Effects of early second-look hysteroscopy combined with intrauterine balloon dilatation on reproductive outcomes for women with intrauterine adhesions.

OBJECTIVE: To investigate the effect of early second-look office hysteroscopy combined with intrauterine balloon dilatation on prognosis and pregnancy rate for women with intrauterine adhesions. METHODS: A retrospective analysis of 156 women diagnosed with intrauterine adhesions by hysteroscopy at Shenyang Women's and Children's Hospital, China, from April 2017 to January 2019. The study women underwent intrauterine balloon dilatation 10 days after transcervical resection of adhesion (TCRA) and hysteroscopy 20 days after TCRA (n=81). The control women underwent hysteroscopy 3 months after TCRA (n=75). Estrogen and aspirin were routinely administered postoperatively to all women. Data, including American Fertility Society (AFS) scores assessed by hysteroscopy, endometrial thickness measured by ultrasound, and menstruation and pregnancy outcomes assessed by interview, were compared between the two groups. RESULTS: The degree of intrauterine adhesions, menstrual status, and endometrial thickness were improved in both groups after TCRA. Greater improvement in AFS score, menstruation, and endometrial thickness was observed in the study group than in the control group. After follow-up, more women in the study group achieved pregnancy (48.1% vs 30.7%, P<0.05). CONCLUSION: Early second-look of hysteroscopy combined with intrauterine balloon dilatation after hysteroscopic TRCA might improve the prognosis and postoperative pregnancy rate for women with intrauterine adhesions.

Reoperation After Primary Lumbar Discectomy with or without Implantation of a Bone-Anchored Annular Closure Device: Surgical Strategies and Clinical Outcomes.

OBJECTIVE: To determine whether presence of a bone-anchored annular closure device (ACD) impacts reoperation strategies and subsequent outcomes. METHODS: Patients with large annular defects after single-level limited lumbar discectomy were randomly allocated to receive an ACD or discectomy alone (controls) and were followed for at least 3 years. RESULTS: Among 550 patients, reoperation risk was lower with ACD (11.0% vs. 19.3%). The types of reoperations and operative time were similar in each group, and the ACD did not interfere with surgical planning or operative technique. Fusion success was 87% with ACD versus 85% for controls. Perioperative complications occurred in 22% and 19% of reoperations, respectively. Leg pain and back function were improved with ACD versus controls after fusion procedures, and no group differences were observed after non-fusion reoperations. CONCLUSIONS: In patients undergoing post-discectomy reoperation, patients with an ACD were treated with similar operative techniques, were not exposed to additional surgical risks, and reported comparable clinical outcomes versus those without an ACD.

Laparoscopic second look operation for ovarian cancer: single center experiences.

We compared the clinical outcomes of laparoscopic surgery with those of laparotomy in second-look operations for ovarian cancer. We retrospectively reviewed the medical records of 35 patients treated between January 2000 and December 2005. They were categorized into two groups: Laparoscopy versus laparotomy group. Among 35 patients, 18 patients (51.4%) were treated with laparoscopy, and 17 patients (48.6%) were treated with laparotomy. There were no statistically significant differences except for hospital stay (laparoscopy vs. laparotomy five days vs. nine days, p < 0.05). Eight patients (44.4%) in the laparoscopy group and six (35.3%) in the laparotomy group were found to be pathologically positive after the second look operation. There were two recurrences (20.0%) in the laparoscopy group and four (36.4%) in the laparotomy group pathologically negative in the second-look operation (p = 0.557). There were no differences in disease-free survival rates (p = 0.705) between the two groups. The second look operation is an ideal method for histologic comfirmation of recurrent or persistent ovarian cancer. Laparoscopic surgery seems a safe and accurate method for the second-look examination, and can also reduce patient discomfort, hospital stay and morbidity associated with laparotomy.

Robotic partial nephrectomy in the setting of prior abdominal surgery.

OBJECTIVE: • To evaluate our experience with robotic partial nephrectomy in patients with previous abdominal surgery and evaluate the effect of previous abdominal surgery on perioperative outcomes. We also describe a technique for intraperitoneal access for patients with prior abdominal surgery utilizing the 8 mm robotic camera for direct-vision trocar placement. PATIENTS AND METHODS: • From a prospective cohort of 197 consecutive patients who underwent robotic renal surgery at a single academic institution, a total of 95 patients underwent transperitoneal robotic partial nephrectomy (RPN). • Patients with and without previous abdominal surgery were compared. Patients with prior abdominal surgery were subcategorized into two groups: upper midline or ipsilateral upper quadrant scar or lower abdominal, contralateral, or minimally-invasive scar. • Demographic and perioperative variables were compared between the surgery and no surgery groups. Access was obtained using a Veress needle or Hassan technique. • We utilized a technique of direct vision placement of the initial trocar on our 10 most recent cases, using an 8 mm robotic camera placed through the obturator of 12 mm clear-tipped trocar. • Lysis of adhesions was performed as needed to allow for placement of additional robotic ports. RESULTS: • A total of 95 patients underwent transperitoneal RPN, of which 41 (43%) had a history of prior abdominal surgery and six had upper midline or ipsilateral upper quadrant scars. • There were no statistically significant differences between patients with previous abdominal surgery and patients with no previous abdominal surgery in BMI (30.4 vs 29.4 kg/m(2) ), median tumor size (2.5 cm vs 2.3), median total operative time (246 vs 250 min), median warm ischemia time (21 vs 16 min), median EBL (150 vs100 ml), clinical stage, transfusion rate, or complications. • A total of six patients underwent 7 previous upper midline or ipsilateral upper quadrant surgeries, including open cholecystectomy-2 patients (33%), open partial gastrectomy-2 patients (33%) and exploratory laparotomy-1 patient (17%). • Complications in this group were an enterotomy during lysis of adhesions that was repaired robotically without sequelae and a mesenteric hematoma during Veress needle placement. A total of 35 patients underwent 16 other prior abdominal surgeries, including abdominal hysterectomy-10 patients (29%), umbilical/inguinal hernia repair-9 patients (26%) and appendectomy-7 patients (20%). There were no access related injuries in the 10 cases in which the robotic 8 mm camera was used for initial trocar placement. CONCLUSIONS: • Transperitoneal robotic partial nephrectomy is feasible in the setting of prior abdominal surgery. The majority of these patients can have their procedure performed safely without an increase in complications. • Direct-vision intraperitoneal placement of initial trocar may be achieved by using an 8 mm robotic camera, without the need to switch between conventional and robotic cameras.

Indications and procedures for second-look surgery in acute mesenteric ischemia.

Acute mesenteric ischemia (AMI) is a highly lethal clinical entity associated with high morbidity and mortality. Bowel necrosis often results, usually necessitating bowel resection; however, deciding on the extent of resection is problematic as accurate identification of ischemic bowel that may undergo subsequent infarction is difficult. Therefore, a second-look laparotomy after the first operation is usually recommended. While the second-look procedure is widely accepted, its optimal indications and mode are still controversial, raising questions such as "second-look or not?," "planned relaparotomy or relaparotomy on demand?," and "open or laparoscopic?" In this review we discuss the relevant literature and reassess the role of the second-look operation in the treatment of AMI.

Revision surgery for posterior stabilized thoracolumbar fracture using mini-open anterior approach and expandable cage.

OBJECTIVE: To evaluate the surgical techniques and outcomes of revision surgery for compromised posterior stabilization or insufficient neurological decompression using anterior mini-open approach and expandable cage. METHODS: From August 2005 to June 2008, a total of 235 patients were operated on in our center for thoracolumbar fractures with dorsal transpedicular stabilization. Twenty-six of these patients underwent revision surgery, the main reasons being back pain and stagnant neurological recovery. The surgical procedure comprised a single-level thoracolumbar corpectomy and/or canal clearance, followed by an expandable cage reconstruction. The average interval between primary and revision surgery was 5 months (range, 3-11 months). A transthoracic (n= 11) or transthoracic transdiaphragmatic (n= 15) mini-open approach was conducted using a table-mounted retractor. RESULTS: The operating time averaged 105 min (range, 95-135 min) for the transthoracic approach and 152 min (range, 120-190 min) for the transthoracic plus transdiaphragmatic approach. The overall mean blood loss was 780 ml (range, 550-1700 ml). Over time, the pre-operative neurological deficit improved in 6/7 patients by at least one Frankel/American Spinal Injury Association (ASIA) grade. On a visual analogue scale (VAS) from 0 to 10, the mean local thoracolumbar back pain was relieved significantly from 6.8 before operation to 3.8 at 3 months, 2.4 at 6 months, and 1.5 at 12 months postoperatively. None of the patients developed intercostal neuralgia or post-thoracotomy pain syndromes. CONCLUSION: For patients with compromised stabilization or insufficient neurological decompression after primary dorsal transpedicular stabilization for thoracolumbar fracture, anterior revision surgery can produce good results. The mini-open anterior approach for corpectomy in the thoracolumbar spine is safe, reliable, and economical. The expandable cage is an excellent alternative for anterior reconstruction.

[Radioimmunotherapy in patients with ovarian cancer in complete remission after the first line surgery and chemotherapy after second look laparoscopy procedure]. / Zastosowanie radioimmunoterapii u chorych na raka jajnika w fazie calkowitej remisji klinicznej po I rzutowym leczeniu chemicznym potwierdzonym operacja typu second look--ocena etapu kwalifikacji do procedury oraz jej wykonania.

OBJECTIVES: The aim of the study was analysed a chance to successful radioimmunotherapy in patients with ovarian cancer as a consolidation procedure. DESIGN: Between 2000 and 2002 we introduced 56 patients into consolidation study with radioimmunotherapy after second look laparoscopy. MATERIALS AND METHODS: 17 patients during screening procedure have failed--mostly with positive CT scans (9/17). We have done 39 laparoscopies. Among 11 patients during laparoscopy we have found in 6 cases a residual disease and in 5 cases adhesions in abdomen or pelvis and this group was excluded from study. The remaining 28 patients were divided into two groups--14 in active and 14 in control arm. RESULTS: Only 50% of patients with ovarian cancer in complete clinical remission after first line surgery and chemotherapy can be candidates to consolidation therapy. Among patients subjected to laparoscopy in 70% there was no evidence of macroscopic disease and adhesions. CONCLUSIONS: Only 50% patients in complete clinical remission after first line surgery and chemotherapy have chance to successful radioimmunotherapy.