Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 10.118
Filtrar
1.
Int J Urol ; 28(3): 268-272, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33760315

RESUMO

OBJECTIVES: To evaluate the safety and efficacy of transvaginal mesh surgery using a polytetrafluoroethylene mesh to treat pelvic organ prolapse. METHODS: This prospective observational study included women undergoing transvaginal mesh surgery for pelvic organ prolapse that used new polytetrafluoroethylene mesh cut into a shape similar to that of Elevate. We evaluated the subjective and objective outcomes at 3 and 12 months, as well as postoperative complication rates. RESULTS: This study included 55 patients. The pelvic organ prolapse quantification scores improved significantly at 3 and 12 months after surgery compared with scores before surgery. In four patients (7.3%), a pelvic examination showed stage 2 objective recurrence without subjective symptoms. Clavien-Dindo grades 2 and 3 perioperative complications were observed in 9.1% and 1.8% of the patients, respectively. Vaginal mesh exposure occurred in one patient (1.8%) at the time of the 3-month follow-up evaluation. The mesh was exposed at the proximal midline of the anterior vaginal wall. CONCLUSIONS: These findings show the safe and effective use of the polytetrafluoroethylene mesh for transvaginal mesh surgery.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Prolapso de Órgão Pélvico/cirurgia , Politetrafluoretileno/uso terapêutico , Telas Cirúrgicas/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Complicações Pós-Operatórias , Resultado do Tratamento , Vagina/cirurgia
2.
Medicine (Baltimore) ; 100(9): e24972, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655964

RESUMO

INTRODUCTION: Vaginal agenesis is a congenital disorder, which can be managed by nonsurgical dilation or surgical reconstruction of the vagina. The sigmoid vaginoplasty procedure is a popular approach, which pulls down part of the sigmoid colon to form a neovagina. One complication of this procedure is introital stenosis. PATIENT CONCERNS: A 55-year-old woman presented to the outpatient general surgery department with severe, persistent abdominal pain. The patient was diagnosed with congenital absence of uterus and vagina, and a sigmoid vaginoplasty was performed 34 years ago. DIAGNOSIS: A pelvic MRI and an abdominal enhanced CT scan were performed, finding that the uterus was absent, and the os of the vagina was closed, forming a closed loop full of fluid. Introital atresia and closed loop of neovaginal colon conduit were diagnosed. INTERVENTIONS: Based on our conclusions and the patient's consent we surgically removed the neovagina. OUTCOMES: After surgery, the abdominal pain was relieved, and the patient reported full recovery during a 6-month follow-up appointment. CONCLUSION: Introital stenosis is one of the long-term complications of sigmoid vaginoplasty procedure. Introital stenosis, leading to introital atresia, is rare but may occur. Surgical removal of neovagina can relieve the pain in patients who do not have the demand of sexual intercourse.


Assuntos
Colo Sigmoide/cirurgia , Anormalidades Congênitas/cirurgia , Procedimentos Cirúrgicos em Ginecologia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estruturas Criadas Cirurgicamente , Vagina/anormalidades , Anormalidades Congênitas/diagnóstico , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Vagina/cirurgia
3.
Medicine (Baltimore) ; 100(10): e25047, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725889

RESUMO

RATIONALE: Nevus sebaceous (NS) is a lesion caused by congenital hyperplastic disorder of the sebaceous glands. It commonly noted in the scalp and face and rarely in the trunk, neck, or oral mucosa. We present a rare case of a lesion arising in the genital region. PATIENT CONCERNS: A 47-year-old woman complained of a gradual increase in the size of her bilateral labia minora over 2 years, which affected her sexual life and caused walking difficulty. She was admitted to the Department of Obstetrics and Gynecology. On physical examination, no ulcer, discharge, and vulval or vaginal bleeding were found. The bilateral inguinal lymph nodes were not palpable, bilateral labia minora were asymmetric, and the right side was evidently bigger than the left. The labia minora had serrated edges and numerous papillae with a maximum diameter of 0.5 cm. The vagina, cervix, and uterus with its attachments were normal. Blood samples tested negative for human immunodeficiency virus, human papilloma virus, hepatitis B virus, and hepatitis C virus. DIAGNOSIS: A diagnosis of NS of the bilateral labia minora was made following histopathological examination of the resected specimen. INTERVENTION: The bilateral labia minora lesions were resected general anesthesia on August 29, 2016. The operation was successful, and intraoperative blood loss was about 10 ml. OUTCOMES: After 40 months of postoperative follow-up, no recurrence or appearance of other tumors were noted. LESSONS: We recommend surgical removal of lesions in the genital area during adolescence or before adulthood. Adolescence may be the best period for surgical intervention owing to a greater risk of malignant change in adulthood. On the other hand, surgical risk should be avoided in children considering the low incidence of malignant transformation.


Assuntos
Nevo/diagnóstico , Neoplasias das Glândulas Sebáceas/diagnóstico , Neoplasias Vulvares/diagnóstico , Diagnóstico Diferencial , Feminino , Procedimentos Cirúrgicos em Ginecologia , Humanos , Pessoa de Meia-Idade , Nevo/patologia , Nevo/cirurgia , Neoplasias das Glândulas Sebáceas/patologia , Neoplasias das Glândulas Sebáceas/cirurgia , Glândulas Sebáceas/patologia , Glândulas Sebáceas/cirurgia , Sífilis/diagnóstico , Vulva/patologia , Neoplasias Vulvares/patologia , Neoplasias Vulvares/cirurgia
5.
Minerva Med ; 112(1): 47-54, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33586397

RESUMO

INTRODUCTION: The cornerstone in the management of endometrial cancer (EC) is surgical staging. Over the last few decades, minimally invasive surgery has been widely accepted as a mainstay in the treatment of endometrial cancer. The first robotic-assisted gynecological surgery was performed in 1998. EVIDENCE ACQUISITION: The literature search was conducted using MEDLINE, EMBASE and PUBMED databases from January 1998 to September 2020. EVIDENCE SYNTHESIS: Several studies have reported the advantages of robotic-assisted surgery over laparoscopy in the management of EC. These are most pronounced in obese patients. Robotic-assisted surgery is also associated with a shorter learning curve, particularly for lymphadenectomy, which enables more surgeons to perform minimally invasive surgery for EC. CONCLUSIONS: The effectiveness and oncological results of robotic surgery for EC appear to be similar to those of other surgical methods, but fewer intraoperative complications occur than with other methods.


Assuntos
Neoplasias do Endométrio/cirurgia , Procedimentos Cirúrgicos Robóticos , Neoplasias do Endométrio/complicações , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Obesidade/complicações , Complicações Pós-Operatórias/epidemiologia
6.
Medicine (Baltimore) ; 100(7): e24676, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607806

RESUMO

ABSTRACT: New generation supraglottic airway devices are suitable for airway management in many laparoscopic surgeries. In this study, we evaluated and compared the ventilation parameters of the laryngeal mask airway-supreme (LM-S) and endotracheal tube (ETT) when a neuromuscular blocker (NMB) agent was not used during laparoscopic gynecological surgery. The second outcome was based on the evaluation of the surgical view because it may affect the surgical procedure.This was a randomized study that enrolled 100 patients between 18 and 65 years old with an ASA I-II classification. Patients were divided into 2 groups: Group ETT and Group LM-S. Standard anesthesia and ventilation protocols were administered to patients in each group. Ventilation parameters [airway peak pressure (Ppeak), mean airway pressure (Pmean), total volume, and oropharyngeal leak pressure] were recorded before, after, and during peritoneal insufflation and before desufflation, as well as after the removal of the airway device. Perioperative surgical view quality and the adequacy of the pneumoperitoneum were also recorded.The data of 100 patients were included in the statistical analysis. The Ppeak values in Group ETT were significantly higher in the second minute after airway device insertion. The Ppeak and Pmean values in Group ETT were significantly higher before desufflation and after removal of the airway device. No significant differences were found between the groups in terms of adequacy of the pneumoperitoneum or quality of the surgical view.The results of this study showed that gynecological laparoscopies can be performed without using a NMB. Satisfactory conditions for ventilation and surgery can be achieved while sparing the use of muscle relaxants in both groups despite the Trendelenburg position and the pneumoperitoneum of the patients, which are typical for laparoscopic gynecological surgery. The results are of clinical significance because they show that the use of a muscle relaxant is unnecessary when supraglottic airways are used for these surgical procedures.


Assuntos
Manuseio das Vias Aéreas/instrumentação , Procedimentos Cirúrgicos em Ginecologia/métodos , Laparoscopia/métodos , Adulto , Idoso , Feminino , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Decúbito Inclinado com Rebaixamento da Cabeça/efeitos adversos , Humanos , Intubação Intratraqueal/instrumentação , Intubação Intratraqueal/estatística & dados numéricos , Máscaras Laríngeas/estatística & dados numéricos , Pessoa de Meia-Idade , Bloqueadores Neuromusculares/efeitos adversos , Pneumoperitônio/epidemiologia , Respiração
7.
Medicine (Baltimore) ; 100(5): e24342, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592880

RESUMO

BACKGROUND: Acupuncture is widely used in treatment of postoperative ileus (POI), but the safety and efficacy of acupuncture in POI after gynecological surgery still lack of evidence-based basis. METHODS: PubMed, CINAHL, EMBASE, Web of science, Google Scholar, Wangfang database, Chinese Biomedical Literature Database (SinoMed), Chinese Science and Technology Periodical Database, and China National Knowledge Infrastructure database will be searched until December 31, 2020. Two independent investigators will screen the relevant randomized controlled trials from Data one by one by using prespecified criteria. The relevant data from included studies will be extracted and analyzed by using RevMan V.5.3 software. Quality of the included studies will be estimated by using the Cochrane Collaboration risk of bias tool, and publication bias will be assessed by using Egger test and Begg test. In addition, quality of evidence will be evaluated by using Grading of Recommendations Assessment, Development, and Evaluation. RESULTS: We will analyze the effect of acupuncture on time to first flatus and time to bowel sound recovery as the primary outcomes of this review. Meanwhile, frequency of bowel sounds, time to defecation, time of hospital stay, biochemical indicators related to gastrointestinal motility, inflammation factors, responder rate, and adverse events for patients receiving gynecological surgery. CONCLUSION: Our findings will benefit researchers and provide reference for the treatment and prevention of POI for the patients undergoing gynecological surgery.


Assuntos
Terapia por Acupuntura/métodos , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Íleus/terapia , Complicações Pós-Operatórias/terapia , Adulto , Feminino , Humanos , Íleus/etiologia , Metanálise como Assunto , Complicações Pós-Operatórias/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento
8.
Anticancer Res ; 41(2): 999-1004, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517307

RESUMO

BACKGROUND/AIM: Identification of predictors of survival of patients with lower genital tract melanoma (LGTM) and evaluation of the effectiveness of immunotherapy. PATIENTS AND METHODS: Data of twenty women with LGTM were retrospectively collected. Survival outcomes were evaluated using the Kaplan-Meier method. Survival distributions were analyzed using the Log rank test. RESULTS: Twenty patients with LGTM (6 vaginal/14 vulvar) were evaluated. Factors significantly affecting Five-year OS was the stage of the American Joint Committee on Cancer (AJCC 2017) (I+II: 55.6% vs. III+IV: 25.9%; p=0.030) and the T-Stage (I+II: 100% vs. III+IV: 7.5%; p=0.280). Factors negatively affecting Five-year PFS was T-Stage >II (p=0.005), AJCC stage >II (p<0.001), depth of tumor infiltration >3 mm (p=0.008), nodal involvement (p=0.013), distant disease (p=0.002), and resection margins <10 mm (p=0.024). Nine patients received immunotherapy [median duration of response (DOR)=4 months]. Three patients received immuno- and radiation therapy (median DOR of 5 months). Two patients received T-VEC, only one responded. CONCLUSION: Surgery has a therapeutic effect in early stage LGTM. Advanced stages may be treated with immunotherapy, radiation therapy, a combination of both, and oncolytic viral immunotherapy.


Assuntos
Terapia Combinada/métodos , Melanoma/terapia , Neoplasias Vaginais/terapia , Neoplasias Vulvares/terapia , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos Imunológicos/uso terapêutico , Terapia Combinada/mortalidade , Feminino , Procedimentos Cirúrgicos em Ginecologia , Humanos , Imunoterapia , Estimativa de Kaplan-Meier , Margens de Excisão , Melanoma/mortalidade , Melanoma/patologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Vírus Oncolíticos/fisiologia , Radioterapia , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias Vaginais/mortalidade , Neoplasias Vaginais/patologia , Neoplasias Vulvares/mortalidade , Neoplasias Vulvares/patologia
9.
Neurourol Urodyn ; 40(2): 695-704, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33492706

RESUMO

AIMS: To investigate the impact of COVID-19 pandemic on health-care provision to patients suffering from pelvic floor dysfunctions in Italy. METHODS: A retrospective web-based interdisciplinary survey was mailed by the Italian Society of Urodynamics to members involved in pelvic floor dysfunctions management from June 22, 2020 to July 17, 2020. The 84-item questionnaire investigated the period March-June 2020 (first epidemic wave) and showed high content validity. The primary outcome was the mean rate of cancellation for health-care services. Secondary outcomes included estimation of the accumulated surgeries backload until return to baseline activity and of the recovery pattern, using linear regression and scenario-based forecasting. RESULTS: A total of 85 participants provided complete responses. Respondents were mostly urologists (47%), followed by gynecologists (29.5%) and physiatrists (17.6%). On average, 78.4% of outpatient services and 82.7% of functional surgeries were canceled, without significant differences by geographical distribution. An impact on patients' quality of life was anticipated by most of the respondents (87%) and 48.2% also reported potentially serious health risks for patients. Thirty-three percent of the respondents reported the use of telemedicine. If the nation-wide surgical activity increases by 20% postpandemic, it would take 37 months to clear the backlog of functional surgeries. We acknowledge the inherent limitations of the survey methodology and retrospective design. CONCLUSIONS: Access to care for patients suffering from pelvic floor dysfunctions has been dramatically affected by the COVID-19 outbreak. The indirect effects of this unprecedented disruption on pelvic floor dysfunctions care may last for several months.


Assuntos
Assistência à Saúde , Procedimentos Cirúrgicos Eletivos , Distúrbios do Assoalho Pélvico/terapia , Tempo para o Tratamento , Adulto , Assistência Ambulatorial , Feminino , Procedimentos Cirúrgicos em Ginecologia , Ginecologia , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Pandemias , Diafragma da Pelve , Prolapso de Órgão Pélvico/cirurgia , Fisiatras , Hiperplasia Prostática/cirurgia , Qualidade de Vida , Doenças Retais/cirurgia , Estudos Retrospectivos , Inquéritos e Questionários , Telemedicina , Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urológicos , Urologistas , Carga de Trabalho
10.
Rev Med Liege ; 76(1): 36-43, 2021 Jan.
Artigo em Francês | MEDLINE | ID: mdl-33443327

RESUMO

Since the introduction of laparoscopy and mini-invasive techniques, gynaecological surgery has largely evolved. However, post-operative recommendations still remain very restrictive with poor evidence from literature. The survey, performed by the GGOLFB surgical working group, shows that the post-operative advices to the patients are very heterogeneous for the sick leave period as for more specific advices like the period of disallowance of sexual intercourse, bathing and weightlifting. It is nevertheless fundamental to prescribe clear and precise advices to patients, from the first pre-operative consultation on, which will substantially improve the perception of their recovery and promote a return to their normal activity under good conditions. It is not necessary to be too restrictive concerning certain activities in the post-operative period, neither to give too long periods of work incapacity because it may have a negative impact on their quality of life. This survey and the data from literature helped our surgical taskforce group to propose and develop harmonised recommendations on recovery and work incapacity after gynaecological surgery, taking into account the actual surgical practice in 2020.


Assuntos
Procedimentos Cirúrgicos em Ginecologia , Qualidade de Vida , Bélgica , Feminino , Humanos , Licença Médica , Inquéritos e Questionários
11.
Medicine (Baltimore) ; 100(1): e23995, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429761

RESUMO

ABSTRACT: The Chinese government is attaching great importance to the development of ambulatory surgery in order to optimize the healthcare system in China. The study aims to examine the complications and quality indicators of patients who underwent gynecological ambulatory surgery at a tertiary hospital in China.This was a retrospective study of patients who underwent ambulatory surgery between July and September 2019 at the Department of Gynecology of the First Affiliated Hospital of Shandong First Medical University. The patients were followed by phone at 30 days after discharge. The postoperative complications, mortality, unplanned re-operation, delayed discharge, unplanned re-hospitalization, and patient satisfaction were collected. The patients who underwent conventional hysteroscopic resection of uterine lesions during the same period were collected as controls for the economics analysis.A total of 392 patients who underwent ambulatory gynecological surgery were included. Fifteen patients had postoperative complications, and the total complication rate was 3.8% (15/392). Eight (8/392, 2.0%) patients had delayed discharge. There were no unplanned re-operations and deaths. There were two (2/392, 0.5%) cases of unplanned re-hospitalization. At 30 days after discharge, two patients were dissatisfied, and 390 cases were satisfied, for an overall satisfaction rate of 99.5%. Compared with conventional hysteroscopic resection of uterine lesions, ambulatory hysteroscopic surgery had a shorter hospital stay and lower total costs (P < .05) but similar surgery-related costs.Ambulatory gynecological surgery is feasible in China, with an acceptable complication profile and obvious economic and social benefits. Nevertheless, hospital management shall be reinforced.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Adulto , Procedimentos Cirúrgicos Ambulatórios/métodos , Procedimentos Cirúrgicos Ambulatórios/normas , Procedimentos Cirúrgicos Ambulatórios/tendências , China/epidemiologia , Estudos de Viabilidade , Feminino , Procedimentos Cirúrgicos em Ginecologia/normas , Procedimentos Cirúrgicos em Ginecologia/tendências , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Desenvolvimento de Programas/métodos , Estudos Retrospectivos
12.
J Minim Invasive Gynecol ; 28(3): 481-489, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33359742

RESUMO

OBJECTIVE: This review formulates the rationale for using enhanced recovery protocols (ERPs) to standardize and optimize perioperative care during this high-risk time to minimize poor outcomes owing to provider, patient, and system vulnerabilities. DATA SOURCES: n/a METHODS OF STUDY SELECTION: A literature review using key Medical Subject Headings terms was performed-according to methods described by the Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines-on studies that described enhanced recovery and coronavirus disease (COVID-19). TABULATION, INTEGRATION, AND RESULTS: Modifications to our existing ERPs related to the COVID-19 pandemic should include new accommodations for patient education, preoperative COVID-19 testing, prehabilitation, and intraoperative infection as well as thromboembolism risk reduction. CONCLUSION: ERPs are evidence-based, best practice guidelines applied across the perioperative continuum to mitigate surgical stress, decrease complications, and accelerate recovery. These benefits are part of the high-value-care equation needed to solve the clinical, operational, and financial challenges of the current COVID-19 pandemic. The factors driving outcomes on ERPs, such as the provision of minimally invasive surgery, warrant careful consideration. Tracking patient outcomes and improving care in response to outcomes data are key to the success of clinical care protocols such as ERPs. Numerous emerging clinical registries and reporting systems have been activated to provide outcomes data on the impact of COVID-19. This will inform and change surgical practice as well as provide opportunity to learn if the advantages that surgeons, patients, and the healthcare system might gain from using ERPs during a pandemic are meaningful.


Assuntos
Protocolos Clínicos , Procedimentos Cirúrgicos em Ginecologia , Assistência Perioperatória , Complicações Pós-Operatórias/prevenção & controle , Guias de Prática Clínica como Assunto , /epidemiologia , Recuperação Pós-Cirúrgica Melhorada , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Controle de Infecções , Inovação Organizacional , Assistência Perioperatória/métodos , Assistência Perioperatória/tendências
13.
J Urol ; 205(1): 199-205, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32808855

RESUMO

PURPOSE: We compared short and long-term outcomes between nursing home residents and matched community dwelling older adults undergoing surgery for pelvic organ prolapse. MATERIALS AND METHODS: This retrospective cohort study evaluates women 65 years old or older undergoing different types of pelvic organ prolapse repairs (anterior/posterior, apical and colpocleisis) between 2007 and 2012 using Medicare claims and the Minimum Data Set for Nursing Home Residents. Long-stay nursing home residents were identified and propensity score matched (1:2) to community dwelling older individuals based on procedure type, age, race and Charlson score. Generalized estimating equation models were created to determine the relative risk of hospital length of stay 3 or more days, 30-day complications and 1-year mortality between the 2 groups. Kaplan-Meier curves were created comparing 1-year mortality between groups. RESULTS: There were 799 nursing home residents and 1,598 matched community dwelling older adults who underwent pelvic organ prolapse surgery and were included in our analyses. Nursing home residents demonstrated statistically significant increased risk for hospital length of stay 3 or more days (38.9% vs 18.6%, adjusted RR 2.1, 95% CI 1.8-2.4), 30-day complications (15.1% vs 3.8%, aRR 3.9, 95% CI 2.9-5.3) and 1-year mortality (11.1% vs 3.2%, aRR 3.5, 95% CI 2.5-4.8) compared to community dwelling older adults. Kaplan-Meier curves illustrated similar survival findings at 1 year (11.1%, 95% CI 9.0-13.3 vs 3.2%, 95% CI 2.3-4.1, p <0.0001). CONCLUSIONS: Despite matching on several characteristics, nursing home residents demonstrated worse short and long-term outcomes compared to community dwelling older adults, suggesting other key vulnerabilities exist that contribute additional surgical risk in this population.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Vida Independente/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Prolapso de Órgão Pélvico/cirurgia , Complicações Pós-Operatórias/epidemiologia , Demandas Administrativas em Assistência à Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Estimativa de Kaplan-Meier , Tempo de Internação/estatística & dados numéricos , Medicare/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia
14.
Gynecol Oncol ; 160(3): 649-654, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33358197

RESUMO

BACKGROUND: Surgery is the cornerstone of gynecological cancer management, but inpatient treatment may expose both patients and healthcare staff to COVID-19 infections. Plans to mitigate the impact of the COVID-19 pandemic have been implemented widely, but few studies have evaluated the effectiveness of these plans in maintaining safe surgical care delivery. AIM: To evaluate the effects of mitigating plans implemented on the delivery of gynecological cancer surgery during the COVID-19 pandemic. METHODS: A comparative cohort study of patients treated in a high-volume tertiary gyneoncological centre in the United Kingdom. Prospectively-recorded consecutive operations performed and early peri-operative outcomes during the same calendar periods (January-August) in 2019 and 2020 were compared. RESULTS: In total, 585 operations were performed (296 in 2019; 289 in 2020). There was no significant difference in patient demographics. Types of surgery performed were different (p = 0.034), with fewer cytoreductive surgeries for ovarian cancer and laparoscopic procedures (p = 0.002) in 2020. There was no difference in intra-operative complication rates, critical care admission rates or length of stay. One patient had confirmed COVID-19 infection (0.4%). The 30-day post-operative complication rates were significantly higher in 2020 than in 2019 (58 [20.1%] versus 32 [10.8%]; p = 0.002) for both minor and major complications. This increase, primarily from March 2020 onwards, coincided with the first peak of the COVID-19 pandemic in the UK. CONCLUSIONS: Maintaining surgical throughput with meticulous and timely planning is feasible during the COVID-19 pandemic but this was associated with an increase in post-operative complications due to a multitude of reasons.


Assuntos
/prevenção & controle , Assistência à Saúde/organização & administração , Neoplasias dos Genitais Femininos/cirurgia , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Ginecologia/organização & administração , Oncologia Cirúrgica/organização & administração , Idoso , Estudos de Coortes , Procedimentos Cirúrgicos de Citorredução/estatística & dados numéricos , Assistência à Saúde/métodos , Feminino , Ginecologia/métodos , Pessoal de Saúde , Humanos , Controle de Infecções/métodos , Unidades de Terapia Intensiva/estatística & dados numéricos , Complicações Intraoperatórias/epidemiologia , Laparoscopia/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Programas de Rastreamento , Pessoa de Meia-Idade , Serviço Hospitalar de Oncologia , Equipamento de Proteção Individual , Complicações Pós-Operatórias/epidemiologia , Quarentena , Medicina Estatal , Oncologia Cirúrgica/métodos , Centros de Atenção Terciária , Reino Unido
15.
J Urol ; 205(1): 191-198, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32648798

RESUMO

PURPOSE: Colpocleisis is an obliterative surgical option for women with pelvic organ prolapse that is often performed in a frail population. However, because outcomes remain largely unknown we aimed to assess the durability and perioperative safety of colpocleisis in a large population based cohort. MATERIALS AND METHODS: All women undergoing colpocleisis and other pelvic organ prolapse repairs in California (2005-2011) were identified using the Office of Statewide Health Planning and Development data sets. Durability was defined as the absence of future pelvic organ prolapse repair after index repair for the duration of the data sets. Thirty-day morbidity was assessed by identifying readmissions, repeat surgeries and complications. A metric to assess frailty in large administrative databases was applied to assess the impact of frailty on outcomes. Colpocleisis outcomes were compared to other types of pelvic organ prolapse repairs by developing propensity score matched groups. RESULTS: Among the 2,707 women undergoing colpocleisis, reoperation for prolapse occurred in 47 (1.8%). At least 1 complication occurred in 11.1% of the cohort, with serious complications occurring in 2%. Frail patients were more likely to experience any complication (23.3% vs 10.3%, p <0.01) and a serious complication (5.0% vs 1.8%, p=0.02) and was the best predictor of morbidity. Colpocleisis was associated with a more durable repair (overall failure 1.8% vs 3.5%, p <0.01) with no difference in complication rates as compared to the matched cohort. CONCLUSIONS: Colpocleisis provides a more durable outcome than reconstructive pelvic organ prolapse repairs without increased perioperative morbidity. Frailty is a better predictor than age for perioperative complications after colpocleisis.


Assuntos
Fragilidade/epidemiologia , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Prolapso de Órgão Pélvico/cirurgia , Complicações Pós-Operatórias/epidemiologia , Vagina/cirurgia , Fatores Etários , Idoso , California/epidemiologia , Conjuntos de Dados como Assunto , Feminino , Seguimentos , Fragilidade/complicações , Fragilidade/diagnóstico , Procedimentos Cirúrgicos em Ginecologia/métodos , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Humanos , Readmissão do Paciente/estatística & dados numéricos , Prolapso de Órgão Pélvico/complicações , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Reoperação/estatística & dados numéricos , Fatores de Risco , Resultado do Tratamento
18.
BJOG ; 128(1): 14-23, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32426903

RESUMO

BACKGROUND: The use of mesh is controversial in the treatment of female pelvic organ prolapse. OBJECTIVES: To systematically review the outcomes of sacrocolpopexy compared with transvaginal mesh surgery and to provide evidence-based suggestions. SEARCH STRATEGY: The MEDLINE, EMBASE, Cochrane Library and clinicaltrials.gov databases were searched on 21 November 2018. SELECTION CRITERIA: Randomised controlled trials and prospective and retrospective cohort studies were included. DATA COLLECTION AND ANALYSIS: Data were extracted by one reviewer and examined by a second reviewer for accuracy. Odds ratios and 95% CI were calculated using random-effects models. MAIN RESULTS: Twenty comparative studies were included. The meta-analysis was performed with subgroups. The summary odds ratios of the randomised controlled group were 1.84 (95% CI 0.79-4.29, I2  = 75%) for anatomical success, 1.41 (95% CI 0.47-4.24, I2  = 38%) for subjective success, 0.42 (95% CI 0.18-0.98, I2  = 0%) for mesh complications, 0.61 (95% CI 0.20-1.91, I2  = 0%) for prolapse reoperation and 0.44 (95% CI 0.23-0.88, I2  = 0%) for de novo dyspareunia. The mean differences were 0.77 (95% CI 0.31-1.23, I2  = 66%) for total vaginal length and -1.28 (95% CI -2.00 to -0.55, I2  = 66%) for point C after surgery. CONCLUSIONS: Very-low-quality evidence indicated that the anatomical and subjective success rates of sacrocolpopexy were similar to those of transvaginal mesh surgery; sacrocolpopexy might be more beneficial than transvaginal mesh surgery in terms of mesh-related complication rates, prolapse recurrence and de novo dyspareunia. However, additional high-quality randomised trials with long-term follow-up durations are needed. TWEETABLE ABSTRACT: Sacrocolpopexy is beneficial after surgical anatomical changes and has decreased rates of mesh-related complications and dyspareunia.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Incontinência Urinária por Estresse/cirurgia , Feminino , Procedimentos Cirúrgicos em Ginecologia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Telas Cirúrgicas , Técnicas de Sutura
19.
Pain Res Manag ; 2020: 6642460, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33376568

RESUMO

Purpose: Temporal summation of pain, which is defined as the perception of greater pain evoked by repetitive painful stimuli, varies among individuals. This study aimed at determining the impact of the timing of rocuronium after induction with propofol on the temporal summation of pain. Methods: One hundred patients aged 19-60 years underwent gynecologic laparoscopic surgery. Patients were randomly assigned to one of the two groups: group PRi received immediate injections of rocuronium after propofol administration and group PRd received rocuronium injections when the bispectral index score (BIS) decreased to <60 after propofol administration. The grade of rocuronium-induced withdrawal movement (RIWM) according to the timing of propofol injection, the incidence and severity of propofol injection pain (PIP), rescue analgesics, visual analog scale (VAS) score after surgery for postoperative pain, patient-controlled analgesia (PCA) opioid consumption, association between PIP and the grade of RIWM, and associations between PIP, the grade of RIWM, and postoperative pain outcomes were measured. Results: The differences between the incidence and severity of PIP in the two groups were not significant. The grade of the RIWM in the PRd group was significantly reduced compared with the PRi group. Rescue analgesics, severity for postoperative pain, and PCA opioid consumption were not significant. Correlations between the incidence and severity of PIP and the grade of RIWM were weakly negative. Correlations between the grade of RIWM and pain outcomes were moderately positive, but correlations between the severity for PIP and the postoperative pain outcomes were negligible. Conclusion: The timing of rocuronium administration after propofol injection played a role in reducing RIWM. The grade of RIWM was significantly related to pain outcomes compared with the severity of PIP. Therefore, delayed rocuronium injection after induction with propofol reduced temporal summation of pain.


Assuntos
Administração Intravenosa/efeitos adversos , Analgésicos/administração & dosagem , Dor Processual/etiologia , Propofol/administração & dosagem , Rocurônio/administração & dosagem , Adulto , Método Duplo-Cego , Feminino , Procedimentos Cirúrgicos em Ginecologia , Humanos , Laparoscopia , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
20.
Zhonghua Fu Chan Ke Za Zhi ; 55(12): 848-856, 2020 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-33355760

RESUMO

Objective: To investigate the diagnosis, treatment and prognosis of uterine serous carcinoma (USC), and further analyze the prognostic factors. Methods: USC patients who underwent surgery with complete follow-up at Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences between January 1, 2004 and December 31, 2014 were retrospectively reviewed. The Kaplan-Meier method and Cox regression analysis were used for survival analysis. Results: (1) Diagnosis and treatment: the study included 71 USC patients. Only 32 patients (45%, 32/71) were diagnosed preoperatively with USC, and 25 cases of them (35%, 25/71) underwent USC standard comprehensive staging surgery. Of the 25 patients, 10 cases (40%, 10/25) had up-staged after operation. (2) Prognosis: the 5-year disease free survival (DFS) rate and overall survival (OS) rate for all patients were 76.5% and 80.6%, respectively. (3) The results of prognostic factors analysis: univariate analysis on age, range of lymphadenectomy, peritoneal cytology, the depth of myometrial invasion, adnexal and (or) serosa involvement and omentum metastasis were significantly associated with 5-year DFS rate (all P<0.05); range of lymphadenectomy, range of surgical staging, peritoneal cytology, adnexal and (or) serosa involvement and postoperative adjuvant treatment were significantly associated with 5-year OS rate (all P<0.05). Multivariate analysis on range of surgical staging (HR=5.18, 95%CI: 1.04-25.70, P=0.044) and adnexal and (or) serosa involvement (HR=8.41, 95%CI: 2.28-31.05, P=0.001) were independent prognostic factors for 5-year DFS rate; range of lymphadenectomy [no lymphadenectomy vs pelvic lymphadenectomy (PLN)+para-aortic lymphadenectomy (PALN), HR=27.76, 95%CI: 1.76-437.78, P=0.018;PLN vs PLN+PALN, HR=5.98, 95%CI: 1.11-32.27, P=0.038] and peritoneal cytology (HR=5.47, 95%CI: 1.18-25.39, P=0.030) were independent prognostic factors for 5-year OS rate. Conclusions: The preoperative pathological diagnosis of USC is difficult, resulting in incomplete surgical staging and inaccurate staging. Range of surgical staging, adnexal and (or) serosa involvement, peritoneal cytology and range of lymphadenectomy are independent prognostic factors, which deserve much attention in clinical practice.


Assuntos
Cistadenocarcinoma Seroso/diagnóstico , Cistadenocarcinoma Seroso/terapia , Procedimentos Cirúrgicos em Ginecologia/métodos , Terapia Neoadjuvante/métodos , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/cirurgia , China/epidemiologia , Cistadenocarcinoma Seroso/mortalidade , Neoplasias do Endométrio/patologia , Feminino , Humanos , Terapia Neoadjuvante/efeitos adversos , Estadiamento de Neoplasias , Cuidados Pós-Operatórios , Prognóstico , Estudos Retrospectivos , Neoplasias Uterinas/mortalidade
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...