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1.
Int. braz. j. urol ; 47(2): 263-273, Mar.-Apr. 2021. graf
Article in English | LILACS | ID: biblio-1154477

ABSTRACT

ABSTRACT Vaginoplasty is a commonly performed surgery for the transfeminine patient. In this review, we discuss how to achieve satisfactory surgical outcomes, and highlight solutions to common complications involved with the surgery, including: wound separation, vaginal stenosis, hematoma, and rectovaginal fistula. Pre-operative evaluation and standard technique are outlined. Goal outcomes regarding aesthetics, creation of a neocavity, urethral management, labial appearance, vaginal packing and clitoral sizing are all described. Peritoneal vaginoplasty technique and visceral interposition technique are detailed as alternatives to the penile inversion technique in case they are needed to be used. Post-operative patient satisfaction, patient care plans, and solutions to common complications are reviewed.


Subject(s)
Humans , Male , Female , Transsexualism , Sex Reassignment Surgery , Penis/surgery , Gynecologic Surgical Procedures , Vagina/surgery
2.
Int. braz. j. urol ; 47(2): 274-274, Mar.-Apr. 2021.
Article in English | LILACS | ID: biblio-1154469
3.
Chinese Medical Journal ; (24): 200-205, 2021.
Article in English | WPRIM | ID: wpr-878027

ABSTRACT

BACKGROUND@#It has been a global trend that increasing complications related to pelvic floor surgeries have been reported over time. The current study aimed to outline the development of Chinese pelvic floor surgeries related to pelvic organ prolapse (POP) over the past 14 years and investigate the potential influence of enhanced monitoring conducted by the Chinese Association of Urogynecology since 2011.@*METHODS@#A total of 44,594 women with POP who underwent pelvic floor surgeries between October 1, 2004 and September 30, 2018 were included from 22 tertiary academic medical centers. The data were reported voluntarily and obtained from a database. We compared the proportion of each procedure in the 7 years before and 7 years after September 30, 2011. The data were analyzed by performing Z test (one-sided).@*RESULTS@#The number of different procedures during October 1, 2011-September 30, 2018 was more than twice that during October 1, 2004-September 30, 2011. Regarding pelvic floor surgeries related to POP, the rate of synthetic mesh procedures increased from 38.1% (5298/13,906) during October 1, 2004-September 30, 2011 to 46.0% (14,107/30,688) during October 1, 2011-September 30, 2018, whereas the rate of non-mesh procedures decreased from 61.9% (8608/13,906) to 54.0% (16,581/30,688) (Z = 15.53, P < 0.001). Regarding synthetic mesh surgeries related to POP, the rates of transvaginal placement of surgical mesh (TVM) procedures decreased from 94.1% (4983/5298) to 82.2% (11,603/14,107) (Z = 20.79, P < 0.001), but the rate of laparoscopic sacrocolpopexy (LSC) procedures increased from 5.9% (315/5298) to 17.8% (2504/14,107).@*CONCLUSIONS@#The rate of synthetic mesh procedures increased while that of non-mesh procedures decreased significantly. The rate of TVM procedures decreased while the rate of LSC procedures increased significantly.@*TRIAL REGISTRATION NUMBER@#NCT03620565, https://register.clinicaltrials.gov.


Subject(s)
China , Female , Gynecologic Surgical Procedures/adverse effects , Humans , Pelvic Floor/surgery , Pelvic Organ Prolapse/surgery , Surgical Mesh/adverse effects , Treatment Outcome , Vagina
4.
Rev. cuba. anestesiol. reanim ; 19(3): e629, sept.-dic. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1138880

ABSTRACT

Introducción: Las náuseas y vómitos posoperatorios son una secuela no deseada durante la etapa de recuperación anestésica. Objetivo: Evaluar la utilidad de la dexametasona en comparación con el ondansetrón para la prevención de las náuseas y vómitos posoperatorios después de procedimientos quirúrgicos ginecológicos mayores, bajo anestesia general orotraqueal. Método: Se realizó un estudio observacional analítico, prospectivo, en 84 pacientes mayores de 19 años, en el Hospital Clínico Quirúrgico Miguel Enríquez desde octubre de 2018 hasta septiembre de 2019, divididas de forma secuencial, en orden de llegada a la unidad quirúrgica, en dos grupos. Al grupo 1 se le administró dexametasona (4 mg endovenosa); al grupo 2 (4 mg de ondansetrón), 30 min antes de finalizar la cirugía. Resultados: Predominó de forma significativa el riesgo medio de náuseas y vómitos posoperatorios en los pacientes con edades comprendidas entre 41 y 50 años. Predominó la condición de excelente y buena (pgt;0,05) en cuanto a la efectividad del tratamiento profiláctico. La cefalea prevaleció de forma significativa en el grupo 2. La mayor parte de las pacientes no presentó eventos adversos. Conclusiones: El ondansetrón y la dexametasona son útiles para la profilaxis de las náuseas y vómitos posoperatorios en pacientes intervenidas de cirugía mayor ginecológica, bajo anestesia general orotraqueal por lo que se considera un tratamiento seguro, con eventos adversos leves y de fácil control(AU)


Introduction: Postoperative nausea and vomiting are an unwanted sequel during the anesthetic recovery stage. Objective: To evaluate the usefulness of dexamethasone compared with ondansetron for the prevention of postoperative nausea and vomiting after major gynecological surgical procedures, under general orotracheal anesthesia. Method: A prospective, analytical and observational study was carried out with 84 patients older than 19 years of age, at Miguel Enríquez Hospital Clinical-Surgical Hospital, from October 2018 to September 2019, divided sequentially, in order of arrival at the surgical unit, into two groups. The group 1 was administered dexamethasone (4 mg intravenously), and the group 2 was administered ondansetron (4 mg), 30 min before the end of the surgery. Results: The average risk of postoperative nausea and vomiting prevailed significantly among patients aged 41-50 years. Excellent and good conditions predominated (pgt;0.05) in terms of effectiveness of prophylactic treatment. Headache prevailed significantly in the group 2. Most of the patients did not present adverse events. Conclusions: Ondansetron and dexamethasone are useful for postoperative nausea and vomiting prophylaxis among patients who received major gynecological surgery, under general orotracheal anesthesia, a reason why it is considered a safe treatment, with mild adverse events and easy control(AU)


Subject(s)
Humans , Female , Ondansetron/therapeutic use , Postoperative Nausea and Vomiting/drug therapy , Anesthesia, General , Gynecologic Surgical Procedures , Dexamethasone/therapeutic use , Prospective Studies , Postoperative Nausea and Vomiting/prevention & control
5.
Rev. chil. obstet. ginecol. (En línea) ; 85(supl.1): S67-S74, set. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1138650

ABSTRACT

INTRODUCCIÓN: La reciente pandemia por SARS-CoV-2 (COVID-19) ha hecho resurgir preocupación sobre la exposición inadvertida del equipo quirúrgico a agentes infecciosos transmisibles por vía aérea durante el acto quirúrgico. El objetivo de este trabajo es describir la confección de un sistema de filtrado simple y de bajo costo que permite reducir el riesgo de exposición al virus, particularmente en el proceso de aspiración, recambio y remoción del neumoperitoneo en cirugía laparoscópica. MATERIALES Y MÉTODO: Se diseñó e implementó un circuito cerrado de evacuación y de filtrado del neumoperitoneo en cirugías ginecológicas laparoscópicas en un centro de salud terciario. El circuito incluye un filtro HEPA (High Efficiency Particulate Air) y una trampa de vacío que contiene una solución de inactivación en base a amonio cuaternario o hipoclorito de sodio. RESULTADOS: Desde su implementación se han realizado 17 cirugías laparoscópicas ginecológicas por diversas patologías. Dos de ellas fueron en pacientes Covid-19 (+). A la fecha no se han reportado contagios en el equipo médico que participó en la cirugía. CONCLUSIONES: Es posible implementar un sistema de evacuación del neumoperitoneo en cirugía laparoscópica presumiblemente eficaz en minimizar el riesgo de exposición al virus SARS-COV-2 (Covid-19). Su bajo costo lo hace especialmente recomendable en países en vías de desarrollo.


INTRODUCTION: The recent SARS-CoV-2 (COVID-19) pandemics has raised concern on the incidental exposition of health team to air transmissible infectious agents during surgeries. The main goal of this work is to communicate a simple and low-cost filtering system allowing to reduce the risk of contagion related to the virus, associated with pneumoperitoneum removal during surgical laparoscopy. METHODS: A closed circuit of gas removal and filtering was developed and implemented in laparoscopic gynecologic procedures at a tertiary teaching hospital. The circuit included an HEPA (High Efficiency Particulate Air) filter and a vacuum trap containing an inactivating solution based on quaternary ammonium or sodium hypochlorite. RESULTS: Since its introduction, seventeen laparoscopic surgeries have been carried out for different gynecologic pathologies. Two of them in Covid (+) cases. To date, no contagion has been reported among health teammates participating in these surgeries. CONCLUSIONS: It is possible to implement a pneumoperitoneum evacuation system in laparoscopic surgery presumably effective in minimizing the risk of exposure to the SARS-COV-2 virus (Covid-19). Its low cost makes it especially recommended in developing countries.


Subject(s)
Humans , Female , Pneumonia, Viral/prevention & control , Gynecologic Surgical Procedures/methods , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/transmission , Pneumoperitoneum , Security Measures , Sodium Hypochlorite , Laparoscopy/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Coronavirus Infections/transmission , Low Cost Technology , Ammonium Compounds , Betacoronavirus
6.
Rev. chil. obstet. ginecol. (En línea) ; 85(4): 343-350, ago. 2020. tab
Article in Spanish | LILACS | ID: biblio-1138630

ABSTRACT

INTRODUCCIÓN: Actualmente la cirugía laparoscópica es el gold standard de la mayoría de las cirugías ginecológicas benignas. Se estima una tasa de complicaciones en cirugía ginecológica por laparoscopía de 3.2 por 1000 pacientes, donde alrededor del 50% ocurren al momento de la primera entrada. Existen numerosas clasificaciones de las complicaciones quirúrgicas, entre ellas, la clasificación Clavien-Dindo se centra en el tratamiento postquirúrgico y tiene como objetivo unificar criterios y hacerlas comparables entre distintos centros. OBJETIVO: Describir las complicaciones en cirugía laparoscópica ginecológica en el Hospital Padre Hurtado, destacando el subgrupo de primera entrada y su clasificación Clavien-Dindo. METODOLOGÍA: Cohorte retrospectiva que incluyó a todas las pacientes operadas por laparoscopía en el pabellón de ginecología del Hospital Padre Hurtado desde el año 2014 al 2017. Se utilizó el software SPSS statistics v25, con prueba X2 para el análisis de las variables no paramétricas y t de Student para las variables paramétrica, considerando una significación estadística con p<0,05. RESULTADOS: De las 513 cirugías laparoscópicas ginecológicas realizadas en el período evaluado, sólo el 4,3% del total de las pacientes tuvieron complicaciones. De éstas, un 9% fueron de primera entrada, y en todos los casos fueron complicaciones menores o Clavien-Dindo I y II. Hubo 2 complicaciones Clavien-Dindo >III B, lo que correspondió a un 0,39%. CONCLUSIÓN: En nuestro grupo hubo una baja incidencia de complicaciones quirúrgicas y de primera entrada lo que es comparable con otras series publicadas.


INTRODUCTION: Laparoscopic surgery is currently the gold standard of most benign gynecological surgeries. A complication rate in gynecological laparoscopy is 3.2 per 1000 patients, where around 50% occur at the time of the first entry. There are numerous classifications of surgical complications, among them, Clavien-Dindo classification focuses on post-surgical treatment and aims to unify criteria and lets compare between different centers. OBJECTIVE: To describe the complications in gynecological laparoscopic surgery at the Padre Hurtado Hospital, highlighting the first entry subgroup and Clavien-Dindo classification. METHODOLOGY: Retrospective cohort that included all gynecological laparoscopy patients in Padre Hurtado Hospital from 2014 to 2017. The SPSS statistics v25 software was used, with X2 test for the analysis of non-parametric variables and t Student for the parametric variables, considering a statistical significance with p <0.05. RESULTS: 513 gynecological laparoscopic surgeries was performed in the evaluated period, only 4.3% of the total patients had complications. Of these, 9% were first entry, and in all cases were minor complications or Clavien-Dindo I and II. There were 2 patients with Clavien-Dindo complications > III B, which corresponded to 0.39%. CONCLUSION: In our group there was a low incidence of surgical complications and first entry which is comparable with other published series.


Subject(s)
Humans , Female , Gynecologic Surgical Procedures/adverse effects , Laparoscopy/adverse effects , Genital Diseases, Female/surgery , Gynecologic Surgical Procedures/methods , Gynecologic Surgical Procedures/statistics & numerical data , Chile , Epidemiology, Descriptive , Retrospective Studies , Cohort Studies , Laparoscopy/statistics & numerical data , Intraoperative Complications/classification , Intraoperative Complications/etiology , Intraoperative Complications/epidemiology
7.
Rev. chil. obstet. ginecol. (En línea) ; 85(3): 222-235, jun. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1126157

ABSTRACT

INTRODUCCIÓN Y OBJETIVOS: Están demostradas las ventajas de la cirugía laparoscópica para el paciente en términos de dolor, rápida recuperación y precisión quirúrgica, sin embargo, no existen estudios nacionales respecto al impacto en los cirujanos. El objetivo de este trabajo es realizar un estudio prospectivo de evaluación ergonómica de ginecólogos que operan cirugía laparoscópica. MÉTODOS: Se utilizaron métodos de evaluación específica por ergónomo experto y percepción de los participantes. Se evaluaron, carga global de trabajo (NASA-tlx), carga bio-mecánica (REBA) y la percepción de molestias músculo-esqueléticas (Escala de Discomfort Corporal). Se recogieron datos personales y de la cirugía, para explorar la existencia de dificultades técnicas. RESULTADOS: 86,7% de los ginecólogos evidenciaron altos niveles de carga global de trabajo, siendo las variables esfuerzo y rendimiento, las de mayor puntaje. El nivel de riesgo bio-mecánico, fue catalogado como medio en la totalidad de la población. 60% manifestó discomfort corporal durante la cirugía. En cuanto a las dificultades técnicas, el efecto fulcrum estuvo presente en el 46% de los cirujanos, el mismo porcentaje tuvo síntomas de ojo seco. El 68% alguna vez accionó el pedal equivocado y ha sentido parestesia del pulgar. CONCLUSIONES: La cirugía laparoscópica ginecológica, presenta una elevada carga global de trabajo. El ginecólogo percibe un importante discomfort corporal y algunas dificultades técnicas. Es necesario incorporar medidas ergonómicas, para minimizar y/o disminuir los factores de riesgo mental y físicos, y así prevenir el desgaste precoz y lesiones a futuro en los cirujanos.


INTRODUCTION AND OBJECTIVES: Laparoscopic surgery had demonstrated advantages such as less pain, rapid recovery and surgical precision. There are no national data regarding the impact on surgeon's health. This is a prospective study on ergonomic evaluation and laparoscopic surgery performed by gynecologists. METHODS: Specific evaluation methods were used such as Global workload (NASA-tlx), bio-mechanical load (REBA) and the perception of musculoskeletal discomfort (Body Part Discomfort Scale). Personal opinions and surgery data were collected to explore the existence of technical difficulties. RESULTS: 86.7% of gynecologists cataloged surgery as high level of global workload. Effort and performance variables were most important. Bio-mechanical risk level was classified as medium in the entire population. 60% showed body discomfort during surgery. Regarding technical difficulties, fulcrum effect was present in 46% of surgeons, the same percentage had dry eye symptoms. 68% have a pedal error activation during surgery and felt paresthesia of the thumb. CONCLUSIONS: Gynecological laparoscopic surgery has a high overall workload. The gynecologist perceives an important body discomfort and some technical difficulties. It is necessary to incorporate ergonomic measures, to minimize and / or reduce mental and physical risk factors, and thus prevent early wear and future injuries in surgeons.


Subject(s)
Humans , Gynecologic Surgical Procedures/adverse effects , Laparoscopy/adverse effects , Ergonomics , Pain/epidemiology , Posture , Stress, Psychological/epidemiology , Gynecologic Surgical Procedures/methods , Biomechanical Phenomena , Dry Eye Syndromes , Epidemiology, Descriptive , Prospective Studies , Risk Factors , Workload , Musculoskeletal Diseases/epidemiology , Risk Assessment , Occupational Diseases/epidemiology
9.
Article in English | WPRIM | ID: wpr-876555

ABSTRACT

@#Background: Robotic surgery is a form of minimally invasive surgery wherein the surgeon controls the camera and instruments in a console, remote from the operating room table. Currently, the system in place is the da Vinci Surgical System which was approved by the United States Food and Drug Administration in 2000 for laparoscopic surgery. Since its approval in 2005 for Gynecologic procedures, the da Vinci Surgical System has been used for hysterectomies, lymph node dissections, sacrocolpopexies, myomectomies, and cerclage. Objective: This paper presents the initial seven cases of benign gynecologic diseases operated on utilizing the da Vinci Surgical System in our institution – six hysterectomies and one myomectomy. Methodology: Seven gynecologic surgeries that utilized the da Vinci Surgical System in 2019 until the first quarter of the year 2020 were done. Medical records of the seven patients were reviewed. Results: The average docking time was 38 minutes (range: 25 – 65 minutes) and the average console time was 227 minutes (range: 175 – 345 minutes). The average blood loss was 576 cc (range: 80 – 1200 cc). No cases converted to an abdominal laparotomy and no morbidities were reported. While two cases underwent blood transfusion intraoperatively, all cases were stable post-operatively and were for discharge after two days. On follow-up, all patients were stable with an unremarkable clinical course. Conclusion: Our initial experience demonstrates that robotic surgery appears as a viable alternative to traditional approaches. As more cases are to be done in the future, fine-tuning of the logistical set-up and surgical skills are expected, as well as venturing into other gynecologic diseases such as malignancies. Further research must be conducted on various aspects of robotic surgery, such as but not limited to outcome comparison with traditional and other laparoscopic approaches, long term outcomes, patient safety, and patient experience and preference, among others.


Subject(s)
Female , Gynecologic Surgical Procedures
10.
Rev. bras. anestesiol ; 69(6): 553-560, nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1057477

ABSTRACT

Abstract Background and objectives: The aim of this study was to investigate the efficacy of the pressure-controlled, volume-guaranteed (PCV-VG) and volume-controlled ventilation (VCV) modes for maintaining adequate airway pressures, lung compliance and oxygenation in obese patients undergoing laparoscopic hysterectomy in the Trendelenburg position. Methods: Patients (104) who underwent laparoscopic gynecologic surgery with a body mass index between 30 and 40 kg.m-2 were randomized to receive either VCV or PCV-VG ventilation. The tidal volume was set at 8 mL.kg-1, with an inspired oxygen concentration of 0.4 with a Positive End-Expiratory Pressure (PEEP) of 5 mmHg. The peak inspiratory pressure, mean inspiratory pressure, plateau pressure, driving pressure, dynamic compliance, respiratory rate, exhaled tidal volume, etCO2, arterial blood gas analysis, heart rate and mean arterial pressure at 5 minutes after induction of anesthesia in the and at 5, 30 and 60 minutes, respectively, after pneumoperitoneum in the Trendelenburg position were recorded. Results: The PCV-VG group had significantly decreased peak inspiratory pressure, mean inspiratory pressur, plateau pressure, driving pressure and increased dynamic compliance compared to the VCV group. Mean PaO2 levels were significantly higher in the PCV-VG group than in the VCV group at every time point after pneumoperitoneum in the Trendelenburg position. Conclusions: The PCV-VG mode of ventilation limited the peak inspiratory pressure, decreased the driving pressure and increased the dynamic compliance compared to VCV in obese patients undergoing laparoscopic hysterectomy. PCV-VG may be a preferable modality to prevent barotrauma during laparoscopic surgeries in obese patients.


Resumo Justificativa e objetivos: O objetivo deste estudo foi investigar a eficácia dos modos de ventilação garantida por volume controlado por pressão (PCV-VG) e ventilação controlada por volume (VCV) para manter pressões adequadas nas vias aéreas, complacência pulmonar e oxigenação em pacientes obesos submetidos à histerectomia laparoscópica na posição de Trendelenburg. Métodos: Cento e quatro pacientes submetidos à cirurgia ginecológica laparoscópica, com índice de massa corporal entre 30 e 40 kg.m-2, foram randomizados para receber ventilação com VCV ou PCV-VG. O volume corrente foi fixado em 8 mL.kg-1, com uma concentração inspirada de oxigênio de 0,4 e pressão positiva expiratória final (PEEP) de 5 mmHg. Registramos os seguintes parâmetros: pressão de pico inspiratório, pressão inspiratória média, pressão de platô, driving pressure, complacência dinâmica, frequência respiratória, volume corrente expirado, etCO2, gasometria arterial, frequência cardíaca e pressão arterial média aos 5, 30 e 60 minutos, respectivamente, após o pneumoperitônio na posição de Trendelenburg. Resultados: O grupo PCV-VG apresentou uma redução significativa da pressão de pico inspiratório, pressão inspiratória média, pressão de platô, driving pressure e aumento da complacência dinâmica comparado ao grupo VCV. Os níveis médios de PaO2 foram significativamente maiores no grupo PCV-VG do que no grupo VCV em todos os momentos após o pneumoperitônio na posição de Trendelenburg. Conclusões: O modo de ventilação PCV-VG limitou a pressão de pico inspiratório, diminuiu a driving pressure e aumentou a complacência dinâmica, comparado ao VCV em pacientes obesas submetidas à histerectomia laparoscópica. O PCV-VG pode ser uma modalidade preferida para prevenir o barotrauma durante cirurgias laparoscópicas em pacientes obesos.


Subject(s)
Humans , Female , Adult , Gynecologic Surgical Procedures/methods , Laparoscopy/methods , Head-Down Tilt , Obesity/complications , Oxygen/metabolism , Respiration, Artificial/methods , Tidal Volume/physiology , Lung Compliance/physiology , Prospective Studies , Positive-Pressure Respiration , Middle Aged
11.
Rev. méd. Urug ; 35(3): 238-240, set. 2019.
Article in Spanish | LILACS | ID: biblio-1023737

ABSTRACT

Introducción: la endosalpingiosis es una enfermedad benigna caracterizada por el crecimiento ectópico del epitelio de la trompa de Falopio, siendo su presencia en cicatrices operatorias excepcional, habiéndose reportado cuatro casos en la literatura internacional. Caso clínico: se presenta el caso de una paciente de 40 años que consultó por dolor sobre incisión de Pfannenstiel y tumoración a dicho nivel. La misma se resecó y el estudio anatomopatológico informó endosalpingiosis. Discusión: el diagnóstico de endosalpingiosis cutánea es posoperatorio y realizado luego del estudio de la pieza de resección. Con su extirpación completa, se resuelve definitivamente la sintomatología y en los pocos casos publicados en la literatura no se ha reportado recidiva.


Introducion: endosalpingiosis is a benign disease characterized by the ectopic growth of the epithelium in the Fallopian tube, being it exceptional in surgical scars, four cases having been reported by international literature. Clinical case: the study presents the clinical case of a 40 year old female patient who consulted for pain in the Pfannenstiel incision and a tumour on the site. After resection, pathological study revealed endosalpingiosis. Discussion: the diagnosis of cutaneous endosalpingiosis occurs after surgery and upon the analysis of the resected piece. Complete removal results in the final solution of symptoms and no relapse has been reported in cases published in literature.


Introdução: a endossalpingiose é uma condição benigna que se caracteriza pelo crescimento ectópico do epitélio da trompa de Falópio; sua presença em cicatrizes operatórias é excepcional sendo que somente quatro casos foram encontrados na literatura internacional. Caso clínico: apresenta-se o caso clínico de uma paciente de 40 anos de sexo feminino que consultou por dor e tumoração na incisão de Pfannenstiel. O laudo de anatomia patológico da tumoração ressecada foi endossalpingiose. Discussão: o diagnóstico de endossalpingiose cutânea é pós-operatório e é feito pelo exame da peça de ressecção. Sua extirpação completa soluciona definitivamente a sintomatologia; os poucos casos publicados na literatura não informam recidivas.


Subject(s)
Postoperative Complications , Skin Diseases , Gynecologic Surgical Procedures , Cicatrix , Fallopian Tubes
12.
Rev. chil. obstet. ginecol. (En línea) ; 84(3): 236-244, jun. 2019. tab, graf, ilus
Article in Spanish | LILACS | ID: biblio-1020642

ABSTRACT

RESUMEN INTRODUCCIÓN: La ausencia congénita de vagina es una condición poco común, algunas causas son el síndrome de Mayer-Rokitansky-Kuster-Hauser y la insensibilidad periférica a los andrógenos. Múltiples técnicas quirúrgicas y no quirúrgicas se han descrito para el manejo de esta condición, siendo el objetivo principal la creación de un canal vaginal de diámetro y longitud adecuada que permitan restaurar la función coital. El objetivo de este estudio es detallar la experiencia del procedimiento de neovagina con la técnica quirúrgica de McIndoe en pacientes con Mayer-Rokitansky-Kuster-Hauser realizados en la Unidad de Uroginecología de la Clínica Universitaria Bolivariana. METODOLOGÍA: Reporte de 5 casos de pacientes con agenesia de vagina secundarios al síndrome de Mayer-Rokitansky-Kuster-Hauser, a las cuales se les realizó neovagina con la técnica de McIndoe con algunas modificaciones en el molde para el implante de piel. RESULTADOS: Se incluyeron cinco pacientes con diagnóstico de Mayer-Rokitansky-Kuster-Hauser, todas tenían desarrollo de características sexuales secundarias, perfil hormonal normal, y un cariotipo XX. Se utilizó la técnica quirúrgica de McIndoe para la realización de la neovagina sin complicaciones intraoperatorias asociadas y con adecuada evolución posoperatoria, con una longitud vaginal entre 7-9 cm y 3 pacientes con vida sexual activa. El tiempo de estancia hospitalaria fue 7 a 9 días. CONCLUSIÓN: La técnica quirúrgica de McIndoe es una opción para restaurar la función sexual en mujeres con agenesia vaginal con resultados favorables. El tiempo para decidir su realización es electivo, sin embargo, se debe contar con madurez física y emocional para ser llevado a cabo. Las pacientes de nuestro reporte tenían una edad promedio de 18 años.


SUMMARY INTRODUCTION: The congenital absence of the vagina is an uncommon condition, some causes are the Mayer-Rokitansky-Küster-Hauser syndrome and peripheral insensitivity to androgens. Multiple surgical and non-surgical techniques have been described for the management of this condition, being the main objective the creation of a vaginal canal of adequate diameter and length to restore coital function. The objective of this study is to detail the experience of the neovagina procedure with the McIndoe surgical technique performed in patients with Mayer-Rokitansky-Küster-Hauser syndrome at the Clinica Universitaria Bolivariana. METHODOLOGY: Report of five cases of patients with vaginal agenesis secondary to the Mayer-Rokitansky-Kuster-Hauser syndrome, who underwent neovagina with the McIndoe technique and some modifications in the mold for the skin implant. RESULTS: Five patients with diagnosis of Mayer-Rokitansky-Kuster-Hauser were included, all had development of secondary sexual characteristics, normal hormonal profile, and a XX karyotype. The McIndoe surgical technique was used to perform the neovagina without associated intraoperative complications and with adequate postoperative evolution, with a vaginal length between 7-9 cm and three patients with active sexual life. The length of hospital stay was 7 to 9 days. CONCLUSION: The McIndoe surgical technique is an option to restore sexual function in women with vaginal agenesis with favorable results. The time to decide its realization is elective, however, they must have the physical and emotional maturity to be carried out. The patients in our report have an average age of 18 years.


Subject(s)
Humans , Female , Adolescent , Adult , Congenital Abnormalities/surgery , Congenital Abnormalities/diagnosis , Congenital Abnormalities/genetics , Vagina/surgery , Gynecologic Surgical Procedures , Vagina/abnormalities , Surgically-Created Structures , 46, XX Disorders of Sex Development/surgery , Mullerian Ducts/abnormalities
13.
Int. braz. j. urol ; 45(2): 408-409, Mar.-Apr. 2019.
Article in English | LILACS | ID: biblio-1040053

ABSTRACT

ABSTRACT A healthy 37 - year - old woman referred to our clinic with one - year history of recurrent urinary tract infection, dysuria and frequency. Her past medical history informed us that an IUD (Copper TCu380A) had been inserted 11 years ago. Eleven months after the IUD insertion she had become pregnant, unexpectedly. At that time, she had undergone gynecological examination and abdominal ultrasound study. However, the IUD had not been found, and the gynecologist had made the diagnosis of spontaneous fall out of the IUD. She had experienced normal pregnancy and caesarian section with no complications. On physical examination, pelvic examination was normal and no other abnormalities were noted. Urinalysis revealed microhematuria and pyuria. Urine culture was positive for Escherichia coli. Ultrasound study revealed a calculus of about 10 mm in the bladder with a hyperdense lesion. A plain abdominal radiograph was requested which showed a metallic foreign body in the pelvis. We failed to remove the IUD by cystoscopic forceps because it had strongly invaded into the uterine and bladder wall. Despite previous papers suggesting open or laparoscopic surgeries in this situation (1, 2), we performed a modified cystoscopic extraction technique. We made a superficial cut in the bladder mucosa and muscle with J - hook monopolar electrocautery and extracted it completely with gentle traction. This technique can decrease the indication of open or laparoscopic surgery for extraction of intravesical IUDs. In the other side of the coin, this technique may increase the risk of uterovesical fistula. Therefore, the depth of incision is important and the surgeon should cut the bladder wall superficially with caution. Although present study is a case report which is normally classified as with low level of evidence, it seems that our modified cystoscopic extraction technique is a safe and useful method for extraction of partially intravesical IUDs.


Subject(s)
Humans , Female , Adult , Urinary Bladder/surgery , Device Removal/instrumentation , Cystoscopy/methods , Intrauterine Devices/adverse effects , Gynecologic Surgical Procedures/methods , Foreign-Body Migration/surgery , Laparoscopy/methods
14.
Article in English | WPRIM | ID: wpr-785894

ABSTRACT

Acute appendicitis is the most common indication for emergency abdominal surgery worldwide. The risks and benefits of incidental appendectomy during other operations have been debated for over a century. There is no right answer to the question of whether or not to perform incidental appendectomy. Although there are only a few indications where it is explicitly recommended such as in gynecological surgery, malrotation, and Ladd's procedure, incidental appendectomy is cost-effective in selected patient groups, especially in the young, without an increase in morbidity and mortality. In this review, the literature on incidental appendectomy was assessed from several perspectives.


Subject(s)
Adolescent , Appendectomy , Appendicitis , Costs and Cost Analysis , Emergencies , Female , Gynecologic Surgical Procedures , Humans , Mortality , Risk Assessment
15.
Article in English | WPRIM | ID: wpr-785371

ABSTRACT

BACKGROUND: Elevated intracranial pressure (ICP), a disadvantage of laparoscopic or robotic surgery, is caused by the steep angle of the Trendelenburg position and the CO₂ pneumoperitoneum. Recently, sonographically measured optic nerve sheath diameter (ONSD) was suggested as a simple and non-invasive method for detecting increased ICP. This study aimed to explore the changes in ONSD in relation to different anesthetic agents used in gynecologic surgery.METHODS: Fifty patients were randomly allocated to two groups, sevoflurane (group SEV, n = 25) and propofol-based total intravenous anesthesia (TIVA) group (group TIVA, n = 25). The ONSD was measured at five time points (T0–T4): T0 was measured 5 min after induction of anesthesia in the supine position; T1, T2, and T3 were measured at 5, 15, and 30 min after CO₂ pneumoperitoneum induction in the Trendelenburg position; and T4 was measured at 5 min after discontinuation of CO₂ pneumoperitoneum in the supine position. Respiratory and hemodynamic variables were also recorded.RESULTS: The intra-group changes in mean ONSD in the Trendelenburg position were significantly increased in both groups. However, inter-group changes in mean ONSD were not significantly different at T0, T1, T2, T3, and T4. Heart rates in group TIVA were significantly lower than those in group SEV at points T1–T4.CONCLUSIONS: There was no significant difference in the ONSD between the two groups until 30 min into the gynecologic surgery with CO₂ pneumoperitoneum in the Trendelenburg position. This study suggests that there is no difference in the ONSD between the two anesthetic methods.


Subject(s)
Anesthesia , Anesthesia, Intravenous , Anesthetics , Female , Gynecologic Surgical Procedures , Head-Down Tilt , Heart Rate , Hemodynamics , Humans , Intracranial Hypertension , Methods , Optic Nerve , Pneumoperitoneum , Propofol , Supine Position , Ultrasonography
16.
Article in English | WPRIM | ID: wpr-785362

ABSTRACT

BACKGROUND: Tracheal intubation is closely associated with increases in intraocular pressure (IOP); however, the effects of double-lumen tube (DLT) intubation on IOP have not been validated. Systemic hypertension (HTN) is another factor that may increase IOP. In this study, we observed differences in IOP increases between DLT and single-lumen tube (SLT) intubation, and evaluated the influence of underlying HTN during rapid sequence induction.METHODS: Sixty-eight patients were allocated into one of the following group: SLT/without HTN (n = 17), SLT/HTN (n = 17), DLT/without HTN (n = 17), and DLT/HTN (n = 17). An SLT was inserted for orthopedic or gynecological surgery, and a DLT was inserted for lung surgery after rapid sequence induction using succinylcholine. IOP was measured before anesthetic induction and until 10 min after intubation using a handheld tonometer (Tono-Pen AVIA®).RESULTS: In the DLT/without HTN and DLT/HTN groups, the maximum increases in IOPs after tracheal intubation were 7.9 and 12.2 mmHg, respectively, compared to baseline. In the SLT/without HTN and SLT/HTN groups, the maximum increases were 5.0 and 4.9 mmHg, respectively, compared to baseline. In comparisons between patients with and without underlying HTN, the values of IOPs were comparable.CONCLUSIONS: Tracheal intubation with a DLT is associated with more increases in IOPs than with an SLT in rapid sequence induction. Well-controlled underlying hypertension did not increase IOP during tracheal intubation.


Subject(s)
Female , Gynecologic Surgical Procedures , Humans , Hypertension , Intraocular Pressure , Intubation , Intubation, Intratracheal , Lung , Orthopedics , Succinylcholine
17.
Article in English | WPRIM | ID: wpr-719244

ABSTRACT

OBJECTIVE: To examine outcomes of patients having treatments for newly diagnosed advanced stage low-grade serous ovarian cancer (LGSC). METHODS: We conducted a retrospective case series of women affected by advanced stage (stage IIIB or more) LGSC undergoing surgery in a single oncologic center between January 2000 and December 2017. Survival outcomes were assessed using Kaplan-Meier and Cox models. RESULTS: Data of 72 patients were retrieved. Primary cytoreductive surgery was attempted in 68 (94.4%) patients: 19 (27.9%) had residual disease (RD) >1 cm after primary surgery. Interval debulking surgery (IDS) was attempted in 15 of these 19 (78.9%) patients and the remaining 4 patients having not primary debulking surgery. Twelve out of 19 (63.1%) patients having IDS had RD. After a mean (±standard deviation) follow-up was 61.6 (±37.2) months, 50 (69.4%) and 22 (30.5%) patients recurred and died of disease, respectively. Via multivariate analysis, non-optimal cytoreduction (hazard ratio [HR]=2.79; 95% confidence interval [CI]=1.16–6.70; p=0.021) and International Federation of Obstetrics and Gynecologists (FIGO) stage IV (HR=3.15; 95% CI=1.29–7.66; p=0.011) were associated with worse disease-free survival. Via multivariate analysis, absence of significant comorbidities (HR=0.56; 95% CI=0.29–1.10; p=0.093) and primary instead of IDS (HR=2.95; 95% CI=1.12–7.74; p=0.027) were independently associated with an improved overall survival. CONCLUSION: LGSC is at high risk of early recurrence. However, owing to the indolent nature of the disease, the majority of patients are long-term survivors. Further prospective studies and innovative treatment modalities are warranted to improve patients care.


Subject(s)
Comorbidity , Cytoreduction Surgical Procedures , Disease-Free Survival , Drug Therapy , Female , Follow-Up Studies , Gynecologic Surgical Procedures , Humans , Multivariate Analysis , Neoplasm Metastasis , Obstetrics , Ovarian Neoplasms , Proportional Hazards Models , Prospective Studies , Recurrence , Retrospective Studies , Survivors
18.
Article in Korean | WPRIM | ID: wpr-766579

ABSTRACT

The development of robotic technology has facilitated the application of minimally invasive techniques for complex gynecologic surgery. Robot-assisted gynecologic surgery has grown exponentially since receiving Food and Drug Administration approval for use in gynecologic surgery in 2005. Robotic surgery has several major advantages, including three-dimensional visual magnification, articulation beyond normal manipulation, and the filtering of the operator's hand tremors. Therefore, robotic surgery is suitable for microsurgery, and it could be an alternative option for laparotomy. Robotic surgery has advantages, especially for suture-intensive operations such as myomectomy. Patients who underwent robot-assisted laparoscopic myomectomy had significantly decreased estimated blood loss, complication rates, and length of hospital stay. The advantages of robotic surgery help to overcome the limitations of laparoscopy, especially for complicated procedures in deep infiltrating endometriosis. Although extensive radical operations for deep infiltrating endometriosis of the bowel and urinary tract, such as segmental resections of the bladder, ureters, and bowel, were performed by laparotomy in the past, they are now performed more easily and more effectively using robotic techniques. In a recent systematic review and meta-analysis, robotic and laparoscopic sacrocolpopexy resulted in similar clinical outcomes, but robotic surgery was associated with a longer operation time and higher costs. Robotic and conventional laparoscopic hysterectomy show equivalent surgical and clinical outcomes. Compared to laparotomy, robotic gynecologic cancer surgery results in improved clinical outcomes and comparable oncologic outcomes. If robotic surgery is tailored in terms of patient selection, surgeon ability, and equipment availability, it could be a feasible option for highly advanced minimally invasive surgery.


Subject(s)
Endometriosis , Female , Gynecologic Surgical Procedures , Gynecology , Hand , Humans , Hysterectomy , Laparoscopy , Laparotomy , Length of Stay , Microsurgery , Minimally Invasive Surgical Procedures , Patient Selection , Robotic Surgical Procedures , Trachelectomy , Tremor , United States Food and Drug Administration , Ureter , Urinary Bladder , Urinary Tract , Uterine Myomectomy
19.
Article in English | WPRIM | ID: wpr-763357

ABSTRACT

Anti-Müllerian hormone (AMH), a peptide growth factor of the transforming growth factor-β family, is a reliable marker of ovarian reserve. Regarding assisted reproductive technology, AMH has been efficiently used as a marker to predict ovarian response to stimulation. The clinical use of AMH has recently been extended and emphasized. The uses of AMH as a predictive marker of menopause onset, diagnostic tool for polycystic ovary syndrome, and assessment of ovarian function before and after gynecologic surgeries or gonadotoxic agents such as chemotherapy have been investigated. Serum AMH levels can also be affected by environmental and genetic factors; thus, the effects of factors that may alter AMH test results should be considered. This review summarizes the findings of recent studies focusing on the clinical application of AMH and factors that influence the AMH level and opinions on the use of the AMH level to assess the probability of conception before reproductive life planning as a “fertility test.”


Subject(s)
Drug Therapy , Female , Fertility , Fertilization , Gynecologic Surgical Procedures , Humans , Menopause , Ovarian Reserve , Polycystic Ovary Syndrome , Reproductive Techniques, Assisted
20.
In. Barbato, Marcelo; Blanco, Raúl; Godino, Mario; Olivera Pertusso, Eduardo; Rodríguez, Ana María. Seguridad del paciente en áreas críticas. Montevideo, Cuadrado, 2019. p.147-158.
Monography in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1342581
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