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2.
Medicine (Baltimore) ; 99(2): e18710, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914080

RESUMO

The present study aimed to assess the effect of removing an indwelling urinary catheter at different times on urinary retention and urinary infection in patients undergoing gynecologic surgery.Electronic databases including PubMed, EMbase, the Cochrane Central Register of Controlled Trials, and Ovid from inception to June 2018 were searched. Relevant randomized controlled trials (RCTs) of removal the indwelling urinary catheter in different time were included.Eight RCTs were included. Data were analyzed by RevMan 5.3 version. There was significant difference in urinary retention (relative risk [RR] 2.46, 95% confidence intervals [CIs] 1.10-5.53), P = .03) between the ≤6 hours and >6 hours indwelling urinary catheter removal groups, while no significant differences were found in the gynecologic surgery excluded the vaginal surgery group and vaginal surgery group. When compared with >6 hours indwelling urinary catheter removal group, the incidence of urinary infection was significantly reduced at the ≤6 hours removal group (RR = 0.66, 95% CI 0.48-0.89, P = .007). The urinary catheter removal time at ≤6 hours also significantly reduced the incidence of urinary retention (RR = 5.06, 95%CI 1.74-14.69, P = .003), and did not statistically increase the incidence of urinary infection (RR = 0.30, 95%CI 0.08 to 1.20, P = .09), compared with immediate urinary catheter removal after surgery.Removal time of the urinary catheter at ≤6 hours postoperatively seems to be more beneficial than immediate or >6 hours for patients undergoing gynecologic surgery which excluded the vaginal surgery.


Assuntos
Remoção de Dispositivo/métodos , Procedimentos Cirúrgicos em Ginecologia/métodos , Cuidados Pós-Operatórios/métodos , Cateteres Urinários , Remoção de Dispositivo/efeitos adversos , Humanos , Cuidados Pós-Operatórios/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Retenção Urinária/etiologia , Infecções Urinárias/etiologia
3.
BJOG ; 127(1): 18-26, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31538709

RESUMO

BACKGROUND: Anterior compartment prolapse is the most common pelvic organ prolapse (POP) with a range of surgical treatment options available. OBJECTIVES: To compare the clinical effectiveness and cost-effectiveness of surgical treatments for the repair of anterior POP. METHODS: We conducted a systematic review of randomised controlled trials comparing surgical treatments for women with POP. Network meta-analysis was possible for anterior POP, same-site recurrence outcome. A Markov model was used to compare the cost-utility of surgical treatments for the primary repair of anterior POP from a UK National Health Service perspective. MAIN RESULTS: We identified 27 eligible trials for the network meta-analysis involving eight surgical treatments tested on 3194 women. Synthetic mesh was the most effective in preventing recurrence at the same site. There was no evidence to suggest a difference between synthetic non-absorbable mesh, synthetic partially absorbable mesh, and biological mesh. The cost-utility analysis, which incorporated effectiveness, complications and cost data, found non-mesh repair to have the highest probability of being cost-effective. The conclusions were robust to model inputs including effectiveness, costs and utility values. CONCLUSIONS: Anterior colporrhaphy augmented with mesh appeared to be cost-ineffective in women requiring primary repair of anterior POP. There is a need for further research on long-term effectiveness and the safety of mesh products to establish their relative cost-effectiveness with a greater certainty. TWEETABLE ABSTRACT: New study finds mesh cost-ineffective in women with anterior pelvic organ prolapse.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/economia , Prolapso de Órgão Pélvico/cirurgia , Telas Cirúrgicas/economia , Análise Custo-Benefício , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Meta-Análise em Rede , Prolapso de Órgão Pélvico/economia , Anos de Vida Ajustados por Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Prevenção Secundária/economia , Resultado do Tratamento
4.
Ceska Gynekol ; 84(5): 376-385, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31826636

RESUMO

OBJECTIVE: To summarize current knowledge of the ERAS protocol in gynecologic oncology surgery. DESIGN: Review article. SETTINGS: Department of Obstetrics and Gynecology, University Hospital Ostrava, Ostrava, Department of Obstetrics and Gynecology, University of Ostrava, Ostrava. METHODS: Literature review, PubMed and Medline databases were used to search relevant literature from 1995 to 2019. CONCLUSION: ERAS (Enhanced Recovery after Surgery) is a perioperative treatment program based on evidence-based medicine. Guidelines consist of pre-operative, perioperative and post-operative care items. Implementation of the ERAS protocol leads to a decrease in complications up to 40% and a reduction in hospitalization by up to 30%, thereby reducing overall costs without increasing the number of rehospitalizations. Multidisciplinary cooperation not only with anesthesiologists and consultant surgeons, but also with nutritional specialists and nurses is crucial.


Assuntos
Neoplasias dos Genitais Femininos/cirurgia , Procedimentos Cirúrgicos em Ginecologia/normas , Assistência Perioperatória/normas , Cuidados Pós-Operatórios/normas , Guias de Prática Clínica como Assunto , Cuidados Pré-Operatórios/normas , Medicina Baseada em Evidências , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Ginecologia , Humanos , Complicações Pós-Operatórias
5.
Medicine (Baltimore) ; 98(50): e18391, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852155

RESUMO

During second-look surgery or hospitalization, intra-abdominal surgeries may cause severe postoperative complications, such as pelvic adhesion, postoperative ileus, and severe pain. However, only few studies have analyzed the outcomes of antiadhesive barriers in second-look surgery. This retrospective study aims to identify the outcomes of different antiadhesive barriers by analyzing surgical images. The study included patients who received an adhesion barrier during second-look surgery between January 2011 and November 2017. Four brands of adhesive barriers were used: Interceed, Seprafilm, Adept, and SurgiWrap. Adhesion scores were calculated for four quadrants of the uterus and surrounding structures before and after the use of antiadhesive barriers. The differences between the data of 2 observers and surgery times were also determined. A total of 18 patients were enrolled in the study. The adhesion scores were not significantly different before and after the placement of antiadhesive barriers. The difference in the adhesion scores between the two observers was also not significant, except in the Seprafilm group (P = .029). Furthermore, no significant change in the adhesion scores was observed between the first and second surgeries. Therefore, using adhesion barriers may not decrease the adhesion scores in the current setting.


Assuntos
Complicações Pós-Operatórias/prevenção & controle , Aderências Teciduais/prevenção & controle , Adulto , Celulose Oxidada/uso terapêutico , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Ácido Hialurônico/uso terapêutico , Icodextrina/uso terapêutico , Estudos Retrospectivos , Cirurgia de Second-Look/métodos , Resultado do Tratamento
6.
Curr Urol Rep ; 20(11): 70, 2019 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-31612341

RESUMO

PURPOSE OF REVIEW: Due to recent concerns over the use of synthetic mesh in pelvic floor reconstructive surgery, there has been a renewed interest in the utilization of non-synthetic repairs for pelvic organ prolapse. The purpose of this review is to review the current literature regarding pelvic organ prolapse repairs performed without the utilization of synthetic mesh. RECENT FINDINGS: Native tissue repairs provide a durable surgical option for pelvic organ prolapse. Based on recent findings of recently performed randomized clinical trials with long-term follow-up, transvaginal native tissue repair continues to play a role in the management of pelvic organ prolapse without the added risk associated with synthetic mesh. In 2019, the FDA called for manufacturers of synthetic mesh for transvaginal mesh to stop selling and distributing their products in the USA. Native tissue and non-synthetic pelvic organ prolapse repairs provide an efficacious alternative without the added risk inherent to the utilization of transvaginal mesh. A recent, multicenter, randomized clinical trial demonstrated no clear advantage to the utilization of synthetic mesh. Furthermore, transvaginal native tissue repairs have demonstrated good long-term efficacy, particularly when anatomic success is not the sole metric used to define surgical success.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Prolapso de Órgão Pélvico/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Feminino , Humanos , Ligamentos/cirurgia , Tratamentos com Preservação do Órgão , Telas Cirúrgicas/efeitos adversos , Técnicas de Sutura , Resultado do Tratamento
7.
Medicine (Baltimore) ; 98(42): e17621, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626143

RESUMO

While the pain after gynecological laparoscopy is assumed to be minor, many women suffer from unexpected postoperative pain in the post-anesthesia care unit (PACU). Prior identification of these patients is significant for effective analgesia. Therefore, we sought to determine the predictors for acute postoperative pain after gynecological laparoscopy. The data of 280 patients undergoing gynecological laparoscopy were analyzed. Data included demographic characteristics, previous obstetric/gynecologic surgical history, menstruation pattern including dysmenorrhea severity, gynecological hormone administration history, and surgical data (surgical time, endometriosis severity, adhesion, drainage insertion, and surgery type). Univariate analysis and binary logistic regression were used to evaluate predictors for substantial pain in the PACU after gynecologic laparoscopy. Among the 280 patients, 115 (41%) suffered from substantial postoperative pain in the PACU. Whenever the level of dysmenorrhea became more severe (none → mild → moderate → severe), the risk of substantial pain in the PACU increased 2.9-fold (odds ratio [OR] 2.92, 95% confidence interval [CI] 2.11-4.03, P < .001). Moreover, patients undergoing laparoscopy for ectopic pregnancy had a higher risk of substantial pain compared with the others (OR 3.11, 95% CI 1.36-7.12, P = .007). Other factors did not show a significant association with substantial pain. Patients with preoperative severe dysmenorrhea and those undergoing laparoscopy for ectopic pregnancy should be considered to have a high risk of substantial postoperative pain in the PACU so that they receive prompt and aggressive analgesic intervention. In particular, dysmenorrhea severity is clinically valuable as a useful predictor for substantial pain after gynecological laparoscopy.


Assuntos
Dor Aguda/diagnóstico , Analgésicos/uso terapêutico , Doenças dos Genitais Femininos/cirurgia , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Laparoscopia/efeitos adversos , Medição da Dor/métodos , Dor Pós-Operatória/diagnóstico , Dor Aguda/tratamento farmacológico , Dor Aguda/etiologia , Adulto , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Estudos Retrospectivos
8.
Rev Prat ; 69(4): 390-393, 2019 Apr.
Artigo em Francês | MEDLINE | ID: mdl-31626489

RESUMO

Although non invasive options exist, surgical management of genital prolapse is a gold standard. The main surgical approaches are abdominal -sacrocolpopexy- and vaginal -with or without mesh-. Sacrocolpopexy has proven to have better results than vaginal techniques, but is not appropriate for all women. Vaginal surgery remains a good option especially in older women who no longer have sexual activity. The surgical approach must adapt to patients' clinical characteristics. The choice has to be a shared decision after patients' loyal information.


Assuntos
Procedimentos Cirúrgicos em Ginecologia , Prolapso de Órgão Pélvico , Prolapso Uterino , Idoso , Feminino , Genitália , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Prolapso de Órgão Pélvico/cirurgia , Telas Cirúrgicas , Prolapso Uterino/cirurgia
9.
Gynecol Oncol ; 155(3): 468-472, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31601494

RESUMO

OBJECTIVE: To determine which non-narcotic analgesic, acetaminophen (Ofirmev®) or ketorolac (Toradol®), provides better post-operative pain control when combined with an opioid patient-controlled analgesia (PCA) pump. Secondary objectives include comparisons of the rates of ileus, post-operative bleeding, transfusions, and length-of-hospitalization (LOH). METHODS: A prospective, randomized trial of acetaminophen (A) 1-g intravenous (IV) every 6-h or ketorolac (K) 15-mg IV every 6-h from post-operative day 1-3 in addition to an opioid PCA for patients undergoing benign or malignant gynecologic laparotomy procedures was performed. Abstracted data included pain levels via visual analogue pain scales (VAS), amount of narcotic used, hepatic enzyme levels, hemoglobin, urine output, blood transfusions, time to return of flatus and LOH. RESULTS: One-hundred patients were accrued and underwent 55 benign gynecologic laparotomies and 45 cancer-related laparotomies. VAS pain levels (3.3 K, 3.5 A) and morphine PCA use (79.1 oral morphine equivalents [OME] K vs. 84.5 A) were not different, however dilaudid PCA usage was less by K patients (84.4 OME K and 136.8 OME A, p < 0.001). There was a significant hemoglobin change between the two groups (2.6 g K vs. 2 g A, p = 0.015), however blood transfusions were equal (28% K, 22% A, p > 0.05). Return of flatus was 2.7-days for K vs. 3.4-days for A (p = 0.011) and LOH was not different (4.4-days K vs. 5.1-days A, p = 0.094). CONCLUSIONS: Both intravenous ketorolac and acetaminophen provide similar post-operative analgesia through VAS pain scales and total usage of morphine via PCA pumps. Use of ketorolac with dilaudid PCA was associated with less dependence on dilaudid and a quicker return of bowel function than acetaminophen, however length of stay and transfusion rates were not different.


Assuntos
Acetaminofen/administração & dosagem , Analgesia Controlada pelo Paciente , Neoplasias dos Genitais Femininos/cirurgia , Hidromorfona/administração & dosagem , Cetorolaco/administração & dosagem , Analgésicos não Entorpecentes/administração & dosagem , Analgésicos Opioides/administração & dosagem , Anti-Inflamatórios não Esteroides/administração & dosagem , Feminino , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Injeções Intravenosas , Dor Pós-Operatória/tratamento farmacológico , Estudos Prospectivos
10.
Zhonghua Fu Chan Ke Za Zhi ; 54(9): 608-614, 2019 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-31550777

RESUMO

Objective: To investigate the similarities and differences between Chinese International Urogynecological Association (IUGA) members and international IUGA members on the treatment of pelvic organ prolapse (POP) and stress urinary incontinence (SUI) with polypropylene (PP) mesh and sling. Methods: Questionnaires were sent to Chinese IUGA members by Email. The contents of the questionnaires included POP mesh, SUI slings, abdominal sacrocolpopexy (ASC), complications, patients' awareness of rights protection, litigation and database use.Chi-square test was used to compare the proportion of Chinese IUGA members and international IUGA members to the problem alternatives. Results: A total of 31 Chinese IUGA members (100%, 31/31) responded to the questionnaire. All Chinese IUGA members (100%, 31/31) recognized and used PP sling to treat SUI, 98% (917/936) of international IUGA members had used and continued to use PP sling. For ASC surgery, 81% (25/31) of Chinese IUGA members and 82% (768/936) of international IUGA members agreed with and implemented the operation (P=0.841), while 94% (29/31) of Chinese IUGA members and 72% (674/936) of international IUGA members had the same or increased surgical volume as before (P=0.019). For the treatment of POP by transvaginal implantation of PP mesh, Chinese IUGA members had significant differences with international IUGA members in terms of whether they had used (P=0.002), were using (P<0.001), reasons for not using mesh (P<0.001), and indications of mesh implantation (P<0.001). Totally 81% (25/31) of Chinese IUGA members used various databases for monitoring and follow-up, while only 62% (580/936) of international IUGA members used databases, but there was no statistical difference (P=0.092). Conclusion: There are great differences in the concept and clinical application of transvaginal PP mesh implantation for POP between Chinese IUGA members and international IUGA members.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Ginecologia/estatística & dados numéricos , Diafragma da Pelve/cirurgia , Prolapso de Órgão Pélvico/cirurgia , Polipropilenos , Telas Cirúrgicas , Incontinência Urinária por Estresse/cirurgia , Feminino , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Humanos , Masculino , Padrões de Prática Médica , Procedimentos Cirúrgicos Reconstrutivos , Inquéritos e Questionários , Incontinência Urinária por Estresse/fisiopatologia
11.
JAMA ; 322(11): 1054-1065, 2019 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-31529008

RESUMO

Importance: Vaginal hysterectomy with suture apical suspension is commonly performed for uterovaginal prolapse. Transvaginal mesh hysteropexy is an alternative option. Objective: To compare the efficacy and adverse events of vaginal hysterectomy with suture apical suspension and transvaginal mesh hysteropexy. Design, Setting, Participants: At 9 clinical sites in the US Pelvic Floor Disorders Network, 183 postmenopausal women with symptomatic uterovaginal prolapse were enrolled in a randomized superiority clinical trial between April 2013 and February 2015. The study was designed for primary analysis when the last randomized participant reached 3 years of follow-up in February 2018. Interventions: Ninety-three women were randomized to undergo vaginal mesh hysteropexy and 90 were randomized to undergo vaginal hysterectomy with uterosacral ligament suspension. Main Outcomes and Measures: The primary treatment failure composite outcome (re-treatment of prolapse, prolapse beyond the hymen, or prolapse symptoms) was evaluated with survival models. Secondary outcomes included operative outcomes and adverse events, and were evaluated with longitudinal models or contingency tables as appropriate. Results: A total of 183 participants (mean age, 66 years) were randomized, 175 were included in the trial, and 169 (97%) completed the 3-year follow-up. The primary outcome was not significantly different among women who underwent hysteropexy vs hysterectomy through 48 months (adjusted hazard ratio, 0.62 [95% CI, 0.38-1.02]; P = .06; 36-month adjusted failure incidence, 26% vs 38%). Mean (SD) operative time was lower in the hysteropexy group vs the hysterectomy group (111.5 [39.7] min vs 156.7 [43.9] min; difference, -45.2 [95% CI, -57.7 to -32.7]; P = <.001). Adverse events in the hysteropexy vs hysterectomy groups included mesh exposure (8% vs 0%), ureteral kinking managed intraoperatively (0% vs 7%), granulation tissue after 12 weeks (1% vs 11%), and suture exposure after 12 weeks (3% vs 21%). Conclusions and Relevance: Among women with symptomatic uterovaginal prolapse undergoing vaginal surgery, vaginal mesh hysteropexy compared with vaginal hysterectomy with uterosacral ligament suspension did not result in a significantly lower rate of the composite prolapse outcome after 3 years. However, imprecision in study results precludes a definitive conclusion, and further research is needed to assess whether vaginal mesh hysteropexy is more effective than vaginal hysterectomy with uterosacral ligament suspension. Trial Registration: ClinicalTrials.gov Identifier: NCT01802281.


Assuntos
Histerectomia Vaginal/métodos , Telas Cirúrgicas , Prolapso Uterino/cirurgia , Útero/cirurgia , Idoso , Feminino , Seguimentos , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Histerectomia Vaginal/efeitos adversos , Estimativa de Kaplan-Meier , Ligamentos/cirurgia , Pessoa de Meia-Idade , Pós-Menopausa , Complicações Pós-Operatórias , Telas Cirúrgicas/efeitos adversos , Resultado do Tratamento , Vagina/cirurgia
12.
New Microbiol ; 42(4): 205-209, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31524943

RESUMO

In this prospective, randomized, controlled study we investigated the effect of subcutaneous rifampicin and povidone-iodine irrigation on incisional surgical site infection. Superficial incisional surgical site infection (SSI) following gynecologic surgery is a serious problem for both patient and surgeon in terms of increased morbidity, length of hospital stay, anxiety, and costs. Three hundred patients scheduled for abdominal surgery due to various benign gynecological pathologies were randomly assigned to one of three groups of 100 members each, as follows: the subcutaneous tissue was irrigated with saline in group 1; saline + rifampicin in group 2; saline +10% povidone iodine in group 3. Patients were invited to follow-up once every 10 days in a 30-day period for evaluation. Patients who developed a superficial incisional SSI were recorded. The superficial incisional SSI rate increased significantly with the use of saline alone (p = 0.006). There was no significant difference between saline +10% povidone iodine and saline + rifampicin (p=0.055). The results suggest that the incidence of superficial incisional SSI is significantly reduced when irrigation is performed using rifampicin and povidone-iodine compared with using saline alone.


Assuntos
Anti-Infecciosos Locais , Procedimentos Cirúrgicos em Ginecologia , Povidona-Iodo , Rifampina , Administração Tópica , Adulto , Anti-Infecciosos Locais/administração & dosagem , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Pessoa de Meia-Idade , Povidona-Iodo/administração & dosagem , Estudos Prospectivos , Rifampina/administração & dosagem , Infecção da Ferida Cirúrgica/prevenção & controle , Resultado do Tratamento
13.
Urology ; 134: 116-123, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31563536

RESUMO

OBJECTIVE: To compare robot assisted to laparoscopic sacrocolpopexy, in terms of efficacy, in the treatment of high-stage pelvic organ prolapse. METHODS: This was a noninferiority prospective randomized trial conducted in a tertiary Urology unit, comparing robot assisted and laparoscopic sacrocolpopexy in patients with symptomatic prolapse stage III and IV, according to the Pelvic Organ Prolapse quantification. All participants provided written informed consent at enrolment. The primary outcome was prolapse objective cure rate. Secondary outcomes included prevalence of urinary, anorectal and sexual symptoms, UDI-6, IIQ7 and FSFI scores, and maximum flow rate. Operative times, intraoperative blood loss, length of hospital stay, postsurgery pain, patient satisfaction as well as surgical and mesh complications were assessed. The Mann-Whitney and Wilcoxon tests for unpaired and paired data, respectively, were used to compare ordinal and nonnormally distributed continuous variables. Categorical data were analyzed by the McNemar, chi-square or Fisher exact test. Two-tailed P <.05 was considered significant. RESULTS: One hundred patients were randomized. At a mean follow-up of 24.06 months the cure rate for the apical compartment was 100% with both approaches. There were no significant between-group differences in any of the secondary outcomes with the only exception of C/D point values, where results were significantly better in the robot-assisted group. Overall surgical procedure time was longer in the robot-assisted group. The main limitation of our study is the single-centre design and the inclusion of docking time in robotic-procedure surgical time calculations. CONCLUSION: Robot-assisted sacrocolpopexy provides outcomes comparable to those of laparoscopic with 100% anatomic correction of the apical compartment.


Assuntos
Procedimentos Cirúrgicos em Ginecologia , Laparoscopia , Prolapso de Órgão Pélvico/cirurgia , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Robóticos , Idoso , Feminino , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Tempo de Internação/estatística & dados numéricos , Pessoa de Meia-Idade , Duração da Cirurgia , Preferência do Paciente , Prolapso de Órgão Pélvico/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/psicologia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Índice de Gravidade de Doença
14.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 46(3): 102-106, jul.-sept. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-182715

RESUMO

Objetivo: Verificar que la técnica de acceso laparoscópico tras insuflación con aguja de Veress en punto de Palmer a presiones elevadas no produce efectos adversos anestésicos relevantes en pacientes sanas y que, además, es útil para la reducción del riesgo de lesiones mayores, comparada con la técnica clásica de insuflación umbilical a presiones estándar. Material y métodos: Estudio analítico observacional prospectivo de cohortes. La cohorte expuesta al factor estudiado la conforman 150 pacientes intervenidas mediante cirugías laparoscópicas ginecológicas en las que se ha utilizado, para las maniobras de acceso a cavidad abdominal, la insuflación con aguja de Veress en punto de Palmer hasta presiones elevadas de 20-25mmHg (grupo 1). La cohorte no expuesta la conforman 150 pacientes en las que se ha utilizado, para las maniobras de acceso a cavidad abdominal, la técnica clásica de insuflación con aguja de Veress a nivel umbilical hasta presiones estándar de 12-14mmHg (grupo 2). Resultados: En el grupo 1 el porcentaje de complicaciones fue del 5,3%, mientras que en el grupo 2 fue del 6,7% (p=0,62). Por otro lado, el porcentaje de cambios de técnica/localización de acceso y de conversión a laparotomía secundaria a efectos adversos durante las maniobras de insuflación/entrada fue del 2% y del 0% en el grupo 1, y del 2,7% y del 2% en el grupo 2, respectivamente. Conclusión: La insuflación en punto de Palmer a presiones elevadas presenta ventajas comparada con la técnica umbilical clásica respecto a la prevención de complicaciones durante las maniobras de acceso laparoscópico


Objective: To demonstrate that the laparoscopic access technique at Palmer's point at elevated pressures does not cause significant anaesthetic adverse effects in healthy patients, and is also useful for reducing the risk of major injuries compared to the classic umbilical insufflation technique at standard pressures. Material and methods: Prospective observational analytical study of cohorts. The cohort exposed to the studied factor consisted of 150 patients undergoing gynaecological laparoscopic surgery in which insufflation with Veress needle in Palmeŕs point until high pressures of 20-25mmHg (Group 1) has been used for access manoeuvres into the abdominal cavity. The unexposed cohort consisted of 150 patients in whom the classical technique of insufflation has been used for access manoeuvres to the abdominal cavity, with the needle at umbilical level up to standard pressures of 12-14mmHg (Group 2). Results: The percentage of complications in Group 1 was 5.3%, whereas it was 6.7% in Group 2 (p=0.62). On the other hand, the percentage of technique changes/access location and conversion to laparotomy due to adverse effects during insufflation/entry manoeuvres was 2% and 0% in Group 1, and 2.7% and 2% in Group 2, respectively. Conclusion: Palmer's point insufflation at elevated pressures has advantages compared to the classical umbilical technique, as regards the prevention of complications during laparoscopic access manoeuvres


Assuntos
Humanos , Feminino , Adulto , Insuflação/classificação , Insuflação/instrumentação , Laparoscopia/métodos , Estudos Prospectivos , Laparoscopia/instrumentação , Procedimentos Cirúrgicos em Ginecologia/métodos
15.
Int J Gynaecol Obstet ; 147(1): 49-53, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31372976

RESUMO

OBJECTIVE: To determine the safety and efficacy of a standardized bilateral abdominal sacrocolpopexy using polyvinylidene fluoride mesh 1-year post-operatively. METHODS: In a retrospective observational study of women undergoing bilateral abdominal sacrocolpo/cervicopexy between July 2013 and October 2016 at the Norfolk and Norwich University Hospital, Norwich, UK, patients were assessed 1 year post-operatively using the International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS). RESULTS: The study involved 100 women, 93 of whom were followed up 1 year post-operatively. The primary outcome was apical prolapse rate, of which there were none. Eight women had anterior and four had posterior wall prolapses; four women required vaginal repairs. Eleven women complained of urinary stress incontinence (six worsening and five de novo) and five had subsequent tension-free vaginal tape procedures. One woman had urethral pain and one had mesh exposure into the vagina. Pre-operatively, mean ICIQ-VS score was 27.87 (standard deviation [SD] 6.8), and at 1 year post-operatively it was 5.82 (SD 3.8). Impact on quality of life score dropped by 83.4%, from 8.35 (SD 2.1) to 1.39 (SD 1.1). CONCLUSION: The modified technique used in the present study retained the advantages of traditional sacrocolpopexy, but required smaller volumes of mesh. We found it to be safe and effective with excellent patient satisfaction at 1 year, and providing a promising treatment option for patients suffering from apical prolapse.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Prolapso de Órgão Pélvico/cirurgia , Idoso , Feminino , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Qualidade de Vida , Estudos Retrospectivos , Telas Cirúrgicas/efeitos adversos , Inquéritos e Questionários
16.
Urology ; 133: 84-90, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31425682

RESUMO

OBJECTIVE: To determine the long-term rate of posterior compartment prolapse (PCP) occurrence after native tissue repair of the anterior compartment with anterior vaginal wall suspension (AVWS) procedure. METHODS: An institutional review board approved surgical prolapse database was reviewed for women who underwent AVWS for any degree of anterior compartment prolapse with minimum of 6-month follow-up and no history of apical or posterior compartment repair. Demographic data, smoking status, parity, and uterine status were collected. The primary outcome was need for secondary PCP repair. RESULTS: A total of 300 women met inclusion criteria with a mean age of 63.8 ± 10.8 years, mean BMI of 26.1 ± 6.2 kg/m2, and a mean parity of 2.5 ± 1.4. At the time of AVWS 46 women (15%) had uterine-sparing AVWS, 74 (25%) had concomitant hysterectomy, and 180 (60%) had prior hysterectomy. Forty-eight women (16%) had secondary posterior compartment repair for PCP (60% abdominal route, 40% done vaginally) over a mean follow-up of 7.1 ± 4.4 years. CONCLUSION: At long-term follow-up, less than 20% of women undergoing AVWS underwent PCP repair.


Assuntos
Complicações Pós-Operatórias/epidemiologia , Prolapso Uterino/epidemiologia , Prolapso Uterino/cirurgia , Vagina/cirurgia , Idoso , Feminino , Seguimentos , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Pessoa de Meia-Idade , Fatores de Tempo
17.
Yonsei Med J ; 60(9): 864-869, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31433584

RESUMO

PURPOSE: The aim of this study was to evaluate the feasibility and safety of laparoendoscopic single site (LESS) surgery using an angiocatheter needle in patients with huge ovarian cysts (diameter ≥15 cm). MATERIALS AND METHODS: Thirty-one patients with huge ovarian cysts underwent LESS surgery using an angiocatheter needle between March 2011 and August 2016. An intra-umbilical vertical incision (1.5-2.0 cm) was made in the midline. After the cyst wall was punctured using an angiocatheter needle, the fluid contents were aspirated with a connected vacuum aspirator. After placing a Glove port in the umbilical incision, LESS surgery was performed using a rigid 0-degree, 5-mm laparoscope and conventional, rigid, straight laparoscopic instruments. Knife-in-bag morcellation was instituted for specimen collection. RESULTS: The median maximal diameter of ovarian cysts was 18 cm (range, 15-30 cm), the median operation time was 150 minutes (range, 80-520 minutes), and the median volume of blood loss was 100 mL (range, 20-800 mL). Three patients (9.7%) were diagnosed with malignant ovarian cancer using intraoperative frozen examination, and 1 patient was converted to laparotomy due to advanced disease. Thirty patients underwent LESS, and there was no need for an additional laparoscopic port. CONCLUSION: LESS surgery using an angiocatheter needle, with leaving only a small postoperative scar, was deemed feasible for the management of huge ovarian cysts.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Laparoscopia/instrumentação , Laparoscopia/métodos , Laparotomia/métodos , Cistos Ovarianos/cirurgia , Neoplasias Ovarianas/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Agulhas , Duração da Cirurgia , Estudos Retrospectivos , Instrumentos Cirúrgicos , Resultado do Tratamento , Adulto Jovem
18.
Surg Technol Int ; 35: 185-188, 2019 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-31373380

RESUMO

The prevalence of obesity has increased, achieving an epidemic status. Obesity has surgical and medical implications on the health of a woman. A minimally invasive surgical approach has several advantages and is considered the preferred approach for various procedures in obese women. The spectrum of gynaecologic surgical care spans over three main domains: benign gynaecologic surgery, reconstructive pelvic surgery, and gynaecologic cancer surgery. In this viewpoint, we chose a signature procedure for each main domain to compare minimally invasive surgery (MIS) trends for obese patients across all domains. Discrepancy was found in minimally invasive surgical trends for obese patients across different gynaecologic surgical domains. Fellowship training or maintaining high surgical volume might help to bridge this gap in the domain of benign gynaecologic surgery and improve quality care offered to obese patients.


Assuntos
Procedimentos Cirúrgicos em Ginecologia , Procedimentos Cirúrgicos Minimamente Invasivos , Obesidade , Procedimentos Cirúrgicos Reconstrutivos , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos
19.
Zhonghua Fu Chan Ke Za Zhi ; 54(7): 445-451, 2019 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-31365956

RESUMO

Objective: To assess the five-year effect of the transvaginal high uterosacral ligament suspension (HUS) with or without additional concomitant native-tissue anterior and (or) posterior repair in women suffering from middle compartment defect. Methods: A retrospective review of records identified 79 women who underwent transvaginal HUS with or without additional concomitant native-tissue anterior and (or) posterior repair from January 2007 to January 2018 in Fourth Medical Center, General Hospital of People's Liberation Army. The middle compartment defects were predominant in these patients with point C no less than point Ba or Bp if accompanied with anterior or posterior vaginal wall prolapse. Follow-up visits were performed 2,6 and 12 months after surgery and then annually. Anatomic results of pelvic organ prolapse (POP) was established by pelvic examination using pelvic organ prolapse quantitation system (POP-Q) staging. Funtional results were obtained by patient global impression of improvement (PGI-I) scale in POP, pelvic floor distress inventory-short form 20 (PFDI-20) and pelvic floor impact questionnaire short form (PFIQ-7). Surgical success required the fulfillment of all 3 criteria: (1) anterior or posterior vaginal wall prolapsed leading edge of 0 cm or less and apex of 1/2 total vaginal length or less; (2) the absence of POP symptoms as reported on the PFDI-20 question No.3 ( "Do you usually have a bulge or something falling out that you can see or feel in your vaginal area?" ); and (3) no prolapse reoperations or pessary use during the study period. Results: Of 79 women, 51(65%, 51/79) women completed the five-year follow-up during the study period. The median follow-up time was 5.2 years (2.8-8.3 years). The overall surgery success rate was 86% (44/51) according to above all 3 criteria. Prolapse recurrence rates were isolated anterior 8% (4/51), isolated apical 0, isolated posterior 2% (1/51) and multiple compartments 4% (2/51). Seven women (14%,7/51) developed anterior or posterior prolapse beyond the hymen with the leading edge≤1 cm. No apical prolapsed occurred. None of recurrent women underwent retreatment,including either surgery or pessary usage at last follow-up. The subjective satisfaction rate was 90% (46/51). There was a 1% (1/79) rate of intraoperative ureteral kinking and 3% (2/79) rate of postoperative morbidity. Conclusions: The transvaginal HUS for middle compartment defect offers good long-term anatomical results with excellent vault suspension. With additional concomitant native-tissue anterior and (or) posterior repair, it will be a reconstructive surgery for the majority of moderate-to-severe POP. It is minimal traumatic and worthy of being popularized for clinical application.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Ligamentos/cirurgia , Prolapso de Órgão Pélvico/cirurgia , Vagina/cirurgia , China , Feminino , Humanos , Diafragma da Pelve/cirurgia , Prolapso de Órgão Pélvico/patologia , Pessários , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Sacro/cirurgia , Slings Suburetrais , Resultado do Tratamento
20.
Fertil Steril ; 112(2): 181-182, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31352956

RESUMO

This month's Views and Reviews sets the stage for a two part series regarding reproductive surgery. The development, importance, and implications for reproductive surgery in the setting of assisted reproductive technology is discussed. Images and videos augment the authors' reflections of the past, present, and/or future. This series will not include a focus on uterine transplantation as this will be a future topic of its own.


Assuntos
Procedimentos Cirúrgicos em Ginecologia , Infertilidade/cirurgia , Técnicas de Reprodução Assistida/tendências , Procedimentos Cirúrgicos Urológicos Masculinos , Feminino , Procedimentos Cirúrgicos em Ginecologia/instrumentação , Procedimentos Cirúrgicos em Ginecologia/métodos , Procedimentos Cirúrgicos em Ginecologia/tendências , Humanos , Masculino , Reprodução/fisiologia , Técnicas de Reprodução Assistida/instrumentação , Procedimentos Cirúrgicos Urológicos Masculinos/instrumentação , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Procedimentos Cirúrgicos Urológicos Masculinos/tendências
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