Purpose/objective
Laparoscopic sacrocolpopexy has been demonstrated to be the gold standard of prolapse surgery in cases with apical defect. Most recurrences seem to occur in the anterior ...compartment, especially if a paravaginal defect is present. To reduce the incidence of anterior recurrence after laparoscopic sacrocolpopexy we modified our previous published technique by placing the anterior mesh not only deep under the bladder but also laterally and fixing it to the lateral edge of the vagina. With this video article, we would like to show and explain our modified technique and demonstrate how lateral mesh placement can be easily and safely performed using laparoscopy.
Methods
The video demonstrates our modified technique with lateral extension and fixation of the anterior mesh to the lateral vagina during laparoscopic sacrocolpopexy in a patient with severe uterine prolapse (grade III) and a large cystocele (grade III). Special emphasis is given to the topographical anatomy of the paravaginal space and the surgical technique of lateral fixation.
Results
This modified new technique shows excellent perioperative results in more than 100 cases without any occurrences of lesions of the ureters. Our initial experience also shows very good anatomical results in all three compartments.
Conclusions
Paravaginal dissection and exposure of the ureters to extend the mesh placement and fixation to the lateral border of the vagina in the anterior compartment during laparoscopic sacrocolpopexy seem to be feasible and safe, helping to significantly reduce the risk of anterior recurrences. Prospective data are needed to evaluate this interesting technique.
The European Society of Breast Cancer Specialists (EUSOMA) has fostered a voluntary certification process for breast centres to establish minimum standards and ensure specialist multidisciplinary ...care. Prospectively collected anonymous information on primary breast cancer cases diagnosed and treated in the units is transferred annually to a central EUSOMA data warehouse for continuous monitoring of quality indicators (QIs) to improve quality of care. Units have to comply with the EUSOMA Breast Centre guidelines and are audited by peers. The database was started in 2006 and includes over 110,000 cancers from breast centres located in Germany, Switzerland, Belgium, Austria, The Netherlands, Spain, Portugal and Italy. The aim of the present study is assessing time trends of QIs in EUSOMA-certified breast centres over the decade 2006–2015.
Previously defined QIs were calculated for 22 EUSOMA-certified breast centres (46122 patients) during 2006–2015.
On the average of all units, the minimum standard of care was achieved in 8 of 13 main EUSOMA QIs in 2006 and in all in 2015. All QIs, except removal of at least 10 lymph nodes at axillary clearance and oestrogen receptor–negative tumours (T > 1 cm or N+) receiving adjuvant chemotherapy, improved significantly in this period. The desirable target was reached for two QIs in 2006 and for 7 of 13 QIs in 2015.
The EUSOMA model of audit and monitoring QIs functions well in different European health systems and results in better performance of QIs over the last decade. QIs should be evaluated and adapted on a regular basis, as guidelines change over time.
•The time trends of quality indicators in EUSOMA-certified breast centres over the decade 2006–2015 are evaluated.•The EUSOMA model of audit and monitoring QIs functions well in different European health systems.•Audit and measuring quality indicators result in better performance.
Abstract Aim of the study The European Society of Breast Cancer Specialists (EUSOMA) has fostered a voluntary certification process for breast units to establish minimum standards and ensure ...specialist multidisciplinary care. In the present study we assess the impact of EUSOMA certification for all breast units for which sufficient information was available before and after certification. Materials and methods For 22 EUSOMA certified breast units data of 30,444 patients could be extracted from the EUSOMA database on the evolution of QI's before and after certification. Results On the average of all units, the minimum standard of care was achieved for 12/13 QI's before and after EUSOMA certification (not met for DCIS receiving just one operation). There was a significant improvement of 5 QI's after certification. The proportion of patients with invasive cancer undergoing an axillary clearance containing >9 lymph nodes (91.5% vs 89.4%, p 0.003) and patients with invasive cancer having just 1 operation (83.1% vs 80.4%, p < 0.001) dropped, but remained above the minimum standard. The targeted standard of breast care was reached for the same 4/13 QI's before and after EUSOMA certification. Conclusion Although the absolute effect of EUSOMA certification was modest it further increases standards of care and should be regarded as part of a process aiming for excellence. Dedicated units already provide a high level of care before certification, but continuous monitoring and audit remains of paramount importance as complete adherence to guidelines is difficult to achieve.
Abstract Advanced breast cancer screening techniques and their availability increased the number of non-palpable breast lesions requiring surgery. Consequently reliable and efficient therapeutic ...management permitting accurate localization and removal of these occult lesions is essential. Aims In our study we evaluated radioguided occult lesion localization (ROLL) for effectiveness of localization, oncological safety and feasibility of concomitant sentinel node biopsy. Methods Hundred patients (120 lesions) underwent ROLL and tumour excision with or without sentinel node biopsy after confirmed histopathological findings via intra-tumoral injection of Tc99m-labelled macro-aggregate albumin for ROLL and Tc99m-labelled nanocolloids with periareolar–subdermal injection for simultaneous sentinel node biopsy. Results Our detection rate for ROLL was 98.3%, respectively, 98.6% for sentinel nodes in cases of concomitant sentinel node biopsy. We had a radical excision rate of 55 out of 69 cases of invasive ductal cancer and 17 out of 26 cases of DCIS to achieve 1 mm, respectively, 10 mm tumour-free margins. Conclusions Intra-tumoral tracer injection of for ROLL and periareolar–subdermal tracer injection for simultaneous sentinel node biopsy seem to be a sensitive technique. According to our results ROLL is a safe, precise and simple technique permitting definitive therapeutic removal of malignant or premalignant breast lesions. The high detection rate of the sentinel node in cases with concomitant sentinel node biopsy shows that the combination of both procedures is possible and safe. In our opinion ROLL is an excellent therapeutic option after histological confirmation of malignancy or premalignant disease.
Red blood cell distribution width (RDW) is a biomarker quantifying the variability of red blood cell size in peripheral blood. Elevated RDW has been found to be an independent prognostic factor for ...cardiovascular events. SSc is characterized by generalized micro- and macroangiopathy. Our aim was to investigate RDW as a potential biomarker for the assessment of the severity of vascular involvement.
One hundred and sixty-eight consecutive SSc patients--62 with dcSSc and 106 with lcSSc--were investigated at baseline and after 1-year of follow-up. Measurements in 93 patients with primary RP and 40 healthy subjects served as controls.
The median RDW value of patients with SSc was higher 14.2% (25th-75th percentiles 13.5-14.8%) compared with the group of primary RP patients 13.9% (13.4-14.4%); P < 0.05) and healthy volunteers 13.6% (13.2-13.8%; P < 0.01. dcSSc and anti-topoisomerase antibody-positive cases showed elevated RDW values compared with lcSSc and anti-topoisomerase antibody-negative cases (P < 0.05). RDW showed a positive correlation with inflammatory markers, including ESR (P < 0.05) and CRP (P < 0.05), and a negative correlation with forced vital capacity (P < 0.05) and diffusing capacity of the lung for carbon monoxide (DLCO) (P < 0.05) during the follow-up. An increase in RDW of >5% during follow-up was associated with an average 8.9% decrease in left ventricular ejection fraction (LVEF) and 7% in DLCO and these associations were independent of each other.
RDW in SSc may represent an integrative measure of multiple pathological processes including extensive vasculopathy, fibrosis or ongoing inflammation. An increase in RDW may indicate an impairment of cardiorespiratory function.
IntroductionThe emphasis on aesthetic outcomes and quality of life (QoL) has motivated surgeons to develop skin-sparing or nipple-sparing mastectomy (SSM/ NSM) for breast cancer treatment or ...prevention. During the same operation, a so-called immediate breast reconstruction is performed. The breast can be reconstructed by positioning of a breast implant above (prepectoral) or below (subpectoral) the pectoralis major muscle or by using the patients’ own tissue (autologous reconstruction). The optimal positioning of the implant prepectoral or subpectoral is currently not clear. Subpectoral implant-based breast reconstruction (IBBR) is still standard care in many countries, but prepectoral IBBR is increasingly performed. This heterogeneity in breast reconstruction practice is calling for randomised clinical trials (RCTs) to guide treatment decisions.Methods and analysisInternational, pragmatic, multicentre, randomised, superiority trial. The primary objective of this trial is to test whether prepectoral IBBR provides better QoL with respect to long-term (24 months) physical well-being (chest) compared with subpectoral IBBR for patients undergoing SSM or NSM for prevention or treatment of breast cancer. Secondary objectives will compare prepectoral versus subpectoral IBBR in terms of safety, QoL and patient satisfaction, aesthetic outcomes and burden on patients. Total number of patients to be included: 372 (186 per arm).Ethics and disseminationThis study will be conducted in compliance with the Declaration of Helsinki. Ethical approval has been obtained for the lead investigator’s site by the Ethics Committee ‘Ethikkommission Nordwest- und Zentralschweiz‘ (2020–00256, 26 March 2020). The results of this study will be published in a peer-reviewed medical journal, independent of the results, following the Consolidated Standards of Reporting Trials standards for RCTs and good publication practice. Metadata describing the type, size and content of the datasets will be shared along with the study protocol and case report forms on public repositories adhering to the FAIR (Findability, Accessibility, Interoperability, and Reuse) principles.Trial registration number NCT04293146.
Fragestellung:
Die Studie verglich OP- und Anästhesiezeit, Spitalsaufenthalt, perioperative Komplikationen und postoperative Schmerzen zwischen vaginaler Hysterektomie (VH) und totaler ...laparoskopischer Hysterektomie (TLH) wegen benignen Indikationen.
Methodik:
Prospektiv randomisierte multicenter Studie.
Ergebnisse:
98 Patientinnen wurden randomisiert und operiert (VH 46, TLH 52). Es gab keine intraoperativen Konversionen. OP-Zeit und Anästhesiezeit waren bei VH signifikant kürzer als bei TLH (54 ± 26 vs. 97 ± 44 Min., P < 0,001, bzw. 97 ± 30 vs. 154 ± 47 Min., P < 0,001). Keine signifikanten Unterschiede zeigten sich beim Spitalsaufenthalt (3,1 ± 1,2 vs. 3,1 ± 1,1 Tage), in der Reoperationsrate (5% bzw. 1%) und bei Wiederaufnahmen innerhalb 6 Wo. (8% vs. 7%). Schmerzscores (VAS) beim Verlassen des Aufwachraumes, am Entlassungstag und nach 6 Wo. zeigten keine signifikanten Unterschiede.
Schlussfolgerung:
In dieser Studie waren OP- und Anästhesiezeiten bei VH deutlich kürzer als bei TLH; postoperative Schmerzscores, Komplikationsraten und Spitalsaufenthaltszeiten waren ähnlich.
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