A targeted educational programme improves fundamental knowledge of menstrual pain and endometriosis in young women: The Endometriosis Awareness Promotion Project.

RESEARCH QUESTION: Would a properly designed educational programme offered to young women improve their awareness and fundamental knowledge of menstrual pain and endometriosis? DESIGN: A multinational cross-sectional study using a pen-and-paper questionnaire among women aged 19-24 years was conducted between 2017 and 2019 to assess fundamental knowledge of menstrual pain and endometriosis. Improvement in knowledge was also analysed using a separate questionnaire completed before, and 1-3 months after, a group discussion, lecture on menstrual pain and endometriosis, or both. RESULTS: Among three groups of students (college [n = 271], medical [n = 877] and nursing [n = 763]), knowledge of menstrual pain and endometriosis was lowest among college students, modest among nursing students and fair among medical students (P < 0.001 for each). The experience of cyclical pain, even when painkillers were taken, was reported by 15.5%, 4.6% and 3.8% of students, respectively. Most students managed their cyclical pain by enduring it or by taking over-the-counter medication. An informative education programme with group discussions, lectures, or both, was successful in improving knowledge and consequences of menstrual pain and endometriosis. Proper education and dissemination of knowledge to college students failed to motivate them to visit gynaecologists; however, medical and nursing students became highly interested in visiting gynaecologists. CONCLUSIONS: An educational programme can improve awareness and knowledge of endometriosis and dysmenorrhoea among young women. The programme motivated nursing and medical students, but not college students, to seek medical attention for early detection and management of endometriosis.

Comparison of 30-degree and 0-degree laparoscopes in the visualisation of the inferior epigastric vessel, rectus abdominis muscle and bladder dome in gynaecologic laparoscopy.

Clear visualisation of the inferior epigastric vessel and bladder dome is important to avoid ancillary port injury. In this prospective cohort study, 52 videos of gynaecologic laparoscopies performed at Songklanagarind Hospital were scored by three expert and three non-expert surgeons in terms of visualisation quality and confidence level in identifying the inferior epigastric vessel, rectus abdominis muscle and bladder dome using 0-degree and 30-degree laparoscopes. No significant difference was reported between the laparoscopes regarding both visualisation quality and confidence level in identifying these three landmarks. When using the 30-degree laparoscope, expert surgeons reported significantly higher visual rating scale scores for both visualisation quality and confidence level than did non-expert surgeons (7.6 (5.3-8.6) vs. 6.5 (4.4-8.3); p=.04 and 7.3 (5.7-8.6) vs. 6.2 (5.2-7.5); p=.02). In conclusion, the two laparoscope angles were similar in terms of both visualisation quality and confidence level in visualising the inferior epigastric vessel and bladder dome.Impact StatementWhat is already known on this subject? Most laparoscopic complications associated with vascular and bladder injuries occur during the process of abdominal penetration. The 30-degree laparoscope tends to be superior to the 0-degree laparoscope in terms of visualisation in the lateral axis. A previous study reported the benefits of using the 30-degree laparoscope in urologic surgery. Data related to the degree of the laparoscope suitable for avoiding abdominal wall injuries are lacking.What do the results of this study add? We demonstrated that both 0- and 30-degree laparoscopes were similar in terms of visualisation and confidence level for the identification of the inferior epigastric vessel and bladder dome. Using the 30-degree laparoscope, expert surgeons reported higher scores for the visualisation of the inferior epigastric vessel than did non-expert surgeons.What are the implications of these findings for clinical practice and/or further research? Before ancillary port penetration, we recommend using either a 30-degree or 0-degree laparoscope to visualise the inferior epigastric vessel and bladder dome. For non-expert surgeons, a learning curve is required to improve the visualisation quality and confidence level for identifying these landmarks, especially using the 30-degree laparoscope.

Effectiveness of celecoxib for pain relief and antipyresis in second trimester medical abortions with misoprostol: a randomized controlled trial.

PURPOSE: To evaluate the effectiveness of celecoxib for pain relief and antipyresis during second trimester abortion using sublingual misoprostol. METHODS: Fifty-six pregnant women of gestational age 14-24 weeks were randomly assigned in a double-blind randomized controlled trial to receive 400 mg of celecoxib or placebo just before sublingual administration of misoprostol 400 µg every 6 h. Pain and body temperature (BT) were assessed every 1 h until the abortion or 24 h after the first dose of misoprostol. Pain was assessed using a 10-cm Visual Analog Scale (VAS). BT was measured with an infrared thermometer. RESULTS: From January 2016 through September 2016, 28 patients were randomized into each study group. The mean VAS pain score at the completion of the abortion in the celecoxib group was significantly lower than in the placebo group (4.6 ± 2.8 vs. 7.3 ± 2.2) (p = 0.012). But 42.9% of patients in both groups experienced severe pain and needed equivalent amounts of morphine rescue. The overall mean BT in the celecoxib group was significantly lower than in the placebo group [- 0.09 (SD = 0.04)] (p = 0.017). The mean BTs at 1, 2 and 6 h after each repeated dose of misoprostol in the celecoxib group were also significantly lower than in the placebo group. CONCLUSIONS: Single-dose 400 mg celecoxib had an inadequate beneficial effect on pain relief but significant antipyretic effect during second trimester abortions using sublingual misoprostol.

Comparison of the TINTARA uterine manipulator with the Cohen cannula in gynecologic laparoscopy.

OBJECTIVE: To assess the efficacy of the TINTARA uterine manipulator and the Cohen cannula for gynecologic laparoscopy. MATERIAL AND METHOD: Sixty women scheduled for laparoscopy were randomized for use of TINTARA (n = 30) or Cohen (n = 30) as a uterine manipulator. The degree of anterior and lateral deviation of the uterus, operative time, surgical complications and ease of use were recorded and compared between the two groups. RESULTS: The mean ranges of anterior and lateral deviation of the uterus in TINTARA and Cohen groups were 61.17 +/- 19.37 vs. 49.33 +/- 22.58 degrees (p = 0.033) and 107.03 +/- 39.68 vs. 85.5 +/- 37.52 degrees (p = 0.035) respectively. The percentage of patients having dye leakage from the cervix in the Cohen group was greater than in the TINTARA group, but the difference was not statistically significant. Both instruments provided similar ease of use. Complications were not found in either group. CONCLUSION: TINTARA was found to have more advantages than the Cohen in moving the uterus in both anterior and lateral directions.

Research publication by the Royal Thai College of Obstetricians and Gynecologists residency training program, 1994-2003.

OBJECTIVE: To evaluate the impact of the manuscript requirement policy on research publications from the Royal Thai College of Obstetricians and Gynecologists (RTCOG) residency training program. MATERIAL AND METHOD: Names and research titles of RTCOG residents from 1994 to 2003 were used to search for publications in the Medline system and Thai Index Medicus. RESULTS: There were 759 residents with 188 (24.8%) articles published. The publications per year varied from 4.8% to 17.0%. Residents were the first authors of 75 articles (39.9%). One hundred and thirteen articles (60.11%) were published in local medical journals. The majority of articles published in international journals (65.3%) were published in the Journal of the Medical Association of Thailand. After initiation of the publication promotion policy in 1999, the number of publications in which residents were not the first authors increased from 39.8% to 60.2%. CONCLUSION: The manuscript requirement policy can maintain the research publication rate.

Effect of thread pitch on pull-out strength of laparoscopic myoma screws.

AIM: The purpose of this study was to evaluate the effect of thread-pitch on pull-out strength and bending strength of buttress-thread screws designed for laparoscopic myoma extraction. METHODS: The ultimate failure load of four 5-mm diameter buttress-thread screws with 3-, 4-, 5-, and 6-mm thread pitch, 40 mm in thread-length were examined on fresh myoma specimens. The myoma tissue at each traction site was evaluated histologically to determine its density. The critical minimal pull-out strength based on moderate-density myoma group was estimated. The bending strength was also determined for each screw. RESULTS: A wide range of ultimate failure loads with a mean +/- SE of 129.3 +/- 5.5 N (range, 30.4-255.7 N) for all screws and tissue densities was recorded. In moderate-density myomas, the mean ultimate failure loads decreased linearly with increasing thread-pitch from 3 mm (148.0 +/- 9.5 N) to 6 mm (119.8 +/- 9.4 N) (test for trend: P < 0.05). Based on the criterion of a minimum pull-out strength of at least 50 N in not less than 95% of tractions in medium-density myomas, the 3-mm and 5-mm pitch screws were found to have acceptable properties. The 5-mm pitch screw had less thread-turn than the 3-mm pitch for the same thread-length and would need less application time. The bending strength also decreased with increasing thread pitch from 3 to 5 mm, then became stable at around 15 N. CONCLUSIONS: The pull-out strength of soft tissue buttress-thread screws decreased linearly with increasing thread-pitch. Thread-pitch should be considered when designing laparoscopic myoma-screws.

Gasless laparoscopic hysterectomy: a comparative study with total abdominal hysterectomy.

AIM: To evaluate the short-term results of gasless laparoscopic hysterectomy (GLH) compared to total abdominal hysterectomy. METHODS: A comparative study of GLH using an abdominal wall-lifting device (n = 31) and total abdominal hysterectomy (TAH) (n = 31) was carried out between July 1999 and July 2001. RESULTS: One patient (3.2%) in the GLH group required conversion to TAH. The operative time was 168 +/- 38 min and 112 +/- 29 min (P < 0.001) for the GLH and TAH groups, respectively. Gasless laparoscopic hysterectomy cases had a shorter hospital stay and convalescent period (2.6 +/- 0.9 days vs 5.0 +/- 1.3 days, P < 0.001 and 8.0 +/- 3.0 days vs 15.8 +/- 2.4 days, P < 0.001, respectively). Postoperative meperidine use and estimated blood loss were lower for GLH (P < 0.001). Complications were comparable in the two groups. Hospital charges were 8.5% higher for GLH (P = 0.02). CONCLUSIONS: Gasless laparoscopic hysterectomy may be an alternative technique for hysterectomy which provides laparoscopic benefit with minimal increase in hospital charges.

Comparative study of the efficacy of the Songkla uterine manipulator and the Hulka controlling tenaculum in laparoscopic tubal ligation.

OBJECTIVE: To compare the efficacy of the Songkla uterine manipulator (SUM) and the Hulka controlling tenaculum for manipulation of the uterus for laparoscopy. METHOD: Forty women scheduled for laparoscopic tubal ligation were randomized to the SUM group (n=20) or the Hulka group (n=20) as uterine manipulator. Laparoscopic evidence of antevertion and lateral uterine movements and organ exposure was video recorded. Assessment of organ exposure and degree of lateral uterine deviation were subsequently evaluated. RESULTS: The characteristics of the women were similar in both groups. Right, left and range of lateral uterine motion were greater in the SUM group than the Hulka group (59 vs 42 degrees, 60 vs 47 degrees, and 118 vs 89 degrees, respectively, p<0.0001). The SUM group had 2.4 times better cul-de-sac exposure than the Hulka controlling tenaculum (95% CI: 0.51-11.51, p= 0.475). The SUM exposed fallopian tubes better than the Hulka tenaculum (p=0.022) but other structures were not significantly better visualized. There were no complications in the SUM group but two had cervical bleeding in the Hulka group. CONCLUSION: The SUM has advantages over the Hulka controlling tenaculum in giving a wider angle of lateral uterine deviation and better exposure of the fallopian tubes.