The merging of dual umbilical port-incisions for contained morcellation in laparoscopic myomectomy.

Uncontained power morcellation during laparoscopic myomectomy may spread tissue fragments or malignant cells into the abdominal cavity. Recently, various approaches to contained morcellation, have been adopted to retrieve the specimen. However, each of these methods has its own drawbacks. Intraabdominal bag-contained power morcellation adopts a complex isolation system, which prolongs the operation and increases medical costs. Contained manual morcellation via colpotomy or mini-laparotomy increases the trauma and the risk of infection. Contained manual morcellation via umbilical incision during single-port laparoscopic myomectomy may be the most minimally invasive and cosmetic approach. But the popularization of single-port laparoscopy is challenging because of technical difficulties and high costs. We have therefore, developed a surgical technique using 2 umbilical port-incisions (5 mm and 10 mm), which are merged into 1 large umbilical incision (25-30mm) for contained manual morcellation during specimen retrieval, and one 5mm incision in the lower left abdomen for an ancillary instrument. As demonstrated in the video, this technique significantly facilitates surgical manipulation using conventional laparoscopic instruments while still keeping the incisions minimal. It is also economical because the use of an expensive single-port platform and special surgical instruments is avoided. In conclusion, the merging of dual umbilical port-incisions for contained morcellation adds a minimally invasive, cosmetic, and economical option to laparoscopic specimen retrieval that would enrich a gynecologist's skill set, which is particularly relevant in a low-resource settings.

Reducing blood loss during laparoscopic myomectomy using a tourniquet loop around the lower uterine segment.

OBJECTIVE: To present a simple and effective hemostatic technique using a tourniquet loop during laparoscopic myomectomy. DESIGN: Pericervical tourniquet has been proven to be a safe and effective measure to reduce blood loss during open myomectomy. However, the use of a tourniquet in laparoscopic myomectomy has been rarely reported probably because the application is difficult and troublesome. In our technique, a prefabricated tourniquet loop, adapted from a Foley catheter, is applied around the lower segment of the uterus. It is easy to apply a tourniquet loop around the lower uterine segment during laparoscopic myomectomy. There is no need to make a window in the broad ligament to apply a pericervical tourniquet or triple tourniquets. Meanwhile, complete blockage of blood supply from the uterine artery and utero-ovarian anastomoses may ensure better hemostasis. SETTING: A tertiary hospital. PATIENT(S): The patient was a 34-year-old woman with uterine leiomyoma and a desire for future fertility. She had been suffering from urinary frequency and chronic bladder pressure for the past 6 months. Magnetic resonance imaging confirmed 2 intramural masses measuring 96 mm × 91 mm and 25 mm × 13 mm at the anterior uterine wall. INTERVENTION(S): Institutional review board and ethics committee approval was obtained. Laparoscopic myomectomy was performed with the application of a tourniquet loop around the lower segment of the uterus (step-by-step video demonstration): homemade tourniquet loop formation using a 14-Fr latex Foley catheter; trocar placement with 2 umbilical ports (10 mm and 5 mm) and a 5-mm port at the lower-left quadrant of the abdomen; application of a tourniquet loop around the lower uterine segment; tumor enucleation and myometrial closure; removal of the tourniquet loop and a check for bleeding; contained specimen extraction via the merged umbilical incision; and inspection of the abdominal cavity and closure of the merged umbilical incision. MAIN OUTCOME MEASURE(S): Feasibility of using a tourniquet loop as an effective hemostatic technique in laparoscopic myomectomy. RESULT(S): The surgery lasted for approximately 90 minutes, and the tourniquet time was approximately half an hour. The estimated blood loss was only 20 mL. Her hemoglobin value on day 1 after the surgery was 131 g/L, the same as the preoperative level. Pathology confirmed the diagnosis of leiomyoma. The patient was discharged 2 days after the surgery with no complications. During follow-up, the patient reported that there was no discomfort and that her menses were normal. Her fallopian tubes were patent in the hysterosalpingogram. Her ovarian function, which was assessed by serum follicle-stimulating hormone concentration (5.34 mIU/mL) on day 3 of her menstrual cycle and antimüllerian hormone level (2.01ng/mL), was in the normal range. She was suggested to conceive 1 year after the procedure. CONCLUSION(S): Application of a tourniquet loop around the lower uterine segment is a simple and effective hemostatic technique during laparoscopic myomectomy. Randomized prospective studies are needed to determine the hemostatic effect of the laparoscopic use of a tourniquet loop and its impact on fertility and ovarian function.

[Protective effect of human amnion epithelial cells through endotracheal instillation against lipopolysaccharide-induced acute lung injury in mice].

Objective To investigate the therapeutic effect of human amnion epithelial cells (hAECs) through endotracheal instillation on acute lung injury (ALI) induced by lipopolysaccharide (LPS) in mice and its underlying mechanism. Methods Male C57BL/6 mice were randomly divided into normal control group, hAECs control group, LPS-induced ALI group and hAECs treatment group (n=10 each group). In the latter two groups, mice were subjected to LPS (5 mg/kg) by oral insertion, and 1 hour later, PBS (50 µL) and hAECs (1×107/mL, 50 µL) were administered by oral insertion in the two groups, respectively. The normal control group and hAECs control group were injected with the same amount of PBS and hAECs by oral insertion, respectively. Twenty-four hours after LPS administration, the mice were sacrificed to collect blood and lung tissues. Cytoplasmic and nuclear proteins were extracted from the lung tissues, and other lung tissues were embedded in paraffin and cut into sections. The wet mass and dry mass of lung tissues were obtained to calculate the wet/dry mass ratios. Concentrations of interleukin (IL)-10, IL-6, IL-1ß and tumor necrosis factor (TNF)-α in sera were measured by ELISA. Pulmonary histological changes were evaluated by HE staining. The nuclear transcription factor-kappaBp65 (NF-κBp65) activation in lung tissues was detected by Western blotting. Results Compared with the control group, the lung wet/dry mass ratios and the serum concentrations of TNF-α, IL-1ß and IL-6 in the LPS-induced model group increased, while the level of IL-10 decreased. Under a light microscope, the lung tissues from LPS-induced model group showed serious pulmonary edema, haemorrhagia in stroma, alveolar wall thickness, alveolus collapse and obvious inflammatory cell infiltration. LPS administration also increased the activation of NF-κBp65 in lung tissues. hAECs administration significantly decreased LPS-induced lung histopathological changes, lung wet/dry mass ratios and the serum levels of IL-6, IL-1ß and TNF-α, and inhibited the activation of NF-κBp65 in lung tissues. Conclusion hAECs can inhibit the activation of NF-κBp65 in lung tissues and significantly attenuat lipopolysaccharide-induced ALI.

[Down-regulation of Zc3h12d expression in lung tissues of rats with acute lung injury induced by intestinal ischemia-reperfusion].

OBJECTIVE: To investigate the changes in the expression levels of CCCH zinc finger type-containing 12D(Zc3h12d) gene in lung tissues of rats with acute lung injury (ALI) induced by small intestinal ischemia-reperfusion (IIRI). METHODS: Forty healthy male Sprague-Dawley (SD) rats were equally randomized into sham-operated group (control), 30-minute IIRI group, 60-minute IIRI group, 120-minute IIRI group. Rats in the IIRI groups were subjected to 60 minutes of superior mesenteric artery (SMA) occlusion and to reperfusion for 30, 60 and 120 minutes, respectively. Then the rats were sacrificed. Their lung tissues and sera were obtained, respectively. The lung tissues were examined for wet/dry (W/D) lung mass ratios and pathological changes through HE staining. The levels of TNF-α and IL-1ß in sera and lung tissue homogenates were detected by ELISA. The dynamic expression of Zc3h12d mRNA and protein in lung tissues was assayed by real-time quantitative PCR (qRT-PCR), immunohistochemistry and Western blotting. RESULTS: Compared with the control group, IIRI groups presented the thickening of alveolar wall, the hemorrhage of alveolar space and the increased W/D ratios (P<0.05). qRT-PCR, immunohistochemistry and Western blotting showed that the expression of Zc3h12d mRNA and protein significantly decreased (P<0.05) after 120-minute reperfusion. CONCLUSION: IIRI can down-regulate Zc3h12d gene expression in lung tissue, which implies that Zc3h12d protein may protect rats from IIRI-induced ALI.