The Rate of Mesh Erosion after Modified Transobturator Tape (Canal Transobturator Tape) Surgery: Analysis of 5 years' Outcome and Influencing Factors.

PURPOSE: To evaluate the long-term cure and complication rates of the canal transobturator tape (TOT) procedure for stress urinary incontinence (SUI) in females and assess how to reduce mesh erosion in TOT surgery. MATERIALS AND METHODS: The canal TOT procedure was developed in 2009 and was effective in mitigating the complications of the original TOT procedure in the short-term follow-up. This study was designed for a long-term follow-up. Between October 2006 and December 2010, 232 consecutive women with stress and mixed urinary incontinence underwent the canal TOT procedure. All patients were followed up by urological examination and self-assessment questionnaires. We performed urodynamic studies in patients with pure SUI symptoms and pelvic examination for all patients 5 years post-surgery. RESULTS: A minimum 5 years follow-up data were available for 144 patients. Complications were evaluated according to the Clavien-Dindo classification. Vaginal mesh erosion was reported in 2 patients (1.4%), and the mesh was surgically removed. No bladder or urethral mesh erosion were observed. The subjective and objective cure rates at 5 years were 77.8 and 94.5% respectively. CONCLUSIONS: Canal TOT procedure is an effective minimally invasive procedure with satisfactory results for female SUI in the long term. Compared to the rate of mesh erosion after the original TOT procedure, this technique might be useful in preventing mesh erosion because the mesh is always anatomically well positioned.

Temporary simultaneous two-arterial occlusion for reducing operative blood loss during laparoscopic myomectomy: a randomized controlled trial.

BACKGROUND: To evaluate the efficacy and safety of temporary simultaneous two-arterial occlusions (TESTO) in terms of operative blood loss during laparoscopic myomectomy. METHODS: A total of 62 patients with symptomatic myomas were randomly assigned to either the experimental group or the control group. In the experimental group, the uterine arteries and utero-ovarian arteries were temporarily occluded with laparoscopic bulldog clamps. The primary outcome measures were operative blood loss and change in hemoglobin. RESULTS: There were no differences in baseline demographics between the two groups. The amounts of operative blood loss (56.3 ± 42.8 mL vs. 138.2 ± 48.8 mL, p < 0.001) and change in hemoglobin (1.0 ± 0.5 g/dL vs. 1.7 ± 1.1 g/dL, p = 0.002) were significantly lower in the experimental group than that in the control group. The total operative time was not significantly different between the two groups. However, it took less time for myoma enucleation (13.1 ± 14.6 min vs. 17.6 ± 10.4 min, p = 0.006) and for uterine suturing (19.5 ± 10.7 min vs. 24.6 ± 8.8 min, p = 0.006) in the experimental group than that in the control group. None of patients in both groups developed operative complications. CONCLUSION: The use of the TESTO procedure is effective in reducing operative blood loss and hemoglobin loss without causing morbidity during laparoscopic myomectomy.

Effectiveness of Fibrin Sealant Patch in Reducing Drain Volume after Pelvic Lymph Node Dissection in Women with Gynecologic Malignancy.

BACKGROUND: The goal of this study was to evaluate the effectiveness of fibrin sealant in decreasing postoperative lymphatic drainage in women after pelvic lymphadenectomy and/or para-aortic lymphadenectomy during gynecologic cancer surgery. METHODS: This study is a retrospective case-control study. Forty-five patients who underwent staging surgery were enrolled. Twenty-seven patients were in the fibrin sealant group (group A) and 18 in the control group (group B). The two groups were compared for the total volume of drain, hospital stay, harvested lymph node, and incidence of asymptomatic lymphocele. Lymphocele formation was evaluated by computed tomography (CT) on 3 months after surgery. RESULTS: There were no significant differences in patient demographics between group A and B with respect to age, BMI, and harvested lymph nodes. Patients who received fibrin sealants had reduced total volume of drainage from postoperative days 2 to 5 compared to the control group (group A versus group B: 994.819 ± 745.85 ml versus 1847.89 ± 1241.41 ml; P = 0.015). However no differences were observed in hospital stay (P = 0.282), duration of drain (P = 0.207), and incidence of asymptomatic lymphocele at 3 months (P = 0.126). CONCLUSION: The results of this study indicate that the application of fibrin sealants after pelvic and/or para-aortic lymphadenectomy may reduce lymphatic drainage in gynecologic malignancy.