Objective To determine the impact of planned preoperative phenazopyridine administration on operative times and costs compared with as-needed intravenous agent use during routine cystoscopy following minimally invasiv...Objective To determine the impact of planned preoperative phenazopyridine administration on operative times and costs compared with as-needed intravenous agent use during routine cystoscopy following minimally invasive hysterectomy for benign indications.Method This prospective cohort study examined patients who underwent laparoscopic or robotic-assisted total or supracervical hysterectomy for benign indications between January 27,2023 and March 11,2024,with one of our minimally invasive gynecologic surgeons at Stony Brook University Hospital.Patients were assigned to the non-phenazopyridine group or the phenazopyridine group.The time needed to visualize the ureteral jets during cystoscopy and the total surgery duration were recorded.A cost analysis was then performed.Results In total,106 patients were included,with 53 patients in each group.Compared with the non-phenazopyridine group,the phenazopyridine group had significantly shorter times from the start of cystoscopy to visualization of the first ureteral jet(31 s vs.42 s,p<0.05).However,there were no significant differences observed for visualization of the second jet,total jet time,or surgery duration.Two patients in the non-phenazopyridine group required the administration of intravenous agents intraoperatively.Routine phenazopyridine was found to be more cost-efficient when medication costs and operative times were examined.Conclusion Routine phenazopyridine use does not significantly shorten overall cystoscopy times,but it is the more cost-efficient option given increased rates of costly intravenous medication use in the non-phenazopyridine group.展开更多
BACKGROUND Despite laparoscopic total hysterectomy provided more benefits to patients and has become one of the most commonly used surgical methods for total hysterectomy.However,vaginal cuff dehiscence is a serious c...BACKGROUND Despite laparoscopic total hysterectomy provided more benefits to patients and has become one of the most commonly used surgical methods for total hysterectomy.However,vaginal cuff dehiscence is a serious complication after laparoscopic total hysterectomy and so far,there are limited studies on vaginal cuff dehiscence after a total hysterectomy.AIM To investigate the factors influencing vaginal cuff dehiscence after laparoscopic hysterectomy and the psychological state of the patients.METHODS This study retrospectively,univariately,and multivariately analyzed the clinical data of patients who experienced vaginal cuff dehiscence after laparoscopic hysterectomy in Yuyao People’s Hospital from January 2015 to December 2021.Logistic regression was utilized to analyze the high-risk factors of vaginal cuff dehiscence.RESULTS Among 1459 cases with laparoscopic hysterectomy,9 reported vaginal cuff dehiscence postoperatively,with an incidence of 0.617%.Univariate logistic regression analysis revealed that preoperative hemoglobin value[odds ratio(OR)=5.12,P=0.016],vaginal cuff suture method(OR=0.26,P=0.048),and postoperative first sexual lifetime(OR=15.86,P=0.002)were associated with vaginal cuff dehiscence following laparoscopic hysterectomy.Multivariate logistic regression analysis revealed that preoperative hemoglobin value of<90 g/L(OR=5.17,P=0.015)and time interval between postoperative first sexual life and operation of<3 months(OR=54.00,P=0.004)are independent risk factors for vaginal cuff dehiscence after laparoscopic hysterectomy.CONCLUSION Postoperative hemoglobin and the time interval between postoperative first sexual life and operation were the independent factors of developing vaginal cuff dehiscence after laparoscopic hysterectomy.展开更多
Objective:To analyze the application value of a non-catheter tampon in abdominal hysterectomy,providing a reference for related research.Methods:A total of 100 patients were included in this study,with data collected ...Objective:To analyze the application value of a non-catheter tampon in abdominal hysterectomy,providing a reference for related research.Methods:A total of 100 patients were included in this study,with data collected between January 4,2022,and January 4,2024.The patients were divided into two groups:the new group and the traditional group,each comprising 50 patients.Results:Compared with the traditional group,the new group demonstrated significantly lower intraoperative blood loss(P<0.05).Additionally,the incidence of complications,operation time,hospital stay,time required to resume normal activities,and postoperative VAS scores were all significantly lower in the new group(P<0.05).Conclusion:The application of a non-catheter tampon during abdominal hysterectomy yields satisfactory results.This approach is worthy of further clinical promotion and application.展开更多
Objective： To study the influences of different time intervals between loop electrosurgical excision （LEEP） and abdominal hysterectomy or radical hysterectomy on postoperative complications. Methods： Sixty-eight p...Objective： To study the influences of different time intervals between loop electrosurgical excision （LEEP） and abdominal hysterectomy or radical hysterectomy on postoperative complications. Methods： Sixty-eight patients, who received subsequent abdominal hysterectomy or radical hysterectomy after LEEP due to C1N III and cervical cancer （IA1, IA2 and IB1）, were included in the present study. The hospital and clinic records of these patients were reviewed. The patients were divided into three groups according to the time intervals between LEEP and hysterectomy or radical hysterectomy： group l（within 48 h）, group 2 （between 48 h to 6 weeks）, and group 3（〉 6 weeks ）.Results： General characteristics of patients, including the mean age, delivery history, BMI, menopausal status, clinical stage and HPV infection, were comparable between patients of different groups. There were no significant differences in the mean transfusion amount, posthysterectomy hospital stay or operation time between different groups. The frequencies and spectrum of complications were not significantly affected by the time interval between LEEP and hysterectomy or radical hysterectomy. Conclusion： It is concluded that whenever the LEEP is done, the operation including hysterectomy or radical hysterectomy can be conducted at any time as it is necessary for the patients.展开更多
Objective: to analyze the effect of laparoscopic radical hysterectomy in the treatment of early cervical cancer. Methods: ninety-two patients with early cervical cancer were randomly divided into control group and stu...Objective: to analyze the effect of laparoscopic radical hysterectomy in the treatment of early cervical cancer. Methods: ninety-two patients with early cervical cancer were randomly divided into control group and study group. Open and laparoscopic radical hysterectomy was performed, and the effect and safety were compared. Results: in the study group, the amount of blood loss during operation was less, the time of anal exhaust and antibiotic treatment after operation were shorter, P < 0.05. The number of lymph nodes beside iliac vessels, deep femoral lymph nodes, obturator lymph nodes and total lymph node dissection in the study group were more, P < 0.05. The scores of PFDI-20, POPDI-6, CRADI-8 and UDI-6 in the study group were higher, P < 0.05. The incidence of postoperative complications between the two groups was P > 0.05. After operation, the levels of SCC-Ag and CA724 in the two groups decreased (P > 0.05). After operation, the levels of IL-6, IL-8 and TNF-α in the study group were lower (P < 0.05). Conclusion: laparoscopic radical hysterectomy in the treatment of early cervical cancer is helpful to reduce the amount of bleeding, promote postoperative recovery and increase the number of lymph node dissection, but it has a great impact on pelvic floor function. It is necessary to choose the best operation method according to the actual condition of patients.展开更多
Objective To evaluate the possibility of vaginal hysterectomy for patients with moderately enlarged uterus of benign lesions. Methods One hundred and seventeen women with benign uterine diseases underwent vaginal hyst...Objective To evaluate the possibility of vaginal hysterectomy for patients with moderately enlarged uterus of benign lesions. Methods One hundred and seventeen women with benign uterine diseases underwent vaginal hysterectomy. These patients were divided into two groups according to uterine weight. Group Ⅰ contained 60 patients with uterine enlargement to a weight of 200 to 750 g, and group Ⅱ contained 57 patients with uterine weight of less than 200 g. Uterine morcellation was performed in some cases. The peri-operative data in both groups were analyzed. Results In group Ⅰ, 59 cases underwent transvaginal hysterectomy successfully, except 1 case con-verted to abdominal operation and the uterine morcellation was performed in 21 women. In group Ⅱ, all patients successfully underwent transvaginal hysterectomy without any assistance of special technique. The mean uterine weight of group Ⅰ was significantly heavier than that of group Ⅱ(280.18 ± 100.40 g vs 146.48 ± 35.19 g). The mean operating time was significantly longer for group Ⅰ than that for group Ⅱ(83.93 ± 26.26 minutes vs 35.22 ± 20.55 minutes). There were no significant differences in blood loss and complications between groupⅠ and group Ⅱ. There was no injury of urinary bladder or rectum, and no vaginal vault infection. Conclusions Vaginal hysterectomy of moderately enlarged uterus can be safely and effectively performed by experienced operators. In some cases, in order to reduce the uterine volume, uterine mor-cellation should be used to shorten operative time, reduce the bleeding, and lower the postoperative complications.展开更多
BACKGROUND Cervical cancer is the most common gynecological malignancy,ranking first in female reproductive malignancies with more than 500000 new cases and 275000 deaths each year.Traditionally,open radical hysterect...BACKGROUND Cervical cancer is the most common gynecological malignancy,ranking first in female reproductive malignancies with more than 500000 new cases and 275000 deaths each year.Traditionally,open radical hysterectomy is considered the standard surgical procedure for the treatment of resectable cervical cancer.The latest guidelines from the National Comprehensive Cancer Network and the European Society of Gynecological Oncology suggest that open surgery and laparoscopic surgery(using traditional laparoscopic or robotic techniques)are the main surgical approaches for radical hysterectomy for patients with stage IA2-IIA cervical cancer.Robotic surgery has been increasingly used in abdominal surgery and has shown more beneficial effects.AIM To analyse the perioperative conditions,complications,and short-term and longterm effects in patients undergoing robotic radical hysterectomy(RRH)and laparoscopic radical hysterectomy(LRH)to compare their clinical efficacy,safety,and feasibility.METHODS The perioperative data of patients undergoing RRH and LRH were extracted and collected from the database of surgical treatments for cervical cancer for statistical analysis.RESULTS Of the patients,342 underwent LRH for cervical cancer,and 216 underwent RRH.The total complication rate was 9.65%(20 patients)in the RRH group and 17.59%(60 patients)in the LRH group.The complication rate was significantly lower in the RRH group than in the LRH group.There was no significant difference in the follow-up period(P=0.658).The total recurrence rates were 15.7%and 12%in the RRH and LRH groups,respectively.The progression-free survival time was 28.91±15.68 mo and 28.34±15.13 mo in the RRH and LRH groups,respectively(P=0.669).The overall survival(OS)rates were 92.13%and 94.45%in the RRH and LRH groups,respectively(P=0.292).The OS time was 29.87±15.92 mo and 29.41±15.14 mo in the RRH and LRH groups,respectively(P=0.732).The survival curves and the progression-free survival curves were not statistically significantly different between the two groups(P=0.407 and 0.28,respectively).CONCLUSION RRH is associated with significantly less operative time and blood loss than LRH.The two procedures have similar complication rates,OS,and progression-free survival time.展开更多
BACKGROUND Uterine myomas are the most common benign gynecological soft tissue tumors in women but polycythemia associated with these tumors is rare.Polycythemia is significantly associated with risk of venous thrombo...BACKGROUND Uterine myomas are the most common benign gynecological soft tissue tumors in women but polycythemia associated with these tumors is rare.Polycythemia is significantly associated with risk of venous thromboembolism(VTE),which is further increased in case of a large pelvic mass and obesity.Here we report the surgical challenges in the case of an obese patient with a giant fibromatous uterus and associated polycythemia.CASE SUMMARY A 42-year-old obese woman was referred to our department for treatment for a huge fibromatous uterus.She suffered of pelvic pressure and abdominal distension and reported severe dyspnea from several months.Laboratory analyses including hemoglobin(Hb)19.2 g/dL and hematocrit(Hct)59.7%were indicative of polycythemia.Arterial blood gas analysis showed arterial oxygen pressure(pO2)of 81.5 mmHg.Abdominal computed tomography confirmed a giant fibromatous uterus measuring 28.2 cm×17 cm×25 cm.To reduce the thromboembolic risk,the patient underwent low molecular weight heparin,phlebotomy twice before surgery,and we opted for a laparoscopic hysterectomy.The uterus weighed 5400 g and the histology confirmed a diagnosis of leiomyoma.We did not find increased erythropoietin levels in the supernatant of the myomatous uterine tissue.There were no complications.On postoperative day 1,the Hb and the Hct levels normalized to 13.3 g/dL and 41.7%,respectively.Arterial blood gas analysis after surgery showed a pO2 of 144.7 mmHg.These results suggested the diagnosis of myomatous erythrocytosis syndrome.The patient was discharged on the second postoperative day in very good condition with no symptoms.CONCLUSION We believe this is the first reported laparoscopic hysterectomy in a patient with a giant uterus,polycythemia and obesity.Multiple VTE risk factors warranted a laparoscopic approach.展开更多
Objective: The aim of this study was to investigate the feasibility of using ultrasonic scalpel combined with vascular clip in parametrial management,called limited energy parametrial resection/dissection(LEPRD),in la...Objective: The aim of this study was to investigate the feasibility of using ultrasonic scalpel combined with vascular clip in parametrial management,called limited energy parametrial resection/dissection(LEPRD),in laparoscopic nerve plane-sparing radical hysterectomy(NPSRH),a modified nerve-sparing radical hysterectomy(NSRH); and to evaluate its effectiveness in pelvic autonomic nerve preservation.Methods: From July 2012 to January 2016,257 consecutive patients with stage IB1 to IIA2 cervical cancer who underwent NPSRH were included in this study.Patients were divided into three cohorts according to the different parametrial resection modality.The clinical,pathological and surgery-related parameters were compared between the three groups.Short-and long-term postoperative bladder functions were evaluated.Results: LEPRD was attempted in 94 patients,and was successful in 65(69.1%) patients(LEPRD group).The remaining 29(30.9%) patients required bipolar coagulation after failure of vascular clipping(combined modality group).Routine bipolar cautery was used in the other 163 patients during the parametrial resection(bipolar group).The blood loss in the LEPRD group was significantly lower than those in the other two groups(P<0.001).The rate of successful Foley removal on postoperative day 7 was significantly higher in the LEPRD group than in the bipolar group(P=0.022).The incidence of chronic voiding dysfunction was significantly lower in the LEPRD group than in the bipolar group(P=0.019).Conclusions: It is feasible to perform LEPRD in NPSRH for cervical cancers.This kind of limited energy surgical technique is associated with less blood loss,and leads to improved postoperative bladder function.展开更多
Background： The radical hysterectomy （RH） surgical technique has improved along the years. It is used for the treatment of cervical cancer, endometrial cancer when affecting the cervix, and upper vaginal carcinomas...Background： The radical hysterectomy （RH） surgical technique has improved along the years. It is used for the treatment of cervical cancer, endometrial cancer when affecting the cervix, and upper vaginal carcinomas. Our aim was to describe the historical evolution of the technique after the introduction of laparoseopy at our institution. Methods： We performed a retrospective review of medical records of patients who underwent RH, grouped in three periods according to the year of surgery： 1990-1999, 2000-2009 and 2010-2013. Patients＇ characteristics, pathologic details, intraoperative and postoperative complications were analyzed and comoared throughout the time periods. Results： A total of 102 cases of RH were performed at our center during the study period. Among all data collected, the presence of necrosis, age, number of lymph nodes, surgery route, operating time, hospital stay, blood loss and transfusion requirement were statistically significant different among groups. Conversion to laparotomy rate was 19% for the second period compared to the absence of cases in the last one. No significant differences （P=0.124） were observed in the adjuvant treatment received among the three different groups. At the time of the last contact the patients free of disease were 12 （85.7%）, 53 （91.3%） and 26 （86.6%） respectively （P=0.406）. Regarding the disease-free interval, we found significant better outcomes in the group of laparotomy compared to laparoscopy （P=0.015）.Conclusions： Laparoscopic RH is an acceptable surgery with advantages like magnified vision of the operation＇s field, lower surgical complications, shorter hospital stay and earlier resumption to daily activities.展开更多
To investigate the efficacy and the clinical value of total laparoscopic radical hysterectomy(TLRH) for the treatment of uterine malignancies,we performed a retrospective review of 87 patients with cervical cancer and...To investigate the efficacy and the clinical value of total laparoscopic radical hysterectomy(TLRH) for the treatment of uterine malignancies,we performed a retrospective review of 87 patients with cervical cancer and 23 patients with endometrial carcinoma who underwent TLRH at Union hospital between June 2008 and September 2009.Data collected included operative time,estimated blood loss,lymph node count,time for the recovery of normal temperature and time to resumption of normal bladder function,intraoperative and postoperative complications.The procedure was completed laparoscopically in 108 patients.Two patients were converted to laparotomy due to common iliac vein injury.The mean overall operative time was 200.6±38.6 min;the mean operative blood loss was 280.5±128.3 mL;the mean number of pelvic lymph nodes that were resected was 26.0±5.8.The time for recovery of normal temperature and the normal bladder function after the operation was 5.8±2.9 d and 15.2±4.3 d.There were 2(1.8%) common iliac vein injuries during the operation and 10(9.1%) bladder retentions post operation.It was concluded that TLRH is feasible,minimally invasive and provides promise for the treatment of uterine malignancies.展开更多
To evaluate the role of hysterectomy for patients with gestational trophoblastic tumor. [WT5”BX]Methods.[WT5”BZ]We retrospectively analyzed 68 cases of gestational trophoblastic neoplasia treated by hysterectomy fro...To evaluate the role of hysterectomy for patients with gestational trophoblastic tumor. [WT5”BX]Methods.[WT5”BZ]We retrospectively analyzed 68 cases of gestational trophoblastic neoplasia treated by hysterectomy from 1985～1997 at PUMC hospital. Thirty eight cases were diagnosed of choriocarcinoma and 30 were invasive mole. [WT5”BX]Results.[WT5”BZ]Twenty three elder patients who didn’t desire to preserve fertility were selected for hysterectomy after shorter courses of chemotherapy, 22 of them had a complete remission(95 6%), the total aver age courses of chemotherapy was 4 2. Of twenty seven chemorefractory cases who were suspected of a refractory isolated lesion in the uterus, delayed hysterectomy as an adjunct to chemotherapy was performed, 20 of them got a complete remission(74 1%), the total average courses of chemotherapy were 9 4. Emergency hysterectomy is indicated in 18 patients with uterine perforation or life threatening hemorrhage, 17 cases had a complete remission(94 4%), the total average courses of chemotherapy were 7 6. [WT5”BX]Conclusion.[WT5”BZ]Although the development of effective chemotherapy has resulted in improved survival of patients with gestational trophoblastic tumor, hysterectomy remains an important adjuncts in the treatment of a selected subset of patients; in order to operate more completely and prevent recurrence, it’s better to perform extended hysterectomy for the indicated patients.展开更多
Objective:To analysis the clinical curative effect on bladder function recovery after radical hysterectomy with acupuncture and acu-physiotherapy.Methods:A total of 564 cervical cancer patients in the gynecology depar...Objective:To analysis the clinical curative effect on bladder function recovery after radical hysterectomy with acupuncture and acu-physiotherapy.Methods:A total of 564 cervical cancer patients in the gynecology department who received radical hysterectomy from January 2011 to December 2017 in Qilu Hospital of Shandong University were collected.According to the inclusion and exclusion criteria,we studied 360 case records at last,with 120 cases respectively.Patients got treatment of acupuncture[acupuncture at Zhongwan(中脘CV12),Tianshu(天枢ST25),Shuidao(水道ST28),TAichong(太冲LI3),Sanyinjiao(三阴交SP6),Zusanli(足三里ST36)and Yinlingquan(阴陵泉SP9)],or acu-physiotherapy with two large-size electrodes placed on the bladder area above the pubic symphysis besides acupuncture,from the 3 rd day after operation once a day till the14 th day that removing the indwelling catheter.And the blank group got no other auxiliary treatment except scrubbed the meatus orifice with iodophor twice a day.We tested the residual urine volume 6 h later after removement of indwelling catheter.Residual urine volume more than 100 mL was defined as urinary retention,and the volume less than 50 mL was defined as adequate bladder emptying.Results:We analyzed patients’age,the International Federation of Gynecology and Obstetrics(FIGO)stage,operation duration,amount of hemorrhage,depth of myometrium infiltration,cancer embolus,parametrium invasion,lymphatic metastasis,treating methods and residual urine volume recorded in case records,and there was no significant difference between every two groups(P>0.05).The incidences of urinary retention of the acupuncture group,the acu-physiotherapy group and the blank group were 24.17%,21.67%,and 44.17%,indicating that both treating methods have significant effects(P<0.05),and acupuncture group was a little better than acu-physiotherapy group.The bladder function recovery rates of the 3 groups were 44.17%,56.67%,and 40.83%correspondingly,which had significant difference between acu-physiotherapy group and blank group(P<0.05).Both acupuncture and acu-physiotherapy could reduce the incidence of urinary retention for the patients of Ibl and IIal stages(P<0.01),whilst for patients of Ib2 and IIa2 stages,neither of the two methods was effective(P>0.05).Conclusion:Both acupuncture and acu-physiotherapy could prevent urinary retention after radical hysterectomy for local early cervical cancer(Ibl and IIal stages)effectively,and acupuncture was a little more effective than acu-physiotherapy group.Acupuncture together with modulated medium frequency eletro-therapy could improve the cure rate of bladder function and minimize the residual urine volume.展开更多
BACKGROUND: The number of females who undergo liver transplantation is growing and sometimes gynecologic operations are needed to control gynecologic diseases after liver transplantation. METHOD: Total laparoscopic hy...BACKGROUND: The number of females who undergo liver transplantation is growing and sometimes gynecologic operations are needed to control gynecologic diseases after liver transplantation. METHOD: Total laparoscopic hysterectomy was performed in 2 patients who had undergone liver transplantation, one for adenomyosis and the other for hysteromyoma. RESULTS: It was safe to create a pneumoperitoneum through the umbilical skinfold even though mild adhesion in the pelvic cavity occurred in one patient. The operative times were 95 and 90 minutes, with blood loss of about 100 and 60 ml, respectively. Oral intake, flatus passage, and ambulation recovered within a day, after the operation. No significant changes in liver function were observed except complication of diarrhea caused by Candida albicans in one patient. CONCLUSIONS: The result of the two patients suggest that total laparoscopic hysterectomy is a safe and effective surgical approach for patients who have undergone liver transplantation.展开更多
Objective:When performing cervical conization in post-menopausal cervical intraepithelial neoplasia 3(CIN3)patients,the positive rate of endocervical cone margin and the incidence of postoperative cervical stenosis in...Objective:When performing cervical conization in post-menopausal cervical intraepithelial neoplasia 3(CIN3)patients,the positive rate of endocervical cone margin and the incidence of postoperative cervical stenosis increase.This study summarized a 4-year experience of total laparoscopic hysterectomy as a treatment option for peri-menopausal and post-menopausal CIN3 patients at a single institution.Furthermore,it shared the refinement strategies used during the surgery.Methods:This study retrospectively analyzed the medical records of CIN3 patient aged45 years and who underwent open or laparoscopic hysterectomy at our institution from January 1,2017 to December 31,2020.Totally,30 CIN3 patients were enrolled and divided into abdominal hysterectomy group and laparoscopic hysterectomy based on surgery method,with 5 patients and 25 patients respectively.Results:Compared to the abdominal hysterectomy group,the perioperative blood loss(20 mL vs.220 mL,p=0.004)was less and the duration of in-hospital stay(7 d vs.11 d,p<0.001)were significantly shorter in the laparoscopic hysterectomy group.However,no significant differences in age at hysterectomy(53 y vs.77 y,p=0.054)and operative time(154.4±27.8 min vs.161.0±62.4 min,p=0.826)were observed between them.Diagnostic conization was performed in advance for 12 patients,and among them,10(83.3%)patients had positive endocervical cone margin.Postoperative intestinal obstructionwas noted in one abdominal hysterectomy patient,no other complications were observed in the remaining patients.Conclusion:Compared to conization,hysterectomy is more invasive;however,it is an acceptable treatment option for peri-menopausal and post-menopausal CIN3 patients.In such cases,opting for total laparoscopic hysterectomy adopted the marionette technique might be preferable because the procedure is less invasive.展开更多
Radical hysterectomy(RH) and pelvic lymphadenectomy are the main treatment methods for early cervical cancer and endometrial carcinoma.Effective care measures,however,can decrease the incidence of UTIs and complicatio...Radical hysterectomy(RH) and pelvic lymphadenectomy are the main treatment methods for early cervical cancer and endometrial carcinoma.Effective care measures,however,can decrease the incidence of UTIs and complications associated with RH and pelvic lymphadenectomy,as well as improve the therapeutic effects of administered drugs and patient prognosis.The writer refers to relevant literatures to analyze the reasons for postoperative UTIs and to provide a brief summary of the nursing methods for and progress in UTI prevention.展开更多
AIM To evaluate the feasibility,safety and peri-and postoperative outcomes of robotic single-site supracervical hysterectomy(RSSSH) for benign gynecologic disease.METHODS We report 3 patients who received RSSSH for ad...AIM To evaluate the feasibility,safety and peri-and postoperative outcomes of robotic single-site supracervical hysterectomy(RSSSH) for benign gynecologic disease.METHODS We report 3 patients who received RSSSH for adenomyosis of the uterus from November 2015 to April 2016.We evaluated the feasibility,safety and outcomes among these patients.RESULTS The mean surgical time was 244 min and the estimated blood loss was 216 mL,with no blood transfusion necessitated.The docking time was shortened gradually from 30 to 10 min.We spent 148 min on console operation.Manual morcel ation time was also short,ranging from 5 to 10 min.The mean hospital stay was 5 d.Lower VAS pain score was also noted.There is no complication during or after surgery.CONCLUSION RSSSH is feasible and safe,incurs less postoperative pain and gives good cosmetic appearance.The technique of inbag,manual morcellation can avoid tumor dissemination.展开更多
Objective To investigate the clinical diagnosis, treatment, and prevention of fallopian tube prolapse (FTP) after hysterectomy.Methods A total of 7949 patients received hysterectomy from January 1983 to August 2005 in...Objective To investigate the clinical diagnosis, treatment, and prevention of fallopian tube prolapse (FTP) after hysterectomy.Methods A total of 7949 patients received hysterectomy from January 1983 to August 2005 in Peking Union Medical College Hospital, and 9 cases (including 1 case from other hospital) of FTP after hysterectomy were involved during this period.All of them were diagnosed according to pathological results and were followed up.The symptoms, diagnosis, and treatment of the FTP patients were analyzed retrospectively.Results The incidence of FTP after hysterectomy was 0.1% (8/7949), with the incidence of FTP after trans- abdominal hysterectomy being 0.06% (4/6229), after trans-vaginal hysterectomy being 0.5% (4/780), after laparoscopic assistant vaginal hysterectomy being 0 (0/940).There was no symptom in 3 cases.The pelvic examination revealed the typical prolapsed fimbrial end of a fallopian tube in 3 cases and the other 6 cases revealed red granulation tissue.All of them were excised vaginally and cauterized.The results were proved by pathological examination.No recurrence was reported during follow-up.Conclusions FTP is a rare complication after hysterectomy.The prognosis is well after proper diagnosis and treatment.Fixation of accessories onto the pelvic wall and complete peritonealization at the time of hysterectomy are the most important methods to prevent FTP after hysterectomy.展开更多
Objective: To investigate the feasibility and safety of laparoscopic hysterectomy (LH) in early-stage malignant gynecological cancer. Methods: Data from patients who underwent surgical management for early-stage gynec...Objective: To investigate the feasibility and safety of laparoscopic hysterectomy (LH) in early-stage malignant gynecological cancer. Methods: Data from patients who underwent surgical management for early-stage gynecological cancer between 2009 and 2014 were retrospectively reviewed. Each woman gave her informed consent to be included into the study, which was previously approved by the local ethics committee and Institutional Review Board. Inclusion Criteria: All patients presented with stage I or II disease, and underwent comprehensive staging surgery consisting of hysterectomy or radical hysterectomy, with or without bilateral salpingo-oophorectomy, with or without para-aortic lymphadenectomy, with or without omentectomy, and peritoneal cytology. Results: 345 patients who underwent laparoscopic surgery (201 cervical cancer cases, 110 endometrial cancer cases and 34 ovarian cancer cases) were identified. Surgery for none of the patients was converted from laparoscopy to laparotomy. The median patient age for early-stage of gynecological cancer was 48 years (range, 29 - 71 years). 87 (25.22%) of whom were elderly (>60 years);98 (28.41%) were obese (>30 kg/m2);164 (62.96%) were postmenopausal;103 (29.86%) had undergone previous abdominal surgery;96 (25%) had a history of medical disease. The median operative time and estimated blood loss were 3.5 hours (range, 2.5 - 5.5 hour) and 80 mL (20 - 200 mL), respectively. Intra-operative and postoperative complications occurred in 6 (1.74%) and 34 (9.86%). None of the patients occurred death. The interval to bowel movement and indwelling catheter were 3 days (range, 1 - 5 days) and 7 days (range, 5 - 11 days). The median postoperative hospital stay was 10 days (range, 6 - 18 days). The mean operating time and hospital days for cervical cancer was shorter;the estimated blood loss was lower;and the peri-operative complications were lower in the second stage (July 2012-May 2014) than in the first three years (May 2009-June 2012) in our department展开更多
BACKGROUND In the presence of a large uterus,total laparoscopic hysterectomy(TLH),always requires morcellation to allow removal of the tissues from the abdominal cavity.However,uncontained morcellation has been scruti...BACKGROUND In the presence of a large uterus,total laparoscopic hysterectomy(TLH),always requires morcellation to allow removal of the tissues from the abdominal cavity.However,uncontained morcellation has been scrutinized because of the possible spread of occult leiomyosarcoma.Therefore,in-bag extracorporeal morcellation has been developed.However,tissue containment and extraction are extremely challenging,especially when considering the increasing uterine size to be removed through minimally invasive surgery.CASE SUMMARY Herein,we describe a novel technique for extracorporeal intrauterine morcellation using the uterus outermost layer as a bag to achieve tissue extraction of very large uteri with suspected occult leiomyosarcoma after TLH.The study enrolled patients who were planned for TLH for large uteri(weight>500 g).TLH was performed following the procedure reported in our previous studies.The novel technique has been described step-by-step in a video,which representatively describes the preoperative imaging and morcellation procedure of three very large uteri weighing 1500 g,1700 g,and 3700 g,respectively.The procedures were performed without any complications.The patients had an uneventful postoperative course,and in all cases,the pathology was benign leiomyoma.CONCLUSION Extracorporeal intrauterine morcellation using the uterus outmost layer as a bag was found to be a feasible technique that allows a careful diagnosis and safe removal of suspected occult malignancies.The technique herein presented may be adopted in surgical practice,by adding it to the other available techniques of contained morcellation.It may represent a valid and feasible alternative,especially useful in cases of very large uteri exceeding the capacity of specimen retrieval bags.展开更多
文摘Objective To determine the impact of planned preoperative phenazopyridine administration on operative times and costs compared with as-needed intravenous agent use during routine cystoscopy following minimally invasive hysterectomy for benign indications.Method This prospective cohort study examined patients who underwent laparoscopic or robotic-assisted total or supracervical hysterectomy for benign indications between January 27,2023 and March 11,2024,with one of our minimally invasive gynecologic surgeons at Stony Brook University Hospital.Patients were assigned to the non-phenazopyridine group or the phenazopyridine group.The time needed to visualize the ureteral jets during cystoscopy and the total surgery duration were recorded.A cost analysis was then performed.Results In total,106 patients were included,with 53 patients in each group.Compared with the non-phenazopyridine group,the phenazopyridine group had significantly shorter times from the start of cystoscopy to visualization of the first ureteral jet(31 s vs.42 s,p<0.05).However,there were no significant differences observed for visualization of the second jet,total jet time,or surgery duration.Two patients in the non-phenazopyridine group required the administration of intravenous agents intraoperatively.Routine phenazopyridine was found to be more cost-efficient when medication costs and operative times were examined.Conclusion Routine phenazopyridine use does not significantly shorten overall cystoscopy times,but it is the more cost-efficient option given increased rates of costly intravenous medication use in the non-phenazopyridine group.
文摘BACKGROUND Despite laparoscopic total hysterectomy provided more benefits to patients and has become one of the most commonly used surgical methods for total hysterectomy.However,vaginal cuff dehiscence is a serious complication after laparoscopic total hysterectomy and so far,there are limited studies on vaginal cuff dehiscence after a total hysterectomy.AIM To investigate the factors influencing vaginal cuff dehiscence after laparoscopic hysterectomy and the psychological state of the patients.METHODS This study retrospectively,univariately,and multivariately analyzed the clinical data of patients who experienced vaginal cuff dehiscence after laparoscopic hysterectomy in Yuyao People’s Hospital from January 2015 to December 2021.Logistic regression was utilized to analyze the high-risk factors of vaginal cuff dehiscence.RESULTS Among 1459 cases with laparoscopic hysterectomy,9 reported vaginal cuff dehiscence postoperatively,with an incidence of 0.617%.Univariate logistic regression analysis revealed that preoperative hemoglobin value[odds ratio(OR)=5.12,P=0.016],vaginal cuff suture method(OR=0.26,P=0.048),and postoperative first sexual lifetime(OR=15.86,P=0.002)were associated with vaginal cuff dehiscence following laparoscopic hysterectomy.Multivariate logistic regression analysis revealed that preoperative hemoglobin value of<90 g/L(OR=5.17,P=0.015)and time interval between postoperative first sexual life and operation of<3 months(OR=54.00,P=0.004)are independent risk factors for vaginal cuff dehiscence after laparoscopic hysterectomy.CONCLUSION Postoperative hemoglobin and the time interval between postoperative first sexual life and operation were the independent factors of developing vaginal cuff dehiscence after laparoscopic hysterectomy.
文摘Objective:To analyze the application value of a non-catheter tampon in abdominal hysterectomy,providing a reference for related research.Methods:A total of 100 patients were included in this study,with data collected between January 4,2022,and January 4,2024.The patients were divided into two groups:the new group and the traditional group,each comprising 50 patients.Results:Compared with the traditional group,the new group demonstrated significantly lower intraoperative blood loss(P<0.05).Additionally,the incidence of complications,operation time,hospital stay,time required to resume normal activities,and postoperative VAS scores were all significantly lower in the new group(P<0.05).Conclusion:The application of a non-catheter tampon during abdominal hysterectomy yields satisfactory results.This approach is worthy of further clinical promotion and application.
文摘Objective： To study the influences of different time intervals between loop electrosurgical excision （LEEP） and abdominal hysterectomy or radical hysterectomy on postoperative complications. Methods： Sixty-eight patients, who received subsequent abdominal hysterectomy or radical hysterectomy after LEEP due to C1N III and cervical cancer （IA1, IA2 and IB1）, were included in the present study. The hospital and clinic records of these patients were reviewed. The patients were divided into three groups according to the time intervals between LEEP and hysterectomy or radical hysterectomy： group l（within 48 h）, group 2 （between 48 h to 6 weeks）, and group 3（〉 6 weeks ）.Results： General characteristics of patients, including the mean age, delivery history, BMI, menopausal status, clinical stage and HPV infection, were comparable between patients of different groups. There were no significant differences in the mean transfusion amount, posthysterectomy hospital stay or operation time between different groups. The frequencies and spectrum of complications were not significantly affected by the time interval between LEEP and hysterectomy or radical hysterectomy. Conclusion： It is concluded that whenever the LEEP is done, the operation including hysterectomy or radical hysterectomy can be conducted at any time as it is necessary for the patients.
文摘Objective: to analyze the effect of laparoscopic radical hysterectomy in the treatment of early cervical cancer. Methods: ninety-two patients with early cervical cancer were randomly divided into control group and study group. Open and laparoscopic radical hysterectomy was performed, and the effect and safety were compared. Results: in the study group, the amount of blood loss during operation was less, the time of anal exhaust and antibiotic treatment after operation were shorter, P < 0.05. The number of lymph nodes beside iliac vessels, deep femoral lymph nodes, obturator lymph nodes and total lymph node dissection in the study group were more, P < 0.05. The scores of PFDI-20, POPDI-6, CRADI-8 and UDI-6 in the study group were higher, P < 0.05. The incidence of postoperative complications between the two groups was P > 0.05. After operation, the levels of SCC-Ag and CA724 in the two groups decreased (P > 0.05). After operation, the levels of IL-6, IL-8 and TNF-α in the study group were lower (P < 0.05). Conclusion: laparoscopic radical hysterectomy in the treatment of early cervical cancer is helpful to reduce the amount of bleeding, promote postoperative recovery and increase the number of lymph node dissection, but it has a great impact on pelvic floor function. It is necessary to choose the best operation method according to the actual condition of patients.
文摘Objective To evaluate the possibility of vaginal hysterectomy for patients with moderately enlarged uterus of benign lesions. Methods One hundred and seventeen women with benign uterine diseases underwent vaginal hysterectomy. These patients were divided into two groups according to uterine weight. Group Ⅰ contained 60 patients with uterine enlargement to a weight of 200 to 750 g, and group Ⅱ contained 57 patients with uterine weight of less than 200 g. Uterine morcellation was performed in some cases. The peri-operative data in both groups were analyzed. Results In group Ⅰ, 59 cases underwent transvaginal hysterectomy successfully, except 1 case con-verted to abdominal operation and the uterine morcellation was performed in 21 women. In group Ⅱ, all patients successfully underwent transvaginal hysterectomy without any assistance of special technique. The mean uterine weight of group Ⅰ was significantly heavier than that of group Ⅱ(280.18 ± 100.40 g vs 146.48 ± 35.19 g). The mean operating time was significantly longer for group Ⅰ than that for group Ⅱ(83.93 ± 26.26 minutes vs 35.22 ± 20.55 minutes). There were no significant differences in blood loss and complications between groupⅠ and group Ⅱ. There was no injury of urinary bladder or rectum, and no vaginal vault infection. Conclusions Vaginal hysterectomy of moderately enlarged uterus can be safely and effectively performed by experienced operators. In some cases, in order to reduce the uterine volume, uterine mor-cellation should be used to shorten operative time, reduce the bleeding, and lower the postoperative complications.
文摘BACKGROUND Cervical cancer is the most common gynecological malignancy,ranking first in female reproductive malignancies with more than 500000 new cases and 275000 deaths each year.Traditionally,open radical hysterectomy is considered the standard surgical procedure for the treatment of resectable cervical cancer.The latest guidelines from the National Comprehensive Cancer Network and the European Society of Gynecological Oncology suggest that open surgery and laparoscopic surgery(using traditional laparoscopic or robotic techniques)are the main surgical approaches for radical hysterectomy for patients with stage IA2-IIA cervical cancer.Robotic surgery has been increasingly used in abdominal surgery and has shown more beneficial effects.AIM To analyse the perioperative conditions,complications,and short-term and longterm effects in patients undergoing robotic radical hysterectomy(RRH)and laparoscopic radical hysterectomy(LRH)to compare their clinical efficacy,safety,and feasibility.METHODS The perioperative data of patients undergoing RRH and LRH were extracted and collected from the database of surgical treatments for cervical cancer for statistical analysis.RESULTS Of the patients,342 underwent LRH for cervical cancer,and 216 underwent RRH.The total complication rate was 9.65%(20 patients)in the RRH group and 17.59%(60 patients)in the LRH group.The complication rate was significantly lower in the RRH group than in the LRH group.There was no significant difference in the follow-up period(P=0.658).The total recurrence rates were 15.7%and 12%in the RRH and LRH groups,respectively.The progression-free survival time was 28.91±15.68 mo and 28.34±15.13 mo in the RRH and LRH groups,respectively(P=0.669).The overall survival(OS)rates were 92.13%and 94.45%in the RRH and LRH groups,respectively(P=0.292).The OS time was 29.87±15.92 mo and 29.41±15.14 mo in the RRH and LRH groups,respectively(P=0.732).The survival curves and the progression-free survival curves were not statistically significantly different between the two groups(P=0.407 and 0.28,respectively).CONCLUSION RRH is associated with significantly less operative time and blood loss than LRH.The two procedures have similar complication rates,OS,and progression-free survival time.
文摘BACKGROUND Uterine myomas are the most common benign gynecological soft tissue tumors in women but polycythemia associated with these tumors is rare.Polycythemia is significantly associated with risk of venous thromboembolism(VTE),which is further increased in case of a large pelvic mass and obesity.Here we report the surgical challenges in the case of an obese patient with a giant fibromatous uterus and associated polycythemia.CASE SUMMARY A 42-year-old obese woman was referred to our department for treatment for a huge fibromatous uterus.She suffered of pelvic pressure and abdominal distension and reported severe dyspnea from several months.Laboratory analyses including hemoglobin(Hb)19.2 g/dL and hematocrit(Hct)59.7%were indicative of polycythemia.Arterial blood gas analysis showed arterial oxygen pressure(pO2)of 81.5 mmHg.Abdominal computed tomography confirmed a giant fibromatous uterus measuring 28.2 cm×17 cm×25 cm.To reduce the thromboembolic risk,the patient underwent low molecular weight heparin,phlebotomy twice before surgery,and we opted for a laparoscopic hysterectomy.The uterus weighed 5400 g and the histology confirmed a diagnosis of leiomyoma.We did not find increased erythropoietin levels in the supernatant of the myomatous uterine tissue.There were no complications.On postoperative day 1,the Hb and the Hct levels normalized to 13.3 g/dL and 41.7%,respectively.Arterial blood gas analysis after surgery showed a pO2 of 144.7 mmHg.These results suggested the diagnosis of myomatous erythrocytosis syndrome.The patient was discharged on the second postoperative day in very good condition with no symptoms.CONCLUSION We believe this is the first reported laparoscopic hysterectomy in a patient with a giant uterus,polycythemia and obesity.Multiple VTE risk factors warranted a laparoscopic approach.
基金supported by the special fund for Capital City Clinical Specific Application Study(No.Z171100001017115)
文摘Objective: The aim of this study was to investigate the feasibility of using ultrasonic scalpel combined with vascular clip in parametrial management,called limited energy parametrial resection/dissection(LEPRD),in laparoscopic nerve plane-sparing radical hysterectomy(NPSRH),a modified nerve-sparing radical hysterectomy(NSRH); and to evaluate its effectiveness in pelvic autonomic nerve preservation.Methods: From July 2012 to January 2016,257 consecutive patients with stage IB1 to IIA2 cervical cancer who underwent NPSRH were included in this study.Patients were divided into three cohorts according to the different parametrial resection modality.The clinical,pathological and surgery-related parameters were compared between the three groups.Short-and long-term postoperative bladder functions were evaluated.Results: LEPRD was attempted in 94 patients,and was successful in 65(69.1%) patients(LEPRD group).The remaining 29(30.9%) patients required bipolar coagulation after failure of vascular clipping(combined modality group).Routine bipolar cautery was used in the other 163 patients during the parametrial resection(bipolar group).The blood loss in the LEPRD group was significantly lower than those in the other two groups(P<0.001).The rate of successful Foley removal on postoperative day 7 was significantly higher in the LEPRD group than in the bipolar group(P=0.022).The incidence of chronic voiding dysfunction was significantly lower in the LEPRD group than in the bipolar group(P=0.019).Conclusions: It is feasible to perform LEPRD in NPSRH for cervical cancers.This kind of limited energy surgical technique is associated with less blood loss,and leads to improved postoperative bladder function.
文摘Background： The radical hysterectomy （RH） surgical technique has improved along the years. It is used for the treatment of cervical cancer, endometrial cancer when affecting the cervix, and upper vaginal carcinomas. Our aim was to describe the historical evolution of the technique after the introduction of laparoseopy at our institution. Methods： We performed a retrospective review of medical records of patients who underwent RH, grouped in three periods according to the year of surgery： 1990-1999, 2000-2009 and 2010-2013. Patients＇ characteristics, pathologic details, intraoperative and postoperative complications were analyzed and comoared throughout the time periods. Results： A total of 102 cases of RH were performed at our center during the study period. Among all data collected, the presence of necrosis, age, number of lymph nodes, surgery route, operating time, hospital stay, blood loss and transfusion requirement were statistically significant different among groups. Conversion to laparotomy rate was 19% for the second period compared to the absence of cases in the last one. No significant differences （P=0.124） were observed in the adjuvant treatment received among the three different groups. At the time of the last contact the patients free of disease were 12 （85.7%）, 53 （91.3%） and 26 （86.6%） respectively （P=0.406）. Regarding the disease-free interval, we found significant better outcomes in the group of laparotomy compared to laparoscopy （P=0.015）.Conclusions： Laparoscopic RH is an acceptable surgery with advantages like magnified vision of the operation＇s field, lower surgical complications, shorter hospital stay and earlier resumption to daily activities.
文摘To investigate the efficacy and the clinical value of total laparoscopic radical hysterectomy(TLRH) for the treatment of uterine malignancies,we performed a retrospective review of 87 patients with cervical cancer and 23 patients with endometrial carcinoma who underwent TLRH at Union hospital between June 2008 and September 2009.Data collected included operative time,estimated blood loss,lymph node count,time for the recovery of normal temperature and time to resumption of normal bladder function,intraoperative and postoperative complications.The procedure was completed laparoscopically in 108 patients.Two patients were converted to laparotomy due to common iliac vein injury.The mean overall operative time was 200.6±38.6 min;the mean operative blood loss was 280.5±128.3 mL;the mean number of pelvic lymph nodes that were resected was 26.0±5.8.The time for recovery of normal temperature and the normal bladder function after the operation was 5.8±2.9 d and 15.2±4.3 d.There were 2(1.8%) common iliac vein injuries during the operation and 10(9.1%) bladder retentions post operation.It was concluded that TLRH is feasible,minimally invasive and provides promise for the treatment of uterine malignancies.
文摘To evaluate the role of hysterectomy for patients with gestational trophoblastic tumor. [WT5”BX]Methods.[WT5”BZ]We retrospectively analyzed 68 cases of gestational trophoblastic neoplasia treated by hysterectomy from 1985～1997 at PUMC hospital. Thirty eight cases were diagnosed of choriocarcinoma and 30 were invasive mole. [WT5”BX]Results.[WT5”BZ]Twenty three elder patients who didn’t desire to preserve fertility were selected for hysterectomy after shorter courses of chemotherapy, 22 of them had a complete remission(95 6%), the total aver age courses of chemotherapy was 4 2. Of twenty seven chemorefractory cases who were suspected of a refractory isolated lesion in the uterus, delayed hysterectomy as an adjunct to chemotherapy was performed, 20 of them got a complete remission(74 1%), the total average courses of chemotherapy were 9 4. Emergency hysterectomy is indicated in 18 patients with uterine perforation or life threatening hemorrhage, 17 cases had a complete remission(94 4%), the total average courses of chemotherapy were 7 6. [WT5”BX]Conclusion.[WT5”BZ]Although the development of effective chemotherapy has resulted in improved survival of patients with gestational trophoblastic tumor, hysterectomy remains an important adjuncts in the treatment of a selected subset of patients; in order to operate more completely and prevent recurrence, it’s better to perform extended hysterectomy for the indicated patients.
文摘Objective:To analysis the clinical curative effect on bladder function recovery after radical hysterectomy with acupuncture and acu-physiotherapy.Methods:A total of 564 cervical cancer patients in the gynecology department who received radical hysterectomy from January 2011 to December 2017 in Qilu Hospital of Shandong University were collected.According to the inclusion and exclusion criteria,we studied 360 case records at last,with 120 cases respectively.Patients got treatment of acupuncture[acupuncture at Zhongwan(中脘CV12),Tianshu(天枢ST25),Shuidao(水道ST28),TAichong(太冲LI3),Sanyinjiao(三阴交SP6),Zusanli(足三里ST36)and Yinlingquan(阴陵泉SP9)],or acu-physiotherapy with two large-size electrodes placed on the bladder area above the pubic symphysis besides acupuncture,from the 3 rd day after operation once a day till the14 th day that removing the indwelling catheter.And the blank group got no other auxiliary treatment except scrubbed the meatus orifice with iodophor twice a day.We tested the residual urine volume 6 h later after removement of indwelling catheter.Residual urine volume more than 100 mL was defined as urinary retention,and the volume less than 50 mL was defined as adequate bladder emptying.Results:We analyzed patients’age,the International Federation of Gynecology and Obstetrics(FIGO)stage,operation duration,amount of hemorrhage,depth of myometrium infiltration,cancer embolus,parametrium invasion,lymphatic metastasis,treating methods and residual urine volume recorded in case records,and there was no significant difference between every two groups(P>0.05).The incidences of urinary retention of the acupuncture group,the acu-physiotherapy group and the blank group were 24.17%,21.67%,and 44.17%,indicating that both treating methods have significant effects(P<0.05),and acupuncture group was a little better than acu-physiotherapy group.The bladder function recovery rates of the 3 groups were 44.17%,56.67%,and 40.83%correspondingly,which had significant difference between acu-physiotherapy group and blank group(P<0.05).Both acupuncture and acu-physiotherapy could reduce the incidence of urinary retention for the patients of Ibl and IIal stages(P<0.01),whilst for patients of Ib2 and IIa2 stages,neither of the two methods was effective(P>0.05).Conclusion:Both acupuncture and acu-physiotherapy could prevent urinary retention after radical hysterectomy for local early cervical cancer(Ibl and IIal stages)effectively,and acupuncture was a little more effective than acu-physiotherapy group.Acupuncture together with modulated medium frequency eletro-therapy could improve the cure rate of bladder function and minimize the residual urine volume.
文摘BACKGROUND: The number of females who undergo liver transplantation is growing and sometimes gynecologic operations are needed to control gynecologic diseases after liver transplantation. METHOD: Total laparoscopic hysterectomy was performed in 2 patients who had undergone liver transplantation, one for adenomyosis and the other for hysteromyoma. RESULTS: It was safe to create a pneumoperitoneum through the umbilical skinfold even though mild adhesion in the pelvic cavity occurred in one patient. The operative times were 95 and 90 minutes, with blood loss of about 100 and 60 ml, respectively. Oral intake, flatus passage, and ambulation recovered within a day, after the operation. No significant changes in liver function were observed except complication of diarrhea caused by Candida albicans in one patient. CONCLUSIONS: The result of the two patients suggest that total laparoscopic hysterectomy is a safe and effective surgical approach for patients who have undergone liver transplantation.
文摘Objective:When performing cervical conization in post-menopausal cervical intraepithelial neoplasia 3(CIN3)patients,the positive rate of endocervical cone margin and the incidence of postoperative cervical stenosis increase.This study summarized a 4-year experience of total laparoscopic hysterectomy as a treatment option for peri-menopausal and post-menopausal CIN3 patients at a single institution.Furthermore,it shared the refinement strategies used during the surgery.Methods:This study retrospectively analyzed the medical records of CIN3 patient aged45 years and who underwent open or laparoscopic hysterectomy at our institution from January 1,2017 to December 31,2020.Totally,30 CIN3 patients were enrolled and divided into abdominal hysterectomy group and laparoscopic hysterectomy based on surgery method,with 5 patients and 25 patients respectively.Results:Compared to the abdominal hysterectomy group,the perioperative blood loss(20 mL vs.220 mL,p=0.004)was less and the duration of in-hospital stay(7 d vs.11 d,p<0.001)were significantly shorter in the laparoscopic hysterectomy group.However,no significant differences in age at hysterectomy(53 y vs.77 y,p=0.054)and operative time(154.4±27.8 min vs.161.0±62.4 min,p=0.826)were observed between them.Diagnostic conization was performed in advance for 12 patients,and among them,10(83.3%)patients had positive endocervical cone margin.Postoperative intestinal obstructionwas noted in one abdominal hysterectomy patient,no other complications were observed in the remaining patients.Conclusion:Compared to conization,hysterectomy is more invasive;however,it is an acceptable treatment option for peri-menopausal and post-menopausal CIN3 patients.In such cases,opting for total laparoscopic hysterectomy adopted the marionette technique might be preferable because the procedure is less invasive.
文摘Radical hysterectomy(RH) and pelvic lymphadenectomy are the main treatment methods for early cervical cancer and endometrial carcinoma.Effective care measures,however,can decrease the incidence of UTIs and complications associated with RH and pelvic lymphadenectomy,as well as improve the therapeutic effects of administered drugs and patient prognosis.The writer refers to relevant literatures to analyze the reasons for postoperative UTIs and to provide a brief summary of the nursing methods for and progress in UTI prevention.
文摘AIM To evaluate the feasibility,safety and peri-and postoperative outcomes of robotic single-site supracervical hysterectomy(RSSSH) for benign gynecologic disease.METHODS We report 3 patients who received RSSSH for adenomyosis of the uterus from November 2015 to April 2016.We evaluated the feasibility,safety and outcomes among these patients.RESULTS The mean surgical time was 244 min and the estimated blood loss was 216 mL,with no blood transfusion necessitated.The docking time was shortened gradually from 30 to 10 min.We spent 148 min on console operation.Manual morcel ation time was also short,ranging from 5 to 10 min.The mean hospital stay was 5 d.Lower VAS pain score was also noted.There is no complication during or after surgery.CONCLUSION RSSSH is feasible and safe,incurs less postoperative pain and gives good cosmetic appearance.The technique of inbag,manual morcellation can avoid tumor dissemination.
文摘Objective To investigate the clinical diagnosis, treatment, and prevention of fallopian tube prolapse (FTP) after hysterectomy.Methods A total of 7949 patients received hysterectomy from January 1983 to August 2005 in Peking Union Medical College Hospital, and 9 cases (including 1 case from other hospital) of FTP after hysterectomy were involved during this period.All of them were diagnosed according to pathological results and were followed up.The symptoms, diagnosis, and treatment of the FTP patients were analyzed retrospectively.Results The incidence of FTP after hysterectomy was 0.1% (8/7949), with the incidence of FTP after trans- abdominal hysterectomy being 0.06% (4/6229), after trans-vaginal hysterectomy being 0.5% (4/780), after laparoscopic assistant vaginal hysterectomy being 0 (0/940).There was no symptom in 3 cases.The pelvic examination revealed the typical prolapsed fimbrial end of a fallopian tube in 3 cases and the other 6 cases revealed red granulation tissue.All of them were excised vaginally and cauterized.The results were proved by pathological examination.No recurrence was reported during follow-up.Conclusions FTP is a rare complication after hysterectomy.The prognosis is well after proper diagnosis and treatment.Fixation of accessories onto the pelvic wall and complete peritonealization at the time of hysterectomy are the most important methods to prevent FTP after hysterectomy.
文摘Objective: To investigate the feasibility and safety of laparoscopic hysterectomy (LH) in early-stage malignant gynecological cancer. Methods: Data from patients who underwent surgical management for early-stage gynecological cancer between 2009 and 2014 were retrospectively reviewed. Each woman gave her informed consent to be included into the study, which was previously approved by the local ethics committee and Institutional Review Board. Inclusion Criteria: All patients presented with stage I or II disease, and underwent comprehensive staging surgery consisting of hysterectomy or radical hysterectomy, with or without bilateral salpingo-oophorectomy, with or without para-aortic lymphadenectomy, with or without omentectomy, and peritoneal cytology. Results: 345 patients who underwent laparoscopic surgery (201 cervical cancer cases, 110 endometrial cancer cases and 34 ovarian cancer cases) were identified. Surgery for none of the patients was converted from laparoscopy to laparotomy. The median patient age for early-stage of gynecological cancer was 48 years (range, 29 - 71 years). 87 (25.22%) of whom were elderly (>60 years);98 (28.41%) were obese (>30 kg/m2);164 (62.96%) were postmenopausal;103 (29.86%) had undergone previous abdominal surgery;96 (25%) had a history of medical disease. The median operative time and estimated blood loss were 3.5 hours (range, 2.5 - 5.5 hour) and 80 mL (20 - 200 mL), respectively. Intra-operative and postoperative complications occurred in 6 (1.74%) and 34 (9.86%). None of the patients occurred death. The interval to bowel movement and indwelling catheter were 3 days (range, 1 - 5 days) and 7 days (range, 5 - 11 days). The median postoperative hospital stay was 10 days (range, 6 - 18 days). The mean operating time and hospital days for cervical cancer was shorter;the estimated blood loss was lower;and the peri-operative complications were lower in the second stage (July 2012-May 2014) than in the first three years (May 2009-June 2012) in our department
文摘BACKGROUND In the presence of a large uterus,total laparoscopic hysterectomy(TLH),always requires morcellation to allow removal of the tissues from the abdominal cavity.However,uncontained morcellation has been scrutinized because of the possible spread of occult leiomyosarcoma.Therefore,in-bag extracorporeal morcellation has been developed.However,tissue containment and extraction are extremely challenging,especially when considering the increasing uterine size to be removed through minimally invasive surgery.CASE SUMMARY Herein,we describe a novel technique for extracorporeal intrauterine morcellation using the uterus outermost layer as a bag to achieve tissue extraction of very large uteri with suspected occult leiomyosarcoma after TLH.The study enrolled patients who were planned for TLH for large uteri(weight>500 g).TLH was performed following the procedure reported in our previous studies.The novel technique has been described step-by-step in a video,which representatively describes the preoperative imaging and morcellation procedure of three very large uteri weighing 1500 g,1700 g,and 3700 g,respectively.The procedures were performed without any complications.The patients had an uneventful postoperative course,and in all cases,the pathology was benign leiomyoma.CONCLUSION Extracorporeal intrauterine morcellation using the uterus outmost layer as a bag was found to be a feasible technique that allows a careful diagnosis and safe removal of suspected occult malignancies.The technique herein presented may be adopted in surgical practice,by adding it to the other available techniques of contained morcellation.It may represent a valid and feasible alternative,especially useful in cases of very large uteri exceeding the capacity of specimen retrieval bags.
