Arm reduced robotic-assisted laparoscopic hysterectomy with transvaginal cuff closure.

INTRODUCTION: The use of robotics for benign etiology in gynecology has not proven to be more beneficial when compared to traditional laparoscopy. The major concern regarding robotic hysterectomy stems from its high cost. AIM: To evaluate the clinical utility and effectiveness of one-arm reduced robotic-assisted laparoscopic hysterectomy as a cost-effective surgical option for total robotic hysterectomy. MATERIAL AND METHODS: A sample population of 54 women who underwent robotic-assisted laparoscopic surgery for benign gynecologic indications was evaluated, and two groups were identified: (1) the two-armed robotic-assisted laparoscopic surgery group (n = 38 patients), and (2) the three-armed robotic-assisted laparoscopic surgery group (n = 16 patients). RESULTS: An increased cost was observed when three-armed robotic surgery was employed for benign gynecologic surgery (p < 0.001). The cost reduction observed in the study group was primarily derived from one robotic arm reduction and vaginal closure of the cuff. This cost reduction was achieved without an increase in complication rates or undesirable postoperative outcomes. An estimated profit between $399.5 and $421.5 was made for each patient depending on the suture material chosen for cuff closure. Two-armed surgery resulted in an 18.6% reduction in procedure-specific costs for robotic hysterectomy. CONCLUSIONS: Two-armed robotic-assisted laparoscopic hysterectomy appears to be a cost-effective solution for robotic gynecologic surgery. This surgical solution can be performed as effectively as classical three-armed robotic hysterectomies for benign indications without the risk of increased surgical-related morbidities. This approach has the potential to be a widely preferred surgical approach in medical communities where cost reduction is one of the primary determinants of surgery type.

Comparison of nine morphological scoring systems to detect ovarian malignancy.

PURPOSE OF INVESTIGATION: The aim of this study was to prospectively compare the diagnostic performances of nine gray-scale sonographic prediction models to detect ovarian malignancy. MATERIALS AND METHODS: Clinical data of 322 women presenting with an adnexal mass were obtained and used in nine scoring systems. For each model a ROC curve demonstrating the capacity of the model to diagnose malignancy was constructed for all cases and for the subgroups of premenopause and postmenopause. The performance of each model was expressed as area under the ROC curve, sensitivity, and specificity. RESULTS: The area under the ROC curve, sensitivity, and specificity of these models in the present study varied between 0.737 and 0.929, 70.7% and 87.9%, 60.2% and 80.3%, respectively. CONCLUSIONS: This study has revealed the usefulness of morphological scoring systems to correctly discriminate between benign and malignant pelvic masses.

A modified technique to reduce spillage and the operative time in laparoscopic dermoid cyst excision.

INTRODUCTION: To determine whether controlled drilling, cyst excision, and removal in a bag can reduce the operative time and intraperitoneal spillage in dermoid cysts. MATERIALS AND METHODS: Laparoscopic dermoid cyst excision was performed in 45 women using a different technique: controlled drilling of dermoid cysts in a bag, excision of these cysts, and their removal in the same bag. RESULTS: The median age of the patients was 29.5 years (range, 18-42 years), the median size of the cysts was 55 mm (range, 30-100 mm), the median operative time was 40 minutes (range, 25-60 minutes), the median level of cancer antigen 19-9 was 28.5 U/mL (range, 1.2-127 U/mL), the median parity was 1 (range, 0-3), and the median hospitalization time was 1 day (range, 1-2 days). Twenty-five cysts were in the right ovary, and 20 were in the left ovary. In all cases, the dermoid cysts were ruptured with the controlled drilling. There was no intraperitoneal spillage of the cyst contents in the abdomen. No complication occurred intraoperatively or postoperatively. There was no recurrence 3 months after the operation. CONCLUSIONS: Controlled drilling, excision, and removal of a dermoid cyst inside the same bag seems to be a feasible method to prevent intraperitoneal spillage and to reduce the operative time.

Tension-free vaginal tape for surgical relief of intrinsic sphincter deficiency: results of 5-year follow-up.

STUDY OBJECTIVE: We evaluated effectiveness of tension-free vaginal tape application for surgical relief of intrinsic sphincter deficiency. DESIGN: A prospective study (Canadian Task Force classification II-3). SETTING: Tertiary center of medical faculty. PATIENTS: We studied 47 patients. INTERVENTIONS: Tension-free vaginal tape procedure, questionnaire form, stress test, cotton swab test, and functional bladder volume measurements. MEASUREMENTS AND MAIN RESULTS: Patients were grouped as intrinsic sphincter deficiency according to American College of Obstetricians and Gynecologists criteria. Operative results were documented at 6, 12, 36, and 60 months after the procedure by using a questionnaire form and objective tests of stress test, cotton swab test, and mean bladder functional volume measurement. At first visit 6 months after procedure, 70% (n = 35) of patients were completely satisfied, 9 (18%) had improved urine control, and 5 (10%) had no change in urine control. Results were: 72% (n = 36), 12% (n = 6), and 14 (n = 7%) at the end of the first year, and 66% (n = 33), 20% (n = 10), and 14% (n = 7) at the end of the third year, respectively. The fifth year's follow-up visit revealed 57.4% (n = 27 of 47) satisfaction, 17.02% (8 of 47) improved urine control, and 25.5% (12 of 47) no change in urine control. CONCLUSION: Tension-free vaginal tape procedure is a safe and effective technique for patients who have exclusively intrinsic sphincter deficiency. Long-term results will clarify the value of this procedure in comparison with classic antistress surgical techniques.

Metformin and oral contraceptive treatments reduced circulating asymmetric dimethylarginine (ADMA) levels in patients with polycystic ovary syndrome (PCOS).

There is a little information in literature about circulating asymmetric dimethylarginine (ADMA) concentrations in polycystic ovary syndrome (PCOS) and the results reported are discrepant. In this study, therefore, we aimed (1) to determine the circulating ADMA concentrations in 44 women with PCOS and 22 age- and BMI-matched healthy controls, (2) to evaluate its correlations with insulin resistance, gonadotrophins, and androgen secretion, and (3) to compare effects of metformin and ethinyl estradiol-cyproterone acetate (EE/CPA) treatments on circulating ADMA concentrations. In conclusion, our data indicate that circulating ADMA concentrations in non-obese, non-hypertensive and young women with PCOS are significantly higher than healthy controls and they improved by a 3-month course of metformin and oral contraceptive treatments.

Metformin decreases circulating acylation-stimulating protein levels in polycystic ovary syndrome.

AIM: There are no studies that examine the circulating acylation-stimulating protein (ASP) levels in patients with polycystic ovary syndrome (PCOS). The present study was designed to determine the ASP levels in PCOS and to evaluate the effect of metformin on plasma fasting ASP concentrations. METHODS: Twenty women with PCOS and 20 healthy controls matched for age and body mass index (BMI) were included in the study. We determined ASP and other biochemical parameters before and after treatment. RESULTS: Baseline levels of plasma ASP, complement 3 (C3), waist-to-hip ratio (WHR), homeostasis model assessment-insulin resistance index (HOMA-IR), fasting insulin, triglycerides (TG) and very-low-density lipoprotein cholesterol (VLDL-C) were significantly higher in patients than in controls. After 3 months of metformin treatment, BMI, WHR, ASP, C3, fasting glucose, fasting insulin, HOMA-IR, total cholesterol, TG, VLDL-C and free testosterone decreased significantly, whereas apolipoprotein A-I and high-density lipoprotein cholesterol increased significantly. CONCLUSIONS: The major novel information of the present study is that ASP and C3 values are markedly increased in non-obese patients with PCOS, with a decrease evidenced with metformin treatment.