ABSTRACT
OBJECTIVE: To analyze the effect of learning in two surgeons on complications and conversion to laparotomy during total and subtotal laparoscopic hysterectomy. MATERIAL AND METHODS: We analyzed retrospectively 236 total and subtotal laparoscopic hysterectomies done by two surgeons from the time they first performed the procedure. The interventions were classified in three groups based on the surgeon's experience: the first 75 hysterectomies ("novice period"), the subsequent 75 hysterectomies ("intermediate"), and the subsequent 86 hysterectomies ("routine period"). RESULTS: Patient's characteristics changed as surgeons gained experience, with more complex operations (greater obesity, previous surgery and malignant disease) becoming more frequent. During the second group of operations when surgeons had an intermediate level of experience, the risk of major complications decreased (adjusted odds ratio: 0.28, 95% confidence interval: 0.10-0.85), as did the risk of type III complications of Clavien-Dindo classification (adjusted odds ratio 0.15, 95% confidence interval: 0.03-0.93). However, the percent rate of conversion to laparotomy remained stable in the second (intermediate experience) group. In the third group, after the surgeons had performed 150 procedures and when the risk of any type of complication was lowest, the risk of conversion to laparotomy decreased compared to the routine group. CONCLUSIONS: The surgeon's experience in performing laparoscopic hysterectomy plays an essential role in the decrease in the risk of complications, and this finding supports the importance of providing appropriate training for residents and gynecologists to enable them to perform this procedure with an optimal degree of competence and safety.
Subject(s)
Clinical Competence , Hysterectomy/statistics & numerical data , Intraoperative Complications , Laparoscopy/statistics & numerical data , Laparotomy/statistics & numerical data , Learning Curve , Surgeons/statistics & numerical data , Adult , Aged , Female , Humans , Middle Aged , Surgeons/standardsABSTRACT
Objetivo: Analizar los resultados de la ablación-resección endometrial (ARE) con resectoscopio monopolar y las complicaciones asociadas. Material y métodos: Estudio observacional descriptivo de 260 pacientes intervenidas mediante ARE por hemorragia uterina anormal (HUA) en el Hospital Universitario Virgen de las Nieves de Granada desde abril de 1998 hasta diciembre de 2005. Resultados: La ablación-resección fue completa en el 83,1% de los casos, realizando miomectomía o polipectomía en el mismo acto operatorio en un 60,4% de las pacientes. El tiempo de seguimiento desde la realización de la ARE hasta la última revisión fue de 30,73 ± 17,15 meses. En este tiempo, un 38,5% de las pacientes permanecieron en amenorrea y solo 40 de las 260 mujeres continuaron con menorragia. Se obtuvo una tasa global de éxito clínico y quirúrgico de 84,6 y de 87,7%, respectivamente. Aparecieron complicaciones intraoperatorias en el 5,8% de las pacientes y tardías en un 16,2%. No hubo ningún caso de cáncer de endometrio ni de gestación tras la ARE
Conclusión: La ARE vía histeroscópica con energía monopolar es un método quirúrgico conservador útil en el tratamiento de la HUA en nuestro medio, con una baja tasa de reintervención y de complicaciones. Objective: To analyze the results of endometrial ablation-resection (ARE) with monopolar resectoscope and associated complications. Material and methods: A descriptive observational study was conducted of 260 patients undergoing ARE for abnormal uterine bleeding at the Virgen de las Nieves University Hospital in Granada from April 1998 to December 2005. Results: The ARE was complete in 83.1% of procedures, with myomectomy and/or polypectomy being performed in the same intervention in 60.4% of the patients. The mean time from the performance of ARE to the last follow-up was 30.73 ± 17.15 months. At this time, 38.5% of the patients remained in amenorrhea and only 40 of 260 women continued to have heavy menstrual bleeding. Overall clinical and surgical success rates were 84.6 and 87.7%, respectively. Early intraoperative complications occurred in 5.8% of the patients and late complications in 16.2%. There were no cases of endometrial cancer or pregnancy after ARE. Conclusion: Monopolar ARE is a conservative surgical method that is useful in the treatment of abnormal uterine bleeding and has low reoperation and complications rates
Subject(s)
Humans , Female , Uterine Diseases/surgery , Uterine Myomectomy/methods , Endometrial Ablation Techniques/methods , Myoma/surgery , Polyps/surgery , Uterine Hemorrhage/etiology , Uterine Hemorrhage/surgeryABSTRACT
Essure(R) es el primer dispositivo intratubárico, colocado mediante histeroscopia, usado como método anticonceptivo definitivo en la mujer. Una complicación poco frecuente es el dolor pélvico que a veces se ha relacionado con alergia a alguno de sus componentes, principalmente al níquel. El níquel es el más frecuente alérgeno de contacto en el mundo desarrollado, por lo que podrían esperarse más problemas de los informados en pacientes portadoras de Essure(R). Se presentan 3 casos de dolor pélvico crónico en pacientes con alergia al níquel desconocida antes de la inserción. En 2 de ellas se resolvió poco después de la extracción del dispositivo Essure(R) mientras que la tercera paciente está asintomática tras haber adoptado una actitud expectante. Actualmente los estudios sobre este tema son escasos. En general, se acepta que, en caso de dolor abdominal más allá de 6 semanas tras la inserción del Essure(R), debe plantearse la retirada del mismo. Sería obligatorio en estos casos investigar si la paciente es alérgica a los metales
Essure(R) is the first intratubal device for permanent contraception inserted under hysteroscopic guidance. A rare complication of this device is pelvic pain, which can be related to allergy to one or more of its components, mainly nickel. Nickel is the most common contact allergen in the industrialized world, and consequently the number of published reports may not reflect the true extent of this complication in women with an Essure(R) device. We report 3 cases of pelvic pain in patients with nickel allergy that was not detected before Essure(R) insertion. The pain resolved after removal of the device in 2 women. An expectant attitude was adopted in the third woman.Currently, few cases have been reported on this topic. It is generally accepted that the device should be removed in women with pelvic pain lasting for more than 6 weeks. In addition, these women should also undergo testing for nickel allergy
Subject(s)
Humans , Female , Adult , Pelvic Pain/etiology , Intrauterine Devices/adverse effects , Hypersensitivity/complications , Dermatitis, Allergic Contact/complications , Nickel/adverse effects , Risk Factors , Fallopian Tubes/immunologyABSTRACT
Objetivo Conocer la fiabilidad, viabilidad y seguridad de la histeroscopia en consulta. Material y métodos Realizamos un estudio retrospectivo. Entre junio de 2003 y abril de 2008, realizamos 5.000 histeroscopias en consulta. La histeroscopia se realizó mediante vaginoscopia con suero salino. Analizamos las indicaciones, éxitos, fracasos, tasas de complicaciones y tipo de cirugía. Resultados La histeroscopia pudo realizarse en cerca del 97% de los casos. Un 4% de mujeres refirieron dolor severo y un 1,4% tuvieron un síndrome vagal. La indicación más frecuente fue la hemorragia uterina anormal y el diagnóstico más frecuente el pólipo endometrial. En un 60% de las histeroscopias realizamos cirugía en la consulta. La polipectomía por histeroscopia fue la cirugía más frecuente (64%). Las tasas de perforación y de enfermedad inflamatoria pélvica fueron del 0 y del 0,08% respectivamente. Conclusiones La histeroscopia en consulta se tolera muy bien, siendo un procedimiento seguro y eficaz. La combinación de pequeños histeroscopios y la introducción de la energía bipolar nos permite tratar patología intrauterina en consulta sin ningún tipo de anestesia (AU)
Objective To assess the reliability, feasibility and safety of outpatient hysteroscopy. Material and method We performed a retrospective study of 5000 outpatient hysteroscopies performed between June 2003 and April 2008. All hysteroscopies were performed using a vaginoscopic approach and saline to distend the uterus. The indications, type of surgery, and success, failure and complication rates were analyzed. Results The hysteroscopies were successfully performed in nearly 97% of the patients. Severe pain and vasovagal syndrome occurred in 4% and 1.4% of the women, respectively. The most common indication was abnormal uterine bleeding and the most common diagnosis was endometrial polyps. Outpatient hysteroscopy was carried out in 60% of the patients. The most frequent type of surgery was hysteroscopic polypectomy (64%). Perforation and inflammatory disease rates were 0% and 0.08%, respectively. Conclusions Outpatient hysteroscopy is a well tolerated, effective and safe procedure. The combination of small-diameter hysteroscope and bipolar energy allows intrauterine disorders to be treated in the office setting without anesthesia (AU)
Subject(s)
Humans , Female , Hysteroscopy/statistics & numerical data , Uterine Diseases/diagnosis , Retrospective Studies , Genital Diseases, Female/diagnosis , Sensitivity and SpecificityABSTRACT
Los tumores primarios múltiples sincrónicos son los que, además de otros criterios, su diagnóstico se hace de forma simultánea. La aparición sincrónica de un carcinoma confinado al endometrio y al ovario es una patología controvertida desde el punto de vista diagnóstico y terapéutico. Dicha patología es rara; los cánceres primarios sincrónicos de endometrio y ovario se encuentran en el 10% de las mujeres con cáncer de ovario y en el 5% de los pacientes con cáncer endometrial. Se presenta un caso de adenocarcinoma endometrioide sincrónico con un cistoadenocarcinoma seroso papilar ovárico que, según la clasificación establecida por Eifel et al2, estaría englobado en el grupo C (constituido por carcinomas de endometrio y ovario de tipos histológicos diferentes). Su etiología es incierta, y en el 45% de las pacientes del grupo C hay invasión miometrial, frente al 10% de las pacientes del grupo A (neoplasias tipo endometrioide idénticas, el tanto en el útero como en el ovario, que constituyen el grupo histológico más frecuente) (AU)
Synchronous multiple primary tumors are those that are diagnosed simultaneously, among other criteria. Synchronous appearance of a carcinoma localized in the endometrium and ovary is controversial from a therapeutic and diagnostic point of view. These entities are rare; synchronous primary cancers of the endometrium and ovary are found in 10% of women with ovarian cancer and in 5% of women with endometrial cancer. We present a case of synchronous endometrioid adenocarcinoma with serous papillary cystadenocarcinoma of the ovary that, according to the classification established by Eifel et al., would be included in group C (composed of carcinomas of the endometrium and ovary of different histological types). The etiology is unclear and, in 45% of patients in group C, there is myometrial invasion, compared with 10% of the patients in group A (concordant endometrioid tumors of the uterus and ovary, which constitute the most frequent histological group) (AU)
Subject(s)
Female , Aged , Humans , Adenocarcinoma/diagnosis , Endometrial Neoplasms/diagnosis , Ovarian Neoplasms/diagnosis , Obesity, Morbid , Metrorrhagia/etiology , Adenocarcinoma/surgery , Hysterectomy/methods , Adnexa Uteri/surgery , Endometrial Neoplasms/surgery , Ovarian Neoplasms/surgeryABSTRACT
Se plantea como objetivo conocer la influenciadel orden al nacimiento en el resultado obstétricode los gemelos, analizando variables relacionadascon el parto. Se estudian retrospectivamente266 parejas de gemelos, valorando elpH y el test de Apgar al nacimiento.El primer gemelo presenta mejores resultadosperinatales. Las variables que influyen sobrelas diferencias de pH son: intervalo de tiempoal nacimiento, diferencia de peso entre ambosgemelos y el peso medio. En el Indice de Apgaral minuto influyen la diferencia de peso ylas interacciones del tiempo de gestación con elpeso medio y la diferencia de peso. El test alquinto minuto se ve influido por la diferenciade peso y el peso medio.Existen diferencias en el resultado neonatalentre las parejas de gemelos, siendo la variableque muestra una influencia más constante, ladiferencia de peso entre ambos fetos
The objective of the study was to investigate;;the effect of birth order on obstetric outcome of;;twin pregnancies, analyzing delivery-related;;variables. 266 pairs of twin babies were studied;;retrospectively, recording umbilical cord blood;;pH and Apgar score at birth.;;The first twin had a better perinatal outcome.;;Variables that led to cord blood pH differences;;were: Time interval in twin delivery,;;weight difference between twins, and mean fetal;;weight. 1 minute Apgar score differences;;are related to weight difference between twins;;and intereactions between gestational age, mean;;fetal weight and weight difference between;;twins. 5 minutes Apgar score was influenced by;;weight difference between twins and mean fetal;;weight. There were differences in neonatal;;outcome between twins, and the variable that;;show a more constant influence is weight difference;;between twins
