1,720,981 research outputs found
Hysteroscopic metroplasty for the septate uterus with diode laser: a pilot study
No full textOBJECTIVE:
To evaluate the feasibility and safety of office hysteroscopic metroplasty using a 980nm diode laser.
STUDY DESIGN:
18 patients were treated for septate uterus between 2013 and 2016. The indications for hysteroscopic metroplasty were recurrent abortion in 11 of the women and primary infertility in the other seven. We used a 5mm-office hysteroscope with a diode laser fibre. After exploration of the cavity, the septum was divided with use of the laser fibre.
RESULTS:
Operating time was 13,16±1,33min. Intraoperative pain was 3,05±0,72. No intraoperative or postoperative complications were observed. Follow-up performed 2 months after the hysteroscopic metroplasty confirmed the complete removal of the septum and no evidence of intrauterine synechiae.
CONCLUSION:
Office hysteroscopic metroplasty with use of a diode laser is safe and feasible; we believe that vaporization of the septum with a diode laser could reduce the formation of adhesions and consequently reduce the occurrence of septum persistence
Safe endobag morcellation in a single-port laparoscopy subtotal hysterectomy
No full textRecently, the American Food and Drug Administration (FDA) published an alert about the risks of
uterine tissue morcellation during laparoscopic procedures. In particular, the possible risk of
spreading an undiagnosed malignant tumor was emphasized. From then on, a fervent debate in
the media has led major scientific societies to express their position on the matter. We present a
safe endobag abdominal morcellation in a single port-access laparoscopy subtotal hysterectomy.
The endobag abdominal morcellation is feasible and safe; consequently, the development of
devices dedicated to intracavitary morcellation in a closed system has been encourage
Bilateral salpingo-oophorectomy and adhesiolysis with single port access laparoscopy and use of diode laser in a BRCA carrier
No full textHerein the authors report the first case of prophylactic bilateral salpingo-ovariectomy (BSO) in single port access laparoscopy (SPAL) with use of diode laser in a patient with BRCA1 mutation. As fimbria could be considered the site of origin for many serous carcinomas in BRCA mutation carriers, many studies are carried out to evaluate the possibility of preventing ovarian carcinoma with BSO. SPAL is a development of endoscopic surgery which further reduces invasiveness of surgical procedures. Diode laser presents a recognized precision for tissue cutting and coagulation and its use could be highly advantageous in SPAL surgery and in particular in such situations avoiding fallopian tube histology distortion and consequently improve the prognosis of BRCA carriers
Review and meta-analysis of prospective randomized controlled trials (RCTs) comparing laparo-endoscopic single site and multiport laparoscopy in gynecologic operative procedures
No full textPurpose: To critically appraise published randomized controlled trials (RCTs) comparing laparo-endoscopic single site (LESS) and multi-port laparoscopic (MPL) in gynecologic operative surgery; the aim was to assess feasibility, safety, and potential benefits of LESS in comparison to MPL. Methods: A systematic review and meta-analysis of eleven RCTs. Women undergoing operative LESS and MPL gynecologic procedure (hysterectomy, cystectomy, salpingectomy, salpingo-oophorectomy, myomectomy). Outcomes evaluated were as follows: postoperative overall morbidity, postoperative pain evaluation at 6, 12, 24 and 48 h, cosmetic patient satisfaction, conversion rate, body mass index (BMI), operative time, blood loss, hemoglobin drop, postoperative hospital stay. Results: Eleven RCTs comprising 956 women with gynecologic surgical disease randomized to either LESS (477) or MPL procedures (479) were analyzed systematically. The LESS approach is a surgical procedure with longer operative and better cosmetic results time than MPL but without statistical significance. Operative outcomes, postoperative recovery, postoperative morbidity and patient satisfaction are similar in LESS and MPL. Conclusion: LESS may be considered an alternative to MPL with comparable feasibility and safety in gynecologic operative procedures. However, it does not offer the expected advantages in terms of postoperative pain and cosmetic satisfaction
Focusing on surgery results in infertile patients with deep endometriosis
No full textInfertility is a common problem in patients with endometriosis and the involved mechanisms are still not completely known. The management of infertility in endometriosis patients includes surgery as well as assisted reproductive technology. Laparoscopic surgery has shown better results in infertility patients with endometriosis in comparison to laparotomy procedures. Laparoscopic surgery has proposed benefits in both minimal to moderate diseases. However, while there may be some benefits with severe diseases, there is still not enough evidence to recommend laparoscopic surgery as the recommended surgery when the main goal is to obtain fertility. We performed a MEDLINE search for articles on fertility in women with deep infiltrating endometriosis (DIE) published between 1990 and April 2015 using the following keywords: "endometriosis", "deep infiltrative endometriosis", "infertility", "fertility after surgery", "laparoscopy surgery", "laparotomy", "pregnancy", "fertility outcome", "bladder endometriosis", and "ureteral endometriosis". The aim of this review was to analyze the results of available clinical studies (randomized controlled or not controlled studies; retrospective cohort studies; or case-control and prospective studies) and guidelines on surgical treatment of infertile endometriosis patients, and pregnancy outcomes after surger
Multidimensional assessment of pain in women with endometriosis: preliminary results of the experience in Cagliari
No full textEndometriosis is a chronic disease that affects women of reproductive age. Chronic pelvic pain, dysmenorrhea, and dyspareunia are its main symptoms; the pain alters the quality of life of the patient and affects her health. Since pain is a highly subjective experience, the purpose of this study is to assess the sensory component of pain perception in endometriosis, alongside the affective-emotional and cognitive aspects. These aspects were linked with anamnestic data, anxiety, and depression. We administered appropriate instruments in order to assess these dimensions (QUID - Italian Pain Questionnaire, Biberoglu's Scale, and the HADS Scale), and we evaluated their relationships
Feasibility of hysteroscopic endometrial polypectomy using a new dual wavelengths laser system (DWLS): preliminary results of a pilot study
Full text linkCurrently, endometrial polyps may be successfully treated in an outpatient setting with 5 Fr mechanical and bipolar instruments. Our aim is to evaluate the benefits of minimally invasive techniques in hysteroscopy, focusing on the use of a new dual wavelengths laser system in the treatment of endometrial polyps in an outpatient setting
Progestins for symptomatic endometriosis: Results of clinical studies
No full textProgestins, which are synthetic progestational compounds, have been used in the management of symptomatic endometriosis, both as primary therapy and as an adjunct to surgery. Several oral compounds have been used for this purpose, and different degrees of benefits have been shown. The lack of a standardized instrument to evaluate painful symptoms makes comparative analysis very difficult. We performed a systematic search of the Pubmed database from January 1980 to January 2015. The database used the term “endometriosis” as the relevant medical subject heading; selected sub- headings were “progestins”, “medical therapy”, “” and “randomized controlled trials”, “controlled trials”, “case-control studies”, and “descriptive studies”. We aimed to review all available trials in order to investigate the medical treatment of endometriosis solely with progestins, with special attention to pharmacodynamic activity. The drugs studied were cyproterone acetate, norethisterone acetate, medroxyprogesterone acetate, levonorgestrel, etonogestrel, dienogest, and selective progesterone receptor modulators. However, it is very difficult to reach a definitive conclusion because most trials were small, retrospective, and uncontrolled. Nevertheless, it is clear that progestins are generally safe, effective, and well tolerated and should be considered as the first line of medical treatment in symptomatic endometriosis provided the patients have no desire for pregnancy
Laparoscopically assisted treatment of imperforate hymen in a patient with ventritrulo-peritoneal (VP) shunt for congenital hydrocephalous: a case report
Full text linkIntroduction: We report a case of laparoscopically assisted treatment of imperforate hymen in a patient with ventriculo-peritoneal (VP) shunt for congenital hydrocephalous. Presentation of case: The patient presented primary amenorrhea and cyclical abdominal pain. At clinical examination a painful mass in the abdomen and normal secondary sex characteristics were observed. Perineal examination showed a bulging hymen and transabdominal ultrasonography and CT scan revealed a dense mass in the pelvis and abdomen. We diagnosed an imperforate hymen with haematocolpos and haematometra. The surgical procedure was performed under laparoscopic guidance in order to check the pelvic anatomy inside, to exclude the presence of adhesions and endometriotic lesions and to evaluate the ventriculo-peritoneal (VP) shunt. Discussion: Imperforate hymen (IH) is the most common obstructive congenital anomaly of female genital tract. It is potentially accompanied by other female reproductive tract anomalies, suggesting a multifactorial genetic etiology. It usually presents during puberty, causing accumulation of menstrual products in the vagina (haematocolpos) or in the uterus (haematometra). Generally, the treatment consists in hymenotomy or hymenectomy, that allows the accumulated blood to be drained away. Laparoscopically assisted treatment of imperforate hymen is not routinely performed but it can be considered in particular clinical conditions. It is a viable procedure very useful to exclude female reproductive anomalies, the presence of pelvic pathology (adhesions and endometriosis) and to evaluate the ventriculo-peritoneal (VP) shunt and its possible complications (abdominal pseudocyst). Conclusion: This is the first case of laparoscopically assisted treatment of imperforate hymen in a patient with ventriculo-peritoneal (VP) shunt for congenital hydrocephalous. Laparoscopic guidance has to be considered to exclude other female reproductive anomalies, pelvic pathology and abdominal complications (shunt dysfunction and abdominal pseudocyst)
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