Value of serum procalcitonin as an early predictor of antibiotic treatment response in inpatients with pelvic inflammatory disease (VALID).

OBJECTIVE: This study aimed to investigate the value of serum procalcitonin as an early predictor of antibiotic treatment response in the inpatient management of pelvic inflammatory disease (PID). MATERIALS AND METHODS: A prospective observational study was carried out at a university hospital. Patients admitted for pelvic inflammatory disease were classified into 2 groups: responders and non-responders. The primary outcome measure was the serum level of procalcitonin at the time of admission. The secondary outcome measures were other serum inflammatory markers including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and white blood cell (WBC) count. RESULTS: Baseline characteristics were similar between the groups. Serum level of procalcitonin at the time of admission did not differ between the groups (P = 0.564). However, the non-responders had more elevated CRP and ESR compared to the responders (P = 0.045 and P = 0.030, respectively). CRP showed the highest accuracy of 72.1% (95% confidence interval [CI], 59.2 to 82.9) in predicting antibiotics response, while procalcitonin showed the lowest accuracy of 49.1% (95% CI, 35.1 to 63.2). CONCLUSION: Compared with standard inflammatory markers such as CRP or ESR, procalcitonin had limited diagnostic value in predicting antibiotics response in patients admitted for PID. Therefore, procalcitonin measurement cannot be recommended as a laboratory test for patients with PID and the value of its routine use remains inconclusive.

Feasibility of Reduced-Port Robotic Surgery for Myomectomy with the da Vinci Surgical System.

STUDY OBJECTIVE: To present our initial experience with reduced-port robotic surgery (RPRS) for myomectomy using the Octo-Port system (DalimSurgNet, Seoul, Korea). DESIGN: Prospective and noncomparative study (Canadian Task Force classification II-3). SETTING: University hospital. PATIENTS: Nineteen consecutive patients with symptomatic uterine myomas desiring conservative minimally invasive robotic surgery from October 2015 to December 2016. INTERVENTIONS: An 8.5-mm or 12-mm robotic camera cannula was inserted through 1 of the Octo-Port channels and an 8-mm conventional robotic port was inserted into a 10-mm channel of the Octo-Port through a 3-cm transumbilical incision. An additional 8-mm conventional robotic port was inserted into a typical robotic port site in the patient's right abdomen. MEASUREMENTS AND MAIN RESULTS: Feasibility and operative outcomes of RPRS myomectomy. The median docking time and console time were 10 minutes (range, 4-22) and 90 minutes (range, 29-198). The largest myoma was located on the anterior uterine wall in 11 patients (57.9%). The median myoma size and weight were 7.2 cm (range, 4.1-10.5) and 141 g (range, 42-590), respectively. Median operative blood loss and change in hemoglobin were 100 mL (range, 30-700) and 2.6 mg/dL (range, .1-3.8), respectively. The procedure was successfully performed via RPRS in 89.5% of patients; 2 patients required placement of 1 to 2 additional robotic ports, resulting in a return to traditional multiport robotic surgery. There were no major postoperative complications or postoperative hernias. CONCLUSION: Our experience demonstrated the feasibility of RPRS for myomectomy using the Octo-Port system in selected patients.

A comparison between reduced-port robotic surgery and multiport robot-assisted laparoscopy for myomectomy.

OBJECTIVE: To compare the surgical outcomes between reduced-port robotic surgery (RPRS) using the Octo-Port channel and multiport robot-assisted laparoscopy for myomectomy. STUDY DESIGN: This prospective study compared and analyzed data from 15 consecutive women who underwent RPRS for myomectomy and 15 consecutive women who underwent multiport robot-assisted laparoscopy to treat symptomatic uterine myoma from January 2016 to June 2016. The patients were treated by two surgeons at two institutions. RESULTS: The two study groups did not differ demographically. The differences in surgical outcomes, such as docking time, console time, hospital stay, estimated blood loss, Hb change, myoma count, and weight, also did not differ between the two groups. On the contrary, the number of port site was only 2 in RPRS compared with 4-5 in multiport robot-assisted laparoscopic myomectomy. CONCLUSION: RPRS for myomectomy seems technically feasible and safe, with short-term perioperative outcomes similar to those from multiport robot-assisted laparoscopic myomectomy.

Public perception of "scarless" laparoendoscopic single-site surgery in gynecology.

OBJECTIVE: To investigate the public perception of laparoendoscopic single-site surgery (LESS) according to the age group. METHODS: An anonymous questionnaire about the desire for cosmesis and the preference for LESS in treatment of benign gynecologic diseases was provided to healthy volunteers (n=102). The survey participants were divided into two age groups (young women ≤40 years and middle-aged women >40 years). The desire for cosmesis was assessed using a validated scale, Body Image Scale. RESULTS: All of the participants completed the questionnaire. The Body Image Scale scores were not different between the two age groups (11.5±3.5 vs. 11.8±4.0, P=0.656). The most common fear of surgery was the risk of complications in both age groups (69% in the young age group and 65% in the middle-aged group). Unless the operative risk increased, most of the participants (61% to 67%) in both age groups preferred LESS. Their choice was influenced by reduced scarring (43% to 61%), more safety (20% to 39%), reduced postoperative pain (8% to 10%), and new technology (4% to 6%). CONCLUSION: Based on these results, there was no difference in the desire for cosmesis and perception of LESS according to the age. Therefore, physicians should discuss and consider LESS even in middle-aged women.