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Gynecology and Minimally Invasive... 2021Retained products of conception (RPOC) can occur after early or mid-trimester pregnancy termination and also following vaginal or cesarean delivery. It is frequently... (Review)
Review
Retained products of conception (RPOC) can occur after early or mid-trimester pregnancy termination and also following vaginal or cesarean delivery. It is frequently associated with continuous vaginal bleeding, pelvic pain, and infection. Late complications include intrauterine adhesions formation and infertility. Conventionally, the management of RPOC has been with blind dilation and suction curettage (D and C); however, hysteroscopic resection of RPOC is a safe and efficient alternative. In this review, we analyze the current available evidence regarding the use of hysteroscopic surgery for the treatment of RPOC comparing outcomes and complications of both traditional curettage and hysteroscopic technique. Data search has been conducted using the following databases MEDLINE, EMBASE, Web of Sciences, Scopus, Clinical Trial. Gov., OVID, and Cochrane Library interrogate all articles related to hysteroscopy and the preserved product of conception, updated through September 2020.
PubMed: 34909376
DOI: 10.4103/GMIT.GMIT_125_20 -
The Canadian Journal of Urology Aug 2021INTRODUCTION Transurethral resection of the prostate (TURP) was considered the "gold standard" surgical treatment for medication-refractory benign prostatic hyperplasia... (Review)
Review
UNLABELLED
INTRODUCTION Transurethral resection of the prostate (TURP) was considered the "gold standard" surgical treatment for medication-refractory benign prostatic hyperplasia (BPH) for decades. With the desire to reduce hospital stay, complications, and cost, less invasive procedures gained usage in the 1990's. With the advent of a soft tissue morcellator, holmium laser enucleation of the prostate (HoLEP) was introduced as an efficacious alternative to TURP and due to its advantageous side effect profile compared to TURP, has grown in popularity ever since. HoLEP has become a size-independent guideline endorsed procedure of choice for the surgical treatment of BPH.
MATERIALS AND METHODS
We provide a review on the evolution of HoLEP as a gold standard compared to the historical reference procedures for BPH, and provide a review of emerging laser technologies.
RESULTS
A growing body of literature has shown HoLEP to be a safe and efficient procedure for the treatment of BPH for all prostate sizes. Long term studies have proven the durability of HoLEP, as a first line surgical therapy for BPH.
CONCLUSIONS
HoLEP is a proven modality for the surgical treatment of BPH. It can be performed on patients with high risk for postoperative bleeding, or after previous prostate reducing procedures. HoLEP is the only procedure that is AUA guideline-endorsed for all prostate sizes for the surgical treatment of BPH. Given these considerations, HoLEP has become the new gold-standard for the surgical treatment of BPH.
Topics: Humans; Laser Therapy; Lasers, Solid-State; Male; Prostate; Prostatic Hyperplasia; Transurethral Resection of Prostate; Treatment Outcome
PubMed: 34453422
DOI: No ID Found -
The Canadian Journal of Urology Aug 2019Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is one of the most common diseases affecting the aging man, with almost 80% of men... (Review)
Review
INTRODUCTION
Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is one of the most common diseases affecting the aging man, with almost 80% of men greater than 70 affected. Historically, transurethral resection of the prostate (TURP) has been considered the historical gold standard in the treatment of LUTS due to BPH for many years, contemporary literature indicates that holmium laser enucleation of the prostate (HoLEP) has replaced TURP and open simple prostatectomy as the size independent surgical gold standard for BPH treatment.
MATERIALS AND METHODS
In this review, we discuss the current techniques utilized, outcomes and safety, as well as the long term durability of results. Adverse events associated with the HoLEP procedure, both enucleation and morcellation, are covered as well.
RESULTS
HoLEP has a robust body of literature supporting the technique, which demonstrates its ability to surpass other surgical BPH procedures, including TURP and open simple prostatectomy. Additionally, there is long term durability of both subjective and objective outcomes greater than 10 years associated with this procedure. One randomized trial showed specific postoperative outcome measures that were superior to TURP at 7 years of follow up, including Qmax (4.36 mL/s improvement), erectile function (2.39 points improvement on the IIEF erectile function section), and weight of prostate removed (15.7 grams greater), while other studies have shown greater reduction in postoperative PSA, lower detrusor pressure at Qmax, and more.
CONCLUSIONS
Overall, HoLEP has proven to be an extremely durable and effective treatment for patients suffering from LUTS due to BPH. Both the Europeans and AUA guidelines on the surgical treatment of BPH recommend HoLEP as a size-independent treatment option for those men with moderate to severe symptoms. HoLEP is an excellent option for many patients who may not be good candidates for other procedures based on prostate size, age, or bleeding risk.
Topics: Holmium; Humans; Laser Therapy; Lasers, Solid-State; Male; Prostatic Hyperplasia; Prostatism; Treatment Outcome
PubMed: 31481144
DOI: No ID Found -
Radiology Feb 2023Laparoscopic myomectomy, a common gynecologic operation in premenopausal women, has become heavily regulated since 2014 following the dissemination of unsuspected... (Review)
Review
Laparoscopic myomectomy, a common gynecologic operation in premenopausal women, has become heavily regulated since 2014 following the dissemination of unsuspected uterine leiomyosarcoma (LMS) throughout the pelvis of a physician treated for symptomatic leiomyoma. Research since that time suggests a higher prevalence than previously suspected of uterine LMS in resected masses presumed to represent leiomyoma, as high as one in 770 women (0.13%). Though rare, the dissemination of an aggressive malignant neoplasm due to noncontained electromechanical morcellation in laparoscopic myomectomy is a devastating outcome. Gynecologic surgeons' desire for an evidence-based, noninvasive evaluation for LMS is driven by a clear need to avoid such harms while maintaining the availability of minimally invasive surgery for symptomatic leiomyoma. Laparoscopic gynecologists could rely upon the distinction of higher-risk uterine masses preoperatively to plan oncologic surgery (ie, potential hysterectomy) for patients with elevated risk for LMS and, conversely, to safely offer women with no or minimal indicators of elevated risk the fertility-preserving laparoscopic myomectomy. MRI evaluation for LMS may potentially serve this purpose in symptomatic women with leiomyomas. This evidence review and consensus statement defines imaging and disease-related terms to allow more uniform and reliable interpretation and identifies the highest priorities for future research on LMS evaluation.
Topics: Female; Humans; Leiomyosarcoma; Leiomyoma; Uterine Neoplasms; Uterine Myomectomy; Hysterectomy; Laparoscopy; Magnetic Resonance Imaging
PubMed: 36194109
DOI: 10.1148/radiol.211658 -
Ugeskrift For Laeger Sep 2021Parasitic myomas are fibromyomas without anatomical relation to the uterus. It is a rare condition mostly described after laparoscopic fibroid morcellation. This is a...
Parasitic myomas are fibromyomas without anatomical relation to the uterus. It is a rare condition mostly described after laparoscopic fibroid morcellation. This is a case report of a patient with a symptomatic abdominal mass eight years after total abdominal hysterectomy. A parasitic myoma was found in relation to coecum and removed laparoscopically. The condition should be considered in symptomatic women with previous fibroid surgery.
Topics: Female; Fibroma; Humans; Hysterectomy; Laparoscopy; Leiomyoma; Morcellation; Uterine Neoplasms
PubMed: 34596516
DOI: No ID Found -
Turkish Journal of Obstetrics and... Dec 2021We sought to analyze all high-quality studies available regarding the possible differences in contained and uncontained techniques for morcellation of fibroids and...
We sought to analyze all high-quality studies available regarding the possible differences in contained and uncontained techniques for morcellation of fibroids and uteri. We systematically searched PubMed, Cochrane Central, Scopus, ClinicalTrials.Gov, MEDLINE and Web of Science from September 2010 to September 2020 for our search terms. We included studies that specifically enrolled patients undergoing power morcellation myomectomy or power morcellation hysterectomy procedures. In our search, we had no restriction to age, country, or publication date. We extracted data related to study design, baseline characteristics of patients, and perioperative outcomes such as total operative time, total blood loss, and duration of hospital stay. We found no substantial difference in total operative time between contained power morcellation and uncontained manual morcellation myomectomy (p=0.52), but contained power morcellation had a significantly longer total operative time than uncontained power morcellation for hysterectomy and myomectomy [135.50 vs. 93.33 minutes, (p=0.003)]. Total blood loss was comparable for contained power morcellation versus uncontained manual morcellation myomectomy (p=0.32) and contained power morcellation versus uncontained power morcellation myomectomy or hysterectomy (p=0.91). Contained power morcellation and uncontained manual morcellation myomectomy had comparable hospital stay periods (p=0.5). Contained power morcellation leads to a longer operating time than uncontained power morcellation for both hysterectomy and myomectomy. No differences were found in comparisons of blood loss, operative time, or comparison to manual methods of morcellation.
PubMed: 34955114
DOI: 10.4274/tjod.galenos.2021.50607 -
Journal of Obstetrics and Gynaecology... Feb 2022We discuss five technical modifications made over 8 years in the technique of robotic myomectomy at our institution. Universal preoperative MRI was the first... (Review)
Review
We discuss five technical modifications made over 8 years in the technique of robotic myomectomy at our institution. Universal preoperative MRI was the first modification. Precise hysterotomy incisions were planned by accurate myoma mapping. The second modification was to reduce the number of ports. We performed surgery with one 12-mm-port for the camera and one 8-mm-port on either side of the patient for scissors and fenestrated bipolar forceps. Third modification was to reduce the number of robotic instruments by using laparoscopic myoma screw instead of robotic tenaculum during enucleation and discard the use of a second needle driver and prograsp forceps. So instead of six instruments in classical technique, we now use only three instruments thus reducing the cost of instruments by 40-50%. The fourth modification was to use a single 30 or 45 cm barbed suture. A single long suture efficiently managed by wristed needle driver of robot was sufficient in most cases for hysterotomy closure. This reduces the time needed for multiple needle pass and cost due to reduced number of sutures used. The fifth modification was to not use the electro mechanical morcellator and commercially available bags. We do cold knife morcellation in indigenous plastic bags. Over a period of eight years, we have made robotic myomectomy efficient and reduced the cost of instruments by 40-50% as compared to the classical technique. This has enabled wider adoption of robotic myomectomy at our institution thus reducing open myomectomy in all types of myomas.
PubMed: 35125746
DOI: 10.1007/s13224-021-01553-3 -
The Canadian Journal of Urology Aug 2021INTRODUCTION Holmium laser enucleation of the prostate (HoLEP) with mechanical tissue morcellation is one of the most effective surgical modalities for the treatment of...
UNLABELLED
INTRODUCTION Holmium laser enucleation of the prostate (HoLEP) with mechanical tissue morcellation is one of the most effective surgical modalities for the treatment of symptomatic BPH. HoLEP has many advantages over the historical gold standards open prostatectomy (OP) and transurethral resection of the prostate (TURP). HoLEP is an AUA guideline endorsed surgical treatment for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH), independent of prostate size.
MATERIALS AND METHODS
We provide a detailed presentation of our experience in performing HoLEP in a teaching university hospital, with an emphasis on the surgical technique and its evolution.
RESULTS
HoLEP is an efficient and durable procedure, although it is very equipment sensitive and has a relatively long learning curve. HoLEP can be performed by several surgical approaches that can be used according to the specific anatomy of the patient. Advances in laser technology, endoscopic morcellators, and surgical technique has improved the HoLEP procedure in efficiency, hemostasis, and safety.
CONCLUSIONS
The HoLEP procedure, first introduced in 1998, has undergone significant changes including advancements in laser technology, endoscopic morcellation devices, and modifications to the surgical technique. These advancements have made HoLEP a more effective, more efficient, easier to perform, and easier to learn technique for the surgical management of BPH. The modified 2-lobe and the en-bloc techniques are a natural progression from the classic 3-lobe technique.
Topics: Holmium; Humans; Laser Therapy; Lasers, Solid-State; Male; Prostatic Hyperplasia; Transurethral Resection of Prostate; Treatment Outcome
PubMed: 34453423
DOI: No ID Found -
Healthcare (Basel, Switzerland) Oct 2022The authors reviewed uterine fibroid (UF) morcellation and its potential consequences, notably a hypothetical spread and dissemination of occult uterine leiomyosarcoma... (Review)
Review
The authors reviewed uterine fibroid (UF) morcellation and its potential consequences, notably a hypothetical spread and dissemination of occult uterine leiomyosarcoma (LMS) tissue, evaluating the effect of laparoscopic versus open myomectomies with and without morcellation on patients' outcomes, as well as related medical-legal issues. MEDLINE and PubMed search was performed for the years 1990-2021, using a combination of keywords on this topic. Relevant articles were identified and included in this narrative review. There is an individual risk, for all patients, for LMS diagnosis after myomectomy. However, the risk for occult LMS diagnosis during a laparoscopic myomectomy is generally reduced when the guidelines of scientific societies are followed, with an overall benefit from the laparoscopic approach with morcellation in appropriate cases. Gynecological societies do not ban morcellation and laparoscopic hysterectomy/myomectomy per se, but recommend their use on the basis of the patients' clinical characteristics. It is suggested for gynecologists to provide detailed information to patients when obtaining an informed consent for open or laparoscopic hysterectomy/myomectomy. A detailed preoperative assessment of patients and the risk benefit ratio of laparoscopic morcellation of uterine mass could overcome the "a priori" banning of the morcellation technique.
PubMed: 36292534
DOI: 10.3390/healthcare10102087 -
Frontiers in Medicine 2023Laparoscopy is a routine procedure for benign gynecological tumors. Although the laparoscopic approach for myomas is a common procedure, it can be challenging. To... (Review)
Review
Laparoscopy is a routine procedure for benign gynecological tumors. Although the laparoscopic approach for myomas is a common procedure, it can be challenging. To improve outcomes, research regarding port access, suture type, morcellation, and complication management remains ongoing. Myomectomy is the main surgical option for patients seeking uterus-sparing procedures to maintain future fertility. The laparoscopic technique is the most important in these cases, given that possible complications can impact fertility and pregnancy outcomes. Herein, we reviewed and collated the available data regarding different suture techniques, including advantages, difficulties, and possible long-term impacts.
PubMed: 37020679
DOI: 10.3389/fmed.2023.1158264