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.
Trocar-site hernias are rare complications of laparoscopic surgery. Although trocar-site hernias occur more often at >10-mm sites, hernias can still develop at 5-mm sites after laparoscopy, and can lead to serious complications. The primary objective of this review is to summarize the current medical literature pertaining to the clinical presentation and pre-disposing risk factors of trocar-site hernias at 5-mm sites after laparoscopy. A total of 295 publications were identified, of which 17 (5.76%) publications met inclusion criteria. Twenty-seven patients with trocar-site hernias were identified after laparoscopic cases. The median age [interquartile range (IQR)] for all adult patients with trocar-site hernias was 63 (IQR 39.5-66.5) years. Eight out of the 18 patients (44.4%) undergoing gynecologic laparoscopy were parous, though details of parity were not reported in most publications. Simple manual reduction or laparoscopic reduction with fascial closure (21 patients, 84%) was utilized more often compared to exploratory laparotomy (4 patients, 16%; P<0.001) to manage trocar-site hernias. There was no statistical difference in the location of trocar-site hernias i.e., umbilical (14 patients, 56%) vs. non-umbilical/lateral (11 patients, 44%; P=0.12). Findings of this review suggest that increased operative times and excessive manipulation can extend 5-mm fascial incisions, thereby increasing the risk of trocar-site hernias. Parous women older than 60 years may have unrecognized fascial defects, which confer a higher risk of trocar-site hernias after laparoscopic surgery, even in the absence of incision manipulation or prolonged surgical duration. Such patients may benefit from closure of 5-mm fascial incisions, though prospective data are required validate the overall generalizability of this management strategy.
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).