1,721,011 research outputs found
Pain in office hysteroscopy: it is not just a matter of size. Comment on: “Paulo AA, Solheiro MH, Paulo CO. Is pain better tolerated with mini-hysteroscopy than with conventional device? A systematic review and meta-analysis: hysteroscopy scope size and pain. Arch Gynecol Obstet. 2015 May 7”
No full textEffectiveness and Safety of Posterior Vaginal Repair with Single-Incision, Ultralightweight, Monofilament Propylene Mesh: First Evidence from a Case Series with Short-Term Results
Full text linkObjective. The use of transvaginal mesh is controversial, and over time, multiple surgical methods for the treatment of posterior vaginal prolapse (PVP) have been proposed including different surgical approaches and techniques. To date, no clear conclusion has been reached about the use of mesh for reinforcing transvaginal posterior repair. The aim of this study was to evaluate the feasibility, safety, and effectiveness of a novel, ultralightweight mesh for the treatment of PVP. Methods. We performed a single-center, prospective observational study on consecutive patients referred for primary or recurrent, symptomatic stage II PVP (according to the international Pelvic Organ Prolapse Quantification System) from April 2017 to September 2018. In all patients, transvaginal posterior repair was augmented with a single-incision, isoelastic polypropylene mesh. Data about the postoperative outcomes were collected until December 2019. Results. A total number of 15 patients were included. The median follow-up after surgery was 18 months (IQR=14). Surgery was completed in all cases without complications. Regarding the anatomical outcomes (as measured according to POP-q classification), a significant improvement was observed in terms of Bp, D, and C (p<0.05). The functional outcomes were significantly ameliorated after surgery, with a reduction of bulge symptom, stypsis, incomplete evacuation, and excessive staining (p<0.05). The quality of life was significantly improved in the majority of patients (p<0.05). Median patients' satisfaction rate was 100% (IQR=22.5%). Neither early nor late postoperative complications occurred. Conclusions. Single-incision, ultralightweight polypropylene meshes were safe and highly effective in the treatment of PVP. As our study has some limitations, further large, controlled studies are needed
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Chapter 20 - Interesting cases registry
No full textFailure holds great value when we extract valuable lessons from it, particularly in surgery. It plays a vital role in preventing the repetition of harmful mistakes. However, if complications remain confined to the operating theater, the lessons learned become mere personal experiences. This principle is also applicable in the field of hysteroscopy. Since the first hysteroscopy reported by Pantaleoni, the significance of complications and their prevention have been emphasizing alongside the description of the procedure itself.
In this chapter, we present a collection of interesting cases gathered from all around the world. The following cases are described by the surgeons involved, providing readers with comprehensive information necessary to recognize, acknowledge, and effectively address complications. The inclusion of videos allows readers to gain insight into the firsthand experiences of surgeons involved in encountering complications. By sharing this knowledge, we aim to make a modest but effective contribution toward enhancing the safety of hysteroscopic procedures
Is the cold loop hysteroscopic technique a myometrial sparing treatment for placenta accreta residuals in a puerperal uterus?
No full textPlacenta accreta is a life-threatening obstetric pathology characterized by an abnormal invasion of chorionic villi into the uterine wall. The management represents a challenge for the gynecologist, especially in patients desiring to preserve their fertility. Several methods have been proposed to avoid hysterectomy. A case of a hysteroscopic conservative management with the cold loop technique in a puerpera with a large mass of placenta accreta residuals is described. The chorionic tissue was safely detached and it was subsequently removed by an electric cutting loop. Even in the absence of a clear cleavage plane, the thermal damage of surrounding healthy myometrium and dreadful complications as uterine perforation due to the electric cutting loop were avoided. The cold-loop hysteroscopic resection seems to be a safe and effective choice for the treatment of retained placenta accreta in patients desiring to preserve fertility. Moreover, it can also be proposed to patients who need to be treated immediately after delivery
Diagnostic Hysteroscopy and Adenomyosis: The Case of a Uterine Cornual Cavern. A Video Article
No full textIntroduction The aim of this study is to show a rare case of adenomyosis presented as a “cavern” which completely involves a uterine cornu. Case description A 39-year-old nulliparous patient, with five previous laparoscopic myomectomies during which multiple myomas and adenomyomas have been removed, presented at the Arbor Vitae Centre for Endoscopic Gynaecology in Rome because of an abnormal uterine bleeding. A 6 cm myoma with multiple endometrial glands inside, located on the left uterine cornu, was enucleated during the last procedure. The ultrasound scan showed a 1 cm endometrial polyp and suspected adenomyosis reaching the serosa on the left uterine cornu. Free-anaesthesia diagnostic hysteroscopy was performed with carbon dioxide as distension medium and using a 30-degree fore-oblique rigid telescope with a diameter of 2.9 mm, covered with a single-flow examination sheath. An electronic hysteroflator was set at a flow rate of 30 mL/min and a maximum intrauterine pressure of 75 mm Hg. Multiple adenomyosis caverns that deepen into the myometrium were found on the left uterine cornu. Conclusions Previous multiple myomectomy may seriously alter the internal uterine anatomy, especially in presence of adenomyosis. In case of presence of numerous recesses in the uterine cavity, a suspicion of adenomyosis should be considered. </jats:sec
Vaginal myomectomy is a safe and feasible procedure: A retrospective study of 46 cases.
No full textAim: The aim of this study was to establish the feasibility and safety of vaginal myomectomy via posterior colpotomy in a series of consecutive procedures performed by one surgeon. Material and methods: We conducted a retrospective study in a tertiary care university hospital, involving 46 patients with symptomatic myomas and uteruses smaller than 16 gestational weeks and with no signs of pelvic disease. After a presurgical study, the patients underwent vaginal myomectomy. Characteristics of patients, position and size of myomas, operative data, intraoperative and postoperative complications, and length of hospital stay were recorded. Results: Forty-four women underwent vaginal myomectomy and conversion to laparotomy was required in two cases (4.3%). Two patients suffered from infertility and one of these achieved pregnancy after the procedure. The median size of myomas was 50 mm (range 16-81). In two cases a culdoscopy was performed with a flexible fiberoptic gastroscope to better evaluate size and localization of myomas. Thirty-two patients underwent vaginal myomectomy under general anesthesia and 12 under locoregional anesthesia. The median vaginal operating time was 70 min (range 30-120). The estimated hemoglobin loss was 0.70 g/dL (range 0.40-3.35 g/dL). No severe intraoperative complications occurred. The median duration of hospital stay was 1 day (range 1-6). Conclusions: Vaginal myomectomy is a safe and feasible surgical procedure if performed by a well-trained, experienced surgeon
New treatment option for early spontaneous rupture of a postmyomectomy gravid uterus
No full textObjective: To report the successful treatment of a postmyomectomy, early uterine rupture with the use of a Bakri balloon. Design: Case report. Setting: University hospital, department of obstetrics and gynecology. Patient(s): A 32-year-old patient, gravida 1, at 19 weeks' gestation, with postmyomectomy spontaneous uterine rupture and concurrent uterine atony. Intervention(s): Laparotomy was done because of massive hemoperitoneum. A Bakri balloon was inserted, and a two-layer suture of the uterine defect was performed. Main Outcome Measure(s): Possibility of controlling hemorrhage and avoiding hysterectomy. Result(s): Contemporary surgical sutures and insertion of a Bakri balloon were effective at controlling hemorrhage. The uterus was preserved. Conclusion(s): The use of a Bakri balloon, combined with traditional surgical techniques, is described as a new method to successfully treat hemorrhage in the case of early spontaneous uterine rupture. In this case, hysterectomy was also avoided
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