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https://www.readbyqxmd.com/read/29437720/uterine-fibroid-or-ovarian-fibroma-importance-of-comprehensive-preoperative-consent-taking-to-include-unexpected-findings-with-management-implications
#1
Lee Koon Kwek, Wei-Wei Wee-Stekly, Su Min Bernard Chern
A 35-year-old woman presented with an abdominal mass found incidentally on an ultrasound scan. On examination, the uterus was mobile and 14 weeks in size. Further imaging showed a large subserosal pedunculated fibroid, and she was counselled for laparoscopic myomectomy, morcellation in a bag, kept in open view. Intraoperatively, the mass was noted to be arising from the right ovarian ligament instead of the uterus, and decision was made to convert to open surgery. This case highlights important issues of consent-taking preoperatively and critical points to note regarding change in operative consent intraoperatively...
February 7, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29430969/retrospective-analysis-of-short-term-outcomes-after-monopolar-versus-laser-endoscopic-enucleation-of-the-prostate-a-single-center-experience
#2
Dmitry Victorovich Enikeev, Petr Vitalievich Glybochko, Zhamshid Okhunov, Yuriy Gennadievich Alyaev, Leonid Mikhailovich Rapoport, Dmitry Tsarichenko, Mikhail Elikovich Enikeev, Nikolay Ivanovich Sorokin, Alim Mukhamedovich Dymov, Mark Sergeevich Taratkin
INTRODUCTION: Endoscopic enucleation of the prostate (EEP) has been recognized as a viable, treatment modality for men with benign prostatic hyperplasia (BPH). The aim of our study was to compare the efficacy and functional outcomes of three different techniques of EEP including monopolar enucleation (MEP), holmium (HoLEP) and thulium laser enucleation (ThuLEP). METHODS: The study consisted of a retrospective comparison of pre- and postoperative parameters in men undergoing three types of EEP: MEP, HoLEP, and ThuLEP...
February 12, 2018: Journal of Endourology
https://www.readbyqxmd.com/read/29417238/options-for-adjuvant-therapy-for-uterine-leiomyosarcoma
#3
REVIEW
Claire F Friedman, Martee L Hensley
Uterine leiomyosarcoma (uLMS) is a rare disease; in the data from the SEER database, 3165 cases of uLMS were diagnosed between January 2000 and December 2012. While a majority of patients (60%) are diagnosed with early stage disease, recurrence rates are high. Five-year disease-specific survival is 76% for patients with FIGO stage I and 60% for patients with FIGO stage II disease. Adjuvant treatments, including radiation therapy, chemotherapy, and combined modality approaches, have been explored with the goal of demonstrating improved survival...
February 8, 2018: Current Treatment Options in Oncology
https://www.readbyqxmd.com/read/29408695/irrigation-after-laparoscopic-power-morcellation-and-the-dispersal-of-leiomyoma-cells-a-pilot-study
#4
Steve P Yu, Bruce B Lee, Michelle N Han, Clara Chan, Jianyu Rao, Mary Levin, Po Chu Fung, William Parker
STUDY OBJECTIVE: To evaluate if copious irrigation and suctioning after electro-mechanical power morcellation will reduce myoma cell dissemination, and if there is a difference between sterile water and normal saline. DESIGN: Prospective single-center cohort pilot study (Canadian Task Force Classification II-2) SETTING: Academic tertiary referral center PATIENTS: Sixteen women undergoing laparoscopic myomectomy with one surgeon between January 1, 2017 and August 31, 2017...
January 31, 2018: Journal of Minimally Invasive Gynecology
https://www.readbyqxmd.com/read/29398899/clinical-characteristics-differentiating-uterine-sarcoma-and-fibroids
#5
Innie Chen, Bianca Firth, Laura Hopkins, Olga Bougie, Ri-Hua Xie, Sukhbir Singh
Background and Objectives: Uterine fibroids are a common indication for laparoscopy. Unsuspected sarcoma can pose a serious risk if morcellation is used in the procedure. We sought to determine the clinical factors associated with uterine sarcoma compared with uterine fibroids. Methods: We conducted a case-control study of 66 women who had hysterectomy for uterine sarcoma from April 1, 2007, to March 31, 2014. Sixty-six patients who had hysterectomy for fibroids were randomly selected as controls...
January 2018: JSLS: Journal of the Society of Laparoendoscopic Surgeons
https://www.readbyqxmd.com/read/29373285/comparison-of-outcomes-obtained-after-regular-surgery-versus-live-operative-surgical-cases-single-centre-experience-with-green-laser-enucleation-of-the-prostate
#6
Vincent Misraï, Cyrille Guillot-Tantay, Marie Pasquié, Benoit Bordier, Julien Guillotreau, Fernando Gomez-Sancha, Henry Woo, Thomas Herrmann
BACKGROUND: Live surgery remains controversial. Although it may improve surgical training and accelerate the dissemination of technical steps of surgical procedures, controversy exists regarding patient safety in live surgery. OBJECTIVE: To compare the perioperative outcomes of "en bloc" green laser enucleation of the prostate (GreenLEP) performed in workshops during live case demonstration (LCD) and in standard conditions (SCs). DESIGN, SETTING, AND PARTICIPANTS: Between June 2015 and January 2017, all consecutive patients who underwent GreenLEP for benign prostatic obstruction performed by a single surgeon were prospectively enrolled...
January 17, 2018: European Urology Focus
https://www.readbyqxmd.com/read/29355897/the-need-for-further-surgical-intervention-following-primary-hysteroscopic-morcellation-of-submucosal-leiomyomas-in-women-with-abnormal-uterine-bleeding
#7
Sarah Maheux-Lacroix, Jennifer Mennen, Amy Arnold, Aaron Budden, Erin Nesbitt-Hawes, HaRyun Won, Jason Abbott
BACKGROUND: Intrauterine hysteroscopic morcellators have been studied as an alternative method for removing submucosal leiomyomas. AIMS: To assess the long-term efficacy of hysteroscopic morcellation of submucosal leiomyomas in women with abnormal uterine bleeding (AUB). MATERIALS AND METHODS: We conducted a prospective cohort study including all women with AUB who underwent a hysteroscopic resection with mechanical morcellation of a benign submucosal leiomyoma confirmed at histopathology...
January 22, 2018: Australian & New Zealand Journal of Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/29338993/peritoneal-sarcomatosis-5-years-after-laparoscopic-morcellation-of-uterine-leiomyoma
#8
Marco Petrillo, Margherita Dessole, Vito Chiantera
No abstract text is available yet for this article.
January 12, 2018: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29251679/morcellation-in-gynecologic-oncology
#9
Eva Chalas
PURPOSE OF REVIEW: Morcellation of uteri with unsuspected malignancies has been the focus of reports for decades. More intensive evaluation of clinical outcomes and evaluation of impact of changes in practice has occurred since the release of FDA statement advising against the use of power morcellators. The review summarizes some of the most relevant publications on this topic. RECENT FINDINGS: The Society of Gynecologic Oncology and the American College of Obstetricians and Gynecologists concur that symptomatic women should undergo appropriate evaluation, morcellation should not be performed whenever malignancy is suspected or diagnosed, and acknowledge the limitations of diagnostic testing currently available to detect leiomyosarcoma...
February 2018: Current Opinion in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/29251677/indications-for-morcellation-in-gynecologic-surgery
#10
William H Parker
PURPOSE OF REVIEW: Minimally invasive gynecologic procedures, in particular laparoscopic hysterectomy and myomectomy, often require tissue morcellation. RECENT FINDINGS: Whether morcellated or not, myometrial cells can be found in the abdomen and pelvis after either laparoscopic or open myomectomy. Following morcellation, careful inspection for and removal of tissue fragments and copious irrigation and suctioning of fluid can remove residual tissue and cells without the use of containment bags...
February 2018: Current Opinion in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/29251674/the-prevalence-of-occult-leiomyosarcoma-in-women-undergoing-presumed-fibroid-surgery-and-outcomes-after-morcellation
#11
Elizabeth A Pritts
PURPOSE OF REVIEW: To review the data-derived prevalence rates for occult leiomyosarcoma (LMS), and outcomes for women who have these tumors inadvertently morcellated. RECENT FINDINGS: In 2014, the Food and Drug Administration presented data showing the prevalence rates of occult LMS at 2.02/1000 surgeries for presumed benign fibroids. They also attributed poorer outcomes for women undergoing power morcellation of these tumors. Two more recent meta-analyses have shown much lower rates, as low as one in 8300 surgeries when including only prospective studies, and one in 1428 surgeries when including both prospective and retrospective studies...
February 2018: Current Opinion in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/29238287/survey-among-esge-members-on-leiomyosarcoma-morcellation-incidence
#12
Vasilios Tanos, Hans Brölmann, Rudi Leon DeWilde, Peter O'Donovan, Elina Symeonidou, Rudi Campo
Background: Increased awareness of leiomyosarcoma (LMS) risk during myomectomy or hysterectomy is essential. Objective and correct reasoning should prevail on any decision regarding the extent and type of surgery to employ. The anticipated risk of a sarcoma after myoma or uterus morcellation is low, and the frequency of leiomyosarcoma especially in women below the age of 40 is very rare. The prevalence data has a wide range and is therefore not reliable. The European Society of Gynaecological Endoscopy (ESGE) initiated a survey among its members looking into the frequency of morcellated leiomyosarcoma after endoscopic surgery...
2017: Gynecological Surgery
https://www.readbyqxmd.com/read/29232258/development-and-history-of-morcellators
#13
Ceana Nezhat, Robert K Zurawin
PURPOSE OF REVIEW: Controversy exists surrounding extraction of tissue in gynecologic surgery using morcellators following cases of disseminated uterine cancers discovered after the use of electromechanical morcellators. This chapter traces the history of tissue extraction in gynecology and reviews the evolving scientific data and opinions regarding the future of morcellation. RECENT FINDINGS: Since the initial Food and Drug Administration warning about morcellation in 2014, subsequent studies do not support the Food and Drug Administration's high incidence of occult uterine cancer...
February 2018: Current Opinion in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/29232257/economics-of-gynecologic-morcellation
#14
Pietro Bortoletto, Jaclyn Friedman, Magdy P Milad
PURPOSE OF REVIEW: As the Food and Drug Administration raised concern over the power morcellator in 2014, the field has seen significant change, with patients and physicians questioning which procedure is safest and most cost-effective. The economic impact of these decisions is poorly understood. RECENT FINDINGS: Multiple new technologies have been developed to allow surgeons to continue to afford patients the many benefits of minimally invasive surgery while minimizing the risks of power morcellation...
December 11, 2017: Current Opinion in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/29227303/alternative-facts-and-morcellation
#15
David L Olive
PURPOSE OF REVIEW: Since the recent black-box warning regarding the use of electromechanical morcellation, there has been a hesitancy to utilize the product and even to perform other types of morcellation by gynecologists. Unfortunately, this Food and Drug Administration action and the continued public criticisms of this procedure are grounded in poor data and faulty reasoning. To truly perform informed consent to patients considering procedures involving morcellation, a thorough review of the facts, not alternative facts, must be communicated...
December 8, 2017: Current Opinion in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/29205507/current-status-of-holmium-laser-enucleation-of-the-prostate
#16
REVIEW
Katsumi Shigemura, Masato Fujisawa
There are several options for the surgical management of benign prostatic hyperplasia representatively from transurethral resection of the prostate. Holmium laser enucleation of the prostate is one of those options, and many institutions and urologists have initiated this technique, and most of them have accomplished better outcomes compared with transurethral resection of the prostate. In contrast to transurethral resection of the prostate, which requires a similar procedure to transurethral resection of bladder tumors, holmium laser enucleation of the prostate requires a special surgical technique: enucleation and morcellation with around 10 years' history of experience, even in Japan...
December 3, 2017: International Journal of Urology: Official Journal of the Japanese Urological Association
https://www.readbyqxmd.com/read/29203157/-anticoagulation-impact-on-bleeding-risk-during-holep-monocentric-study-of-156-patients
#17
P Neuville, R Codas, E Ravier, D Maucort-Boulch, L Badet, H Fassi-Fehri
OBJECTIVE: Compare the length of hospital stay and the complications after HoLEP between three groups of patients: a control group, a group with antiplatelet therapy, a group with anticoagulation therapy. MATERIALS: Retrospective cohort study that included all consecutive patients who underwent HoLEP for prostatic hyperplasia in our center from may 2013 to may 2016. Anticoagulated patients and patients under clopidogrel had respectively a relay with heparine and aspirine...
December 1, 2017: Progrès en Urologie
https://www.readbyqxmd.com/read/29200989/pushing-the-boundaries-of-laparoscopic-myomectomy-a-comparative-analysis-of-peri-operative-outcomes-in-323-women-undergoing-laparoscopic-myomectomy-in-a-tertiary-referral-centre
#18
Rebecca Mallick, Funlayo Odejinmi
Background: The aim of this study was to analyse the demographic data and peri-operative outcomes of women undergoing a laparoscopic myomectomy and assess what factors, if any, precluded using the laparoscopic approach. Methods: A single surgeon observational study of 323 patients undergoing a laparoscopic myomectomy was undertaken. Data was collected prospectively over a 12-year period and analysed using SPSS. Surgical outcomes included operating time, estimated blood loss, conversion to laparotomy, intraoperative and postoperative complications and duration of inpatient stay...
2017: Gynecological Surgery
https://www.readbyqxmd.com/read/29194076/morcellation-equipment-past-present-and-future
#19
Charles E Miller
PURPOSE OF REVIEW: This review was written in an effort to describe the evolution of power morcellation equipment from their creation to their current state. In addition, this review addresses the continuously evolving equipment involved with power morcellation and looks to describe where the field is headed in the future. In addition, recent professional and federal recommendations have changed the way power morcellation is being approached and has led to the development of contained morcellation systems, which, although in their infancy, are also being proven to be well tolerated options...
November 30, 2017: Current Opinion in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/29181031/laparoscopic-supracervical-hysterectomy-with-in-bag-morcellation-in-very-large-uterus
#20
Harald Krentel, Rudy Leon De Wilde
Laparoscopic supracervical hysterectomy (LASH) is a safe and fast minimally invasive approach in hysterectomy. In order to extract the uterine body from the abdominal cavity, one condition for LASH is the morcellation of the tissue. The intra-abdominal dissemination of benign and occult malignant uterine cells is a possible risk of this method, which can be avoided by the use of special bags for laparoscopic in-bag morcellation. We present a case of laparoscopic supracervical hysterectomy with in-bag morcellation in a uterus of more than 1400 g...
2017: Case Reports in Medicine
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