Uterine fibroids, laparoscopic surgery and morcellation: comparative analysis of the results of organ-preserving operations

GYNECOLOGY ◽  
2021 ◽  
Vol 23 (1) ◽  
pp. 73-77
Author(s):  
Alexander A. Seregin ◽  
Anastasiia B. Nadezhdenskaia ◽  
Anna S. Makarova ◽  
Polina L. Sheshko ◽  
Anna V. Tregubova ◽  
...  
Keyword(s):  
Comparative Analysis ◽  
Blood Loss ◽  
Abdominal Cavity ◽  
Uterine Fibroids ◽  
Operation Time ◽  
Main Group ◽  
Laparoscopic Myomectomy ◽  
Control Group ◽  
Tumor Spread ◽  
Plastic Containers

Aim. To conduct a comparative analysis of the results of organ-preserving laparoscopic operations performed for uterine fibroids with the use of plastic containers for morcellation and without it. Materials and methods. We examined 57 patients with a diagnosis of uterine fibroids who were admitted to the Department of Innovative Oncology and Gynecology of the Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology for organ-preserving surgical treatment. To achieve the goal of the study, the patients were divided into the following groups: the main group 29 patients who underwent laparoscopic myomectomy and morcellation of removed nodes using plastic containers. The control group consisted of 28 patients who underwent morcellation during laparoscopic myomectomy without the use of plastic containers. Results. The duration of laparoscopic operations performed using plastic containers main group was 85.6925.87 minutes. Laparoscopic conservative myomectomies, performed without the use of limiting systems, took a slightly longer amount of time control group 88.7530.36 minutes. There were no statistically significant differences, but in the second group, more prolonged sanitation of the abdominal cavity and removal of small fragments of myomatous nodes after morcellation outside the sacs were required. Autoinfusion was used in 6 (20.69%) patients in the main group, in 7 (25%) patients in the control group. Blood transfusion was not used in any case. Average blood loss was 120.6967.50 ml in the main group, 125.0099.54 ml in the control. The duration of hospitalization in the main group was 4.661.76 days, in the control group 5.793.62 days. In the main group, histological examination revealed leiomyoma in all cases, leiomyoma was detected in 96.4% (27 patients) of cases in the control group, and leiomyosarcoma in 1 patient (3.6%). Conclusion. In all groups of patients, there was a favorable course of the postoperative period, early activation of patients. In the group of laparoscopic operations, one patient (3.6%) after morcellation of the myomatous node without the use of a plastic container was found to have leiomyosarcoma. The use of plastic containers in our study did not increase the duration of operations and did not affect the volume of blood loss, the frequency of intra- and postoperative complications. In contrast, the operation time was slightly higher among patients who were operated without the use of containers. In all likelihood, this was due to the fact that the morcellation stage itself took longer, since it was required to extract small fragments of myomatous nodes, as well as thorough and prolonged sanitation of the abdominal cavity. It should be noted that the use of plastic containers, of course, requires the development of certain skills from the surgeon, taking less and less time in parallel with the learning curve. Of course, further studies are required to assess the risk of tumor spread in patients undergoing surgery using plastic containers, but preliminary data indicate that ablastic morcellation can and should be used in organ-preserving surgery for uterine myoma.

scholarly journals Are there any advantages of 3D laparoscopic technologies in surgery for rectocele and rectal prolapse?

2021 ◽  
Vol 20 (4) ◽  
pp. 56-69
Author(s):  
A. G. Khitaryan ◽  
A. A. Golovina ◽  
S. A. Kovalev ◽  
N. A. Romodan ◽  
A. Z. Alibekov ◽  
...  
Keyword(s):  
Blood Loss ◽  
Rectal Prolapse ◽  
Fluid Collection ◽  
Operation Time ◽  
Main Group ◽  
Control Group ◽  
Intraoperative Blood Loss ◽  
Laparoscopic Ventral Mesh Rectopexy ◽  
Ventral Mesh Rectopexy ◽  
Mesh Rectopexy

AIM: to assess results of 3D laparoscopic ventral mesh rectopexy versus traditional 2D laparoscopy for rectocele and rectal prolapse.PATIENTS AND METHODS: a prospective randomized study (NCT 04817150) included patients aged 18 to 70 years who underwent laparoscopic ventral mesh rectopexy for rectocele and/or rectal prolapse. The assessment included operation time, intraoperative blood loss, complications rate and their severity by Clavien-Dindo scale, the pain intensity by VAS, the volume of the fluid collection in the implant site 2–3 days and 2–3 weeks after the procedure. The surgeon’s comfort and ergonomics when using 3D systems was evaluated using POMS questionnaire. The late results were assessed by recurrence rate, functional results — by Cleveland Clinic Constipation scale score, Incontinence scale score, P-Qol, and PGII.RESULTS: the study included 29 patients of the main and 32 patients of the control group. The follow-up was 21 ± 20.3 months. One complication developed in the control group (p = 1.0). The operation time in the main group was 74.1 ± 14 minutes (87.1 ± 24.3 minutes in controls, p = 0.01). The intraoperative blood loss was 19.8 ± 9.6 ml in the main group (55 ± 39.2 ml in controls, p = 0.001). The pain intensity was significantly lower in the main group (18.0 vs 22.5 points, p = 0.03). The volume of fluid collection 2–3 after surgery mesh site was 21.2 ± 9.7 cm3 in the main group (30.7 ± 25.6 cm3 in the control group, p = 0.02). The POMS scale assessment for a surgeon in the main group was 56.4 ± 33.5 points (87.3 ± 30.8 points in the control group). A follow-up examination 12 months postop revealed no recurrence in both groups (p = 1.0). The main and the control group showed no significant differences in functional outcomes.CONCLUSIONS: the use of 3D laparoscopic ventral mesh rectopexy for rectocele and rectal prolapse is comparable in late results with traditional laparoscopic procedure. However, it takes less operation time, lower pain intensity, less intraoperative blood loss, smaller fluid collection at mesh site, better comfort and ergonomics for surgeon.

scholarly journals Efficacy of carprostol tromethamine combined with mifepristone in the treatment of uterine fibroids

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Jun Wang ◽  
Xian Zhang
Keyword(s):  
Estrogen Receptor ◽  
Progesterone Receptor ◽  
Treatment Effect ◽  
Uterine Fibroids ◽  
Operation Time ◽  
Clinical Treatment ◽  
Control Group ◽  
Observation Group ◽  
Significant Difference ◽  
Better Than

【Abstract】Objective: To investigate the clinical efficacy of carboprost tromethamine combined with mifepristone in the treatment of uterine fibroids. METHODS: A total of 66 patients with uterine fibroids admitted to our hospital between April 2018 and January 2019 were selected as subjects. According to the two different treatment methods, patients were divided equally. The observation group and the control group, each group of 33 people. The oxytocin drug treatment was medicated to the control group, and the prostaglandin tromethamine combined with mifepristone was medicated to the observation group. The treatment effect, adverse reaction, operation, and uterine muscle before and after surgery were observed in these two groups. Tumor tissue progesterone receptor and estrogen receptor levels. Results: The clinical treatment effect of the observation group was 93.94%, and the clinical treatment effect of the control group was 60.61%. The clinical treatment effect of the observation group was significantly higher than that of the control group; also the incidence of adverse reactions in the observation group in terms of rash, fatigue, nausea and vomiting was much lower than the control group, and could observe a significant difference. Finally in observation group, the amount of intraoperative blood loss, operation time and hospitalization time were better than those of the control group. The progesterone receptor and estrogen receptor levels in the uterine fibroid tissue after surgery should also be better than the control group, it is worth to make further comparison. Conclusion: Carprostol tromethamine combined with mifepristone is effective in the treatment of uterine fibroids and can be further developed.

scholarly journals Efficiency of minimally invasive surgery for liver echinococcosis and its complications

2021 ◽  
Vol 26 (1) ◽  
pp. 84-91
Author(s):  
Z. A. Azizzoda ◽  
K. M. Kurbonov ◽  
K. R. Ruziboyzoda ◽  
S. G. Ali-Zade
Keyword(s):  
Minimally Invasive Surgery ◽  
Comparative Analysis ◽  
Surgical Treatment ◽  
Liver Resection ◽  
Minimally Invasive ◽  
Postoperative Mortality ◽  
Main Group ◽  
Control Group ◽  
Surgical Methods ◽  
Access Surgery

Aim. Improving outcomes of diagnosis and treatment of patients with liver echinococcosis and its complications. Materials and methods. A comparative analysis of the results of surgical treatment of liver echinococcosis and its complications with traditional laparotomy access surgery (control group) and minimally invasive interventions (main group) was performed.Results. The study included 300 patients (170 in the control and 130 in the main group). In the main group, 37 (28.4%) cases performed open echinococcectomy from various mini-accesses, and 27 (20.7%) performed twostage operations using minimally invasive technology. Laparoscopic echinococcectomy was performed in 23 (17.7%) patients, laparoscopic pericystectomy 12 (9.2%) and laparoscopic liver resection in 10 (7.7%) patients. The frequency of postoperative complications in the main group was 17.7%, in the control 51.8%, postoperative mortality decreased from 2.3% to 0.8%.Conclusion. Minimally invasive technologies in the surgical treatment of liver echinococcosis show the better immediate results compared to traditional open surgical methods.

scholarly journals Caesarean myomectomy - a safe procedure: A retrospective case controlled study

1970 ◽  
Vol 2 (2) ◽  
pp. 59-62 ◽  
Author(s):  
Alexander T Owolabi ◽  
Oluwafemi Kuti ◽  
Olabisi M Loto ◽  
Oluwafemiwa N Makinde ◽  
Adebanjo B Adeyemi
Keyword(s):  
Caesarean Section ◽  
Blood Loss ◽  
Post Partum ◽  
Uterine Fibroids ◽  
Controlled Study ◽  
Control Group ◽  
High Dose ◽  
Safe Procedure ◽  
The Mean ◽  
Duration Of Operation

Objective(s): The aim of the study is to determine whether myomectomy at the time of caesarean section leads to increase incidence of intrapartum and postpartum complications. Methods: Fourteen women, with uterine fibroids in pregnancy who were treated by caesarean myomectomy between January 2001 and June 2007, were compared retrospectively with fourteen women, without uterine fibroids who had routine caesarean section during the same period. Myomectomy for all types of myoma was performed at caesarean section after the delivery of the baby. Haemorrhage was controlled with the use of Foleys catheter tourniquet and high dose oxytocin infusion. The cases and control were analysed for age of the patient, parity, pre and post-operative haematocrit levels, duration of operation, blood loss, blood transfusions, and incidence of postpartum fever. Results: Caesarean myomectomy resulted in the mean blood loss of 589 ml (range 300-1300 ml) compared with 518 ml (range 350-850 ml) in the control group (p=0.376). The mean duration of operation was longer in the cases of caesarean myomectomy (66.8 mins) than those of the controls (56.4 mins). There were no significant differences between the two groups in the incidence of intraoperative haemorrhage, the need for blood transfusion, post partum fever, and length of hospital stay. Conclusions: This study shows that myomectomy during caesarean section is a safe procedure in experienced hands and is not as dangerous as generations of obstetricians have been trained to believe. Further research is necessary to establish the cost effectiveness of the procedure. Key words: myomectomy, cesarean section, hemorrhage      doi:10.3126/njog.v2i2.1457 N. J. Obstet. Gynaecol 2007 Nov-Dec; 2 (2): 59 - 62

scholarly journals The Results of Duodenum-Preserving Resections of the Pancreas in Chronic Pancreatitis Using the Technology of Sealing the Pancreatic-Intestinal Anastomosis

2019 ◽  
Vol 4 (2) ◽  
pp. 122-126
Author(s):  
V. G. Lubyanskiy ◽  
V. V. Seroshtanov
Keyword(s):  
Chronic Pancreatitis ◽  
Intestinal Anastomosis ◽  
Abdominal Cavity ◽  
Main Group ◽  
Control Group ◽  
Cervical Anastomosis ◽  
Pancreatic Anastomosis ◽  
Drainage Fluid ◽  
Results Of Treatment ◽  
Cause Of Deaths

Background. The problem of chronic pancreatitis in recent years is acute, primarily due to the occurrence of complications and pain that forces you to turn to a surgeon. The main cause of deaths is the failure of the pancreatic anastomosis and the occurrence of bleeding into the cavity of the pancreatic intestinal anastomosis (40 %).Aims: to improve the results of duodenum-preserving resections by introducing the technology of sealing the pancreaticintestinal anastomosis.Materials and methods. The clinic operated 225 patients with chronic pancreatitis. All patients before the operation and in the postoperative period were carried out clinical and biochemical studies, the Frey operation was performed. Patients were divided into two groups. The first group, the group of comparison, included 184 (81.8 %) patients with pancreatoenteroanastomosis formed without additional sealing methods. The second group – the main one – consisted of 41 (18.2 %)patients in which the suture of the pancreatic anastomosis was strengthened with an adhesive composite or with the loop of the small intestine.Results. After the surgery, complications in the control group were recorded in 19 (8.4 %) patients: failure – in 6 (3 %), bleeding into the lumen of pancreatoenteroanastomosis – in 9 (4 %), mortality was 1.8 % (4 persons). There were no complications in the main group. The analysis of the amylase content in the drainage fluid revealed high values in the control group on the 3rd day – 916 ± 15 U/l, in comparison with the main group – 437 ± 16 U/l (p < 0.05). The data obtained indicate that the cause of insolvency of the pancreatic-intestinal anastomosis is the penetration of enzymes through the pancreatic-cervical anastomosis zone into the abdominal cavity. When analyzing the results, it turned out that the failure of the pancreatic-intestinal anastomosis was not detected in any case in patients with sealing.Conclusion. The escape of enzymes destroys the tightness of the superimposed fistula and is characterized by an increase in the level of amylase in the drainage fluid. The proposed sealing technologies decrease the number of postoperative complications and improve the results of treatment.

scholarly journals Study on the Effect of Removing the Slide Wire Screw on Locking Plate by Nail Groove Reconstruction Method

2021 ◽  
Author(s):  
Guanglei Zheng ◽  
Yingjie Qi
Keyword(s):  
Blood Loss ◽  
Locking Plate ◽  
Operation Time ◽  
Healing Time ◽  
Control Group ◽  
Reconstruction Method ◽  
Intraoperative Blood Loss ◽  
Limb Function ◽  
Experimental Group ◽  
Tungsten Steel

Abstract Background: This paper is to describe and evaluate the nail groove reconstruction method in removing slide wire screw on locking plate. Then compare the method with tungsten steel drilling nail method, to explore a new method of removing slide wire screw on locking plate.Method: A total of 1254 patients with removal fracture internal fixation devices were collected from the Affiliated Hospital of Hangzhou Normal University from July 2015 to September 2021, of which 62 cases met the inclusion and exclusion criteria. All patients were randomly divided into the experimental group and the control group. 31 people per group. There were 19 males and 12 females in the experimental group, the age of patients was 35.68±11.70years; while 18 males and 13 females in the control group, the age of patients was 36.27±10.37years. Nail groove reconstruction method was used in the experimental group, and the tungsten steel drilling nail method was used in the control group. Collect and count surgical-related indicators, the data of two groups were compared and analyzed from four aspects: intraoperative blood loss, operation time, incision healing time and limb function recovery time.Result: All slide wire screws were removed successfully, and all patients had no serious postoperative complications such as internal fixation retention and neurovascular injury. The experimental group was better than the control group in the following three aspects: the amount of intraoperative blood loss, the operative time, the recovery time of limb function, and the differences were statistically significant(p < 0.05). There was no significant difference in incision healing time between the two groups.Conclusion: The nail groove reconstruction method has less damage to the bone and soft tissue, less intraoperative blood loss, shorter operation time, and faster postoperative recovery of limb function. The nail groove reconstruction method is a simple and effective method, it has obvious advantages compared with the traditional method.

scholarly journals Diagnostics and treatment of abdominal complications after gynecological endoscopic operations

2021 ◽  
Vol 1 ◽  
pp. 75-79
Author(s):  
Yu.P.  Vdovichenko ◽  
V.I.  Boyko ◽  
V.A.  Terehov
Keyword(s):  
Postoperative Complications ◽  
Postoperative Period ◽  
Diagnostic Laparoscopy ◽  
Abdominal Cavity ◽  
Early Postoperative Period ◽  
Main Group ◽  
Laparoscopic Technique ◽  
Control Group ◽  
Diffuse Peritonitis ◽  
Abdominal Complications

The objective: to analyze the results of repeated laparoscopy in gynecological patients with suspected intraperitoneal postoperative complications.Materials and methods. The study involved 42 patients (mean age 46±11,3 years), in whom postoperative abdominal complications after surgical treatment of various gynecological diseases required repeated operations. Depending on the method of re-intervention, the patients were divided into 2 groups: the main group (n=20) – women who only used laparoscopy to correct postoperative complications; control (n=22) – women who were given indications for relaparotomy to correct postoperative complications during diagnostic laparoscopy. Relaparotomy was performed in 8 patients of the control group. All patients underwent a comprehensive examination using clinical, instrumental and laboratory research methods. The groups were homogeneous in terms of age and structure of operations performed on the pelvic organs, and statistically comparable.Results. During the study, the results of repeated laparoscopy of 34 gynecological patients with suspected intraperitoneal postoperative complications were analyzed. In all patients of the main group (47,6%), laparoscopy was revealed as the only and final method of treatment of postoperative complications, while in 7 women repeated relaparoscopy was used from 2 to 4 times, and in 13 women laparoscopy was performed once. In the control group (53,3%), 10 patients during diagnostic laparoscopy were exposed to indications for relaparotomy, in 4 patients the capabilities of the operating team and laparoscopic technique allowed performing some elements of the operation and completing it with a minilaparotomy approach, and 8 patients underwent relaparotomy immediately.Peritonitis and intraperitoneal bleeding prevail in the structure of early abdominal complications. The use of the video laparoscopic technique made it possible in 28,6% of patients with diffuse peritonitis to successfully eliminate the developed complication, eliminate its source and sanitize the abdominal cavity. Laparoscopic hemostasis was successfully performed in 7 patients.Compared with the standard, the use of video endoscopic technique allowed improving the indicators of diagnostic value: to increase the sensitivity level by 1,07 times, specificity by 1,39 times and diagnostic accuracy by 1,11 times.Conclusion. In general, in the early postoperative period, 47 relaparoscopies were performed for suspected complications, which is explained by programmed abdominal sanitization and the use of dynamic laparoscopy to control the course of intraperitoneal complications. Based on the analysis of the material under study, we proposed general indications and contraindications for relaparoscopy in the early postoperative period in order to diagnose and treat postoperative complications. Justifying each of the points, we were guided by the real possibilities of the method in general clinical practice, which in some cases are inferior in their effectiveness to relaparotomy.

scholarly journals Laparoscopic-assisted reversal of Hartmann's procedure

2010 ◽  
Vol 57 (3) ◽  
pp. 59-65 ◽  
Author(s):  
S. Achkasov ◽  
G. Vorobiev ◽  
A. Zhuchenko ◽  
M. Rinchinov
Keyword(s):  
Wound Infection ◽  
Operation Time ◽  
Main Group ◽  
Hartmann’S Procedure ◽  
Control Group ◽  
Open Approach ◽  
Hartmann's Procedure ◽  
Comparable Control ◽  
Hospital Stays ◽  
Laparoscopic Assisted

BACKGROUND: Postoperative morbidity after reversal of Hartmann's procedure remains high. AIM: to evaluate efficacy of laparoscopic-assisted approach. PATIENTS AND METHODS: 36 patients (19 men, aged 55.71+1.5 years) underwent laparoscopic-assisted reversal procedures in May 2008 - June 2010. The comparable control group consisted of 35 patients (16 men, aged 51.5+13.9 years). RESULTS: operation time was 179.5+65.1 min, 266.9+71.8 min in controls. Blood loss was 64.7+33.7 ml, 181.8+120.4 ml in controls. No conversions occurred in the main group. In three patients of the main group preventive ileostomy was performed. There were 11 diverting stomas in the control group. Postoperative hospital stays were 9.1+2.7 days (12.9+3.4 days in controls). There were 2 (5.9%) postoperative complications in the main group: one wound infection and one parastomal fistula. No mortality occurred. In the control group 3 (9.1%) complications (wound infection and haematoma) were detected. CONCLUSION: laparoscopic-assisted reversal of Hartmann's procedure promotes faster rehabilitation, its results are not worse than after open approach.

scholarly journals Influence of ICG-technology on the results of surgical treatment of early forms of breast cancer

2021 ◽  
Vol 26 (2) ◽  
pp. 67-72
Author(s):  
J. Masia ◽  
O.Y. Savenkov
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Surgical Treatment ◽  
Sentinel Lymph Node ◽  
Intraoperative Imaging ◽  
Surgical Techniques ◽  
Main Group ◽  
Control Group ◽  
Subcutaneous Mastectomy ◽  
Tumor Spread

Breast cancer (BC) is one of the most common causes of death in women up to 50 years old. For today the choice of an adequate methods of surgical intervention and the need for an adequate surgical adjuvant therapy, quality of life of patients after surgeryis are important. The aim of our study was to select the volume of surgery for breast cancer using the technique of intraoperative identification of the sentinel lymph node (intraoperative ICG technology) and to evaluate the results of its urgent histological examination. It was shown that the most common method of surgery in patients who underwent intraoperative ICG technology was quadrantectomy, which was performed in 27 cases (54%), rarely subcutaneous mastectomy was performed (30%) and radical mastectomy (by Madden) – 16%. In the control group, priority was given to radical removal of the breast (63.2% of cases); partial resection (by U. Veronesi) was performed in 33.3% of patients, and subcutaneous mastectomy – in 3.5%. Pathomorphological examination of the sentinel lymph node during its intraoperative imaging using ICG-technology established metastatic lesion in 10 of 50 cases (20%) in the main group. The obtained results of the assessment of the regional lymph dissection size in the main group indicate its adequate nature to ensure the radicality of surgical treatment. In our opinion, this is one of the important preliminary conclusions of this study, because to assess the clinical significance of signal lymph node (SLN) analysis as a marker of regional tumor spread, firstly it is necessary to be sured that existing surgical techniques provide radical tumor removal.

On dissection of the uterine wall during laparoscopic myomectomy

2021 ◽  
Vol 70 (5) ◽  
pp. 157-162
Author(s):  
Andrey N. Plekhanov ◽  
Vitaly F. Bezhenar ◽  
Yulia S. Shishkina ◽  
Viktor A. Linde
Keyword(s):  
Comparative Analysis ◽  
Surgical Treatment ◽  
Energy Supply ◽  
Uterine Fibroids ◽  
Operating Mode ◽  
Uterine Wall ◽  
Laparoscopic Myomectomy ◽  
Surgical Instrument ◽  
Output Frequency ◽  
Ultrasound Energy

BACKGROUND: Laparoscopic myomectomy is becoming the leading method of surgical treatment of uterine fibroids while preserving reproductive and menstrual functions. Increasingly, ultrasound energy is used to dissect the myometrium. Meanwhile, the mode and direction of the ultrasound energy supply to minimize damage to the underlying tissues have not been specified. AIM: The aim of this study was to perform a comparative analysis of the myometrium and the fibroid pseudocapsule in the projection of the myoma nodule after dissection using ultrasound energy with different initial characteristics of the surgical instrument. MATERIALS AND METHODS: For comparison, we selected two instruments with a longitudinal ultrasound energy supply with an output frequency of 80 MHz ... 2.5 GHz and 47 kHz at intermittent operating mode of 5/10 sec and one torsion instrument with a transverse ultrasound energy supply with an output frequency of 36 kHz at intermittent operating mode of 3/30 sec. RESULTS: Our study has shown that the smallest zone of irreversible changes is formed when using ultrasound energy with an output frequency of 36 kHz at intermittent operating mode of 3/30 sec with its transverse feed at 90 degrees to the blade, and the largest zone of irreversible changes is formed when using ultrasound energy with an output frequency of 47 kHz at intermittent operating mode of 5/10 sec with its longitudinal feed. CONCLUSIONS: Morphometric studies with an analysis of the depth of necrotic and necrobiotic changes in the myometrial tissue showed that from the standpoint of reproductive surgery, it is preferable to use USE with an output frequency of 36 kHz at intermittent operating mode of 3/30 sec with its transverse feed.

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