two tertiary-level university-affiliated hospitals. PATIENTS Women with histologically confirmed endometriosis within the randomized controlled trial between April 2012 and November 2019, where baseline urinary function was determined. INTERVENTIONS Women with histologically confirmed endometriosis were contacted between February and October 2020, and urinary function was re-assessed. MEASUREMENTS AND MAIN RESULTS Urinary function was assessed using validated questionnaires across the domains of filling, voiding, incontinence, and quality of life determined distant from surgery. Higher scores correlated with a greater severity of symptoms. From 518/711 (72.9%) women with histologically confirmed endometriosis, 289/518 (55.8%) consented to the nested study. At a mean of 50 months (range 12-103 months) post-operatively, 35 participants (12.1%) had sought treatment for bladder symptoms, and 81 participants (28.0%) reported at least one urinary tract infection since their index surgery. There was a significant worsening of symptoms for filling, voiding, incontinence, and quality of life pre-operative to post-operatively (2.27 vs 3.32, 0.93 vs 2.02, 1.06 vs 2.32, 0.83 vs 2.13 respectively, p <.001). There was no statistically significant difference in urinary questionnaire scores in participants with and without uterovesical endometriosis. There was no statistically significant difference in any parameter when comparing any revised American Society of Reproductive Medicine (rASM) stage of endometriosis. Participants who had post-operative urinary retention reported a higher mean voiding score than those who did not (3.24 vs 1.94, p = .017), while participants with post-operative urinary tract infection reported a higher mean frequency score than those who did not (5.17 vs 3.24, p = .016). CONCLUSION This study suggests a decline in urinary function over time following laparoscopic surgery for endometriosis that is not dependent on the severity or location of the disease.
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Affiliation(s)
- Kimberly Nguyen
- School of Clinical Medicine, UNSW Sydney, and Gynaecology Research and Clinical Evaluation (GRACE) Group, Sydney, New South Wales (all authors)..
| | - Lalla McCormack
- School of Clinical Medicine, UNSW Sydney, and Gynaecology Research and Clinical Evaluation (GRACE) Group, Sydney, New South Wales (all authors)
| | - Rebecca Deans
- School of Clinical Medicine, UNSW Sydney, and Gynaecology Research and Clinical Evaluation (GRACE) Group, Sydney, New South Wales (all authors)
| | - Erin Nesbitt-Hawes
- School of Clinical Medicine, UNSW Sydney, and Gynaecology Research and Clinical Evaluation (GRACE) Group, Sydney, New South Wales (all authors)
| | - Blake Knapman
- School of Clinical Medicine, UNSW Sydney, and Gynaecology Research and Clinical Evaluation (GRACE) Group, Sydney, New South Wales (all authors)
| | - Fiona Li
- School of Clinical Medicine, UNSW Sydney, and Gynaecology Research and Clinical Evaluation (GRACE) Group, Sydney, New South Wales (all authors)
| | - Claire Lim
- School of Clinical Medicine, UNSW Sydney, and Gynaecology Research and Clinical Evaluation (GRACE) Group, Sydney, New South Wales (all authors)
| | - Jason A Abbott
- School of Clinical Medicine, UNSW Sydney, and Gynaecology Research and Clinical Evaluation (GRACE) Group, Sydney, New South Wales (all authors)
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Knapman BL, Li FG, Deans R, Nesbitt-Hawes E, Maheux-Lacroix S, Abbott J. Botulinum Toxin for the Management of Pelvic Floor Tension Myalgia and Persistent Pelvic Pain: A Systematic Review and Meta-analysis. Obstet Gynecol 2024; 143:e7-e17. [PMID: 37797336 DOI: 10.1097/aog.0000000000005388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 06/29/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE To systematically review the literature on use of botulinum toxin to treat pelvic floor tension myalgia and persistent pelvic pain. DATA SOURCES The ClinicalTrials.gov , PubMed, EMBASE, and Scopus databases were searched from inception to November 2022 by two independent assessors (B.L.K. and F.G.L.). Identified studies were screened by title and abstract and included after full-text review. Data extraction was subsequently performed and recorded in Microsoft Excel. METHODS This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines after registration in PROSPERO (CRD42022289132). All randomized studies, prospective studies with more than five participants, and retrospective studies with more than 10 participants published in English or French and assessing the use of botulinum toxin for the treatment of pelvic floor tension myalgia and persistent pelvic pain in women were included. Meta-analyses were performed on randomized data. TABULATION, INTEGRATION, AND RESULTS Of 4,722 articles identified, 24 satisfied inclusion criteria. A meta-analysis of five randomized controlled trials totaling 329 participants demonstrated no differences in patient- and clinician-reported outcome measures, including pain, dyspareunia, sexual function, and vaginal manometry. Mean duration of follow-up was 6 months. A qualitative analysis of 14 prospective and four retrospective studies including 804 participants is supportive of botulinum toxin; however, the quality of data is low, and there is marked heterogeneity between studies. CONCLUSION Meta-analyses of randomized data do not support the use of botulinum toxin to treat pelvic floor tension myalgia and persistent pelvic pain. Failure of these data to confirm the findings of nonrandomized prospective studies that suggest a treatment benefit may be attributable to the absence of placebo control and confounding outcomes obtained from an active comparator group. Further randomized controlled trials with true placebo are strongly recommended. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42022289132.
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Affiliation(s)
- Blake Lawson Knapman
- University of New South Wales, Sydney, New South Wales, Australia; and Université Laval, Québec City, Québec, Canada
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Budden AK, Song S, Henry A, Nesbitt-Hawes E, Wakefield CE, Abbott JA. Acute Biological Changes in Gynecologic Surgeons during Surgery: A Prospective Study. J Minim Invasive Gynecol 2023; 30:841-849. [PMID: 37379897 DOI: 10.1016/j.jmig.2023.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023]
Abstract
STUDY OBJECTIVE To assess changes in biological measures of acute stress in surgeons during surgery in real-world settings DESIGN: A prospective cohort study. SETTING A tertiary teaching hospital. PATIENTS 8 consultant and 9 training gynecologists. INTERVENTION A total of, 161 elective gynecologic surgeries of 3 procedures: laparoscopic hysterectomy, laparoscopic excision of endometriosis, or hysteroscopic myomectomy. MEASUREMENTS AND MAIN RESULTS Changes in surgeons' biological measures of acute stress while undertaking elective surgery. Salivary cortisol, mean and maximum heart rate (HR), and indices of the HR variability were recorded before and during surgery. From baseline to during surgery over the cohort, salivary cortisol decreased from 4.1 nmol/L to 3.6 nmol/L (p = .03), maximum HR increased from 101.8 beats per min (bpm) to 106.5 bpm (p <.01), root mean square of standard deviation decreased from 51.1 ms to 39.0 ms (p <.01), and standard deviation of beat-to-beat variability decreased from 73.7 to 59.8 ms (p <.01). Analysis of individual changes in stress by participant-surgery event by paired data graphs reveal inconsistent direction of change in all measures of biological stress despite stratification by surgical experience, role in surgery, level of training, or type of surgery performed. CONCLUSION This study measured biometric stress changes at both a group and individual level in real-world, live surgical settings. Individual changes have not previously been reported and the variable direction of stress change by participant-surgery episode identified in this study demonstrates a problematic interpretation of mean cohort findings previously reported. Results from this study suggest that either live surgery with tight environment control or surgical simulation studies may identify what, if any, biological measures of stress can predict acute stress reactions during surgery.
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Affiliation(s)
- Aaron K Budden
- School of Clinical Medicine, University of New South Wales, Sydney, Australia (Drs. Budden, Song, Henry, Nesbitt-Hawes, Wakefield, and Abbott); Gynecology Research and Clinical Excellence, Royal Hospital for Women, Sydney, Australia (Drs. Budden, Song, Nesbitt-Hawes, and Abbott).
| | - Sophia Song
- School of Clinical Medicine, University of New South Wales, Sydney, Australia (Drs. Budden, Song, Henry, Nesbitt-Hawes, Wakefield, and Abbott); Gynecology Research and Clinical Excellence, Royal Hospital for Women, Sydney, Australia (Drs. Budden, Song, Nesbitt-Hawes, and Abbott)
| | - Amanda Henry
- School of Clinical Medicine, University of New South Wales, Sydney, Australia (Drs. Budden, Song, Henry, Nesbitt-Hawes, Wakefield, and Abbott); Department of Women's and Children's Health, St George Hospital, Sydney, Australia (Dr. Henry)
| | - Erin Nesbitt-Hawes
- School of Clinical Medicine, University of New South Wales, Sydney, Australia (Drs. Budden, Song, Henry, Nesbitt-Hawes, Wakefield, and Abbott); Gynecology Research and Clinical Excellence, Royal Hospital for Women, Sydney, Australia (Drs. Budden, Song, Nesbitt-Hawes, and Abbott)
| | - Claire E Wakefield
- School of Clinical Medicine, University of New South Wales, Sydney, Australia (Drs. Budden, Song, Henry, Nesbitt-Hawes, Wakefield, and Abbott); Kids Cancer Center, Sydney Children's Hospital, Sydney, Australia (Dr. Wakefield)
| | - Jason A Abbott
- School of Clinical Medicine, University of New South Wales, Sydney, Australia (Drs. Budden, Song, Henry, Nesbitt-Hawes, Wakefield, and Abbott); Gynecology Research and Clinical Excellence, Royal Hospital for Women, Sydney, Australia (Drs. Budden, Song, Nesbitt-Hawes, and Abbott)
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Li FG, Fuchs T, Deans R, McCormack L, Nesbitt-Hawes E, Abbott J, Farnsworth A. Vaginal epithelial histology before and after fractional CO 2 laser in postmenopausal women: a double-blind, sham-controlled randomized trial. Am J Obstet Gynecol 2023; 229:278.e1-278.e9. [PMID: 37192705 DOI: 10.1016/j.ajog.2023.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Postmenopausal vaginal symptoms affect over 60% of women and may substantially impact a woman's quality of life. Since 2012, fractional CO2 laser has been suggested as a treatment for this indication. Structural assessment of vaginal epithelium using microscopic biopsy examination has been used as a primary outcome measure and surrogate determinant of success of vaginal laser in previous clinical studies. OBJECTIVE This study aimed to report the effects of laser compared with sham treatment on human vaginal epithelium from postmenopausal women using microscopic examination of tissue biopsies. STUDY DESIGN This single-center double-blind, sham-controlled randomized controlled trial was performed in a tertiary hospital in Sydney, Australia. A total of 49 postmenopausal women who were symptomatic of at least 1 vaginal symptom (vaginal dryness, burning, itching; dyspareunia; or dryness) were randomized to either laser or sham treatment. For this nested histologic study, participants had a pre- and post-treatment vaginal wall biopsy collected. Biopsy samples were analyzed by 3 independent specialist gynecologic pathologists and categorized as Type 1 (well-estrogenized), 2 (poorly estrogenized), or 3 (combination) mucosae. Other outcomes assessed included symptom severity (visual analog scale for symptoms including most bothersome symptom, and Vulvovaginal Symptom Questionnaire) and Vaginal Health Index. Prespecified secondary analyses of data were performed. Categorical data were analyzed using the Pearson chi-square test (or Fisher exact test if <5 in any category) or related-samples McNemar test for paired nonparametric data. Nonparametric, continuous variables were assessed using Wilcoxon signed-rank test or Mann-Whitney U test, and parametric variables with t test or 1-way analysis of variance as appropriate. All analyses were performed using SPSS software version 26.0 (IBM Corp, Armonk, NY). RESULTS There was no significant difference in microscopic features of vaginal epithelium following laser or sham treatment (P=.20). Further subgroup analyses of age, menopause type, duration of reproductive life, time since menopause and BMI, still demonstrated no significant difference between laser and sham groups in histological category of vaginal epithelium. Microscopic features at pre-treatment vaginal biopsy were Type 1 in 27% (13/49). There was no significant difference in VAS score for overall vaginal symptom between those classified as Type 1 vs. Type 2/3 (VAS score overall: Type 1 vs. Type 2/3, (48.1 [95% CI 27.0, 69.2] vs. 61.5 [95% CI 49.8, 73.3]; P=.166). CONCLUSION Data from this double-blind, sham-controlled randomized controlled trial demonstrate that fractional CO2 laser and sham treatment have a comparable histologic effect on vaginal tissue that is not significantly different. Fractional CO2 laser is not significantly different from sham treatment and should not be recommended for clinical use for postmenopausal vaginal symptoms.
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Affiliation(s)
- Fiona G Li
- School of Clinical Medicine, University of New South Wales Sydney, New South Wales, Australia; Gynaecological Research and Clinical Evaluation Group, New South Wales, Australia.
| | - Talia Fuchs
- Douglas Hanly Moir Pathology, New South Wales, Australia
| | - Rebecca Deans
- School of Clinical Medicine, University of New South Wales Sydney, New South Wales, Australia; Gynaecological Research and Clinical Evaluation Group, New South Wales, Australia
| | - Lalla McCormack
- School of Clinical Medicine, University of New South Wales Sydney, New South Wales, Australia; Gynaecological Research and Clinical Evaluation Group, New South Wales, Australia
| | - Erin Nesbitt-Hawes
- School of Clinical Medicine, University of New South Wales Sydney, New South Wales, Australia; Gynaecological Research and Clinical Evaluation Group, New South Wales, Australia
| | - Jason Abbott
- School of Clinical Medicine, University of New South Wales Sydney, New South Wales, Australia; Gynaecological Research and Clinical Evaluation Group, New South Wales, Australia
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McCormack L, Song S, Budden A, Ma C, Nguyen K, Li FG, Lim CY, Maheux-Lacroix S, Arnold A, Deans R, Won HR, Knapman B, Nesbitt-Hawes E, Abbott JA. Immediate versus delayed urinary catheter removal following non-hysterectomy benign gynaecological laparoscopy: a randomised trial. BJOG 2023; 130:1112-1119. [PMID: 36852512 DOI: 10.1111/1471-0528.17442] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/06/2023] [Accepted: 01/17/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVE To compare rates of urinary retention and postoperative urinary tract infection between women with immediate versus women with delayed removal of indwelling catheter following benign non-hysterectomy gynaecological laparoscopic surgery. DESIGN This randomised clinical trial was conducted between February 2012 and December 2019, with follow-up to 6 weeks. SETTING Two university-affiliated teaching hospitals in Sydney, Australia. POPULATION Study participants were 693 women aged 18 years or over, undergoing non-hysterectomy laparoscopy for benign gynaecological conditions, excluding pelvic floor or concomitant bowel surgery. METHODS Three hundred and fifty-five participants were randomised to immediate removal of urinary catheter and 338 participants were randomised to delayed removal of urinary catheter. MAIN OUTCOME MEASURES The co-primary outcomes were urinary retention and urinary tract infection. Secondary outcomes included hospital readmission, analgesia requirements, duration of hospitalisation and validated bladder function questionnaires. RESULTS Urinary retention was higher after immediate compared with delayed removal of the urinary catheter (8.2% vs 4.2%, RR 1.8, 95% CI 1.0-3.0, p = 0.04). Although urinary tract infection was 7.2% following delayed removal of the urinary catheter and 4.7% following immediate removal of the urinary catheter, the difference was not statistically significant (RR 0.7, 95% CI 0.3-1.2, p = 0.2). CONCLUSIONS There is an increased risk of urinary retention with the immediate compared with the delayed removal of the urinary catheter following benign non-hysterectomy gynaecological laparoscopic surgery. The difference in urinary tract infection was not significant. There is 1/12 risk of re-catheterisation after immediate urinary catheter removal. It is important to ensure that patients report normal voiding and emptying prior to discharge, to reduce the need for readmission for the management of urinary retention.
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Affiliation(s)
- Lalla McCormack
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Sophia Song
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Aaron Budden
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Christine Ma
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Kimberly Nguyen
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Fiona G Li
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Claire Y Lim
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Sarah Maheux-Lacroix
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Amy Arnold
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Rebecca Deans
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Ha Ryun Won
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Blake Knapman
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Erin Nesbitt-Hawes
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
| | - Jason A Abbott
- School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Gynaecology Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, Randwick, New South Wales, Australia
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Schubert R, Song S, Everist R, Nesbitt-Hawes E, Abbott J. The impact of multimodal physiotherapy in an interdisciplinary setting for the management of women with persistent pelvic pain and pelvic floor tension myalgia. European Journal of Physiotherapy 2023. [DOI: 10.1080/21679169.2023.2188901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
| | - Sophia Song
- School of Clinical Medicine, UNSW Sydney, Sydney, Australia
- Gynaecological Research and Clinical Evaluation (GRACE) Group, RHW, Sydney, Australia
| | - Rebecca Everist
- School of Clinical Medicine, UNSW Sydney, Sydney, Australia
- Gynaecological Research and Clinical Evaluation (GRACE) Group, RHW, Sydney, Australia
| | - Erin Nesbitt-Hawes
- Alana Healthcare for Women, Randwick, Australia
- School of Clinical Medicine, UNSW Sydney, Sydney, Australia
- Gynaecological Research and Clinical Evaluation (GRACE) Group, RHW, Sydney, Australia
| | - Jason Abbott
- Alana Healthcare for Women, Randwick, Australia
- School of Clinical Medicine, UNSW Sydney, Sydney, Australia
- Gynaecological Research and Clinical Evaluation (GRACE) Group, RHW, Sydney, Australia
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Lim CY, Alonso A, Koh YY, Roydhouse S, McCormack L, Deans R, Nesbitt-Hawes E, Rao A, Causer L, Abbott JA. A Double-Blinded, Randomised, Placebo-Controlled Trial of Antibiotic Prophylaxis in Elective Non-Hysterectomy Laparoscopic Surgery for Benign Gynaecological Conditions: A Pilot Study. J Minim Invasive Gynecol 2022; 29:992-997. [PMID: 35513301 DOI: 10.1016/j.jmig.2022.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
Abstract
STUDY OBJECTIVE To determine the feasibility of a double-blinded randomised, placebo-controlled study in determining the efficacy of antibiotic prophylaxis in preventing postoperative infections (POI) in elective non-hysterectomy laparoscopic procedures for benign gynaecological conditions. DESIGN Double-blinded, randomised, placebo-controlled trial. SETTING University-affiliated tertiary referral hospital in Sydney, Australia. PATIENTS Women over the age of 18 undergoing elective non-hysterectomy laparoscopic procedures for benign gynaecological conditions were eligible for the study and approached. INTERVENTIONS Prior to surgery, participants were randomised to receive either 2g cephazolin or placebo (10ml normal saline) administered by the anaesthetist. Participants and other research staff were blinded to group allocation. MEASUREMENTS AND MAIN RESULTS The primary outcome was study feasibility measured by recruitment rates, compliance rates of drug administration, compliance rates of delivery, maintenance of double blinding and follow-up rates. Secondary outcomes included rate of postoperative infections, length of hospitalisation, re-admission to hospital, unscheduled presentations to healthcare facilities and antibiotic-related reactions. Between February 2019 and March 2021, 170 patients were approached with 117 (68.8%) participants recruited and randomised. The study had a high compliance rate of trial drug delivery (95.7%) and a high follow-up rate (99.1%). CONCLUSION This pilot study has demonstrated feasibility of a large-scale study with a recruitment rate of 68% of patients approached and excellent trial drug delivery and follow-up rates. As anticipated, it is underpowered for identifying clinically significant findings for postoperative infection rates. A large-scale study is appropriate and essential to determine the health-related risks of antibiotic prophylaxis with an emphasis on antimicrobial stewardship. The sample size for a large-scale study is 1678 participants based on infection rates in this pilot study.
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Affiliation(s)
- Claire Yinn Lim
- School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia; The Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Anaïs Alonso
- School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia; The Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Yi Ying Koh
- School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia; The Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Stephanie Roydhouse
- School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia; The Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Lalla McCormack
- School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia; The Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Rebecca Deans
- School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia; The Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Erin Nesbitt-Hawes
- School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia; The Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Archana Rao
- Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Louise Causer
- Kirby Institute, UNSW Sydney, New South Wales, Australia
| | - Jason A Abbott
- School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia; The Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia.
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McCormack L, Nesbitt-Hawes E, Deans R, Alonso A, Lim C, Li F, Knapman B, Abbott JA. A review of gynaecological surgical practices for trainees and certified specialists in Australia by volume using MBS and AIHW databases. Aust N Z J Obstet Gynaecol 2022; 62:574-580. [PMID: 35474508 PMCID: PMC9542106 DOI: 10.1111/ajo.13523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is a finite volume of surgery performed annually by trainees and certified specialists alike. The detailed assessment of this surgical substrate is important, since it guides true exposure in gynaecological surgical training and practice after fellowship. AIMS This study quantifies the volume and profile of major gynaecological surgical procedures performed in Australia within a specified five-year period and discusses the implications for training and practice. MATERIALS AND METHODS Australian Institute of Health and Welfare data were examined to quantify the total number of major gynaecological procedures performed between 2013 and 2018. Medicare data were analysed to quantify the number of billed procedures. These data were compared with published Australian RANZCOG trainees and operative gynaecologists, to estimate the potential annual average exposure for each procedure. RESULTS Major open, laparoscopic and vaginal surgeries constitute less than 27% of the 600 000 gynaecological procedures performed annually in Australia. Most major gynaecological surgeries are performed at rates lower than 12 cases per year for both trainees and specialists. Over the study period, laparotomies, vaginal hysterectomies and continence procedures decreased, and operative laparoscopies and laparoscopic hysterectomies increased. CONCLUSIONS The volume of available major gynaecological procedures in Australia may not allow sufficient exposure for optimal training and practice for all trainees and specialists in operative gynaecology. This shortfall may compromise the ability to obtain and maintain proficiency in some core gynaecological operative procedures.
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Affiliation(s)
- Lalla McCormack
- Gynaecologic Research and Clinical Evaluation (GRACE) group, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Erin Nesbitt-Hawes
- Gynaecologic Research and Clinical Evaluation (GRACE) group, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
| | - Rebecca Deans
- Gynaecologic Research and Clinical Evaluation (GRACE) group, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
| | - Anais Alonso
- Gynaecologic Research and Clinical Evaluation (GRACE) group, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
| | - Claire Lim
- Gynaecologic Research and Clinical Evaluation (GRACE) group, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
| | - Fiona Li
- Gynaecologic Research and Clinical Evaluation (GRACE) group, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
| | - Blake Knapman
- Gynaecologic Research and Clinical Evaluation (GRACE) group, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
| | - Jason A Abbott
- Gynaecologic Research and Clinical Evaluation (GRACE) group, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
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9
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Li FG, Nesbitt-Hawes E, Abbott JA. Effect of Fractional Carbon Dioxide Laser vs Sham Treatment on Vaginal Symptom Severity in Postmenopausal Women-Reply. JAMA 2022; 327:284-285. [PMID: 35040889 DOI: 10.1001/jama.2021.22308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Fiona G Li
- School of Women's and Children's Health, Sydney, New South Wales, Australia
| | - Erin Nesbitt-Hawes
- School of Women's and Children's Health, Sydney, New South Wales, Australia
| | - Jason A Abbott
- School of Women's and Children's Health, Sydney, New South Wales, Australia
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10
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Li FG, Maheux-Lacroix S, Deans R, Nesbitt-Hawes E, Budden A, Nguyen K, Lim CY, Song S, McCormack L, Lyons SD, Segelov E, Abbott JA. Effect of Fractional Carbon Dioxide Laser vs Sham Treatment on Symptom Severity in Women With Postmenopausal Vaginal Symptoms: A Randomized Clinical Trial. JAMA 2021; 326:1381-1389. [PMID: 34636862 PMCID: PMC8511979 DOI: 10.1001/jama.2021.14892] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
IMPORTANCE Postmenopausal vaginal symptoms are common and frequently detrimental to a woman's quality of life. Fractional carbon dioxide vaginal laser is increasingly offered as a treatment, but the efficacy remains unproven. OBJECTIVE To determine the efficacy of fractional carbon dioxide laser for treatment of vaginal symptoms associated with menopause. DESIGN, SETTING, AND PARTICIPANTS A double-blind, randomized, sham-controlled trial with 12-month follow-up was undertaken at a single tertiary referral hospital in Sydney, Australia. Enrollment commenced on September 19, 2016, with final follow-up on June 30, 2020. Participants were postmenopausal women with vaginal symptoms substantive enough to seek medical treatment. Of 232 participants approached, 85 were randomized. INTERVENTIONS Three treatments using a fractional microablative carbon dioxide laser system performed 4 to 8 weeks apart, with 43 women randomized to the laser group and 42 to the sham group. MAIN OUTCOMES AND MEASURES The co-primary outcomes were symptom severity assessed using a visual analog scale (VAS; range, 0-100; 0 indicates no symptoms and 100 indicates the most severe symptoms) and the Vulvovaginal Symptom Questionnaire (VSQ; range, 0-20; 0 indicates no symptoms and 20 indicates the most severe symptoms) at 12 months. The minimal clinically important difference was specified as a 50% decrease in both VAS and VSQ severity scores. There were 5 prespecified secondary outcomes, including quality of life (range, 0-100; higher scores indicate better quality of life), the Vaginal Health Index Score (range, 5-25; higher scores indicate better health), and vaginal histology (premenopausal or postmenopausal status). RESULTS Of 85 randomized participants (mean [SD] age, 57 [8] years), 78 (91.7%) completed the 12-month follow-up. From baseline to 12 months, there was no significant difference between the carbon dioxide laser group and the sham group in change in symptom severity (VAS score for overall vaginal symptoms: -17.2 vs -26.6; difference, 9.4 [95% CI, -28.6 to 47.5]; VAS score for the most severe symptom: -24.5 vs -20.4; difference -4.1 [95% CI, -32.5 to 24.3]; VSQ score: -3.1 vs -1.6; difference, -1.5 [95% CI, -5.9 to 3.0]). There were no significant differences between the laser and sham group in the mean quality of life score (6.3 vs 1.4; difference, 4.8 [95% CI, -3.9 to 13.5]) and Vaginal Health Index Score (0.9 vs 1.3; difference, -0.4 [95% CI, -4.3 to 3.6]) or in histological comparisons between laser and sham treatment groups. There were 16 adverse events in the laser group and 17 in the sham group, including vaginal pain/discomfort (44% vs 68%), spotting, discharge, and lower urinary tract symptoms. No severe adverse events were reported in either group. CONCLUSIONS AND RELEVANCE Among women with postmenopausal vaginal symptoms, treatment with fractional carbon dioxide laser vs sham treatment did not significantly improve vaginal symptoms after 12 months. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry: ACTRN12616001403426.
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Affiliation(s)
- Fiona G. Li
- School of Women’s and Children’s Health, UNSW Sydney, New South Wales, Australia
| | - Sarah Maheux-Lacroix
- School of Women’s and Children’s Health, UNSW Sydney, New South Wales, Australia
| | - Rebecca Deans
- School of Women’s and Children’s Health, UNSW Sydney, New South Wales, Australia
| | - Erin Nesbitt-Hawes
- School of Women’s and Children’s Health, UNSW Sydney, New South Wales, Australia
| | - Aaron Budden
- School of Women’s and Children’s Health, UNSW Sydney, New South Wales, Australia
| | - Kimberly Nguyen
- School of Women’s and Children’s Health, UNSW Sydney, New South Wales, Australia
| | - Claire Y. Lim
- School of Women’s and Children’s Health, UNSW Sydney, New South Wales, Australia
| | - Sophia Song
- School of Women’s and Children’s Health, UNSW Sydney, New South Wales, Australia
| | - Lalla McCormack
- School of Women’s and Children’s Health, UNSW Sydney, New South Wales, Australia
| | - Stephen D. Lyons
- School of Women’s and Children’s Health, UNSW Sydney, New South Wales, Australia
| | - Eva Segelov
- School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Jason A. Abbott
- School of Women’s and Children’s Health, UNSW Sydney, New South Wales, Australia
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11
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Alonso A, Deans R, Nesbitt-Hawes E, Yazdani A, McCormack L, Koh YY, Abbott J. Gynaecological and IVF procedures billed through the Medicare Benefits Schedule (MBS) during the COVID-19 pandemic. Aust N Z J Obstet Gynaecol 2021; 61:585-590. [PMID: 33890300 PMCID: PMC8251179 DOI: 10.1111/ajo.13355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 11/28/2022]
Abstract
Background In response to the COVID‐19 pandemic in Australia, restrictions to elective surgeries were implemented nationwide. Aims To investigate the response to these restrictions in elective gynaecological and In vitro fertilisation (IVF) procedures during the first wave of the COVID‐19 pandemic. Materials and Methods We analysed the Medicare Item Reports for the number of elective gynaecological (labioplasty, vulvoplasty; prolapse and continence; operative hysteroscopy; hysterectomy; fertility) and IVF procedures claimed in Australia between January–June 2020 and compared these to January–June 2019. Results The number of included gynaecological and IVF procedures performed in January–June 2020 decreased by −13.71% and −12.56%, respectively, compared to January–June 2019. The greatest reductions were in May 2020 (gynaecology −43.71%; IVF −51.63% compared to May 2019), while April 2020 reported decreases of −37.69% and −31.42% in gynaecological and IVF procedures, respectively. In April 2020, 1963 IVF cycle initiations (−45.20% compared to April 2019), 2453 oocyte retrievals (−26.99%) and 3136 embryo transfers (−22.95%) were billed. The procedures with greatest paired monthly decrease were prolapse and continence surgeries in April (676 procedures; −51.85%) and May 2020 (704 procedures; −60.05%), and oocyte retrievals in May 2020 (1637 procedures; −56.70%). Conclusions While we observed a decrease in procedural volumes, elective gynaecological and IVF procedures continued in considerable numbers during the restricted timeframes. In the event of future overwhelming biological threat, careful consideration must be given to more effective measures of limiting access for non‐emergency procedures to conserve essential resources and reduce risk to both the public and healthcare staff.
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Affiliation(s)
- Anais Alonso
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Rebecca Deans
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Erin Nesbitt-Hawes
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Anusch Yazdani
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Lalla McCormack
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Yi Ying Koh
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Jason Abbott
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
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12
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Li F, Deans R, Nesbitt-Hawes E, Budden A, McCormack L, Maheux-Lacroix S, Segelov E, Lyons S, Abbott J. Fractionated Laser for Vaginal Atrophy Symptoms: A Randomized, Double-Blind Placebo Controlled Study. J Minim Invasive Gynecol 2020. [DOI: 10.1016/j.jmig.2020.08.590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Maheux-Lacroix S, Mennen J, Arnold A, Budden A, Nesbitt-Hawes E, Won H, Abbott J. Resolution of Abnormal Uterine Bleeding After Hysteroscopic Morcellation of Endometrial Polyps. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2018.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sarah Maheux-Lacroix
- Department of Obstetrics and Gynecology, CHU de Quebec, Laval University, Quebec, Canada
| | - Jennifer Mennen
- School of Women's and Children's Health, Royal Hospital for Women, University of New South Wales, Sydney, Australia
| | - Amy Arnold
- School of Women's and Children's Health, Royal Hospital for Women, University of New South Wales, Sydney, Australia
| | - Aaron Budden
- School of Women's and Children's Health, Royal Hospital for Women, University of New South Wales, Sydney, Australia
| | - Erin Nesbitt-Hawes
- School of Women's and Children's Health, Royal Hospital for Women, University of New South Wales, Sydney, Australia
| | - HaRyun Won
- School of Women's and Children's Health, Royal Hospital for Women, University of New South Wales, Sydney, Australia
| | - Jason Abbott
- School of Women's and Children's Health, Royal Hospital for Women, University of New South Wales, Sydney, Australia
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14
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Song S, Budden A, Short A, Nesbitt-Hawes E, Deans R, Abbott J. Author response to Letter to the Editor. Aust N Z J Obstet Gynaecol 2019; 59:E3-E4. [PMID: 30784051 DOI: 10.1111/ajo.12898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sophia Song
- Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Aaron Budden
- Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Asha Short
- Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Erin Nesbitt-Hawes
- Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Rebecca Deans
- Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Jason Abbott
- Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
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15
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Song S, Everist R, Deans R, Nesbitt-Hawes E, Hallam T, Abbott J. Using Physical Therapy as an Adjunct for Women with Chronic Pelvic Pain and Pelvic Floor Myalgia. J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Song S, Budden A, Short A, Nesbitt-Hawes E, Deans R, Abbott J. Reply to: 'Concerns regarding the use of vaginal fractional CO 2 laser'. Aust N Z J Obstet Gynaecol 2018; 58:E17-E18. [PMID: 30306553 DOI: 10.1111/ajo.12877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sophia Song
- Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, University of New South Wales, Sydney, Australia
| | - Aaron Budden
- Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, University of New South Wales, Sydney, Australia
| | - Asha Short
- Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, University of New South Wales, Sydney, Australia
| | - Erin Nesbitt-Hawes
- Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, University of New South Wales, Sydney, Australia
| | - Rebecca Deans
- Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, University of New South Wales, Sydney, Australia
| | - Jason Abbott
- Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, University of New South Wales, Sydney, Australia
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17
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Maheux-Lacroix S, Nesbitt-Hawes E, Deans R, Won H, Budden A, Adamson D, Abbott JA. Endometriosis fertility index predicts live births following surgical resection of moderate and severe endometriosis. Hum Reprod 2018; 32:2243-2249. [PMID: 29040471 DOI: 10.1093/humrep/dex291] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 08/24/2017] [Indexed: 01/02/2023] Open
Abstract
STUDY QUESTION Can live birth be accurately predicted following surgical resection of moderate-severe (Stage III-IV) endometriosis? SUMMARY ANSWER Live births can accurately be predicted with the endometriosis fertility index (EFI), with adnexal function being the most important factor to predict non-assisted reproductive technology (non-ART) fertility or the requirement for ART (www.endometriosisefi.com). WHAT IS KNOWN ALREADY Fertility prognosis is important to many women with severe endometriosis. Controversy persists regarding optimal post-operative management to achieve pregnancy and the counselling of patients regarding duration of conventional treatments before undergoing ART. The EFI is reported to correlate with expectant management pregnancy rate, although external validation has been performed without specifically addressing fertility in women with moderate and severe endometriosis. STUDY DESIGN, SIZE, DURATION Retrospective cohort study of 279 women from September 2001 to June 2016. PARTICIPANTS/MATERIALS, SETTINGS, METHODS We included women undergoing laparoscopic resection of Stage III-IV endometriosis who attempted pregnancy post-operatively. The EFI was calculated based on detailed operative reports and surgical images. Fertility outcomes were obtained by direct patient contact. Kaplan-Meier model, log rank test and Cox regression were used for analyses. MAIN RESULTS AND THE ROLE OF CHANCE The follow-up rate was 84% with a mean duration of 4.1 years. A total of 147 women (63%) had a live birth following surgery, 94 of them (64%) without ART. The EFI was highly associated with live births (P < 0.001): for women with an EFI of 0-2 the estimated cumulative non-ART live birth rate at five years was 0% and steadily increased up to 91% with an EFI of 9-10, while the proportion of women who attempted ART and had a live birth, steadily increased from 38 to 71% among the same EFI strata (P = 0.1). A low least function score was the most significant predictor of failure (P = 0.003), followed by having had a previous resection (P = 0.019) or incomplete resection (P = 0.028), being older than 40 compared to <35 years of age (P = 0.027), and having leiomyomas (P = 0.037). LIMITATIONS REASONS FOR CAUTION The main limitation of this study is its retrospective design. Imprecision was higher with low EFI due to smaller sample size in this subgroup. Finally, the EFI is somewhat subjective and could be prone to intra- and inter-observer variations. WIDER IMPLICATIONS OF THE FINDINGS Women with a high EFI score have excellent fertility prognosis and may be advised to try to become pregnant with timed intercourse compared to women with a low score, for which prompt referral to ART seems more reasonable. Other prognostic factors can be used to guide the management of women with an intermediate EFI score. These data follow women over many years post-resection and represent longitudinal fertility data rarely demonstrated in such a cohort. The location and impact of lesions on the ability of the adnexa to function seems crucial for the fertility prognosis and should be further investigated. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by the GRACE Research funds. S.M.-L. is the recipient of a Training Award from the Fonds de Recherche Quebec-Sante. D.A. is the primary author of the Endometriosis Fertility Index. All authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- S Maheux-Lacroix
- School of Women's and Children's Health, UNSW, Barker St, Sydney, NSW 2031, Australia.,GRACE Unit, Royal Hospital for Women, Barker St, Sydney, NSW 2031, Australia
| | - E Nesbitt-Hawes
- School of Women's and Children's Health, UNSW, Barker St, Sydney, NSW 2031, Australia.,GRACE Unit, Royal Hospital for Women, Barker St, Sydney, NSW 2031, Australia
| | - R Deans
- School of Women's and Children's Health, UNSW, Barker St, Sydney, NSW 2031, Australia.,GRACE Unit, Royal Hospital for Women, Barker St, Sydney, NSW 2031, Australia
| | - H Won
- School of Women's and Children's Health, UNSW, Barker St, Sydney, NSW 2031, Australia.,GRACE Unit, Royal Hospital for Women, Barker St, Sydney, NSW 2031, Australia
| | - A Budden
- School of Women's and Children's Health, UNSW, Barker St, Sydney, NSW 2031, Australia.,GRACE Unit, Royal Hospital for Women, Barker St, Sydney, NSW 2031, Australia
| | - D Adamson
- GRACE Unit, Royal Hospital for Women, Barker St, Sydney, NSW 2031, Australia.,Palo Alto Medical Foundation Fertility Physicians of Northern California, 2581 Samaritan Drive, San Jose, CA 95124, USA
| | - J A Abbott
- School of Women's and Children's Health, UNSW, Barker St, Sydney, NSW 2031, Australia.,GRACE Unit, Royal Hospital for Women, Barker St, Sydney, NSW 2031, Australia
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18
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Maheux-Lacroix S, Mennen J, Arnold A, Budden A, Nesbitt-Hawes E, Won H, Abbott J. The need for further surgical intervention following primary hysteroscopic morcellation of submucosal leiomyomas in women with abnormal uterine bleeding. Aust N Z J Obstet Gynaecol 2018; 58:570-575. [DOI: 10.1111/ajo.12781] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 12/21/2017] [Indexed: 02/04/2023]
Affiliation(s)
- Sarah Maheux-Lacroix
- School of Women's and Children's Health; University of New South Wales; Sydney New South Wales Australia
| | - Jennifer Mennen
- School of Women's and Children's Health; University of New South Wales; Sydney New South Wales Australia
| | - Amy Arnold
- School of Women's and Children's Health; University of New South Wales; Sydney New South Wales Australia
| | - Aaron Budden
- School of Women's and Children's Health; University of New South Wales; Sydney New South Wales Australia
| | - Erin Nesbitt-Hawes
- School of Women's and Children's Health; University of New South Wales; Sydney New South Wales Australia
| | - HaRyun Won
- School of Women's and Children's Health; University of New South Wales; Sydney New South Wales Australia
| | - Jason Abbott
- School of Women's and Children's Health; University of New South Wales; Sydney New South Wales Australia
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19
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Bhatti M, Ketheeswaran A, Arnold A, Nesbitt-Hawes E, Deans R, Won H, Abbott J. Pelvic examination may be meaningfully taught to novices and be used to predict operating times for laparoscopic excision of endometriosis in one surgical procedure. Aust N Z J Obstet Gynaecol 2017; 58:239-246. [PMID: 29168563 DOI: 10.1111/ajo.12733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 09/26/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate whether pelvic examination may be meaningfully taught to novice medical students and its accuracy in predicting operating times for laparoscopic excision of endometriosis at a single surgical procedure. METHODS Women with suspected endometriosis scheduled for laparoscopy underwent pelvic examination to estimate operative time by medical students (novices), trainees, senior clinicians with <10 years surgical experience (experts) and ≥10 years (masters). Examination and intraoperative findings were compared and stage of disease recorded. RESULTS There were 138 estimations of operating time at the initial assessment and 251 estimations of operating time prior to surgery. The median surgical duration was 44 min (range 12-398) and increased progressively with revised American Society for Reproductive Medicine disease stage. Clinical predictions exceeded actual operating times by a median of 18 min (range overestimating by 180 min and underestimating by 120 min) with 80% of procedures completed in less time than predicted and none requiring a second procedure. There was no statistical difference in operative time estimations between the groups with students and trainees underestimating surgical duration by a median of two and five minutes, respectively, experts having a median time difference of zero minutes, and masters overestimating by 4.5 min. CONCLUSION Targeted pelvic examining may be taught to novices (medical students) and can be used to predict operating time at one surgical procedure. Less experienced examiners have a tendency to underestimate surgical duration, with masters overestimating surgical time when scheduling laparoscopies for endometriosis, and increasing disease stage is associated with a less precise estimation of surgical duration.
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Affiliation(s)
- Mominah Bhatti
- School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia
| | | | - Amy Arnold
- School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia.,Gynaecolgical Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Erin Nesbitt-Hawes
- School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia.,Gynaecolgical Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia.,Prince of Wales Private Hospital, Sydney, New South Wales, Australia
| | - Rebecca Deans
- School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia.,Gynaecolgical Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia.,Prince of Wales Private Hospital, Sydney, New South Wales, Australia
| | - HaRyun Won
- School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia.,Gynaecolgical Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia.,Prince of Wales Private Hospital, Sydney, New South Wales, Australia
| | - Jason Abbott
- School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia.,Gynaecolgical Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia.,Prince of Wales Private Hospital, Sydney, New South Wales, Australia
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20
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Maheux-Lacroix S, Mennen J, Arnold A, Nesbitt-Hawes E, Won H, Budden A, Abbott J. Long-Term Efficacy of Hysteroscopic Morcellation of Polyps and Submucosal Leiomyomas in Women with Abnormal Uterine Bleeding. J Minim Invasive Gynecol 2017. [DOI: 10.1016/j.jmig.2017.08.394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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21
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Maheux-Lacroix S, Nesbitt-Hawes E, Deans R, Won H, Budden A, Abbott J. The Endometriosis Fertility Index Accurately Predicts Fertility Outcomes in Women Having Surgery for Severe Endometriosis. J Minim Invasive Gynecol 2017. [DOI: 10.1016/j.jmig.2017.08.583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Aitchison L, Cui C, Arnold A, Nesbitt-Hawes E, Abbott J. The Ergonomics of Laparoscopic Surgery: a Quantitative Study of the Time and Motion of Laparoscopic Surgeons in Live Surgical Environments. J Minim Invasive Gynecol 2017. [DOI: 10.1016/j.jmig.2017.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Maheux-Lacroix S, Li F, Bujold E, Nesbitt-Hawes E, Deans R, Abbott J. Cesarean Scar Pregnancies: A Systematic Review of Treatment Options. J Minim Invasive Gynecol 2017. [DOI: 10.1016/j.jmig.2017.08.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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24
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Song S, Budden A, Short A, Nesbitt-Hawes E, Deans R, Abbott J. The evidence for laser treatments to the vulvo-vagina: Making sure we do not repeat past mistakes. Aust N Z J Obstet Gynaecol 2017; 58:148-162. [PMID: 29067688 DOI: 10.1111/ajo.12735] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/27/2017] [Indexed: 12/26/2022]
Abstract
Following menopause, up to 49% of women will experience genitourinary symptoms such as vaginal itching, dryness, dyspareunia and incontinence as a result of oestrogen deficiency. Treatments such as vaginal lubricants and moisturisers only temporarily relieve symptoms, while local oestrogen treatments are often unacceptable or unsafe for many women. Recently, a novel laser treatment has been proposed as a non-invasive, long-term solution to vulvo-vaginal and urinary symptoms. While preliminary histological results have been promising, its therapeutic, clinical effect has yet to be determined. However, despite the scarcity of evidence for its safety and long-term benefit, laser treatments are widely marketed for a range of genitourinary symptoms, with high uptake by both clinicians and women alike. This review aims to examine the evidence for laser treatments to the vulvo-vagina and to evaluate its safety and efficacy. Our results include 17 studies investigating the effect of laser therapy for vulvo-vaginal symptoms, seven for its effects on urinary incontinence and four for histology. These are limited to non-randomised, observational data with small sample sizes between 15 to 175 women and follow-up duration from none to two years. As such, strong evidence for laser efficacy and safety is limited and warrants more robust, placebo-controlled, randomised trials before widespread implementation.
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Affiliation(s)
- Sophia Song
- School of Women's and Children's Health, Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, UNSW, Sydney, NSW, Australia
| | - Aaron Budden
- School of Women's and Children's Health, Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, UNSW, Sydney, NSW, Australia
| | - Asha Short
- School of Women's and Children's Health, Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, UNSW, Sydney, NSW, Australia
| | - Erin Nesbitt-Hawes
- School of Women's and Children's Health, Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, UNSW, Sydney, NSW, Australia
| | - Rebecca Deans
- School of Women's and Children's Health, Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, UNSW, Sydney, NSW, Australia
| | - Jason Abbott
- School of Women's and Children's Health, Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, UNSW, Sydney, NSW, Australia
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Maheux-Lacroix S, Li F, Bujold E, Nesbitt-Hawes E, Deans R, Abbott J. Cesarean Scar Pregnancies: A Systematic Review of Treatment Options. J Minim Invasive Gynecol 2017; 24:915-925. [DOI: 10.1016/j.jmig.2017.05.019] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/29/2017] [Accepted: 05/31/2017] [Indexed: 10/19/2022]
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Arnold A, Ketheeswaran A, Bhatti M, Nesbitt-Hawes E, Abbott J. Prospective Study on the of Use of the MyoSure ® for Hysteroscopic Resection of Endometrial Pathology. J Minim Invasive Gynecol 2016; 22:S45-S46. [PMID: 27679245 DOI: 10.1016/j.jmig.2015.08.125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A Arnold
- Royal Hospital for Women, Randwick, NSW, Australia
| | | | - M Bhatti
- University of New South Wales, Sydney, NSW, Australia
| | | | - J Abbott
- University of New South Wales, Sydney, NSW, Australia
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Aitchison LP, Cui CK, Arnold A, Nesbitt-Hawes E, Abbott J. The ergonomics of laparoscopic surgery: a quantitative study of the time and motion of laparoscopic surgeons in live surgical environments. Surg Endosc 2016; 30:5068-5076. [PMID: 27059965 DOI: 10.1007/s00464-016-4855-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 03/02/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Laparoscopic surgery presents multiple ergonomic difficulties for the surgeon, requiring awkward body postures and prolonged static muscle loading that increases risk of musculoskeletal strain and injury. This prospective study quantitatively measures the biomechanical movements of surgeons during laparoscopic procedures to determine at-risk movements from prolonged static muscle loading and repetitive motions that may lead to injury. METHODS A total of 150 video recordings of 18 surgeons, standing at the patient's left, were captured from three fixed camera positions during live gynecological laparoscopic surgery. Postoperative processing quantified surgeon movements at the neck, shoulders and elbows using computer software to measure extreme joint angles and time spent within defined joint angle ranges. RESULTS Surgeons spent a median of 98 % (range 77-100 %) of surgical time with their neck rotated at 21° (range 0°-52°). The non-dominant arm was subjected to more extreme positions for significantly longer periods of time compared to the dominant, with shoulder flexion at 45°-90° for 35 vs. 0 % (p < 0.001) and elbow flexion at >120° for 31 vs. 0 % (p < 0.001) of total surgical time. Procedures involving power morcellation required significantly greater number of instrument insertion/removals-119 (range 56-182) compared with 12 (range 2-122) when morcellation was not used (p < 0.001). Shorter surgeons maintained significantly greater degrees of neck rotation when viewing the monitor (p < 0.003) and surgeons with shorter arm lengths spent longer in extreme positions with their non-dominant shoulder at >90° (p = 0.04) and elbow at >120° (p < 0.001) compared with taller surgeons. No significant correlations were found between BMI or surgical experience and more extreme joint positions. CONCLUSIONS Four primary areas have been identified where surgeons are consistently demonstrating movements that increase their risk of harm: (1) extended periods of neck rotation; (2) asymmetrical loading between the dominant and non-dominant shoulders; (3) power morcellation and frequent insertions/removals of laparoscopic instruments resulting in repetitions of the most extreme shoulder positions and (4) a negative correlation between height and percentage time spent in more extreme positions.
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Affiliation(s)
| | | | - Amy Arnold
- University of New South Wales, Sydney, Australia.,The Royal Hospital for Women, Barker St, Randwick, NSW, 2031, Australia
| | - Erin Nesbitt-Hawes
- University of New South Wales, Sydney, Australia.,The Royal Hospital for Women, Barker St, Randwick, NSW, 2031, Australia.,Prince of Wales Private Hospital, Sydney, Australia
| | - Jason Abbott
- University of New South Wales, Sydney, Australia. .,The Royal Hospital for Women, Barker St, Randwick, NSW, 2031, Australia. .,Prince of Wales Private Hospital, Sydney, Australia.
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Arnold A, Ketheeswaran A, Bhatti M, Nesbitt-Hawes E, Abbott J. A Prospective Analysis of Hysteroscopic Morcellation in the Management of Intrauterine Pathologies. J Minim Invasive Gynecol 2016; 23:435-41. [DOI: 10.1016/j.jmig.2016.01.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/06/2016] [Accepted: 01/11/2016] [Indexed: 10/22/2022]
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Aitchison LP, Flint J, Nesbitt-Hawes E, Ledger W, Abbott J. A feasibility study determining surgical ergonomics in a live surgical setting. J Minim Invasive Gynecol 2015; 22:626-30. [PMID: 25638044 DOI: 10.1016/j.jmig.2015.01.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/06/2015] [Accepted: 01/08/2015] [Indexed: 12/22/2022]
Abstract
STUDY OBJECTIVE To identify the biomechanical movements of laparoscopic surgeons during laparoscopic gynecologic procedures, and to determine whether such movements can be assessed and measured both temporally and biomechanically. DESIGN Prospective descriptive kinematic study (Canadian Task Force classification II-3). SETTING A tertiary referral hospital in Sydney, Australia. STUDY SUBJECTS Five gynecologic laparoscopic surgeons. INTERVENTIONS Video recording from a variety of fixed positions to assess surgeon stance, time spent in specific postures, and relative change of limb angles during laparoscopic surgical procedures. MEASUREMENTS AND MAIN RESULTS Postoperative review of surgical movements during laparoscopic surgery was able to provide quantitative data. Motion and timing could be classified by angle banding ranges among surgeons. The most extreme shoulder abduction angles occurred during trocar insertion (61°) and insertion or removal of laparoscopic instruments (63.5°), with procedures involving morcellation requiring the greatest number of instrument insertions or removals (n = 57). The elbow is most frequently in a neutral position in TLH, and the shoulder spends the most time in abduction during myomectomy. CONCLUSION This proof-of-concept study confirms that detailed ergonomic assessment is possible within live surgical settings, with identified limitations. This study may allow for a larger-scale study to determine at-risk movements during the various phases of a laparoscopic surgery and possibly control for some of these hazardous behaviors.
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Affiliation(s)
- Lucy Ping Aitchison
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - James Flint
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Erin Nesbitt-Hawes
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - William Ledger
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Jason Abbott
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia.
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Nesbitt-Hawes E, Campbell N, Won H, Maley P, Henry A, Abbott J, Potdar N, Mason-Birks S, Elson CJ, Gelbaya TA, Nardo LG, Stavroulis A, Nnoaham K, Hummelshoj L, Zondervan K, Saridogan E, GSWH Consortium WERF, Chamie LP, Soares ACP, Kimati CT, Gomes C, Fettback P, Riboldi M, Serafini P, Lalitkumar S, Menezes J, Evdokia D, Gemzell-Danielsson K, Lalitkumar PGL, Bailey J, Newman TA, Johnston A, Zisimopoulou K, White M, Sadek K, Shreeve N, Macklon N, Cheong Y, Al-Akoum M, Akoum A, Giles J, Garrido N, Vidal C, Mondion M, Gallo C, Ramirez J, Pellicer A, Remohi J, Ghosh S, Chattopadhyay R, Jana S, Goswami SK, Bose G, Chakravarty M, Chowdhuri K, Chakravarty BN, Kendirci Ceviren A, Ozcelik Tanriverdi N, Urfan A, Donmez L, Isikoglu M, Romano A, Schreinemacher MH, Backes WH, Slenter JM, Xanthoulea SA, Delvoux B, van Winden L, Beets-Tan RG, Evers JLH, Dunselman GAJ, Jana SK, Chaudhury K, Chattopadhyay R, Chakravarty BN, Maruyama T, Yamasaki A, Miyazaki K, Arase T, Uchida H, Yoshimura Y, Kaser D, Ginsburg E, Missmer S, Correia K, Racowsky C, Streuli I, Chouzenoux S, de Ziegler D, Chereau C, Weill B, Chapron C, Batteux F, Arianmanesh M, Fowler PA, Al-Gubory KH, Urata Y, Osuga Y, Izumi G, Nagai M, Takamura M, Yamamoto N, Saito A, Hasegawa A, Takemura Y, Harada M, Hirata T, Hirota Y, Yoshino O, Koga K, Taketani Y, Mohebbi A, Janan A, Nasri S, Lakpour MR, Ramazanali F, Moini A, Aflatoonian R, Germeyer A, Novak O, Renke T, Jung M, Jackus J, Toth B, Strowitzki T, Bhattacharya J, Mitra A, Kundu S, Pal M, Kundu A, Gumusel A, Basar M, Yaprak E, Aslan E, Arda O, Ilvan S, Kayisli U, Guzel E, Haouzi D, Monzo C, Lehmann S, Hirtz C, Tiers L, Hamamah S, Choi D, Choi J, Jo M, Lee E, Shen X, Wang BIN, Li X, Tamura I, Maekawa R, Asada H, Tamura H, Sugino N, Tamura H, Tamura I, Maekawa R, Asada H, Sugino N, Liu H, Jiang Y, Chen J, Zhu L, Shen X, Wang B, Yan G, Sun H, Coughlan C, Sinagra M, Ledger W, Li TC, Laird SM, Dafopoulos K, Vrekoussis T, Chalvatzas N, Messini CI, Kalantaridou S, Georgoulias P, Messinis IE, Makrigiannakis A, Xue Q, Xu Y, Zuo WL, Zhang L, Shang J, Zhu SN, Bulun SE, Tomassetti C, Geysenbergh B, Meuleman C, Fieuws S, D'Hooghe T, Suginami K, Sato Y, Horie A, Matsumoto H, Fujiwara H, Konishi I, Jung Y, Cho S, Choi Y, Lee B, Seo S, Urman B, Yakin K, Oktem O, Alper E, Taskiran C, Aksoy S, Takeuchi K, Kurematsu T, Yu-ki Y, Fukumoto Y, Homan Y, Sata Y, Kuroki Y, Takeuchi M, Awata S, Muneyyirci-Delale O, Charles C, Anopa J, Osei-Tutu N, Dalloul M, Weedon J, Muney A, Stratton P, Yilmaz B, Kilic S, Aksakal O, Kelekci S, Aksoy Y, Lordlar N, Sut N, Gungor T, Chan J, Tan CW, Lee YH, Tan HH, Choolani M, Griffith L, Oldeweme J, Barcena de Arellano ML, Reichelt U, Schneider A, Mechsner S, Barcena de Arellano ML, Munch S, Vercellino GF, Chiantera V, Schneider A, Mechsner S, Santoro L, D'Onofrio F, Campo S, Ferraro PM, Tondi P, Gasbarrini A, Santoliquido A, Jung MH, Kim HY, Barcena de Arellano ML, Arnold J, Vercellino GF, Chiantera V, Schneider A, Mechsner S, Arnold J, Barcena de Arellano ML, Buttner A, Vercellino GF, Chiantera V, Schneider A, Mechsner S, Karaer A, Celik O, Bay Karabulut A, Celik E, Kiran TR, Simsek OY, Yilmaz E, Turkcuoglu I, Tanrikut E, Alieva K, Kulakova E, Ipatova M, Smolnikova V, Kalinina E. ENDOMETRIOSIS, ENDOMETRIUM, IMPLANTATION AND FALLOPIAN TUBE. Hum Reprod 2012. [DOI: 10.1093/humrep/27.s2.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Salim S, Won H, Nesbitt-Hawes E, Campbell N, Abbott J. Diagnosis and Management of Endometrial Polyps: A Critical Review of the Literature. J Minim Invasive Gynecol 2011; 18:569-81. [DOI: 10.1016/j.jmig.2011.05.018] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 05/18/2011] [Accepted: 05/26/2011] [Indexed: 01/02/2023]
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