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Robotic Assisted Laparoscopic Apical Suspension. Description of a 4 Points Technique (RALAS-4): First Case Reported

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Open Journal of obstetrics and Gynecology 2017年第9期7卷 944-950页

作者： Hugo H Davila Lindsey Bruce Lindsey Goodman Taryn Gallo Florida Healthcare specialist Urology and Minimally Invasive Surgery Florida Cancer Specialist & Research Institute Sebastian and Vero Beach USA Department of Surgery Division of Urology and Gynecology Sebastian River Medical Center Sebastian USA Florida State University College of Medicine Fort Pierce Campus Fort Pierce USA

The uterosacral ligaments (UTSL), together with the cardinal ligament (CL), hold the upper vagina and cervix over the levator plate. These 2 ligaments provided 4 points support at the apex. Here we describe our surgical technique of robotic assisted laparoscopic apical suspension (RALAS) using non-absorbable sutures and describe a new 4 points technique (RALAS-4). 73-year-old Caucasian woman, gravida 5, para 4 had symptomatic pelvic organ prolapse (POP) apical/anterior stage III. At pelvic ultrasound evaluation the uterus was small and normal appearing of adnexa bilaterally. She failed pessaries and was sexually active. The most relevant complaints were vaginal bulging, pressure and urinary incontinence, mainly stress urinary incontinence;she is using 5 - 7 pads/day. Robotic assisted laparoscopic hysterectomy, mid-urthral sling and apical suspension was successfully performed in 125 min. Once we finished with hysterectomy, we proceed with RALAS-4, we used V-Loc 3-0, CV-23 (Covidien) sutures (absorbable) on the right and left uterosacral ligaments (2 points) and theses were reinforced with Gore-Tex 2-0, CV-2 (non-absorbable, Gore Medical). On the right/left anterior apical support we used Gore-Tex 2-0 and these provided the 2 point suspension (UTLS = 2 and anterior vagina = 2). The 2 anterior apical support sutures are taken from the vagina to the transversalis fascia and the obliterated umbilical artery on the anterior abdominal wall. The tension of these anterior sutures was maintained with Hem-o-lock (TeleFlex) and LAPRA-TY (Ethicon). In our opinion RALAS-4 may represents an alternative to robotic or laparoscopic sacrocolpopexy. This new approach simulate the natural 4 points support given by uterosacral ligaments and cardinal ligament, with the additional benefit of no mesh and no dissection on the sacrum promontory. With this technique we are chasing the Trifecta: no mesh, no complications and good anatomic support.

关键词： Apical Prolapse Vaginal Prolapse Pelvic Anatomy Robotic Surgery Uterosacral Ligament Cardinal Ligament

Anatomic Evaluation of Uterosacral and Cardinal Ligament during Robotic and Laparoscopic Surgery for Pelvic Organ Prolapse

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Open Journal of obstetrics and Gynecology 2017年第12期7卷 1216-1227页

作者： Hugo H Davila Renzo Di Natale Lindsey Bruce Lindsey Goodman Taryn Gallo Florida Healthcare specialist Urology and Minimally Invasive Surgery Florida Cancer Specialist & Research Institute Sebastian and Vero Beach FL USA Department of Surgery Division of Urology and Gynecology Sebastian River Medical Center Sebastian FL USA Florida State University College of Medicine Fort Pierce Campus FL USA

Introduction: It is widely accepted that the uterosacral ligaments (UTSL), together with the cardinal ligament (CL), hold the upper vagina and cervix over the levator plate. The aim of this study is to evaluate the anatomical relationship between the right vs. left CL and UTSL during robotic and laparoscopic utero-sacral ligament suspension (UTSLS) and its implication with the surgical technique during UTSL suspension. Material and Methods: We evaluated 25 women with apical pelvic organ prolapses of stages 2 - 4 and we analyzed 100 uterosacral and cardinal ligaments. They were assigned (non-randomly) to: a) robotic-assisted laparoscopic uterosacral ligament suspension (RAL-UTSLS), b) robotic-assisted single-site utero-sacral ligament suspension (RASS-UTSLS) or laparo-endoscopic single site utero-sacral ligament suspension (LESS-UTSLS). We evaluated the length (distance between origins and insertions) of the aforementioned ligaments using the Da Vinci Si and other laparoscopic instruments like calipers. Results: The mean length of the UTSL in their caudal-cranial extent was 3.5 ± 0.5 cm (right side) and 2.58 ± 0.3 cm (left side). Measurements were performed on the same way for the CL, resulting in 5.1 ± 0.3 cm (both side). The only significant difference was observed when comparing the right vs. left UTSL. This anatomic difference translates to 5 ± 1 suture stitches on the right UTSL vs. 2 ± 1 on the left UTSL. Conclusion: In our evaluation on cardinal and uterosacral ligament, the right UTSL was significantly longer as compared to the left and this allowed us to take 3 additional stitches on the right UTSL vs. left during RAL-UTSLS. Future studies are necessary to compare females with/without POP.

关键词： Apical Prolapse Vaginal Prolapse Pelvic Anatomy Robotic Surgery Pelvic Floor Pelvic Ligaments

Current diagnostic approach to patients with adnexal masses: which tools are relevant in routine praxis?

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Chinese Journal of Cancer Research 2013年第1期25卷 55-62页

作者： Milan M. Terzic Jelena Dotlic Ivana Likic Nebojsa Ladjevic Natasa Brndusic Nebojsa Arsenovic Sanja Maricic Tihomir Mihailovic Sasa Andrijasevic Clinic of obstetrics and Gynecology Clinical Center of Serbia School of Medicine University of Belgrade Center for anesthesiology and resuscitation Clinical Center of Serbia Department of Cellular Pathology PathLinks Pathology Services Lincoln County Hospital Occupational Health Department General Health Center "Savski Venac" Department of Radiology Ultramedica Clinic American Medical Academy

Objective： The aim of the study was to investigate which anamnestic, laboratory and ultrasound parameters used in routine practice could predict the nature of adnexal mass, thus enabling referral to relevant specialist. Methods： Study involved the women treated for adnexal tumors throughout a period of 2 years. On admission, detailed anamnestic and laboratory data were obtained, expert ultrasound scan was performed, and power Doppler index （PDI）, risk of malignancy index （RMI） and body mass index （BMI） were calculated for all patients. Obtained data were related to histopathological findings, and statistically analyzed. Results： The study included 689 women （112 malignant, 544 benignant, and 33 borderline tumors）. Malignant and borderline tumors were more frequent in postmenopausal women （P=0.000）. Women who had benignant tumors had the lowest BMI （P=0.000）. There were significant （P〈0.05） differences among tumor types regarding erythrocyte sedimentation rate, CA125 and carcinoembryonic antigen （CEA） levels. Among ultrasound findings, larger tumor diameter and ascites were more frequent in malignant tumors （P=0.000）. Women with malignant tumors had highest values of RMI and PDI （P=0.000）. Conclusions： Anamnestic data, ultrasound parameters and laboratory analyses were all found to be good discriminating factors among malignant, benignant and borderline tumors.

关键词： Adnexal mass risk of malignancy index power Doppler index tumor markers body mass index

Opinions and Perceptions of Gynecologists and Midwives on the Use of the Intrauterine Device in Senegal

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Open Journal of obstetrics and Gynecology 2021年第11期11卷 1484-1493页

作者： Hadja Maimouna Barro Daff Khalifa Babacar Mansour Fall Youssoupha Touré Aïssatou Mbodji Moussa Diallo Abdoul Aziz Diouf Magatte Mbaye Khalifa Babacar Gueye Babacar Biaye Alassane Diouf Public Institution Aristide-Le Dantec Health Center Gynecological and Obstetric Clinic Cheikh Anta Diop University of Dakar Dakar Senegal Department of obstetrics and Gynecology Phillipe Maguilene Senghor Center Yoff Senegal Department of obstetrics and Gynecology Pikine University Hospital Thiaroye Pikine Senegal

Objective: The purpose of this study was to analyze the opinions of gynecologists, midwives, and interns/specialist students practicing in Senegal about the use of IUD, and to assess factors that stand as obstacles to... 详细信息

Objective: The purpose of this study was to analyze the opinions of gynecologists, midwives, and interns/Specialist students practicing in Senegal about the use of IUD, and to assess factors that stand as obstacles to IUD prescribing. Patients and methods: An online questionnaire was developed to assess providers’ IUD practices and attitudes. The questionnaire was based on the one used in a Swiss study on the same topic. The platform used was Google forms. The questionnaire was shared in associative platforms involving gynecologists, midwives and interns/Specialist students. Results and comments: We received 292 feedbacks. Gynecologists represented 13.7% of the sample, interns and specialist students 11.3% and midwives 76%. Parity is a determining factor in IUD selection. The care-providers were concerned about the followings, which might have prevented the use of IUD, even though it was indicated: infections (75.7%), pelvic pain (61.3%), expulsion (48.3%), increased risk of perforation (46.9%), women’s appreciation (45.2%), ectopic pregnancy (33.9%) and sexual behavior (28.4%). Conclusion: Our study reveals that providers’ apprehensions and concerns severely limit the availability of IUDs. These concerns are often unf

关键词： Intrauterine Device IUD Parity Gynecologists Midwives Interns

2例多囊卵巢综合征妇女应用甲福明相关的多胎妊娠病例报道及文献回顾

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世界核心医学期刊文摘（妇产科学分册） 2006年第4期2卷 34-35页

作者： Boothroyd C. Yazdani A. 张旸 Greenslopes specialist Centre 25/121 Newdegate St Brisbane QLD 4120 Australia

Objective: To describe the first reported cases of two women with polycystic ovary syndrome (PCOS) desirous of pregnancy who conceived trichorionic pregnancies following ovulation induction with metformin alone and metformin plus clomiphene. Design: Case report. Setting: Private fertility practice. Patient(s): Two women with polycystic ovary syndrome, one lean and one overweight, both oligoovulatory and not undertaking their first cycle of treatment. Intervention(s): Ovulation induction by metformin alone or in combination with clomiphene. Main Outcome Measure(s): Higher-order multiple pregnancy (triplet or greater). Result(s): Two cases of trichorionic pregnancy. Conclusion(s): This is the first report of higher-order multiple pregnancies resulting from the use of either metformin alone or in combination with clomiphene. The additive effects of adjunctive treatments such as weight reduction, ovarian drilling, and clomiphene and metformin therapy may result in an increased incidence of higher-order multiple pregnancy and women need to be counseled about this risk. Further research is required to quantify the risk of this event per treatment cycle.

关键词：多囊卵巢综合征多胎妊娠甲福明文献回顾诱导排卵克罗米芬治疗周期膜性首次治疗

Quality Control of Second Trimester Ultrasound Examinations in the Gynecology and obstetrics Department of the University Teaching Hospital Yalgado Ouedraogo (UTH-YO) of Ouagadougou, Burkina Faso

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Open Journal of obstetrics and Gynecology 2018年第13期8卷 1324-1336页

作者： Ouattara Adama Nde Ouédraogo Nina Astrid Lankoandé Bako Natacha Ouédraogo Smaila Bayala René-Philippe Yi Dia Tougma Sanou Aline Sawadogo Yobi Alexis Millogo Traoré Francoise Ouédraogo Marie Charlemagne Ouédraogo Ali Thieba Bonané Blandine Training and Research Unit in Health Sciences (TRU/HS) University Ouaga 1 Pr Joseph KI ZERBO Ouagadougou Burkina Faso Department of Gynecology and obstetrics The University Teaching Hospital Yalgado Ouedraogo of Ouagadougou (UTH-YO) Ouagadougou Burkina Faso Department of Gynecology and obstetrics The Bogodogo University Teaching Hospital of Ouagadougou (UTH-B) Ouagadougou Burkina Faso

Objective: To evaluate the quality of second trimester ultrasound examinations in patients consulting in the gynecology and obstetrics department at the University Teaching Hospital Yalgado Ouedraogo (UTH-YO) of Ouagadougou. Method: Our study took place from January 1st to March 31st 2017, in the department of obstetrics and Gynecology of the University Teaching Hospital Yalgado Ouedraogo of Ouagadougou. This was a descriptive study on the records of the second trimester ultrasound of pregnancy, with analysis of the iconography. We used the criteria of the Technical Committee of Fetal Echography (TCFE) of France to analyse all the ultrasound reports brought by the patients. Results: Three hundred ultrasound reports were collected over three months. It revealed that, in terms of patient identification, 100% of the reports bore the surname and first name of the pregnant woman;88% and 94.67% of the ultrasound scans bore the surname and first name of the ultrasound specialist respectively. Only 2% presented the brand and type of ultrasound scanner. The study of the quality of the appointment showed that 52% of the ultrasounds had been performed at the right time, between 20 Gestational Age (GA) and 25 GA. For the quality of the iconography, referring to the recommendations of the Technical Committee of Fetal Echography (TCFE) of France and taking into account the data confirmed by the literature, we found that the quality was slightly acceptable either respectively for biometric and morphological sections. Conclusion: The quality of the ultrasound reports of the second trimester ultrasounds in patients consulting in the obstetrics and gynecology department of the University Hospital Yalgado OUEDRAOGO was not totally satisfactory.

关键词： Ultrasonography Second Trimester Reports UTH-YO

Valvuloplasty of fetal pulmonary atresia with intact ventricular septum and hypoplastic right heart: Mid-term follow-up results

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Journal of Interventional Medicine 2022年第4期5卷 196-199页

作者： Gang Luo Shuai Gao Hongxiao Sun Zhixian Ji Dunliang Wang Yue Sun Silin Pan Heart Center Women and Children’s HospitalQingdao UniversityQingdao266034PR China Department of Anesthesiology Women and Children’s HospitalQingdao UniversityQingdao266034PR China Department of obstetrics Women and Children’s HospitalQingdao UniversityQingdao266034PR China

Objective:This study aimed to analyze and evaluate the results of mid-term follow-up after fetal pulmonary valvuloplasty(FPV)in fetuses with pulmonary atresia with intact ventricular septum(PA/IVS).Methods:From August 31,2018,to May 31,2019,seven fetuses with PA/IVS and hypoplastic right heart were included in this *** underwent echocardiography by the same specialist and were operated on by the same *** and echocardiography data were collected,and changes in the associated indices noted during follow-up were ***:All seven fetuses successfully underwent *** median gestational age at FPV was 27.54 *** average FPV procedural time was 6 *** bradycardia requiring treatment occurred in 4/7 ***,five pregnancies were successfully delivered,and the other two were *** to data before fetal cardiac interventions(FCI),tricuspid valve annulus diameter/mitral valve annulus diameter(TV/MV)and right ventricle diameter/left ventricle diameter(RV/LV)of all fetuses had progressively *** maximum tricuspid regurgitation velocity decreased from 4.60 m/s to 3.64 m/*** average follow-up time was 30.40±2.05 *** the follow-up period,the diameter of the tricuspid valve ring in five children continued to improve,and the development rate of the tricuspid valve was relatively obvious from 6 months to 1 year after ***,the development of the right ventricle after birth was relatively *** was discovered that there were individual variations in the development of the right ventricle during ***:The findings support the potential for the development of the right ventricle and tricuspid valve in fetuses with PA/IVS who underwent *** of the right ventricle and tricuspid valve does not occur synchronously during *** right ventricle develops rapidly in utero,but the development of tricuspid valve is more apparent after birth than in utero.

关键词： Congenital heart disease fetal cardiac intervention fetal pulmonary valvuloplasty hypoplastic right heart syndrome pulmonary atresia with intact septum

Sonography Cervical Assessment in Multiple Pregnancy in Correlation with Gestational Age

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Open Journal of obstetrics and Gynecology 2022年第2期12卷 113-117页

作者： Mahrous Areej Wesam Kurdi Samar Nahas Department of Obstetrician and Gynecologists King Salman Hospital Riyadh Saudi Arabia Department of Obstetrician and Gynecologists King Faisal Specialist Hospital and Research Centre Riyadh Saudi Arabia Department of Obstetrician and Gynecologists University of California Riverside California USA

Objective: Observe and correlate the cervical length by ultrasound and likelihood of cervical incompetence and premature delivery in multiple gestations. Materials and Methods: Retrospective study in multiple pregnancy (twin, triplet, quadruplet) delivered between 2002-2003, in King Faisal specialist Hospital and Research Centre, Riyadh, Saudi Arabia. A total of 68 multiple pregnancies underwent routine ultrasound for fetal assessment between 16 - 32 weeks when the cervix was observed. The sonographic measurements included cervix > 2.5 cm and 32 weeks. The gestational age at delivery was our outcome parameter. The data was analyzed statistically using Fisher’s exact test and P-value below 0.05 was considered significant. Results: Endovaginal ultrasongoraphic cervical measurement in multiple pregnancies predicted increased preterm delivery risk regardless of maternal age, previous history of preterm deliveries or presence of vaginal infection. It was found that spontaneous preterm labor 25 mm;this majority reached > 32 weeks while the patient who had cervix < 25 mm, 1 in 25 of the women who underwent a cervical ultrasound assessment will have preterm labor. The finding in ultrasound justifies the results of higher aggressive management inpatient with cervix Conclusion: Cervical assessment during routine ultrasound in multiple gestations seems to be useful for prediction of preterm delivery and counseling the patient without risk factors regarding cervical cerclage. Because of restricted number of patients, we suggest further study with bigger sample and prospective trial for valued conclusions.

关键词： Sonography Multiple Pregnancy Cervical Assessment

Sonography Cervical Assessment in Twin Pregnancy Correlation with Gestational Age at Delivery

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Open Journal of obstetrics and Gynecology 2022年第2期12卷 169-179页

作者： Mahrous Areej Wesam Kurdi Mylene Martins Lavado Department of Obstetrician and Gynecologists King Salman Hospital. Riyadh Saudi Arabia Department of Obstetrician and Gynecologists King Faisal specialist Hospital and Research Centre Riyadh Saudi Arabia Department of Medicine Faculty at Univali University Universidade do Vale do Itajai Itajai State of Santa Catarina South of Brazil Brazil

Objective: Observe and correlate the funneling of upper cervical canal by ultrasound and likelihood of cervical incompetence and premature delivery in twin pregnancy. Materials and methods: Retrospective study in twin pregnancies deliveries in 1997, in king Faisal specialist hospital and research center, Riyadh, Saudi Arabia. A total of 67 twin pregnancies underwent routine ultrasound for fetal assessment, when the cervix closed, long;and short, funneling. The time of ultrasound was divided in three groups by gestational age: from 18 to 22 weeks;from 22 to 26 weeks and from 26 to 30 weeks. The gestational age at delivery was our outcome parameter and subdivided the patients in 4 groups, group 1: patients delivered before 24 weeks (n = 4);group 2: delivered between 24 and 34 weeks (n = 16);group 3: delivered between 34 weeks and 36 weeks and 6 days (n = 18);and group 4: delivered with gestational age equal or above 37 weeks (n = 29). The data was analyzed statistically using Pearson chi square method and p value below 0.05 was considered significant. Results: There was no significant difference among the 4 subgroups in maternal age, body mass index, parity, previous history of preterm delivery or presence of urinary/vaginal infection in actual pregnancy. There was stronger history of mid trimester abortion in patients delivered before 34 weeks of gestational age. Considering the cervical sonographic findings, the diagnosis of funneling between 18 - 22 weeks was higher among the group delivered before 34 weeks of gestational age (1 and 2) comparing to other groups (3 and 4) with p value equal to 0.016. The finding in ultrasound justifies the results of higher aggressive management in patients from groups 1 and 2 comparing with groups 3 and 4;admission to hospital (p = 0.007);emergency cerclage (p = 0.04), complete hospital bed rest (p = 0.002). Conclusion: Cervical assessment during routine ultrasound in twins pregnancy seems to be useful for prediction of preterm del

关键词： Cervix Twin Pregnancy Ultrasonography Cervical Assessment Delivery