A multimodal concept for vaginal cuff closure by modification of the Bakay technique in total laparoscopic hysterectomy: a randomized clinical study

Background The aim of this study was to compare the outcomes of modified Bakay technique (MT) to standard colpotomy (ST) and cuff closure in total laparoscopic hysterectomy (TLH). Methods This two-centre, randomized-controlled study included a total of 160 patients who were scheduled for TLH for benign diseases (ClinicalTrials.gov Identifier is NCT05080114 and the first posted date was 15/10/2021). The patients were allocated into two groups by a computer-based randomization programme as ST group and MT group. Total operative time, cuff closure time, length of hospital stay, intra- and postoperative complications according to the Clavien-Dindo classification, pre- and postoperative vaginal length, and patient satisfaction according to the Patient Global Impression of Improvement (PGI-I) questionnaire were assessed. Results Seventy-seven patients in the ST group and 80 patients in the MT group underwent TLH. The total operative time was significantly shorter in the MT compared to the ST (55.5 vs. 59 min, respectively; p = 0.001). The median total operative time for colpotomy, extraction of uterus, and vaginal cuff closure steps was 9 (range 6–12 in MT vs. 6 to 11 in ST) min in both groups. The median hospital stay was 2 (range 1–4) days in both groups. Intraoperative blood loss was not significantly different between the groups (90 mL in ST vs. 80 mL in MT; p = 0.456). The mean uterine weight for the ST group and MT group was comparable (258.6 ± 88.6 g vs. 232.9 ± 102.5 g, respectively; p = 0.107). The preoperative vaginal length was not significantly different between the groups (p = 0.502). The median postoperative vaginal length was significantly higher in the MT group compared to the ST group on Day 90 (8 cm vs. 7,5 cm, respectively; p = 0.001). The PGI-I questionnaire score on Day 90 postoperatively was 2 (range 1–5) in both groups (p = 0.636). The complication rates were similar between the groups (p = 0.230). Conclusion The MT can be safely performed in most of the cases requiring TLH with the advantages of vaginal cuff closure before the alteration of pelvic anatomy, support to primary healing of the vaginal cuff, and routine concomitant apical support.

Clinical Risk Factors for Uterine Cervical Elongation among Women with Pelvic Organ Prolapse

Background: Cervical elongation is commonly associated with pelvic organ prolapse (POP). It was an identified risk for recurrent prolapse after hysteropexy, requiring additional surgeries. The aim of the study is to investigate the risk factors for uterine cervical elongation among women with POP. Methods: In this single-center retrospective cohort study, women who underwent vaginal total hysterectomy for POP between 2014 and 2016 were collected. The cervical and total uterine lengths were measured by pathologists, while the ratio of cervical length to total uterine length were calculated. The cervical elongation is defined as corpus/cervix ratio ≤ 1.5. Results: A total of 133 patients were enrolled in this study. Among these patients, 43 women had cervical elongation and 90 women had normal length of uterine cervix. We found that age > 65 years old (67.4% vs. 42.2%, p = 0.007), total vaginal length ≥ 9.5 cm (65.1% vs. 45.6%, p = 0.035), uterine weight < 51 gm (72.1% vs. 52.2%, p = 0.03), and Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6) ≥ 12 (30.2% vs. 14.4%, p = 0.032) were associated with the risk of cervical elongation. There were no significant differences on preoperative urodynamic parameters in the two groups. Conclusion: The patient age > 65 years old, the total vaginal length of POP-Q system ≥ 9.5 cm, uterine weight < 51 g, and POPDI-6 ≥ 12 are independent risk factors of cervical elongation in women with POP. For women scheduled for pelvic reconstructive hysteropexy, concomitant cervical amputation should be considered.

Laparoscopic sacrohysteropexy versus vaginal hysterectomy and apical suspension: 7-year follow-up of a randomized controlled trial

Introduction and hypothesis Laparoscopic mesh sacrohysteropexy offers a uterine-sparing alternative to vaginal hysterectomy with apical suspension, although randomised comparative data are lacking. This study was aimed at comparing the long-term efficacy of laparoscopic mesh sacrohysteropexy and vaginal hysterectomy with apical suspension for the treatment of uterine prolapse. Methods A randomised controlled trial comparing laparoscopic mesh sacrohysteropexy and vaginal hysterectomy with apical suspension for the treatment of uterine prolapse was performed, with a minimum follow-up of 7 years. The primary outcome was reoperation for apical prolapse. Secondary outcomes included patient-reported mesh complications, Pelvic Organ Prolapse Quantification, Patient Global Impression of Improvement in prolapse symptoms and the International Consultation on Incontinence Questionnaire Vaginal Symptoms, Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and PISQ-12 questionnaires. Results A total of 101 women were randomised and 62 women attended for follow-up at a mean of 100 months postoperatively (range 84–119 months). None reported a mesh-associated complication. The risk of reoperation for apical prolapse was 17.2% following vaginal hysterectomy (VH) and 6.1% following laparoscopic mesh sacrohysteropexy (LSH; relative risk 0.34, 95% CI 0.07–1.68, p = 0.17). Laparoscopic sacrohysteropexy was associated with a statistically significantly higher apical suspension (POP-Q point C −5 vs −4.25, p = 0.02) and longer total vaginal length (9 cm vs 6 cm, p < 0.001). There was no difference in the change in ICIQ-VS scores between the two groups (ICIQ-VS change −22 vs −25, p = 0.59). Conclusion Laparoscopic sacrohysteropexy and vaginal hysterectomy with apical suspension have comparable reoperation rates and subjective outcomes. Potential advantages of laparoscopic sacrohysteropexy include a lower risk of apical reoperation, greater apical support and increased total vaginal length.

Sexual Outcomes and Motherhood Plans of The Mayer Rokitansky Küster Hauser Syndrome Patients Operated with Uncu Modified Remnant-Supported Laparoscopic Double-Layer Peritoneal Pull-Down Vaginoplasty Technique

Objective: To determine the sexual outcomes and motherhood plans of the Mayer Rokitansky Küster Hauser (MRKH) Syndrome patients operated with Uncu Modified Remnant-Supported Laparoscopic Double-Layer Peritoneal Pull-Down Vaginoplasty operation Design: Cohort Study Setting: Tertiary University Hospital Patients: Women with MRKH syndrome Methods: This study involves the patients with MRKH syndrome who underwent Uncu Modified Remnant-Supported Laparoscopic Double-Layer Peritoneal Pull-Down Vaginoplasty Operation between the years 2008-2020. The first step of the study is about our surgical technique outcomes. The second step consists of long-term results for sexual functioning which was assessed by female sexual function index (FSFI) survey and motherhood plans by another survey. Main Outcome Measure: FSFI and Motherhood Survey Results Results Total 42 patients with MRKH syndrome underwent vaginoplasty operation. At least one year after surgery all patients was physically examined. The mean vaginal length was 8.4 + 1.9 cm. The mean FSFI score was 31.5 + 3.9 (min:24-max:36) Thirty-six of the patients answered a survey about motherhood. Thirty-one of the patients (86%) had a desire for motherhood. Most of the patients (21/31 – 68%) choose uterine transplantation as a first option. Three of the patients (9.6%) choose mater option and seven patients (22.5%) wants to be a mother by adoption. Conclusion: Uncu Modified Remnant-Supported Laparoscopic Double-Layer Peritoneal Pull-Down Vaginoplasty Operation is a satisfactory option for patients with MRKH syndrome with high FSFI scores and low complication rates. But creating only a neovagina is not enough for these patients, because of nearly 70% motherhood desire by uterine transplantation.

Effect of Fermented Kangkong Seed (Ipomoea reptans Poir.) on Characteristics and Histology of Female Quail Reproductive Organs

Quail has a high reproductive ability, which can reach 3 to 4 generations a year. The quail also have high eggs productivity and capable of producing 250-300 eggs/quail/year. Egg production is closely related to the reproductive system and feed. It is necessary to know the effect of feeding fermented kangkong on the characteristics and histology of the quail reproductive organs. The increase in livestock population should be balanced with an increase in the availability of feed. Kangkong seeds waste (Ipomoea reptans Poir.) is rejected seeds from seed factories that have the potential to become alternative feed ingredients because it contains about 13.46% protein. The purpose of this study was to determine the effect of fermented kangkong seed feed (Bikafer) on the characteristics of reproductive tract organs and histology of quail oviducts because feeds affect the development of the reproductive tract and quail egg production. This study used a completely randomized design method (CRD) with 5 treatments and 4 replications. The treatments were as follows: R0 = commercial feed, R1 = 0% (Bikafer), R2 = 7.5% (Bikafer), R3 = 15% (Bikafer) ,R4 = 22.5% (Bikafer). Data were analyzed using one-way ANOVA with a significance level of 95% (α = 0.05) and the Kruskal-Wallis test, while histological observations were described descriptively. The results showed that there were significant differences in the characteristics of the uterus, vaginal length, and isthmus weights. The histology of the quail reproductive tract developed well and showed the tunica mucosal tissue, serous tunica, muscular tunica, goblet cells, epithelium, and tubular gland cells.

Effects of different vaginal mould use approaches after vaginoplasty with artificial dermis in patients with Mayer–Rokitansky–Küster–Hauser syndrome

Objective To assess the therapeutic effects of different vaginal mould use approaches after vaginoplasty in patients with Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome. Methods Patients with MRKH syndrome who underwent surgery from 2010 to 2015 in our hospital were retrospectively evaluated. Vaginoplasty was performed with artificial dermis, and vaginal moulds were used for 6 months postoperatively. The patients were divided into an intermittent group and continuous group according to the vaginal mould approach. Results Thirty-five patients were evaluated (intermittent group, 19 patients; continuous group, 16 patients). One month postoperatively, the mean vaginal length and width in the intermittent group were 9.26 ± 0.56 and 3.82 ± 0.25 cm, respectively, and those in the continuous group were 9.44 ± 0.51 and 3.86 ± 0.22 cm, respectively. Six months postoperatively, the mean vaginal length and width in the intermittent group were 8.94 ± 0.71 and 3.76 ± 0.26 cm, respectively, and those in the continuous group were 8.69 ± 0.48 and 3.65 ± 0.30 cm, respectively. The mean Female Sexual Function Index scores in the intermittent and continuous groups were 28.61 ± 0.71 and 28.4 80 ±0.79 respectively, after normal sexual life. Conclusion Both intermittent and continuous use of postoperative vaginal moulds may be effective.

Neovagina creation in congenital vaginal agenesis: New mini-laparoscopic approach applying intraoperative indocyanine green fluorescence

Background. There is still no standardized treatment for vaginal agenesis; surgical repair using a minimally invasive technique is a good option, as it offers rapid results along with a fast postoperative recovery. Objective. To describe a new modified Vecchietti procedure by a mini-laparoscopic approach with intraoperative use of indocyanine green fluorescence technology for the creation of a neovagina in the setting of congenital vaginal agenesis. Methods. Retrospective review of all cases of congenital vaginal agenesis submitted to a mini-laparoscopic modified Vecchietti procedure with intraoperative use of indocyanine green (ICG) fluorescence (between June and September 2019). Patient relevant medical history, surgical technique, postoperative care, outcomes, and complications are described. Results. Four patients with Mayer–Rokitansky–Küster–Hauser syndrome (mean age: 19 years; mean preoperative vaginal length: 1.5 cm) were included in the study. The procedure was completed successfully and uneventfully in all patients. External traction device was removed 5–7 days after surgery and replaced by external vaginal silicone dilators. This technique was able to create 10–11 cm neovaginas in 1 week; six weeks after surgery all patients had an epithelized 10.5–12 cm length and 2.5–3 cm diameter neovagina. Complications consisted of one case of isolated fever at the ninth postoperative day, solved with empiric antibiotic treatment. Conclusion. The mini-laparoscopic modified Vecchietti approach, associated with ICG fluorescence imaging, is feasible and effective in the treatment of congenital vaginal agenesis, as it is a simple and safe procedure with promising outcomes.

A Study of 52 Cases of Uterovaginal Prolapse by New Procedure Sacro-Spinous Colpopexy in Rajshahi Bangladesh

The analysis intended to evaluate urogenital and defecatory signs, and life conditions ahead of and following a sacrospinous Colpopexy/hysteropexy for uterovaginal prolapse. To prevent recurrence of uterine prolapse and to maintain adequate vaginal length, a new surgical procedure Sacro-spinous Colpopexy was introduced in Rajshahi, Bangladesh. Fifty-two women with indicative uterovaginal prolapse were cured using sacrospinous Colpopexy/hysteropexy. Ahead of and following surgery, urogenital and defecatory signs and life conditions were evaluated with a authenticated question form. Data were obtained using a Standardized questionnaires forms which were completed by the patients. Questionnaires were about their basic demographic information, complaint history, patient obstetric history, gynecological history, patient examination history, patient operations performed, and patient post-operations follow-up. Anatomical results were evaluated by examining the pelvic ahead of and following surgery. The average return sequel timing was 6 months. Grades of all areas of urogenital and defecatory signs, fecal incontinency and pain improved substantially. Additionally, on all areas there is betterment of life and no main difficulties were confronted.