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International Journal of Gynaecology... Mar 2024Studies aimed to assess risk factors for pelvic organ prolapse (POP) recurrence following colpocleisis with nonconclusive results. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Studies aimed to assess risk factors for pelvic organ prolapse (POP) recurrence following colpocleisis with nonconclusive results.
OBJECTIVE
To investigate risk factors for POP recurrence following colpocleisis.
SEARCH STRATEGY
MEDLINE, PUBMED, Embase, Web of Science, and Cochrane databases were systematically searched.
SELECTION CRITERIA
Experimental and non-experimental studies investigating POP recurrence following colpocleisis.
DATA COLLECTION AND ANALYSIS
We assessed the association between preoperative and postoperative physical examination findings, demographics and medical history, and the risk of recurrence following colpocleisis.
MAIN RESULTS
A total of 954 studies were identified, of which five studies comprising 2978 patients were eligible for analysis. Both preoperative and postoperative genital hiatus length were significantly longer in the recurrence group (mean difference [MD] 0.48, 95% confidence interval [CI] 0.01-0.94, P = 0.04, I = 0% and MD 1.15, 95% CI 0.50-1.81, P = 0.005, I = 0%; respectively). Preoperative total vaginal length (TVL) did not differ between groups (MD 0.05, 95% CI -0.40 to 0.50, P = 0.83, I = 6%), postoperative TVL was found significantly longer in the recurrence group (MD 0.07, 95% CI -0.03 to 1.38, P = 0.04, I = 68%). Both preoperative and postoperative perineal body did not differ between groups. Women with a previous POP surgery were more likely to experience recurrence following colpocleisis (relative risk 2.09, 95% CI 1.18-3.69, P = 0.01, I = 0%). Patient's age and previous hysterectomy did not affect recurrence rates.
CONCLUSION
Wider preoperative and postoperative genital hiatus as well as longer post-operative TVL and previous POP surgery were associated with a higher risk for recurrence following colpocleisis, highlighting the importance of appropriate patient selection and surgical technique in minimizing this risk.
Topics: Pregnancy; Humans; Female; Colpotomy; Vagina; Pelvic Organ Prolapse; Hysterectomy; Risk Factors; Treatment Outcome; Gynecologic Surgical Procedures; Recurrence
PubMed: 37488940
DOI: 10.1002/ijgo.14999 -
Best Practice & Research. Clinical... Aug 2023Caesarean scar pregnancy (CSP) is an increasingly common clinical conundrum. The non-curettage surgical management of CSP can be categorised into hysteroscopic, vaginal,... (Review)
Review
Caesarean scar pregnancy (CSP) is an increasingly common clinical conundrum. The non-curettage surgical management of CSP can be categorised into hysteroscopic, vaginal, laparoscopic, and open removal modalities and the choice of treatment is surgeon-dependent. A systematic review of original studies reporting surgical treatment outcomes of CSP until March 2023 was conducted to evaluate the non-curettage surgical management of this highly morbid condition. A total of 60 studies of mostly weak methodological quality were identified involving 6720 CSP cases. Success rates were generally high across all treatment modalities although highest in vaginal and laparoscopic excisional approaches. Morbidity was most associated with haemorrhage although unplanned hysterectomy rates remained low across all treatment groups. Subsequent pregnancies are associated with morbidity despite being underreported and the impact of CSP treatment on future pregnancy is poorly understood. Substantive study heterogeneity precludes meta-analyses of pooled data and treatment superiority has not been demonstrated.
Topics: Pregnancy; Female; Humans; Hysteroscopy; Cesarean Section; Cicatrix; Pregnancy, Ectopic; Laparoscopy; Treatment Outcome
PubMed: 37379723
DOI: 10.1016/j.bpobgyn.2023.102367 -
Gynecologic and Obstetric Investigation 2023Minimally invasive surgery aims to reduce surgical trauma and post-operative morbidity. Natural orifice transluminal endoscopic surgery is a safe and valid surgical...
Hysterectomy Using Vaginal Natural Orifice Transluminal Endoscopic Surgery Compared with Classic Laparoscopic Hysterectomy: A New Advantageous Approach? A Systematic Review on Surgical Outcomes.
INTRODUCTION
Minimally invasive surgery aims to reduce surgical trauma and post-operative morbidity. Natural orifice transluminal endoscopic surgery is a safe and valid surgical option for hysterectomy. The present systematic review aims to compare hysterectomy by transvaginal natural orifice transluminal endoscopic surgery (vNOTES) with laparoscopic hysterectomy in terms of efficacy, surgical outcomes, complications, and cost.
MATERIALS AND METHODS
This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. It includes randomized controlled trials, controlled clinical trials, prospective or retrospective cohorts, case-control studies, and previous systematic reviews. Inclusion criteria are as follows: female patients undergoing hysterectomy for benign pathologies by vNOTES or laparoscopic hysterectomy. The assessed outcomes were the following: conversion rate, mean uterus weight (g), operative time (mins), hospital stay (days), peri-operative complications, post-operative complications, peri-operative blood loss (mL), blood transfusion needs, post-operative day 1 hemoglobin (Hb) change (g/dL), post-operative pain level (VAS), and cost (USD) in both techniques.
RESULTS
Seven studies were included. vNOTES hysterectomy was not inferior to laparoscopic hysterectomy regarding surgical outcomes, with a shorter operative time, shorter recovery time, less post-operative pain, and fewer post-operative complications. There was no significant difference in the rate of peri-operative complications and no differences in peri-operative blood loss, post-operative day 1 Hb change, and transfusions. Nevertheless, vNOTES hysterectomy was shown to be more expensive than its laparoscopic counterpart.
CONCLUSIONS
While the feasibility and safety of the vNOTES hysterectomy were already established, this review also underlines the noninferiority of this technique when compared to laparoscopic hysterectomy in terms of surgical outcomes. In addition, vNOTES hysterectomy was associated with faster operating time, shorter hospital stay, and better post-operative pain scores compared with laparoscopic hysterectomy.
Topics: Humans; Female; Retrospective Studies; Blood Loss, Surgical; Prospective Studies; Vagina; Natural Orifice Endoscopic Surgery; Laparoscopy; Postoperative Complications; Pain, Postoperative; Treatment Outcome
PubMed: 37231836
DOI: 10.1159/000530797 -
The Journal of Maternal-fetal &... Dec 2023Women's choice of birth following a cesarean delivery either includes a trial of elective repeat cesarean section (ERCS) or a trial of labor after cesarean (TOLAC). No... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Women's choice of birth following a cesarean delivery either includes a trial of elective repeat cesarean section (ERCS) or a trial of labor after cesarean (TOLAC). No comprehensive overview or systematic summary is currently available.
METHODS
EMBASE, PubMed, and the Cochrane Library databases were searched from inception to 1 February 2020. Studies reporting the safety of TOLAC and ERCS in pregnant women with prior cesarean delivery were included. Statistical analysis was performed using RevMan 5.3 and Stata 15.0. Odds ratios (ORs) and 95% confidence intervals (CIs) were adopted as the effective measures.
RESULTS
A total of 13 studies covering 676,532 cases were included in this meta-analysis. The results demonstrated that the rates of uterine rupture (OR = 3.35, 95%CI [1.57, 7.15], = 81%), neonatal asphyxia (OR = 2.32, 95%CI [1.76, 3.08], = 0%) and perinatal death (OR = 1.71, 95%CI [1.29, 2.25], = 0%) were higher in the TOLAC group compared with the ERCS group. The rates of peripartum hysterectomy (OR = 0.70, 95%CI [0.44, 1.11], = 62%), blood transfusion (OR = 1.24, 95%CI [0.72, 2.12], = 95%), and puerperal infection (OR = 1.11, 95%CI [0.77, 1.60], = 95%) showed no significant differences between the two groups.
CONCLUSION
TOLAC is associated with a higher risk of uterine rupture, neonatal asphyxia, and perinatal death compared with ERCS. Nevertheless, it should be noted that the risks of all complications were small in both groups. This information is important for healthcare providers and women choosing the delivery type.
Topics: Infant, Newborn; Female; Pregnancy; Humans; Cesarean Section; Cesarean Section, Repeat; Trial of Labor; Perinatal Death; Uterine Rupture; Asphyxia; Vaginal Birth after Cesarean; Retrospective Studies
PubMed: 37217450
DOI: 10.1080/14767058.2023.2214831 -
Biology Mar 2023Primary malignant melanoma (MM) of the cervix uteri is a rare and aggressive malignancy of the female reproductive tract. Considering that clinical data on this cancer... (Review)
Review
Primary malignant melanoma (MM) of the cervix uteri is a rare and aggressive malignancy of the female reproductive tract. Considering that clinical data on this cancer are scarce, we aimed to comprehensively examine the currently available literature and provide an overview of the reported cases of cervical MM focusing on the clinical characteristics, diagnosis and therapeutic management. We conducted a systematic review of the literature by screening three electronic databases until June 2022. The critical appraisal checklist provided by the Joanna Briggs Institute was employed to evaluate the overall quality of the studies. We included 96 reports, which comprised 137 patients diagnosed with MM of the cervix. The mean age of the patients was 56.5 (median: 58, age range: 33-88). Data regarding menopausal status were provided for 98 patients with 15 being premenopausal and 83 being postmenopausal. The most common presenting symptom was vaginal bleeding (83%, 100/121). Biopsy (either excisional or punch biopsy) was used as the first diagnostic modality in most of the patients (67%, 64/95), followed by cytology (18%, 17/95). In 74 cases, the FIGO staging system for cervical cancer was used with the most common stage being FIGO stage I (38%, 28/74), followed by FIGO stage II (36%, 27/74), FIGO stage III (19%, 14/74) and FIGO stage IV (7%, 5/74). Most of the patients were managed surgically (90%, 119/131) with a hysterectomy (either radical or total), and a salpingo-oophorectomy with/without lymphadenectomy was the most common approach utilized (40%, 48/119). The data of clinical outcomes were provided for 105 patients, of whom 61 died (58%, 61/105) and 44 survived (42%, 44/105). Knowledge regarding the rare occurrence of MM in the cervix and the increased awareness of clinicians can prevent clinical misdiagnosis and ultimately improve further the clinical outcomes of patients developing this rare malignancy.
PubMed: 36979090
DOI: 10.3390/biology12030398 -
Obstetrics and Gynecology Apr 2023To assess the amount of opioid medication used by patients and the prevalence of persistent opioid use after discharge for gynecologic surgery for benign indications.
OBJECTIVE
To assess the amount of opioid medication used by patients and the prevalence of persistent opioid use after discharge for gynecologic surgery for benign indications.
DATA SOURCES
We systematically searched MEDLINE, EMBASE, and ClinicalTrials.gov from inception to October 2020.
METHODS OF STUDY SELECTION
Studies with data on gynecologic surgical procedures for benign indications and the amount of outpatient opioids consumed, or the incidence of either persistent opioid use or opioid-use disorder postsurgery were included. Two reviewers independently screened citations and extracted data from eligible studies.
TABULATION, INTEGRATION, AND RESULTS
Thirty-six studies (37 articles) met inclusion criteria. Data were extracted from 35 studies; 23 studies included data on opioids consumed after hospital discharge, and 12 studies included data on persistent opioid use after gynecologic surgery. Average morphine milligram equivalents (MME) used in the 14 days after discharge were 54.0 (95% CI 39.9-68.0, seven tablets of 5-mg oxycodone) across all gynecologic surgery types, 35.0 (95% CI 0-75.12, 4.5 tablets of 5-mg oxycodone) after a vaginal hysterectomy, 59.5 (95% CI 44.4-74.6, eight tablets of 5-mg oxycodone) after laparoscopic hysterectomy, and 108.1 (95% CI 80.5-135.8, 14.5 tablets of 5-mg oxycodone) after abdominal hysterectomy. Patients used 22.4 MME (95% CI 12.4-32.3, three tablets of 5-mg oxycodone) within 24 hours of discharge after laparoscopic procedures without hysterectomy and 79.8 MME (95% CI 37.1-122.6, 10.5 tablets of 5-mg oxycodone) from discharge to 7 or 14 days postdischarge after surgery for prolapse. Persistent opioid use occurred in about 4.4% of patients after gynecologic surgery, but this outcome had high heterogeneity due to variation in populations and definitions of the outcome.
CONCLUSION
On average, patients use the equivalent of 15 or fewer 5-mg oxycodone tablets (or equivalent) in the 2 weeks after discharge after major gynecologic surgery for benign indications. Persistent opioid use occurred in 4.4% of patients who underwent gynecologic surgery for benign indications. Our findings could help surgeons minimize overprescribing and reduce medication diversion or misuse.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, CRD42020146120.
Topics: Humans; Female; Analgesics, Opioid; Oxycodone; Pain, Postoperative; Acute Pain; Aftercare; Patient Discharge; Opioid-Related Disorders; Gynecologic Surgical Procedures; Prescriptions; Practice Patterns, Physicians'
PubMed: 36897135
DOI: 10.1097/AOG.0000000000005104 -
Medicina (Kaunas, Lithuania) Feb 2023Total hysterectomy is one of the most common gynecologic surgical procedures and it is mainly performed for benign pathologies. The introduction of robotic single-site... (Review)
Review
Total hysterectomy is one of the most common gynecologic surgical procedures and it is mainly performed for benign pathologies. The introduction of robotic single-site surgery (RSS) as an acceptable alternative to laparoendoscopic surgery combines the advantages of robotics with the aesthetic result of a single incision. This study aims to review the existing literature on a single-site robotic hysterectomy in patients with benign pathologies and verify its safety and feasibility. : Following the recommendations in the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement, FP and AR systematically screened the PubMed, Embase, and Scopus databases. No temporal or geographical limitation was discriminatory. Studies containing data about feasibility and safety were included. : From 219, only eight studies met the inclusion criteria, and a total of 212 patients were included with a mean patient age of 45.42 years old (range 28-49.5 years old) and a mean BMI of 25.74 kg/m (range 22-28.5 kg/m). The mean presurgical time, including port placement and docking time, was 15.56 (range 3-30) minutes. Mean console time was reported in six studies and is 83.21 min (range 25-180 min). The mean operative time is 136.6 min (range 60-294 min) and the mean blood loss is 43.68 mL (range 15-300 mL). Only two patients in the total analyzed had intraoperative complications and no conversion to LPT occurred. The median hospital stay was 1.71 days (range 0.96-3.5 days). The postoperative complication rate was estimated at 1.4% (vaginal bleeding). Our review supports the safety and feasibility of robotic single-site hysterectomy for benign gynecological diseases.
Topics: Humans; Female; Adult; Middle Aged; Laparoscopy; Robotic Surgical Procedures; Hysterectomy; Robotics; Gynecologic Surgical Procedures; Retrospective Studies
PubMed: 36837612
DOI: 10.3390/medicina59020411 -
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 -
Journal of Personalized Medicine Nov 2022Uterine leiomyomas usually arise from the uterine body (95%), and rarely from the cervix (0.6%) or other urogenital sites. Lipoleiomyomas are benign, uncommon variants...
Uterine leiomyomas usually arise from the uterine body (95%), and rarely from the cervix (0.6%) or other urogenital sites. Lipoleiomyomas are benign, uncommon variants of leiomyomas (0.03-0.2%), histologically composed of smooth muscle cells and mature adipocytes; they usually occur in the uterine body and exceptionally in the cervix. We performed the first systematic literature review of cervical lipoleiomyomas (PRISMA guidelines), presenting five new cases. Including our series, thirty-one detailed cases were reported in the literature (mainly in Asia). The age range was 35-74 years, revealing a higher mean age than conventional cervical leiomyomas (46.5 vs. 39.4 years). Patients were usually multiparous (94%), typically complaining of vaginal bleeding (11/31, 36%), pelvic/abdominal pain (10/31, 32%), and/or urinary disturbances (6/31, 19%) 1 week to 10 months before presentation. Clinical examination revealed a pedunculated tumor (48%), or prolapse of ≥1 pelvic organs (16%). Twenty-four (77%) patients underwent total hysterectomy ± additional surgery; simple myomectomy/excision was performed in five (16%) cases. Only one (3%) of our cases recurred 2 years after partial excision; no evidence of disease was found 13 years after recurrence excision. Adipocytes occupied ≤50% of the tumor volume. Hyaline or myxoid changes and cartilaginous metaplasia were uncommon histological findings. Surgically challenging cases or pregnant patients may require expert gynecologists. Interventional radiology or conservative treatments were rarely proposed.
PubMed: 36579603
DOI: 10.3390/jpm12111852 -
American Journal of Obstetrics and... Jul 2023This meta-analysis was conducted to (1) assess the quantity and dose of perioperatively dispensed opioids for benign hysterectomy by procedure route and (2) identify the... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This meta-analysis was conducted to (1) assess the quantity and dose of perioperatively dispensed opioids for benign hysterectomy by procedure route and (2) identify the predictors of persistent opioid use after the procedure.
DATA SOURCES
PubMed, Web of Science, and Embase were systematically searched from study inception to 25 March 2022.
STUDY ELIGIBILITY CRITERIA
Studies reporting data on opioid dispensing among patients undergoing benign hysterectomy were considered eligible. The primary outcome was the dosage of opioids dispensed perioperatively (from 30 preoperative days to 21 postoperative days). The secondary outcome was the predictors of persistent opioid use after benign hysterectomy (from 3 months to 3 years postoperatively). Total opioid dispensing was measured in morphine milligram equivalents units.
METHODS
The random-effects model was used to pool the mean differences or odds ratios and the corresponding 95% confidence intervals.
RESULTS
A total of 8 studies presenting data on 377,569 women undergoing benign hysterectomy were included. Of these women, 83% (95% confidence interval, 81-84) were dispensed opioids during the perioperative period. The average amount of perioperatively dispensed opioids was 143.5 morphine milligram equivalents (95% confidence interval, 40-247). Women undergoing vaginal hysterectomy were dispensed a significantly lower amount of opioids than those undergoing laparoscopic or abdominal hysterectomies. The overall rate of persistent opioid use after benign hysterectomy was 5% (95% confidence interval, 2-8). Younger patient age (odds ratio, 1.38; 95% confidence interval, 1.17-1.63), smoking history (odds ratio, 1.87; 95% confidence interval, 1.67-2.10), alcohol use (odds ratio, 3.16; 95% confidence interval, 2.34-4.27), back pain (odds ratio, 1.50; 95% confidence interval, 1.10-2.05), and fibromyalgia (odds ratio, 1.60; 95% confidence interval, 1.39-1.83) were significantly associated with a higher risk of persistent opioid use after benign hysterectomy. However, there was no significant effect of hysterectomy route and operative complexity on persistent opioid use postoperatively.
CONCLUSION
Perioperative opioid dispensing was significantly dependent on the route of hysterectomy, with the lowest dispensed morphine milligram equivalents of opioids for vaginal hysterectomy and the highest for abdominal hysterectomy. Nevertheless, hysterectomy route did not significantly predict persistent opioid use postoperatively, whereas younger age, smoking, alcohol use, back pain, and fibromyalgia were significantly associated with persistent opioid use.
Topics: Humans; Female; Analgesics, Opioid; Fibromyalgia; Pain, Postoperative; Hysterectomy; Opioid-Related Disorders; Morphine Derivatives
PubMed: 36539027
DOI: 10.1016/j.ajog.2022.12.015