ABSTRACT
AIM: To evaluate the efficacy of an articulating laparoscopic needle holder in laparoscopic surgery for cesarean scar defect. METHODS: We performed a retrospective case-control study at the Shiga University of Medical Science. Patients who underwent laparoscopic uterine scar repair were divided into an articulating laparoscopic needle holder (ArtiSential®) group and a rigid needle holder (conventional) group to compare the suture and total operative times. Uterine myometrial suturing involves a double-layer interrupted suture, including a modified Gambee suture for the first layer. We measured the residual myometrial thickness using magnetic resonance imaging preoperatively and at 3 months postoperatively. RESULTS: Both groups comprised 10 patients each. The time per stitch for the first and second layers was significantly shorter in the ArtiSential group than in the conventional group (median 208 s vs. 403 s, p < 0.0001 and median 17 s vs. 29 s; p < 0.0001, respectively). The total operating time was significantly shorter in the ArtiSential group (mean 188 min vs. 240 min, p = 0.0015). The postoperative residual myometrial thickness (mean 9.1 mm in the ArtiSential group and 9.6 mm in the conventional group) was significantly higher than the preoperative residual myometrial thickness (mean 1.6 mm in the ArtiSential group and 1.6 mm in the conventional group) (p < 0.0001 in both groups). CONCLUSIONS: An articulating needle holder is useful in laparoscopic surgery for cesarean scar defect, especially when a modified Gambee suture is required.
Subject(s)
Cesarean Section , Cicatrix , Laparoscopy , Humans , Female , Cicatrix/etiology , Laparoscopy/methods , Laparoscopy/instrumentation , Cesarean Section/adverse effects , Adult , Retrospective Studies , Case-Control Studies , Suture Techniques/instrumentation , Needles , Pregnancy , Operative TimeABSTRACT
Gallbladder torsion is a rare disease that requires immediate surgical intervention to avoid maternal and/or foetal sepsis and death. However, preoperative diagnosis is challenging because the disease has no specific symptoms. A 37-year-old pregnant woman at 34 weeks of gestation presented with severe epigastric pain. Ultrasonography and computed tomography scan findings showed a distended gallbladder without stones, floating from the hepatic bed, and laboratory examination demonstrated normal liver function; therefore, we made a diagnosis of gallbladder torsion and performed a caesarean section and an open cholecystectomy under general anaesthesia. This is the first report wherein gallbladder torsion in pregnancy was diagnosed preoperatively. Gallbladder torsion should be considered as a differential diagnosis in case of such imaging findings.
Subject(s)
Gallbladder Diseases , Humans , Pregnancy , Female , Adult , Gallbladder Diseases/diagnostic imaging , Gallbladder Diseases/surgery , Cesarean Section , Torsion Abnormality/diagnostic imaging , Torsion Abnormality/surgery , CholecystectomyABSTRACT
The major risk factor for adnexal torsion is the presence of adnexal neoplasms, and torsion without a neoplastic lesion of the adnexa is rare. We report three cases of right adnexal torsion without neoplastic lesion after laparoscopic hysterectomy. In all three cases, the right adnexas, which did not form adhesions, had undergone torsion. According to several case reports, most cases of adnexal torsion after laparoscopic hysterectomy developed without neoplastic lesion. In fact, adnexal torsion without neoplasm is reported to occur relatively frequently after laparoscopic hysterectomy and more commonly involves the right side. Therefore, at the end of laparoscopic hysterectomy, ovariopexy should be performed to prevent postoperative adnexal torsion.
