International Journal of Gynecology & Obstetrics

Social and therapeutic challenges of pelvic floor dysfunction

Bozo Kralj — 2010-01-20

Bozo Kralj, MD. School of Health Sciences, Novo Mesto, Slovenia Professor Bozo Kralj graduated from the Faculty of Medicine, University of Ljubljana, Slovenia, in 1956 and received a PhD degree from the same faculty in 1974. He became Full Professor of Obstetrics and Gynecology (1990) and Director of the University Department of Obstetrics and Gynecology, Ljubljana (1991–1999). Professor Kralj subsequently became the Dean of the High School of Health Sciences in Ljubljana and Novo Mesto, Slovenia. He was president of the Slovene Society of Obstetricians and Gynecologists (1994–2005), and vice president (1985–1988) and president (1988–1990) of the International Urogynecological Association (IUGA). He is an honorary member of the Italian, Slovak, Slovene, and Macedonian Society of Obstetricians and Gynecologists. Professor Kralj has published over 220 professional and scientific articles and acts on the editorial boards of several international medical journals. He has been awarded numerous decorations for his professional work, including the IUGA award for lifetime achievement in 2009. Professor Kralj was a member of the FIGO Scientific Board from 1997–2000, and a member of the FIGO Executive Board from 2003–2009.

Contemporary issues in women's health

Richard M.K. Adanu, Maya M. Hammoud — 2010-02-18

José Barzelatto lecture: Vision on unsafe abortion

Anibal Faúndes — 2010-01-12

Abstract: José Barzelatto first distinguished himself as a leader with a vision in his years as a medical student. Later, principally as Director of the Reproductive Health Program at the World Health Organization and of the Ford Foundation program for women's sexual and reproductive rights, he contributed immensely toward the recognition of women's sexual and reproductive rights as part of their basic human rights. José Barzelatto's vision on abortion reflects his drive to promote social justice and respect individual rights, respect diversity, and promote a social consensus for a peaceful society. He believed that the fetus has moral value and did not accept abortion as a method of fertility control, but understood that abortion is a social phenomenon that cannot be changed with legal or moral condemnation. He accepted that condemning women who abort does not prevent abortion, is unfair, and causes great human suffering at a high social cost. José proposed nine points to form the basis for an overlapping consensus on abortion, on which to base a practical consensus that would allow societies to reduce the number of abortions and minimize their consequences. If we can agree on all or most of those points we would achieve the common objectives of: fewer women confronting the dilemma of how to deal with an unwanted pregnancy; fewer induced abortions; and fewer women suffering the consequences of unsafe abortion.

Peripartum hysterectomy: An evolving picture

Michael J. Turner — 2010-02-22

Abstract: Peripartum hysterectomy (PH) is one of the obstetric catastrophes. Evidence is emerging that the role of PH in modern obstetrics is evolving. Improving management of postpartum hemorrhage and newer surgical techniques should decrease PH for uterine atony. Rising levels of repeat elective cesarean deliveries should decrease PH following uterine scar rupture in labor. Increasing cesarean rates, however, have led to an increase in the number of PHs for morbidly adherent placenta. In the case of uterine atony or rupture where PH is required, a subtotal PH is often sufficient. In the case of pathological placental localization involving the cervix, however, a total hysterectomy is required. Furthermore, the involvement of other pelvic structures may prospectively make the diagnosis difficult and the surgery challenging. If resources permit, PH for pathological placental localization merits a multidisciplinary approach. Despite advances in clinical practice, it is likely that peripartum hysterectomy will be more challenging for obstetricians in the future.

Risk factors and management patterns for emergency obstetric hysterectomy over 2decades

Farah Lone, Abdul H. Sultan, Ranee Thakar, Andrew Beggs — 2009-12-02

Abstract: Objective: To review the demographic characteristics of patients, risk factors, indications, and complications of emergency obstetric hysterectomy (EOH), and to determine the changing trends in EOH over the last 2decades.Methods: A retrospective review of all consecutive cases of EOH over the last 20years at Mayday University Hospital, UK.Results: There were 84698 deliveries between January 1989 and January 2009. Fifty-two women had an EOH, with an incidence of 0.6 per 1000 deliveries. The underlying cause of EOH was uncontrolled primary hemorrhage in 50 (96.2%) women and severe sepsis leading to secondary hemorrhage in 2 (3.8%) women. A total of 38 (73%) EOHs were performed for intractable bleeding after cesarean delivery. Twenty-five EOHs were performed in the first decade, and 27 EOHs were performed in last decade.Conclusion: Despite the introduction of pharmacologic agents and new surgical techniques to control postpartum hemorrhage, there was no reduction in the prevalence of EOH. Previous cesarean delivery with associated placenta previa or placenta accreta was a major contributor toward EOH.

Effectiveness of an instructional DVD on third- and fourth-degree laceration repair for obstetrics and gynecology postgraduate trainees

Tamara T. Chao, George D. Wendel, Donald D. McIntire, Marlene M. Corton — 2009-12-18

Abstract: Objective: To assess the effectiveness of an instructional DVD on the anatomy and repair of anal sphincter lacerations to improve postgraduate trainees’ understanding.Methods: A total of 71 obstetrics and gynecology trainees completed a pretest of third- and fourth-degree lacerations to assess baseline knowledge and perceptions. Question categories included anatomy, antibiotics, anesthesia, repair methods, complications, postoperative care, and risk factors. After 1year of clinical experience, 67 trainees (94%) were randomly assigned into DVD (intervention) and non-DVD (control) groups. A post-test was administered 4weeks later.Results: In the DVD group (n=34), mean scores on the pretest versus the post-test were 65% vs 74% for postgraduate year (PGY)-1 (P=0.09); 72% vs 83% for PGY-2 (P=0.06); 67% vs 83% for PGY-3 (P=0.01); and 75% vs 87% for PGY-4 (P<0.001). In the non-DVD group (n=33), mean scores did not change significantly for any year level. The increase in score from pretest to post-test was significantly different between the 2 groups, independent of year (P<0.001). DVD group scores improved significantly over non-DVD group scores in anatomy (P=0.005) and repair methods (P=0.042) subscales.Conclusion: An educational video is an effective tool for improving understanding of third- and fourth-degree lacerations for physicians-in-training.

A comparative study of the non-pneumatic anti-shock garment for the treatment of obstetric hemorrhage in Egypt

2010-01-25

Abstract: Objective: To assess the impact of the non-pneumatic anti-shock garment (NASG) on maternal outcome following severe obstetric hemorrhage.Methods: A non-randomized pre-intervention/intervention study was conducted in 2 tertiary hospitals in Egypt from June 2006 to May 2008. Women with obstetric hemorrhage (estimated blood loss ≥1000mL and/or ≥1 sign of shock [systolic blood pressure <100mm Hg or pulse >100 beats per minute]) were treated with either a standardized protocol (pre-intervention) or a standardized protocol plus the NASG (intervention). The primary outcome was extreme adverse outcome (EAO), combining maternal mortality and severe morbidity (cardiac, respiratory, renal, or cerebral dysfunction). Secondary outcomes were measured blood loss, urine output, emergency hysterectomy, and (individually) mortality or morbidity. Analyses were performed to examine independent association of the NASG with EAO.Results: Mean measured blood loss decreased from 379mL pre-intervention to 253mL in the intervention group (P<0.01). In a multiple logistic regression model, the NASG was associated with reduced odds of EAO (odds ratio 0.38; 95% confidence interval, 0.17–0.85).Conclusion: The NASG, in addition to standardized protocols at tertiary facilities for obstetric hemorrhage and shock, resulted in lower measured blood loss and reduced EAO.

Rectally administered misoprostol versus intravenous oxytocin infusion during cesarean delivery to reduce intraoperative and postoperative blood loss

Picklu Chaudhuri, Gita Basu Banerjee, Apurba Mandal — 2010-01-13

Abstract: Objective: To compare the efficacy of rectally administered misoprostol with intravenous oxytocin infusion in preventing uterine atony and blood loss during cesarean delivery.Methods: In this prospective, randomized, double-blind trial, 200 women undergoing cesarean delivery who did not have risk factors for postpartum hemorrhage were randomly allocated to receive either 800µg of rectal misoprostol at the time of peritoneal incision or an intravenous infusion of oxytocin after delivery of the neonate. Primary outcome measures were estimated amount of intraoperative and postoperative (8hours) blood loss and changes in hemoglobin levels 24hours after delivery.Results: A total of 96 and 94 women were analyzed in the misoprostol and oxytocin groups, respectively. Intraoperative and postoperative blood loss was significantly lower in the misoprostol group than in the oxytocin group (503 vs 592mL, P=0.003 and 74 vs 114mL, P=0.045, respectively). The incidence of shivering was higher in the misoprostol group (8.3% vs 1.1%, P=0.018; RR 7.83; 95% confidence interval, 0.99–61.42).Conclusion: Rectal misoprostol appears to be an effective alternative to intravenous oxytocin in preventing blood loss for routine use during cesarean delivery. Clinical Trials Registration: CTRI/2009/091/000075.

Cell-free placental mRNA in maternal plasma to predict placental invasion in patients with placenta accreta

Manal M. El Behery, Etewa Rasha L., Yehya El Alfy — 2010-01-13

Abstract: Objective: To evaluate whether measuring cell-free placental mRNA in maternal plasma improves the diagnostic accuracy of ultrasound and color Doppler in detecting placental invasion in patients at risk for placenta accreta.Methods: Thirty-five singleton pregnant women of more than 28weeks of gestation and at risk for placenta accreta underwent ultrasound and color Doppler assessment. Cell-free placental mRNA in maternal plasma was measured using real-time reverse-transcription polymerase chain reaction. Patients were classified into 2 groups based on the findings at cesarean delivery and histological examination: women with placenta accreta (n=7) and women without placenta accreta (n=28).Results: The median MoM (multiples of the median) value of cell-free placental mRNA was significantly higher in patients with placenta accreta than in those without placenta accreta (6.50 vs 2.60; P<0.001. Moreover, cell-free placental mRNA was significantly elevated in patients with placenta increta and percreta than in those with simple accreta. Six false-positive results were found on ultrasound, all from patients without placenta accreta and an insignificant rise in cell-free placental mRNA levels.Conclusion: Measuring cell-free placental mRNA in maternal plasma may increase the accuracy of ultrasound and color Doppler in prenatal prediction of placental invasion in patients with suspected placenta accreta.

Risk of heart failure relapse in subsequent pregnancy among peripartum cardiomyopathy mothers

James D. Fett, Karie L. Fristoe, Serena N. Welsh — 2009-11-30

Abstract: Objective: To quantify the level of risk for heart failure relapse in a subsequent pregnancy in women who have had peripartum cardiomyopathy (PPCM), and to test the hypothesis that meeting additional criteria may help lower the risk.Methods: Prospectively-identified PPCM patients volunteering between 2003 and 2009 were identified from the PPCM Registry of Hôpital Albert Schweitzer, Deschapelles, Haiti, and an internet support group. Data were assessed for full adherence to monitoring and diagnostic criteria, clinical data, statistical analysis, and reporting.Results: Of 61 post-PPCM pregnancies identified, there were 18 relapses (29.5%) of heart failure. Of 26 pregnancies with a left ventricular ejection fraction (LVEF) of less than 0.55 prior to the pregnancy, relapse occurred in 12 (46.2%) pregnancies. Of 35 pregnancies with an LVEF of 0.55 or greater prior to the pregnancy, relapse occurred in 6 (17.1%) (P<0.01). No relapses occurred in 9 women who also demonstrated adequate contractile reserve.Conclusion: The most important criterion associated with reduced risk for heart failure relapse in a post-PPCM pregnancy is recovery defined by an LVEF 0.55 or greater before the subsequent pregnancy. Exercise stress echocardiography showing adequate contractile reserve may help to identify women at an even lower risk of relapse.

Fertility outcome following transvaginal cervicoisthmic cerclage using a polypropylene sling

2010-01-13

Abstract: Objective: To report fertility and pregnancy outcomes following transvaginal cervicoisthmic cerclage with a polypropylene sling during a previous pregnancy.Methods: A continuous series of 57 women who underwent prophylactic cervicoisthmic cerclage during a previous (reference) pregnancy were enrolled. Telephone interviews were carried out to evaluate each patient's subsequent fertility.Results: Among the 57 women interviewed, 8 had an inadequate follow-up, 13 women were lost to follow-up, 1 woman required a hemostatic hysterectomy, and 2 women required removal of the sling. Nineteen women did not desire a subsequent pregnancy. Of the 14 women who did desire a subsequent pregnancy, 1 woman had previously known tubal infertility. Of the 13 remaining women, 7 subsequently became pregnant. One woman had a spontaneous abortion (11weeks of pregnancy); 1 woman delivered at 22weeks of pregnancy, after a spontaneous premature membrane rupture; 1 woman had a cesarean delivery at 25weeks of pregnancy; and 4 patients had a cesarean delivery after 37weeks of pregnancy. Median duration of the 4 subsequent pregnancies at delivery was 37weeks (interquartile range [IQR], 37–38weeks). Median birth weight was 3040g (IQR, 2500–3250g).Conclusion: Subsequent pregnancy is possible after transvaginal cervicoisthmic cerclage using a synthetic sling.

Prepregnancy body mass index, gestational weight gain, and pregnancy outcomes in China

Zhenyu Chen, Juan Du, Ling Shao, Liqiang Zheng, Meiyan Wu, Mo Ai, Yinling Zhang — 2009-12-17

Abstract: Objective: To look for associations between pregnancy outcomes and prepregnancy body mass index and gestational weight gain among Han women from Shenyang province, China.Method: A total of 2586 women were distributed across 4 prepregnancy categories according to the Chinese classification of body mass index, and to 4 end-of-pregnancy categories according to median weekly gestational weight gain.Results: The risks for gestational hypertension, pre-eclampsia, gestational diabetes, and preterm premature rupture of membranes were higher for those who were overweight or obese before becoming pregnant (P<0.05). Moreover, a gestational weight gain of 0.50kg per week or greater was associated with a higher risk for gestational hypertension, preterm premature rupture of membranes, and fetal macrosomia (P<0.05). Women in the highest quartile for weight gain (≥0.59kg per week) were at higher risk for pre-eclampsia (P<0.05).Conclusion: A high prepregnancy body mass index and excessive gestational weight gain were associated with increased risks for adverse pregnancy outcomes.

Pelvic hydatid (echinococcal) disease

2009-12-23

Abstract: Objective: To study epidemiologic and clinical features of pelvic hydatid disease and discuss its management.Method: A retrospective analysis of 11 cases of pelvic hydatid disease managed over 7years and 8months at the Maternity and Neonatalogy Unit, Tunisian Medical Center La Rabta, Tunis, Tunisia. All cases were identified from histopathologic reports.Results: The 11 affected patients had a mean age of 41.6years (range, 22–79years), 6 had a history of surgery for hydatid disease, 8 presented for chronic pelvic pain, and 1 was admitted for acute surgical abdomen. On physical examination, 6 had a pelvic mass. An ultrasound examination suggested the diagnosis preoperatively in 6. All were treated surgically. Primary laparoscopy was performed in 5 patients. Unroofing (or partial cystectomy) was performed in 6 patients and complete cystectomy in 4. The postoperative course was uneventful in all cases. Recurrence occurred only in 1 patient, 6months after initial surgery.Conclusion: Pelvic hydatid disease is rare and its diagnosis often difficult preoperatively. The treatment mainstay is surgery. The laparoscopic approach seems to be safe and effective, and may increasingly replace laparotomy.

A simple procedure to prevent chronic vaginal colpotomy wound bleeding after laparoscopically assisted vaginal hysterectomy

Kok-Min Seow, Yu-Hung Lin, Jiann-Loung Hwang, Lee-Wen Huang, Ching-Pin Pan — 2009-12-23

Abstract: Objective: To determine whether injecting the colpotomy wound with diluted vasopressin decreases vaginal bleeding after laparoscopically assisted vaginal hysterectomy (LAVH).Methods: In this prospective controlled study 100 patients who underwent LAVH from July 1, 2005 to June 30, 2007, were randomized to receive an injection of vasopressin (n=50) or normal saline (n=50) solution in the colpotomy wound.Results: In the vasopressin group, bleeding from the colpotomy wound occurred for more than 7days in 9 patients (18%), and none was bleeding after 1month; in the control group, the corresponding values were 29 (58%) and 2 (4%). Compared with the study group, the control group had a significantly higher rate of chronic bleeding from the colpotomy wound for more than 7days and for more than 14days after LAVH (P<0.001 for both).Conclusion: Infiltrating the colpotomy wound with diluted vasopressin was found to prevent chronic vaginal bleeding, which frequently occurs following LAVH.

Use of intrauterine devices in women with uterine anatomic abnormalities

Naomi K. Tepper, Lauren B. Zapata, Denise J. Jamieson, Kathryn M. Curtis — 2009-12-25

Abstract: Objective: To examine the evidence regarding the safety and effectiveness of intrauterine devices (IUDs) in women with uterine abnormalities.Methods: We searched PubMed for all peer-reviewed articles in any language that had been published on the topic from database inception to September 2009. Primary research articles were included if they addressed the safety or effectiveness of any type of IUD among women with Müllerian anomalies or uterine synechiae.Results: In total, 19 case reports or case series met the inclusion criteria. Reported complications included expulsion, pregnancy, bleeding, perforation, and pain. In several case reports, no complications were reported.Conclusion: Evidence concerning the safety and effectiveness of IUD use among women with uterine abnormalities is very limited.

Epidemiology of mixed urinary incontinence in China

Lan Zhu, Lin Li, Jinghe Lang, Tao Xu, Felix Wong — 2009-12-21

Abstract: Objectives: To determine the prevalence and risk factors for mixed urinary incontinence (MUI) among Chinese women.Method: In this cross-sectional survey study we analyzed the answers to a modified Bristol Female Lower Urinary Tract Symptoms questionnaire provided by 19024 women older than 20years and from 6 regions in China.Results: The overall prevalence of MUI was 9.4%. The prevalence of MUI increased with age and reached 24.1% among women older than 70years. Multivariable logistic regression analysis revealed that age, vaginal delivery, chronic constipation, pelvic organ prolapse, chronic pelvic pain, respiratory system disease, menstrual disorder, urinary system disease, alcohol consumption, pelvic surgery, obesity, and a low educational level were independent risk factors for MUI.Conclusion: We found age, vaginal delivery, and chronic constipation to be the main risk factors for MUI among adult women in China.

“Top hat” versus conventional loop electrosurgical excision procedure in women with a type 3 transformation zone

2009-12-23

Abstract: Objective: To compare the “top-hat” and conventional loop electrosurgical excision procedures (LEEP) performed in women with a type 3 transformation zone to assess the rate of endocervical margin involvement.Methods: Women with a type 3 transformation zone randomly allocated into the conventional (n=94) and top-hat LEEP (n=86) groups were analyzed.Results: The rate of endocervical margin involvement in the top-hat group was lower than that in the conventional group (32.6% vs 53.2%; RR 0.36; 95% CI, 0.19–0.68; P=0.003). Among women with positive endocervical margins, women undergoing top-hat LEEP were less likely to have residual lesions compared with those in the conventional group (52.2% vs 84.1%, respectively, P=0.04). There was no significant difference in the complication rate between the top-hat and conventional groups (7.0% vs 10.6%, respectively, P=0.39).Conclusion: Top-hat LEEP performed in women with a type 3 transformation zone reduces the risks of endocervical margin involvement and residual diseases compared with conventional LEEP, with no significant difference in perioperative complications.

Use of Chinese herbal medicine among menopausal women in Taiwan

Lih-Chi Chen, Bi-Ru Wang, I-Chin Chen, Chun-Hui Shao — 2009-12-08

Abstract: Objective: To assess the patterns of use of Chinese herbal medicine (CHM) used by women in Taiwan to treat menopausal symptoms.Methods: A retrospective review of the records of women who received CHM therapies for menopausal symptoms at the Traditional Medicine Center, Veterans General Hospital, Taipei, between January 2003 and December 2006. The average number of therapies per prescription, dosage, and duration of the prescription were recorded. The most commonly prescribed herbs and formulae were also recorded. Data were analyzed using descriptive statistics.Results: The records of 3432 women who were administered a total of 19370 CHMs to treat symptoms of the menopause were reviewed. The average number of drugs per prescription was 5.64. Most of the prescriptions (97.1%) were prescribed to be taken 3times a day. The most commonly prescribed Chinese herb was Leonurus heterophyllus. Jia-Wey-Shiau-Yau-San was the most commonly prescribed Chinese herbal formula.Conclusion: CHM is commonly used in Taiwan for the treatment of menopausal symptoms. The efficacy and safety of CHM drugs used for the management of menopausal symptoms require further study.

Sublingual misoprostol for first trimester termination of pregnancy

2010-01-06

Abstract: Objectives: To compare blood loss, efficiency, and acceptability of repeated doses of sublingual misoprostol with the standard Tunisian regimen of mifepristone–misoprostol for first trimester medical abortion.Methods: A prospective randomized trial of 252 healthy pregnant women requesting medical abortion in the first trimester (up to 56days). Participants were randomized to receive 200mg of oral mifepristone followed by 400µg of oral misoprostol (group 1) or 800µg of sublingual misoprostol repeated every 4hours for up to a maximum of 3doses (group 2). Primary outcome was blood loss assessed by decrease in hematocrit.Results: Mean decrease in hematocrit at follow-up was significantly greater in group 1 than in group 2 (3.65%±1.18% vs 2.69%±1.89%, respectively; P=0.02). There was no difference in efficiency rates between groups 1 and 2 (94.5% vs 92.1%; P=0.7). Comparable proportions of women experiencing at least one adverse effect after misoprostol administration were reported in groups 1 and 2 (81.7% vs 79.4%; P=0.75).Conclusion: Compared with the most widely used regimen in Tunisia (mifepristone–misoprostol), sublingual misoprostol alone induces less blood loss (although not clinically significant); it is less expensive and offers reduced interval time to expulsion.

Knowledge of correct dosages of misoprostol in reproductive health

Nishigandh Deole, Andrew Weeks — 2010-01-14

The prostaglandin E1 analog misoprostol is a powerful uterotonic that is effective for labor induction, uterine evacuation, and prevention and treatment of postpartum hemorrhage . Its low cost and ease of storage/administration make it ideally suited to use in low-resource settings. The patent holder has never applied to get a license for any of these indications and, consequently, misoprostol is used off-label in most countries. Furthermore, dosage regimens are complex because they vary by indication, gestation, and route of administration; there is therefore potential for the dangerous use of incorrect doses. To address this issue, a WHO-convened expert group met in Bellagio, Italy, in 2007 to create dosage guidelines (), which were adopted by FIGO in 2009.

Consequences of delay in obstetric care for maternal and perinatal outcomes

Vinita Das, Smriti Agrawal, Anjoo Agarwal — 2009-12-23

The timing of medical interventions for obstetric emergencies is vital to prevent maternal and neonatal morbidity and mortality. A principal model of maternal mortality is the “3 delays model” – delay in seeking care; delay in identifying and reaching medical facilities; and delay in receiving adequate and appropriate treatment . Recognized causes of these delays in low-resource countries are transport availability, the costs involved, and accessibility to health facilities.

Granuloma gravidarum (pyogenic granuloma) treated with periodontal plastic surgery

Luis Eduardo R. da Nova Cruz, Josué Martos — 2010-01-13

Granuloma gravidarum (pyogenic granuloma) is a benign lesion that affects mainly the gingival mucosa, but also the skin and other mucosa. It is generally associated with periodontal disease, and inflammatory and hormonal factors such as pregnancy . The lesion is characterized by localized polypoid growth that is exophytic, sessile or pedicled, erythematous or brownish, and usually ulcerated—in addition to spontaneous bleeding. The surface color of oral pyogenic granuloma varies depending on the age of the lesion .

Japanese single women have limited knowledge of age-related reproductive time limits

2009-12-30

In 2007, the total fertility rate in Japan decreased to 1.34, compared with 2.10 in the USA. This decline in fertility is partly due to increased age at marriage and delay in childbearing. Increased maternal age is associated with an increased risk of infertility, miscarriage, and poor pregnancy outcome . A 1986 study found that the percentage of women who did not use contraception and remained childless increased steadily according to age at marriage (6% among 20–24-year-old women compared with 64% among 40–44-year-old women) . The miscarriage rate rose from 14% among patients younger than 35years of age to 40% among those older than 40years of age . The average childbearing age in Japan has increased over the past 3decades as more women have postponed marriage to pursue higher education and careers.

Laparoendoscopic single-site surgery for total hysterectomy

Francesco Fanfani, Anna Fagotti, Giovanni Scambia — 2009-12-08

Single-access laparoscopic procedures, such as laparoendoscopic single-site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES), are new techniques for less invasive surgical procedures.

Single access laparoscopy for adnexal pathologies using a novel reusable port and curved instruments

Liliana Mereu, Stefano Angioni, Gian Benedetto Melis, Luca Mencaglia — 2010-01-13

Abstract: Objective: To present our initial experience using single access laparoscopic surgery for the treatment of benign adnexal pathologies.Methods: Sixteen patients with benign adnexal pathologies underwent salpingoophorectomy (n=9), ovarian cyst enucleation (n=5), or salpingectomy (n=2) using a laparoendoscopic single site approach with a new multiport reusable trocar and flexible and curved—as well as standard—laparoscopic instruments.Results: Conversion to a multi-access standard laparoscopic technique was not required in any patient and no intraoperative complications were observed. Postoperatively, one umbilical scar infection was detected. Mean operative time was 42minutes.Conclusion: Laparoscopic single site enucleation for adnexal pathologies is feasible, safe, and effective, and has good results for cosmetic appearance and postoperative pain. Use of specialized instruments and standardization of the technique affect surgical ergonomy and operating time.

John J. Sciarra Prize Paper Award for 2010

2010-04-01

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