ABSTRACT
BACKGROUNDS: There are variable results regarding the risk factors associated with levels of pain during office hysteroscopy. OBJECTIVE: Describe levels of pain in Colombian patients who undergo office hysteroscopy performed by doctors in training. MATERIAL AND METHODS: Case series study. Conducted in patients who undergo office hysteroscopy without anesthesia in outpatient clinic in May 2012. The procedure was performed by Gynecologists in training and under supervision of the specialist. The Obstetric and Gynecological history was obtained through questionnaire. The pain perception, according to visual analog scale (VAS), was taken at three moments during the study: (1) 5 minutes before the procedure, (2) At the end of the procedure, (3) 10 minutes after the procedure.The major outcomes were: VAS 0-4, considered as absent or mild pain and VAS 5-10 considered as moderate or severe pain. RESULTS: We studied 44 patients, aged between 29 and 65 years. The group of patients with a VAS score >5 was mainly compose by: (1) Patients older than 50 years (58.8%), (2) with positive history of C-section (66.7%), (3) with positive history of abortion (75%) and menopausal (56.3%). CONCLUSION: 47.7% of our patients presentVAS score > 5. The majority of this group was composed by patients with risk factors to have pain during office hysteroscopy. Then we can't conclude that the level of pain experimented by our patients was due to the level of training of the doctors.
Subject(s)
Clinical Competence , Hysteroscopy , Intraoperative Complications/epidemiology , Pain, Postoperative/epidemiology , Adult , Aged , Ambulatory Surgical Procedures , Female , Humans , Hysteroscopy/education , Hysteroscopy/standards , Middle Aged , Office Visits , Pain/epidemiology , Pain MeasurementABSTRACT
Parasitic myomas are rare and their ethiopathogenesis is uncertain. They may develop from a detached fibroid adhering to an extrauterine surface in order to obtain new blood supply. It has been stated that they form from uterine or myoma fragments left behind after morcellation in the abdominopelvic cavity and thus are called "iatrogenic". Surgeons must be aware of this recently reported complication related to the increasing number of laparoscopic procedures. Thorough inspection and washing of the abdominal cavity are recommended. A case of a patient with iatrogenic parasitic myomas, which appeared six years after a laparoscopic supracervical hysterectomy involving a morcellator, is reported.
Subject(s)
Hysterectomy/adverse effects , Laparoscopy/adverse effects , Leiomyoma/surgery , Leiomyomatosis/etiology , Neoplasm Seeding , Uterine Cervical Neoplasms/secondary , Adult , Diagnosis, Differential , Endometrial Stromal Tumors/diagnosis , Equipment Design , Female , Humans , Hysterectomy/instrumentation , Hysterectomy/methods , Laparoscopes , Laparoscopy/methods , Leiomyomatosis/diagnosis , Leiomyomatosis/surgery , Sarcoma/diagnosis , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/surgeryABSTRACT
Interstitial pregnancy is a dangerous and uncommon variation of ectopic pregnancy occurring in the interstitial part of the fallopian tube and extending beyond the muscular layer of the uterus. This ectopic pregnancy-related mortality rate has been reported to be as high as 2%-2,5% due to complications involving bleeding and hypervascularity. No prospective clinical trials have evaluated available treatment options for interstitial ectopic pregnancy due to its low incidence; there is thus no consensus regarding optimal treatment. Surgical treatment can be divided into conservative approaches, such as cornuectomy or cornuostomy, and radical approaches such as hysterectomy. However, intraoperative hemorrhage is an ever-present risk, regardless of the surgical approach adopted. This paper presents a case involving a patient who underwent laparoscopic resection of an interstitial twin ectopic pregnancy; a barbed suture pursestring was used which proved useful during the surgical technique and improved hemostasia.
