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Obstetrics and Gynecology International 2023To study the outcomes of new pregnancies after a previous complete uterine rupture.
OBJECTIVE
To study the outcomes of new pregnancies after a previous complete uterine rupture.
DESIGN
Descriptive study based on population data from the Medical Birth Registry of Norway, the Patient Administration System, and the medical records. . Maternities with a previous complete uterine rupture in Norway during the period 1967-2011 ( = 72), extracted from 2 455 797 maternities.
METHOD
We measured the rate of new complete ruptures and partial ruptures, as well as the maternal and perinatal outcomes of these pregnancies. The characteristics of both previous ruptures and new ruptures were described.
RESULTS
Among 72 maternities, there were thirty-seven with previous ruptures in the lower segment (LS) and 35 outside the LS. We found three new complete ruptures and six uneventful partial ruptures, resulting in a rate of 4.2% and 8.3%, respectively. All three complete ruptures occurred preterm in scars outside the LS. The rate of the new complete rupture was 0% in those with previous ruptures in the LS and 8.6% in those with previous ruptures outside the LS. The corrected perinatal mortality was 1.3%, and prematurity (<37 weeks) was high (36.1%); this was noticed even in the absence of new ruptures and was mostly iatrogenic. Two hysterectomies were performed in the absence of rupture and two cases had abnormal invasive placenta.
CONCLUSION
The prognosis for pregnancies after a previous complete uterine rupture is favorable. Prematurity is a problem caused by both obstetrician and mother's anxiety; therefore, the timing of delivery is the most challenging. Management should include careful counseling, vigilance for symptoms, and immediate delivery when a rupture is suspected.
PubMed: 36819713
DOI: 10.1155/2023/9056489 -
BMC Cancer Dec 2022Preoperative neoadjuvant chemotherapy (NACT) has been widely used in developing countries for the treatment of patients with International Federation of Gynecology and... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Preoperative neoadjuvant chemotherapy (NACT) has been widely used in developing countries for the treatment of patients with International Federation of Gynecology and Obstetrics (FIGO) stages IB3 and IIA2 cervical cancer. However, the effectiveness of NACT and treatment options for NACT-insensitive patients have been concerning. This study will assess prognostic differences between NACT and primary surgery treatment (PST), determine factors associated with prognosis, and explore better adjuvant treatment modalities for NACT-insensitive patients.
METHODS
This study analyzed clinical characteristics, pathological characteristics, treatment options, and follow-up information of 774 patients with FIGO stages IB3 and IIA2 cervical cancer from 28 centers from January 2016 to October 2019 who participated in a multicenter, prospective, randomized controlled trial.
RESULTS
For patients undergoing NACT, the 5-year OS and PFS rate was 85.8 and 80.5% respectively. They were similar in the PST group. There was no significant difference in OS and PFS between clinical response (CR)/partial response (PR) groups and stable disease (SD)/progressive disease (PD) groups. Apart from deep cervical invasion (p = 0.046) affecting OS for patients undergoing NACT, no other clinical and pathological factors were associated with OS. 97.8% of NACT-insensitive patients opted for surgery. If these patients did not have intermediate- or high-risk factors, whether they had undergone postoperative adjuvant therapy was irrelevant to their prognosis, whereas for patients with intermediate- or high-risk factors, adjuvant chemotherapy resulted in better PFS (chemotherapy vs. no therapy, p < 0.001; chemotherapy vs. radiotherapy, p = 0.019) and OS (chemotherapy vs. no therapy, p < 0.001; chemotherapy vs. radiotherapy, p = 0.002).
CONCLUSIONS
NACT could be a choice for patients with FIGO stages IB3 and IIA2 cervical cancer. The main risk factor influencing prognosis in the NACT group is deep cervical invasion. After systematic treatment, insensitivity to NACT does not indicate a poorer prognosis. For NACT-insensitive patients, Chinese prefer surgery. Postoperative adjuvant therapy in patients with no intermediate- or high-risk factors does not improve prognosis, and chemotherapy in patients with intermediate- and high-risk factors is more effective than radiation therapy and other treatments.
TRIAL REGISTRATION
The study was prospectively registered on ClinicalTrials.gov (NCT03308591); date of registration: 12/10/2017.
Topics: Female; Humans; Neoadjuvant Therapy; Uterine Cervical Neoplasms; Prospective Studies; Neoplasm Staging; Retrospective Studies; Treatment Outcome; Chemotherapy, Adjuvant; Hysterectomy; Antineoplastic Combined Chemotherapy Protocols
PubMed: 36471257
DOI: 10.1186/s12885-022-10355-3 -
Clinical Medicine Insights. Case Reports 2021Endometriosis is defined as an ectopic presence of endometrium-like tissue outside uterine cavity, which most commonly involves intraperitoneal organs. However, one of...
Endometriosis is defined as an ectopic presence of endometrium-like tissue outside uterine cavity, which most commonly involves intraperitoneal organs. However, one of the less frequent forms of the disease is abdominal wall endometriosis usually developing in surgical scars following obstetric and gynaecological surgeries involving uterine cavity entering, that is, caesarean section, myomectomy or hysterectomy. In this case report we present a case of a patient with extensive caesarean scar endometriosis, who required complex surgical management. Successful surgical treatment involved not only radical tumour resection and application of mesh in postoperative hernia prevention but also adequate wound closure ensuring satisfactory cosmetic results, which was most challenging. The abdominal wall defect could not be sutured by traditional technique, thus polypropylene mesh was used and partial abdominoplasty was performed. The wound healed without complication and 24-month follow-up showed no evidence of local recurrence and satisfactory cosmetic result. In case of extensive endometrial abdominal wall tumours surgical treatment may involve application of advanced plastic surgery techniques, like abdominoplasty or skin/musculocutaneous flaps transposition.
PubMed: 34248360
DOI: 10.1177/11795476211027666 -
JAMA Network Open Jan 2020Expensive technologies-including robotic surgery-experience rapid adoption without evidence of superior outcomes. Although previous studies have examined perioperative...
IMPORTANCE
Expensive technologies-including robotic surgery-experience rapid adoption without evidence of superior outcomes. Although previous studies have examined perioperative outcomes and costs, differences in out-of-pocket costs for patients undergoing robotic surgery are not well understood.
OBJECTIVE
To assess out-of-pocket costs and total payments for 5 types of common oncologic procedures that can be performed using an open or robotic approach.
DESIGN, SETTING, AND PARTICIPANTS
A retrospective, cross-sectional, propensity score-weighted analysis was performed using deidentified insurance claims for 1.9 million enrollees from the MarketScan database from January 1, 2012, to December 31, 2017. The final study sample comprised 15 893 US adults aged 18 to 64 years who were enrolled in an employer-sponsored health plan. Patients underwent either an open or robotic radical prostatectomy, hysterectomy, partial colectomy, radical nephrectomy, or partial nephrectomy for a solid-organ malignant neoplasm. Statistical analysis was performed from December 18, 2018, to June 5, 2019.
EXPOSURES
Type of surgical procedure-robotic vs open.
MAIN OUTCOMES AND MEASURES
The primary outcome of interest was out-of-pocket costs associated with robotic and open surgery. The secondary outcome of interest was associated total payments.
RESULTS
Among 15 893 patients (11 102 men; mean [SD] age, 55.4 [6.6] years), 8260 underwent robotic and 7633 underwent open procedures; patients undergoing robotic hysterectomy were older than those undergoing open hysterectomy (mean [SD] age, 55.7 [6.7] vs 54.6 [7.2] years), and patients undergoing open radical nephrectomy had more comorbidities than those undergoing robotic radical nephrectomy (≥2 comorbidities, 658 of 861 [76.4%] vs 244 of 347 [70.3%]). After adjustment for baseline characteristics, the robotic approach was associated with lower out-of-pocket costs for all procedures: -$137.75 (95% CI, -$240.24 to -$38.63) for radical prostatectomy (P = .006); -$640.63 (95% CI, -$933.62 to -$368.79) for hysterectomy (P < .001); -$1140.54 (95% CI, -$1397.79 to -$896.54) for partial colectomy (P < .001); -$728.32 (95% CI, -$1126.90 to -$366.08) for radical nephrectomy (P < .001); and -$302.74 (95% CI, -$523.14 to -$97.10) for partial nephrectomy (P = .003). The robotic approach was similarly associated with lower adjusted total payments: -$3872.62 (95% CI, -$5385.49 to -$2399.04) for radical prostatectomy (P < .001); -$29 640.69 (95% CI, -$36 243.82 to -$23 465.94) for hysterectomy (P < .001); -$38 151.74 (95% CI, -$46 386.16 to -$30 346.22) for partial colectomy; (P < .001); -$33 394.15 (95% CI, -$42 603.03 to -$24 955.20) for radical nephrectomy (P < .001); and -$9162.52 (95% CI, -$12 728.33 to -$5781.99) for partial nephrectomy (P < .001).
CONCLUSIONS AND RELEVANCE
This study found significant variation in perioperative costs according to surgical technique for both patients (out-of-pocket costs) and payers (total payments); the robotic approach was associated with lower out-of-pocket costs for all studied oncologic procedures.
Topics: Adolescent; Adult; Cross-Sectional Studies; Female; Health Expenditures; Humans; Male; Middle Aged; Neoplasms; Propensity Score; Retrospective Studies; Robotic Surgical Procedures; United States; Young Adult
PubMed: 31940036
DOI: 10.1001/jamanetworkopen.2019.19185 -
Ultrasound in Obstetrics & Gynecology :... Aug 2023To describe the clinical and sonographic characteristics of intramural pregnancy, as well as the available management options and treatment outcomes.
OBJECTIVE
To describe the clinical and sonographic characteristics of intramural pregnancy, as well as the available management options and treatment outcomes.
METHODS
This was a retrospective single-center study of consecutive patients with a sonographic diagnosis of intramural pregnancy between November 2008 and November 2022. An intramural pregnancy was diagnosed on ultrasound when a pregnancy was implanted within the uterine corpus, above the level of the internal cervical os and separate from the interstitial section of the Fallopian tube, and extended beyond the decidual-myometrial junction. Clinical, ultrasound, relevant surgical and histological information and outcomes were retrieved from each patient's record and analyzed.
RESULTS
Eighteen patients were diagnosed with an intramural pregnancy during the study period. Their median age was 35 (range, 28-43) years and the median gestational age at diagnosis was 8 + 1 (range, 5 + 5 to 12 + 0) weeks. Vaginal bleeding with or without abdominal pain was the most common presenting symptom, recorded in eight patients. Nine (50%) patients had a partial and nine (50%) had a complete intramural pregnancy. Embryonic cardiac activity was present in eight (44%) pregnancies. The majority of pregnancies (n = 10 (56%)) were initially managed conservatively, including expectant management in eight (44%) cases, local injection of methotrexate in one (6%) and embryocide in one (6%). Conservative management was successful in nine of the 10 (90%) pregnancies, with a median time to serum human chorionic gonadotropin resolution of 71 (range, 35-143) days. One patient with an ongoing live pregnancy had an emergency hysterectomy for a major vaginal bleed at 20 weeks' gestation. No other patient managed conservatively experienced any significant complication. The remaining eight (44%) patients had primary surgical treatment, comprising transcervical suction curettage in seven (88%) of these cases, while one patient presented with uterine rupture and underwent emergency laparoscopy and repair.
CONCLUSIONS
We describe the ultrasound features of partial and complete intramural pregnancy, demonstrating key diagnostic features. Our series suggests that, when intramural pregnancy is diagnosed before 12 weeks' gestation, it can be managed either conservatively or by surgery, with preservation of reproductive function in most women. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Topics: Humans; Female; Pregnancy; Pregnancy, Ectopic; Ultrasonography; Adult; Myometrium; Retrospective Studies; Uterine Hemorrhage; Methotrexate; Abortifacient Agents, Nonsteroidal
PubMed: 37058401
DOI: 10.1002/uog.26219 -
International Journal of Surgery Case... Apr 2022Vaginal mesenchymal cancer is one of the rarest cases, covering only 3% of all cases of vaginal malignancies. While risk factors are not heavily studied, genetic...
INTRODUCTION
Vaginal mesenchymal cancer is one of the rarest cases, covering only 3% of all cases of vaginal malignancies. While risk factors are not heavily studied, genetic disorders and hereditary diseases have been stated to be responsible for the increasing incidence of vaginal mesenchymal carcinoma. The diagnosis of leiomyosarcoma could be done through anamnesis to find abnormal uterine discharge and pelvic pain and physical examination to find a protruding mass on the vagina, which then should be confirmed through a series of radiologic examinations and histopathological examinations. Due to its rarity, each case should be properly evaluated for its clinical manifestation, diagnostic results, and outcome of the treatment.
CASE PRESENTATION
A 46-year-old woman came in with vaginal discharge and a protruding mass from the vagina without bleeding or urinary or defecation difficulties, which was suspected to be pedunculated submucous myoma. Based on pelvic USG and MRI, the mass was suspected to have originated from the vagina. Histopathology examinations from biopsy showed a possible mesenchymal malignant type. The patient then underwent total hysterectomy, bilateral salpingo-oophorectomy, and partial vaginectomy. Histopathological evaluation confirmed the diagnosis of leiomyosarcoma in the patient.
DISCUSSION AND CONCLUSION
The patient was diagnosed with a vaginal malignant mesenchymal tumor stage II intraoperatively and underwent total hysterectomy and bilateral salpingo-oophorectomy. Leiomyosarcoma is not commonly diagnosed preoperatively, hence implying the importance of radiologic examination to do an early diagnosis prior to the histopathological analysis. Due to the rarity of vaginal mesenchymal malignancy, further studies are needed to increase understanding of this case.
PubMed: 35318185
DOI: 10.1016/j.ijscr.2022.106864 -
Surgical Endoscopy Apr 2021There is controversy regarding the widespread uptake of robotic surgery across several surgical disciplines. While it has been shown to confer clinical benefits such as...
BACKGROUND
There is controversy regarding the widespread uptake of robotic surgery across several surgical disciplines. While it has been shown to confer clinical benefits such as decreased blood loss and shorter hospital stays, some argue that the benefits of this technology do not outweigh its high cost. We performed a retrospective insurance-based analysis to investigate how undergoing robotic surgery, compared to open surgery, may impact the time in which an employed individual returns to work after undergoing major surgery.
METHODS
We identified a cohort of US adults with employer-sponsored insurance using claims data from the MarketScan database who underwent either open or robotic radical prostatectomy, hysterectomy/myomectomy, and partial colectomy from 2012 to 2016. We performed multiple regression models incorporating propensity scores to assess the effect of robotic vs. open surgery on the number of absent days from work, adjusting for demographic characteristics and baseline absenteeism.
RESULTS
In a cohort of 1157 individuals with employer-sponsored insurance, those undergoing open surgery, compared to robotic surgery, had 9.9 more absent workdays for radical prostatectomy (95%CI 5.0 to 14.7, p < 0.001), 25.3 for hysterectomy/myomectomy (95%CI 11.0-39.6, p < 0.001), and 29.8 for partial colectomy (95%CI 14.8-44.8, p < 0.001) CONCLUSION: For the three major procedures studied, robotic surgery was associated with fewer missed days from work compared to open surgery. This information helps payers, patients, and providers better understand some of the indirect benefits of robotic surgery relative to its cost.
Topics: Absenteeism; Adolescent; Adult; Colectomy; Female; Humans; Hysterectomy; Male; Middle Aged; Prostatectomy; Retrospective Studies; Robotic Surgical Procedures; Workplace; Young Adult
PubMed: 32291540
DOI: 10.1007/s00464-020-07547-y -
International Cancer Conference Journal Jul 2021The diagnosis and management of borderline ovarian tumors during pregnancy are still not standardized, because these tumors are rarely encountered. We report the case of... (Review)
Review
The diagnosis and management of borderline ovarian tumors during pregnancy are still not standardized, because these tumors are rarely encountered. We report the case of a 27-year-old pregnant woman who presented with an ovarian mass in her first trimester. Magnetic resonance imaging revealed a multilocular cystic component with papillary lesions in the background of endometriosis, suggesting a seromucinous borderline tumor or ovarian cancer. A right salpingo-oophorectomy and partial omentectomy were performed at 7 weeks of gestation. Pathological examination demonstrated a serous borderline tumor. The subsequent pregnancy course was uneventful, and she gave birth to a healthy baby at 39 weeks of gestation. She wanted to retain fertility, and close follow-up was performed. Four years later, she became pregnant, and a lesion suggesting recurrence in the left ovary was detected. An abdominal left ovarian cystectomy was performed at 13 weeks of gestation, which demonstrated recurrence of the serous borderline tumor. She gave birth to a healthy baby at 39 weeks of gestation. Two months after delivery, she underwent total abdominal hysterectomy with left salpingo-oophorectomy, which revealed no malignant findings. We also reviewed 10 reports that included 58 cases of borderline ovarian tumors diagnosed during pregnancy. The borderline ovarian tumors diagnosed during pregnancy exhibited different characteristics according to each subtype, suggesting the importance of diagnosing borderline ovarian tumor subtypes preoperatively.
PubMed: 34221825
DOI: 10.1007/s13691-021-00471-5 -
Case Reports in Obstetrics and... 2021Postoperative vision loss (POVL) is a rare but devastating complication that has only recently been reported following laparoscopic surgery. We present the case of a...
Postoperative vision loss (POVL) is a rare but devastating complication that has only recently been reported following laparoscopic surgery. We present the case of a 34-year-old gravida 6 para 4 female who experienced POVL following an uncomplicated laparoscopic hysterectomy. Operating time was 174 minutes, and EBL was 75 mL. After surgery, she complained of complete vision loss with no light perception. No cerebral hemorrhage or ischemia was detected on imaging. Funduscopic exam revealed no structural abnormalities. On postoperative day 7, she received an IV methylprednisolone taper. The following morning, she reported mild light perception. Later that night, she reported a partial return of visual acuity and was discharged home. At her 2-week postoperative visit, her vision had returned to baseline. POVL is an emergency and prompt evaluation should be initiated to optimize outcome.
PubMed: 33728078
DOI: 10.1155/2021/6643703 -
International Journal of Computer... May 2022Robotic-assisted laparoscopic surgery has become the trend in medicine thanks to its convenience and lower risk of infection against traditional open surgery. However,...
PURPOSE
Robotic-assisted laparoscopic surgery has become the trend in medicine thanks to its convenience and lower risk of infection against traditional open surgery. However, the visibility during these procedures may severely deteriorate due to electrocauterisation which generates smoke in the operating cavity. This decreased visibility hinders the procedural time and surgical performance. Recent deep learning-based techniques have shown the potential for smoke and glare removal, but few targets laparoscopic videos.
METHOD
We propose DeSmoke-LAP, a new method for removing smoke from real robotic laparoscopic hysterectomy videos. The proposed method is based on the unpaired image-to-image cycle-consistent generative adversarial network in which two novel loss functions, namely, inter-channel discrepancies and dark channel prior, are integrated to facilitate smoke removal while maintaining the true semantics and illumination of the scene.
RESULTS
DeSmoke-LAP is compared with several state-of-the-art desmoking methods qualitatively and quantitatively using referenceless image quality metrics on 10 laparoscopic hysterectomy videos through 5-fold cross-validation.
CONCLUSION
DeSmoke-LAP outperformed existing methods and generated smoke-free images without applying ground truths (paired images) and atmospheric scattering model. This shows distinctive achievement in dehazing in surgery, even in scenarios with partial inhomogenenous smoke. Our code and hysterectomy dataset will be made publicly available at https://www.ucl.ac.uk/interventional-surgical-sciences/weiss-open-research/weiss-open-data-server/desmoke-lap .
Topics: Female; Humans; Image Processing, Computer-Assisted; Laparoscopy; Semantics
PubMed: 35355212
DOI: 10.1007/s11548-022-02595-2