Updates on the Surgical Approach to Fibroids: The Importance of Radiofrequency Ablation.

Uterine fibroids are the most common benign neoplasm of the female pelvis and have a lifetime prevalence exceeding 80% among African American women and approaching 70% among Caucasian women. Approximately 50% of women with fibroids experience symptoms which can range from heavy menstrual bleeding and bulk-related symptoms such as pelvic pressure with bladder and bowel dysfunction to reproductive dysfunction (e.g., infertility or obstetric complications) and pain. The choice of treatment is primarily guided by the type of symptoms in the individual patient and whether they prefer to retain fertility. While hysterectomy provides definitive resolution of fibroid symptoms and remains the most common treatment option, this procedure is invasive with a long recovery window. Radiofrequency ablation (RFA) is now emerging as a uterine preserving and minimally invasive therapy for symptomatic fibroids. Since its introduction, growing evidence for safety and efficacy of RFA has been generated with low rates of complications. This review will discuss RFA for the management of symptomatic uterine fibroids with a special focus on technical approaches, short- and long-term outcomes including fertility outcomes.

Trocar site hernia after laparoscopy: Early recognition prevents catastrophic sequelae.

BACKGROUND: Trocar site hernia is a rare but potentially serious complication of laparoscopic surgery that may lead to bowel incarceration and strangulation. Prompt diagnosis by emergency physicians facilitates timely intervention that prevents bowel necrosis. We report a case of trocar site hernia presenting to the emergency department (ED) with abdominal pain that was correctly diagnosed and promptly managed. CASE REPORT: A 25-year-old woman, gravida 2, abortion 2, underwent outpatient surgery and laparoscopic removal of a ruptured right-sided tubal pregnancy without any intraoperative difficulties. However, 48 h later, she presented to the ED complaining of acute abdominal pain and nausea. Computed tomography revealed a loop of small bowel herniating through a 12-mm right lower quadrant trocar site defect in the fascia. She was taken back to the operating room, where the computed tomography findings were confirmed and the entrapped bowel was successfully reduced and the fascial defect repaired. The patient was discharged home feeling much improved. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Trocar site hernia is a rare but potentially dangerous complication that can present with acute symptoms or be asymptomatic if late in onset. Intestinal necrosis begins as soon as 6 h after constriction of blood flow to entrapped bowel, so timely intervention is critically important. Therefore, trocar site hernias should be considered in patients presenting with abdominal complaints after laparoscopic surgery and included in the differential diagnosis of bowel obstruction.

The Impact of TeamSTEPPS Training on Obstetric Team Attitudes and Outcomes on the Labor and Delivery Unit of a Regional Perinatal Center.

OBJECTIVE: We investigated the effect of TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) training on teamwork perceptions and patient safety outcomes in an inpatient obstetrics setting. STUDY DESIGN: Physicians and nurses from the regional perinatal center were offered TeamSTEPPS instruction and administered a voluntary survey to assess subjective perceptions of team dynamics and patient safety prior to and 6 months following TeamSTEPPS training. Responses were analyzed using analysis of variance (ANOVA) and Chi-square test. Objective measures of patient safety outcomes were the incidence and blood loss of postpartum hemorrhage after vaginal delivery (PPH-VD) or cesarean section (PPH-CS) and incidence of shoulder dystocia (SD). Outcomes were analyzed using Mann-Whitney and Kruskal-Wallis tests. RESULTS: Surveys were collected from 20 physicians and 15 nurses prior to training and from 9 physicians and 20 nurses 6 months following training. Survey data showed an overall positive perception of teamwork and patient safety behaviors across all respondents. However, we found no significant changes in perception of team dynamics or behaviors to promote patient safety between pre- and posttraining time points. Physicians and nurses differed in perception of team dynamics (p = 0.001) and patient safety behaviors (p < 0.001), with nurses reporting more negative perception of safety behaviors posttraining. Physician attendees experienced a nonsignificant lower rate of PPH-VD and PPH-CS with unchanged blood loss, and an increased rate of SD compared with nonattendees in the 6 months following TeamSTEPPS training (p = 0.058, 0.20, and 0.21, respectively). CONCLUSION: Our experience with perinatal TeamSTEPPS training as a singular intervention was not demonstrative of improvement in teamwork and patient safety perceptions or incidences of obstetric emergencies suggesting that integration into a more comprehensive patient safety program and ongoing training of a larger proportion of providers per department may be necessary to realize tangible benefits of TeamSTEPPS. Our survey results also highlight important differences between physician and nursing staff perceptions. KEY POINTS: · There is value in a comprehensive patient safety program, such as TEAMSTEPPS, with ongoing training.. · Patient safety perceptions may differ between physician and nursing staff in the same unit.. · Health care staff must agree about the situation to improve patient safety..

Peritoneal hernia following abdominal hysterectomy: A case report.

BACKGROUND: Internal hernias rarely lead to bowel obstruction; they are caused by a natural or unnatural opening within the peritoneal cavity. Defects in the peritoneum are extremely rare. Patients present with features of intestinal obstruction and most cases are diagnosed during surgery. CASE PRESENTATION: A 47-year-old woman with a history of multiple abdominal surgeries had a small bowel hernia through a peritoneal defect of the anterior abdominal wall. She presented with abdominal pain and distension and was taken to the operating room, where findings revealed an intact fascia and small bowel herniation through a midline peritoneal defect. CONCLUSION: Herniation of small bowel through the peritoneum is a rare type of internal hernia that can manifest in a patient with extensive history of abdominal surgeries. This type of clinical picture warrants a high degree of suspicion for prompt and proper management. Surgery should not be delayed, to avoid increased morbidity and mortality.