Surgical Technology International
34th edition
Contains 67 peer-reviewed articles featuring the latest advances in surgical techniques and technologies.
521 pages
May 2019 - ISSN:1090-3941
1 year Institutional Subscription
both electronic and print versions
Uterine Fibroids - Current Trends and Strategies
Marcel Grube, Medical Doctor (trainee), Felix Neis, MD, Consultant of Operative Gynecology, Sara Y. Brucker, PhD, Professor of Women’s Health and Gynecology, Stefan Kommoss, PhD, Consultant of Operative Gynecology, Jürgen Andress, MD, Consultant of Operative Gynecology, Martin Weiss, MD, Medical Doctor of Women’s Health and Gynecology, Sascha Hoffmann, MD, Medical Doctor of Women’s Health and Gynecology, Florin-Andrei Taran, PhD, Consultant of Operative Gynecology, Bernhard Krämer, PhD, Deputy Medical Director and Senior Consultant Of Operative Gynecology, University of Tübingen, Tübingen, Germany
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Fibroids are the most common benign tumors in women of childbearing age and can be found in almost 80-90% of all women by age 50 years. They can cause pain, excessive menstrual bleeding or infertility. The development of fibroids increases with age. Since the age of women in industrial countries who are trying to conceive is generally increasing, there has been a growing demand for minimally invasive and uterine-sparing surgical treatment of fibroids. Whereas the main focus of previous surgical techniques for the treatment of fibroids was enucleation of the tumour with subsequent closure of the uterine incision, modern devices developed over the past decade can destroy fibroids by using ultrasound or radio-frequency without incising the uterine wall. Thus, there is no uterine scar, which would impart a risk of rupture during labour or pregnancy.
This article provides an overview of the latest techniques and devices used for uterine-sparing surgical treatment of fibroids. While laparoscopic myomectomy is still the gold standard, novel laparoscopic and transcervical radiofrequency ablation techniques use low-voltage and alternating current to induce heat in the uterine tissue, which triggers necrosis in fibroids. This enables the removal of multiple fibroids without the need for large incisions in the uterine wall. In addition, we address the benefits and potential risks, as well as the impact on fertility and pregnancy, of the different surgical approaches used for the treatment of uterine fibroids.
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Shared Decision-Making to Improve Patient Engagement in Minimally Invasive Hysterectomy
Steven D. McCarus, MD, FACOG, Chief, Division of Gynecologic Surgery, Florida Hospital Celebration Health, Assistant Professor, University of Central Florida, Founder and Director, McCarus Surgical Specialists for Women, Orlando, Florida, Karen Wiercinski, RN, BSN, Women’s Health & CAPPS, Clinical Care Coordinator, Florida Hospital Celebration Health, Celebration, Florida, Natalie Heidrich, MS, Director, Health Economics and Reimbursement, Edwards Lifesciences, Irvine, California
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Shared decision-making (SDM) between the patient and physician is receiving increased attention as a way to improve patient satisfaction and value of care. Having a readily implemented tool available to inform conversation may enable SDM at a high-volume gynecologic surgery practice. Our objective was to evaluate the impact of an SDM tool on patients’ decision to have minimally invasive gynecology surgery. We conducted a feasibility study using the SDM tool plus a follow-up survey for 100 patients recommended to undergo minimally invasive hysterectomy. Nearly all patients (97%) indicated that they were satisfied with their decision to undergo a minimally invasive procedure, including laparoscopic total and supracervical hysterectomy with or without the aid of the robotic platform. Anecdotally, patients expressed appreciation for the provided materials and the presentation of care options. For the care provider, use of the SDM tool did not add substantial time to the visit. Knowing that comprehensive information was provided to all patients was reassuring. Implementing a shared decision-making model in a gynecological practice is feasible and increases awareness and engagement, as well as satisfaction, among patients electing to have a hysterectomy.
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Use of Growth Factors for Vulvo/Vaginal Bio-Stimulation
Pablo González Isaza, MD,
Head Chief Urogynecology and Minimally Invasive Surgery Unit,
Department of Obstetrics and Gynecology,
Hospital Universitario San Jorge,
Pereira, Colombia
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Vulvo-vaginal atrophy as a main symptom of the Genito Urinary Syndrome of Menopause (GSM) is a consequence of aging, particularly after menopause as a result of follicular ovarian follicle depletion and consequently low estrogen levels. Anatomical structures derived from the urogenital sinus, such as the distal urethra trigone and vestibule, are the most affected areas because of the high concentrations of alfa- and beta-estrogen receptors. The most common symptoms associated with vulvo-vaginal atrophy are dyspareunia, vaginal dryness, irritation, recurrent urinary tract infection and urinary incontinence, which negatively affect the patient’s quality of life and sexuality. The purpose of this pilot study was to evaluate a protocol with topical growth factors that seeks to activate collagen and elastin at a molecular level, and thus restore all vaginal functions such as secretion, absorption, elasticity, lubrication and vaginal epithelium thickness.
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Endometriosis of the Bladder: Clinical and Surgical Outcomes after Laparoscopic Surgery
Daniela Reis Gonçalves, MD, Resident of Obstetrics and Gynecology, Ana Galvão, MD, Resident of Obstetrics and Gynecology, Marta Moreira, MD, Resident of Obstetrics and Gynecology, Alexandre Morgado, MD, Associate Professor, Miguel Ramos, MD, PhD, Associate Professor, Hélder Ferreira, MD, PhD, Associate Professor, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal, Centro Hospitalar Universitário do Porto, Porto, Portugal
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Background/Aims: Urinary tract endometriosis is rare. The bladder is the most common site affected. The nonspecific symptoms can make a diagnosis difficult. The aim of this study was to evaluate the clinical and surgical outcomes in women who underwent surgical treatment for bladder endometriosis (BE).
Methods: Ten patients who underwent surgical treatment for BE from January 2012 to November 2016 were retrospectively reviewed. Pre- and postoperative data, intraoperative findings, type of surgical procedure, and intra- and postoperative complications were analyzed.
Results: Two women were treated by laparoscopic shaving of the bladder lesion and 8 underwent laparoscopic partial cystectomy. Simultaneous resection of coexisting pelvic nodules was performed. No conversions to laparotomy were observed. There was only one intraoperative complication. No major or minor postoperative complications were observed and none of the patients required repeated interventions. Improvements in clinical symptoms were reported and there was no increase in long-term urinary frequency after surgery. There was 1 case of urinary symptom recurrence.
Conclusion: Laparoscopic partial cystectomy and shaving of the bladder lesion seem to improve urinary symptoms, with a low rate of intra- and postoperative complications and a low rate of recurrence, without affecting long-term bladder capacity. This surgical approach requires an experienced gynecologist and urologist team.
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Application of Indocyanine Green in Gynecology: Review of the Literature
Helder Ferreira, MD, PhD, Professor, Head of Minimally Invasive Gynecological Surgery Unit of Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas, Abel Salazar Universidade do Porto, Porto, Portugal, Andres Vigeras Smith, MD, Consultant, Minimally Invasive Gynecological Surgery Unit of Centro Hospitalar Universitário do Porto, Porto, Portugal, Arnaud Wattiez, MD, PhD, Professor, University of Strasbourg, Strasbourg, France, Latifa Hospital, Dubai, United Arab Emirates
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The present review aims to analyze the current data available on the different applications of indocyanine green (ICG) in gynecology. A semantic review of English-language publications was performed by searching for MeSH terms and keywords in the PubMed and Google Scholar databases. The studies were finally selected by one author according to the aim of this review. ICG is a highly water-soluble tricarbocyanine dye that fluoresces in the NIR spectrum. Approved by the FDA in 1959, it can be administered either IV (usual dose of 5 mg) or locally/submucosally (usual dose of 5-6.25 mg) according to the pathology or indication. It is used most often in the setting of oncology, endometriosis and other gynecological conditions. In oncological applications, ICG is used to identify sentinel lymph nodes (SLN) using near-infrared light in endometrial, cervical and vulvar cancers. The main advantages that it offers include a reduction of surgical time, improved SLN detection rates, and the ability to avoid radioactivity. In cases of endometrial (submucosal or hysteroscopic applications) or cervical (intracervical administration) cancer, ICG can detect SLN at an accuracy of 95% to 98%. For vulvar cancer, the SLN detection rate can reach 100%. In endometriosis, the lack of good evidence hinders the final evaluation of this method in both diagnostic and therapeutic scenarios. An analytical, well-designed, prospective study is currently underway.
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