RESUMEN
PURPOSE OF REVIEW: We review the literature regarding the use of dyes and fluorescence-guided visualization techniques in gynaecological surgery. We also discuss advances in imaging that may enhance surgery by incorporating real-time visual feedback through augmented reality and preoperative planning with patient-specific, three-dimensional printed surgical fields. RECENT FINDINGS: Methylene blue is one of the most commonly used dyes, while indocyanine green is the most used agent in fluorescence-guided surgery. Augmented reality and three-dimensional printing are also being increasingly used in gynaecology. SUMMARY: Dyes and fluorescence-based surgeries are commonly utilized to improve anatomic identification, preservation of healthy tissue and excision of disease. In addition, we explore how augmented reality and three-dimensional printing are used in gynaecology.
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Colorantes , Cirugía Asistida por Computador , Femenino , Fluorescencia , Procedimientos Quirúrgicos Ginecológicos , Humanos , Imagenología Tridimensional/métodos , Verde de Indocianina , Cirugía Asistida por Computador/métodosRESUMEN
OBJECTIVE: The incidence of adnexal masses in pregnancy is 1% to 6%. Although surgery is often indicated, there are no definitive management guidelines. We aimed to investigate the optimal approach to surgical management of adnexal masses in pregnancy on the basis of a meta-analysis of previous studies. DATA SOURCES: We performed a systematic review using MEDLINE, Embase, Cochrane Library, and Clinicaltrials.gov from inception to July 17, 2020. METHODS OF STUDY SELECTION: There were no restrictions on study type, language, or publication date. Comparative and noncomparative retrospective studies that reviewed operative techniques used in surgery of adnexal masses in pregnancy were included. Meta-analyses were performed to assess outcomes. This study was registered in the International Prospective Register of Systematic Reviews (CRD42019129709). TABULATION, INTEGRATION, AND RESULTS: Comparative studies were identified for laparoscopy vs laparotomy and elective vs emergent surgery (11 and 4, respectively). Elective surgery is defined as a scheduled antepartum procedure. For laparoscopy vs laparotomy, the mean maternal ages and gestational ages at time of surgery were similar (27.8 years vs 27.7 years, pâ¯=â¯.85; 16.2 weeks in laparoscopy vs 15.4 weeks in laparotomy, pâ¯=â¯.59). Mass size was larger in those undergoing laparotomy (mean 8.8 cm vs 7.8 cm, pâ¯=â¯.03). The most common pathologic condition was dermoid cyst (36%), and the risk of discovering a malignant tumor was 1%. Laparoscopy was not associated with a statistically increased risk of spontaneous abortion (SAB) or preterm delivery (PTD) (odds ratio [OR] 1.53; 95% confidence interval [CI], 0.67-3.52; pâ¯=â¯.31 and OR 0.95; 95% CI, 0.47-1.89; pâ¯=â¯.88, respectively). The mean length of hospital stay was 2.5 days after laparoscopy vs 5.3 days after laparotomy (p <.001). The decrease in estimated blood loss in laparoscopy was not statistically significant (94.0 mL in laparotomy vs 54.0 mL in laparoscopy, pâ¯=â¯.06). Operative times were similar in laparoscopy and laparotomy (80.0 minutes vs 72.5 minutes, pâ¯=â¯.09). Elective surgery was associated with a decreased risk of PTD (OR 0.13; 95% CI, 0.04-0.48; pâ¯=â¯.05). Noncomparative studies were identified for laparoscopy and laparotomy. Laparotomy had more SABs and PTDs than laparoscopy (pooled proportionâ¯=â¯0.02 vs 0.07 and pooled proportionâ¯=â¯0.02 vs 0.14, respectively). CONCLUSION: Laparoscopy for the surgical management of adnexal masses in pregnancy is associated with shorter length of hospital stay and similar risk of SAB or PTD. Elective surgery is associated with a decreased risk of PTD.
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Enfermedades de los Anexos , Laparoscopía , Enfermedades de los Anexos/cirugía , Femenino , Humanos , Recién Nacido , Laparotomía , Embarazo , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
STUDY OBJECTIVE: To assess the change in the rate of laparoscopic salpingectomy for sterilization after the release of the November 2013 Society of Gynecologic Oncology Clinical Practice Statement and the January 2015 American College of Obstetricians and Gynecologists Committee Opinion: Salpingectomy for Ovarian Cancer Prevention. We hypothesized there would be an increase in salpingectomy as a percentage of total laparoscopic sterilizations performed without an increase in complications when compared with conventional bilateral tubal ligation (BTL). DESIGN: A retrospective cohort study. SETTING: Four university-affiliated hospitals in Houston, TX, and New York, NY. PATIENTS: All women 21 years or older who underwent interval laparoscopic permanent sterilization between April 2013 and September 2016. INTERVENTIONS: Sterilization by bilateral salpingectomy or conventional tubal ligation. MEASUREMENTS AND MAIN RESULTS: There were 454 sterilization procedures identified; 60% were BTLs, whereas 40% were salpingectomies. The rate of use of salpingectomy significantly increased from 5% to 9% in 2013 to 2014 to 78% by 2016. There was no significant difference in intraoperative or postoperative complications or estimated blood loss. The mean procedure time was 54 minutes for salpingectomy compared with 45 minutes for BTL (p <.0001). Salpingectomy was more likely to require 3 ports compared with 2 ports for BTL (p <.0001). CONCLUSIONS: The Society of Gynecologic Oncology and the American College of Obstetricians and Gynecologists' support of salpingectomy for ovarian cancer prevention increased its use for sterilization. Based on this study, laparoscopic bilateral salpingectomy is a safe method of sterilization without an increase in perioperative risk compared with conventional tubal ligation. Physicians should incorporate these findings and implications when counseling patients regarding contraception and permanent sterilization.
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Seguridad del Paciente/estadística & datos numéricos , Salpingectomía/métodos , Esterilización Reproductiva/métodos , Esterilización Tubaria/métodos , Adulto , Estudios de Factibilidad , Femenino , Humanos , Laparoscopía , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: To compare postoperative pain after conventional laparoscopic and robotically assisted laparoscopic surgery in gynecology. METHODS: This is a prospective nonrandomized analysis of patients undergoing conventional laparoscopy or robotically assisted laparoscopy in a university-affiliated hospital between March 2011 and March 2012. Postoperative pain was measured using the Numeric Rating Scale and the narcotic use converted to morphine sulfate equivalents. The primary outcome was the Numeric Rating Scale pain score obtained on the first postoperative day. RESULTS: One hundred ten patients were enrolled; 91 were included in the statistical analysis. Both groups were similar with regard to race, history of abdominopelvic surgeries, psychiatric history, and substance abuse. Patients undergoing robotically assisted laparoscopy were 6 years older and had a body mass index 6 points higher. Median length of hospital stay for conventional laparoscopy and robotically assisted laparoscopy was 2 days and 3 days, respectively (P<.001); median to being off narcotics was 4 days and 4.5 days, respectively (P=.336); and median return to normal activities was 13 days and 21 days, respectively (P=.021). There were no significant differences in mean Numeric Rating Scale pain scores over time (P=.499) or mean narcotic requirements (P=.393) between groups. CONCLUSION: Robotically assisted laparoscopy is equivalent to conventional laparoscopy in terms of subjective and objective measures of postoperative pain.
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Procedimientos Quirúrgicos Ginecológicos/efectos adversos , Laparoscopía/efectos adversos , Dolor Postoperatorio/etiología , Robótica , Adulto , Anciano , Analgesia/estadística & datos numéricos , Analgésicos/administración & dosificación , Femenino , Humanos , Persona de Mediana Edad , Dimensión del Dolor , Dolor Postoperatorio/tratamiento farmacológico , Estudios Prospectivos , Recuperación de la FunciónRESUMEN
We performed a search of PUBMED and MEDLINE for articles concerning surgical management of early stage endometrial cancer from 1950 to 2011. From the articles collected we extracted data such as estimated blood loss, operating room time, complications, conversion to laparotomy, and length of hospital stay. Forty-seven relevant sources were analyzed. The patients in the laparoscopy group had less blood loss, fewer complications, longer operating room times, and a shorter length of stay. Lymph node count was similar in both groups. Although obesity is not a contraindication to laparoscopy, it does lead to a higher conversion rate. Route of surgical treatment had no impact on recurrence or survival. Robotic surgery has significant advantages over laparotomy, but advantages over laparoscopy are not as distinct. Laparoscopic hysterectomy offers several advantages over laparotomy. These advantages relate to improvements in patient care with comparable clinical outcome. After careful analysis we believe laparoscopy should be the standard of care for surgical management of early stage endometrial cancer.
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Carcinoma/cirugía , Neoplasias Endometriales/cirugía , Histerectomía/efectos adversos , Laparoscopía/efectos adversos , Pérdida de Sangre Quirúrgica , Carcinoma/patología , Supervivencia sin Enfermedad , Neoplasias Endometriales/patología , Femenino , Humanos , Histerectomía/economía , Histerectomía/métodos , Tiempo de Internación , Análisis de Supervivencia , Factores de TiempoRESUMEN
BACKGROUND: Obturator nerve injury may occur in gynecologic surgery, particularly in cases in which extensive pelvic sidewall retroperitoneal dissection is performed. The lack of tactile feedback from the robotic surgical system may contribute to obturator nerve injury. If surgical division occurs, microsurgical end-to-end anastomosis of the obturator nerve may be performed. CASE: A 76-year-old woman with stage IA endometrial adenocarcinoma sustained a left obturator nerve transection during pelvic lymphadenectomy that was recognized immediately. Robotic-assisted laparoscopic repair was performed successfully, with the patient experiencing no residual neuropathy 6 months postoperatively. CONCLUSION: Robotic-assisted laparoscopic repair is feasible for the treatment of obturator nerve injury.
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Adenocarcinoma/cirugía , Neoplasias Endometriales/cirugía , Laparoscopía/efectos adversos , Nervio Obturador/lesiones , Nervio Obturador/cirugía , Anciano , Femenino , Humanos , Ganglios Linfáticos/cirugía , Pelvis , RobóticaRESUMEN
Although supracervical hysterectomy is an increasingly popular modality for surgical management of benign uterine conditions data exploring all of its consequences are still forth coming. This case report will discuss the scenario of leiomyoma recurrence at the cervical stump after supracervical hysterectomy. After supracervical hysterectomy, the remnant cervix has the potential for leiomyoma formation. Surgeons performing supracervical hysterectomy should be aware of this possible outcome.
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Leiomioma/cirugía , Recurrencia Local de Neoplasia/cirugía , Neoplasias del Cuello Uterino/cirugía , Neoplasias Uterinas/cirugía , Femenino , Humanos , Histerectomía , Persona de Mediana Edad , Recurrencia Local de Neoplasia/diagnóstico , Neoplasias del Cuello Uterino/diagnósticoRESUMEN
BACKGROUND: As cesarean sections become a more common mode of delivery, they have become the most likely cause of vesicouterine fistula formation. The associated pathology with repeat cesarean deliveries may make repair of these fistulas difficult. Computer-enhanced telesurgery, also known as robotic-assisted surgery, offers a 3-dimensional view of the operative field and allows for intricate movements necessary for complex suturing and dissection. These qualities are advantageous in vesicouterine fistula repair. CASE: A healthy 34-year-old woman who underwent 4 cesarean deliveries presented with a persistent vesicouterine fistula. Conservative management with bladder decompression and amenorrhea-inducing agents failed. RESULTS: Robotic-assisted laparoscopic repair was successfully performed with the patient maintaining continence after surgery. CONCLUSION: Robotic-assisted laparoscopic repair of vesicouterine fistulas offers a minimally invasive approach to treatment of a complex disease process.
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Cesárea Repetida/efectos adversos , Fístula/cirugía , Laparoscopía/métodos , Robótica , Fístula Urinaria/cirugía , Enfermedades Uterinas/cirugía , Adulto , Cistoscopía , Femenino , Fístula/etiología , Humanos , Histeroscopía , Complicaciones Posoperatorias/cirugía , Fístula Urinaria/etiología , Enfermedades Uterinas/etiologíaRESUMEN
OBJECTIVE: The hysterosalpingogram is commonly used to evaluate the uterine cavity and the fallopian tubes in the workup of infertile couples. The sonohysterogram is gaining popularity as part of this evaluation. This study compares hysterosalpingography to sonohysterography for the detection of polyps, cavitary fibroids, adhesions, and septae in infertile patients. METHODS: We conducted a retrospective chart review of 149 infertility patients seen at a University Hospital Center, divisions of Reproductive Endocrinology and Interventional Radiology. Patients underwent hysterosalpingography and sonohysterography as part of their infertility evaluation. The reports were reviewed and findings like polyps, fibroids, adhesions, and septae were compared to the findings obtained at the time of hysteroscopy. Sensitivity, specificity, and accuracy of radiologic tests were the main outcome measures. RESULTS: The sensitivity of hysterosalpingography and sonohysterography was 58.2% and 81.8%, respectively. The specificity for hysterosalpingography and sonohysterography was 25.6% and 93.8%. The differences in sensitivity and specificity were both statistically significant. Hysterosalpingography had a general accuracy of 50.3%, while sonohysterography had a significantly higher accuracy of 75.5%. CONCLUSION: Although hysterosalpingography is the standard screening test for the diagnosis of tubal infertility and can provide useful information about the uterine cavity, sonohysterography is more sensitive, specific, and accurate in the evaluation of the uterine cavity.
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Histerosalpingografía , Histeroscopía/métodos , Infertilidad Femenina/diagnóstico por imagen , Ultrasonografía/métodos , Enfermedades Uterinas/diagnóstico por imagen , Adulto , Diagnóstico Diferencial , Femenino , Humanos , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: To assess the success of day 4 embryo transfers (ETs) following IVF at one institution. DESIGN: Retrospective analysis. SETTING: A university hospital IVF program. PATIENT(S): Two hundred nondonor, fresh IVF cycles. INTERVENTION(S): None. MAIN OUTCOME MEASURE: Outcomes of IVF. Outcome assessments after day 4 ETs included rates of implantation, clinical pregnancy, and singleton and multiple live births. RESULT(S): The overall live-birth rate was 54.4%. Implantation rates were highest in younger age groups, and similar in patients 35-40 years of age. Pregnancy and live-birth rates were similar across all age groups up to age 40 years. Multiple gestations were highest in women < or =40 years of age. CONCLUSION: Acceptable pregnancy rates can be achieved with day 4 ETs.