Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.618
Filtrar
1.
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
2.
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
3.
Obstet Gynecol ; 136(5): 908-911, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33030861

RESUMO

BACKGROUND: Wireless signal transduction is the future in the field of laparoscopic surgery. Cable-free endoscopic equipment would be the ideal surgical instrument for every laparoscopic surgeon. INSTRUMENT: Our department has developed a new cable-free laparoscopic setup that couples a rigid 0°, 10-mm laparoscope with a wireless camera modified with a special adapter. We used a portable and rechargeable LED cold light source. The signal was wirelessly transmitted from the camera to a tablet computer using the corresponding mobile application. EXPERIENCE: Our team has used this setup in 14 laparoscopic operations with excellent results. Two cases performed exclusively with the new setup are presented in the videos. The image quality obtained was comparable with the conventional laparoscopic setup, and the operations performed were unaffected. CONCLUSION: This report presents the use of a wireless camera throughout the course of a laparoscopic surgery, and the results are promising. The new systems' favorable characteristics, such as wireless signal transmission, cost, flexibility, and size, support this as a feasible new technique for performing laparoscopic surgery.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/instrumentação , Laparoscópios/tendências , Laparoscopia/instrumentação , Tecnologia sem Fio/tendências , Desenho de Equipamento , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Procedimentos Cirúrgicos em Ginecologia/tendências , Humanos , Laparoscopia/métodos , Laparoscopia/tendências
4.
Obstet Gynecol ; 136(4): 870-871, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32976377

RESUMO

There are three broad categories of hemostatic agents: 1) caustic, 2) physical, and 3) biologic. Because of the paucity of data on the use of topical hemostatic agents in gynecologic and obstetric surgery, indications for use are extrapolated from data on the use of these agents in other types of surgeries and are based on expert opinion. Topical hemostatic agents can be a useful adjunct to assist in the management of intraoperative bleeding in select circumstances. Topical hemostatic agents most commonly are used in situations where the use of electrocautery or sutures for hemostatic control of surgical bleeding is not ideal or safe, including bleeding in areas with nearby vulnerable structures or in the presence of diffuse bleeding from peritoneal surfaces or cut surfaces of solid organs. When managing intraoperative bleeding, there is no substitute for meticulous surgical technique. When possible, the surgeon should attempt to control intraoperative bleeding with sutures, clips, or electrosurgery before the use of hemostatic agents. It is essential for surgeons to understand the appropriate use, contraindications, and cost of these agents in order to make the most informed decision for patient care.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Procedimentos Cirúrgicos em Ginecologia/métodos , Hemostasia Cirúrgica/métodos , Hemostáticos , Complicações do Trabalho de Parto/cirurgia , Administração Tópica , Adolescente , Tomada de Decisão Clínica , Feminino , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Hemostáticos/classificação , Hemostáticos/uso terapêutico , Humanos , Cuidados Intraoperatórios/métodos , Seleção de Pacientes , Padrões de Prática Médica , Gravidez
5.
Obstet Gynecol ; 136(4): e81-e89, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32976379

RESUMO

There are three broad categories of hemostatic agents: 1) caustic, 2) physical, and 3) biologic. Because of the paucity of data on the use of topical hemostatic agents in gynecologic and obstetric surgery, indications for use are extrapolated from data on the use of these agents in other types of surgeries and are based on expert opinion. Topical hemostatic agents can be a useful adjunct to assist in the management of intraoperative bleeding in select circumstances. Topical hemostatic agents most commonly are used in situations where the use of electrocautery or sutures for hemostatic control of surgical bleeding is not ideal or safe, including bleeding in areas with nearby vulnerable structures or in the presence of diffuse bleeding from peritoneal surfaces or cut surfaces of solid organs. When managing intraoperative bleeding, there is no substitute for meticulous surgical technique. When possible, the surgeon should attempt to control intraoperative bleeding with sutures, clips, or electrosurgery before the use of hemostatic agents. It is essential for surgeons to understand the appropriate use, contraindications, and cost of these agents in order to make the most informed decision for patient care.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Procedimentos Cirúrgicos em Ginecologia/métodos , Hemostasia Cirúrgica/métodos , Hemostáticos , Complicações do Trabalho de Parto/cirurgia , Administração Tópica , Adolescente , Tomada de Decisão Clínica , Feminino , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Hemostáticos/classificação , Hemostáticos/uso terapêutico , Humanos , Cuidados Intraoperatórios/métodos , Seleção de Pacientes , Padrões de Prática Médica , Gravidez
6.
Obstet Gynecol ; 136(4): 792-801, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925609

RESUMO

OBJECTIVE: To assess whether resting genital hiatus, perineal body, and total vaginal length measured intraoperatively at the conclusion of surgery are associated with prolapse recurrence 2 years after native tissue pelvic organ prolapse reconstruction. METHODS: This ancillary analysis of the OPTIMAL (Operations and Pelvic Muscle Training in the Management of Apical Support Loss) trial included women who had an immediate postoperative pelvic organ prolapse quantification (POP-Q) examination and 2-year follow-up. Primary outcome was bothersome bulge symptoms. Secondary outcomes were anatomic failure, surgical failure (either anatomic failure or bothersome bulge symptoms), and sexual function. Descriptive statistics assessed relationships between postprocedure POP-Q measures and these four outcomes. Multivariable models were fit to the data to control for baseline differences in bivariate comparisons. Receiver operating characteristic curves were generated to identify an optimal genital hiatus cut point associated with bothersome bulge, and this threshold was explored. RESULTS: This analysis included 368 participants. Bivariate analyses identified age, body mass index, vaginal deliveries, baseline genital hiatus, perineal body, and advanced POP-Q stage (3 or higher vs 2) as clinically relevant variables to include in multivariable models. After adjusting for these variables, the association between immediate postoperative genital hiatus and bothersome bulge (adjusted odds ratio [aOR] 1.4; 95% CI 0.9-2.1) was not significant at the P<.05 level; however, immediate postoperative genital hiatus was associated with anatomic (aOR 1.6; 95% CI 1.1-2.3) and surgical failure (aOR 1.5; 95% CI 1.0-2.1). Immediate postoperative genital hiatus of 3.5 cm was the selected cutoff (area under the curve 0.58, 95% CI 0.50-0.66 from the bothersome bulge model). Women with genital hiatus 3.5 cm or greater were more likely to have anatomic and surgical failures at 2 years. No POP-Q measures were correlated with 2-year sexual function. CONCLUSION: A larger immediate postoperative genital hiatus measurement of 3.5 cm or greater is not associated with bothersome bulge symptoms or sexual dysfunction but is associated with anatomic and surgical failures 2 years after native tissue vaginal reconstructive surgery.


Assuntos
Procedimentos Cirúrgicos em Ginecologia , Prolapso de Órgão Pélvico , Complicações Pós-Operatórias/diagnóstico , Procedimentos Cirúrgicos Reconstrutivos , Risco Ajustado/métodos , Disfunções Sexuais Fisiológicas , Feminino , Seguimentos , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Diafragma da Pelve/cirurgia , Prolapso de Órgão Pélvico/diagnóstico , Prolapso de Órgão Pélvico/fisiopatologia , Prolapso de Órgão Pélvico/cirurgia , Prognóstico , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Recidiva , Índice de Gravidade de Doença , Disfunções Sexuais Fisiológicas/diagnóstico , Disfunções Sexuais Fisiológicas/etiologia , Avaliação de Sintomas/métodos
7.
Obstet Gynecol ; 136(4): 663-665, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925610

RESUMO

Multiple studies suggest that health care workers treating human papillomavirus (HPV)-associated conditions may experience occupational exposure to the virus. Case reports describe the development of cancer and other disease in health care professionals at low risk for such conditions except for their work. Despite limited data, vaccination can be a safe and effective method to reduce this uncertain risk. We argue that health care workers, including physicians, nurses, and others, who participate in the treatment of HPV-associated disease should consider vaccination.


Assuntos
Pessoal de Saúde , Exposição Ocupacional , Neoplasias Orofaríngeas , Papillomaviridae , Infecções por Papillomavirus , Atitude do Pessoal de Saúde , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Procedimentos Cirúrgicos em Ginecologia/métodos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Exposição Ocupacional/efeitos adversos , Exposição Ocupacional/análise , Exposição Ocupacional/prevenção & controle , Vírus Oncogênicos , Neoplasias Orofaríngeas/diagnóstico , Neoplasias Orofaríngeas/prevenção & controle , Neoplasias Orofaríngeas/virologia , Papillomaviridae/isolamento & purificação , Papillomaviridae/patogenicidade , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/virologia , Vacinas contra Papillomavirus/uso terapêutico , Vacinação/métodos
8.
Obstet Gynecol ; 136(4): 844-846, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925632

RESUMO

: With the current issue, the journal continues to bring new insights from Cochrane Systematic Reviews to the readers of Obstetrics & Gynecology. This month, we focus on potential interventions to improve pregnancy outcomes for women with recurrent pregnancy loss and antiphospholipid antibodies, the utility of pelvic floor muscle training in the perinatal period to prevent incontinence, and the use of adhesion barriers in gynecologic surgery. The summaries are published below, and the complete references with hyperlinks are listed in Box 1. BOX 1. ABSTRACTS DISCUSSED IN THIS SUMMARY.


Assuntos
Aborto Espontâneo , Incontinência Fecal , Procedimentos Cirúrgicos em Ginecologia , Assistência Perinatal , Aderências Teciduais , Incontinência Urinária , Aborto Espontâneo/etiologia , Aborto Espontâneo/prevenção & controle , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/tratamento farmacológico , Incontinência Fecal/etiologia , Incontinência Fecal/prevenção & controle , Feminino , Fibrinolíticos/farmacologia , Procedimentos Cirúrgicos em Ginecologia/métodos , Procedimentos Cirúrgicos em Ginecologia/normas , Humanos , Debilidade Muscular/etiologia , Debilidade Muscular/reabilitação , Diafragma da Pelve/fisiopatologia , Assistência Perinatal/métodos , Assistência Perinatal/normas , Gravidez , Resultado da Gravidez , Melhoria de Qualidade , Revisões Sistemáticas como Assunto , Aderências Teciduais/etiologia , Aderências Teciduais/prevenção & controle , Incontinência Urinária/etiologia , Incontinência Urinária/prevenção & controle
9.
Obstet Gynecol ; 136(4): 811-822, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925633

RESUMO

Nine percent of adult women experience episodes of fecal incontinence at least monthly. Fecal incontinence is more common in older women and those with chronic bowel disturbance, diabetes, obesity, prior anal sphincter injury, or urinary incontinence. Fecal incontinence negatively affects quality of life and mental health and is associated with increased risk of nursing home placement. Fewer than 30% of women with fecal incontinence seek care, and lack of information about effective solutions is an important barrier for both patients and health care professionals. Even among women with both urinary and fecal incontinence presenting for urogynecologic care, the rate of verbal disclosure of fecal incontinence symptoms remains low. This article provides an overview of the evaluation and management of fecal incontinence for the busy obstetrician-gynecologist, incorporating existing guidance from the American College of Obstetricians and Gynecologists, the American College of Gastroenterology, and the American Society of Colon and Rectal Surgeons. The initial clinical evaluation of fecal incontinence requires a focused history and physical examination. Recording patient symptoms using a standard diary or questionnaire can help document symptoms and response to treatment. Invasive diagnostic testing and imaging generally are not needed to initiate treatment but may be considered in complex cases. Most women have mild symptoms that will improve with optimized stool consistency and medications. Additional treatment options include pelvic floor muscle strengthening with or without biofeedback, devices placed anally or vaginally, and surgery, including sacral neurostimulation, anal sphincteroplasty, and, for severely affected individuals for whom other interventions fail, colonic diversion.


Assuntos
Tratamento Conservador , Incontinência Fecal , Procedimentos Cirúrgicos em Ginecologia/métodos , Qualidade de Vida , Idoso , Comorbidade , Tratamento Conservador/instrumentação , Tratamento Conservador/métodos , Incontinência Fecal/etiologia , Incontinência Fecal/fisiopatologia , Incontinência Fecal/psicologia , Incontinência Fecal/terapia , Feminino , Humanos , Anamnese/métodos , Administração dos Cuidados ao Paciente/métodos , Seleção de Pacientes
10.
Rev. chil. obstet. ginecol. (En línea) ; 85(supl.1): S67-S74, set. 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1138650

RESUMO

INTRODUCCIÓN: La reciente pandemia por SARS-CoV-2 (COVID-19) ha hecho resurgir preocupación sobre la exposición inadvertida del equipo quirúrgico a agentes infecciosos transmisibles por vía aérea durante el acto quirúrgico. El objetivo de este trabajo es describir la confección de un sistema de filtrado simple y de bajo costo que permite reducir el riesgo de exposición al virus, particularmente en el proceso de aspiración, recambio y remoción del neumoperitoneo en cirugía laparoscópica. MATERIALES Y MÉTODO: Se diseñó e implementó un circuito cerrado de evacuación y de filtrado del neumoperitoneo en cirugías ginecológicas laparoscópicas en un centro de salud terciario. El circuito incluye un filtro HEPA (High Efficiency Particulate Air) y una trampa de vacío que contiene una solución de inactivación en base a amonio cuaternario o hipoclorito de sodio. RESULTADOS: Desde su implementación se han realizado 17 cirugías laparoscópicas ginecológicas por diversas patologías. Dos de ellas fueron en pacientes Covid-19 (+). A la fecha no se han reportado contagios en el equipo médico que participó en la cirugía. CONCLUSIONES: Es posible implementar un sistema de evacuación del neumoperitoneo en cirugía laparoscópica presumiblemente eficaz en minimizar el riesgo de exposición al virus SARS-COV-2 (Covid-19). Su bajo costo lo hace especialmente recomendable en países en vías de desarrollo.


INTRODUCTION: The recent SARS-CoV-2 (COVID-19) pandemics has raised concern on the incidental exposition of health team to air transmissible infectious agents during surgeries. The main goal of this work is to communicate a simple and low-cost filtering system allowing to reduce the risk of contagion related to the virus, associated with pneumoperitoneum removal during surgical laparoscopy. METHODS: A closed circuit of gas removal and filtering was developed and implemented in laparoscopic gynecologic procedures at a tertiary teaching hospital. The circuit included an HEPA (High Efficiency Particulate Air) filter and a vacuum trap containing an inactivating solution based on quaternary ammonium or sodium hypochlorite. RESULTS: Since its introduction, seventeen laparoscopic surgeries have been carried out for different gynecologic pathologies. Two of them in Covid (+) cases. To date, no contagion has been reported among health teammates participating in these surgeries. CONCLUSIONS: It is possible to implement a pneumoperitoneum evacuation system in laparoscopic surgery presumably effective in minimizing the risk of exposure to the SARS-COV-2 virus (Covid-19). Its low cost makes it especially recommended in developing countries.


Assuntos
Humanos , Feminino , Pneumonia Viral/prevenção & controle , Procedimentos Cirúrgicos em Ginecologia/métodos , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/transmissão , Pneumoperitônio , Medidas de Segurança , Hipoclorito de Sódio , Laparoscopia/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Infecções por Coronavirus/transmissão , Tecnologia de Baixo Custo , Compostos de Amônio , Betacoronavirus
11.
Urologiia ; (4): 139-143, 2020 Sep.
Artigo em Russo | MEDLINE | ID: mdl-32897028

RESUMO

A review of current literature on the results of surgical treatment of patients with pelvic organ prolapse by vaginal approach is presented in the article. The relevant issues are the safety and efficiency of using mesh implants for the surgical correction of pelvic organ prolapse. Most experts recognize a need for further improvement of vaginal reconstruction techniques using synthetic meshes, however, current restrictions in a number of countries significantly impact on the respective studies. Despite the many scientific works and various publications, to date there is no single concept of the pelvic organ prolapse. It is necessary to conduct multicenter clinical studies in order to further develop clinical guidelines and to determine a place of these operations in the surgical treatment of pelvic organ prolapse.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Prolapso de Órgão Pélvico , Prolapso Uterino , Feminino , Humanos , Prolapso de Órgão Pélvico/cirurgia , Telas Cirúrgicas , Prolapso Uterino/cirurgia , Vagina
12.
Plast Reconstr Surg ; 146(4): 451e-463e, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32970012

RESUMO

LEARNING OBJECTIVES: After studying this article, participants should be able to: (1) Identify the most appropriate type of anesthesia for the female genital plastic surgical patient and minimize risks of nerve injury and thromboembolic event through proper preoperative evaluation and knowledge of positioning. (2) Define the vulvovaginal anatomy, including common variants, and assess vulvovaginal tissues after childbirth and menopause. (3) Apply surgical techniques to minimize complications in female genital plastic surgery. (4) Classify the types of female genital mutilation/cutting and design methods of reconstruction after female genital mutilation/cutting. SUMMARY: Female genital plastic surgery is growing in popularity and in numbers performed. This CME article covers several aspects of safety in the performance of these procedures. In choosing the best candidates, the impact of patient motivation, body mass index, parity, menopause and estrogen therapy is discussed. Under anesthesia, consideration for the risks associated with the dorsal lithotomy position and avoidance of compartment syndrome, nerve injury, deep venous thromboses, and pulmonary embolus are covered. Anatomical variations are discussed, as is the impact of childbirth on tissues and muscles. Surgical safety, avoidance of complications, and postoperative care of a variety of vulvovaginal procedures are discussed. Videos showing anatomical variations and surgical techniques of the most common female genital procedures with recommendations to reduce the complication rate are included in the article. Finally, female genital mutilation/cutting is defined, and treatment, avoidance of complications, and postoperative care are discussed.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Vagina/cirurgia , Vulva/cirurgia , Feminino , Humanos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos
13.
Obstet Gynecol ; 136(3): 640-641, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32826595

RESUMO

For noncancerous conditions, such as hysterectomy, a minimally invasive approach to gynecologic surgery has well-documented advantages-including faster return to normal activities, decreased length of stay, and better quality of life-compared with an abdominal approach. Although the quality of data for robot-assisted surgery is still low to moderate, the use of robot-assisted surgery has rapidly increased since its approval, which highlights the need to develop effective and thoughtful strategies for its implementation. Reporting of adverse events currently is voluntary and nonstandardized; therefore, the true rate of complications is not known. Adoption of new surgical techniques should be driven by what is best for the patient and by evidence-based medicine, rather than external pressures. Although training in robot-assisted surgery increasingly is incorporated into obstetric and gynecologic residency programs, exposure to and training with robotic devices varies nationally. Obstetrician-gynecologists not previously trained in robot-assisted surgery can acquire the necessary skills through independent robot-assisted training programs and through courses offered and accredited by organizations such as the American College of Obstetricians and Gynecologists, the Society of Gynecologic Surgeons, the American Association of Gynecologic Laparoscopists, the Society of Gynecologic Oncology, and the American Urogynecologic Society. Ongoing quality assurance is essential to ensure appropriate use of the technology and, most importantly, patient safety. Well-designed studies are needed to determine which patients are most likely to benefit from robot-assisted surgery over other minimally invasive approaches.


Assuntos
Doenças dos Genitais Femininos/cirurgia , Procedimentos Cirúrgicos em Ginecologia/métodos , Procedimentos Cirúrgicos em Ginecologia/normas , Procedimentos Cirúrgicos Robóticos , Feminino , Humanos , Guias de Prática Clínica como Assunto
14.
Obstet Gynecol ; 136(3): e22-e30, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32826597

RESUMO

For noncancerous conditions, such as hysterectomy, a minimally invasive approach to gynecologic surgery has well-documented advantages-including faster return to normal activities, decreased length of stay, and better quality of life-compared with an abdominal approach. Although the quality of data for robot-assisted surgery is still low to moderate, the use of robot-assisted surgery has rapidly increased since its approval, which highlights the need to develop effective and thoughtful strategies for its implementation. Reporting of adverse events currently is voluntary and nonstandardized; therefore, the true rate of complications is not known. Adoption of new surgical techniques should be driven by what is best for the patient and by evidence-based medicine, rather than external pressures. Although training in robot-assisted surgery increasingly is incorporated into obstetric and gynecologic residency programs, exposure to and training with robotic devices varies nationally. Obstetrician-gynecologists not previously trained in robot-assisted surgery can acquire the necessary skills through independent robot-assisted training programs and through courses offered and accredited by organizations such as the American College of Obstetricians and Gynecologists, the Society of Gynecologic Surgeons, the American Association of Gynecologic Laparoscopists, the Society of Gynecologic Oncology, and the American Urogynecologic Society. Ongoing quality assurance is essential to ensure appropriate use of the technology and, most importantly, patient safety. Well-designed studies are needed to determine which patients are most likely to benefit from robot-assisted surgery over other minimally invasive approaches.


Assuntos
Doenças dos Genitais Femininos/cirurgia , Procedimentos Cirúrgicos em Ginecologia/métodos , Procedimentos Cirúrgicos em Ginecologia/normas , Procedimentos Cirúrgicos Robóticos , Feminino , Humanos
16.
Plast Reconstr Surg ; 146(3): 526-536, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32842103

RESUMO

BACKGROUND: Labiaplasty has grown in popularity, but it remains controversial. Few studies have quantified the change in specific symptomatology from before to after labiaplasty to establish its effectiveness in improving quality of life. METHODS: In a prospective study, 62 patients undergoing labiaplasty completed written surveys privately in an examination room preoperatively and postoperatively about the presence of 11 physical and appearance-related symptoms. RESULTS: Mean patient age was 33.5 years (range, 17 to 61 years). Two patients were of minority age. All patients presented with at least one symptom, averaging 6.5 (range, one to 11). Most (82.2 percent) had a trim labiaplasty, and the rest (17.7 percent) had a wedge. After labiaplasty, 93.5 percent of patients were symptom-free, with the average dropping to 0.23 of 11 symptoms. Symptom-prevalence changes from preoperatively to postoperatively included self-consciousness, dropping from 93 percent to 6.5 percent; tugging (from 66.1 percent to 0 percent); feeling less attractive (from 66.1 percent to 0 percent); negative impact on self-esteem (from 64.5 percent to 1.6 percent); negative impact on intimacy (from 62.5 percent to 0 percent); twisting (from 58.1 percent to 3.2 percent); being uncomfortable (from 56.5 percent to 4.8 percent); clothing restriction (from 54.8 percent to 3.2 percent); visible outline (from 46.8 percent to 1.6 percent); pain (from 43.5 percent to 1.6 percent); and exposure in swimsuits (from 38.7 percent to 1.6 percent). No major complications occurred. Two patients felt their labia were still too long and revision was offered. Average follow-up was 13.3 months (range, 6 to 24 months). CONCLUSIONS: Patients with elongated labia have a high incidence of functional and appearance-related symptoms. Labiaplasty is a safe procedure that yields significant improvement in quality of life. CLINICAL QUESTIONS/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Satisfação do Paciente , Procedimentos Cirúrgicos Reconstrutivos/métodos , Vulva/cirurgia , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Período Pós-Operatório , Período Pré-Operatório , Estudos Prospectivos , Adulto Jovem
17.
Am J Obstet Gynecol ; 223(5): 762-763, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32693094

RESUMO

Vaginal hysterectomy rates in the United States are decreasing, despite it being the recommended hysterectomy route for benign hysterectomy by multiple societies. Visualization issues are a known barrier to a medical student learning in the operating room, and it is likely that this also extends to resident training. In addition, vaginal surgery can be taxing on both the surgeons and assistants, with high rates of musculoskeletal work disorders reported in vaginal surgeons. The use of a camera is integral to endoscopic surgery, and table-mounted retractor systems have been used for decades in open surgery. We bring these 2 features into vaginal surgery, that is, using a table-mounted camera system and a table-mounted vaginal retractor. When used together as demonstrated in this video, these tools can improve visualization and may improve ergonomics for the entire surgical team, including learners, during vaginal surgery.


Assuntos
Ergonomia , Histerectomia Vaginal/instrumentação , Equipamentos Cirúrgicos , Terminais de Computador , Feminino , Procedimentos Cirúrgicos em Ginecologia/instrumentação , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Histerectomia Vaginal/métodos , Vagina/cirurgia
18.
JSLS ; 24(2)2020.
Artigo em Inglês | MEDLINE | ID: mdl-32612345

RESUMO

Background and Objectives: Operative laparoscopy is generally performed under general anesthesia. Local anesthesia and conscious sedation may be useful in select short procedures. In the present study, we evaluated safety and efficacy of operative laparoscopy under conscious sedation. Methods: Retrospective observational study evaluating patients undergoing gynecologic laparoscopy. Laparoscopy under conscious sedation was performed for each patient with umbilical direct insertion of a 12-mm port, followed by 2 ancillary ports at 1 cm medially to the anterior superior iliac spine. Conversion to conventional laparoscopy or laparotomy was recorded. Conscious sedation was obtained using Remifentanil and Propofol, administered by an infusion system based on pharmacokinetic and pharmacodynamic models. Local anesthesia was administered at port insertion sites and for paracervical block. Pain intensity was evaluated with the Visual Analog Scale (VAS). Adverse events and drug concentrations throughout the procedure were retrieved. Results: Our study population included 166 patients. They underwent laparoscopic unilateral versus bilateral salpingo-oophorectomy, ovarian cystectomy, bilateral salpingo-oophorectomy and omentectomy for a borderline ovarian tumor, myomectomy; or underwent surgery for unexplained infertility evaluation, pelvic pain, staging of ovarian cancer. Mean duration of pneumoperitoneum was 22.3 ± 7.2 min. Rate of conversion to laparoscopy under general anesthesia was 17/166 (10.2%) and there were only 3 cases of patients with low tolerability to the procedure. No severe adverse events occurred. Hospital discharge occurred in all unconverted cases after 6 to 18 h. Conclusions: Operative laparoscopy under conscious sedation and local anesthesia appears to be a feasible technique in gynecologic surgery with no adverse patient outcomes.


Assuntos
Sedação Consciente/métodos , Procedimentos Cirúrgicos em Ginecologia/métodos , Laparoscopia/métodos , Adulto , Idoso , Anestesia Obstétrica , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos
19.
Am J Obstet Gynecol ; 223(4): 543.e1-543.e14, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32652064

RESUMO

BACKGROUND: The enhanced recovery after surgery concept, which was introduced 20 years ago, is based on a multimodal approach to improve the functional rehabilitation of patients after surgery. OBJECTIVE: This study aimed to validate an enhanced recovery after surgery protocol in gynecologic surgery for both benign and malignant diseases (endometrial cancer and advanced ovarian cancer) and to measure the adherence to the enhanced recovery after surgery protocol items in a randomized trial setting. STUDY DESIGN: In this trial (NCT03347409), we randomly assigned patients to undergo standard perioperative care or enhanced recovery after surgery protocol. The primary outcome is a shorter length of stay in favor of the enhanced recovery after surgery protocol. Secondary outcomes include measurement of adherence to the enhanced recovery after surgery protocol items: comparison of postoperative pain, vomiting, and nausea; anesthesiologic and surgical complications up to 30 days after surgery; rate of readmissions; the time to event in hours for bowel movements, flatus, drinking, hunger, eating, and walking; and the quality of recovery using a validated questionnaire (QoR-15). Finally, we explored the length of stay in the prespecified subgroups at randomization, based on the type of surgical access and gynecologic disease. RESULTS: A total of 168 women were available for analysis: 85 women (50.6%) were assigned to the standard perioperative care group, and 83 women (49.4%) were assigned to the enhanced recovery after surgery protocol group. The 2 groups were similar for age, body mass index, comorbidities, anesthesiological risk, smoking habits, surgical access, and complexity of surgical procedures. Seventy-two patients (42.9%) underwent surgery for benign disease, 48 (28.6%) for endometrial cancer, and 48 (28.6%) for ovarian cancer. Women in the enhanced recovery after surgery protocol group had a shorter length of stay (median: 2 [interquartile range, 2-3] vs 4 [interquartile range, 4-7] days; P<.001). A decreased rate of postoperative complications was noted for the enhanced recovery after surgery protocol group, as well as an earlier time to occur for all the events. Mean adherence to protocol items was 84.8% (95% confidence interval, 79.7-89.8), and we registered a better satisfaction in the enhanced recovery after surgery protocol group. The shortening of the length of stay was confirmed also in the prespecified subgroup analysis. CONCLUSION: Application of the enhanced recovery after surgery protocol in gynecologic surgery translated to a shorter length of stay regardless of surgical access and type of gynecologic disease. Adherence to the enhanced recovery after surgery protocol items in the setting of a randomized trial was high.


Assuntos
Neoplasias do Endométrio/cirurgia , Recuperação Pós-Cirúrgica Melhorada , Procedimentos Cirúrgicos em Ginecologia/métodos , Tempo de Internação/estatística & dados numéricos , Neoplasias Ovarianas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Recuperação de Função Fisiológica , Idoso , Feminino , Doenças dos Genitais Femininos/cirurgia , Fidelidade a Diretrizes , Humanos , Íleus/epidemiologia , Itália/epidemiologia , Excisão de Linfonodo , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/epidemiologia , Readmissão do Paciente , Satisfação do Paciente , Náusea e Vômito Pós-Operatórios/epidemiologia , Fatores de Tempo
20.
Am J Obstet Gynecol ; 223(4): 475-485, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32717257

RESUMO

This is the first collaborative Enhanced Recovery After Surgery Society guideline for optimal perioperative care for vulvar and vaginal surgeries. An Embase and PubMed database search of publications was performed. Studies on each topic within the Enhanced Recovery After Surgery vulvar and vaginal outline were selected, with emphasis on meta-analyses, randomized controlled trials, and prospective cohort studies. All studies were reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation system. All recommendations on the Enhanced Recovery After Surgery topics are based on the best available evidence. The level of evidence for each item is presented.


Assuntos
Recuperação Pós-Cirúrgica Melhorada , Procedimentos Cirúrgicos em Ginecologia/métodos , Vagina/cirurgia , Vulva/cirurgia , Antibioticoprofilaxia/métodos , Bandagens , Feminino , Hidratação/métodos , Humanos , Dor Pós-Operatória/tratamento farmacológico , Educação de Pacientes como Assunto/métodos , Assistência Perioperatória , Tromboembolia/prevenção & controle , Cateterismo Urinário/métodos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA