Robotic-assisted laparoscopic tubal anastomosis: Single institution analysis.

BACKGROUND: Tubal anastomosis has similar pregnancy rates regardless of approach. Historically, robotic anastomosis has been associated with increased cost and operative time. We sought to perform a contemporary study of these metrics. METHODS: One hundred and nine patients were identified who underwent robotic-assisted laparoscopic tubal anastomosis. Retrospective analysis of medical records was performed. Phone survey was conducted. RESULTS: The mean operative time decreased from 140.7 ± 27.0 min in 2013 to 60.0 ± 9.1 min in 2018, with significant downward trend (p < 0.001). The mean cost was $7153.46 ± $1484.41. The pregnancy rate was 59% (35/59), and tubal patency rate was 81% (42/52). Seventy-two percent of patients under 37 years became pregnant. CONCLUSIONS: There is significant improvement in operative time of robotic-assisted tubal anastomosis with surgical experience. Robotic tubal anastomosis outperformed historical metrics of laparoscopy and laparotomy with regard to operative time and cost in this series.

Prediction of proteinuria and microalbuminuria in diabetic pregnancies with a random single void.

OBJECTIVE: To determine whether a single urine specimen could effectively replace the 24 hour (24-h) urine collection in screening for microalbuminuria and proteinuria in pregnant women with pregestational diabetes. MATERIALS AND METHODS: A total of 42 pregnant women with pregestational diabetes mellitus were involved in the eventual analysis. Demographic and clinical variables were collected and analyzed. Urinary Protein (P) to Creatinine (Cr) ratio and microalbumin (MA) to Cr ratios were measured for the spot sample, and the total P, total MA, and serum Cr were measured for the 24-h urine sample. Analysis was done using linear regression and the Pearson correlation coefficient (r). RESULTS: Mean maternal age was 30.8 years, and the mean gestational age at collection was 19.8 weeks. A strong correlation exists between the spot MA to Cr value and 24-h MA, with an r = 0.81 (P < 0.0001). The association between the spot P to Cr ratio and 24-h urinary P was not as strong, r = 0.58 (P < 0.0001). CONCLUSIONS: A strong association between spot MA to Cr ratio and 24-h urinary microalbuminuria may suggest a predictive role for random urine assessment of MA in pregnant pregestational diabetic patients. However, based on our data, the spot P to Cr ratio may be inadequate for assessing proteinuria in pregestational diabetic pregnancies.

Decreased maternal serum inhibin-A in pregestational diabetic women: implication for adjustment.

OBJECTIVE: To evaluate the effect of maternal pregestational diabetes on serum dimeric inhibin-A (DIA), 1 of the 4 markers of the quadruple screen. STUDY DESIGN: The data were collected retrospectively from women with singleton pregnancies who had a quadruple screen drawn at 15-20 weeks of gestation in 2004-2006. A total of 84 women with pregestational diabetes were identified and their DIA values were compared with those of 100 nondiabetic pregnant women. We compared the mean multiples of the median (MoM) for DIA levels among diabetics, among nondiabetics and between the 2 types of diabetics. We also measured the degree of correlation between the quadruple screen markers and glycosylated hemoglobin (HbA1C). RESULTS: The corrected mean MoM for DIA levels among diabetic patients was 0.85 (95% CI, 0.77-0.95) vs. 1.0 (95% CI, 0.93-1.09) in the nondiabetic control group (p = 0.02). The mean MoMfor DIA levels did not appear to differ between type 1 and type 2 diabetes, and there does not appear to be a correlation between the quadruple screen markers and HbA1C. CONCLUSION: The DIA levels among pregestational diabetic women are lower than in the nondiabetic population, suggesting a need for adjustment.

Laparoscopic abdominal cerclage during pregnancy: A case report and a review of the described operative techniques.

A case report and systematic review of the literature. We report on a 26-year-old patient, gravida 2, para 0, at 12 weeks gestation with the diagnosis of cervical incompetence, in whom transvaginal cerclage was not technically possible and laparoscopic transcervical abdominal cerclage was performed. The operation lasted 100 minutes and was completed successfully. The patient was discharged the next day and the remainder of her pregnancy was uneventful. A healthy infant weighing 3010 g was delivered at 38.4 weeks by cesarean section. Laparoscopic transcervical abdominal cerclage approach is safe and effective to pregnant patients when abdominal cerclage is recommended and offers faster patient recovery.

Use of packing in obstetric hemorrhage of uterine origin.

OBJECTIVE: To determine the safety and effectiveness of uterine packing to stop hemorrhage in obstetric patients following delivery and pregnancy termination. STUDY DESIGN: A review of obstetric records at Children's Hospital of Buffalo in a 9-year period was undertaken. Patients with uterine packing were identified. Indications, additional medical and surgical procedures, estimated blood loss, postoperative complications and packing material used were reviewed. RESULTS: A total of 9 patients were identified among 34,071. Five patients had hemorrhage during cesarean section. Two patients had hemorrhage after vaginal delivery; 1 case of which had failure with packing and resulted in postpartum hysterectomy. The remaining 2 patients had hemorrhage after dilation and evacuation. Uterine atony unresponsive to oxytocics was the most common indication for uterine packing (44%). The average hematocrit decrease was 10.4% (average total blood loss, 2,200 mL), and all patients received transfusion except 1. The only immediate postoperative complications occurred in a patient with postpartum hysterectomy after failed packing; she developed a pelvic abscess but did well after drainage. CONCLUSION: Uterine packing may be a reasonable alternative to further surgical intervention in patients with intractable obstetric hemorrhage who wish to preserve fertility.