Journal: Journal of minimally invasive gynecology
Current strategies for fertility preservation rely heavily on assisted reproductive technology and fertility-sparing surgery. Whether seeking to avert loss of fertility associated with excision of adnexal or uterine disease or to preempt gonadal failure resulting from chemotherapy or radiation, each woman is unique in her reproductive endeavor and will benefit from careful consideration of her fertility goals together with a specialist in assisted reproductive technology and reproductive surgery. Because avoidance of laparotomy reduces tissue trauma and adhesion formation, advanced laparoscopic surgery is an indispensable tool for all specialists who provide care for women seeking fertility preservation. Computer-assisted laparoscopy, commonly known as robotic surgery, addresses the practical limitations of conventional laparoscopic surgery and holds the promise of making complex fertility-sparing procedures safe and reproducible in the hands of reproductive specialists. Herein we illustrate the transforming capabilities of robotics in reproductive surgery and highlight the current and future potential of this technology in fertility preservation.
Abnormal placentation is the most common indication for peripartum hysterectomy. To date, the approach described in the literature is laparotomy, which is associated with high morbidity and mortality. A 30-year-old gravida 4 para 3 had a postpartum diagnosis of placenta percreta. She was first treated conservatively. On day 3 after delivery, because of persistent vaginal bleeding, she underwent a laparoscopic hysterectomy. No postoperative complications occurred, and the patient was discharged on postoperative day 3. Laparoscopic peripartum hysterectomy could become the approach of choice in selected patients with abnormal placentation to avoid complications associated with laparotomy.
The aim of this study is to describe the surgical technique and our initial experience with single-port laparoscopically assisted transumbilical ultraminilaparotomic myomectomy (SPLA-TUM).
To evaluate the adverse events encountered during robotic gynecologic surgery, as reported to the FDA MAUDE database from January 2006 to December 2012.
A retrospective evaluation of our series to evaluate feasibility and safety of laparoscopic segmental bowel resection for deep infiltrating endometriosis.
Minilaparoscopy is an attractive approach for hysterectomy due to advantages such as reduced morbidities and enhanced cosmesis. However, it has not been popularized due to the lack of suitable instruments and high technical demand. We aim to highlight the first case of laparoscopic hysterectomy performed with percutaneous instruments (The Percuvance™ System, Teleflex Incorporated,USA) that represents a significant advance in minimally invasive surgery.
To demonstrate a stepwise surgical technique of robotic-assisted transabdominal cerclage placement in a patient with deeply infiltrative endometriosis DESIGN: Step-by-step surgical tutorial using narrated video.
To evaluate if peritoneal washings of the abdominopelvic cavity during laparoscopic myomectomy can detect leiomyoma cells after power morcellation.
To describe our technique of transvaginal sacrocolpopexy using single-port laparoscopy for middle compartment Pelvic Organ Prolapse (POP).
Hysterectomies performed laparoscopically have greatly increased within the last few decades and even exceed the number of vaginal hysterectomies (VH). This systematic review compares surgical outcomes of total laparoscopic hysterectomy (TLH) and VH to evaluate which approach offers the most benefits and was conducted according to the Meta-analysis of Observational Studies in Epidemiology guidelines. A literature search was performed in PubMed, Embase, Web of Science for all relevant publications from January 2000 through February 2016. All randomized controlled trials and cohort studies for benign indication or low-grade malignancy comparing TLH to VH were considered for inclusion. From the literature search, 24 articles were found relevant and included in this review. The results of our meta-analysis showed no difference between the two groups for overall complications (Odds ratio (OR) 1.24 [0.68, 2.28] for major complications, OR 0.83 [0.53, 1.28] for minor complications), risk of ureter and bladder injuries (OR 0.81 [0.34, 1.92]), intraoperative blood loss (MD -30 mL [-67.34, 7.60]), length of hospital stay (-0.61 days [-1.23, -0.01]), VH was associated with a shorter operative time (MD 42 min [29.34, 55.91]), a lower rate of vaginal cuff dehiscence (OR 6.28 [2.38, 16.57]), and conversion to laparotomy (OR 3.89 [2.18, 6.95]). Although not significant, the costs of procedure were lower for VH (MD 3889.9 dollars [2120.3; 89000]). Patients in the TLH group had lower postoperative VAS scores (MD -1.08, [-1.74, -0.42]) and required less analgesia during a shorter period of time (MD -0.64 days, [-1.06, -0.22]) Defining the best surgical approach is a dynamic process that requires frequent re-evaluation as techniques improve. Although TLH and VH result in similar outcomes, our meta-analysis showed that when both procedures are feasible, VH is currently still associated with greater benefits: shorter operative time, lower rate of vaginal dehiscence and conversion to laparotomy, lower costs. Many factors influence choice for surgical approach to hysterectomy and shared-decision making is recommended.