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Archives of Gynecology and Obstetrics Sep 2023The authors discuss the incidence, the embryological development, the classification, the presentation and the treatment options of this rare reproductive tract... (Review)
Review
The authors discuss the incidence, the embryological development, the classification, the presentation and the treatment options of this rare reproductive tract abnormality. In the past, the treatment proposed almost unanimously was hysterectomy and subsequent construction, when necessary, of a neovagina. In recent decades, numerous experiences of conservative therapies have accumulated that allow the restoration of menstrual function and in some rare cases even the achievement of a pregnancy. However, complications associated with recanalization of the cervix frequently resulted in the need for repeated surgery, risk of serious and sometimes fatal ascending infection. This review aims to analyze the most recent and significant experiences of conservative surgery in this field to provide an accurate picture of the various techniques and their outcomes, especially from the point of view of fertility. Conservative surgery should now be considered as the first-line treatment option. On the other hand, it is not possible to draw conclusions on the superiority of one technique over another among the various conservative options. This would require large series with adequate follow-up, which unfortunately are not available.
Topics: Pregnancy; Female; Humans; Cervix Uteri; Surgery, Plastic; Uterine Cervical Neoplasms; Plastic Surgery Procedures; Hysterectomy; Vagina; Congenital Abnormalities
PubMed: 36305896
DOI: 10.1007/s00404-022-06825-5 -
Frontiers in Medicine 2023Vaginal vault prolapse, also known as apical prolapse, is a distressing condition that may affect women following hysterectomy, necessitating surgical intervention when...
Comparison of laparoscopic sacrocolpopexy with vaginal reconstructive procedures and abdominal sacrocolpopexy for the surgical management of vaginal vault prolapse: a systematic review and meta-analysis.
INTRODUCTION
Vaginal vault prolapse, also known as apical prolapse, is a distressing condition that may affect women following hysterectomy, necessitating surgical intervention when conservative measures prove ineffective. The surgical management of apical compartment prolapse includes procedures such as laparoscopic sacrocolpopexy (LSCP), abdominal sacrocolpopexy (ASCP) or vaginal reconstructive procedures (VRP). This systematic review and meta-analysis aims to compare the outcomes of these interventions.
METHODS
A comprehensive search of electronic databases was conducted to identify eligible studies. Fourteen studies comprising a total of 1,289 women were included. The selected studies were analyzed to evaluate outcomes such as duration of surgery, length of hospital stay, blood loss, complication rates, and patient satisfaction.
RESULTS
LSCP did not demonstrate significant advantages over VRP in terms of perioperative or long-term outcomes. However, when compared to ASCP, LSCP showed shorter hospital stay, reduced blood loss, decreased postoperative pain, and lower rates of ileus.
DISCUSSION
This systematic review contributes to evidence-based decision-making for the surgical treatment of vaginal vault prolapse. While LSCP did not exhibit substantial benefits over VRP, it emerged as a preferable option compared to ASCP due to shorter hospital stays and reduced postoperative complications. The findings from this study provide valuable insights for clinicians and patients in selecting the most appropriate surgical approach for vaginal vault prolapse. However, future research should focus on long-term follow-ups, standardizing outcomes, and outcome measures, and evaluating cost-effectiveness to further enhance clinical practice.
PubMed: 37766917
DOI: 10.3389/fmed.2023.1269214 -
Obstetrics and Gynecology Apr 2024To systematically review the literature to evaluate clinical and surgical outcomes for technologies that facilitate vaginal surgical procedures.
OBJECTIVE
To systematically review the literature to evaluate clinical and surgical outcomes for technologies that facilitate vaginal surgical procedures.
DATA SOURCES
We systematically searched MEDLINE, EMBASE, and ClinicalTrials.gov from January 1990 to May 2022.
METHODS OF STUDY SELECTION
Comparative and single-arm studies with data on contemporary tools or technologies facilitating intraoperative performance of vaginal gynecologic surgical procedures for benign indications were included. Citations were independently double screened, and eligible full-text articles were extracted by two reviewers. Data collected included study characteristics, technology, patient demographics, and intraoperative and postoperative outcomes. Risk of bias for comparative studies was assessed using established methods, and restricted maximum likelihood model meta-analyses were conducted as indicated.
TABULATION, INTEGRATION, AND RESULTS
The search yielded 8,658 abstracts, with 116 eligible studies that evaluated pedicle sealing devices (n=32), nonrobotic and robotic vaginal natural orifice transluminal endoscopic surgery (n=64), suture capture devices (n=17), loop ligatures (n=2), and table-mounted telescopic cameras (n=1). Based on 19 comparative studies, pedicle sealing devices lowered vaginal hysterectomy operative time by 15.9 minutes (95% CI, -23.3 to -85), blood loss by 36.9 mL (95% CI, -56.9 to -17.0), hospital stay by 0.2 days (95% CI, -0.4 to -0.1), and visual analog scale pain scores by 1.4 points on a subjective 10-point scale (95% CI, -1.7 to -1.1). Three nonrandomized comparative studies and 53 single-arm studies supported the feasibility of nonrobotic vaginal natural orifice transluminal endoscopic surgery for hysterectomy, adnexal surgery, pelvic reconstruction, and myomectomy. Data were limited for robotic vaginal natural orifice transluminal endoscopic surgery, suture capture devices, loop ligatures, and table-mounted cameras due to few studies or study heterogeneity.
CONCLUSION
Pedicle sealing devices lower operative time and blood loss for vaginal hysterectomy, with modest reductions in hospital stay and pain scores. Although other technologies identified in the literature may have potential to facilitate vaginal surgical procedures and improve outcomes, additional comparative effectiveness research is needed.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, CRD42022327490.
Topics: Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Gynecologic Surgical Procedures; Vagina; Laparoscopy; Pain; Natural Orifice Endoscopic Surgery
PubMed: 38301255
DOI: 10.1097/AOG.0000000000005522 -
International Journal of Gynaecology... Dec 2019The incidence of placenta accreta has increased in recent years and it has been suggested that the rising trend in cesarean delivery and other uterine surgery is the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The incidence of placenta accreta has increased in recent years and it has been suggested that the rising trend in cesarean delivery and other uterine surgery is the underlying cause.
OBJECTIVE
To explore the magnitude of the effect of performing single and repeat cesarean deliveries or other uterine surgery on the incidence of placenta accreta.
SEARCH STRATEGY
Relevant databases were searched for papers published before August 1, 2018, using terms including "accreta" and "cesarean."
SELECTION CRITERIA
Cohort studies assessing the risk of placenta accreta according to women's history of uterine surgery.
DATA COLLECTION AND ANALYSIS
Meta-analyses were performed to assess the risks associated between uterine surgery and placenta accreta, hysterectomy, and uterine rupture. The I statistic was used to examine between-study heterogeneity.
MAIN RESULTS
The risk of placenta accreta in a second pregnancy increased for women who had undergone a cesarean in their first pregnancy compared with vaginal delivery (OR 3.02; 95% CI, 1.50-6.08). Absolute risk of placenta accreta increased with the number of previous cesareans. The risk of uterine rupture and hysterectomy was also associated with the number of cesareans.
CONCLUSIONS
Risk of placenta accreta, hysterectomy, and uterine rupture increases with the number of previous cesarean deliveries.
PROSPERO
CRD42016050646.
Topics: Adult; Cesarean Section, Repeat; Female; Humans; Hysterectomy; Incidence; Placenta Accreta; Pregnancy; Retrospective Studies; Risk Factors; Uterine Rupture
PubMed: 31469907
DOI: 10.1002/ijgo.12948 -
Journal of Pediatric Urology Oct 2021Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome is a rare female urogenital tract malformation.
INTRODUCTION
Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome is a rare female urogenital tract malformation.
STUDY OBJECTIVE
To present 10 patients with OHVIRA treated at the clinical center. To perform a systematic review of OHVIRA case series related to the prevalence of anatomical variants, surgical interventions and endometriosis, and to compare them with our case series.
MATERIALS AND METHODS
Medical records from 10 OHVIRA patients treated between 2016 and 2020 were retrospectively reviewed. For the systematic review, PubMed and Web of Science were used to search for relevant studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were strictly followed.
RESULTS
The most common anatomical variant includes left obstructed hemivagina (50.7%) with isolated hematocolpos or hydrocolpos (55.9%), uterus didelphys (82.9%), and ipsilateral renal agenesis (92.2%). Vaginal septectomy was the most common surgical approach (86.5%). Hemivaginectomy (2.2%), hemihysterectomy (4.2%), or total hysterectomy (0.7%) were also performed in several patients. Some subjects required salpingectomy (3.3%) or oophorectomy (1.8%). 7.5% of patients, mainly infants, did not require surgery due to the spontaneous resolution of hydrocolpos. Endometriosis was fortuitously found in 13.6% of the selected cases who underwent laparoscopy or laparotomy.
DISCUSSION
The most common variant of OHVIRA includes isolated hematocolpos and a thick vaginal septum between adjacent hemivaginas. Endometriosis was present in approximately 14% of OHVIRA patients, but this number is probably underestimated. Routine laparoscopy is not required. However, all patients need further monitoring due to a higher risk of endometriosis. Based on the analyzed studies and our case series, vaginal septectomy is a sufficient surgical technique to relieve symptoms and prevent possible complications in most OHVIRA patients.
Topics: Abnormalities, Multiple; Female; Humans; Infant; Kidney; Kidney Diseases; Retrospective Studies; Urogenital Abnormalities; Uterus; Vagina
PubMed: 34274235
DOI: 10.1016/j.jpurol.2021.06.023 -
International Journal of Environmental... Apr 2021In hysterectomized patients, even though there is still controversy, evidence indicates that in the short term, the vaginal approach shows benefits over the laparoscopic...
In hysterectomized patients, even though there is still controversy, evidence indicates that in the short term, the vaginal approach shows benefits over the laparoscopic approach, as it is less invasive, faster and less costly. However, the quality of sexual life has not been systematically reviewed in terms of the approach adopted. Through a systematic review, we analyzed (CRD42020158465 in PROSPERO) the impact of hysterectomy on sexual quality and whether there are differences according to the surgical procedure (abdominal or vaginal) for noncancer patients. MEDLINE (through PubMed), Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and Scopus were reviewed to find randomized clinical trials assessing sexuality in noncancer patients undergoing total hysterectomy, comparing vaginal and abdominal (laparoscopic and/or open) surgery. Three studies that assessed the issue under study were finally included. Two of these had a low risk of bias (Cochrane risk of bias tool); one was unclear. There was significant variability in how sexuality was measured, with no differences between the two approaches considered in the review. In conclusion, no evidence was found to support one procedure (abdominal or vaginal) over another for non-oncological hysterectomized patients regarding benefits in terms of sexuality.
Topics: Female; Humans; Hysterectomy; Laparoscopy; Sexuality
PubMed: 33920177
DOI: 10.3390/ijerph18083994 -
Updates in Surgery Apr 2023Laparoscopic surgery underwent great improvements during the last few years. This review aims to compare the performance of Trainee Surgeons using 2D versus 3D/4 K... (Meta-Analysis)
Meta-Analysis Review
Laparoscopic surgery underwent great improvements during the last few years. This review aims to compare the performance of Trainee Surgeons using 2D versus 3D/4 K laparoscopy. A systematic review of the literature was done on Pubmed, Embase, Cochrane's Library and Scopus. The following words and key phrases have been searched: "Two-dimensional vision", "Three-dimensional vision", "2D and 3D laparoscopy", "Trainee surgeons". This systematic review was reported according to the PRISMA statement 2020. PROSPERO registration No. CRD42022328045. Twenty-two randomized controlled trials (RCTs) and two observational studies were included in the systematic review. Two trials were carried out in a clinical setting, and twenty-two trials were performed in a simulated setting. In studies involving the use of a box trainer, the number of errors in the 2D laparoscopic group was significantly higher than in the 3D laparoscopic group during the performance of FLS skill tasks: peg transfer (MD: -0.82; 95% CI - 1.17 to - 0.47; p < 0.00001), cutting (MD: - 1.09; 95% CI - 1.50 to - 0.69 p < 0.00001), suturing (MD: - 0.48; 95% CI - 0.83 to - 0.13 p = 0.007), However, in clinical studies, there was no significant difference in the time taken for laparoscopic total hysterectomy (MD: 8.71; 95% CI - 13.55 to 30.98; p = 0.44) and vaginal cuff closure (MD: 2.00; 95% CI - 0.72 to - 4.72; p = 0.15) between 2D group and 3D group. 3D laparoscopy facilitates learning for novice surgeons and shows improvements in their laparoscopic performance.
Topics: Female; Humans; Surgeons; Laparoscopy; Clinical Competence; Learning; Operative Time; Imaging, Three-Dimensional
PubMed: 36811183
DOI: 10.1007/s13304-023-01465-z -
Medicina (Kaunas, Lithuania) Jun 2022: To assess the use of near infrared radiation imaging after injection of indocyanine green (NIR-ICG) during laparoscopic treatment of benign gynecologic conditions. : A... (Review)
Review
The Use of near Infra-Red Radiation Imaging after Injection of Indocyanine Green (NIR-ICG) during Laparoscopic Treatment of Benign Gynecologic Conditions: Towards Minimalized Surgery. A Systematic Review of Literature.
: To assess the use of near infrared radiation imaging after injection of indocyanine green (NIR-ICG) during laparoscopic treatment of benign gynecologic conditions. : A systematic review of the literature was performed searching 7 electronic databases from their inception to March 2022 for all studies which assessed the use of NIR-ICG during laparoscopic treatment of benign gynecological conditions. : 16 studies (1 randomized within subject clinical trial and 15 observational studies) with 416 women were included. Thirteen studies assessed patients with endometriosis, and 3 studies assessed non-endometriosis patients. In endometriosis patients, NIR-ICG use appeared to be a safe tool for improving the visualization of endometriotic lesions and ureters, the surgical decision-making process with the assessment of ureteral perfusion after conservative surgery and the intraoperative assessment of bowel perfusion during recto-sigmoid endometriosis nodule surgery. In non-endometriosis patients, NIR-ICG use appeared to be a safe tool for evaluating vascular perfusion of the vaginal cuff during total laparoscopic hysterectomy (TLH) and robotic-assisted total laparoscopic hysterectomy (RATLH), and intraoperative assessment of ovarian perfusion in adnexal torsion. : NIR-ICG appeared to be a useful tool for enhancing laparoscopic treatment of some benign gynecologic conditions and for moving from minimally invasive surgery to minimalized surgery. In particular, it might improve treatment of endometriosis (with particular regard to deep infiltrating endometriosis), benign diseases requiring TLH and RATLH and adnexal torsion. However, although preliminary findings appear promising, further investigation with well-designed larger studies is needed.
Topics: Endometriosis; Female; Humans; Indocyanine Green; Laparoscopy; Ovarian Torsion; Randomized Controlled Trials as Topic; Ureter
PubMed: 35744056
DOI: 10.3390/medicina58060792 -
Medicine Jul 2022This study aimed to systematically review the existing literature on epithelioid trophoblastic tumors (ETTs), the rarest type of gestational trophoblastic neoplasia.
BACKGROUND
This study aimed to systematically review the existing literature on epithelioid trophoblastic tumors (ETTs), the rarest type of gestational trophoblastic neoplasia.
METHODS
A systematic review according to PRISMA guidelines was performed, using ScienceDirect, Web of Science, and Scopus databases. The only filter used was the English language. Eligibility/inclusion criteria: retrospective observational studies (case reports, case series) including full case description of epithelioid trophoblastic tumor lesions.
RESULTS
Seventy studies were assessed for synthesis, including 147 cases. 66.7% of patients with ETT presented with irregular vaginal bleeding. Pretreatment β-hCG levels ranged up to 1000 mIU/mL in 58.5% patients. Of most patients, 42.2% had stage I disease, 10.9% stage II, 25.2% stage III, and 21.8% of patients had stage IV. The most common sites of metastatic disease were the lungs, followed by the liver and brain. After treatment, complete remission was achieved in 75.5% of patients, partial remission in 10.2% of patients, and 14.3% of patients died. On univariate and multivariate analyses, stage IV disease was an independent prognostic factor for overall and disease-free survival.
CONCLUSIONS
Hysterectomy and metastatic lesion resection are essential for controlling ETT. Investigational studies on molecules like EGFR, VEGF, PD-1, CD105, and LPCAT1 are potential therapeutic targets for metastatic ETT.
Topics: Female; Gestational Trophoblastic Disease; Humans; Hysterectomy; Pregnancy; Trophoblastic Neoplasms; Uterine Neoplasms
PubMed: 35905248
DOI: 10.1097/MD.0000000000029934 -
International Journal of Gynaecology... Jul 2024Previous reviews on hysterectomy versus uterine-sparing surgery in pelvic organ prolapse (POP) repair did not consider that the open abdominal approach or transvaginal... (Meta-Analysis)
Meta-Analysis Comparative Study Review
BACKGROUND
Previous reviews on hysterectomy versus uterine-sparing surgery in pelvic organ prolapse (POP) repair did not consider that the open abdominal approach or transvaginal mesh use have been largely abandoned.
OBJECTIVES
To provide up-to-date evidence by examining only studies investigating techniques currently in use for POP repair.
SEARCH STRATEGY
MEDLINE and Embase databases were searched from inception to January 2023.
SELECTION CRITERIA
We included randomized and non-randomized studies comparing surgical procedures for POP with or without concomitant hysterectomy. Studies describing open abdominal approaches or transvaginal mesh implantation were excluded.
DATA COLLECTION AND ANALYSIS
A random effect meta-analysis was conducted on extracted data reporting pooled mean differences and odds ratios (OR) between groups with 95% confidence intervals (CI).
MAIN RESULTS
Thirty-eight studies were included. Hysterectomy and uterine-sparing procedures did not differ in reoperation rate (OR 0.93; 95% CI 0.74-1.17), intraoperative major (OR 1.34; 95% CI 0.79-2.26) and minor (OR 1.38; 95% CI 0.79-2.4) complications, postoperative major (OR 1.42; 95% CI 0.85-2.37) and minor (OR 1.18; 95% CI 0.9-1.53) complications, and objective (OR 1.38; 95% CI 0.92-2.07) or subjective (OR 1.23; 95% CI 0.8-1.88) success. Uterine preservation was associated with a shorter operative time (-22.7 min; 95% CI -16.92 to -28.51 min), shorter hospital stay (-0.35 days, 95% CI -0.04 to -0.65 days), and less blood loss (-61.7 mL; 95% CI -31.3 to -92.1 mL). When only studies using a laparoscopic approach for both arms were considered, no differences were observed in investigated outcomes between the two groups.
CONCLUSIONS
No major differences were observed in POP outcomes between procedures with and without concomitant hysterectomy. The decision to preserve or remove the uterus should be tailored on individual factors.
Topics: Humans; Female; Pelvic Organ Prolapse; Hysterectomy; Organ Sparing Treatments; Postoperative Complications; Uterus; Reoperation; Operative Time
PubMed: 38269852
DOI: 10.1002/ijgo.15343