Journal of minimally invasive gynecology
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J Minim Invasive Gynecol · Nov 2018
ReviewManaging Postoperative Pain After Minimally Invasive Gynecologic Surgery in the Era of the Opioid Epidemic.
In this review, we examine the evidence behind nonopioid medication alternatives, peripheral nerve blocks, surgical techniques, and postoperative recovery protocols that can help minimize and effectively treat postoperative pain after minimally invasive gynecologic surgery (MIGS). Because of the depth and heterogeneity of the data, a narrative review was performed of reported interventions. A comprehensive review was performed of PubMed, Embase, and the Cochrane Database with a focus on randomized controlled trials. ⋯ Surgically, minimally invasive approaches, reducing the laparoscopic trocar size to <10 mm, and evacuating the pneumoperitoneum at the end of the case all have significant benefits. Lastly, enhanced recovery pathways show promise in reducing pain after MIGS. By using a multimodal approach, minimally invasive gynecologic surgeons can help to minimize and manage postoperative pain with less reliance on opioid pain medications.
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J Minim Invasive Gynecol · Nov 2018
Case ReportsNerve-Sparing Technique during Laparoscopic Radical Hysterectomy: Critical Steps.
To show the feasibility and safety of nerve-preserving laparoscopic radical hysterectomy (type C1 Querleu-Morrow Classification [1]) for the treatment of early cervical cancer. ⋯ Nerve-sparing laparoscopic radical hysterectomy is an attractive surgical approach for early-stage cervical cancer. Direct visualization of the pelvic autonomic nervous system (sympathetic and parasympathetic branches) innervating the bladder and rectum makes the nerve-sparing approach a safe and feasible procedure.
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J Minim Invasive Gynecol · Nov 2018
EditorialSurgical Catastrophe. Supporting the Gynecologic Surgeon after an Adverse Event.
Medical errors and adverse events (AEs) are unavoidable, and the effect of adverse outcomes on providers can be devastating. An intraoperative AE is often directly attributable to surgeon technical error or suboptimal intraoperative judgment. ⋯ Common reactions to AEs and individual and organizational strategies to support clinicians through the aftermath are reviewed. The goal of this commentary is to create awareness of the mental health impact and to describe options to help physicians involved in intraoperative AEs to recover from their experience related to bad surgical outcomes.
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J Minim Invasive Gynecol · Nov 2018
Observational StudyAssessment of Obstetric and Gynecologic Food and Drug Administration Device Approvals and Recalls.
To evaluate and compare the recall rates of obstetric and gynecologic devices approved via the Food and Drug Administration's 510(k) and premarket approval (PMA) processes. ⋯ The recall event rate for the 510(k) approval process is 13.6 times the rate for the PMA approval process for obstetric and gynecologic devices. Analysis of the results suggests improper device risk classification, inappropriate assignment of the approval process, increased device malfunctions, recalls by the 510(k) process and, therefore, increased risk to patients by these devices. This warrants a call for improvement and increased scrutiny in the 510(k) approval process for devices used in obstetrics and gynecology.