Introduction and hypothesis
In this video we present the surgical management of a 58-year-old woman presenting with a large prolapsed myomatous uterus treated with vaginal hysterectomy (VH) and ...pelvic floor repair (PFR) (uterosacral ligament suspension and posterior colporraphy) under local anesthesia and conscious sedation.
Methods
The patient underwent VH and PFR by using an infiltration of a local anesthetic solution of lidocaine, ropivacaine and adrenaline in combination with intravenous (iv) conscious sedation. Debulking techniques, such as intramyometrial coring, uterine bisection, myomectomy and wedge resection, were used to facilitate VH. The final weight of the removed uterus was 870 g.
Results
This video demonstrates that performing a surgically challenging VH under local anesthesia is feasible.
Conclusions
Vaginal uterine morcellation can be performed to debulk the enlarged uterus so that hysterectomy can be accomplished under local anesthesia. The use of local anesthesia may safely be offered as an alternative to patients undergoing a complex vaginal hysterectomy and reconstructive surgery.
Aim of the video
In this video we present the surgical management of a 59-year-old woman with stress urinary incontinece (SUI) and pelvic organ prolapse (POP) who had a history of rheumatoid ...arthritis and endometrial hyperplasia with atypia.
Methods
A concomitant laparoscopic hysterectomy with bilateral oophorectomy and a multi-compartment laparoscopic native tissue repair of the POP, combined with a Burch urethropexy, was performed to restore pelvic floor defects and treat the underlying endometrial pathology.
Conclusion
Total laparoscopic multi-compartment repair of POP and/or SUI using native tissue appears to be a viable alternative to both laparoscopic procedures using synthetic meshes and vaginal native tissue repairs. Although not a routine option for the majority of patients with POP and SUI, this procedure may be offered in selected cases, where native tissue repair of the pelvic floor is preferred.
We describe a useful technique, in laparoscopic cystectomy in‐a‐bag, for suspension and stabilization of endobag and adnexa using temporary sutures. It intends to create an isolated field to avoid ...spillage of the cyst content into the abdomen in case of rupture, thereby allowing the safe laparoscopic removal of ovarian masses.
This simple technique permits simultaneous suspension and stabilization of endobag and adnexa, facilitating the surgeon's work and making the operation safer for the patient.
A simple technique that permits to reduce the cost during gynecologic laparoscopic surgery. Small specimens may be retrieved with the use of a modified urine pediatric bag.
A simple technique that ...permits to reduce the cost during gynecologic laparoscopic surgery. Small specimens may be retrieved with the use of a modified urine pediatric bag.
Although the blunt uterine incision expansion during a low‐transverse cesarean delivery has prevailed over the sharp technique, the latter should not be completely abandoned. The sharp method with ...scissors should be considered when managing patients with previous cesarean sections, although more studies are required for a definite answer.
During a low‐transverse cesarean delivery, the blunt technique is the preferred modality, concerning the maternal outcomes. However, the sharp expansion of the lower uterine segment incision could have a role when delivering women with previous cesarean scars, since it is more controlled, without unintended transverse and vertical extensions, thus resulting in better closure. Nonetheless, more research is required for a definite answer to be given.
This is a presentation of a study protocol in order to evaluate whether the application of CO2 laser can additionally benefit the improvement of the symptoms of overactive bladder in postmenopausal ...women who have just started mirabegron as a treatment.
This is a study protocol of a randomized double-blind placebo-controlled trial. A total of 50 menopausal women will participate in the study. All patients will start treatment with mirabegron 50 mg and will be randomized into two groups. Women in group A (control) will undergo CO2 laser treatments while those in group B (placebo group) will receive placebo CO2 laser treatments. In total, three monthly sessions will be held in both groups. The monitoring and evaluation of the results will be carried out by completing a three-day urination diary, as well as by completing the Female Lower Urinary Tract Symptoms, Overactive Bladder Questionnaire, King's Health Questionnaire, Urinary Distress Inventory, Pelvic Floor Impact Questionnaire, Patient Global Impression of Improvement, before each session and a month after the last one. Differences between groups will be assessed at baseline and every month following the three laser therapies.
This is an ongoing study protocol, and we are expecting the analysis of the results in 2024.
The use of laser CO2 in postmenopausal women with overactive bladder syndrome may be a well-tolerated alternative treatment. The goal of our study is to evaluate the efficacy of laser treatment in combination with b3-adrenoreceptor agonist therapy.
We describe a rare case of a pedunculated myoma receiving multiple de‐novo developed parasitic collateral blood supply from the adjacent organs. The main feeding vessels arise from the omentum and ...the bladder.
Primary parasitic blood supply on myomas is a rare pathological entity that make laparoscopic myomectomy a demanding operation.
Leiomyomas may develop at extra‐uterine locations and pose diagnostic dile mmas. This is a case of a fibroma originating from the left round ligament presenting as a symptomatic inguinal hernia.
The ...tumor is developing retroperitoneally, 2cm from the left side of the uterus independently of it and the ipsilateral ovary.
Myomectomy is the preferred surgical treatment for symptomatic women with uterine myomas who wish to preserve their fertility. The procedure may be associated with significant intraoperative blood ...loss, which predisposes to increased transfusion rates and morbidity. The objective of our systematic review and meta-analysis is to investigate whether intravenous (IV) use of tranexamic acid (TXA) may reduce blood loss during myomectomy. Three electronic databases were screened until June 2022. The eligible studies were assessed for risk of bias. Four randomized controlled trials that reported outcomes from a total of 310 women were finally included in the meta-analysis—155 patients received intravenous TXA while the remaining 155 received placebo injection with normal saline or water for injection. Total estimated blood loss was significantly lower in patients who received TXA before myomectomy compared to control (230 patients MD −227.09 mL 95% CI −426.26, −27.91, p = 0.03). This difference in favor of TXA group remained when intraoperative and postoperative blood loss was separately analyzed. Postoperative hematocrit values and hemoglobin levels did not differ among the two groups (180 patients MD 0.67% 95% CI −0.26, 1.59, p = 0.16 and 250 patients MD 0.17 mg/dL 95% CI 0.07, 0.41, p = 0.17, respectively). The number of patients that received blood transfusion was also not different (310 patients OR 0.46 95% CI −0.14, 1.49, p = 0.19). Total operative time was significantly prolonged in control group compared to TXA (310 patients MD −16.39 min 95% CI −31.44, −1.34 p = 0.03). Our data show that the IV use of TXA may significantly reduce intraoperative blood loss in patients undergoing myomectomy and contribute to reduced operative time.
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