Journal of minimally invasive gynecology
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J Minim Invasive Gynecol · Mar 2019
Safety of Laparoscopic Surgery for Benign Diseases during Pregnancy: A Nationwide Retrospective Cohort Study.
To compare fetal, maternal, and operative outcomes of laparoscopic surgery versus laparotomy for major benign diseases including appendicitis, cholecystitis, adnexal masses, and uterine myoma during pregnancy. ⋯ Our current study using propensity score matching suggests the advantages of laparoscopic surgery for benign diseases compared with laparotomy because laparoscopic surgery had advantages in short-term fetal adverse events, incidence of blood transfusion, operative time, and hospital stay.
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J Minim Invasive Gynecol · Mar 2019
Observational StudyUltrasound-Guided Percutaneous Microwave Ablation for Subserosal Uterine Myomas.
To prospectively evaluate the clinical effectiveness and safety of ultrasound-guided percutaneous microwave ablation for symptomatic subserosal uterine myomas. ⋯ Ultrasound-guided percutaneous microwave ablation of subserosal uterine myomas is a promising treatment method. Further studies with larger sample sizes and a control group are needed.
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J Minim Invasive Gynecol · Mar 2019
Relationship between Race/Ethnicity and Hysterectomy Outcomes for Benign Gynecologic Conditions.
To examine the association between race/ethnicity, route of hysterectomy, and risk of inpatient surgical complications. ⋯ Among women undergoing an elective hysterectomy, black women were less likely to receive minimally invasive hysterectomy compared with white women. However, the rate of inpatient surgical complications did not vary significantly by race/ethnicity. Further research is encouraged to identify and address the influential factors behind the disparity in minimally invasive hysterectomy use among black women in the United States.
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To demonstrate techniques of ureterolysis during complex laparoscopic hysterectomy. ⋯ Ureteric injury has significant morbidity and is the most common reason for litigation following hysterectomy, with an estimated risk of 0.02% to 0.4%. [1,2]. Ureterolysis is infrequently practiced by benign gynecologists; however, it may be necessary during complex surgery. Benign pathology requiring hysterectomy, such as endometriosis, myomas, large uteri, and adnexal masses, are recognized risk factors for ureteric injury [3]. Most injuries occur during division of the uterine artery at the level of the internal cervical os. The average distance between the ureter and cervix is 2 cm, but it is only 0.5 cm in 3.2% of the population with a normal pelvis [4]. Preventive strategies, such as the use of a uterine manipulator, may increase this distance, although it still might not be sufficient to prevent injury in women with normal anatomic variants and complex pathology. Visualizing the ureter at the pelvic brim and side wall without retroperitoneal dissection may be inadequate because the segment of ureter between the intersection of the uterine artery and the bladder is not visible. The ureter can be safely dissected up to 15 cm without compromising its viability. In this educational video, we demonstrate various simple, quick, and reproducible techniques to perform ureterolysis for complex benign pathology. These techniques can be used by both expert and novice surgeons to perform and teach ureterolysis. Our method determines the course of the ureter throughout the pelvis and relation to the uterine artery to reduce intraoperative injury. We have performed more than 350 cases with no injuries.
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J Minim Invasive Gynecol · Mar 2019
Case ReportsLaparoscopic Resection of Cesarean Scar Ectopic Pregnancy after Unsuccessful Systemic Methotrexate Treatment.
To present a case of a cesarean scar ectopic pregnancy treated by laparoscopic resection followed by isthmocele repair. ⋯ The laparoscopic approach with excision and repair of the uterine wall represents a safe and efficient therapeutic option for the treatment of the cesarean scar ectopic pregnancy.