目的探讨多学科协作在杂交手术室行腹主动脉球囊阻断在凶险性前置胎盘并胎盘植入患者剖宫产术中的的临床应用的效果及安全性。方法选取2017年2月—2020年2月在平顶山市第一人民医院行剖宫产治疗前置胎盘伴胎盘植入的产妇89例,32例多学...目的探讨多学科协作在杂交手术室行腹主动脉球囊阻断在凶险性前置胎盘并胎盘植入患者剖宫产术中的的临床应用的效果及安全性。方法选取2017年2月—2020年2月在平顶山市第一人民医院行剖宫产治疗前置胎盘伴胎盘植入的产妇89例,32例多学科协作在杂交手术室行剖宫产术,57例常规手术室直接行剖宫产术。根据手术方案将产妇分为观察组(32例)和对照组(57例),观察组剖宫产术前行腹主动脉球囊阻断术;对照组直接行剖宫产术。比较分析2组手术情况、术后并发症发生情况、新生儿健康情况。结果观察组手术出血量、术中输血量、手术时间及住院时间均少于对照组,差异具有统计学意义(t=20.581、20.645、5.345、3.399,P均<0.05)。观察组失血性休克、次全子宫切除及肾功能异常的发生率少于对照组,差异具有统计学意义(χ^(2)=2.739、5.148、4.954,P均<0.001),观察组术后感染、盆腔粘连的发生率与对照组比较差异无统计学意义(P>0.05)。观察组新生儿出生后1 min Apgar评分、5 min Apgar评分与对照组比较差异无统计学意义(P>0.05)。结论多学科协作在杂交手术室行腹主动脉球囊阻断术应用于凶险性前置胎盘并胎盘植入患者剖宫产术能够明显减少术中出血、次全子宫切除、缩短手术时间、减少术后并发症,且不影响新生儿健康情况。展开更多
BACKGROUND A large cervical cyst with a cervical high-grade squamous intraepithelial lesion arising from the cervical stump is rare.After supracervical hysterectomy,there is a risk of various lesions occurring in the ...BACKGROUND A large cervical cyst with a cervical high-grade squamous intraepithelial lesion arising from the cervical stump is rare.After supracervical hysterectomy,there is a risk of various lesions occurring in the cervical stump.We review the types and characteristics of cervical stump lesions and compare total hysterectomy with subtotal hysterectomy.Gynecologists should choose the most suitable surgical method based on both the patient’s condition and wishes.If the cervix is retained,patients require a close follow-up.CASE SUMMARY A 57-year-old woman was admitted to the Gynecology Department for a large pelvic mass.Her chief complaint was abdominal distention for two months.She had undergone subtotal supracervical hysterectomy for leiomyoma 14 years prior.Abdominal ultrasonography detected a 9.1 cm×8.5 cm×8.4 cm anechoic mass with silvery fluid in the pelvic cavity and high-risk human papilloma virus 53(HPV53)was positive.The admission diagnosis we first considered was a pelvic mass mimicking carcinoma of the cervical stump.We performed a laparotomy and a rapid frozen biopsy was suggestive of a fibrous cyst wall coated with a high squamous intraepithelial lesion.The pelvic mass was removed,and a bilateral adnexectomy was implemented.Final pathology confirmed that the pelvic mass was a large inflammatory cyst with a cervical high-grade squamous intraepithelial lesion.After successful intervention,the patient was discharged one week after surgery and there was no recurrence of the vaginal stump at 43 mo.CONCLUSION When addressing benign uterine diseases,gynecologists should pay adequate attention to retaining the cervix.If the cervix is retained,patients require a close follow-up.展开更多
AIM To evaluate the feasibility,safety and peri-and postoperative outcomes of robotic single-site supracervical hysterectomy(RSSSH) for benign gynecologic disease.METHODS We report 3 patients who received RSSSH for ad...AIM To evaluate the feasibility,safety and peri-and postoperative outcomes of robotic single-site supracervical hysterectomy(RSSSH) for benign gynecologic disease.METHODS We report 3 patients who received RSSSH for adenomyosis of the uterus from November 2015 to April 2016.We evaluated the feasibility,safety and outcomes among these patients.RESULTS The mean surgical time was 244 min and the estimated blood loss was 216 mL,with no blood transfusion necessitated.The docking time was shortened gradually from 30 to 10 min.We spent 148 min on console operation.Manual morcel ation time was also short,ranging from 5 to 10 min.The mean hospital stay was 5 d.Lower VAS pain score was also noted.There is no complication during or after surgery.CONCLUSION RSSSH is feasible and safe,incurs less postoperative pain and gives good cosmetic appearance.The technique of inbag,manual morcellation can avoid tumor dissemination.展开更多
Background and Objectives: The supracervical hysterectomy (SCH) has resulted in a group of patients with a retained cervix at risk of persistent symptoms, who may require a trachelectomy in the future. This study was ...Background and Objectives: The supracervical hysterectomy (SCH) has resulted in a group of patients with a retained cervix at risk of persistent symptoms, who may require a trachelectomy in the future. This study was to evaluate the efficacy of vaginal trachelectomy (VT) after a previous SCH. Methods: This was a prospective study that includes 13 cases with different ages and different complaints, sharing the same primary operation supracervical hysterectomy. They have different pathologies of the SCH specimen but they share the same completion surgery. The surgical outcome was analyzed. Results: Thirteen patients underwent vaginal trachelectomy for recurrent symptoms. The ages of patients were ranged from 37 years to 68 years (Mean ± SD, 56.4 ± 10.7). SCH was most commonly performed for abnormal uterine bleeding AUB (7/13, 53.8%), pelvic mass (5/1, 38.5%), and pelvic pain (1/13, 7.7%), the symptoms leading to vaginal trachelectomy were the same as those leading to supracervical hysterectomy. The median interval time from SCH to seeking medical help for the persistence or recurrence of symptoms and to VT was 2 weeks (1 to 96 weeks). Concomitant procedures were laparoscopic removal of both ovaries in 2 cases and pelvic lymphadenectomy in 1 case. The median length of operation was 45 minutes. In all cases, symptoms leading to trachelectomy resolved completely after surgery, and patients reported a significant improvement. Conclusions: The cervix, left behind at subtotal hysterectomy, requires removal, the vaginal route is probably the safest, and least traumatic. Vaginal radical trachelectomy appears to be feasible and safe for the treatment of endometrial malignancy discovered after supracervical hysterectomy.展开更多
Objective: To gain insight into the feasibility and safety of a novel vaginal robot for performing supracervical hysterectomy in an ovine model. Introduction: The clinical application of transvaginal natural or fice t...Objective: To gain insight into the feasibility and safety of a novel vaginal robot for performing supracervical hysterectomy in an ovine model. Introduction: The clinical application of transvaginal natural or fice transluminal endoscopic surgery (vNOTES) has broadened significantly. vNOTES reduces wound complications such as infection, hematoma formation, or herniation and is currently utilized for hysterectomy, adnexal surgery, myomectomy, and staging surgery for endometrial cancer. Robotic assistance has been proposed to overcome the current vNOTES mechanical obstacles. The implementation of the current robots has limited utility due to their bulk and inflexibility. Robotic Natural Orifice Transluminal Surgery (rNOTES) is the new frontier in advancement of surgical robots. In developing new task specific robots, it is important to utilize an accurate model for testing. A novel vaginal robot introduced through the posterior cul-de-sac to perform a complete retrograde hysterectomy is the subject of this study. Methods: The study was conducted at the animal lab, Asaf-Harofe hospital, Israel. The ovine model was preferred since the anatomical landmarks and vascular anatomy are comparable to the human except for a bicornuate uterus in sheep. A vaginal robotic supra-cervical hysterectomy was performed in a sheep. Results: A vaginal robotic supracervical hysterectomy was performed successfully in an ovine model. The uterus was extracted via the entry point in the pouch of Douglas. 20 cc of blood loss was reported and no complications were observed. Conclusions: Vaginal supracervical hysterectomy via a vaginal approach using a novel robotic system was found to be feasible.展开更多
文摘目的探讨多学科协作在杂交手术室行腹主动脉球囊阻断在凶险性前置胎盘并胎盘植入患者剖宫产术中的的临床应用的效果及安全性。方法选取2017年2月—2020年2月在平顶山市第一人民医院行剖宫产治疗前置胎盘伴胎盘植入的产妇89例,32例多学科协作在杂交手术室行剖宫产术,57例常规手术室直接行剖宫产术。根据手术方案将产妇分为观察组(32例)和对照组(57例),观察组剖宫产术前行腹主动脉球囊阻断术;对照组直接行剖宫产术。比较分析2组手术情况、术后并发症发生情况、新生儿健康情况。结果观察组手术出血量、术中输血量、手术时间及住院时间均少于对照组,差异具有统计学意义(t=20.581、20.645、5.345、3.399,P均<0.05)。观察组失血性休克、次全子宫切除及肾功能异常的发生率少于对照组,差异具有统计学意义(χ^(2)=2.739、5.148、4.954,P均<0.001),观察组术后感染、盆腔粘连的发生率与对照组比较差异无统计学意义(P>0.05)。观察组新生儿出生后1 min Apgar评分、5 min Apgar评分与对照组比较差异无统计学意义(P>0.05)。结论多学科协作在杂交手术室行腹主动脉球囊阻断术应用于凶险性前置胎盘并胎盘植入患者剖宫产术能够明显减少术中出血、次全子宫切除、缩短手术时间、减少术后并发症,且不影响新生儿健康情况。
基金Supported by National Natural Science Foundation of China,No.81772790 and No.81602293Postgraduate Innovation Fund of 13th Five-year Comprehensive Investment,Tianjin Medical University,No.YJSCX201812
文摘BACKGROUND A large cervical cyst with a cervical high-grade squamous intraepithelial lesion arising from the cervical stump is rare.After supracervical hysterectomy,there is a risk of various lesions occurring in the cervical stump.We review the types and characteristics of cervical stump lesions and compare total hysterectomy with subtotal hysterectomy.Gynecologists should choose the most suitable surgical method based on both the patient’s condition and wishes.If the cervix is retained,patients require a close follow-up.CASE SUMMARY A 57-year-old woman was admitted to the Gynecology Department for a large pelvic mass.Her chief complaint was abdominal distention for two months.She had undergone subtotal supracervical hysterectomy for leiomyoma 14 years prior.Abdominal ultrasonography detected a 9.1 cm×8.5 cm×8.4 cm anechoic mass with silvery fluid in the pelvic cavity and high-risk human papilloma virus 53(HPV53)was positive.The admission diagnosis we first considered was a pelvic mass mimicking carcinoma of the cervical stump.We performed a laparotomy and a rapid frozen biopsy was suggestive of a fibrous cyst wall coated with a high squamous intraepithelial lesion.The pelvic mass was removed,and a bilateral adnexectomy was implemented.Final pathology confirmed that the pelvic mass was a large inflammatory cyst with a cervical high-grade squamous intraepithelial lesion.After successful intervention,the patient was discharged one week after surgery and there was no recurrence of the vaginal stump at 43 mo.CONCLUSION When addressing benign uterine diseases,gynecologists should pay adequate attention to retaining the cervix.If the cervix is retained,patients require a close follow-up.
文摘AIM To evaluate the feasibility,safety and peri-and postoperative outcomes of robotic single-site supracervical hysterectomy(RSSSH) for benign gynecologic disease.METHODS We report 3 patients who received RSSSH for adenomyosis of the uterus from November 2015 to April 2016.We evaluated the feasibility,safety and outcomes among these patients.RESULTS The mean surgical time was 244 min and the estimated blood loss was 216 mL,with no blood transfusion necessitated.The docking time was shortened gradually from 30 to 10 min.We spent 148 min on console operation.Manual morcel ation time was also short,ranging from 5 to 10 min.The mean hospital stay was 5 d.Lower VAS pain score was also noted.There is no complication during or after surgery.CONCLUSION RSSSH is feasible and safe,incurs less postoperative pain and gives good cosmetic appearance.The technique of inbag,manual morcellation can avoid tumor dissemination.
文摘Background and Objectives: The supracervical hysterectomy (SCH) has resulted in a group of patients with a retained cervix at risk of persistent symptoms, who may require a trachelectomy in the future. This study was to evaluate the efficacy of vaginal trachelectomy (VT) after a previous SCH. Methods: This was a prospective study that includes 13 cases with different ages and different complaints, sharing the same primary operation supracervical hysterectomy. They have different pathologies of the SCH specimen but they share the same completion surgery. The surgical outcome was analyzed. Results: Thirteen patients underwent vaginal trachelectomy for recurrent symptoms. The ages of patients were ranged from 37 years to 68 years (Mean ± SD, 56.4 ± 10.7). SCH was most commonly performed for abnormal uterine bleeding AUB (7/13, 53.8%), pelvic mass (5/1, 38.5%), and pelvic pain (1/13, 7.7%), the symptoms leading to vaginal trachelectomy were the same as those leading to supracervical hysterectomy. The median interval time from SCH to seeking medical help for the persistence or recurrence of symptoms and to VT was 2 weeks (1 to 96 weeks). Concomitant procedures were laparoscopic removal of both ovaries in 2 cases and pelvic lymphadenectomy in 1 case. The median length of operation was 45 minutes. In all cases, symptoms leading to trachelectomy resolved completely after surgery, and patients reported a significant improvement. Conclusions: The cervix, left behind at subtotal hysterectomy, requires removal, the vaginal route is probably the safest, and least traumatic. Vaginal radical trachelectomy appears to be feasible and safe for the treatment of endometrial malignancy discovered after supracervical hysterectomy.
文摘Objective: To gain insight into the feasibility and safety of a novel vaginal robot for performing supracervical hysterectomy in an ovine model. Introduction: The clinical application of transvaginal natural or fice transluminal endoscopic surgery (vNOTES) has broadened significantly. vNOTES reduces wound complications such as infection, hematoma formation, or herniation and is currently utilized for hysterectomy, adnexal surgery, myomectomy, and staging surgery for endometrial cancer. Robotic assistance has been proposed to overcome the current vNOTES mechanical obstacles. The implementation of the current robots has limited utility due to their bulk and inflexibility. Robotic Natural Orifice Transluminal Surgery (rNOTES) is the new frontier in advancement of surgical robots. In developing new task specific robots, it is important to utilize an accurate model for testing. A novel vaginal robot introduced through the posterior cul-de-sac to perform a complete retrograde hysterectomy is the subject of this study. Methods: The study was conducted at the animal lab, Asaf-Harofe hospital, Israel. The ovine model was preferred since the anatomical landmarks and vascular anatomy are comparable to the human except for a bicornuate uterus in sheep. A vaginal robotic supra-cervical hysterectomy was performed in a sheep. Results: A vaginal robotic supracervical hysterectomy was performed successfully in an ovine model. The uterus was extracted via the entry point in the pouch of Douglas. 20 cc of blood loss was reported and no complications were observed. Conclusions: Vaginal supracervical hysterectomy via a vaginal approach using a novel robotic system was found to be feasible.
